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1. Expanding the 3 Wishes Project for compassionate end-of-life care: a qualitative evaluation of local adaptations

Author

Meredith Vanstone, Thanh H. Neville, Marilyn E. Swinton, Marina Sadik, France J. Clarke, Allana LeBlanc, Benjamin Tam, Alyson Takaoka, Neala Hoad, Jennifer Hancock, Sarah McMullen, Brenda Reeve, William Dechert, Orla M. Smith, Gyan Sandhu, Julie Lockington, and Deborah J. Cook

Subjects
Intensive care unit, End of life care, Empathy, Program evaluation, Qualitative research, Special situations and conditions, RC952-1245
Abstract

Abstract Background The 3 Wishes Project (3WP) is an end-of-life program that honors the dignity of dying patients by fostering meaningful connections among patients, families, and clinicians. Since 2013, it has become embedded in the culture of end-of-life care in over 20 ICUs across North America. The purpose of the current study is to describe the variation in implementation of 3WP across sites, in order to ascertain which factors facilitated multicenter implementation, which factors remain consistent across sites, and which may be adapted to suit local needs. Methods Using the methodology of qualitative description, we collected interview and focus group data from 85 clinicians who participated in the successful initiation and sustainment of 3WP in 9 ICUs. We describe the transition between different models of 3WP implementation, from core clinical program to the incorporation of various research activities. We describe various sources of financial and in-kind resources accessed to support the program. Results Beyond sharing a common goal of improving end-of-life care, sites varied considerably in organizational context, staff complement, and resources. Despite these differences, the program was successfully implemented at each site and eventually evolved from a clinical or research intervention to a general approach to end-of-life care. Key to this success was flexibility and the empowerment of frontline staff to tailor the program to address identified needs with available resources. This adaptability was fueled by cross-pollination of ideas within and outside of each site, resulting in the establishment of a network of like-minded individuals with a shared purpose. Conclusions The successful initiation and sustainment of 3WP relied on local adaptations to suit organizational needs and resources. The semi-structured nature of the program facilitated these adaptations, encouraged creative and important ways of relating within local clinical cultures, and reinforced the main tenet of the program: meaningful human connection at the end of life. Local adaptations also encouraged a team approach to care, supplementing the typical patient-clinician dyad by explicitly empowering the healthcare team to collectively recognize and respond to the needs of dying patients, families, and each other. Trial registration NCT04147169 , retrospectively registered with clinicaltrials.gov on October 31, 2019.

Published
2020
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2. 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

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

Subjects
Chlorhexidine, Critical care, Ventilator-associated pneumonia, Oral care, Stepped-wedge cluster randomized controlled trial, Process evaluation, Medicine (General), R5-920
Abstract

Abstract Background Routine application of chlorhexidine oral rinse is recommended to reduce risk of ventilator-associated pneumonia (VAP) in mechanically ventilated patients. Recent reappraisal of the evidence from two meta-analyses suggests chlorhexidine may cause excess mortality in non-cardiac surgery patients and does not reduce VAP. Mechanisms for possible excess mortality are unclear. The CHORAL study will evaluate the impact of de-adopting chlorhexidine and implementing an oral care bundle (excluding chlorhexidine) on mortality, infection-related ventilator-associated complications (IVACs), and oral health status. Methods The CHORAL study is a stepped wedge, cluster randomized controlled trial in six academic intensive care units (ICUs) in Toronto, Canada. Clusters (ICU) will be randomly allocated to six sequential steps over a 14-month period to de-adopt oral chlorhexidine and implement a standardized oral care bundle (oral assessment, tooth brushing, moisturization, and secretion removal). On study commencement, all clusters begin with a control period in which the standard of care is oral chlorhexidine. Clusters then begin crossover from control to intervention every 2 months according to the randomization schedule. Participants include all mechanically ventilated adults eligible to receive the standardized oral care bundle. The primary outcome is ICU mortality; secondary outcomes are IVACs and oral health status. We will determine demographics, antibiotic usage, mortality, and IVAC rates from a validated local ICU clinical registry. With six clusters and 50 ventilated patients on average each month per cluster, we estimate that 4200 patients provide 80% power after accounting for intracluster correlation to detect an absolute reduction in mortality of 5.5%. We will analyze our primary outcome of mortality using a generalized linear mixed model adjusting for time to account for secular trends. We will conduct a process evaluation to determine intervention fidelity and to inform interpretation of the trial results. Discussion The CHORAL study will inform understanding of the effectiveness of de-adoption of oral chlorhexidine and implementation of a standardized oral care bundle for decreasing ICU mortality and IVAC rates while improving oral health status. Our process evaluation will inform clinicians and decision makers about intervention delivery to support future de-adoption if justified by trial results. Trial registration ClinicalTrials.gov, NCT03382730. Registered on December 26, 2017.

Published
2019
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3. The Effect of an Accelerated Renal Replacement Therapy Initiation Is Not Modified by Baseline Risk

Author

Federico Angriman, Bruno L. Ferreyro, Natalia Angeloni, Bruno R. da Costa, Ron Wald, Sean M. Bagshaw, Neill K.J. Adhikari, Rinaldo Bellomo, Didier Dreyfuss, Bin Du, Martin P. Gallagher, Stéphane Gaudry, François Lamontagne, Michael Joannidis, Kathleen D. Liu, Daniel F. McAuley, Shay P. McGuinness, Alistair D. Nichol, Marlies Ostermann, Paul M. Palevsky, Haibo Qiu, Ville Pettilä, Antoine G. Schneider, Orla M. Smith, Suvi T. Vaara, Matthew Weir, Glenn M. Eastwood, Leah Peck, Helen Young, Peter Kruger, Gordon Laurie, Emma Saylor, Jason Meyer, Ellen Venz, Krista Wetzig, Craig French, Forbes McGain, John Mulder, Gerard Fennessy, Sathyajith Koottayi, Samantha Bates, Miriam Towns, Rebecca Morgan, Anna Tippett, Andrew Udy, Chris Mason, Elisa Licari, Dashiell Gantner, Jason McClure, Alistair Nichol, Phoebe McCracken, Jasmin Board, Emma Martin, Shirley Vallance, Meredith Young, Chelsey Vladic, Steve McGloughlin, David Gattas, Heidi Buhr, Jennifer Coles, Debra Hutch, James Wun, Louise Cole, Christina Whitehead, Julie Lowrey, Kristy Masters, Rebecca Gresham, Victoria Campbell, David Gutierrez, Jane Brailsford, Loretta Forbes, Lauren Murray, Teena Maguire, Martina NiChonghaile, Neil Orford, Allison Bone, Tania Elderkin, Tania Salerno, Tim Chimunda, Jason Fletcher, Emma Broadfield, Sanjay Porwal, Cameron Knott, Catherine Boschert, Julie Smith, Angus Richardson, Dianne Hill, Graeme Duke, Peter Oziemski, Santiago Cegarra, Peter Chan, Deborah Welsh, Stephanie Hunter, Owen Roodenburg, John Dyett, Nicos Kokotsis, Max Moser, Yang Yang, Laven Padayachee, Joseph Vetro, Himangsu Gangopadhyay, Melissa Kaufman, Angaj Ghosh, Simone Said, Alpesh Patel, Shailesh Bihari, Elisha Matheson, Xia Jin, Tapaswi Shrestha, Kate Schwartz, Rosalba Cross, Winston Cheung, Helen Wong, Mark Kol, Asim Shah, Amanda Y. Wang, Zoltan Endre, Celia Bradford, Pierre Janin, Simon Finfer, Naomi Diel, Jonathan Gatward, Naomi Hammond, Anthony Delaney, Frances Bass, Elizabeth Yarad, Hergen Buscher, Claire Reynolds, Nerilee Baker, Romuald Bellmann, Andreas Peer, Julia Hasslacher, Paul Koglberger, Sebastian Klein, Klemens Zotter, Anna Brandtner, Armin Finkenstedt, Adelheid Ditlbacher, Frank Hartig, Dietmar Fries, Mirjam Bachler, Bettina Schenk, Martin Wagner, Philipp Eller, Thomas Staudinger, Esther Tiller, Peter Schellongowski, Andja Bojic, Eric A. Hoste, Stephanie Bracke, Luc De Crop, Daisy Vermeiren, Fernando Thome, Bianca Chiella, Lucia Fendt, Veronica Antunes, Frédérick D'Aragon, Charles St-Arnaud, Michael Mayette, Élaine Carbonnaeu, Joannie Marchand, Marie-Hélène Masse, Marilène Ladouceur, Alexis F. Turgeon, François Lauzier, David Bellemare, Charles Langis Francoeur, Guillaume LeBlanc, Gabrielle Guilbault, Stéphanie Grenier, Eve Cloutier, Annick Boivin, Charles Delisle-Thibault, Panagiota Giannakouros, Olivier Costerousse, Jean-François Cailhier, François-Martin Carrier, Ali Ghamraoui, Martine Lebrasseur, Fatna Benettaib, Maya Salamé, Dounia Boumahni, Ying Tung Sia, Jean-François Naud, Isabelle Roy, Henry T. Stelfox, Stacey Ruddell, Braden J. Manns, Shelley Duggan, Dominic Carney, Jennifer Barchard, Richard P. Whitlock, Emilie Belley-Cote, Nevena Savija, Alexandra Sabev, Troy Campbell, Thais Creary, Kelson Devereaux, Shira Brodutch, Claudio Rigatto, Bojan Paunovic, Owen Mooney, Anna Glybina, Oksana Harasemiw, Michelle Di Nella, John Harmon, Navdeep Mehta, Louis Lakatos, Nicole Haslam, Francois Lellouche, Mathieu Simon, Ying Tung, Patricia Lizotte, Pierre-Alexandre Bourchard, Bram Rochwerg, Tim Karachi, Tina Millen, John Muscedere, David Maslove, J. Gordon Boyd, Stephanie Sibley, John Drover, Miranda Hunt, Ilinca Georgescu, Randy Wax, Ilan Lenga, Kavita Sridhar, Andrew Steele, Kelly Fusco, Taneera Ghate, Michael Tolibas, Holly Robinson, Matthew A. Weir, Ravi Taneja, Ian M. Ball, Amit Garg, Eileen Campbell, Athena Ovsenek, Sean van Diepen, Nadia Baig, Sheldon Magder, Han Yao, Ahsan Alam, Josie Campisi, Erika MacIntyre, Ella Rokosh, Kimberly Scherr, Stephen Lapinsky, Sangeeta Mehta, Sumesh Shah, Daniel J. Niven, Michael Russell, Kym Jim, Gillian Brown, Kerry Oxtoby, Adam Hall, Luc Benoit, Colleen Sokolowski, Bhanu Prasad, Jag Rao, Shelley Giebel, Demetrios J. Kutsogiannis, Patricia Thompson, Tayne Thompson, Robert Cirone, Kanthi Kavikondala, Mark Soth, France Clarke, Alyson Takaoka, David Mazer, Karen Burns, Jan Friedrich, David Klein, Gyan Sandhu, Marlene Santos, Imrana Khalid, Jennifer Hodder, Peter Dodek, Najib Ayas, Victoria Alcuaz, Gabriel Suen, Oleksa Rewa, Gurmeet Singh, Sean Norris, Neil Gibson, Castro Arias, Aysha Shami, Celine Pelletier, Alireza Zahirieh, Andre Amaral, Nicole Marinoff, Navjot Kaur, Adic Perez, Jane Wang, Gregory Haljan, Christopher Condin, Lauralyn McIntyre, Brigette Gomes, Rebecca Porteous, Irene Watpool, Swapnil Hiremath, Edward Clark, Margaret S. Herridge, Felicity Backhouse, M. Elizabeth Wilcox, Karolina Walczak, Vincent Ki, Asheer Sharman, Martin Romano, R.T. Noel Gibney, Adam S. Romanovsky, Lorena McCoshen, Gordon Wood, Daniel Ovakim, Fiona Auld, Gayle Carney, Meili Duan, Xiaojun Ji, Dongchen Guo, Zhili Qi, Jin Lin, Meng Zhang, Lei Dong, Jingfeng Liu, Pei Liu, Deyuan Zhi, Guoqiang Bai, Yu Qiu, Ziqi Yang, Jing Bai, Zhuang Liu, Haizhou Zhuang, Haiman Wang, Jian Li, Mengya Zhao, Xiao Zhou, Xianqing Shi, Baning Ye, Manli Liu, Jing Wu, Yongjian Fu, Dali Long, Yu Pan, Jinlong Wang, Huaxian Mei, Songsong Zhang, Mingxiang Wen, Enyu Yang, Sijie Mu, Jianquan Li, Tingting Hu, Bingyu Qin, Min Li, Cunzhen Wang, Xin Dong, Kaiwu Wang, Haibo Wang, Jianxu Yang, Chuanyao Wang, Dongxin Wang, Nan Li, Zhui Yu, Song Xu, Lan Yao, Guo Hou, Zhou Liu, Liping Lu, Yingtao Lian, Chunting Wang, Jichen Zhang, Ruiqi Ding, Guoqing Qi, Qizhi Wang, Peng Wang, Zhaoli Meng, Man Chen, Xiaobo Hu, Xiandi He, Shibing Zhao, Lele Hang, Rui Li, Suhui Qin, Kun Lu, Shijuan Dun, Cheng Liu, Qi Zhou, Zhenzhen Chen, Jing Mei, Minwei Zhang, Hao Xu, Jincan Lin, Qindong Shi, Lijuan Fu, Qinjing Zeng, Hongye Ma, Jinqi Yan, Lan Gao, Hongjuan Liu, Lei Zhang, Hao Li, Xiaona He, Jingqun Fan, Litao Guo, Yu Liu, Xue Wang, Jingjing Sun, Zhongmin Liu, Juan Yang, Lili Ding, Lulu Sheng, Xingang Liu, Jie Yan, Quihui Wang, Yifeng Wang, Dan Zhao, Shuangping Zhao, Chenghuan Hu, Jing Li, Fuxing Deng, Haibo Qui, Yi Yang, Min Mo, Chun Pan, Changde Wu, Yingzi Huang, Lili Huang, Airan Liu, Anna-Maija Korhonen, Sanna Törnblom, Sari Sutinen, Leena Pettilä, Jonna Heinonen, Eliria Lappi, Taria Suhonen, Sari Karlsson, Sanna Hoppu, Ville Jalkanen, Anne Kuitunen, Markus Levoranta, Jaakko Långsjö, Sanna Ristimäki, Kaisa Malila, Anna Wootten, Simo Varila, Mikko J Järvisalo, Outi Inkinen, Satu Kentala, Keijo Leivo, Paivi Haltia, Jean-Damien Ricard, Jonathan Messika, Abirami Tiagarajah, Malo Emery, Aline Dechanet, Coralie Gernez, Damien Roux, Laurent Martin-Lefevre, Maud Fiancette, Isabelle Vinatier, Jean Claude Lacherade, Gwenhaël Colin, Christine Lebert, Marie-Ange Azais, Aihem Yehia, Caroline Pouplet, Matthieu Henry- Lagarrigue, Amélie Seguin, Laura Crosby, Julien Maizel, Dimitri Titeca-Beauport, Alain Combes, Ania Nieszkowska, Paul Masi, Alexandre Demoule, Julien Mayaux, Martin Dres, Elise Morawiec, Maxens Decalvele, Suela Demiri, Morgane Faure, Clémence Marios, Maxime Mallet, Marie Amélie Ordon, Laura Morizot, Marie Cantien, François Pousset, Florent Poirson, Yves Cohen, Laurent Argaud, Martin Cour, Laurent Bitker, Marie Simon, Romain Hernu, Thomas Baudry, Sylvie De La Salle, Adrien Robine, Nicholas Sedillot, Xavier Tchenio, Camille Bouisse, Sylvie Roux, Fabienne Tamion, Steven Grangé, Dorothée Carpentier, Guillaume Chevrel, Luis Ensenyat-Martin, Sophie Marque, Jean-Pierre Quenot, Pascal Andreu, Auguste Dargent, Audrey Large, Nicolas Chudeau, Mickael Landais, Benoit Derrien, Jean Christophe Callahan, Christophe Guitton, Charlène Le Moal, Alain Robert, Karim Asehnoune, Raphaël Cinotti, Nicolas Grillot, Dominique Demeure, Christophe Vinsonneau, Imen Rahmani, Mehdi Marzouk, Thibault Dekeyser, Caroline Sejourne, Mélanie Verlay, Fabienne Thevenin, Lucie Delecolle, Didier Thevenin, Bertrand Souweine, Elisabeth Coupez, Mireille Adda, Jean-Pierre Eraldi, Antoine Marchalot, Nicolas De Prost, Armand Mekontso Dessap, Keyvan Razazi, Ferhat Meziani, Julie Boisrame-Helms, Raphael Clere-Jehl, Xavier Delabranche, Christine Kummerlen, Hamid Merdji, Alexandra Monnier, Yannick Rabouel, Hassene Rahmani, Hayat Allam, Samir Chenaf, Vincenta Franja, Bertrand Pons, Michel Carles, Frédéric Martino, Régine Richard, Benjamin Zuber, Guillaume Lacave, Karim Lakhal, Bertrand Rozec, Hoa Dang Van, Éric Boulet, Fouad Fadel, Cedric Cleophax, Nicolas Dufour, Caroline Grant, Marie Thuong, Jean Reignier, Emmanuel Canet, Laurent Nicolet, Thierry Boulain, Mai-Anh Nay, Dalila Benzekri, François Barbier, Anne Bretagnol, Toufik Kamel, Armelle Mathonnet, Grégoire Muller, Marie Skarzynski, Julie Rossi, Amandine Pradet, Sandra Dos Santos, Aurore Guery, Lucie Muller, Luis Felix, Julien Bohé, Guillaume Thiéry, Nadia Aissaoui, Damien Vimpere, Morgane Commeureuc, Jean-Luc Diehl, Emmanuel Guerot, Orfeas Liangos, Monika Wittig, Alexander Zarbock, Mira Küllmar, Thomas van Waegeningh, Nadine Rosenow, Kathy Brickell, Peter Doran, Patrick T. Murray, Giovanni Landoni, Rosalba Lembo, Alberto Zangrillo, Giacomo Monti, Margherita Tozzi, Matteo Marzaroli, Gaetano Lombardi, Gianluca Paternoster, Michelangelo Vitiello, Shay McGuinness, Rachael Parke, Magdalena Butler, Eileen Gilder, Keri-Anne Cowdrey, Samantha Wallace, Jane Hallion, Melissa Woolett, Philippa Neal, Karina Duffy, Stephanie Long, Colin McArthur, Catherine Simmonds, Yan Chen, Rachael McConnochie, Lynette Newby, David Knight, Seton Henderson, Jan Mehrtens, Stacey Morgan, Anna Morris, Kymbalee Vander Hayden, Tara Burke, Matthew Bailey, Ross Freebairn, Lesley Chadwick, Penelope Park, Christine Rolls, Liz Thomas, Ulrike Buehner, Erin Williams, Jonathan Albrett, Simon Kirkham, Carolyn Jackson, Troy Browne, Jennifer Goodson, David Jackson, James Houghton, Owen Callender, Vicki Higson, Owen Keet, Clive Dominy, Paul Young, Anna Hunt, Harriet Judd, Cassie Lawrence, Shaanti Olatunji, Yvonne Robertson, Charlotte Latimer-Bell, Deborah Hendry, Agnes Mckay-Vucago, Nina Beehre, Eden Lesona, Leanlove Navarra, Chelsea Robinson, Ryan Jang, Andrea Junge, Bridget Lambert, Michel Thibault, Philippe Eckert, Sébastien Kissling, Erietta Polychronopoulos, Elettra Poli, Marco Altarelli, Madeleine Schnorf, Samia Abed Mallaird, Claudia Heidegger, Aurelie Perret, Philippe Montillier, Frederic Sangla, Seigenthaller Neils, Aude De Watteville, Mandeep-Kaur Phull, Aparna George, Nauman Hussain, Tatiana Pogreban, Steve Lobaz, Alison Daniels, Mishell Cunningham, Deborah Kerr, Alice Nicholson, Pradeep Shanmugasundaram, Judith Abrams, Katarina Manso, Geraldine Hambrook, Elizabeth McKerrow, Juvy Salva, Stephen Foulkes, Matthew Wise, Matt Morgan, Jenny Brooks, Jade Cole, Tracy Michelle Davies, Helen Hill, Emma Thomas, Marcela Vizcaychipi, Behrad Baharlo, Jaime Carungcong, Patricia Costa, Laura Martins, Ritoo Kapoor, Tracy Hazelton, Angela Moon, Janine Musselwhite, Ben Shelley, Philip McCall, Gill Arbane, Aneta Bociek, Martina Marotti, Rosario Lim, Sara Campos, Neus Grau Novellas, Armando Cennamo, Andrew Slack, Duncan Wyncoll, Luigi Camporota, Simon Sparkes, Rosalinde Tilley, Austin Rattray, Gayle Moreland, Jane Duffy, Elizabeth McGonigal, Philip Hopkins, Clare Finney, John Smith, Harriet Noble, Hayley Watson, Claire-Louise Harris, Emma Clarey, Eleanor Corcoran, James Beck, Clare Howcroft, Nora Youngs, Elizabeth Wilby, Bethan Ogg, Adam Wolverson, Sandra Lee, Susie Butler, Maryanne Okubanjo, Julia Hindle, Ingeborg Welters, Karen Williams, Emily Johnson, Julie Patrick-Heselton, David Shaw, Victoria Waugh, Richard Stewart, Esther Mwaura, Lynn Wren, Louise Mew, Sara-Beth Sutherland, Jane Adderley, Jim Ruddy, Margaret Harkins, Callum Kaye, Teresa Scott, Wendy Mitchell, Felicity Anderson, Fiona Willox, Vijay Jagannathan, Michele Clark, Sarah Purv, Andrew Sharman, Megan Meredith, Lucy Ryan, Louise Conner, Cecilia Peters, Dan Harvey, Ashraf Roshdy, Amy Collins, Malcolm Sim, Steven Henderson, Nigel Chee, Sally Pitts, Katie Bowman, Maria Dilawershah, Luke Vamplew, Elizabeth Howe, Paula Rogers, Clara Hernandez, Clara Prendergast, Jane Benton, Alex Rosenberg, Lui G. Forni, Alice Grant, Paula Carvelli, Ajay Raithatha, Sarah Bird, Max Richardson, Matthew Needham, Claire Hirst, Jonathan Ball, Susannah Leaver, Luisa Howlett, Carlos Castro Delgado, Sarah Farnell-Ward, Helen Farrah, Geraldine Gray, Gipsy Joseph, Francesca Robinson, Ascanio Tridente, Clare Harrop, Karen Shuker, Derek McLaughlan, Judith Ramsey, Sharon Meehan, Bernd Oliver Rose, Rosie Reece-Anthony, Babita Gurung, Tony Whitehouse, Catherine Snelson, Tonny Veenith, Andy Johnston, Lauren Cooper, Ron Carrera, Karen Ellis, Emma Fellows, Samanth Harkett, Colin Bergin, Elaine Spruce, Liesl Despy, Stephanie Goundry, Natalie Dooley, Tracy Mason, Amy Clark, Gemma Dignam, Geraldine Ward, Ben Attwood, Penny Parsons, Sophie Mason, Michael Margarson, Jenny Lord, Philip McGlone, Luke E. Hodgson, Indra Chadbourn, Raquel Gomez, Jordi Margalef, Rinus Pretorius, Alexandra Hamshere, Joseph Carter, Hazel Cahill, Lia Grainger, Kate Howard, Greg Forshaw, Zoe Guy, Kianoush B. Kashani, Robert C. Albright, Amy Amsbaugh, Anita Stoltenberg, Alexander S. Niven, Matthew Lynch, AnnMarie O'Mara, Syed Naeem, Sairah Sharif, Joyce McKenney Goulart, Ashita Tolwani, Claretha Lyas, Laura Latta, Azra Bihorac, Haleh Hashemighouchani, Philip Efron, Matthew Ruppert, Julie Cupka, Sean Kiley, Joshua Carson, Peggy White, George Omalay, Sherry Brown, Laura Velez, Alina Marceron, Javier A. Neyra, Juan Carlos Aycinena, Madona Elias, Victor M. Ortiz-Soriano, Caroline Hauschild, and Robert Dorfman

Subjects
Renal Replacement Therapy, Pulmonary and Respiratory Medicine, Critical Illness, Medicine and Health Sciences, Humans, Acute Kidney Injury
Published
2022
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4. A mixed-methods systematic review protocol to examine the use of physical restraint with critically ill adults and strategies for minimizing their use

Author

Louise Rose, Craig Dale, Orla M. Smith, Lisa Burry, Glenn Enright, Dean Fergusson, Samir Sinha, Lesley Wiesenfeld, Tasnim Sinuff, and Sangeeta Mehta

Subjects
Physical restraint, Patient safety, Intensive care, Mechanical ventilation, Systematic review, Medicine
Abstract

Abstract Background Critically ill patients frequently experience severe agitation placing them at risk of harm. Physical restraint is common in intensive care units (ICUs) for clinician concerns about safety. However, physical restraint may not prevent medical device removal and has been associated with negative physical and psychological consequences. While professional society guidelines, legislation, and accreditation standards recommend physical restraint minimization, guidelines for critically ill patients are over a decade old, with recommendations that are non-specific. Our systematic review will synthesize evidence on physical restraint in critically ill adults with the primary objective of identifying effective minimization strategies. Methods Two authors will independently search from inception to July 2016 the following: Ovid MEDLINE, CINAHL, Embase, Web of Science, Cochrane Library, PROSPERO, Joanna Briggs Institute, grey literature, professional society websites, and the International Clinical Trials Registry Platform. We will include quantitative and qualitative study designs, clinical practice guidelines, policy documents, and professional society recommendations relevant to physical restraint of critically ill adults. Authors will independently perform data extraction in duplicate and complete risk of bias and quality assessment using recommended tools. We will assess evidence quality for quantitative studies using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and for qualitative studies using the Confidence in the Evidence from Reviews of Qualitative Research (CERQual) guidelines. Outcomes of interest include (1) efficacy/effectiveness of physical restraint minimization strategies; (2) adverse events (unintentional device removal, psychological impact, physical injury) and associated benefits including harm prevention; (3) ICU outcomes (ventilation duration, length of stay, and mortality); (4) prevalence, incidence, patterns of use including patient and treatment characteristics and chemical restraint; (5) barriers and facilitators to minimization; (6) patient, family, and healthcare professional perspectives; (7) professional society-endorsed recommendations; and (8) evidence gaps and research priorities. Discussion We will use our systematic review findings to produce updated guidelines on physical restraint use for critically ill adults and to develop a professional society-endorsed position statement. This will foster patient and clinician safety by providing clinicians, administrators, and policy makers with a tool to promote minimal and safe use of physical restraint for critically ill adults. Systematic review registration PROSPERO CRD42015027860

Published
2016
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6. In Science Journals

Author

Pamela J, Hines, Bianca, Lopez, Caroline, Ash, Jake, Yeston, L Bryan, Ray, Orla M, Smith, Yury, Suleymanov, Ian S, Osborne, John F, Foley, and Dan A, Erkes

Subjects
Multidisciplinary
Published
2022
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8. Integration of Equipoise into Eligibility Criteria in the STARRT-AKI Trial

Author

Ron Wald, Sean M. Bagshaw, Neill K. J. Adhikari, Rinaldo Bellomo, Didier Dreyfuss, Bin Du, Martin P. Gallagher, Stéphane Gaudry, Eric A. Hoste, François Lamontagne, Michael Joannidis, Kathleen D. Liu, Daniel F. McAuley, Shay P. McGuinness, Alistair D. Nichol, Marlies Ostermann, Paul M. Palevsky, Haibo Qiu, Ville Pettilä, Antoine G. Schneider, Orla M. Smith, Suvi Vaara, and Matthew Weir

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, Randomized controlled trial, law, business.industry, medicine.medical_treatment, medicine, Generalizability theory, Renal replacement therapy, Critical Care and Intensive Care Medicine, Intensive care medicine, business, law.invention
Published
2021
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10. Characteristics, clinical course, and outcomes of homeless and non-homeless patients admitted to ICU: A retrospective cohort study.

Author

Orla M Smith, Clarence Chant, Karen E A Burns, Maninder Kaur, Said Ashraf, Claudia C DosSantos, Stephen W Hwang, and Jan O Friedrich

Subjects
Medicine, Science
Abstract

Little is known about homeless patients in intensive care units (ICUs).To compare clinical characteristics, treatments, and outcomes of homeless to non-homeless patients admitted to four ICUs in a large inner-city academic hospital.63 randomly-selected homeless compared to 63 age-, sex-, and admitting-ICU-matched non-homeless patients.Compared to matched non-homeless, homeless patients (average age 48±12 years, 90% male, 87% admitted by ambulance, 56% mechanically ventilated, average APACHE II 17) had similar comorbidities and illness severity except for increased alcohol (70% vs 17%,p

Published
2017
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11. Family and Clinician Experiences of Sympathy Cards in the 3 Wishes Project

Author

Alyson Takaoka, Meredith Vanstone, Thanh H. Neville, Sophia Goksoyr, Marilyn Swinton, France J. Clarke, Orla M. Smith, Allana LeBlanc, Denise Foster, Yuhan Kao, Xueqing Xu, Neala Hoad, Feli Toledo, and Deborah J. Cook

Subjects
medicine.medical_specialty, media_common.quotation_subject, Condolences, Compassion, Critical Care Nursing, 03 medical and health sciences, 0302 clinical medicine, Professional-Family Relations, Intervention (counseling), Humans, Medicine, Family, 030212 general & internal medicine, media_common, Terminal Care, business.industry, 030208 emergency & critical care medicine, General Medicine, medicine.disease, Focus group, Intensive Care Units, Surprise, Posttraumatic stress, Content analysis, Family medicine, Sympathy, business, Bereavement
Abstract

Background A recent randomized trial of bereaved family members of patients who died in an intensive care unit identified symptoms of depression and posttraumatic stress in recipients of semistructured condolence letters. Objectives To explore family member and clinician experiences with receiving or sending handwritten sympathy cards upon the death of patients involved in a personalized end-of-life intervention, the 3 Wishes Project. Methods Interviews and focus groups were held with 171 family members and 222 clinicians at 4 centers to discuss their experiences with the 3 Wishes Project. Interview transcripts were searched to identify participants who discussed sympathy cards. Data related to sympathy cards were independently coded by 2 investigators through conventional content analysis. Results Sympathy cards were discussed during 32 interviews (by 25 family members of 21 patients and by 11 clinicians) and 2 focus groups (8 other clinicians). Family members reported that personalized sympathy cards were a welcome surprise; they experienced them as a heartfelt act of compassion. Clinicians viewed cards as an opportunity to express shared humanity with families, reminding them that they and their loved one were not forgotten. Signing cards allowed clinicians to reminisce individually and collectively with colleagues. Family members and clinicians experienced sympathy cards as a meaningful continuation of care after a patient’s death. Conclusions Inviting clinicians who cared for deceased patients to offer personalized, handwritten condolences to bereaved family members may cultivate sincere and individualized expressions of sympathy that bereaved families appreciate after the death of patients involved in the 3 Wishes Project.

Published
2020
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12. Hospital leadership perspectives on the value of the 3 Wishes Project: a qualitative study

Author

Marilyn Swinton, Meredith Vanstone, Peter Phung, Thanh H Neville, Alyson Takaoka, Orla M Smith, Andrew Baker, Allana LeBlanc, Denise Foster, Vinay Dhingra, France J Clarke, Neala Hoad, Anne Woods, Anne Boyle, Feli Toledo, and Deborah J Cook

Subjects
Value (ethics), Medical education, Palliative care, 030504 nursing, Leadership and Management, business.industry, Strategy and Management, Health Policy, media_common.quotation_subject, Compassion, 03 medical and health sciences, 0302 clinical medicine, Resource (project management), Health care, Narrative, Grief, 030212 general & internal medicine, 0305 other medical science, Psychology, business, media_common, Qualitative research
Abstract

BackgroundHealthcare organisations are increasingly interested in improving the work life of their employees. By encouraging individualised acts of compassion for dying patients and their families, the 3 Wishes Project (3WP) has been shown to ease grief for both families and clinicians.PurposeThe objective of this study was to explore the perspectives of hospital leaders on the value of the 3WP to the hospital and how decisions are made about which programmes to support.MethodsWe conducted semistructured interviews with 20 hospital leaders in four North American institutions. Transcripts were analysed using qualitative content analysis.ResultsInterviews with 12 clinical managers and 8 senior administrators identified the institutional value of the 3WP as improving patient and family experiences, enhancing staff morale, translating institutional mission and values into front-line practice, and creating positive public relations. Hospital leaders acknowledged potential resource challenges, including staff time, space to store supplies and funds to purchase items for some wishes. However, citing stories they had heard from families and staff, hospital leaders shared their view of how their decisions about the value of clinical programmes extend beyond quantifiable outcomes.ConclusionsWhen reflecting on this personalised palliative care programme, hospital leaders described how inspiring narratives promoted institutional values in ways that are difficult to measure quantitatively. Leaders underscored the need to balance the value that a programme brings with the resources it requires, stating how different types of evidence influence their support of new programmes.Trial registration numberNCT04147169.

Published
2020
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13. In Science Journals

Author

H. Jesse Smith, Jake Yeston, Peter Stern, L. Bryan Ray, Wei Wong, Brent Grocholski, Douglas H. Erwin, Marc S. Lavine, Gemma Alderton, Pamela J. Hines, Orla M. Smith, and Claire Olingy

Subjects
Multidisciplinary
Abstract

Highlights from the Science family of journals

Published
2022
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14. This Week in Science

Author

Pamela J. Hines, Valda Vinson, Jelena Stajic, Sacha Vignieri, L. Bryan Ray, Orla M. Smith, Wei Wong, Yury Suleymanov, Keith T. Smith, Peter Stern, Michael A. Funk, Laura M. Zahn, Di Jiang, Jake Yeston, Andrew M. Sugden, Caroline Ash, Marc S. Lavine, Claire Olingy, and Laura Na Liu

Subjects
Multidisciplinary
Published
2021
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15. In Science Journals

Author

Leslie K. Ferrarelli, L. Bryan Ray, Priscilla N. Kelly, Di Jiang, Caroline Ash, Marc S. Lavine, Mark Aldenderfer, Stella M. Hurtley, Seth Thomas Scanlon, Peter Stern, Brent Grocholski, Laura M. Zahn, Orla M. Smith, and Claire Olingy

Subjects
Multidisciplinary
Abstract

Highlights from the Science family of journals

Published
2022

16. This Week in Science

Author

Gemma Alderton, Brent Grocholski, Pamela J. Hines, Ian S. Osborne, Leslie K. Ferrarelli, Orla M. Smith, Sacha Vignieri, Phil Szuromi, Claire Olingy, Valda Vinson, Marc S. Lavine, Laura M. Zahn, Mark Aldenderfer, and Caroline Ash

Subjects
Multidisciplinary
Published
2021
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17. This Week in Science

Author

Gemma Alderton, Ifor Williams, Leslie K. Ferrarelli, Orla M. Smith, Laura M. Zahn, Stella M. Hurtley, Beverly A. Purnell, H. Jesse Smith, Paula A. Kiberstis, Jake Yeston, Michael M. Lee, Phil Szuromi, Michael A. Funk, Ian S. Osborne, and Sacha Vignieri

Subjects
Multidisciplinary
Published
2020
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18. Organ Donation at the End of Life: Experiences From the 3 Wishes Project

Author

Alyson Takaoka, Kimia Honarmand, Meredith Vanstone, Benjamin Tam, Orla M. Smith, Andrew Baker, Allana LeBlanc, Marilyn Swinton, Thanh H. Neville, France J. Clarke, Jennifer Hancock, Sarah McMullen, Maureen O. Meade, Trudy Rose, Samantha Arora, and Deborah J. Cook

Subjects
Canada, Tissue and Organ Procurement, Palliative care, media_common.quotation_subject, Decision Making, Compassion, 030230 surgery, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, Nursing, law, Humans, Medicine, Family, 030212 general & internal medicine, Organ donation, media_common, Terminal Care, business.industry, Intensive care unit, Death, Intensive Care Units, Honor, business, End-of-life care
Abstract

Purpose: The 3 Wishes Project (3WP) promotes holistic end-of-life care in the intensive care unit (ICU) to honor dying patients, support families, and encourage clinician compassion. Organ donation is a wish that is sometimes made by, or on behalf of, critically ill patients. Our objective was to describe the interface between the 3WP and organ donation as experienced by families, clinicians, and organ donation coordinators. Methods: In a multicenter evaluation of the 3WP in 4 Canadian ICUs, we conducted a thematic analysis of transcripts from interviews and focus groups with clinicians, organ donation coordinators, and families of dying or died patients for whom donation was considered. Results: We analyzed transcripts from 26 interviews and 2 focus groups with 18 family members, 17 clinicians, and 6 organ donation coordinators. The central theme describes the mutual goals of the 3WP and organ donation—emphasizing personhood and agency across the temporal continuum of care. During family decision-making, conversations encouraged by the 3WP can facilitate preliminary discussions about donation. During preparation for donation, memory-making activities supported by the 3WP redirect focus toward personhood. During postmortem family care, the 3WP supports families, including when donation is unsuccessful, and highlights aspirational pursuits of donation while encouraging reflections on other fulfilled wishes. Conclusions: Organ donation and the 3WP provide complementary opportunities to engage in value-based conversations during the dying process. The shared values of these programs may help to incorporate organ donation and death into a person’s life narrative and incorporate new life into a person’s death narrative.

Published
2020
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20. Keepsakes at the End of Life

Author

Thanh H. Neville, France Clarke, Alyson Takaoka, Marina Sadik, Meredith Vanstone, Peter Phung, Kristen Hjelmhaug, Jessica Hainje, Orla M. Smith, Allana LeBlanc, Neala Hoad, Benjamin Tam, Brenda Reeve, and Deborah J. Cook

Subjects
Adult, Palliative care, media_common.quotation_subject, Wish, Compassion, Bereaved family, Context (language use), 03 medical and health sciences, 0302 clinical medicine, Nursing, Intervention (counseling), Medicine, Humans, Family, 030212 general & internal medicine, General Nursing, media_common, Receipt, Terminal Care, business.industry, Palliative Care, Death, Intensive Care Units, Anesthesiology and Pain Medicine, Adult intensive care unit, 030220 oncology & carcinogenesis, Neurology (clinical), business, Bereavement
Abstract

Context Keepsakes are a relatively unexplored form of bereavement support that is frequently provided as part of the 3 Wishes Project (3WP). The 3WP is a palliative care intervention in which individualized wishes are implemented in the adult intensive care unit for dying patients and their families. Objectives We aimed to characterize and enumerate the keepsakes that were created as part of the 3WP and to understand their value from the perspective of bereaved family members. Methods We performed a secondary analysis of family interviews during a multicenter study on the 3WP and characterized all wishes that involved keepsakes. Sixty interviews with family members regarding the 3WP were reanalyzed using qualitative analysis to identify substantive themes related to keepsakes. Results Of 730 patients, 345 (47%) received keepsakes as part of their participation in 3WP. Most keepsakes were either tangible items that served as reminders of the patient's presence (thumbprints and locks of hair) or technology-assisted items (photographs and word clouds). The median cost per keepsake wish was $8.50 (interquartile range $2.00–$25.00). Qualitative analysis revealed two major themes: keepsakes are tangible items that are highly valued by family members; and the creation of the keepsake with clinical staff is valued and viewed as a gesture of compassion. Conclusion Keepsakes are common wishes that clinicians in the intensive care unit are able to provide and sometimes cocreate with families when patients are dying. Both the offering to create the keepsake and receipt of the final product are perceived by family members as helpful.

Published
2020

21. This Week in Science

Author

H. Jesse Smith, Mark Aldenderfer, Peter Stern, Orla M. Smith, Stella M. Hurtley, Ian S. Osborne, Paula A. Kiberstis, Phil Szuromi, Wei Wong, Brent Grocholski, Caroline Ash, Steve Mao, Seth Thomas Scanlon, Christiana N. Fogg, and Jake Yeston

Subjects
Multidisciplinary
Published
2018
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22. This Week in Science

Author

Lynden Archer, Kollen Post, Ifor Williams, Jelena Stajic, Ian S. Osborne, Laura M. Zahn, Pamela J. Hines, Beverly A. Purnell, Sacha Vignieri, Erin Williams, Peter Stern, H. Jesse Smith, L. Bryan Ray, Orla M. Smith, Gemma Alderton, and Phil Szuromi

Subjects
Multidisciplinary
Published
2019
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23. This Week in Science

Author

Laura M. Zahn, Sacha Vignieri, Anand Balasubramani, Kollen Post, Orla M. Smith, Gemma Alderton, Seth Thomas Scanlon, Leslie K. Ferrarelli, Jake Yeston, Andrew M. Sugden, H. Jesse Smith, Brent Grocholski, Marc S. Lavine, Paula A. Kiberstis, and L. Bryan Ray

Subjects
Multidisciplinary
Published
2019
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24. This Week in Science

Author

Andrew M. Sugden, Jake Yeston, Keith T. Smith, Brent Grocholski, Anand Balasubramani, Barbara R. Jasny, Philippa J. Benson, Orla M. Smith, Tage S. Rai, Rachel Kline, Steve Mao, Pamela J. Hines, Stella M. Hurtley, John F. Foley, Sacha Vignieri, Beverly A. Purnell, and Priscilla N. Kelly

Subjects
Multidisciplinary
Published
2018
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25. This Week in Science

Author

Jake Yeston, Ian S. Osborne, John F. Foley, L. Bryan Ray, Sacha Vignieri, Caroline Ash, Barbara R. Jasny, Rachel Kline, Phil Szuromi, Philippa J. Benson, Orla M. Smith, Peter Stern, Steve Mao, Keith T. Smith, and Beverly A. Purnell

Subjects
Multidisciplinary
Published
2018
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26. This Week in Science

Author

Anand Balasubramani, Beverly A. Purnell, Rachel Kline, Ian S. Osborne, Orla M. Smith, Phil Szuromi, Jake Yeston, Marc S. Lavine, John F. Foley, Aaron Clauset, H. Jesse Smith, Pamela J. Hines, Brent Grocholski, Laura M. Zahn, and Seth Thomas Scanlon

Subjects
Multidisciplinary
Published
2018
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27. This Week in Science

Author

Orla M. Smith, L. Bryan Ray, John F. Foley, Marc S. Lavine, Ifor Williams, Seth Thomas Scanlon, Phil Szuromi, Valda Vinson, Pamela J. Hines, Caroline Ash, Peter Stern, Laura M. Zahn, Julia Fahrenkamp-Uppenbrink, and Brent Grocholski

Subjects
Multidisciplinary
Published
2018
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30. This Week in Science

Author

Christiana N. Fogg, H. Jesse Smith, Ian S. Osborne, Stella M. Hurtley, Paula A. Kiberstis, Priscilla N. Kelly, Valda Vinson, Andrew M. Sugden, Sacha Vignieri, Steve Mao, Julia Fahrenkamp-Uppenbrink, Wei Wong, Jake Yeston, and Orla M. Smith

Subjects
Multidisciplinary
Published
2018
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31. This Week in Science

Author

Keith T. Smith, Peter Stern, Priscilla N. Kelly, Phil Szuromi, Steve Mao, Kip Hodges, Paula A. Kiberstis, Michael A. Funk, Anand Balasubramani, Jelena Stajic, Seth Thomas Scanlon, Laura M. Zahn, Caroline Ash, Leslie K. Ferrarelli, and Orla M. Smith

Subjects
Multidisciplinary
Published
2018
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32. This Week in Science

Author

Julia Fahrenkamp-Uppenbrink, Seth Thomas Scanlon, Sacha Vignieri, Keith T. Smith, Aaron Clauset, Christiana N. Fogg, Caroline Ash, Priscilla N. Kelly, Jelena Stajic, Leslie K. Ferrarelli, Marc S. Lavine, Laura M. Zahn, Orla M. Smith, Stella M. Hurtley, and Steve Mao

Subjects
Multidisciplinary
Published
2018
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33. This Week in Science

Author

Jake Yeston, Ian S. Osborne, Sacha Vignieri, Phil Szuromi, Valda Vinson, Lynden Archer, Wei Wong, Brent Grocholski, Jelena Stajic, Caroline Ash, Orla M. Smith, Priscilla N. Kelly, Seth Thomas Scanlon, Marc S. Lavine, and Paula A. Kiberstis

Subjects
Multidisciplinary
Published
2017
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34. This Week in Science

Author

Beverly A. Purnell, Marc S. Lavine, Peter Stern, Jelena Stajic, Shahid Naeem, Priscilla N. Kelly, Sacha Vignieri, Angela Colmone, Leslie K. Ferrarelli, Jake Yeston, Pamela J. Hines, Laura M. Zahn, Caroline Ash, and Orla M. Smith

Subjects
Multidisciplinary
Published
2017
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35. This Week in Science

Author

John F. Foley, Marc S. Lavine, Anand Balasubramani, Pamela J. Hines, Orla M. Smith, Laura M. Zahn, Gilbert Chin, Keith T. Smith, Jelena Stajic, Philip Yeagle, Phil Szuromi, Julia Fahrenkamp-Uppenbrink, Paula A. Kiberstis, and Jake Yeston

Subjects
Multidisciplinary
Published
2017
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36. This Week in Science

Author

H. Jesse Smith, Marc S. Lavine, Cedric Tan, Keith T. Smith, Orla M. Smith, Pamela J. Hines, Annalisa VanHook, Julia Fahrenkamp-Uppenbrink, Andrew M. Sugden, Laura M. Zahn, Phil Szuromi, Caroline Ash, Angela Colmone, Jake Yeston, Priscilla N. Kelly, and Peter Stern

Subjects
Multidisciplinary
Published
2017
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38. Elucidating the foreign body response

Author

Orla M. Smith

Subjects
Pathology, medicine.medical_specialty, Multidisciplinary, Stromal cell, Chemistry, Blocking (radio), Fibrous capsule, medicine.disease, Synthetic materials, Tissue engineering, Fibrosis, medicine, Implant, Foreign body
Abstract

Tissue Engineering Synthetic materials are the building blocks for medical devices and implants but can induce a foreign body response after implantation, resulting in fibrous scar tissue encompassing the implant. Chung et al. define the role of interleukin-17 (IL-17) and cellular senescence in driving the foreign body response. The fibrous capsule from excised breast implants contained IL-17–producing T cells and senescent stromal cells. These findings were further validated in a murine model, and the authors found that blocking the IL-17 pathway or eliminating senescent cells mitigated local fibrosis around the implant. Sci. Transl. Med. 12 , eaax3799 (2020).

Published
2020
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39. This Week in Science

Author

Jake Yeston, Jelena Stajic, Marc S. Lavine, Wei Wong, Shahid Naeem, Gilbert Chin, Laura M. Zahn, Julia Fahrenkamp-Uppenbrink, Orla M. Smith, Peter Stern, Guy Riddihough, Valda Vinson, and Keith T. Smith

Subjects
Multidisciplinary
Published
2016
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40. This Week in Science

Author

Laura M. Zahn, Barbara R. Jasny, Julia Fahrenkamp-Uppenbrink, Pamela J. Hines, Paula A. Kiberstis, Ian S. Osborne, null AC, Jelena Stajic, Orla M. Smith, Nicholas S. Wigginton, Wei Wong, and H. Jesse Smith

Subjects
Multidisciplinary
Published
2016
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41. TYK2's balancing act

Author

Orla M. Smith

Subjects
Multidisciplinary, Immune signaling, Drug target, Genetic variants, Biology, medicine.disease_cause, medicine.disease, Bioinformatics, Autoimmunity, Tyrosine kinase 2, Immunology, medicine, Gene, Immunodeficiency
Abstract

Autoimmunity Determining the biological consequences of the thousands of genetic variants that contribute to common diseases is challenging. Genetic variants that influence autoimmune diseases have been identified in the gene encoding TYK2 (tyrosine kinase 2), but conflicting evidence regarding their biological impact obscures the therapeutic potential of TYK2. In resolving this conflict, Dendrou et al. have revealed a genetic effect that drives an optimal degree of immune signaling: low enough to be protective against autoimmunity but high enough to prevent immunodeficiency. These findings indicate that TYK2 may be a potential drug target in a number of autoimmune conditions. Sci. Transl. Med. 8 , 363ra149 (2016).

Published
2016
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42. Stemming MRSA-induced pneumonia

Author

Orla M. Smith

Subjects
Multidisciplinary, biology, Necrotizing pneumonia, business.industry, Leukocidin, Improved survival, biochemical phenomena, metabolism, and nutrition, bacterial infections and mycoses, Specific antibody, chemistry.chemical_compound, chemistry, Infectious disease (medical specialty), hemic and lymphatic diseases, Linezolid, Immunology, biology.protein, medicine, Vancomycin, Antibody, business, medicine.drug
Abstract

Infectious Disease Controversies persist about the use of human intravenous immunoglobulin (IVIG) as an adjunct treatment for severe pneumonia caused by Staphylococcus aureus infections. Diep et al. show that in rabbits, only two specific antibodies contained in IVIG are necessary and sufficient to confer protection against necrotizing pneumonia caused by methicillin-resistant S. aureus (MRSA) strains. These antibodies neutralize the toxic effects of α-toxin and Panton-Valentine leukocidin. Preexposure prophylaxis with IVIG, or postexposure treatment with IVIG in combination with either vancomycin or linezolid, improved survival outcomes. Sci. Transl. Med. 8 , 357ra124 (2016).

Published
2016
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43. This Week in Science

Author

L. Bryan Ray, Caroline Ash, Orla M. Smith, Beverly A. Purnell, Andrew M. Sugden, Pamela J. Hines, Shahid Naeem, Kristen L. Mueller, Nancy R. Gough, Ian S. Osborne, Laura M. Zahn, Gilbert Chin, H. Jesse Smith, Julia Fahrenkamp-Uppenbrink, Jake Yeston, and Stella M. Hurtley

Subjects
Multidisciplinary
Published
2016
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44. This Week in Science

Author

Stella M. Hurtley, Sacha Vignieri, Pamela J. Hines, Julia Fahrenkamp-Uppenbrink, Brent Grocholski, Zakya H. Kafafi, Valda Vinson, L. Bryan Ray, Leslie K. Ferrarelli, H. Jesse Smith, Ian S. Osborne, Jelena Stajic, Andrew M. Sugden, Orla M. Smith, and Jake Yeston

Subjects
Multidisciplinary
Published
2016
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45. This Week in Science

Author

Julia Fahrenkamp-Uppenbrink, Caroline Ash, Jake Yeston, Laura M. Zahn, Guy Riddihough, Phil Szuromi, John F. Foley, Orla M. Smith, Keith T. Smith, Barbara R. Jasny, Ian S. Osborne, Jelena Stajic, Paula A. Kiberstis, Philip Yeagle, Kristen L. Mueller, Pamela J. Hines, and Valda Vinson

Subjects
Multidisciplinary
Published
2016
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46. This Week in Science

Author

Phil Szuromi, Guy Riddihough, H. Jesse Smith, Kristen L. Mueller, Nicholas S. Wigginton, Laura M. Zahn, Ian S. Osborne, Peter Stern, Gilbert Chin, Leslie K. Ferrarelli, Jake Yeston, Julie A. Phillippi, Sacha Vignieri, Brent Grocholski, Orla M. Smith, and Caroline Ash

Subjects
Multidisciplinary
Published
2016
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47. This Week in Science

Author

Brent Grocholski, Sacha Vignieri, Julia Fahrenkamp-Uppenbrink, Kristen L. Mueller, Laura M. Zahn, Orla M. Smith, Jelena Stajic, Ian S. Osborne, Valda Vinson, Wei Wong, Stella M. Hurtley, Jake Yeston, Kip Hodges, and Nicholas S. Wigginton

Subjects
Multidisciplinary
Published
2016
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48. A gain in pain control

Author

Orla M. Smith

Subjects
Multidisciplinary, business.industry, Sodium channel, Sensory system, Pharmacology, medicine.disease, Blockade, Peripheral, Sodium channel blocker, Pain control, Erythromelalgia, Medicine, Induced pluripotent stem cell, business
Abstract

Pain The sodium channel Nav1.7 is important for the firing of peripheral pain-signaling neurons. Inherited erythromelalgia (IEM) is a painful disorder in which gain-of-function Nav1.7 mutations produce hyper-responsiveness of peripheral sensory neurons to warmth. Cao et al. created induced pluripotent stem cell (iPSC)-derived sensory neurons from IEM patients. A selective Nav1.7 sodium channel blocker normalized the phenotype of the iPSC-derived sensory neurons and blocked pain perception in human patients with IEM. Thus, selective Nav1.7 blockade may be useful in pain alleviation. Sci. Transl. Med. 8 , 335ra56 (2016).

Published
2016
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49. LAMP shines a light on Zika virus

Author

Orla M. Smith

Subjects
0301 basic medicine, 03 medical and health sciences, 030104 developmental biology, Multidisciplinary, Outbreak, Biology, biology.organism_classification, Virology, Zika virus
Abstract

Zika Virus Rapid and simple assays to detect infectious agents are key to tracking emerging epidemics. Chotiwan et al. describe a loop-mediated amplification (LAMP) assay that detects Zika virus RNA in human biofluids such as serum and semen, as well as in mosquitoes, the insect vector that transmits the disease. The assay successfully distinguished the Asian-lineage Zika virus, which is associated with the current outbreak in the Americas, from the African-lineage Zika virus. This approach should enable tracking of the Asian-lineage strain as it moves into new geographical locations. Sci. Transl. Med. 9 , eaag0538 (2017).

Published
2017

50. Mapping a path to HIV elimination

Author

Orla M. Smith

Subjects
education.field_of_study, Multidisciplinary, Population, Human immunodeficiency virus (HIV), virus diseases, medicine.disease_cause, Virology, Geographic distribution, Geography, Spatial dispersion, Path (graph theory), medicine, education, Demography
Abstract

HIV About 25 million people in sub-Saharan Africa are living with HIV. Coburn et al. looked into the design of HIV elimination strategies. They focused on Lesotho, where ∼25% of the population is infected with HIV. They combined several large data sets and constructed a map that revealed the countrywide geographic distribution of HIV-infected people. About 20% live in urban areas, and almost all rural communities have at least one HIV-infected person. The spatial dispersion of Lesotho's population may thus hinder and even prevent the elimination of HIV, and this may hold true for other predominantly rural countries in sub-Saharan Africa. Sci. Transl. Med. 9 , eaag0019 (2017).

Published
2017

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