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2. Operational Definitions Related to Pediatric Ventilator Liberation

Author

Abu-Sultaneh, Samer, Iyer, Narayan Prabhu, Fernández, Analía, Gaies, Michael, González-Dambrauskas, Sebastián, Hotz, Justin Christian, Kneyber, Martin CJ, López-Fernández, Yolanda M, Rotta, Alexandre T, Werho, David K, Baranwal, Arun Kumar, Blackwood, Bronagh, Craven, Hannah J, Curley, Martha AQ, Essouri, Sandrine, Fioretto, Jose Roberto, Hartmann, Silvia MM, Jouvet, Philippe, Korang, Steven Kwasi, Rafferty, Gerrard F, Ramnarayan, Padmanabhan, Rose, Louise, Tume, Lyvonne N, Whipple, Elizabeth C, Wong, Judith Ju Ming, Emeriaud, Guillaume, Mastropietro, Christopher W, Napolitano, Natalie, Newth, Christopher JL, Khemani, Robinder G, and Network, Pediatric Acute Lung Injury and Sepsis Investigators

Subjects
Lung, Bioengineering, Pediatric, Assistive Technology, Patient Safety, Humans, Child, Respiration, Artificial, Ventilator Weaning, Ventilators, Mechanical, Research Design, Airway Extubation, airway extubation, extubation failure, high-flow nasal cannula, mechanical ventilation, noninvasive ventilation, pediatric ICU, ventilator weaning, Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network, Clinical Sciences, Respiratory System
Abstract

BackgroundCommon, operational definitions are crucial to assess interventions and outcomes related to pediatric mechanical ventilation. These definitions can reduce unnecessary variability among research and quality improvement efforts, to ensure findings are generalizable, and can be pooled to establish best practices.Research questionCan we establish operational definitions for key elements related to pediatric ventilator liberation using a combination of detailed literature review and consensus-based approaches?Study design and methodsA panel of 26 international experts in pediatric ventilator liberation, two methodologists, and two librarians conducted systematic reviews on eight topic areas related to pediatric ventilator liberation. Through a series of virtual meetings, we established draft definitions that were voted upon using an anonymous web-based process. Definitions were revised by incorporating extracted data gathered during the systematic review and discussed in another consensus meeting. A second round of voting was conducted to confirm the final definitions.ResultsIn eight topic areas identified by the experts, 16 preliminary definitions were established. Based on initial discussion and the first round of voting, modifications were suggested for 11 of the 16 definitions. There was significant variability in how these items were defined in the literature reviewed. The final round of voting achieved ≥ 80% agreement for all 16 definitions in the following areas: what constitutes respiratory support (invasive mechanical ventilation and noninvasive respiratory support), liberation and failed attempts to liberate from invasive mechanical ventilation, liberation from respiratory support, duration of noninvasive respiratory support, total duration of invasive mechanical ventilation, spontaneous breathing trials, extubation readiness testing, 28 ventilator-free days, and planned vs rescue use of post-extubation noninvasive respiratory support.InterpretationWe propose that these consensus-based definitions for elements of pediatric ventilator liberation, informed by evidence, be used for future quality improvement initiatives and research studies to improve generalizability and facilitate comparison.

Published
2023

3. Executive Summary: International Clinical Practice Guidelines for Pediatric Ventilator Liberation, A Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Document.

Author

Abu-Sultaneh, Samer, Iyer, Narayan, Fernández, Analía, Gaies, Michael, González-Dambrauskas, Sebastián, Hotz, Justin, Kneyber, Martin, López-Fernández, Yolanda, Rotta, Alexandre, Werho, David, Baranwal, Arun, Blackwood, Bronagh, Craven, Hannah, Curley, Martha, Essouri, Sandrine, Fioretto, Jose, Hartmann, Silvia, Jouvet, Philippe, Korang, Steven, Rafferty, Gerrard, Ramnarayan, Padmanabhan, Rose, Louise, Tume, Lyvonne, Whipple, Elizabeth, Wong, Judith, Emeriaud, Guillaume, Mastropietro, Christopher, Napolitano, Natalie, Newth, Christopher, and Khemani, Robinder

Subjects
airway extubation, clinical protocols, mechanical ventilators, pediatric intensive care units, ventilator weaning, Humans, Child, Respiration, Artificial, Ventilator Weaning, Ventilators, Mechanical, Airway Extubation, Sepsis
Abstract

Rationale: Pediatric-specific ventilator liberation guidelines are lacking despite the many studies exploring elements of extubation readiness testing. The lack of clinical practice guidelines has led to significant and unnecessary variation in methods used to assess pediatric patients readiness for extubation. Methods: Twenty-six international experts comprised a multiprofessional panel to establish pediatrics-specific ventilator liberation clinical practice guidelines, focusing on acutely hospitalized children receiving invasive mechanical ventilation for more than 24 hours. Eleven key questions were identified and first prioritized using the Modified Convergence of Opinion on Recommendations and Evidence. A systematic review was conducted for questions that did not meet an a priori threshold of ⩾80% agreement, with Grading of Recommendations, Assessment, Development, and Evaluation methodologies applied to develop the guidelines. The panel evaluated the evidence and drafted and voted on the recommendations. Measurements and Main Results: Three questions related to systematic screening using an extubation readiness testing bundle and a spontaneous breathing trial as part of the bundle met Modified Convergence of Opinion on Recommendations criteria of ⩾80% agreement. For the remaining eight questions, five systematic reviews yielded 12 recommendations related to the methods and duration of spontaneous breathing trials, measures of respiratory muscle strength, assessment of risk of postextubation upper airway obstruction and its prevention, use of postextubation noninvasive respiratory support, and sedation. Most recommendations were conditional and based on low to very low certainty of evidence. Conclusions: This clinical practice guideline provides a conceptual framework with evidence-based recommendations for best practices related to pediatric ventilator liberation.

Published
2023

7. Digital peer-to-peer support programme for informal caregivers of people living with motor neuron disease: study protocol for a multi-centre parallel group, single-blinded (outcome assessor) randomised controlled superiority trial

Author

Rose, Louise, Thaventhiran, Thilipan, Hobson, Esther, Rogers, Rebecca, James, Kirsty, Chu, Petrina, Carter, Ben, Faull, Christina, Saha, Sian, Lee, Jeong Su, Kaltsakas, Georgios, McDermott, Christopher, and Ramsay, Michelle

Published
2023
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8. Barcoded Transposon Directed Insertion-site Sequencing (TraDIS) : a tool to improve our understanding of the functional genomics of Streptococcus equi subsp. equi

Author

Charbonneau, Amelia Rose Louise, Waller, Andrew, and Sargan, David

Subjects
Transposon, strangles, sequencing, tradis, tnseq, essential
Abstract

Strangles, caused by Streptococcus equi (S. equi) remains the most frequently diagnosed infectious disease of horses and is a cause of significant welfare and economic cost. Vaccine research has been limited by the time taken to make mutations in individual genes to determine their role in the disease process. However, the development of transposon directed insertion-site sequencing (TraDIS) technologies provides an opportunity to simultaneously determine the importance of every gene in S. equi under disease relevant conditions, significantly enhancing the capacity to identify new vaccine targets. In this project, a novel barcoded TraDIS technique was designed, which identified that 19.5 percent of the S. equi genome is essential to basic survival in rich medium in vitro, 73.4 percent of genes being non-essential, with the remainder either not defined or of an ambiguous assignment. Comparative analysis revealed that more than 83 percent of the essential gene set of S. equi was concordant with the essential genomes of S. pyogenes and S. agalactiae, highlighting the close genetic relationships between these important pathogenic bacteria. Barcoded libraries were exposed to hydrogen peroxide (H2O2) and whole equine blood, to simulate the interaction with the equine immune system. Sequencing of surviving mutants enabled identification of genes important to S. equi under these conditions in vitro. Fifteen and 36 genes were implicated in the survival of S. equi in H2O2 and whole equine blood, respectively. Results were validated by generating deletion mutant strains in 4 of the genes (pyrP, mnmE, addA and recG). Mutant strains were exposed to H2O2 or whole equine blood and surviving bacteria measured over time. An additional 2 deletion strains in eqbE and hasA, generated prior to this project, were also utilised. Barcoded TraDIS is proposed to reduce the effects of stochastic loss commonly seen in similar datasets, enhancing the ability to resolve differences in the fitness of mutants. To determine the in vivo capabilities of barcoded TraDIS, 12 Welsh mountain ponies were each infected with 2 of 3 barcoded libraries. Viable mutants were recovered and sequenced from the abscess material of infected lymph nodes and data analysed both exploiting (barcoded analysis; BC) and disregarding (per animal analysis; PA) the input library barcodes. Exploiting the barcodes enables output data to be combined on a per input library basis, as opposed to a per animal basis as is traditionally completed in comparable in vivo transposon library studies. From the BC analysis, sequencing identified 368 genes required for fitness. Mutations in a further 85 genes conferred a fitness advantage in vivo. In the PA analysis, only 97 genes required for fitness were identified, which were all similarly identified in the barcoded analysis. No genes in which an insertion conferred a fitness advantage were identified in the PA analysis. To validate these results and confirm the benefit of applying a barcoded technique, 12 genes required for fitness were selected, plus 1 control gene where transposon insertions did not alter fitness, for tagged allelic replacement mutagenesis and repeat challenge in vivo. Seven genes required for fitness in both methods of analysis were selected, plus an additional 5 genes uniquely identified by the BC analysis. All deletion mutants appeared to be attenuated in vivo, however the control mutants and wild-type S. equi did not behave as expected, confounding statistical analysis. Thirty-nine percent (14/36) and 60 percent (9/15) of fitness genes identified in the whole equine blood and H2O2 TraDIS screens, respectively, were also identified as being required for in vivo fitness. Nine consensus genes were identified as required in all 3 experiments. Comparison of the genes implicated in in vivo survival of S. equi to those in S. pyogenes in a non-human primate model of necrotising myositis and in a mouse model of subcutaneous infection, uncovered a set of 23 pan-species fitness genes. Eighteen genes were also commonly identified between the S. equi in vivo data and S. pyogenes ex vivo in human saliva, alluding to the potential genes required by S. equi to survive in the nasopharynx before translocation to the local lymph nodes. The data presented in this thesis provide an unprecedented insight into the mechanisms employed by S. equi to cause disease in the natural host. The data also shed light on the pan-streptococcal pathways important for virulence that are likely to be important for future development of novel therapeutics and vaccines.

Published
2019
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10. Measures for the Core Outcome Set for Research Evaluating Interventions to Prevent and/or Treat Delirium in Critically Ill Adults: An International Consensus Study (Del-COrS)

Author

Rose, Louise, Blackwood, Bronagh, Needham, Dale M., Devlin, John W., Clarke, Mike, Burry, Lisa D., Agar, Meera, Boland, Jason, Bush, Shirley, Campbell, Noll L., Featherstone, Imogen, Fornear, Leslie, Hosie, Annmarie, Johnson, Miriam, Jones, Richard N., Lawlor, Peter, Lee, Jacques, Marshall, John, Siddiqi, Najma, and Page, Valerie

Published
2023
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11. Protocol summary and statistical analysis plan for the Selective Decontamination of the Digestive Tract in Intensive Care Unit Patients (SuDDICU) crossover, cluster randomised controlled trial

Author

Billot, Laurent, Cuthbertson, Brian, Gordon, Anthony, Al-Beidh, Farah, Correa, Maryam, Davis, Joshua, Finfer, Simon, Glass, Parisa, Goodman, Fiona, Hammond, Naomi, Iredell, Jonathon, Miller, Jennene, Murthy, Srinivas, Rose, Louise, Seppelt, Ian, Taylor, Colman, Young, Paul, and Myburgh, John

Published
2021

12. Left ventricular unloading in patients supported with veno-arterial extra corporeal membrane oxygenation; an international EuroELSO survey

Author

Medische Staf Intensive Care, Other research (not in main researchprogram), Ezad, Saad M., Ryan, Matthew, Barrett, Nicholas, Camporota, Luigi, Swol, Justyna, Antonini, Marta V., Donker, Dirk W., Pappalardo, Federico, Kapur, Navin K., Rose, Louise, Perera, Divaka, Medische Staf Intensive Care, Other research (not in main researchprogram), Ezad, Saad M., Ryan, Matthew, Barrett, Nicholas, Camporota, Luigi, Swol, Justyna, Antonini, Marta V., Donker, Dirk W., Pappalardo, Federico, Kapur, Navin K., Rose, Louise, and Perera, Divaka

Published
2024

13. Impact of a peer-support programme to improve loneliness and social isolation due to COVID-19: does adding a secure, user friendly video-conference solution work better than telephone support alone? Protocol for a three-arm randomised clinical trial

Author

Lee, Jacques Simon, primary, Rose, Louise, additional, Borgundvaag, Bjug, additional, McLeod, Shelley L, additional, Melady, Donald, additional, Mohindra, Rohit, additional, Sinha, Samir K, additional, Wesson, Virginia, additional, Wiesenfeld, Lesley, additional, Kolker, Sabrina, additional, Kiss, Alex, additional, and Lowthian, Judy, additional

Published
2024
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14. Soins virtuels innovants pour la ventilation mecanique a domicile

Author

Amin, Reshma, Pizzuti, Regina, Buchanan, Francine, and Rose, Louise

Subjects
Ventilation -- Health aspects -- Care and treatment, Sparsely populated areas, Coronaviruses, Health
Abstract

Le programme LIVE (Long-Term In-Home Ventilator Engagement) est un nouveau programme de soins virtuels, qui a ete deploye pendant la pandemie de maladie a coronavirus 2019 (COVID-19) pour permettre aux [...]

Published
2021
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17. A virtual care innovation for home mechanical Ventilation

Author

Amin, Reshma, Pizzuti, Regina, Buchanan, Francine, and Rose, Louise

Subjects
Home care -- Methods -- Technology application, Artificial respiration -- Methods -- Technology application, Telemedicine -- Methods, Technology application, Health
Abstract

The Long-Term In-Home Ventilator Engagement (LIVE) program is a new virtual care program, rolled out during the coronavirus disease 2019 (COVID-19) pandemic to enable specialized centres to provide virtual support [...]

Published
2021
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18. The social performance of microfinance institutions in rural Bangladesh

Author

Maitrot, Mathilde Rose Louise, Hulme, David, and Brockington, Daniel

Subjects
332, Microfinance, Social performance, Bangladesh, Livelihood, Micro finance, Poverty
Abstract

Microfinance was rapidly hailed as a poverty alleviation tool by development agencies, researchers and practitioners. Despite the increasing capacity of MFIs to manage their financial sustainability, impact studies available report disappointingly low social achievements. Social performance assessment tools available struggle to combat a narrow MFI-centric approach which often overlooks contextual issues and institutional characteristics which can influence MFIs’ poverty reduction potential. This research’s main objective is to identify which and explain how organisational structures and management systems impact on MFIs’ social performance. This work uses a bottom-up research strategy, based on a 10-month extensive fieldwork in Bangladesh, a 490 household data-set, an ethnographic community study in Modhupur and institutional analyses of ASA and PDBF. It analyses the livelihoods, capitals and strategies of rural households in Bangladesh, explores their perceptions and experiences of microfinance and examines the management of socio-financial trade-offs within MFIs at different hierarchical levels. The research’s main findings seriously question the poverty reducing potential of standardised commercialised microfinance in settings characterised by vulnerability, shocks and seasonality, such as rural Bangladesh. It finds that although most MFIs have similar poverty reduction missions it is the way in which their organisational structures, managementsystems and working cultures are arranged that shapes their financial and social achievements. There is strong evidence that commercial MFIs can experience a silent practice drift at the field level in Bangladesh and that the commercialisation of MFIs provides strong incentives for the field staff to prioritise the achievement of their financial targets to the detriment of social performance, discouraging them from reporting low social performance. There are therefore few reasons why MFI senior managers should question their model and policies. This drift can manifest itself through malpractices hard-selling of loans, poor client selection and follow-up procedures, forcing clients into borrowing more and larger loans, using extreme forms of pressure through abusive language and behaviours and micro-collateral. This process usually has longer-term negative impacts on clients, especially the very poor who adopt successive short-term coping tactics to meet inflexible repayment schedules. This thesis concludes that commercial microfinance should not be targeted to the poorest and that more consideration should be given to clientselection and follow-up procedures. This thesis argues that the commercialisation of the global microfinance industry serves the interests of diverse stakeholders who contribute to maintaining the industry’s reputation though the media. This can be deemed an iceberg industry (that shows little of its actual workings and impacts to the public) which is sustained through considerable support from an increasing number of private investors for whom MFIs’ commercial expansion (regardless of its social achievements) serves their financial and political interests.

Published
2014

19. Health shocks, care-seeking behaviour and coping strategies of extreme poor households in Bangladesh’s Chittagong Hill tracts

Author

Ashraful Kabir, Rupa Datta, Sayeed Hasan Raza, and Mathilde Rose Louise Maitrot

Subjects
Adivasi (ethnic minority), Care-seeking behaviour, Bangladesh, Chittagong Hill tracts, Coping strategies extreme poor households, Health shocks, Public aspects of medicine, RA1-1270
Abstract

Abstract Background How and whether health shocks, care-seeking behaviour and coping strategies are interlinked and influence households resilience to ill-health remains an under-researched subject in the context of Bangladesh. This study investigates whether and how health shocks, care-seeking processes and coping strategies interplay and impact the resilience of extremely poor adivasi (ethnic minority) households in the Chittagong Hill Tracts (CHT), Bangladesh. Methods Our analysis draws from qualitative data collected through a range of methods (see Additional file 1). We conducted 25 in-depth interviews (IDIs) of two adivasi communities targeted by an extreme-poverty alleviation programme, 11 key informant interviews (KIIs) with project personnel (community workers, field officers, project managers), community leaders, and healthcare providers, and 9 focus group discussions (FGDs) with community members. Data triangulation was performed to further validate the data, and a thematic analysis approach was used to analyze the data. Results Health shocks were a defining characteristic of households’ experiences of extreme poverty in the studied region. Care-seeking behaviours are influenced by an array of cultural and economic factors. Households adopt a range of coping strategies during the treatment or care-seeking process, which are often insufficient to allow households to maintain a stable economic status. This is largely due to the fact that healthcare costs are borne by the household, primarily through out-of-pocket payments. Households meet healthcare cost by selling their means of livelihoods, borrowing cash, and marketing livestock. This process erodes their wellbeing and hinders they attempt at achieving resilience, despite their involvement in an extreme poverty-alleviation programme. Conclusions Livelihood supports or asset-transfers alone are insufficient to improve household resilience in this context. Therefore, we argue that extreme poor households’ healthcare needs should be central to the design of poverty-alleviating intervention for them to contribute to foster resilience.

Published
2019
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23. Neurally adjusted ventilatory assist versus pressure support ventilation: a randomized controlled feasibility trial performed in patients at risk of prolonged mechanical ventilation

Author

Hadfield, Daniel J., Rose, Louise, Reid, Fiona, Cornelius, Victoria, Hart, Nicholas, Finney, Clare, Penhaligon, Bethany, Molai, Jasmine, Harris, Clair, Saha, Sian, Noble, Harriet, Clarey, Emma, Thompson, Leah, Smith, John, Johnson, Lucy, Hopkins, Phillip A., and Rafferty, Gerrard F.

Published
2020
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26. Qualitative exploration of factors affecting progress in antipoverty interventions: Experiences from a poverty-reduction program in Bangladesh

Author

Ashraful Kabir and Mathilde Rose Louise Maitrot

Subjects
antipoverty programme, bangladesh, extreme poverty, livelihood, ngo, poverty reduction, qualitative study, Social Sciences
Abstract

Understanding and addressing the factors that affect progress in antipoverty interventions is central to achieving the Sustainable Development Goals. In Bangladesh this topic has been largely explored through quantitative approaches, and we believe in-depth qualitative analyses of household dynamics in the context of antipoverty interventions is lacking. This article addresses this lacuna. Based on 49 focus group discussions and 15 case studies, we analyse livelihood dynamics of beneficiary households within a national extreme poverty alleviation program. We identify five determining factors to the effectiveness of antipoverty interventions: 1) health shocks, natural hazards, and vulnerabilities; 2) household demography; 3) inappropriate IGA planning, implementation, and monitoring; 4) dependence/inaction; and 5) political and social instability. We argue that livelihood-based antipoverty initiatives often fail because they do not address these five factors, and call for a comprehensive approach that prioritises them in program design.

Published
2019
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27. Protocol for a multi-centered, stepped wedge, cluster randomized controlled trial of the de-adoption of oral chlorhexidine prophylaxis and implementation of an oral care bundle for mechanically ventilated critically ill patients: the CHORAL study

Author

Dale, Craig M., Rose, Louise, Carbone, Sarah, Smith, Orla M., Burry, Lisa, Fan, Eddy, Amaral, Andre Carlos Kajdacsy-Balla, McCredie, Victoria A., Pinto, Ruxandra, Quiñonez, Carlos R., Sutherland, Susan, Scales, Damon C., and Cuthbertson, Brian H.

Published
2019
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31. Informing the standardising of care for prolonged stay patients in the ICU: A scoping review of quality improvement tools

Author

Allum, Laura, Apps, Chloe, Pattison, Natalie, Connolly, Bronwen, and Rose, Louise

Subjects
Bundle, Critical care, Care standardisation, Persistent or chronic critical illness, Quality improvement, Checklist
Abstract

ObjectivesTo inform design of quality improvement tools specific to patients with prolonged intensive care unit stay, we determined characteristics (format/content), development, implementation and outcomes of published multi-component quality improvement tools used in the intenisve care unit irrespective of length of stay.Research MethodologyScoping review searching electronic databases, trial registries and grey literature (January 2000 to January 2022).ResultsWe screened 58,378 citations, identifying 96 studies. All tools were designed for use commencing at intensive care unit admission except three tools implemented at 3, 5 or 14 days. We identified 32 studies of locally developed checklists, 28 goal setting/structured communication templates, 23 care bundles and 9 studies of mixed format tools. Most (43 %) tools were designed for use during rounds, fewer tools were designed for use throughout the ICU day (27 %) or stay (9 %). Most studies (55 %) reported process objectives i.e., improving communication, care standardisation, or rounding efficiency. Most common clinical processes quality improvement tools were used to standardise were sedation (62, 65 %), ventilation and weaning (55, 57 %) and analgesia management (58, 60 %). 44 studies reported the effect of the tool on patient outcomes. Of these, only two identified a negative effect; increased length of stay and increased days with pain and delirium.ConclusionAlthough we identified numerous quality improvement tools for use in the intensive care unit, few were designed to specifically address actionable processes of care relevant to the unique needs of prolonged stay patients. Tools that address these needs are urgently required.

Published
2022

33. Exploring the effects of health shocks on anti-poverty interventions: Experience of poor beneficiary households in Bangladesh

Author

Ashraful Kabir and Mathilde Rose Louise Maitrot

Subjects
anti-poverty program, bangladesh, chronic diseases, health shock, health-care cost, ngo, out-of-pocket, Medicine
Abstract

How and whether health shocks impact poverty reduction interventions remains a largely unexplored topic to which not much attention has been paid. This study explored whether and how health shocks affect anti-poverty interventions targeted to extremely poor households using data from 8 focus group discussions and 12 case studies. Those in extremely poor households mostly experienced episodes of chronic disease that incurred greater health-care costs, largely financed by the out-of-pocket payment system. The majority of those from poor households met health-care costs by selling their means of livelihood, borrowing cash, and marketing physical assets. This study argues that livelihood support alone is likely to be insufficient to reduce poverty. Health needs, subsequently, should be prioritized while designing an anti-poverty program.

Published
2018
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35. Factors influencing feeding practices of extreme poor infants and young children in families of working mothers in Dhaka slums: A qualitative study.

Author

Ashraful Kabir and Mathilde Rose Louise Maitrot

Subjects
Medicine, Science
Abstract

Nutritional status differs between infants and young children living in slum and non-slum conditions-infants and young children living in City Corporation slums are likely to have worse nutritional status compared to those from non-slums. Furthermore, families in slums tend to engage female labor in cash-earning activities as a survival strategy; hence, a higher percentage of mothers stay at work. However, little is known about feeding practices for infants and young children in families with working mothers in slums. This study aims to understand the factors that determine feeding practices for infants and young children living in families with working mothers in Dhaka slums.This study adopted a qualitative approach. Sixteen In-depth Interviews, five Key Informant Interviews, and Focused Group Discussions were conducted with family members, community leaders, and program staff. Method triangulation and thematic analyses were conducted.Feeding practices for infants and young children in families with working mothers are broadly determined by mothers' occupation, basis civic facilities, and limited family buying capacity. Although mothers have good nutritional knowledge, they negotiate between work and feeding their infants and young children. Household composition, access to cooking facilities, and poverty level were also found to be significant determining factors.The results suggest a trade-off between mothers' work and childcare. The absence of alternative care support in homes and/or work places along with societal factors outweighs full benefits of project interventions. Improving alternative childcare support could reduce the burden of feeding practice experienced by working mothers and may improve nutritional outcomes.

Published
2017
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36. In Pursuit of a Holistic Learning Environment: The Impact of Music in the Medical Physiology Classroom

Author

Modell, Harold I., DeMiero, Frank G., and Rose, Louise

Abstract

A holistic learning environment is one that nurtures all aspects of students' learning. The environment is safe, supportive, and provides opportunities to help students deal with nonacademic as well as academic factors that impact their learning. Creation of such an environment requires the establishment of a supportive learning community. For a variety of reasons, establishing such a learning community of first-year medical students can be challenging. This communication presents one approach to meeting this challenge in a medical school Human Physiology course. Steps were taken at the beginning of the course to create the community, and activities designed to reinforce these efforts were incorporated into the course as it progressed. Two pilot studies were conducted to test the hypothesis that providing students with a participatory music experience may help to promote a holistic learning environment by helping them restore a sense of balance to their emotional well-being as well as reinforce a sense of community in the classroom. Student response to these activities indicated that these efforts provided emotional support during stressful periods during the quarter, helped promote a feeling of safety within the environment, and reenergized the class during long class sessions. This project illustrates that each instructor, within the confines of his/her own classroom, can make a significant contribution to achieving a holistic learning environment for his/her students. (Contains 5 tables.)

Published
2009
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37. Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Author

Labeau, Sonia O, Afonso, Elsa, Benbenishty, Julie, Blackwood, Bronagh, Boulanger, Carole, Brett, Stephen J, Calvino-Gunther, Silvia, Chaboyer, Wendy, Coyer, Fiona, Deschepper, Mieke, François, Guy, Honore, Patrick M, Jankovic, Radmilo, Khanna, Ashish K, Llaurado-Serra, Mireia, Lin, Frances, Rose, Louise, Rubulotta, Francesca, Saager, Leif, Williams, Ged, Blot, Stijn I, Dritan, Muzha, Antoni Margarit Ribas, Fernando, Lipovesty, Cecilia, Loudet, Fiona, Coyer, Philipp, Eller, Nafseen, Mostafa, Patrick, M Honoré, Vanesa Mercado Telleria, Jasmina, Smajic, Paula Cristina Nogueira, Khalid Mahmood Khan Nafees, Romuald, Hentchoya, Louise, Rose, Javiera, Soledad, Frances, Lin, Yenny, Cardenas, Amylkar Garay Reyes, Alan, Sustic, Meropi, Mpouzika, Tamas, Vymazal, Hanne Irene Jensen, Hernan, Aguirre-Bermeo, Liivi, Maddison, Maija, Valta, Silvia, Calvino-Gunther, Frank, Bloos, Faustina Excel Adipa, Vasilios, Koulouras, Judy, Enamorado, Zsuzsann, Ágoston, Hrönn, Birgisdóttir, Amit, Gupta, Mohan, Gurjar, Bram, Kilapong, Seyed Mohammadreza Hashemian, Ignacio, Martin-Loeches, Julie, Benbenishty, Andrea, Cortegiani, Kelly, Fletcher, Yoshiro, Hayashi, Wangari, Waweru-Siika, Khalid, Abidi, Sang-Min, Lee, Burhan, Hadri, Mihails, Dolgusevs, Fayez François Abillama, Tomas, Jovaisa, Cyril, Thix, Muhammed, Elhadi, Basri Mat Nor, Shanti, Ratnam, Mohd Zulfakar Mazlan, Sundaresan, Maiyalagan, Luis, Sánchez-Hurtado, Adrian, Belii, Mendsaikhan, Naranpurev, Prabha, Gautam, Dylan De Lange, Rachael, Parke, Rose Ekama Ilesanmi, Mirjana, Shosholcheva, Antonija, Petosic, Ranveig, Lind, Madiha Hashmi Ffarcsi, Javier, Bogarin, Aaron Mark Hernandez, Malgorzata, Mikaszewska-Sokolewicz, Bruno, Sousa, Dana, Tomescu, Dorel, Sandesc, Theogene, Twagirumugabe, Vitaly, Gusarov, Maie, Ebaid, Radmilo, Jankovic, Gari, Slobodianiuk, Andrea, Martonova, Rihard, Knafelj, Mervyn, Mer, Emilio, Maseda, Bernardo, Panka, Joerg, C Schefold, Eva, Joelsson-Alm, Konlawij, Trongtrakul, Lorna, Merritt-Charles, Lamia Ouanes Besbes, Yalım, Dikmen, Lesia, Zgrzheblovska, Mark, Fielding, Francesca, Rubulotta, Ashish, K Khanna, Leif, Saager, Ingrid von der Osten, Alban, Greca, Alma, Cani, Nordian, Xhindi, Genci, Hyska, Antonio Margarit Ribas, Susana, Pinto, Paulo, Alves, Romina, Esposito, Emanuel, Valgolio, John Thomas Sanchez Minope, Antonio, Abdala, Maria, Ayala, Silvina, Bravo, Ana, Bantar, Patricia, Delgado, Gustavo, Badariotti, Fernando, Lipovestky, Ana, Diaz, Pablo, Saul, Mariano, Setten, Alejandra, Aucapina, Ysica, Acosta, Victor, Gonzalez, Luis, Camputaro, Fernando, Baccaro, Robert, Villa, Marcela, Mastantuono, Emiliano, Dean, Oscar Fernández Rostello, Patricia, Brizuela, Julio Ricardo Bartoli, Matias, Guereschi, Cristian, Quiroga, Sofia, Putruele, Paula, Villegas, Veronica, Curilen, Ruben, Fernandez, Mariangeles Gabriela Nocheretti, Rosana Gabriela Escalante, Cecilia Inés Loudet, Silvia, Fernandez, Ana Laura Gonzalez, Gustavo Andres Alvarez, Federico, Iglesias, Silvia, Chaparro, Graciela, Zakalik, 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Michael, Isanan, Marta, Tubacka, Przemyslaw, Jasiewicz, Miroslaw, Czuczwar, Michal, Borys, Aleksandra, Gutysz-Wojnicka, Lidia, Glinka, Ryszard, Gawda, Jan, Bilawicz, Paula, Cabrita, João, Vieira, Margarida Ferreira Figueiredo, Cristiana Mota Pinheiro, Nelson, Antunes, Laura, Pedro, Fatima, Ferreira, Isabel, Parente, Maria, Varela, Fatima, Fernandes, Claudia, Martins, Abel, Viveiros, Raquel, Cavaco, Clara Santa Rita, Sofia, Dias, Ana Margarida Feranandes, Pedro, Silva, Catarina, Nunes, João, Cabral, Filpe, Pires, Hilaryano, Ferreira, Jacinta, Santos, Vitor Manuel Vaz Pinto, Bruno Miguel Bispo, Amelia, Ferreira, Elena, Molinos, Estevão, Lafuente, Ricardo, Gregorio, Humberto, Costa, Ângela, Lima, Susana, Ferreira, Vanda, Seromenho, Eulália, Luis, Idália, Valerio, Helena, Cesar, Ana, Tavares, Ahmed Subhy Alsheikhly, Saeed, Mahmood, Catalin Traian Guran, Alida, Moise, Daniela Carmen Filipescu, Mihail, Luchian, Mihai, Popescu, Monica Adriana Scutariu, Cristina, Petrisor, Natalia, Hagau, 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Slobodianiuk, Daria, Rabarova, Danca, Lančaričová, Janko, Vlaovic, Matjaž, Groznik, Milica, Lukic, Janja, Perme, Maja, Sostaric, Nejc, Umek, Tomislav, Mirkovic, Simon, Dolenc, Misa, Fister, Nika, Zorko, Andrej, Markota, Nomhle Princess Yeni, Phumele, Jali, Shelley, Schmollgruber, Muhommed Ridwaan Syed, Nivisha, Parag, Robert, Wise, Maria, Galiana, José Alejandro Navarro, Ana María De Pablo, Patricia, Albert, Pilar, Martinez, Yolanda, Mendiara, Barbara, Garcia, Ana Alabart Llinas, Marilyn, Riveiro, Elisabet, Gallart, Alba, Riera, Miquel, Sanz, Swagotika, Salo, Miguel Angel Gimenez Lajara, Montserrat Venturas Nieto, Rosa, Garcia, José Manuel Garcia Pena, Maria Carmen Gorgolas, Maria Aranzazu Isasi, Rafael, Sierra, Federico, Gordo, Isabel, Conejo, Vicent, Salvà-Costa, Carolina, Garzón-Tovar, Sara, Lospitao, Rafael, Gonzalez, Pedro, Gutierrez, Mercè, Girona, Jordi, Adamuz, Pablo Garcia Olivares, José Peral Gutierrez de Ceballos, Celia, Tirado, Irene De Wit, Ana Belén Curto Polo, Maria Del Mar Diaz Salcedo, Javier, Ripolles-Melchor, Eugenio, Martinez-Hurtado, Jorge Duerto Alvarez, María Luisa Bravo Arcas, Juan Ignacio Torres Gonzalez, Ana Belén Sánchez de la Ventana, Pablo Lopez-Arcas Calleja, Raquel Garcia Alvarez, Purificacion Sanchez Zamora, Alvaro Ortega Guerrero, Rosario, Cosano, Jonathan, Perez-Vacas, Margarita, Campos-Perez, Emma Moreno Barreiro, Losune Cano Sanchez, Monica Garcia Diaz, Raquel, Jimenez, Lorena Del Rio Cabajo, Daniel Sancho Muriel, Helena Fernandez Alonso, Ana Wensell Fernández, Isabel Santín Piñan, Guillermo Muñiz Albaiceta, Maria Cristina Iglesias Fernandez, Francisco Javier Saenz Abos, Pablo, Monedero, Ramon Molina Chueca, Lydia Gallego Aguirre, Silvia Call Manosa, Carmen Partera Luque, Neus, Calpe, Monica Recio Losilla, Meritxell Tapia Fores, Olga, Farre, Oscar, Fernandez, M Del Rosario Villar Redondo, Donaldo, S Arteta Arteta, Maria Angeles Hurtado Sanchez, Cristina Paños Espinosa, Laura Martinez Reyes, Laura Claramunt Domenech, Carmen Velasco Guillén, Josep Trenado Alvarez, Mercedes Del Cotillo, Jesus Emilio Barrueco-Francioni, Belen Burgos Conde, Maria Pilar Sogues Blanco, Maria Luisa Blasco, Ana Isabel Clement, Clara, Hurtado, Luz Coronado Sanz, David, Perez-Torres, Estefanía, Prol-Silva, Jorge, Pereira, Iván Areán González, Anastasio Espejo Cano, Cesar Rodriguez Nuñez, Inmaculada Lorenzo Fernadez, Alejandra Azahara Marguello Fernandez, Rosa Del Bosque Diez, Badiola, Hilario, Begoña, Zalba-Etayo, Ana, Pascual-Bielsa, Preveen, Banwarie, Dick, Nahar, Alisha van Axel, Naraindath, N Boedjawan, Erika Backlund Jansson, Ann-Sofie, Malvemyr, Lotta, Johansson, Ulla, Sandberg, Catarina, Tingsvik, Gunilla, Mattsson, Gun, Löf, Martin, Spångfors, Mona, Ringdal, Sebastian, Geijer, Lotti, Orvelius, Mia, Hylen, Caroline, Lagerhäll, Eva, Åkerman, Viveca Hamback Hellkvist, Ulrica, Mickelsson, Ewa, Wahlbom, Ing-Marie, Larsson, Ewa, Wallin, Filippo, Boroli, Solenne, Ory, Margaret Lynn Jong, Alexander, Dullenkopf, Martin, Lang, Yvan, Fleury, Marianne, Maus, Nawfel, Ben-Hamouda, Anne, Fishman, Mei Yu Hsu, Shu Chuan Chang, Konlawij, Trongtratul, Chaiwut, Sawawiboon, Sunthiti, Morakul, Bodin, Khwannimit, Keevan, Singh, Dale, Ventour, Dianne, Figaro-Barclay, Sasha, Sankar-Maharaj, Mhamed Sami Mebazaa, Salma, Kamoun, Souheil, Elatrous, Lamia, Besbes, Fekri, Abroug, Walid, Naija, Youssef Zied Elhechmi, Walid, Sellami, Zied, Hajjej, Takoua, Merhabene, Imen, Talik, Ozlem Ozkan Kuscu, Ozcengiz, Dilek, Avşar, Zerman, Hayriye Cankar Dal, Sema, Turan, Semih, Aydemir, Hakan, Yilmaz, Duygu Kayar Calili, Seval, İzdes, Melike, Cengiz, Ayça, Gümüş, Banu, Taşdemir, Ali, Kağnıcı, Mustafa, Ay, Serap Avcı Ay, Gulbahar, Caliskan, Turkay, Akbas, Abidin Oner Balbay, Serdar, Efe, Volkan, Inal, Gülseren, Elay, Pınar, Karabacak, Boğaç, Özserezli, Evren, Şentürk, Oktay, Demirkiran, Suha, Bozbay, Elif, Erdogan, Mustafa, Akker, Nebia, Peker, Asu, Ozgultekin, Sibel Ocak Serin, Can, Turan, Gulsah, Karaoren, Senay, Goksu, Sait, Karakurt, Huseyin, Arikan, Fethi, Gül, İsmail, Cinel, Iskender, Kara, Hasan Nabi Undar, Yesim Serife Bayraktar, Jale Bengi Çelik, Murat Emre Tokur, Demet Tok Aydin, İsmail, Yildiz, Beysim, Özcan, Başar, Erdivanli, Ahmet, Eroglu, Devrim, Akdağ, Nurdan, Ünlü, Adonis, Dungca, Ashwaq, Ali, Bindu, Thankamma, Paul Eric Reyes, Sini, John, Ajitha, Rajendran, Fatima Kasem El Ahmad, Kathleen Ann Smiley, Susanna, Hojden, Mia Thorning Miller, Vishnu Das Sasidharan Nair, Maria Gracia San Antonio, Khaled Al Qawasmeh, Sabah Abu Shawish, Hilary, Twiggs, Ines, Rosado, Volodymyr, Babych, Faye, Morren, Charlotte, Young, Nicola, Vaughan-Jones, Stephanie, Harris, Karen, Burns, Carmel, Georgiev, Rosina, Shayamano, Ian, Kerslake, Peter, Creber, Ana, Vochin, Catherine, O'Brien, Paul, Caddell, Samantha, Hagan, Mandy, Hughes, Tomasz, Torlinski, James, Sherwin, Santhana, Kannan, Amber, Markham, Richard, Lebon, Jason, Cupitt, Julius, Cranshaw, Nigel, White, Victoria, Marriott, Wendy, Milner, Casiano Barrera Groba, Joao, Azoia, Petra, 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A.S., Goller, S., Afonso, E., Larina, E., Labeau, Sonia O. 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[0000-0003-2145-0345], Apollo - University of Cambridge Repository, Critical Care, Labeau S.O., Afonso E., Benbenishty J., Blackwood B., Boulanger C., Brett S.J., Calvino-Gunther S., Chaboyer W., Coyer F., Deschepper M., Francois G., Honore P.M., Jankovic R., Khanna A.K., Llaurado-Serra M., Lin F., Rose L., Rubulotta F., Saager L., Williams G., Blot S.I., Muzha D., Ribas A.M., Lipovesty F., Loudet C., Eller P., Mostafa N., Telleria V.M., Smajic J., Nogueira P.C., Nafees K.M.K., Hentchoya R., Soledad J., Cardenas Y., Reyes A.G., Sustic A., Mpouzika M., Vymazal T., Jensen H.I., Aguirre-Bermeo H., Maddison L., Valta M., Bloos F., Adipa F.E., Koulouras V., Enamorado J., Agoston Z., Birgisdottir H., Gupta A., Gurjar M., Kilapong B., Hashemian S.M., Martin-Loeches I., Cortegiani A., Fletcher K., Hayashi Y., Waweru-Siika W., Abidi K., Lee S.-M., Hadri B., Dolgusevs M., Abillama F.F., Jovaisa T., Thix C., Elhadi M., Nor B.M., Ratnam S., Mazlan M.Z., Maiyalagan S., Sanchez-Hurtado L., Belii A., 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Bielskute E., Horrigan N., Jacob R., Habgood K., Zaki A., Collins A., Lord J., Ramiro C., Kubisz-Pudelko A., Kotze M., Williams H., Iovenko I., Tsarev A., Briva A., Mendez G., Napolitano L., Teig M., Rodriguez G.E., Ben-Jacob T., Potestio C., Eng T., Mahanes D., Khanna A., Duggal A., Nananmori M., Lois M., Karamchandani K., Bealer C., Barefield C., Terry D., Fivecoat P., Idowu O., Cata J., Clesi T., Peterson J., Hatton K., Dhaliwal J., Mueller D., Tao J., Eltorai A.S., Pastores S.M., Remor N., Salazar J., Barkas D., Joffe A., Barnes C., Sona C., Schallom M., Short J., Lorenzo J., Von Der Osten I., Borkowska M., Demarre L., Pleitinckx V., Xing C., Debue A.-S., Goller S., Larina E., Labeau, S. O., Blackwood, B., Brett, S. J., Deschepper, M., Francois, G., Honore, P. M., Khanna, A. K., Williams, G., Blot, S. I., Ribas, A. M., Telleria, V. M., Nogueira, P. C., Nafees, K. M. K., Reyes, A. G., Jensen, H. I., Adipa, F. E., Agoston, Z., Hashemian, S. M., Lee, S. -M., Abillama, F. F., Nor, B. M., Mazlan, M. Z., Sanchez-Hurtado, L., De lange, D., Ilesanmi, R. E., Ffarcsi, M. H., Hernandez, A. M., Schefold, J. C., Besbes, L. O., Minope, J. T. S., Rostello, O. F., Bartoli, J. R., Nocheretti, M. G., Escalante, R. G., Loudet, C. I., Gonzalez, A. L., Alvarez, G. A., Campos, P. A., Fonseca, I. P., Alvarez, G. M., Bascary, C. A., del Valle Gimenez, G., Bertoletti, F. P., Bonsignore, P. J. M., Fernandez, M. A., Leslie, G. D., Mclucas, A., Jacquet, L. -M., de Almeida, A. O., Jorge, S. A., Schmidt, R. C., Garcia, P. C., Ronchini, A. L. V., Manap, N. B. A., Laizner, A. M., Mcquirter, M., Kampayana, B. S., Sepulveda, M. I., Zamorano, M. J. F., Zhao, R. H., Hu, L. P., Jiao, Q. F., Wang, H. Y., Xia, C. J., Insu, L., Zhu, J. Y., Zhu, J. F., Huang, R. F., Wang, L. L., Song, J. H., Liu, X. M., Li, Z. S., Li, L. C., Zeng, J. M., Hu, X. C., Wang, R. X., Tak, P. S., Ho, S. W., Jiang, Q. X., Huang, L. P., Liu, X. L., Jiang, J. H., Gong, Y. Y., Lei, D. H., Bi, A. P., Zhao, H. M., Cao, Z. Q., Wu, S. F., Tian, X. F., Feng, Z. X., Liu, X. Z., Jiang, Z. X., Wang, G. X., Hu, R. L., Li, X. Q., Yu, Z. J., Yang, Y. X., Gama, L. M. S., Hernandez, J. S., Ochoa, M. -E., Reyes, A. J. G., Filipovic-Grcic, I., Vukovic, A., Pecenkovic, S., Suput, A., Radivojevic, R. C., Culjak, H., Adam, V. N., Pedersen, K. R., Kjaergard, I. E., Kodal, A. M., Hansen, T. C. B., Pedersen, A. S. B., Thomsen, T. D., Frandsen, T. M., Bliksted, I. A., Tamayo, L. M., Tutillo, D. R. M., Hurtado, C. V., Garcia, M. F., Kutimets, M., Lofqvist, C., Sakki, J. -K., Valta, M. A., Plantefeve, G., Deserts, M. D., Gunther, S. C., Timsit, J. -F., Farkas, J. -C., Bosl, K., Schuppel, S., Stubner, A., Osei, I. P., Kusi-Appiah, A. -C., Yakubu, Y. H., Patsiou, E. -C., Stalika, K. M. M., Enamorado, J. E., Jonasdottir, R. J., Lestari, M. I., Finn, D. O. C. R., Mcpherson, S., Ghioldi, D. M., Bruno, A. V., Maggiore, S. M., Volta, C. A., Taibi, M. R., Tranello, F. P., Giusti, G. D., Martin, M. A., Correia, M. C., Kim, J. H., Kim, K. C., Bae, J. -M., Park, S. Y., Park, T. S., Lee, H. B., Kim, S. C., Chee, H. K., Huh, J. W., Sim, Y. S., Ahn, J. -J., Kang, B. J., Lee, W. -Y., Lee, S. J., Feghaly, M. E., Belkhair, W. A., Tababa, O. W. E., Alkhumsi, S. I. R., Alshrif, A. I., Aboufray, A. A., Triki, A. R., Zahra, H. B., Al-Alawi, M. M. S., Ghula, M. A. A., Bahrin, L. K. K., Deva, S. R., Rahim, A. H. A., Hassan, W. N. W., Ismail, W. N. W., Ali, M. N., Khoo, T. M., Samat, N. M., Tong, J. M. G., Adib, N. A. N., Nor, M. B. M., Sulaiman, S. R., Foong, K. W., Hua, N. P., Zermeno, J. M., Nava, C. L. L., Nandyelly, S. J. R., Sanchez-Hurtado, L. A., Nava, L. P. A., Herrera, J. G., de Anda, G. F. V., Namendys-Silva, S. A., Romero-Gonzalez, J. P., Sosa, M. A., de Molina Serrano, J. I. R., Iburrigarro, S. R., Padilla, N. R. C., Pineda, A. A. V., Villafuerte, M. V. E., Herrera, M. O. G., Subedi, N. B., Pathak, S. D., Vermeijden, J. W., Gerritsen, R. T., Fijen, J. -W., Adejumo, P. O., Sankey, B. J., Olsen, B. F., Jensen, K. D., Johansen, B. F., Finnstrom, I. J., Skorstad, E. M., Lunde, G. A., Akselsen, G. R., Monstad, K. R., Hogvall, L., Malmin, S. K., Andersen, M. H., Hargott, R. F., de Jesus Ortiz, A., Cabral, D. M. B., Rivas, J. C., Moreira, M. L., Ellazar, C. G., Cerezo, F. D., Palo, J. E., Aperocho, C. A. J., Figueiredo, M. F., Pinheiro, C. M., Rita, C. S., Feranandes, A. M., Pinto, V. M. V., Bispo, B. M., Lima, A., Alsheikhly, A. S., Guran, C. T., Filipescu, D. C., Scutariu, M. A., Ebaid, M. S., Velickovic, D., Rajkovic, M., Stanojevic, M., Turcan, A., Lancaricova, D., Yeni, N. P., Syed, M. R., Navarro, J. A., De Pablo, A. M., Llinas, A. A., Lajara, M. A. G., Nieto, M. V., Pena, J. M. G., Gorgolas, M. C., Isasi, M. A., Salva-Costa, V., Garzon-Tovar, C., Olivares, P. G., de Ceballos, J. P. G., Polo, A. B. C., del Mar Diaz Salcedo, M., Alvarez, J. D., Arcas, M. L. B., Gonzalez, J. I. T., de la Ventana, A. B. S., Calleja, P. L. -A., Alvarez, R. G., Zamora, P. S., Guerrero, A. O., Barreiro, E. M., Sanchez, L. C., Diaz, M. G., Muriel, D. S., Alonso, H. F., Fernandez, A. W., Pinan, I. S., Albaiceta, G. M., Fernandez, M. C. I., Abos, F. J. S., Chueca, R. M., Aguirre, L. G., Manosa, S. C., Luque, C. P., Losilla, M. R., Fores, M. T., del Rosario Villar Redondo, M., Arteta Arteta, D. S., Sanchez, M. A. H., Espinosa, C. P., Reyes, L. M., Domenech, L. C., Guillen, C. V., Alvarez, J. T., del Cotillo, M., Barrueco-Francioni, J. E., Conde, B. B., Blanco, M. P. S., Blasco, M. L., Clement, A. I., Sanz, L. C., Gonzalez, I. A., Cano, A. E., Nunez, C. R., Fernadez, I. L., Fernandez, A. A. M., Boedjawan, N. N., Jansson, E. B., Malvemyr, A. -S., Lof, G., Spangfors, M., Lagerhall, C., Akerman, E., Hellkvist, V. H., Larsson, I. -M., Jong, M. L., Hsu, M. Y., Chang, S. C., Mebazaa, M. S., Elhechmi, Y. Z., Kuscu, O. O., Dal, H. C., Calili, D. K., Izdes, S., Gumus, A., Tasdemir, B., Kagnici, A., Ay, S. A., Balbay, A. O., Ozserezli, B., Senturk, E., Serin, S. O., Gul, F., Cinel, I., Undar, H. N., Bayraktar, Y. S., Celik, J. B., Tokur, M. E., Aydin, D. T., Yildiz, I., Ozcan, B., Akdag, D., Unlu, N., Reyes, P. E., Ahmad, F. K. E., Smiley, K. A., Miller, M. T., Antonio, M. G. S., Qawasmeh, K. A., Shawish, S. A., Groba, C. B., Raj, A. S., Ei, P. P., Legorburo, M. S., Welters, I. D., Mcmullen, J., Mcdonnell, A., Rose, B. O., Delgado, C. C., Mccann, N., Turner, S. J., Rodriguez, G. E., Eltorai, A. S., Pastores, S. M., Demarre, L., and Debue, A. -S.

Subjects
Male, Original, medicine.medical_treatment, artificial, Critical Care and Intensive Care Medicine, Medical and Health Sciences, Pressure ulcer, law.invention, Decubitus epidemiology, ICU, Morbidity, Mortality, Outcome, Pressure injury, Risk factors, Adult, Aged, Hospital Mortality, Humans, Patient Discharge, Prevalence, Risk Factors, Intensive Care Units, Respiration, Artificial, 0302 clinical medicine, decubitus epidemiology, pressure injury, pressure ulcer, outcome, risk factors, morbidity, mortality, law, Medicine and Health Sciences, adults, Medicine, Simplified Acute Physiology Score, icu, ziekenhuissterfte, Immunodeficiency, intensive care, European Society of Intensive Care Medicine (ESICM) Trials Group Collaborators, mannen, volwassenen, COST, Intensive care unit, STATE, ULCERS, Underweight, medicine.symptom, Life Sciences & Biomedicine, Human, medicine.medical_specialty, risicofactoren, Decubitus epidemiology, ICU, Pressure injury, Pressure ulcer, Outcome, Risk factors, Morbidity, Mortality, pressure injuries, Intensive Care Unit, prevalentie, NO, 1117 Public Health and Health Services, DecubICUs Study Team, 03 medical and health sciences, Critical Care Medicine, Anesthesiology, General & Internal Medicine, Health Sciences, ouderen, Mechanical ventilation, Science & Technology, business.industry, decubitus, Risk Factor, 030208 emergency & critical care medicine, 1103 Clinical Sciences, Odds ratio, medicine.disease, Emergency & Critical Care Medicine, Confidence interval, 030228 respiratory system, Emergency medicine, kunstmatige ademhaling, RISK-FACTORS, business, respiration
Abstract

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347, Funder: Flemish Society for Critical Care Nurses, Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score < 19, ICU stay > 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat.

Published
2021
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38. Variation in communication and family visiting policies in intensive care within and between countries during the Covid-19 pandemic : The COVISIT international survey

Author

Tabah, Alexis, Elhadi, Muhammed, Ballard, Emma, Cortegiani, Andrea, Cecconi, Maurizio, Unoki, Takeshi, Galarza, Laurą, Rosa, Regis Goulart, Barbier, Francois, Azoulay, Elie, Laupland, Kevin B., Ssi Yan Kai, Nathalie, Ostermann, Marlies, Francois, Guy, De Waele, Jan J., Fiest, Kirsten, Spronk, Peter, Benbenishty, Julie, Pellegrini, Mariangela, Rose, Louise, other, and, Tabah, Alexis, Elhadi, Muhammed, Ballard, Emma, Cortegiani, Andrea, Cecconi, Maurizio, Unoki, Takeshi, Galarza, Laurą, Rosa, Regis Goulart, Barbier, Francois, Azoulay, Elie, Laupland, Kevin B., Ssi Yan Kai, Nathalie, Ostermann, Marlies, Francois, Guy, De Waele, Jan J., Fiest, Kirsten, Spronk, Peter, Benbenishty, Julie, Pellegrini, Mariangela, Rose, Louise, and other, and

Abstract

Background: During the COVID-19 pandemic, intensive care units (ICU) introduced restrictions to in-person family visiting to safeguard patients, healthcare personnel, and visitors. Methods: We conducted a web-based survey (March–July 2021) investigating ICU visiting practices before the pandemic, at peak COVID-19 ICU admissions, and at the time of survey response. We sought data on visiting policies and communication modes including use of virtual visiting (videoconferencing). Results: We obtained 667 valid responses representing ICUs in all continents. Before the pandemic, 20% (106/525) had unrestricted visiting hours; 6% (30/525) did not allow in-person visiting. At peak, 84% (558/667) did not allow in-person visiting for patients with COVID-19; 66% for patients without COVID-19. This proportion had decreased to 55% (369/667) at time of survey reporting. A government mandate to restrict hospital visiting was reported by 53% (354/646). Most ICUs (55%, 353/615) used regular telephone updates; 50% (306/667) used telephone for formal meetings and discussions regarding prognosis or end-of-life. Virtual visiting was available in 63% (418/667) at time of survey. Conclusions: Highly restrictive visiting policies were introduced at the initial pandemic peaks, were subsequently liberalized, but without returning to pre-pandemic practices. Telephone became the primary communication mode in most ICUs, supplemented with virtual visits.

Published
2022

39. Epidemiology and outcome of pressure injuries in critically ill patients with chronic obstructive pulmonary disease: A propensity score adjusted analysis

Author

Martin-Loeches, Ignacio, Rose, Louise, Afonso, Elsa, Benbenishty, Julie, Blackwood, Bronagh, Boulanger, Carole, Calvino-Gunther, Silvia, Chaboyer, Wendy, Coyer, Fiona, Llaurado-Serra, Mireia, Lin, Frances, Rubulotta, Francesca, Williams, Ged, Deschepper, Mieke, Francois, Guy, Labeau, Sonia O., Blot, Stijn I., Martin-Loeches, Ignacio, Rose, Louise, Afonso, Elsa, Benbenishty, Julie, Blackwood, Bronagh, Boulanger, Carole, Calvino-Gunther, Silvia, Chaboyer, Wendy, Coyer, Fiona, Llaurado-Serra, Mireia, Lin, Frances, Rubulotta, Francesca, Williams, Ged, Deschepper, Mieke, Francois, Guy, Labeau, Sonia O., and Blot, Stijn I.

Abstract

Background: Pressure injuries are a frequent complication in intensive care unit (ICU) patients, especially in those with comorbid conditions such as chronic obstructive pulmonary disease (COPD). Yet no epidemiological data on pressure injuries in critically ill COPD patients are available. Objective: To assess the prevalence of ICU-acquired pressure injuries in critically ill COPD patients and to investigate associations between COPD status, presence of ICU-acquired pressure injury, and mortality. Study design and methods: This is a secondary analysis of prospectively collected data from DecubICUs, a multinational one-day point-prevalence study of pressure injuries in adult ICU patients. We generated a propensity score summarizing risk for COPD and ICU-acquired pressure injury. The propensity score was used as matching criterion (1:1-ratio) to assess the proportion of ICU-acquired pressure injury attributable to COPD. The propensity score was then used in regression modeling assessing the association of COPD with risk of ICU-acquired pressure injury, and examining variables associated with mortality (Cox proportional-hazard regression). Results: Of the 13,254 patients recruited to DecubICUs, 1663 (12.5%) had documented COPD. ICU-acquired pressure injury prevalence was higher in COPD patients: 22.1% (95% confidence interval [CI] 20.2 to 24.2) vs. 15.3% (95% CI 14.7 to 16.0). COPD was independently associated with developing ICU-acquired pressure injury (odds ratio 1.40, 95% CI 1.23 to 1.61); the proportion attributable to COPD was 6.4% (95% CI 5.2 to 7.6). Compared with non-COPD patients without pressure injury, mortality was no different among patients without COPD but with pressure injury (hazard ratio [HR] 1.07, 95% CI 0.97 to 1.17) or COPD patients without pressure injury (HR 1.13, 95% CI 1.00 to 1.27). Mortality was higher among COPD patients with pressure injury (HR 1.35, 95% CI 1.15 to 1.58). Conclusion and implications: Critically ill COPD patients have a

Published
2022

40. Dysphagia in Intensive Care Evaluation (DICE):An International Cross-Sectional Survey

Author

Spronk, P. E., Spronk, Laura E.J., Egerod, Ingrid, McGaughey, J., McRae, Jackie, Rose, Louise, Brodsky, Martin B., Brodsky, M. B., Rose, L., Lut, J., Clavé, P., Nanchal, R., Inamoto, Y., van der Hoeven, J. I., Freeman-Sanderson, A., Hiesmayr, M., Veraar, C., Hickmann, C. E., Gosselink, R., Gershman, S., Skoretz, S., Martino, R., Mpouzika, M., Cerny, M., Chrobok, V., Zeinerova, L., Kaldan, G., McRae, J., Bäcklund, M., Ramos, T., Nydahl, P., Kalafati, M., Andrews, T., Sperlinga, R., Katsukawa, H., Kasai, F., Spronk, L. E.J., Miles, A., Duncan, S., Fossum, M., Ágústdóttir, V., Senneset, T., Larsson, M., Hammond, G., Owczuk, R., Mestre, S., Merriweather, J., Spronk, P. E., Spronk, Laura E.J., Egerod, Ingrid, McGaughey, J., McRae, Jackie, Rose, Louise, Brodsky, Martin B., Brodsky, M. B., Rose, L., Lut, J., Clavé, P., Nanchal, R., Inamoto, Y., van der Hoeven, J. I., Freeman-Sanderson, A., Hiesmayr, M., Veraar, C., Hickmann, C. E., Gosselink, R., Gershman, S., Skoretz, S., Martino, R., Mpouzika, M., Cerny, M., Chrobok, V., Zeinerova, L., Kaldan, G., McRae, J., Bäcklund, M., Ramos, T., Nydahl, P., Kalafati, M., Andrews, T., Sperlinga, R., Katsukawa, H., Kasai, F., Spronk, L. E.J., Miles, A., Duncan, S., Fossum, M., Ágústdóttir, V., Senneset, T., Larsson, M., Hammond, G., Owczuk, R., Mestre, S., and Merriweather, J.

Abstract

Dysphagia occurs commonly in the intensive care unit (ICU). Despite the clinical relevance, there is little worldwide research on prevention, assessment, evaluation, and/or treatment of dysphagia for ICU patients. We aimed to gain insight into this international knowledge gap. We conducted a multi-center, international online cross-sectional survey of adult ICUs. Local survey distribution champions were recruited through professional and personal networks. The survey was administered from November 2017 to June 2019 with three emails and a final telephone reminder. Responses were received from 746 ICUs (26 countries). In patients intubated > 48 h, 17% expected a > 50% chance that dysphagia would develop. This proportion increased to 43% in patients intubated > 7 days, and to 52% in tracheotomized patients. Speech-language pathologist (SLP) consultation was available in 66% of ICUs, only 4% reported a dedicated SLP. Although 66% considered a routine post-extubation dysphagia protocol important, most (67%) did not have a protocol. Few ICUs routinely assessed for dysphagia after 48 h of intubation (30%) or tracheostomy (41%). A large proportion (46%) used water swallow screening tests to determine aspiration, few (8%) used instrumental assessments (i.e., flexible endoscopic evaluation of swallowing). Swallowing exercises were used for dysphagia management by 30% of ICUs. There seems to be limited awareness among ICU practitioners that patients are at risk of dysphagia, particularly as ventilation persists, protocols, routine assessment, and instrumental assessments are generally not used. We recommend the development of a research agenda to increase the quality of evidence and ameliorate the implementation of evidence-based dysphagia protocols by dedicated SLPs.

Published
2022

41. An Official American Thoracic Society Systematic Review: The Effect of Nighttime Intensivist Staffing on Mortality and Length of Stay among Intensive Care Unit Patients

Author

Kerlin, Meeta Prasad, Adhikari, Neill K. J., Rose, Louise, Wilcox, Elizabeth M., Bellamy, Cassandra J., Costa, Deena Kelly, Gershengorn, Hayley B., Halpern, Scott D., Kahn, Jeremy M., Lane-Fall, Meghan B., Wallace, David J., Weiss, Curtis H., Wunsch, Hannah, and Cooke, Colin R.

Published
2017
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46. Prevalence, management and outcomes of unrecognized delirium in a National Sample of 1,493 older emergency department patients: how many were sent home and what happened to them?

Author

Lee, Jacques S, primary, Tong, Tiffany, additional, Chignell, Mark, additional, Tierney, Mary C, additional, Goldstein, Judah, additional, Eagles, Debra, additional, Perry, Jeffrey J, additional, McRae, Andrew, additional, Lang, Eddy, additional, Hefferon, Darren, additional, Rose, Louise, additional, Kiss, Alex, additional, Borgundvaag, Bjug, additional, McLeod, Shelley, additional, Melady, Don, additional, Boucher, Valérie, additional, Sirois, Marie-Josée, additional, and Émond, Marcel, additional

Published
2022
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47. Development of a core outcome set for multimorbidity trials in low/middle-income countries (COSMOS): study protocol

Author

Boehnke, Jan R., primary, Rana, Rusham Zahra, additional, Kirkham, Jamie J., additional, Rose, Louise, additional, Agarwal, Gina, additional, Barbui, Corrado, additional, Chase-Vilchez, Alyssa, additional, Churchill, Rachel, additional, Flores-Flores, Oscar, additional, Hurst, John R., additional, Levitt, Naomi, additional, van Olmen, Josefien, additional, Purgato, Marianna, additional, Siddiqi, Kamran, additional, Uphoff, Eleonora, additional, Vedanthan, Rajesh, additional, Wright, Judy, additional, Wright, Kath, additional, Zavala, Gerardo A., additional, and Siddiqi, Najma, additional

Published
2022
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50. Exploring factors affecting the timely transition of ventilator assisted individuals in Ontario from acute to long-term care: Perspectives of healthcare professionals.

Author

Selzler, Anne-Marie, Lee, Leanna, Brooks, Dina, Kohli, Raj, Rose, Louise, and Goldstein, Roger

Abstract

Rationale Ventilator Assisted Individuals (VAIs) frequently remain in intensive care units (ICUs) for a prolonged period once clinically stable due to a lack of transition options. These VAIs occupy ICU beds and resources that patients with more acute needs could better utilize. Moreover, VAIs experience improved outcomes and quality of life in long-term and community-based environments. Objective To better understand the perspectives of healthcare providers (HCPs) working in an Ontario ICU regarding barriers and facilitators to referral and transition of VAIs from the ICU to a long-term setting. Methods We conducted semi-structured interviews with ten healthcare providers involved in VAI transitions. Main Results Perceived barriers included long wait times for long-term care settings, insufficient bed availability at discharge locations, medical complexity of patients, long waitlists, and a lack of transparency of waitlists. Facilitators included strong partnerships and trusting relationships between referring and discharge locations, a centralized referral system, and utilization of community partnerships across care sectors. Conclusions Insufficient resourcing of long-term care is a key barrier to transitioning VAIs from ICU to long-term settings; strong partnerships across care sectors are a facilitator. System-level approaches, such as a single-streamlined referral system, are needed to address key barriers to timely transition. [ABSTRACT FROM AUTHOR]

Published
2023
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