scholarly journals Hospital post-intensive management of major trauma: a pilot study in Internal Medicine

2013 ◽  
pp. 30-34
Author(s):  
Valerio Verdiani ◽  
Chiara Lombardo ◽  
Elisabetta Catini ◽  
Alberto Camaiti ◽  
Alberto Conti ◽  
...  
Keyword(s):  
Intensive Care ◽  
Pilot Study ◽  
Hospital Mortality ◽  
Clinical Pathway ◽  
Hospital Readmission ◽  
Major Trauma ◽  
Hospital Nurses ◽  
Tracheotomy Tube ◽  
Medical Wards

BACKGROUND Major trauma is the fourth cause of death in Western countries, and the first one in patients aged 35 years or younger. In-hospital post-intensive care represents a crucial step in the comprehensive medical assistance for these patients, but no data is available. AIM OF THE STUDY To evaluate an hospital post-intensive clinical pathway for patients with major trauma discharged from Intensive Care Unit (ICU). PATIENTS AND METHODS We designed a clinical pathway project for patients with major trauma discharged from an ICU at Careggi Hospital, in Florence. Patients were admitted in two Internal Medical wards of the same hospital. Nurses and physicians were trained to the management of devices and essential critical problems. We analysed characteristics of patients, APACHE score, devices, clinical and biochemical parameters. We determined medical complicances, ICU readmissions and hospital mortality. After a three months follow-up we evaluated hospital readmission, mortality and residual disability. RESULTS AND DISCUSSION We studied 92 patients (mean age 41 ± 20 years; 70 male) with major trauma discharged from ICU (82.6% of patients underwent invasive mechanic ventilation). On admission, tracheotomy tube was present in 21 patients (22.8%). During internal wards stay, tracheotomy tube was removed in 16 patients. Medical complicances were identified and treated in more than 80% of patients. Four patients (4.3%) were readmitted to ICU, one patient (1.1%) died. Mean internal medical ward stay was 13 ± 9.6 days. After three months follow-up: three patients (3.2%) died; the rate of planned hospital readmission for orthopedic or surgery interventions was 14.7%; 70% of patients did not have any disability. CONCLUSIONS Patients with major trauma discharged from ICU often have medical complications and are managed by the use of multiple devices. Results of our pilot study suggest that a post-intensive clinical pathway in internal wards for patients with major trauma is feasible and could reduce ICU readmissions and hospital mortality.

scholarly journals Clinical Prognosis of Pericardial Effusion in COVID 19

2021 ◽  
Author(s):  
İbrahim Saraç ◽  
Gökhan Tonkaz ◽  
Emrah Aksakal ◽  
Faruk Aydınyılmaz ◽  
Kaan Alişar ◽  
...  
Keyword(s):  
Intensive Care ◽  
Mortality Rate ◽  
Pericardial Effusion ◽  
Hospital Mortality ◽  
Elevated Serum ◽  
Clinical Prognosis ◽  
Pneumonia Severity ◽  
Polymerase Chain ◽  
The Relationship

Abstract Purpose In our study, we investigated the relationship between pneumonia severity and pericardial effusion, predisposing factors and the effect of pericardial effusion on clinical prognosis and mortality in COVID-19 patients. Methods A total of 3794 patients who were diagnosed with COVID- 19 by polymerase chain reaction (PCR), were hospitalized between March 21 and November 30, 2020 were included in the study. For each of the 3794 patients, the initial chest CT images, pericardial efusion (PE), pleural efusion and pneumonia severity were evaluated. Results The mean age of patients with PE was higher and it was more common in males. Patients with PE had more comorbid diseases and significantly elevated serum cardiac and inflammatory biomarkers. In addition, the need for intensive care and mortality rates were higher in these patients. While the in-hospital mortality rate was 56.9% in patients with PE and AC involvement above 50%, in-hospital mortality rate was 34.4% in patients with AC involvement above 50% and without PE (p < 0.001). Conclusions In patients presenting with severe AC involvement on CT or being followed up with COVID-19 pneumonia, PE often accompanies the deterioration in the laboratories and clinics of the patients. The clinical prognosis in patients presenting with PE was quite poor, and the frequency of intensive care admissions and mortality were significantly higher. In conclusion, in our study, PE emerged as an important finding in the follow-up and management of patients with COVID-19 and reflects the clinical prognosis.

scholarly journals Are the French SAMU data relevant for health surveillance?

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Isabelle Pontais ◽  
Florian Franke ◽  
Barbara Philippot ◽  
François Valli ◽  
Gilles Viudes ◽  
...  
Keyword(s):  
Intensive Care ◽  
Pilot Study ◽  
Santé Publique ◽  
Syndromic Surveillance ◽  
Health Impact ◽  
Health Surveillance ◽  
Data Sources ◽  
Daily Data ◽  
Sante Publique

ObjectiveTo evaluate whether SAMU data could be relevant for health surveillance and proposed to be integrated into the French national syndromic surveillance SurSaUD® system.IntroductionThe syndromic surveillance SurSaUD® system developed by Santé publique France, the French National Public Health Agency collects daily data from 4 data sources: emergency departments (OSCOUR® ED network) [1], emergency general practioners (SOS Médecins network), crude mortality (civil status data) and electronic death certification including causes of death [2]. The system aims to timely identify, follow and assess the health impact of unusual or seasonal events on emergency medical activity and mortality. However some information could be missed by the system especially for non-severe (absence of ED consultation) or, in contrast, highly severe purposes (direct access to intensive care units).The French pre-hospital emergency medical service (SAMU) [3] represents a potential valuable data source to complete the SurSaUD® surveillance system, thanks to reactive pre-hospital data collection and a large geographical coverage on the whole territory. Data are still not completely standardized and computerized but a governmental project to develop a national common IT system involving all French SAMU is in progress and will be experimented in the following years.MethodsA pilot study was performed in the South of France PACA region, where data from the six local SAMU structures are centralized into an interconnected database. A minimal set of variables required for health monitoring (administrative and medical items) and modalities for data extraction and transmission to Santé publique France were defined.SAMU data were transmitted daily to Santé Publique France and the PACA regional team developed a Microsoft Access® application to import decrypted data, request database and analyze indicators.Retrospective part of the study was performed over a 2-year period (2013-2014) and the prospective part during 2015 was based on daily data collection. Completeness and quality of variables were analyzed. SAMU indicators including several level of specificity were built and compared to existing SurSaUD® indicators in different situations (for detection, seasonal follow-up and health impact assessment) using Spearman coefficient correlation.ResultsDuring the pilot study, data from five of the six SAMU structures of PACA region were structured enough to be analyzed. On the study period, almost 2,400,000 files were recorded and 89% contain medical information. Data completeness was high (87%) and stable during the whole period. The annual rate of SAMU solicitation was 16 for 100 inhabitants at the regional scale. 15% of the records were opened only for medical advice. In contrast, patients were evacuated directly in intensive care unit in 9.5% of cases without ED admission. Coding quality depended on the existence and the use of official thesauri and varied widely among SAMU structures. Despite coding variations, SAMU indicators for winter epidemics were significantly correlated with ED and SOS Médecins indicators. Respectively with ED flu, bronchiolitis and gastroenteritis indicators, the strongest correlations were found for SAMU lower respiratory infection (0.74), SAMU bronchiolitis (0.72) and SAMU gastroenteritis / diarrhea / vomiting (0.81).ConclusionsThis pilot study demonstrated the feasibility to collect daily SAMU activity data. The key strengths of SAMU data were a large geographic coverage, the subsidiarity with SurSaUD® system data sources, the follow-up of prehospital activity and for patients directly admitted into an intensive care unit. Some limitations were highlighted related to differences in coding practices especially for medical diagnosis. The generalization of this study will require the standardization of coding practices and homogenization of thesaurus. The implementation of the national SAMU information system should allow in a very next future to widely progressing on these topics.References[1] Fouillet A, Bousquet V, Pontais I, Gallay A and Caserio-Schönemann C. The French Emergency Department OSCOUR Network:Evaluation After a 10-year Existence. Online Journal of Public Health Informatics ISSN 1947-2579-7(1):e74, 2015[2] Caserio-Schönemann C, Bousquet V, Fouillet A, Henry V. Le système de surveillance syndromique SurSaUD (R). Bull Epidémiol Hebd 2014;3-4:38-44.[3] Baker, D.J.. The French prehospital emergency medicine system (SAMU): An introduction(2005) CPD Anaesthesia, 7 (1), pp. 20-25.

Pilot Study Assessing the Impact of Bereavement Support on Families of Deceased Intensive Care Unit Patients

2018 ◽  
Vol 27 (5) ◽  
pp. 372-380 ◽  
Author(s):  
Jennifer L. McAdam ◽  
Kathleen Puntillo
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pilot Study ◽  
Posttraumatic Stress ◽  
Stress Disorder ◽  
Family Members ◽  
Satisfaction With Care ◽  
Prolonged Grief ◽  
Anxiety Depression

Background Family members of patients who die in an intensive care unit (ICU) may experience negative outcomes. However, few studies have assessed the effectiveness of bereavement care for families. Objective To evaluate the effectiveness of bereavement follow-up on family members’ anxiety, depression, posttraumatic stress, prolonged grief, and satisfaction with care. Methods A cross-sectional, prospective pilot study of 40 family members of patients who died in 2 tertiary care ICUs. Those in the medical-surgical ICU received bereavement follow-up (bereavement group); those in the cardiac ICU received standard care (nonbereavement group). Both groups completed surveys 13 months after the death. Surveys included the Hospital Anxiety and Depression Scale, Impact of Event Scale-Revised, Family Satisfaction With Care in the Intensive Care Unit, Prolonged Grief Disorder, and a bereavement survey. Results Of 30 family members in the bereavement group and 10 in the nonbereavement group, most were female and spouses, with a mean (SD) age of 60.1 (13.3) years. Significantly more participants in the nonbereavement group than in the bereavement group had prolonged grief. Posttraumatic stress, anxiety, depression, and satisfaction with care were not significantly different in the 2 groups. However, overall posttraumatic stress scores were higher in the nonbereavement group than the bereavement group, indicating a higher risk of posttraumatic stress disorder. Conclusions Bereavement follow-up after an ICU death reduced family members’ prolonged grief and may also reduce their risk of posttraumatic stress disorder. This type of support did not have a measurable effect on depression or satisfaction with ICU care.

scholarly journals Etomidate infusion at low doses is an effective and safe treatment for severe Cushing’s syndrome outside intensive care

2020 ◽  
Vol 183 (2) ◽  
pp. 161-167
Author(s):  
Stefan M Constantinescu ◽  
Natacha Driessens ◽  
Aurélie Lefebvre ◽  
Raluca M Furnica ◽  
Bernard Corvilain ◽  
...  
Keyword(s):  
Intensive Care ◽  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Low Doses ◽  
Ectopic Acth ◽  
Ectopic Acth Secretion ◽  
Frequent Monitoring ◽  
Cortisol Levels ◽  
Medical Wards

Introduction Intravenous etomidate infusion is effective to rapidly lower cortisol levels in severe Cushing’s syndrome (CS) in the intensive care unit (ICU). Recently, etomidate treatment has also been proposed at lower doses in non-ICU wards, but it is not yet clear how this approach compares to ICU treatment. Methods We compared data from patients with severe CS treated with high starting doses of etomidate (median: 0.30 mg/kg BW/day) in ICU or with lower starting doses (median: 0.025 mg/kg BW/day) in non-ICU medical wards. Results Fourteen patients were included, among which ten were treated with low starting doses (LD) and four with high starting doses etomidate (HD). All patients had severe and complicated CS related to adrenal carcinoma (n = 8) or ectopic ACTH secretion (n = 6). Etomidate was effective in reducing cortisol levels below 500 nmol/L in a median of 1 day in the HD group compared to 3 days in the LD group (P = 0.013). However, all patients of the HD group had etomidate-induced cortisol insufficiency and needed frequent monitoring, while no patient from the LD group required hydrocortisone supplementation. No patient in either group died from complications of CS or etomidate treatment, but final outcome was poor as six patients in the LD group and all four patients in the HD group died from their cancer during follow-up. Conclusion Our study suggests that, for patients with severe CS who do not require intensive organ-supporting therapy, the use of very low doses of etomidate in medical wards should be considered.

Characteristics and outcomes of oncology patients requiring admission to an Australian intensive care unit.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21653-e21653
Author(s):  
Aaron Tan ◽  
Sarah Freyberg ◽  
Meredith Oatley ◽  
Alexander David Guminski
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Data Collection ◽  
Hospital Mortality ◽  
Palliative Treatment ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Oncology Patients ◽  
Icu Admission

e21653 Background: Patients with advanced malignancies have historically been considered poor candidates for the intensive care unit (ICU), however survival and prognosis is continually improving and requirements for use of intensive care services is increasing. This study aimed to understand the characteristics and outcomes of oncology patients admitted to an Australian ICU and identify potential prognostic factors. Methods: A single-centre, retrospective, cohort study was conducted at Royal North Shore Hospital, a tertiary public hospital in Sydney, Australia with a 58-bed quaternary ICU. All patients aged > 18 years, admitted under the medical oncology team requiring ICU admission between June 2014 and June 2016 were evaluated. Data collected included basic demographics, cancer type and status, performance status (ECOG) and co-morbidities (ACE-27 score). Clinical outcomes were determined including ICU and hospital mortality, requirements (ventilation, dialysis, vasopressors, infection) and APACHE II scores. Results: There were 96 patients admitted to the ICU during the study period. Mean age was 61 years, 58% were male and 76% had metastatic disease. Most patients were receiving palliative treatment (89%), with recent chemotherapy (43%), immunotherapy (10%) and other therapies (5%). Of the 10 patients with recent immunotherapy, three (all melanoma) required ICU admission due to immunotoxicity with all three alive at time of data collection (mean 222 days follow-up). 13% were admitted due to an oncological emergency. Most common primary tumour site was thoracic (20%), genitourinary (11%), breast (10%) and melanoma (10%). Mean APACHE II score was 17 (SD 5.33), mean SOFA score was 4 (SD 2.70), ICU mortality was 5% and hospital mortality was 22%. For the 75 patients (78%) discharged from hospital, 42 (56%) were still alive at time of data collection (mean 321 days follow-up). Conclusions: Our patient population had good short-term outcomes for survival despite most receiving palliative treatment, although prognostic scores were also favourable. This suggests cancer patients can achieve positive outcomes after ICU admission with appropriate selection of patients crucial.

scholarly journals Feasibility and acceptability of follow-up for prostate cancer in primary care: a pilot study

BJGP Open ◽  
2018 ◽  
Vol 2 (4) ◽  
pp. bjgpopen18X101616 ◽  
Author(s):  
Marianne Heins ◽  
François Schellevis ◽  
Mirjam Schotman ◽  
Bart van Bezooijen ◽  
Ismene Tchaoussoglou ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Pilot Study ◽  
Clinical Pathway ◽  
Specific Antigen ◽  
Stable Phase ◽  
Number Of Patients ◽  
One Year ◽  
The Cost ◽  
Practice Care

BackgroundThe number of patients with prostate cancer is increasing, which puts additional pressure on health care. GP-led follow up may help reduce costs, travel time for patients, and workload for urologists and improve continuity of care.AimTo test the feasibility and acceptability of a new clinical pathway for GP-led prostate cancer follow-up.Design & settingA feasibility pilot study was performed in cooperation with six GP practices in the Dutch region of Amersfoort.MethodThe study included 20 patients with prostate cancer in a stable phase, who were aged ≥65 years and with comorbidity. Follow-up for prostate cancer was transferred to the GP for one year. Participating GPs and urologists jointly developed a protocol. Patient satisfaction was measured at 0 and 12 months with the ‘personalised care’ subscale of the Consumer Quality (CQ) index 'general practice care'. Next, patients, GPs, and urologists were interviewed about their experiences. The clinical pathway was considered successful if no patients were referred back to the urologist, except for an increase in prostate-specific antigen (PSA), and if the majority of patients and participating urologists and GPs were satisfied.ResultsOf the 20 patients included in the study, three were referred back to the urologist because of increasing PSA levels and one died (unrelated to prostate cancer). Most patients (73%) were satisfied with the transfer of care, indicated by a score of ≥3 on the ‘personalised care’ subscale. GPs and urologists had confidence in the ability of GPs to provide follow-up care and preferred to continue this.ConclusionThe new clinical pathway was successful, warranting a larger study to provide evidence for the (cost-)effectiveness of GP-led prostate cancer follow-up.

scholarly journals AKI in Hospitalized Patients with COVID-19

2020 ◽  
Vol 32 (1) ◽  
pp. 151-160 ◽  
Author(s):  
Lili Chan ◽  
Kumardeep Chaudhary ◽  
Aparna Saha ◽  
Kinsuk Chauhan ◽  
Akhil Vaid ◽  
...  
Keyword(s):  
United States ◽  
Intensive Care ◽  
Observational Study ◽  
Confidence Interval ◽  
Hospital Mortality ◽  
Kidney Function ◽  
The United States ◽  
Hospitalized Patients ◽  
Health Records

BackgroundEarly reports indicate that AKI is common among patients with coronavirus disease 2019 (COVID-19) and associated with worse outcomes. However, AKI among hospitalized patients with COVID-19 in the United States is not well described.MethodsThis retrospective, observational study involved a review of data from electronic health records of patients aged ≥18 years with laboratory-confirmed COVID-19 admitted to the Mount Sinai Health System from February 27 to May 30, 2020. We describe the frequency of AKI and dialysis requirement, AKI recovery, and adjusted odds ratios (aORs) with mortality.ResultsOf 3993 hospitalized patients with COVID-19, AKI occurred in 1835 (46%) patients; 347 (19%) of the patients with AKI required dialysis. The proportions with stages 1, 2, or 3 AKI were 39%, 19%, and 42%, respectively. A total of 976 (24%) patients were admitted to intensive care, and 745 (76%) experienced AKI. Of the 435 patients with AKI and urine studies, 84% had proteinuria, 81% had hematuria, and 60% had leukocyturia. Independent predictors of severe AKI were CKD, men, and higher serum potassium at admission. In-hospital mortality was 50% among patients with AKI versus 8% among those without AKI (aOR, 9.2; 95% confidence interval, 7.5 to 11.3). Of survivors with AKI who were discharged, 35% had not recovered to baseline kidney function by the time of discharge. An additional 28 of 77 (36%) patients who had not recovered kidney function at discharge did so on posthospital follow-up.ConclusionsAKI is common among patients hospitalized with COVID-19 and is associated with high mortality. Of all patients with AKI, only 30% survived with recovery of kidney function by the time of discharge.

Short- and long-term follow-up of intensive care unit patients after sedation with isoflurane and midazolam—A pilot study*

2008 ◽  
Vol 36 (3) ◽  
pp. 801-806 ◽  
Author(s):  
Peter V. Sackey ◽  
Claes-Roland Martling ◽  
Christine Carlswärd ◽  
Örjan Sundin ◽  
Peter J. Radell
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pilot Study ◽  
Long Term Follow Up ◽  
Short And Long Term

A Pilot Study of Mobile Telephone Message Interventions with Suicide Attempters in China

Crisis ◽  
2010 ◽  
Vol 31 (2) ◽  
pp. 109-112 ◽  
Author(s):  
Hui Chen ◽  
Brian L. Mishara ◽  
Xiao Xian Liu
Keyword(s):  
Pilot Study ◽  
Effective Means ◽  
Text Message ◽  
Text Messages ◽  
Mobile Telephone ◽  
Future Research ◽  
Quick Method ◽  
Suicide Attempters ◽  
To Receive

Background: In China, where follow-up with hospitalized attempters is generally lacking, there is a great need for inexpensive and effective means of maintaining contact and decreasing recidivism. Aims: Our objective was to test whether mobile telephone message contacts after discharge would be feasible and acceptable to suicide attempters in China. Methods: Fifteen participants were recruited from suicide attempters seen in the Emergency Department in Wuhan, China, to participate in a pilot study to receive mobile telephone messages after discharge. All participants have access to a mobile telephone, and there is no charge for the user to receive text messages. Results: Most participants (12) considered the text message contacts an acceptable and useful form of help and would like to continue to receive them for a longer period of time. Conclusions: This suggests that, as a low-cost and quick method of intervention in areas where more intensive follow-up is not practical or available, telephone messages contacts are accessible, feasible, and acceptable to suicide attempters. We hope that this will inspire future research on regular and long-term message interventions to prevent recidivism in suicide attempters.

Reducing hospital readmission through team-based primary care: A 7-week pilot study integrating behavioral health and pharmacy.

2017 ◽  
Vol 35 (2) ◽  
pp. 217-226 ◽  
Author(s):  
Lauren N. DeCaporale-Ryan ◽  
Nabila Ahmed-Sarwar ◽  
Robbyn Upham ◽  
Karen Mahler ◽  
Katie Lashway
Keyword(s):  
Primary Care ◽  
Pilot Study ◽  
Behavioral Health ◽  
Hospital Readmission
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