Bibliografie tematiche / Pediatric intensive care research

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Letteratura scientifica selezionata sul tema "Pediatric intensive care research"

Autore: Grafiati

Pubblicato: 4 giugno 2021

Ultima modifica: 21 febbraio 2023

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Articoli di riviste sul tema "Pediatric intensive care research"

Prout, Andrew, e Kathleen L. Meert. "Research in Pediatric Intensive Care". Pediatric Clinics of North America 69, n. 3 (giugno 2022): 607–20. http://dx.doi.org/10.1016/j.pcl.2022.01.015.

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Hutchison, Jamie. "Research in Pediatric Intensive Care*". Pediatric Critical Care Medicine 17, n. 1 (gennaio 2016): 97. http://dx.doi.org/10.1097/pcc.0000000000000575.

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Pollack, Murray M. "Pediatric transport research". Critical Care Medicine 22, n. 7 (luglio 1994): 1073–74. http://dx.doi.org/10.1097/00003246-199407000-00003.

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Kleiber, Niina, Krista Tromp, Miriam G. Mooij, Suzanne van de Vathorst, Dick Tibboel e Saskia N. de Wildt. "Ethics of Drug Research in the Pediatric Intensive Care Unit". Pediatric Drugs 17, n. 1 (30 ottobre 2014): 43–53. http://dx.doi.org/10.1007/s40272-014-0101-5.

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Richardson, Douglas K., e William O. Tarnow-Mordi. "Measuring Illness Severity in Newborn Intensive Care". Journal of Intensive Care Medicine 9, n. 1 (gennaio 1994): 20–33. http://dx.doi.org/10.1177/088506669400900104.

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Measurement of illness severity has found increasing use in adult and pediatric intensive care research over the past decade. The development of illness severity indices for neonatal intensive care has lagged because birth weight has served as an excellent proxy for illness severity. However, a number of recent studies have shown marked variation in survival and morbidity among neonatal intensive care units (NICUs) despite birth weight adjustment, making clear the need for neonatal illness severity scoring. We discuss advantages and disadvantages of the 4 types of scoring systems used in adult intensive care—diagnosis, risk-factor, therapeutic, and physiological—and review their applications in adult and pediatric ICU research. Criteria for score design, as well as standards for validation and performance, are enumerated. The 30 neonatal scores fall in 5 major categories: obstetric risk, general use pediatric scores, predictors of developmental outcome, bronchopulmonary dysplasia risk, and acute mortality risk. Few have been adequately validated on large, concurrent independent samples. The most promising scores are those that measure acute physiological derangement on admission. Potential applications for these new illness severity scores are discussed.

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Ackerman, Alice D. "The Core of Pediatric Critical Care Research*". Critical Care Medicine 48, n. 12 (20 novembre 2020): 1909–11. http://dx.doi.org/10.1097/ccm.0000000000004699.

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Davidson, Jacob, Avani Shukla e Erin Paquette. "549: PARENT EXPERIENCES WITH RESEARCH IN A PEDIATRIC INTENSIVE CARE UNIT". Critical Care Medicine 44, n. 12 (dicembre 2016): 214. http://dx.doi.org/10.1097/01.ccm.0000509227.04261.b6.

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Truog, Robert D. "Ethical assessment of pediatric research protocols". Intensive Care Medicine 34, n. 1 (3 novembre 2007): 198–202. http://dx.doi.org/10.1007/s00134-007-0917-3.

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Rivara, Frederick P., e Keith T. Oldham. "Pediatric Trauma Care: Defining a Research Agenda". Journal of Trauma: Injury, Infection, and Critical Care 63, Supplement (dicembre 2007): S52—S53. http://dx.doi.org/10.1097/ta.0b013e31815aca0a.

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Burns, Karen E. A., Leena Rizvi, Anna Charteris, Samuel Laskey, Saima B. Bhatti, Kamalprit Chokar e Karen L. M. Choong. "Characterizing Citizens’ Preferences for Engagement in Patient Care and Research in Adult and Pediatric Intensive Care Units". Journal of Intensive Care Medicine 35, n. 2 (13 settembre 2017): 170–78. http://dx.doi.org/10.1177/0885066617729127.

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Rationale: Engagement promotes and supports the active participation of patients and families in health care and research to strengthen their influence on decision-making. We sought to characterize how citizens wish to be engaged in care and research in the intensive care unit (ICU). Methods: Interviewers administered questionnaires to visitors in 3 adult ICUs and 1 pediatric ICU. Results: We surveyed 202 (adult [n = 130] and pediatric [n = 72]) visitors. Adults and pediatric visitors prioritized 3 patient care topics (family involvement in rounds, improving communication between family members and health-care providers, and information transmission between health-care practitioners during patient transfers) and 2 research topics (evaluating prevention and recovery from critical illness). Preferred engagement activities included sharing personal experiences, identifying important topics and outcomes, and finding ways to make changes that respected their needs. Both respondent groups preferred to participate by completing electronic surveys or comment cards and answering questions on a website. Few respondents (<5%) wanted to participate in committees that met regularly. Although adult and pediatric respondents identified common facilitators and barriers to participation, they ranked them differently. Although both groups perceived engagement to be highly important, adult respondents were significantly less confident that their participation would impact care (7.6 ± 2.2 vs 8.3 ± 1.8; P = .01) and research (7.3 ± 2.4 vs 8.2 ± 2.0; P = .01) and were significantly less willing to participate in care (5.6 ± 2.9 vs 6.7 ± 3.0; P = .007) and research (4.7 ± 3.0 vs ± 5.8 ± 3.0; P = .02). Conclusions: Adult and pediatric visitors expressed comparable engagement preferences, identified similar facilitators and barriers, and rated engagement highly. Adult visitors were significantly less confident that their participation would be impactful and were significantly less willing to engage in care and research.

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Tesi sul tema "Pediatric intensive care research"

Ismail, Ahmad. "The Influence of Context on Utilizing Research Evidence for Pain Management in Jordanian Pediatric Intensive Care Units". Thesis, Université d'Ottawa / University of Ottawa, 2018. http://hdl.handle.net/10393/38503.

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Background: Little is known about the use of pain management evidence in Jordanian Pediatric Intensive Care Units (PICUs). Purpose: To assess the existence, content, and the factors influencing the use of pain management evidence in Jordanian PICUs. Methods: Three studies were guided by the Promoting Action on Research Implementation in Health Services (PARiHS) framework. 1. A scoping review of the literature to identify pain management interventions in the PICU; 2. A cross-sectional and multisite survey to determine the current pain management practices, and the availability and content of practice guidelines in Jordanian PICUs; 3. A correlational and multisite survey to examine the relationship between the contextual factors and nurses’ use of pain management research evidence in Jordanian PICUs. Results: 1. Twenty-seven studies were included in the scoping review. The majority of the studies focused mainly on pharmacological interventions (n= 21, 78%). Morphine and fentanyl were the most commonly used pharmacological agents for pain management in the PICUs. The use of non-pharmacological interventions was limited. 2. Four of six eligible PICUs participated in the cross-sectional study. All four units had written pain management guidelines. Fentanyl was the most commonly used pharmacological agent in two units. Intravenous infusions of opioids were not administered for patients on mechanical ventilation in two units. The use of non-pharmacological interventions was reported in one unit. 3. From the four participating units, 73 nurses completed the correlation study survey. Social capital predicted both the instrumental and conceptual research use for pain management by Jordanian PICU nurses. Structural and electronic resources predicted the instrumental research use for pain management by Jordanian PICU nurses. Conclusions: Pain management practices and supporting guidelines varied in Jordanian PICUs. Context influences Jordanian PICU nurses’ use of research for pain management. Not all of the pain management practices in Jordan are evidence informed. There is an opportunity for improvement in pain management in Jordanian PICUs.

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Maxton, Fiona, University of Western Sydney, College of Social and Health Sciences e of Nursing Family and Community Health School. "Sharing and surviving the resuscitation : parental presence during resuscitation of a child in PICU : the experiences of parents and nurses". THESIS_CSHS_NFC_Maxto_F.xml, 2005. http://handle.uws.edu.au:8081/1959.7/593.

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Parents’ presence and participation in their child’s care in the paediatric intensive care unit (PICU) is now commonplace. Despite parents expressing a deep need to be with their child particularly during periods of crisis, it is precisely at these times that they are often prevented from staying. The growing debate regarding family presence during a cardiopulmonary (CPR) resuscitation attempt continues to be controversial and conflicting. Current knowledge is mostly derived from quantitative studies conducted in the adult intensive care or emergency environments. The experiences of parents of children in the PICU, and the nurses caring for them are unknown. Using van Manen’s hermeneutic phenomenological approach, this study describes the phenomenon of parental presence during resuscitation of a child in PICU for eight Australian parent couples and six nurses. Experiential descriptions, obtained in tape-recorded unstructured interviews were subjected to two layers of analysis. Thematic analysis provided the phenomenological description in seven themes. Four themes refer to the parents’ experience in Being only for a child; Making sense of a living nightmare; Maintaining hope: facing reality and Living in a relationship with staff. Three themes describe the nurses’ experience: Under the parents’ gaze; Walking in their shoes and Holding parents in mind. A second layer of hermeneutic analysis revealed parents’ and nurses’ collective experience to have their being in four elements of the phenomenon. These elements are Being in chaos; Struggling to connect; Being for another and Being complete. The final description of the parents’ and nurses’ experience of parental presence during resuscitation in PICU as Sharing and surviving the resuscitation is drawn from the findings from each of these layers of meaning. The findings from this study conclude that the parents’ inherent need to be with their child overrode their anxieties of the resuscitation scene, curbing their feelings of chaos. Parental presence however, was a complex and dynamic concept that required a new relationship between parents and nurses. Implications of this study include recommendations for improving staff knowledge and education, as well as practical interventions for enhanced support for both parents and nurses
Doctor of Philosophy (PhD)

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O'Hara, Sullivan Susan. "Macrocognition in the Health Care Built Environment (m-HCBE): A Focused Ethnographic Study of 'Neighborhoods' in a Pediatric Intensive Care Unit: A Dissertation". eScholarship@UMMS, 2016. https://escholarship.umassmed.edu/gsn_diss/46.

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Objectives: The objectives of this research were to describe the interactions (formal and informal) in which macrocognitive functions occur and their location on a pediatric intensive care unit (PICU); describe challenges and facilitators of macrocognition using three constructs of space syntax (openness, connectivity, and visibility); and analyze the health care built environment (HCBE) using those constructs to explicate influences on macrocognition. Background: In high reliability, complex industries, macrocognition is an approach to develop new knowledge among interprofessional team members. Although macrocognitive functions have been analyzed in multiple health care settings, the effect of the HCBE on those functions has not been directly studied. The theoretical framework, “Macrocognition in the Health Care Built Environment” (m-HCBE) addresses this relationship. Methods: A focused ethnographic study was conducted, including observation and focus groups. Architectural drawing files used to create distance matrices and isovist field view analyses were compared to panoramic photographs and ethnographic data. Results: Neighborhoods comprised of corner configurations with maximized visibility enhanced team interactions as well as observation of patients, offering the greatest opportunity for informal situated macrocognitive interactions (SMIs). Conclusions: Results from this study support the intricate link between macrocognitive interactions and space syntax constructs within the HCBE. These findings help to advance the m-HCBE theory for improving physical space by designing new spaces or refining existing spaces, or for adapting IPT practices to maximize formal and informal SMI opportunities; this lays the groundwork for future research to improve safety and quality for patient and family care.

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Gill, Fenella. "Paediatric intensive care nursing behaviours to reduce parental stress". Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2001. https://ro.ecu.edu.au/theses/1028.

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A child's admission to a paediatric intensive care unit (PICU) is stressful for the family. Parental presence and involvement with their child in hospital have been recognised as important in reducing their stress. Several studies have identified parental needs in the PICU. Nurses have reported that they felt inadequately prepared to meet those needs. Although principles to guide nursing strategies have been identified, contextual behaviours of PICU nurses to reduce parental stress have not A qualitative study, using an ethnographic approach, was designed to describe contextual behaviours of experienced PICU nurses. Participants self identified their level of clinical practice to be at The Competency Standards for Specialist Critical Care Nurses (CACCN Inc., 1996). Fifteen nurses from six Australian PJCUs (two each in Brisbane and Sydney, one each in Melbourne and Adelaide) were interviewed. Recalled critical incidents identifying nursing behaviours to reduce parental stress were audiotaped, transcribed, analysed and interpreted. NUD•IST (version 4.0) was used to facilitate the initial data analysis. King's conceptual framework for nursing (1981), was used to illustrate the interactions of the interpersonal relationships between staff and parents and the effect of the culture within the PlCU. King's conceptual framework consists of three interacting, open systems; individuals as personal systems, two or more individuals forming interpersonal systems, and larger groups with common interests forming social systems or cultures. The nurses described parental stressors and behaviours. Nursing behaviours were anticipatory or in response to parental cues. Demonstrating empathy, sensitivity, caring and encouraging the parental role enabled rapport to be developed. Keeping parents fully informed, listening and talking through problems were also important stress reducing behaviours. PICU cultural behaviours, such as restricting parents' presence with their child, resulted in increased stress. The nurses found their role more difficult when parents were non English speaking, were of a different culture, religion or social background, or had long stays in the PICU. The nurses' personal challenges included the death of a patient, the need to remain impartial, and the pressure to always perform. The PICU nurses' ability to quickly establish rapport during a stressful time in the parents' lives was crucial to be able to reduce their stress. Many contextual nursing behaviours to reduce parental stress were described. However, consideration must be given to modifying those behaviours that increased parental stress. From both the perspective of positive and negative nursing behaviour, this study will enable nurses to be aware of behaviours that reduce and exacerbate parental stress in order to improve their practice in supporting parents.

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Kallio, M. (Merja). "Neurally adjusted ventilatory assist in pediatric intensive care". Doctoral thesis, Oulun yliopisto, 2014. http://urn.fi/urn:isbn:9789526206349.

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Abstract Guidelines and instructions derived from adult randomized controlled trials are generally followed in pediatric ventilation, as there have been no large trials of this kind in children. Current treatment strategies aim at preventing ventilator-induced lung injury by avoiding too large tidal volumes, supporting patient's spontaneous breathing and preventing lung collapse with positive end-expiratory airway pressure. Neurally adjusted ventilatory assist (NAVA) is a novel ventilation mode that provides respiratory support proportional to the electrical activity of the diaphragm (Edi). The aims of this thesis were to assess daily practices in pediatric ventilation in Finland and to compare NAVA with conventional ventilation in terms of safety and quality of care. Current treatment practices were studied with a preliminary enquiry and a 3-month prospective survey that was offered to all hospital units providing ventilatory care for children <16 years of age. NAVA was compared with current standard ventilation in a crossover trial involving 18 pediatric patients and in a larger controlled trial in which 170 patients were randomized to receive either NAVA or conventional ventilation. Respiratory distress was the most common indication for invasive ventilation in neonates, and postoperative care in older children. The principles of lung-protective ventilation were generally accepted and the goals were achieved in the majority of treatment episodes. The low incidence of pediatric invasive ventilation favours centralization. NAVA proved to be a safe and feasible primary ventilation mode in pediatric intensive care. It improved patient-ventilator synchrony and led to lower peak inspiratory pressures and oxygen requirements. It also reduced the need for sedation during longer treatment periods. Information derived from the Edi-signal could be used to optimize the level of sedation and to identify patients with a potential risk of extubation failure
Tiivistelmä Nykyisin käytössä olevat menetelmät lasten hengityskonehoidossa perustuvat suurelta osin aikuisilla tehtyihin tutkimuksiin ja totuttuihin tapoihin, sillä lasten hengityskonehoidosta on olemassa vain vähän tutkittua tietoa. Hengityskonehoidon aiheuttamaa keuhkovauriota pyritään ehkäisemään välttämällä suuria kertahengitystilavuuksia, tukemalla potilaan omia hengityksiä ja säilyttämällä ilmateissä positiivinen paine uloshengityksen aikanakin. Neuraalisesti ohjattu ventilaatio (NAVA) on uusi hengityskonehoitomuoto, joka tukee potilaan omia hengityksiä ohjaamalla koneen antamaa tukea pallealihaksen sähköisen signaalin avulla. Tämän tutkimuksen tavoitteena oli selvittää lasten hengityskonehoidon nykytilaa Suomessa sekä tutkia, voidaanko NAVAa käyttämällä parantaa hoidon laatua ja turvallisuutta. Nykyisiä hoitokäytäntöjä selvitettiin vuonna 2010 kysely- ja seurantatutkimuksella, johon kutsuttiin mukaan kaikki Suomessa lapsia ja vastasyntyneitä hoitavat tehohoito-osastot. NAVAa verrattiin nykyiseen hengityskonehoitoon 18 potilaan vaihtovuoroisessa tutkimuksessa sekä suuremmassa 170 lapsipotilaan satunnaistetussa kontrolloidussa tutkimuksessa. Eri syistä johtuvat hengitysvaikeudet ovat yleisin syy hengityskonehoitoon vastasyntyneillä ja suurten leikkausten jälkeinen hoito isommilla lapsilla. Keuhkoja säästävän hoidon periaatteet ovat Suomessa yleisesti hyväksyttyjä ja toteutuvat valtaosassa hoitojaksoja. Hengityskonehoitojaksojen määrän vähäisyys puoltaa hoidon keskittämistä suuriin sairaaloihin. NAVAa käyttämällä hengityskoneen antama tuki ajoittuu paremmin potilaan omien hengitysten mukaan ja sen avulla saavutetaan matalammat ilmatiepaineet sekä vähäisempi lisähapen tarve. Pitkissä hoitojaksoissa NAVA vähentää rauhoittavan lääkityksen tarvetta, ja pallealihaksen signaalia seuraamalla on mahdollista optimoida sedaatioaste aikaisempaa tarkemmin. Palleasignaalia voidaan myös hyödyntää arvioitaessa potilaan valmiutta hengitystuesta vieroittamiseen

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Rashotte, Judith Mary. "Pediatric intensive care nurses and their grief experiences". Thesis, University of Ottawa (Canada), 1996. http://hdl.handle.net/10393/10425.

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While the phenomenon of grief has received considerable attention and has been researched at length, there is a paucity of literature that has focused on health care professionals' experience of grief. The purpose of this study was to investigate the grief experience of pediatric intensive care nurses when their patients die. A phenomenological method was used in this study in order to obtain rich descriptions of nurses' experience of grief within their workplace. The purposive sample consisted of six registered nurses employed in an intensive care unit in a university-teaching pediatric hospital. In-depth, semi-structured interviews were conducted with the study participants in order to generate the data base. The audio-taped interviews were transcribed and analyzed for recurring themes emerging from the data according to the procedure outlined by Colaizzi. These nurses acknowledged they suffered multiple exposures to children's deaths and experienced grief. The interviews revealed eight themes that included one about their grief responses--hurting; two that described the influencing contextual factors--nurse-family unit relationship and dissonance, and five that related to coping strategies employed to manage their feelings of grief--self-expression, self-nurturance, termination of relationship activities, engaging in control taking activities and self-reflection. Further analysis revealed that managing grief effectively was an experiential learning process for the participants. The resultant themes were compared with the broader literature on grieving the loss of a significant other, grief and the health care professional, and the literature that addressed issues of occupational stress in the care of the critically ill, the dying, and the bereaved. The findings of this study could encourage further research that examines interventions designed to enhance the type of education and support needed in relation to the grief experience of nurses.

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Koontz, Victoria S. "Parental satisfaction in a pediatric intensive care unit". Huntington, WV : [Marshall University Libraries], 2003. http://www.marshall.edu/etd/descript.asp?ref=346.

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Simas, Ana Luísa Oliveira de. "Training report : clinical studies coordination in oncology". Master's thesis, Universidade de Aveiro, 2014. http://hdl.handle.net/10773/12966.

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Mestrado em Biomedicina Farmacêutica
This report describes a curricular training experience in Study Coordination, developed at Unidade de Investigação Clínica (Clinical Research Unit) of Instituto Português de Oncologia do Porto Francisco Gentil, E.P.E. (Portuguese Oncology Institute-Porto), in the ambit of the Master in Pharmaceutical Medicine at University of Aveiro. This report describes the State of the Art in Pharmaceutical R&D Process in Europe, especially in Oncology, emphasising its current trends and stressing specificities of special and vulnerable populations, in the scope of the traineeship. The study coordination activities were essentially performed in the Pathology Clinics of Lung, Urology, Gynaecology, Paediatrics, and the Intensive Care Service. The activities developed had the main goal of acquiring experience in oncology clinical trials, while reinforcing the knowledge from my academic background. These activities included screening and randomisation of patients, preparation and processing of study visits, data entry and query resolution, and documents management, among other activities transversal to the 15 clinical trials, accompanied in the traineeship. Globally, the traineeship allowed a good overview of the activities involved in the conduction of clinical trials in a hospital, and a worthy introduction to the marketplace. I strengthened the knowledge acquired from my academic background. I developed competences and skills at the professional and personal level, such as dealing with unforeseen situations, and developed strategies to overcome challenges. I sharpened my vision of careers in clinical research, and hope to continue addressing new challenges in this area.

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Palmer, Lydia Helmick. "Prevention of Skin Breakdown in the Pediatric Intensive Care Unit". Thesis, University of South Carolina, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=3561837.

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Skin breakdown occurs when one or more layers of the skin have been disrupted (McLane et al., 2004; National Pressure Ulcer Advisory Panel, 2007). While some literature uses the terms skin breakdown and pressure ulcer interchangeably, these are actually two distinct conditions and pressure ulcers are encompassed in the definition of skin breakdown (Kuller, 2001; Lund, 1999; Suddaby et al., 2006). The consequences of skin breakdown in the pediatric population can include increased cost of treatment, infection, increased morbidity and mortality as well as psychological consequences from resulting alopecia or scarring (Schindler, 2010; Willock & Maylor, 2004). Development of skin breakdown has also been associated with increased morbidity, increased length of stay, and higher costs of care (McCord et al., 2004).

Prevention of skin breakdown can be accomplished by the use of barriers and specialty surfaces. Barrier protection is achieved by the use of preparations, such as zinc oxide, petrolatum-containing compounds, and alcohol-free barrier films, and also by the application of transparent film and hydrogel dressings (Atherton, 2004; Atherton, 2005; Baharestani, 2007; Campbell et al., 2000; Lund et al., 2001). Surfaces can be useful in the prevention of skin breakdown by aiding in the distribution of pressure and decreasing moisture, and can also be used to aid in temperature control for some patients (Norton, Coutts, & Sibbald, 2011). The PICO format question used to guide this project is: For patients in Pediatric Intensive Care Units, is barrier protection or use of specialty surfaces more effective at preventing skin breakdown?

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Watson, J'ai. "Impact of Noise on Nurses in Pediatric Intensive Care Units". University of Cincinnati / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1378393887.

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Più fonti

Libri sul tema "Pediatric intensive care research"

Eliezer, Nussbaum, a cura di. Pediatric intensive care. 2^a ed. Mount Kisco, NY: Futura Pub. Co., 1989.

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P, Morray Jeffrey, a cura di. Pediatric intensive care. Norwalk, Conn: Appleton & Lange, 1987.

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Paediatric intensive care. Oxford: Oxford University Press, 2010.

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S, Morton N., a cura di. Paediatric intensive care. Oxford: Oxford University Press, 1997.

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Shanmugam, Naresh, e Anil Dhawan, a cura di. Pediatric Liver Intensive Care. Singapore: Springer Singapore, 2019. http://dx.doi.org/10.1007/978-981-13-1304-2.

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Pediatric critical care. 4^a ed. Philadelphia, PA: Elsevier Saunders, 2011.

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Crawford, Doreen, e Michaela Dixon. Paediatric intensive care nursing. Chichester, West Sussex: Wiley-Blackwell, 2012.

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Orlowski, James P. Pediatric critical care. Philadelphia: Saunders, 2008.

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P, Fuhrman Bradley, e Zimmerman Jerry J, a cura di. Pediatric critical care. 3^a ed. Philadelphia, PA: Mosby-Elsevier, 2006.

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P, Fuhrman Bradley, e Zimmerman Jerry J, a cura di. Pediatric critical care. 2^a ed. St. Louis: Mosby, 1998.

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Capitoli di libri sul tema "Pediatric intensive care research"

Cruz, Suzanne Osorio-da, Paul Flecknell e Claire Richardson. "Animal Research in Pediatric Cardiology and Cardiac Surgery". In Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care, 3453–69. London: Springer London, 2013. http://dx.doi.org/10.1007/978-1-4471-4619-3_65.

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Gaies, Michael G., Sara K. Pasquali, Mark Russell e Richard G. Ohye. "Clinical and Translational Research in Pediatric Cardiology and Cardiac Surgery". In Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care, 3491–505. London: Springer London, 2013. http://dx.doi.org/10.1007/978-1-4471-4619-3_80.

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Barasa, Immaculate W. K., e Erik N. Hansen. "Intensive Care". In Pediatric Surgery, 123–35. Cham: Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-41724-6_12.

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Ishak, Badr A., e Zehava L. Noah. "Neurologic Intensive Care". In Pediatric Neurosurgery, 509–17. New York, NY: Springer New York, 1987. http://dx.doi.org/10.1007/978-1-4757-4202-2_17.

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Ross, Patrick A., Robert Bart e Randall C. Wetzel. "Pediatric Intensive Care". In Gregory's Pediatric Anesthesia, 946–92. Oxford, UK: Wiley-Blackwell, 2011. http://dx.doi.org/10.1002/9781444345186.ch37.

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Hulst, Jessie, e Hans Van Goudoever. "3.23 Intensive Care". In Pediatric Nutrition in Practice, 248–53. Basel: KARGER, 2008. http://dx.doi.org/10.1159/000155526.

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Khilnani, Praveen. "Research in the Pediatric Intensive Care Unit". In Practical Approach to Pediatric Intensive Care, 1095. Jaypee Brothers Medical Publishers (P) Ltd., 2015. http://dx.doi.org/10.5005/jp/books/12720_112.

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Khilnani, Praveen. "Research in the Pediatric Intensive Care Unit". In Practical Approach to Pediatric Intensive Care, 1047. Jaypee Brothers Medical Publishers (P) Ltd., 2009. http://dx.doi.org/10.5005/jp/books/10637_99.

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Khilnani, Praveen. "Chapter-99 Research in the Pediatric Intensive Care Unit". In Practical Approach to Pediatric Intensive Care, 1047–56. Jaypee Brothers Medical Publishers (P) Ltd., 2009. http://dx.doi.org/10.5005/jp/books/10637_104.

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Cohn, Moshe, Emily Johnston e Julia McBee. "Settings of Care". In Interdisciplinary Pediatric Palliative Care, a cura di Joanne Wolfe, Pamela S. Hinds e Barbara M. Sourkes, 41–52. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780190090012.003.0004.

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Pediatric palliative care (PPC) is provided wherever the children who receive it may be found. Settings include the emergency room, inpatient floor and intensive care units, outpatient clinics, and hospice, as well as at home and at school. Each setting is characterized by a different combination of patients and families, palliative care needs, interdisciplinary team members, and medical and psychosocial environments. A successful PPC team adapts to the unique demands of each setting in providing high-quality PPC. To this end, new models of care delivery and team integration are needed, such as telehealth and tiered expertise, and research efforts must be expanded to guide PPC clinicians and healthcare leaders in keeping pace with the rapidly changing landscape of PPC in different settings.

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Atti di convegni sul tema "Pediatric intensive care research"

Hsueh, Andy, Kelly Fong, Kayla Kendrics, Nadia Saddiqi, Tammy Phan, Ellen Reibling e Brian Wolk. "Unwitting Adult Marijuana Poisoning: A Case Series". In 2021 Virtual Scientific Meeting of the Research Society on Marijuana. Research Society on Marijuana, 2022. http://dx.doi.org/10.26828/cannabis.2022.01.000.34.

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Study purpose: With increasing state legalization, marijuana use has become commonplace throughout much of the United States. This has resulted in expected and potentially dangerous consequences. Existing literature on unintentional exposure focuses primarily on the pediatric population. Despite mounting cases of unintentional exposure to marijuana, minimal research has been published on the effects of non-consensual marijuana consumption in adults. Here, we report on a cluster of adults with unwitting marijuana exposure. Methods: A cluster of patients who presented to the Emergency Department (ED) within one hour of ingesting marijuana-contaminated food at a wedding reception event were subsequently referred to the Medical Toxicology Service. We conducted a retrospective analysis of twelve subject charts who were exposed to the marijuana-contaminated food and a qualitative analysis of six of the 12 subjects’ experiences who willingly consented to be interviewed. The interviews were then analyzed and coded to categorize common themes within the subjects’ experiences. Themes categorically selected throughout the interview analysis included “Thoughts & Feelings” and “Effect on Work.” The study was approved by the Institutional Review Board. Results: Three of the subjects (25%) required prolonged observation due to persistent symptoms of acute marijuana intoxication. Eleven (92%) were urine immunoassay positive for tetrahydrocannabinol (THC). Two subjects (17%) tested positive for ethanol in their blood. None of the subjects reported a prior history of marijuana use. Common symptoms experienced by the subjects included confusion (50%), difficulty speaking (67%), nausea (25%), tremors (17%), and feelings of unreality (33%). All interviewed subjects reported sleepiness and three (50%) reported a negative impact on work. Subjects also reported multiple emotions, including anger, confusion, disbelief, and helplessness. None of the cases resulted in admission to the intensive care unit or death. Conclusions: Our case series illuminates the effects of unwitting and/or unintentional marijuana exposure in adults, with sufficient systemic effects resulting in individuals seeking emergency care. Legal and ethical barriers have limited the study of marijuana outside of controlled conditions. While the exposure in this study did not result in admission to the ICU or death, it did result in psychological distress and reported symptoms lasting weeks after the incident. As marijuana becomes readily available, the potential as an unwitting or even malicious intoxicant may increase.

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Bae, Woo Ri, Beom Joon Kim, Kyung Hoon Kim, Hye Jin Lee e Jong-Seo Yoon. "Comparison of pediatric patients managed in the pediatric intensive care unit and other intensive care units". In ERS International Congress 2018 abstracts. European Respiratory Society, 2018. http://dx.doi.org/10.1183/13993003.congress-2018.pa2340.

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Al-qaqaa, Yasir, Jodi Herbsman, Tiffany Folks e Mary Ellen Sheldon. "Early Mobilization in the Pediatric Intensive Care Unit". In Selection of Abstracts From NCE 2016. American Academy of Pediatrics, 2018. http://dx.doi.org/10.1542/peds.141.1_meetingabstract.108.

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Madden, Kate, Ying Feng, Ellen Smith, Shannon Keisling, Henry Feldman, Catherine M. Gordon, Bruce W. Hollis, Anna Agan e Adrienne G. Randolph. "Vitamin D Deficiency In The Pediatric Intensive Care Unit". In American Thoracic Society 2011 International Conference, May 13-18, 2011 • Denver Colorado. American Thoracic Society, 2011. http://dx.doi.org/10.1164/ajrccm-conference.2011.183.1_meetingabstracts.a6277.

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Agarwal, Hemant S. "Parental Satisfaction in the Pediatric Intensive Care Unit (picu)". In Selection of Abstracts From NCE 2016. American Academy of Pediatrics, 2018. http://dx.doi.org/10.1542/peds.141.1_meetingabstract.328.

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Garcia Delgado, E., E. Sanchez Ezquerra, E. Tores Garcia, S. Moran Arribas, P. Herrera Monge, A. Daza Diaz, M. Protero Diaz et al. "Early Mobilization Program in a Pediatric Intensive Care Unit". In ERS International Congress 2022 abstracts. European Respiratory Society, 2022. http://dx.doi.org/10.1183/13993003.congress-2022.4241.

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Balistreri, Kathryn A., Paulina S. Lim, Nina G. Linneman, Julia Tager, W. Hobart Davies, Matthew c. Scanlon, Kathleen Murkowski et al. "Critical Care Fellows’ Perceptions of Parent Distress in the Pediatric Intensive Care Unit". In AAP National Conference & Exhibition Meeting Abstracts. American Academy of Pediatrics, 2021. http://dx.doi.org/10.1542/peds.147.3_meetingabstract.523.

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Bal, Ufuk, e Alkan Bal. "Non-contact heart rate estimation in pediatric intensive care units". In 2014 18th National Biomedical Engineering Meeting (BIYOMUT). IEEE, 2014. http://dx.doi.org/10.1109/biyomut.2014.7026335.

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Crichton, Daniel J., Chris A. Mattmann, Andrew F. Hart, David Kale, Robinder G. Khemani, Patrick Ross, Sarah Rubin et al. "An informatics architecture for the Virtual Pediatric Intensive Care Unit". In 2011 24th International Symposium on Computer-Based Medical Systems (CBMS). IEEE, 2011. http://dx.doi.org/10.1109/cbms.2011.5999031.

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Rowe, Callum, Jessica Signoff e JoAnn Natale. "19 Improving handoff efficiency in the pediatric intensive care unit". In IHI Scientific Symposium, Gaylord Palms Resort & Convention Center Orlando, Florida, 9th December 2019. British Medical Journal Publishing Group, 2019. http://dx.doi.org/10.1136/bmjoq-2019-ihi.19.

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Rapporti di organizzazioni sul tema "Pediatric intensive care research"

Mobley, Erin M., Diana J. Moke, Joel Milam, Carol Y. Ochoa, Julia Stal, Nosa Osazuwa, Maria Bolshakova et al. Disparities and Barriers to Pediatric Cancer Survivorship Care. Agency for Healthcare Research and Quality (AHRQ), marzo 2021. http://dx.doi.org/10.23970/ahrqepctb39.

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Objectives. Survival rates for pediatric cancer have dramatically increased since the 1970s, and the population of childhood cancer survivors (CCS) exceeds 500,000 in the United States. Cancer during childhood and related treatments lead to long-term health problems, many of which are poorly understood. These problems can be amplified by suboptimal survivorship care. This report provides an overview of the existing evidence and forthcoming research relevant to disparities and barriers for pediatric cancer survivorship care, outlines pending questions, and offers guidance for future research. Data sources. This Technical Brief reviews published peer-reviewed literature, grey literature, and Key Informant interviews to answer five Guiding Questions regarding disparities in the care of pediatric survivors, barriers to cancer survivorship care, proposed strategies, evaluated interventions, and future directions. Review methods. We searched research databases, research registries, and published reviews for ongoing and published studies in CCS to October 2020. We used the authors’ definition of CCS; where not specified, CCS included those diagnosed with any cancer prior to age 21. The grey literature search included relevant professional and nonprofit organizational websites and guideline clearinghouses. Key Informants provided content expertise regarding published and ongoing research, and recommended approaches to fill identified gaps. Results. In total, 110 studies met inclusion criteria. We identified 26 studies that assessed disparities in survivorship care for CCS. Key Informants discussed subgroups of CCS by race or ethnicity, sex, socioeconomic status, and insurance coverage that may experience disparities in survivorship care, and these were supported in the published literature. Key Informants indicated that major barriers to care are providers (e.g., insufficient knowledge), the health system (e.g., availability of services), and payers (e.g., network adequacy); we identified 47 studies that assessed a large range of barriers to survivorship care. Sixteen organizations have outlined strategies to address pediatric survivorship care. Our searches identified only 27 published studies that evaluated interventions to alleviate disparities and reduce barriers to care. These predominantly assessed approaches that targeted patients. We found only eight ongoing studies that evaluated strategies to address disparities and barriers. Conclusions. While research has addressed disparities and barriers to survivorship care for childhood cancer survivors, evidence-based interventions to address these disparities and barriers to care are sparse. Additional research is also needed to examine less frequently studied disparities and barriers and to evaluate ameliorative strategies in order to improve the survivorship care for CCS.

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Enlow, Michelle Bosquet, Richard J. Chung, Melissa A. Parisi, Sharon K. Sagiv, Margaret A. Sheridan, Annemarie Stroustrup, Rosalind J. Wright et al. Standard Measurement Protocols for Pediatric Development Research in the PhenX Toolkit. RTI Press, settembre 2022. http://dx.doi.org/10.3768/rtipress.2022.mr.0049.2209.

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A challenge in conducting pediatric research is selecting reliable, valid measurement protocols, across a range of domains, that are appropriate for the developmental level of the study population. The purpose of this report is to introduce the research community to the Pediatric Development Research Domain of the National Institutes of Health (NIH)–supported PhenX Toolkit (consensus measures for Phenotypes and eXposures). The PhenX Toolkit provides a catalog of recommended measurement protocols to address a wide range of research topics that are suitable for inclusion in a variety of study designs. In 2018, the Pediatric Development Working Group of experts identified 18 well-established protocols of pediatric development for inclusion in the Toolkit to complement existing protocols. Collectively, the protocols assess parenting, child care attendance and quality, peer relationships, home environment, neonatal abstinence, emotional and behavioral functioning, and other factors that influence child development. The Toolkit provides detailed data collection protocols, data dictionaries, and worksheets to help investigators incorporate these protocols into their study designs. Using standard protocols in studies with pediatric participants will support consistent data collection, improve data quality, and facilitate cross-study analyses to ultimately improve child health.

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Parsons, Helen M., Hamdi I. Abdi, Victoria A. Nelson, Amy M. Claussen, Brittin L. Wagner, Karim T. Sadak, Peter B. Scal, Timothy J. Wilt e Mary Butler. Transitions of Care From Pediatric to Adult Services for Children With Special Healthcare Needs. Agency for Healthcare Research and Quality (AHRQ), maggio 2022. http://dx.doi.org/10.23970/ahrqepccer255.

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Objective. To understand the evidence base for care interventions, implementation strategies, and between-provider communication tools among children with special healthcare needs (CSHCN) transitioning from pediatric to adult medical care services. Data sources. We searched Ovid MEDLINE, Ovid Embase, the Cochrane Central trials (CENTRAL) registry, and CINAHL to identify studies through September 10, 2021. We conducted grey literature searches to identify additional resources relevant to contextual questions. Review methods. Using a mixed-studies review approach, we searched for interventions or implementation strategies for transitioning CSHCN from pediatric to adult services. Two investigators screened abstracts and full-text articles of identified references for eligibility. Eligible studies included randomized controlled trials, quasi-experimental observational studies, and mixed-method studies of CSHCN, their families, caregivers, or healthcare providers. We extracted basic study information from all eligible studies and grouped interventions into categories based on disease conditions. We summarized basic study characteristics for included studies and outcomes for studies assessed as low to medium risk of bias using RoB-2. Results. We identified 9,549 unique references, 440 of which represented empirical research; of these, 154 (16 major disease categories) described or examined a care transition intervention with enough detail to potentially be eligible for inclusion in any of the Key Questions. Of these, 96 studies met comparator criteria to undergo risk of bias assessment; however only 9 studies were assessed as low or medium risk of bias and included in our analytic set. Low-strength evidence shows transition clinics may not improve hemoglobin A1C levels either at 12 or 24 months in youth with type 1 diabetes mellitus compared with youth who received usual care. For all other interventions and outcomes, the evidence was insufficient to draw meaningful conclusions because the uncertainty of evidence was too high. Some approaches to addressing barriers include dedicating time and resources to support transition planning, developing a workforce trained to care for the needs of this population, and creating structured processes and tools to facilitate the transition process. No globally accepted definition for effective transition of care from pediatric to adult services for CSHCN exists; definitions are often drawn from principles for transitions, encompassing a broad set of clinical aspects and other factors that influence care outcomes or promote continuity of care. There is also no single measure or set of measures consistently used to evaluate effectiveness of transitions of care. The literature identifies a limited number of available training and other implementation strategies focused on specific clinical specialties in targeted settings. No eligible studies measured the effectiveness of providing linguistically and culturally competent healthcare for CSHCN. Identified transition care training, and care interventions to

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Wallace, Ina F. Universal Screening of Young Children for Developmental Disorders: Unpacking the Controversies. RTI Press, febbraio 2018. http://dx.doi.org/10.3768/rtipress.2018.op.0048.1802.

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In the past decade, American and Canadian pediatric societies have recommended that pediatric care clinicians follow a schedule of routine surveillance and screening for young children to detect conditions such as developmental delay, speech and language delays and disorders, and autism spectrum disorder. The goal of these recommendations is to ensure that children with these developmental issues receive appropriate referrals for evaluation and intervention. However, in 2015 and 2016, the US Preventive Services Task Force (USPSTF) and the Canadian Task Force on Preventive Health Care issued recommendations that did not support universal screening for these conditions. This occasional paper is designed to help make sense of the discrepancy between Task Force recommendations and those of the pediatric community in light of research and practice. To clarify the issues, this paper reviews the distinction between screening and surveillance; the benefits of screening and early identification; how the USPSTF makes its recommendations; and what the implications of not supporting screening are for research, clinical practice, and families.

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Wong, Melanie, Tania Beekmans, Fuatino Taliaoa e Liam M. Oades. Effectiveness of the Breaking Ground Programme in Transforming Parenting Skills and Practice. Unitec ePress, novembre 2021. http://dx.doi.org/10.34074/rsrp.093.

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The Breaking Ground programme was an 18-month pilot programme to support families and parents in a mana-enhancing process while developing parenting skills and practices, focused on intensive family intervention. Practitioners worked alongside families who were on a trajectory towards having their children placed in state care, with the goal of preventing entry to such care. This research uses a case-study methodology with data collected through interviews with social workers and families involved in the programme. The aims of this research were: 1) to examine the effectiveness of social workers working with families on the Breaking Ground programme; and 2) to examine the effectiveness of social workers providing cultural support for the families on the programme.

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W, Nedra, Laura B. Strange, Sara M. Kennedy, Katrina D. Burson e Gina L. Kilpatrick. Completeness of Prenatal Records in Community Hospital Charts. RTI Press, febbraio 2018. http://dx.doi.org/10.3768/rtipress.2018.rr.0032.1802.

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We describe the completeness of prenatal data in maternal delivery records and the prevalence of selected medical conditions and complications among patients delivering at community hospitals around Atlanta, Georgia. Medical charts for 199 maternal-infant dyads (99 infants in normal newborn nurseries and 104 infants in newborn intensive care nurseries) were identified by medical records staff at 9 hospitals and abstracted on site. Ninety-eight percent of hospital charts included prenatal records, but over 20 percent were missing results for common laboratory tests and prenatal procedures. Forty-nine percent of women had a pre-existing medical condition, 64 percent had a prenatal complication, and 63 percent had a labor or delivery complication. Missing prenatal information limits the usefulness of these records for research and may result in unnecessary tests or procedures or inappropriate medical care.

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Patton, Amy, Kylie Dunavan, Kyla Key, Steffani Takahashi, Kathryn Tenner e Megan Wilson. Reducing Stress, Anxiety, and Depression for NICU Parents. University of Tennessee Health Science Center, maggio 2021. http://dx.doi.org/10.21007/chp.mot2.2021.0012.

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This project aims to appraise evidence of the effectiveness of various practices on reducing stress, anxiety, and depression among parents of infants in the neonatal intensive care unit (NICU). The project contains six research articles from both national and international journals. Study designs include one meta-analysis, one randomized controlled trial, one small scale randomized controlled trial, one prospective phase lag cohort study, on pretest-posttest study, and one mixed-methods pretest-posttest study. Recommendations for effective interventions were based on best evidence discovered through quality appraisal and study outcomes. All interventions, except for educational programs and Kangaroo Care, resulted in a statistically significant reduction of either stress, anxiety, and/ or depression. Family centered care and mindfulness-based intervention reduced all barriers of interest. There is strong and high-quality evidence for the effect of Cognitive Behavioral Therapy on depression, moderate evidence for the effect of activity-based group therapy on anxiety, and promising evidence for the effect of HUG Your Baby on stress.

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Uhl, Stacey, Shazia Mehmood Siddique, Liam McKeever, Aaron Bloschichak, Kristen D’Anci, Brian Leas, Nikhil K. Mull e Amy Y. Tsou. Malnutrition in Hospitalized Adults: A Systematic Review. Agency for Healthcare Research and Quality (AHRQ), ottobre 2021. http://dx.doi.org/10.23970/ahrqepccer249.

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Objectives. To review the association between malnutrition and clinical outcomes among hospitalized patients, evaluate effectiveness of measurement tools for malnutrition on clinical outcomes, and assess effectiveness of hospital-initiated interventions for patients diagnosed with malnutrition. Data sources. We searched electronic databases (Embase®, MEDLINE®, PubMed®, and the Cochrane Library) from January 1, 2000, to June 3, 2021. We hand-searched reference lists of relevant studies and searched for unpublished studies in ClinicalTrials.gov. Review methods. Using predefined criteria and dual review, we selected (1) existing systematic reviews (SRs) to assess the association between malnutrition and clinical outcomes, (2) randomized and non-randomized studies to evaluate the effectiveness of malnutrition tools on clinical outcomes, and (3) randomized controlled trials (RCTs) to assess effectiveness of hospital-initiated treatments for malnutrition. Clinical outcomes of interest included mortality, length of stay, 30-day readmission, quality of life, functional status, activities of daily living, hospital acquired conditions, wound healing, and discharge disposition. When appropriate, we conducted meta-analysis to quantitatively summarize study findings; otherwise, data were narratively synthesized. When available, we used pooled estimates from existing SRs to determine the association between malnutrition and clinical outcomes, and assessed the strength of evidence. Results. Six existing SRs (including 43 unique studies) provided evidence on the association between malnutrition and clinical outcomes. Low to moderate strength of evidence (SOE) showed an association between malnutrition and increased hospital mortality and prolonged hospital length of stay. This association was observed across patients hospitalized for an acute medical event requiring intensive care unit care, heart failure, and cirrhosis. Literature searches found no studies that met inclusion criteria and assessed effectiveness of measurement tools. The primary reason studies did not meet inclusion criteria is because they lacked an appropriate control group. Moderate SOE from 11 RCTs found that hospital-initiated malnutrition interventions likely reduce mortality compared with usual care among hospitalized patients diagnosed with malnutrition. Low SOE indicated that hospital-initiated malnutrition interventions may also improve quality of life compared to usual care. Conclusions. Evidence shows an association between malnutrition and increased mortality and prolonged length of hospital stay among hospitalized patients identified as malnourished. However, the strength of this association varied depending on patient population and tool used to identify malnutrition. Evidence indicates malnutrition-focused hospital-initiated interventions likely reduce mortality and may improve quality of life compared to usual care among patients diagnosed with malnutrition. Research is needed to assess the clinical utility of measurement tools for malnutrition.

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Totten, Annette, Dana M. Womack, Marian S. McDonagh, Cynthia Davis-O’Reilly, Jessica C. Griffin, Ian Blazina, Sara Grusing e Nancy Elder. Improving Rural Health Through Telehealth-Guided Provider-to-Provider Communication. Agency for Healthcare Research and Quality, dicembre 2022. http://dx.doi.org/10.23970/ahrqepccer254.

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Objectives. To assess the use, effectiveness, and implementation of telehealth-supported provider-to-provider communication and collaboration for the provision of healthcare services to rural populations and to inform a scientific workshop convened by the National Institutes of Health Office of Disease Prevention on October 12–14, 2021. Data sources. We conducted a comprehensive literature search of Ovid MEDLINE®, CINAHL®, Embase®, and Cochrane CENTRAL. We searched for articles published from January 1, 2015, to October 12, 2021, to identify data on use of rural provider-to-provider telehealth (Key Question 1) and the same databases for articles published January 1, 2010, to October 12, 2021, for studies of effectiveness and implementation (Key Questions 2 and 3) and to identify methodological weaknesses in the research (Key Question 4). Additional sources were identified through reference lists, stakeholder suggestions, and responses to a Federal Register notice. Review methods. Our methods followed the Agency for Healthcare Research and Quality Methods Guide (available at https://effectivehealthcare.ahrq.gov/topics/cer-methods-guide/overview) and the PRISMA reporting guidelines. We used predefined criteria and dual review of abstracts and full-text articles to identify research results on (1) regional or national use, (2) effectiveness, (3) barriers and facilitators to implementation, and (4) methodological weakness in studies of provider-to-provider telehealth for rural populations. We assessed the risk of bias of the effectiveness studies using criteria specific to the different study designs and evaluated strength of evidence (SOE) for studies of similar telehealth interventions with similar outcomes. We categorized barriers and facilitators to implementation using the Consolidated Framework for Implementation Research (CFIR) and summarized methodological weaknesses of studies. Results. We included 166 studies reported in 179 publications. Studies on the degree of uptake of provider-to-provider telehealth were limited to specific clinical uses (pharmacy, psychiatry, emergency care, and stroke management) in seven studies using national or regional surveys and claims data. They reported variability across States and regions, but increasing uptake over time. Ninety-seven studies (20 trials and 77 observational studies) evaluated the effectiveness of provider-to-provider telehealth in rural settings, finding that there may be similar rates of transfers and lengths of stay with telehealth for inpatient consultations; similar mortality rates for remote intensive care unit care; similar clinical outcomes and transfer rates for neonates; improvements in medication adherence and treatment response in outpatient care for depression; improvements in some clinical monitoring measures for diabetes with endocrinology or pharmacy outpatient consultations; similar mortality or time to treatment when used to support emergency assessment and management of stroke, heart attack, or chest pain at rural hospitals; and similar rates of appropriate versus inappropriate transfers of critical care and trauma patients with specialist telehealth consultations for rural emergency departments (SOE: low). Studies of telehealth for education and mentoring of rural healthcare providers may result in intended changes in provider behavior and increases in provider knowledge, confidence, and self-efficacy (SOE: low). Patient outcomes were not frequently reported for telehealth provider education, but two studies reported improvement (SOE: low). Evidence for telehealth interventions for other clinical uses and outcomes was insufficient. We identified 67 program evaluations and qualitative studies that identified barriers and facilitators to rural provider-to-provider telehealth. Success was linked to well-functioning technology; sufficient resources, including time, staff, leadership, and equipment; and adequate payment or reimbursement. Some considerations may be unique to implementation of provider-to-provider telehealth in rural areas. These include the need for consultants to better understand the rural context; regional initiatives that pool resources among rural organizations that may not be able to support telehealth individually; and programs that can support care for infrequent as well as frequent clinical situations in rural practices. An assessment of methodological weaknesses found that studies were limited by less rigorous study designs, small sample sizes, and lack of analyses that address risks for bias. A key weakness was that studies did not assess or attempt to adjust for the risk that temporal changes may impact the results in studies that compared outcomes before and after telehealth implementation. Conclusions. While the evidence base is limited, what is available suggests that telehealth supporting provider-to-provider communications and collaboration may be beneficial. Telehealth studies report better patient outcomes in some clinical scenarios (e.g., outpatient care for depression or diabetes, education/mentoring) where telehealth interventions increase access to expertise and high-quality care. In other applications (e.g., inpatient care, emergency care), telehealth results in patient outcomes that are similar to usual care, which may be interpreted as a benefit when the purpose of telehealth is to make equivalent services available locally to rural residents. Most barriers to implementation are common to practice change efforts. Methodological weaknesses stem from weaker study designs, such as before-after studies, and small numbers of participants. The rapid increase in the use of telehealth in response to the Coronavirus disease 2019 (COVID-19) pandemic is likely to produce more data and offer opportunities for more rigorous studies.

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Newman-Toker, David E., Susan M. Peterson, Shervin Badihian, Ahmed Hassoon, Najlla Nassery, Donna Parizadeh, Lisa M. Wilson et al. Diagnostic Errors in the Emergency Department: A Systematic Review. Agency for Healthcare Research and Quality (AHRQ), dicembre 2022. http://dx.doi.org/10.23970/ahrqepccer258.

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Objectives. Diagnostic errors are a known patient safety concern across all clinical settings, including the emergency department (ED). We conducted a systematic review to determine the most frequent diseases and clinical presentations associated with diagnostic errors (and resulting harms) in the ED, measure error and harm frequency, as well as assess causal factors. Methods. We searched PubMed®, Cumulative Index to Nursing and Allied Health Literature (CINAHL®), and Embase® from January 2000 through September 2021. We included research studies and targeted grey literature reporting diagnostic errors or misdiagnosis-related harms in EDs in the United States or other developed countries with ED care deemed comparable by a technical expert panel. We applied standard definitions for diagnostic errors, misdiagnosis-related harms (adverse events), and serious harms (permanent disability or death). Preventability was determined by original study authors or differences in harms across groups. Two reviewers independently screened search results for eligibility; serially extracted data regarding common diseases, error/harm rates, and causes/risk factors; and independently assessed risk of bias of included studies. We synthesized results for each question and extrapolated U.S. estimates. We present 95 percent confidence intervals (CIs) or plausible range (PR) bounds, as appropriate. Results. We identified 19,127 citations and included 279 studies. The top 15 clinical conditions associated with serious misdiagnosis-related harms (accounting for 68% [95% CI 66 to 71] of serious harms) were (1) stroke, (2) myocardial infarction, (3) aortic aneurysm and dissection, (4) spinal cord compression and injury, (5) venous thromboembolism, (6/7 – tie) meningitis and encephalitis, (6/7 – tie) sepsis, (8) lung cancer, (9) traumatic brain injury and traumatic intracranial hemorrhage, (10) arterial thromboembolism, (11) spinal and intracranial abscess, (12) cardiac arrhythmia, (13) pneumonia, (14) gastrointestinal perforation and rupture, and (15) intestinal obstruction. Average disease-specific error rates ranged from 1.5 percent (myocardial infarction) to 56 percent (spinal abscess), with additional variation by clinical presentation (e.g., missed stroke average 17%, but 4% for weakness and 40% for dizziness/vertigo). There was also wide, superimposed variation by hospital (e.g., missed myocardial infarction 0% to 29% across hospitals within a single study). An estimated 5.7 percent (95% CI 4.4 to 7.1) of all ED visits had at least one diagnostic error. Estimated preventable adverse event rates were as follows: any harm severity (2.0%, 95% CI 1.0 to 3.6), any serious harms (0.3%, PR 0.1 to 0.7), and deaths (0.2%, PR 0.1 to 0.4). While most disease-specific error rates derived from mainly U.S.-based studies, overall error and harm rates were derived from three prospective studies conducted outside the United States (in Canada, Spain, and Switzerland, with combined n=1,758). If overall rates are generalizable to all U.S. ED visits (130 million, 95% CI 116 to 144), this would translate to 7.4 million (PR 5.1 to 10.2) ED diagnostic errors annually; 2.6 million (PR 1.1 to 5.2) diagnostic adverse events with preventable harms; and 371,000 (PR 142,000 to 909,000) serious misdiagnosis-related harms, including more than 100,000 permanent, high-severity disabilities and 250,000 deaths. Although errors were often multifactorial, 89 percent (95% CI 88 to 90) of diagnostic error malpractice claims involved failures of clinical decision-making or judgment, regardless of the underlying disease present. Key process failures were errors in diagnostic assessment, test ordering, and test interpretation. Most often these were attributed to inadequate knowledge, skills, or reasoning, particularly in “atypical” or otherwise subtle case presentations. Limitations included use of malpractice claims and incident reports for distribution of diseases leading to serious harms, reliance on a small number of non-U.S. studies for overall (disease-agnostic) diagnostic error and harm rates, and methodologic variability across studies in measuring disease-specific rates, determining preventability, and assessing causal factors. Conclusions. Although estimated ED error rates are low (and comparable to those found in other clinical settings), the number of patients potentially impacted is large. Not all diagnostic errors or harms are preventable, but wide variability in diagnostic error rates across diseases, symptoms, and hospitals suggests improvement is possible. With 130 million U.S. ED visits, estimated rates for diagnostic error (5.7%), misdiagnosis-related harms (2.0%), and serious misdiagnosis-related harms (0.3%) could translate to more than 7 million errors, 2.5 million harms, and 350,000 patients suffering potentially preventable permanent disability or death. Over two-thirds of serious harms are attributable to just 15 diseases and linked to cognitive errors, particularly in cases with “atypical” manifestations. Scalable solutions to enhance bedside diagnostic processes are needed, and these should target the most commonly misdiagnosed clinical presentations of key diseases causing serious harms. New studies should confirm overall rates are representative of current U.S.-based ED practice and focus on identified evidence gaps (errors among common diseases with lower-severity harms, pediatric ED errors and harms, dynamic systems factors such as overcrowding, and false positives). Policy changes to consider based on this review include: (1) standardizing measurement and research results reporting to maximize comparability of measures of diagnostic error and misdiagnosis-related harms; (2) creating a National Diagnostic Performance Dashboard to track performance; and (3) using multiple policy levers (e.g., research funding, public accountability, payment reforms) to facilitate the rapid development and deployment of solutions to address this critically important patient safety concern.

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