116 results on '"Pwb Nanayakkara"'
Search Results
2. A prospective, observational study of the performance of MEWS, NEWS, SIRS and qSOFA for early risk stratification for adverse outcomes in patients with suspected infections at the emergency department
- Author
-
V Brown, T. Minderhoud, P. Mohammadi, Pwb Nanayakkara, T Attaye, K. Azijli, R Dekker, S J Huisman, A A Hettinga-Roest, Surgery, Internal medicine, ACS - Diabetes & metabolism, APH - Quality of Care, and APH - Digital Health
- Subjects
medicine.medical_specialty ,business.industry ,Retrospective cohort study ,General Medicine ,Emergency department ,Critical Care and Intensive Care Medicine ,Confidence interval ,Mews ,Organ Dysfunction Scores ,Emergency medicine ,Emergency Medicine ,Internal Medicine ,Medicine ,Observational study ,business ,Risk assessment ,Prospective cohort study - Abstract
Background: Many patients with suspected infection are presented to the emergency Department. Several scoring systems have been proposed to identify patients at high risk of adverse outcomes. Methods: We compared generic early warning scores (MEWS and NEWS) to the (SIRS) criteria and quick Sequential Organ Failure Assessement (qSOFA), for early risk stratification in 1400 patients with suspected infection in the ED. The primary study end point was 30-day mortality. Results: The AUROC of the NEWS score for predicting 30-day mortality was 0.740 (95% Confidence Interval 0.682-0.798), higher than qSOFA (AUROC of 0.689, 95% CI 0.615- 0.763), MEWS (AUROC 0.643 (95% CI 0.583-0.702) and SIRS (AUROC 0.586, 95%CI 0.521 – 0.651). The sensitivity was also highest for NEWS≥ 5 (sensitivity 75,8% specificity of 67,4%). Conclusion: Among patients presenting to the ED with suspected infection, early risk stratification with NEWS (cut-off of ≥5) is more sensitive for prediction of mortality than qSOFA, MEWS or SIRS, with adequate specificity.
- Published
- 2021
3. Evaluating quality in acute care using patient reported outcome measures: a scoping review
- Author
-
E M, Mols, Mgam, van der Velde, Pwb, Nanayakkara, H R, Haak, and Mnt, Kremers
- Subjects
Critical Care ,Psychometrics ,Surveys and Questionnaires ,Humans ,Patient Reported Outcome Measures ,Checklist - Abstract
The aim of this scoping review is to identify patient reported outcome measures (PROMs) in acute care settings, assess their psychometric properties and provide recommendations for their use in daily practice. We performed a search in the PubMed database to identify publications concerning PROMs in an acute care setting. The COSMIN checklist was used to assess the psychometric properties of the reported PROMs. We found 1407 publications and included 14 articles, describing 15 measures. Most publications provided limited information on psychometric properties. Three generic PROMs were deemed of adequate quality for use in acute care. We recommend future development and evaluation of PROMs focussing on acute care to further evaluate and improve the quality of acute care.
- Published
- 2021
4. Predicting poor outcome in patients with suspected COVID-19 presenting to the Emergency Department (COVERED) - Development, internal and external validation of a prediction model
- Author
-
K, Azijli, Awe, Lieveld, Sfb, van der Horst, N, de Graaf, R S, Kootte, M W, Heijmans, P M, van de Ven, Ejg, Peters, J, Heijmans, P, Terragnoli, G, Natalini, M, Abu Hilal, T, de Rooij, and Pwb, Nanayakkara
- Subjects
SARS-CoV-2 ,COVID-19 ,Humans ,Multicenter Studies as Topic ,Prospective Studies ,Emergency Service, Hospital ,Prognosis ,Netherlands ,Retrospective Studies - Abstract
A recent systematic review recommends against the use of any of the current COVID-19 prediction models in clinical practice. To enable clinicians to appropriately profile and treat suspected COVID-19 patients at the emergency department (ED), externally validated models that predict poor outcome are desperately needed.Our aims were to identify predictors of poor outcome, defined as mortality or ICU admission within 30 days, in patients presenting to the ED with a clinical suspicion of COVID-19, and to develop and externally validate a prediction model for poor outcome.In this prospective, multi-center study, we enrolled suspected COVID-19 patients presenting at the EDs of two hospitals in the Netherlands. We used backward logistic regression to develop a prediction model. We used the area under the curve (AUC), Brier score and pseudo-R2 to assess model performance. The model was externally validated in an Italian cohort.We included 1193 patients between March 12 and May 27 2020, of whom 196 (16.4%) had a poor outcome. We identified 10 predictors of poor outcome: current malignancy (OR 2.774; 95%CI 1.682-4.576), systolic blood pressure (OR 0.981; 95%CI 0.964-0.998), heart rate (OR 1.001; 95%CI 0.97-1.028), respiratory rate (OR 1.078; 95%CI 1.046-1.111), oxygen saturation (OR 0.899; 95%CI 0.850-0.952), body temperature (OR 0.505; 95%CI 0.359-0.710), serum urea (OR 1.404; 95%CI 1.198-1.645), C-reactive protein (OR 1.013; 95%CI 1.001-1.024), lactate dehydrogenase (OR 1.007; 95%CI 1.002-1.013) and SARS-CoV-2 PCR result (OR 2.456; 95%CI 1.526-3.953). The AUC was 0.86 (95%CI 0.83-0.89), with a Brier score of 0.32 and, and R2 of 0.41. The AUC in the external validation in 500 patients was 0.70 (95%CI 0.65-0.75).The COVERED risk score showed excellent discriminatory ability, also in an external validation. It may aid clinical decision making, and improve triage at the ED in health care environments with high patient throughputs.
- Published
- 2021
5. Predicting poor outcome in patients with suspected COVID-19 presenting to the Emergency Department (COVERED) - Development, internal and external validation of a prediction model
- Author
-
Kaoutar Azijli, Giuseppe Natalini, Sfb van der Horst, J Heijmans, T de Rooij, P. M. van de Ven, Pwb Nanayakkara, P Terragnoli, M W Heijmans, Ejg Peters, M. Abu Hilal, Awe Lieveld, N. de Graaf, Ruud S. Kootte, Internal medicine, Surgery, Dermatology, Epidemiology and Data Science, APH - Methodology, APH - Personalized Medicine, AII - Infectious diseases, AMS - Rehabilitation & Development, Hematology, Anesthesiology, APH - Quality of Care, APH - Digital Health, ACS - Diabetes & metabolism, and ACS - Heart failure & arrhythmias
- Subjects
medicine.medical_specialty ,Framingham Risk Score ,business.industry ,Retrospective cohort study ,General Medicine ,Emergency department ,Critical Care and Intensive Care Medicine ,Logistic regression ,Triage ,Brier score ,Emergency medicine ,Cohort ,Emergency Medicine ,Internal Medicine ,medicine ,Prospective cohort study ,business - Abstract
BACKGROUND: A recent systematic review recommends against the use of any of the current COVID-19 prediction models in clinical practice. To enable clinicians to appropriately profile and treat suspected COVID-19 patients at the emergency department (ED), externally validated models that predict poor outcome are desperately needed.OBJECTIVE: Our aims were to identify predictors of poor outcome, defined as mortality or ICU admission within 30 days, in patients presenting to the ED with a clinical suspicion of COVID-19, and to develop and externally validate a prediction model for poor outcome.METHODS: In this prospective, multi-center study, we enrolled suspected COVID-19 patients presenting at the EDs of two hospitals in the Netherlands. We used backward logistic regression to develop a prediction model. We used the area under the curve (AUC), Brier score and pseudo-R2 to assess model performance. The model was externally validated in an Italian cohort.RESULTS: We included 1193 patients between March 12 and May 27 2020, of whom 196 (16.4%) had a poor outcome. We identified 10 predictors of poor outcome: current malignancy (OR 2.774; 95%CI 1.682-4.576), systolic blood pressure (OR 0.981; 95%CI 0.964-0.998), heart rate (OR 1.001; 95%CI 0.97-1.028), respiratory rate (OR 1.078; 95%CI 1.046-1.111), oxygen saturation (OR 0.899; 95%CI 0.850-0.952), body temperature (OR 0.505; 95%CI 0.359-0.710), serum urea (OR 1.404; 95%CI 1.198-1.645), C-reactive protein (OR 1.013; 95%CI 1.001-1.024), lactate dehydrogenase (OR 1.007; 95%CI 1.002-1.013) and SARS-CoV-2 PCR result (OR 2.456; 95%CI 1.526-3.953). The AUC was 0.86 (95%CI 0.83-0.89), with a Brier score of 0.32 and, and R2 of 0.41. The AUC in the external validation in 500 patients was 0.70 (95%CI 0.65-0.75).CONCLUSION: The COVERED risk score showed excellent discriminatory ability, also in an external validation. It may aid clinical decision making, and improve triage at the ED in health care environments with high patient throughputs.
- Published
- 2021
6. The utility of peripheral venous lactate in emergency department patients with normal and higher lactate levels: A prospective observational study
- Author
-
A J, Van Tienhoven, Caj, Van Beers, Ceh, Siegert, and Pwb, Nanayakkara
- Subjects
Humans ,Arteries ,Lactic Acid ,Prospective Studies ,Emergency Service, Hospital ,Veins - Abstract
to assess the utility of peripheral venous lactate (PVL) in Emergency Department patients.arteriovenous agreement was assessed in three subgroups: PVL2 mmol/l, PVL ≥ 2 mmol/l to4 mmol/l and PVL ≥ 4 mmol/l. The predictive value of PVL to predict arterial lactate (AL) ≥2 mmol/l was assessed at different cut-off values.74 samples were analysed. The venous-arterial mean difference and 95% limits of agreement for the subgroups were 0.25 mmol/l (-0.18 to 0.68), 0.37 mmol/l (-0.57 to 1.32) and -0.89 mmol/l (-3.75 to 1.97). PVL ≥2 mmol/l predicts AL ≥2 mmol/l with 100% sensitivity.PVL2 mmol/l rules out arterial hyperlactatemia. As agreement declines in higher levels, arterial sampling should be considered.
- Published
- 2020
7. Perspectives on the preventability of emergency department visits by older patients
- Author
-
Mth, Verhaegh, Snijders F, Loes Janssen, Nalr, Peters, Mol Y, Kamerman-Celie F, Ls, Galen, Pwb, Nanayakkara, and Dg, Barten
- Subjects
Aged, 80 and over ,Male ,Patients ,Attitude of Health Personnel ,Interviews as Topic ,Primary Prevention ,Caregivers ,Physicians ,Humans ,Female ,Emergency Service, Hospital ,Hospitals, Teaching ,Attitude to Health ,Aged ,Netherlands - Abstract
Older people increasingly demand emergency department (ED) care. ED visits have a profound impact on older patients, including high risk of adverse outcomes and loss of independency. In this study, we evaluated the opinions of patients, caregivers, general practitioners, and ED physicians on the preventability of ED visits.Prospective, mixed-method observational and qualitative study of 200 patients aged ≥ 70 years visiting a teaching hospital ED in the Netherlands. Semi-structured interviews were performed with patients, caregivers, and general practitioners. ED physicians were provided with written surveys. Patient data were extracted to determine vulnerability.The mean age of the patients was 79.6 years; 49.5% were male. Ninety-five percent lived independently before the ED visit. Most patients reported domiciliary care (23%), a caregiver (21.5%), or both (29.5%). Patients considered 12.2% of visits potentially preventable, caregivers 9%, general practitioners 20.7%, and ED physicians 31.2%. Consensus on preventability was poor, especially among patients and professionals. While patients most frequently blamed themselves, healthcare providers predominantly mentioned lack of communication and organisational issues as contributing factors.Patients and caregivers consider an ED visit preventable less frequently than professionals do. Little consensus was found among patients and healthcare providers, and the perspectives on contributing factors to a preventable visit differ between groups. To help improve geriatric emergency care, future studies should focus on why these perspectives are so different and aim to align them.
- Published
- 2019
8. Exploring the value of routinely measured hematology parameters for identification of elderly patients at high risk of death at the Emergency Department
- Author
-
R S, Bindraban, M J, Ten Berg, S, Haitjema, I E, Hoefer, M, de Regt, Mhh, Kramer, W W, van Solinge, Pwb, Nanayakkara, and C A, Naaktgeboren
- Subjects
C-Reactive Protein ,Diagnostic Tests, Routine ,Humans ,Hematology ,Emergency Service, Hospital ,Prognosis ,Risk Assessment ,Aged - Abstract
Of the warning scores in use for recognition of high-risk patients at the Emergency Department (ED), few incorporate laboratory results. Although hematological characteristics have shown prognostic value in small studies, large studies in elderly ED populations are lacking. We studied the association between blood cell and platelet counts and characteristics as well as C-reactive protein (CRP) at ED presentation with mortality in non-multitrauma patients ≥ 65 years. Comparison between survivors and non-survivors showed small, significant differences with AUROCs ranging between 56.6% and 65.2% for 30-day mortality. Combining parameters yielded an evident improvement (AUROC of 70.4%). Efforts should be pursued to study the added value of hematological parameters on top of clinical data when assessing patient risk.
- Published
- 2019
9. Are we able to predict who needs a bed the most?
- Author
-
Mnt Kremers and Pwb Nanayakkara
- Subjects
Forcing (recursion theory) ,Risk analysis (engineering) ,business.industry ,Health care ,Emergency Medicine ,Internal Medicine ,Psychological intervention ,Medicine ,General Medicine ,Critical Care and Intensive Care Medicine ,business - Abstract
In recent years we indeed have witnessed an increasing demand on healthcare services coupled with spiraling healthcare costs forcing us towards identifying factors and interventions leading to greater healthcare efficiency. The case mix of our ED patients is changing with an increase in the number of the elderly needing acute (hospital) care, often suffering from multiple comorbidities leading to simple problems becoming easily complex and demanding admission. Partly due to this changing case mix, acute bed capacity is under serious pressure leading to ED stagnation and increased waiting times internationally. When the ED is at its capacity, acute physicians have to make choices how to divide the few available beds. Are we able to predict who needs a bed the most and make justified decisions? Which patient can wait at the ED before admission and which ones can’t? The study of Byrne et al. in this issue focused on the association between ED waiting times and clinical outcomes in Ireland, measured by 30 days mortality, using patient data of admitted acute medical patients collected from 2002 until 2017. High Risk Score patients with a longer waiting time at the ED, appear to have an increased risk on mortality. It is therefore necessary to identify these patients early and prioritize their hospital admission. However, to our knowledge, the used risk score isn’t implemented in daily practice. In 2012 the National Early Warning Score (NEWS) has been broadly implemented and it would be of interest to know whether the used retrospective Risk Score using laboratory data accord to the NEWS. Curiously, in this study, patients in all three MTS urgent categories with 6 hours have increased by 50%, from 10 to 15 hours. What caused this increase? What happened in the acute care in Ireland? Have other European countries experienced the same effect or can’t the Irish results not being extrapolated to other European acute care systems? For example, in the Netherlands, the total number of patients being seen at the ED has decreased and stabilised in the last years, although the number of acute medical patients, especially elderly, is increasing. During the last flu season patients we were faced with ED closures, long length of stay and overnight ED stays due to the lack of beds in-hospital. However, waiting hours >12 hours at the ED are rare in Dutch EDs. A key factor in constraining the patient flow to the ED is the well-functioning primary care system with adequate out of office hours care by GP-posts. When a GP post is placed at an ED, GPs treat 75% of the self-referred patient, which is safe and cost-effective. Due to this the ED`s can concentrate on the sick patients who need urgent care. Despite the decreased patient flow to the ED in the Netherlands, the organisation of the acute care has gained much attention of policy makers, media and health care professionals due to frequent ED closures and stagnation in some regions in the Netherlands. Recently, a prediction model for hospital admission in a mixed ED population has been established by using data directly available after triage, aiming to use for shortening the Length of Stay (LOS) at the ED. A computerised tool calculates admission probability for any patient at the time of triage by using age, triage category, arrival mode and main symptom. It demonstrates that different European countries are facing the same issues and are trying to optimize the acute care with some overlapping focus. We believe that at a time where the demand on acute care is increasing, it’s essential to pay attention to the organisation of acute care so that high-quality care is guaranteed and the available resources should be handled efficiently. Studies such as executed by Byrne et al. contribute to this topic and provide lessons which can be learned internationally. We need tools to identify sick patients who need properly care on time and acute physicians can play a central role in developing these tools.
- Published
- 2018
10. Screening instruments for identification of vulnerable older adults at the emergency department: a critical appraisal
- Author
-
C S, van Dam, N, Moss, S A, Schaper, M C, Trappenburg, M M, Ter Wee, K, Scheerman, M, Muller, Pwb, Nanayakkara, and Mjl, Peters
- Abstract
Early detection of vulnerable older adults at the emergency department (ED) and implementation of targeted interventions to prevent functional decline may lead to better patient outcomes.To assess the level of agreement between four frequently used screening instruments: ISAR-HP, VMS, InterRAI ED Screener and APOP.Observational prospective cohort study in patients ≥ 70 years attending Dutch ED.The prevalence of vulnerability ranged from 19% (APOP) to 45% (ISAR-HP). Overall there was a moderate agreement between the screening instruments (Fleiss Kappa of 0.42 (p0.001)).Depending on the screening instrument used, either only a small percentage or almost as many as half of the presenting patients will be eligible for targeted interventions, leading to large dissimilarities in working processes, resources and costs.
- Published
- 2018
11. Results on patient flow of implementing an Acute Medical Unit
- Author
-
S M, Rombach, G, Balke- Budai, J, van Galen, R, Bekker, S E, Smit-Bruineberg, T H, Biesheuvel, Mhh, Kramer, and Pwb, Nanayakkara
- Subjects
Tertiary Care Centers ,Patient Admission ,Humans ,Hospital Mortality ,Length of Stay ,Emergency Service, Hospital ,Delivery of Health Care ,Netherlands - Abstract
There is an increased influx of patients needing admission. Introducing an acute medical unit (AMU) may increase the admission capacity without increasing the total number of beds.Data collected during the first four years after implementation of an AMU in an academic tertiary care center in Amsterdam were analyzed.A 24 bed unit was realized. The total number of admissions increased in the first year with 977 (16%), with an additional 4.1% increase after 2 years with stabilization thereafter. The length of stay decreased, the absolute number of refusals declined, the number of readmissions remained unchanged.Introduction of AMUs in overcrowded services could be beneficial in improving the strain on the acute healthcare systems.
- Published
- 2018
12. Research Protocol: Intravenous Access during Resuscitation: the IVAR trial
- Author
-
Pwb, Nanayakkara and Y M, Smulder
- Abstract
To compare the effects of central versus peripheral drug administration on the rate of return of organised electrical activity and/or spontaneous circulation during CPR.Randomized clinical trial.Hospitalized patients and patients presenting at the emergency department, older than 18 years, requiring CPR.Central venous access Main study parameters/endpoints: Combined primary endpoint: rate of appearance of organised electrical activity or return of spontaneous circulation. Nature and extent of the burden and risks associated with participation, benefit and group relatedness: All patients are treated according to the guidelines of the European Resuscitation Council, which are endorsed by the local VUMC CPR-committee. Central access will be obtained by cannulation of the external or internal jugular vein. To avoid interference with initial management, central venous access will be obtained after initiation of chest compressions, first attempt at defibrillation (if applicable), securing the airway and obtaining a peripheral access. All resuscitated patients require vascular access and almost all successfully resuscitated patients require central venous access. Obtaining central access during CPR may be associated with a slightly higher complication rate, such as arterial puncture and pneumothorax. Possible benefits for study subjects are a higher success rate of CPR.
- Published
- 2017
13. Measurement of generic patient reported outcome measures (PROMs) in an acute admission unit: A feasibility study
- Author
-
L S van, Galen, W van, der Schors, N L, Damen, Mhh, Kramer, C, Wagner, and Pwb, Nanayakkara
- Subjects
Adult ,Male ,Patient Preference ,Quality Improvement ,Patient Care Management ,Hospitalization ,Tertiary Care Centers ,Surveys and Questionnaires ,Outcome Assessment, Health Care ,Feasibility Studies ,Humans ,Female ,Patient Reported Outcome Measures ,Emergency Service, Hospital ,Netherlands - Abstract
Measuring patient-reported outcome measures (PROMs) is a challenge in Acute Admission Units (AAUs), where patients present with a variety of pathologies. Generic PROMs may be used to measure the quality of care in this population. The main objective of this study was to assess the feasibility of measuring generic PROMs in a Dutch AAU.Longitudinal cohort study Setting: An AAU of a tertiary hospital in Amsterdam, the Netherlands Participants: 123 patients admitted to the AAU during 5 weeks in May and June 2015 METHODS: Patients admitted to the AAU were asked to fill out a questionnaire relating to three time points: 7 days before, during, and within 2 weeks after admission. Additionally, patients were asked to report on their experienced level of safety on the AAU and the contribution of the AAU to their recovery.There were significant trends in generic PROMs for all three domains. Physical functioning decreased during hospital admission and almost fully returned to the previous level after discharge. Satisfaction with social role and anxiety significantly decreased over time.Measuring generic PROMs in the AAU is feasible. The analysis of the PROMs took little effort and results could be reported back to the healthcare workers on the AAU quickly. Patients appreciated being asked about their own perceived health and the quality of care. Given that this is the first study focusing on PROMs in AAU patients in the Netherlands, future studies with larger sample sizes, and from other nations are needed to further investigate PROMs in this patient group to establish International reference values.
- Published
- 2016
14. Screening instruments for identification of vulnerable older adults at the emergency department: A critical appraisal
- Author
-
C S van Dam, N Moss, Mjl Peters, K Scheerman, S A Schaper, Marijke C. Trappenburg, M M Ter Wee, Majon Muller, Pwb Nanayakkara, AMS - Ageing and Morbidity, Neuromechanics, Internal medicine, APH - Aging & Later Life, Amsterdam Movement Sciences - Rehabilitation & Development, Epidemiology and Data Science, ACS - Atherosclerosis & ischemic syndromes, APH - Quality of Care, ACS - Diabetes & metabolism, and APH - Digital Health
- Subjects
InterRAI ED screener ,medicine.medical_specialty ,ISAR-HP ,Vulnerability ,Fleiss' kappa ,Critical Care and Intensive Care Medicine ,Internal Medicine ,Medicine ,In patient ,Prospective cohort study ,business.industry ,Emergency department ,APOP ,General Medicine ,Targeted interventions ,Critical appraisal ,Older adults ,Emergency medicine ,Emergency Medicine ,Screening ,VMS ,Observational study ,business - Abstract
BACKGROUND: Early detection of vulnerable older adults at the emergency department (ED) and implementation of targeted interventions to prevent functional decline may lead to better patient outcomes.OBJECTIVE: To assess the level of agreement between four frequently used screening instruments: ISAR-HP, VMS, InterRAI ED Screener and APOP.METHODS: Observational prospective cohort study in patients ≥ 70 years attending Dutch ED.RESULTS: The prevalence of vulnerability ranged from 19% (APOP) to 45% (ISAR-HP). Overall there was a moderate agreement between the screening instruments (Fleiss Kappa of 0.42 (pCONCLUSION: Depending on the screening instrument used, either only a small percentage or almost as many as half of the presenting patients will be eligible for targeted interventions, leading to large dissimilarities in working processes, resources and costs.
15. Strategies for implementation of a transmural fall-prevention care pathway for older adults with fall-related injuries at the emergency department.
- Author
-
Charmant WM, Snoeker BAM, van Hout HPJ, Geleijn E, van der Velde N, Veenhof C, and Nanayakkara PWB
- Subjects
- Humans, Aged, Female, Male, Risk Assessment, Aged, 80 and over, Critical Pathways, Wounds and Injuries prevention & control, Accidental Falls prevention & control, Emergency Service, Hospital
- Abstract
Background: Although indicated, referrals for multifactorial fall risk assessments in older adults with fall related injuries presenting at the emergency department (ED) are not standard. The implementation of a transmural fall-prevention care pathway (TFCP) could bridge this gap by guiding patients to multifactorial fall risk assessments and personalised multidomain interventions in primary care. This study aims to develop and evaluate implementation strategies for a TFCP., Methods: In this mixed-methods implementation study, strategies were developed using the Consolidated Framework for Implementation Research Expert Recommendations for Implementing Change Matching Tool. These were evaluated with patients, involved healthcare professionals, and other stakeholders using the Reach, Adoption, Implementation, and Maintenance of the RE-AIM framework in two cycles. Patients of the TFCP consisted of frail community dwelling individuals aged 65 and over presenting at the ED with fall related injuries., Results: During the first implementation phase, strategies were focussed on assessing readiness, adaptability, local champions, incentives and education for all involved healthcare professions in the TFCP. Only 34.4% of eligible patients were informed of the TFCP at the ED, 30.6% agreed to a fall risk assessment and 8.3% patients received the fall risk assessment. In the second phase, this improved to 67.1%, 64.6%, and 35.4%, respectively. Strategies in this phase focussed on adaptability, obtaining sustainable financial resources, local champions, assessing readiness, and education. The implementation was facilitated by strategies related to awareness, champion recruitment, educational meetings, adaptability of TFCP elements and evaluations of facilitators and barriers., Conclusion: The study outlined strategies for implementing TFCPs in EDs. Strategies included increasing awareness, utilising local champions, educational initiatives, adaptability of the TFCP, and continuous monitoring of facilitators and barriers. These insights can serve as a blueprint for enhancing fall prevention efforts for older adults in emergency department settings., (© 2024. The Author(s).)
- Published
- 2024
- Full Text
- View/download PDF
16. Patients' Perspectives and Feasibility of Home Monitoring in Acute Care: The AcuteCare@Home Flash Mob Study.
- Author
-
Weijers J, Prins MLM, van Dam DGHA, van Nieuwkoop C, Alsma J, Haak HR, V Uffen JW, Kaasjager KAH, Kremers MNT, Nanayakkara PWB, Stassen PM, and Groeneveld GH
- Subjects
- Humans, Male, Aged, Female, Middle Aged, Netherlands, Prospective Studies, Feasibility Studies, Acute Disease, Monitoring, Physiologic methods, Patient Preference, Aged, 80 and over, Emergency Service, Hospital, Home Care Services organization & administration
- Abstract
Objective: To determine patients' perspectives on home monitoring at emergency department (ED) presentation and shortly after admission and compare these with their physicians' perspectives. Methods: Forty Dutch hospitals participated in this prospective flash mob study. Adult patients with acute medical conditions, treated by internal medicine specialties, presenting at the ED or admitted at the admission ward within the previous 24 h were included. The primary outcome was the proportion of patients who were able and willing to undergo home monitoring. Secondary outcomes included identifying barriers to home monitoring, patient's prerequisites, and assessing the agreement between the perspectives of patients and treating physicians. Results: On February 2, 2023, in total 665 patients [median age 69 (interquartile range: 55-78) years; 95.5% community dwelling; 29.3% Modified Early Warning Score ≥3; 29.5% clinical frailty score ≥5] were included. In total, 19.6% of ED patients were admitted and 26% of ward patients preferred home monitoring as continuation of care. Guaranteed readmission (87.8%), ability to contact the hospital 24/7 (77.3%), and a family caregiver at home (55.7%) were the most often reported prerequisites. Barriers for home monitoring were feeling too severely ill (78.8%) and inability to receive the required treatment at home (64.4%). The agreement between patients and physicians was fair (Cohens kappa coefficient 0.26). Conclusions: A substantial proportion of acutely ill patients stated that they were willing and able to be monitored at home. Guaranteed readmission, availability of a treatment team (24/7), and a home support system are needed for successful implementation of home monitoring in acute care.
- Published
- 2024
- Full Text
- View/download PDF
17. Fatal Adverse Events in Femoral Neck Fracture Patients Undergoing Hemiarthroplasty or Total Hip Arthroplasty-A Retrospective Record Review Study in a Nationwide Sample of Deceased Patients.
- Author
-
Schouten B, Baartmans M, van Eikenhorst L, Gerritsen GP, Merten H, van Schoten S, Nanayakkara PWB, and Wagner C
- Subjects
- Humans, Retrospective Studies, Female, Male, Aged, 80 and over, Aged, Netherlands, Postoperative Complications epidemiology, Postoperative Complications etiology, Patient Safety statistics & numerical data, Middle Aged, Femoral Neck Fractures surgery, Arthroplasty, Replacement, Hip adverse effects, Hemiarthroplasty adverse effects, Hemiarthroplasty methods
- Abstract
Objectives: Patient safety is a core component of quality of hospital care and measurable through adverse event (AE) rates. A high-risk group are femoral neck fracture patients. The Dutch clinical guideline states that the treatment of choice is cemented total hip arthroplasty (THA) or hemiarthroplasty (HA). We aimed to identify the prevalence of AEs related to THA/HA in a sample of patients who died in the hospital., Methods: We used data of a nationwide retrospective record review study. Records were systematically reviewed for AEs, preventability and contribution to the patient's death. We drew a subsample of THA/HA AEs and analyzed these cases., Results: Of the 2998 reviewed records, 38 patients underwent THA/HA, of whom 24 patients suffered 25 AEs (prevalence = 68.1%; 95% confidence interval, 51.4-81.2), and 24 contributed to death. Patients with a THA/HA AE were of high age (median = 82.5 y) and had severe comorbidity (Charlson score ≥5). The majority of THA/HA AEs had a patient-related cause and was considered partly preventable. Examples of suggested actions that might have prevented the AEs: refraining from surgery, adhering to medication guidelines, uncemented procedures, comprehensive presurgical geriatric assessment, and better postsurgical monitoring., Discussion: Our study shows a high prevalence of (fatal) adverse events in patients undergoing THA/HA. This seems particularly valid for cemented implants in frail old patients, indicating room for improvement of patient safety in this group. Therefore, we recommend physicians to engage in comprehensive shared decision making with these patients and decide on a treatment fitting to a patient's preexisting health status, preferences, and values., Competing Interests: The authors disclose no conflict of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)
- Published
- 2024
- Full Text
- View/download PDF
18. Sleep assessment using EEG-based wearables - A systematic review.
- Author
-
de Gans CJ, Burger P, van den Ende ES, Hermanides J, Nanayakkara PWB, Gemke RJBJ, Rutters F, and Stenvers DJ
- Subjects
- Humans, Sleep Stages physiology, Sleep physiology, Electroencephalography methods, Wearable Electronic Devices, Polysomnography
- Abstract
Polysomnography (PSG) is the reference standard of sleep measurement, but is burdensome for the participant and labor intensive. Affordable electroencephalography (EEG)-based wearables are easy to use and are gaining popularity, yet selecting the most suitable device is a challenge for clinicians and researchers. In this systematic review, we aim to provide a comprehensive overview of available EEG-based wearables to measure human sleep. For each wearable, an overview will be provided regarding validated population and reported measurement properties. A systematic search was conducted in the databases OVID MEDLINE, Embase.com and CINAHL. A machine learning algorithm (ASReview) was utilized to screen titles and abstracts for eligibility. In total, 60 papers were selected, covering 34 unique EEG-based wearables. Feasibility studies indicated good tolerance, high compliance, and success rates. The 42 included validation studies were conducted across diverse populations and showed consistently high accuracy in sleep staging detection. Therefore, the recent advancements in EEG-based wearables show great promise as alternative for PSG and for at-home sleep monitoring. Users should consider factors like user-friendliness, comfort, and costs, as these devices vary in features and pricing, impacting their suitability for individual needs., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
19. A Prospective Observational Clinical Cohort of Women with Suspected Breast Implant Illness.
- Author
-
Spit KA, Azahaf S, de Blok CJM, and Nanayakkara PWB
- Abstract
Background : This study aims to describe a prospective clinical cohort of patients with silicone breast implants and suspected Breast Implant Illness (BII). Methods : Women were included in a specialized silicone outpatient clinic at Amsterdam UMC, the Netherlands. Baseline characteristics were collected including medical history, implant details, and symptoms. Experienced physicians categorized BII suspicion as high, moderate, or low, based on symptoms and after exclusion of other probable causes. Additionally, participants completed questionnaires assessing symptoms and daily life impact at baseline, 6 months, 1, 2, and 5 years. For this initial analysis, the results from the first three years of inclusions were collected. Results : Data from 353 women were collected from December 2020-December 2023. At baseline, the most reported symptoms were fatigue, arthralgia, myalgia, and morning stiffness, accompanied by local symptoms in 83.3% of patients. At the clinic, 112 women were categorized as having high suspicion of BII, 147 women as moderate, and 94 women as low. At follow-up, 182 women (51.6%) opted for explantation. Following explantation, women with a high or moderate suspicion of BII experienced more significant symptom improvement, accompanied by a decrease in anxiety and a greater sense of control over their illness, compared to women with a low suspicion of BII. Conclusions : Our study highlights a distinct interplay of systemic and local symptoms among women with suspicion of BII. Women with a high or moderate BII suspicion benefit significantly more from explantation than women with low suspicion. Experienced physicians are pivotal in effectively assessing and guiding this patient group, highlighting the need for tailored clinical approaches.
- Published
- 2024
- Full Text
- View/download PDF
20. [A redesign of the acute care chain: evaluation of acute care in Den Helder, The Netherlands].
- Author
-
van Goor MA, Minderhoud TC, Hengeveld E, Schouten B, Kleppe CG, Kremers MNT, Haak-van der Lely F, and Nanayakkara PWB
- Subjects
- Humans, Netherlands, Surveys and Questionnaires, Focus Groups, Quality Indicators, Health Care, Emergency Service, Hospital organization & administration, Quality of Health Care
- Abstract
This study researches the quality of care of the newly redesigned Department of Acute Care (AAZ), at the Noordwest Hospital in Den Helder. It is a multi-methodological study. Quality indicators were descriptively compared with a conventional Emergency Department (ED) at the location in Alkmaar. Moreover, focus groups were held among nurses employed in the AAZ and patient experiences were recorded by the Picker Institute with a validated questionnaire. The study shows that the quality of acute care in the harmonica model of the AAZ achieves comparable results compared to the conventional ED design at Alkmaar. These results imply that it is feasible to provide acute care near the patient, with efficient staffing through a redesign of the acute care chain.
- Published
- 2024
21. Diagnostic agreement between emergency medical service and emergency department physicians, a prospective multicentre study.
- Author
-
Veldhuis LI, Gouma P, Nanayakkara PWB, and Ludikhuize J
- Subjects
- Humans, Prospective Studies, Female, Male, Middle Aged, Netherlands, Aged, Adult, Emergency Medical Services, Wounds and Injuries diagnosis, Emergency Service, Hospital
- Abstract
Introduction: Early and adequate preliminary diagnosis reduce emergency department (ED) and hospital stay and may reduce mortality. Several studies demonstrated adequate preliminary diagnosis as stated by emergency medical services (EMS) ranging between 61 and 77%. Dutch EMS are highly trained, but performance of stating adequate preliminary diagnosis remains unknown., Methods: This prospective observational study included 781 patients (> 18years), who arrived in the emergency department (ED) by ambulance in two academic hospitals. For each patient, the diagnosis as stated by EMS and the ED physician was obtained and compared. Diagnosis was categorized based on the International Classification of Diseases, 11th Revision., Results: The overall diagnostic agreement was 79% [95%-CI: 76-82%]. Agreement was high for traumatic injuries (94%), neurological emergencies (90%), infectious diseases (84%), cardiovascular (78%), moderate for mental and drug related (71%), gastrointestinal (70%), and low for endocrine and metabolic (50%), and acute internal emergencies (41%). There is no correlation between 28-day mortality, the need for ICU admission or the need for hospital admission with an adequate preliminary diagnosis., Conclusion: In the Netherlands, the extent of agreement between EMS diagnosis and ED discharge diagnosis varies between categories. Accuracy is high in diseases with specific observations, e.g., neurological failure, detectable injuries, and electrocardiographic abnormalities. Further studies should use these findings to improve patient outcome., (© 2024. The Author(s).)
- Published
- 2024
- Full Text
- View/download PDF
22. Ultrasound versus MRI for evaluation of silicone leakage from silicone breast implants.
- Author
-
Spit KA, Azahaf S, de Blok CJM, Duvivier KM, Wiebenga OT, and Nanayakkara PWB
- Abstract
Background: Implant ruptures and gel bleed are not uncommon among women with silicone breast implants. While magnetic resonance imaging (MRI) is traditionally considered the gold standard diagnostic modality, recent studies suggest ultrasound might be an acceptable alternative. This study compares the efficacy of ultrasound and MRI in assessing implant integrity., Methods: Women with silicone breast implants underwent a breast and axillary ultrasound and MRI on the same day. All tests were assessed by experienced radiologists. The accuracy, sensitivity, and specificity of ultrasound and MRI for implant rupture detection and silicone depositions in axillary lymph nodes were evaluated., Findings: A total of 104 women participated in the study. The accuracy, sensitivity, and specificity of ultrasound for detecting implant ruptures compared to MRI were 96 %, 95 %, and 96 %, respectively. MRI demonstrated significantly lower sensitivity (44 %) for detecting silicone depositions in axillary lymph nodes compared to ultrasound. A significant association was observed between the presence of enlarged axillary lymph nodes and/or axillary pain and the detection of silicone depositions in axillary lymph nodes on ultrasound (χ
2 (1, N = 104) = 5·1, p = 0·024). Six women exhibited silicone depositions in axillary lymph nodes despite having intact first-pair implants, indicative of gel bleed., Interpretation: Ultrasound is nearly as effective as MRI for detecting breast implant ruptures and is superior for detecting silicone depositions in axillary lymph nodes. We therefore recommend initiating radiological examination in women with breast implants with a breast and axillary ultrasound, proceeding to MRI only if the ultrasound is inconclusive. The prevalence of gel bleed is understudied and its potential adverse health effects might be underestimated. Further research is needed to explore its potential association with development of systemic symptoms., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Ltd.)- Published
- 2024
- Full Text
- View/download PDF
23. Adverse events at the end of life of hospital patients with or without a condition relevant for palliative care: a nationwide retrospective record review study in the Netherlands.
- Author
-
Schouten B, van Schoten SM, Bijnsdorp FM, Merten H, Nanayakkara PWB, Reyners AKL, Francke AL, and Wagner C
- Subjects
- Humans, Netherlands epidemiology, Retrospective Studies, Male, Female, Aged, Middle Aged, Aged, 80 and over, Terminal Care methods, Terminal Care standards, Terminal Care statistics & numerical data, Adult, Medical Errors statistics & numerical data, Patient Safety standards, Patient Safety statistics & numerical data, Palliative Care methods, Palliative Care standards, Palliative Care statistics & numerical data
- Abstract
Background: Patient safety is crucial for quality of care. Preventable adverse events (AEs) occur in 1 of 20 patients in the hospital, but it is unknown whether this is different for patients with a condition relevant for palliative care. The majority of the limited available research on this topic is only focused on patients already receiving palliative care, and do not make comparisons with other patients at the end-of-life. We identified and compared the prevalence, preventability, nature and causes of AEs in patients with and without a condition relevant for palliative care., Methods: A nationwide retrospective record review study was performed in 20 Dutch hospitals. A total of 2,998 records of patients who died in hospital in 2019 was included. Records were reviewed for AEs. We identified two subgroups: patients with (n = 2,370) or without (n = 248) a condition relevant for palliative care through the selection method of Etkind (2017). Descriptive analyses were performed to calculate prevalence, nature, causes and prevention strategies. T-tests were performed to calculate differences between subgroups., Results: We found no significant differences between subgroups regarding AE prevalence, this was 15.3% in patients with a condition relevant for palliative care, versus 12.0% in patients without a condition relevant for palliative care (p = 0.148). Potentially preventable AE prevalence was 4.3% versus 4.4% (p = 0.975). Potentially preventable death prevalence in both groups was 3.2% (p = 0.938). There were differences in the nature of AEs: in patients with a condition relevant for palliative care this was mostly related to medication (33.1%), and in patients without a condition relevant for palliative care to surgery (50.8%). In both subgroups in the majority of AEs a patient related cause was identified. For the potentially preventable AEs in both subgroups the two most important prevention strategies as suggested by the medical reviewers were reflection and evaluation and quality assurance., Discussion: Patient safety risks appeared to be equally prevalent in both subgroups. The nature of AEs does differ between subgroups: medication- versus surgery-related, indicating that tailored safety measures are needed. Recommendations for practice are to focus on reflecting on AEs, complemented with case evaluations., (© 2024. The Author(s).)
- Published
- 2024
- Full Text
- View/download PDF
24. Appropriate use of blood cultures in the emergency department through machine learning (ABC): study protocol for a randomised controlled non-inferiority trial.
- Author
-
van der Zaag AY, Bhagirath SC, Boerman AW, Schinkel M, Paranjape K, Azijli K, Ridderikhof ML, Lie M, Lissenberg-Witte B, Schade R, Wiersinga J, de Jonge R, and Nanayakkara PWB
- Subjects
- Humans, Netherlands, Hospital Mortality, Equivalence Trials as Topic, Length of Stay statistics & numerical data, Randomized Controlled Trials as Topic, Unnecessary Procedures statistics & numerical data, Anti-Bacterial Agents therapeutic use, Emergency Service, Hospital, Machine Learning, Blood Culture methods
- Abstract
Introduction: The liberal use of blood cultures in emergency departments (EDs) leads to low yields and high numbers of false-positive results. False-positive, contaminated cultures are associated with prolonged hospital stays, increased antibiotic usage and even higher hospital mortality rates. This trial aims to investigate whether a recently developed and validated machine learning model for predicting blood culture outcomes can safely and effectively guide clinicians in withholding unnecessary blood culture analysis., Methods and Analysis: A randomised controlled, non-inferiority trial comparing current practice with a machine learning-guided approach. The primary objective is to determine whether the machine learning based approach is non-inferior to standard practice based on 30-day mortality. Secondary outcomes include hospital length-of stay and hospital admission rates. Other outcomes include model performance and antibiotic usage. Participants will be recruited in the EDs of multiple hospitals in the Netherlands. A total of 7584 participants will be included., Ethics and Dissemination: Possible participants will receive verbal information and a paper information brochure regarding the trial. They will be given at least 1 hour consideration time before providing informed consent. Research results will be published in peer-reviewed journals. This study has been approved by the Amsterdam University Medical Centers' local medical ethics review committee (No 22.0567). The study will be conducted in concordance with the principles of the Declaration of Helsinki and in accordance with the Medical Research Involving Human Subjects Act, General Data Privacy Regulation and Medical Device Regulation., Trial Registration Number: NCT06163781., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)
- Published
- 2024
- Full Text
- View/download PDF
25. Can acutely ill patients predict their outcomes? A scoping review.
- Author
-
Mols EM, Haak H, Holland M, Schouten B, Ibsen S, Merten H, Christensen EF, Nanayakkara PWB, Nickel CH, Weichert I, Kellett J, Subbe CP, and Kremers MNT
- Subjects
- Humans, Acute Disease, Prognosis, Patient Satisfaction
- Abstract
Introduction: The full impact of an acute illness on subsequent health is seldom explicitly discussed with patients. Patients' estimates of their likely prognosis have been explored in chronic care settings and can contribute to the improvement of clinical outcomes and patient satisfaction. This scoping review aimed to identify studies of acutely ill patients' estimates of their outcomes and potential benefits for their care., Methods: A search was conducted in PubMed, Embase, Web of Science and Google Scholar, using terms related to prognostication and acute care. After removal of duplicates, all articles were assessed for relevance by six investigator pairs; disagreements were resolved by a third investigator. Risk of bias was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions., Results: Our search identified 3265 articles, of which 10 were included. The methods of assessing self-prognostication were very heterogeneous. Patients seem to be able to predict their need for hospital admission in certain settings, but not their length of stay. The severity of their symptoms and the burden of their disease are often overestimated or underestimated by patients. Patients with severe health conditions and their relatives tend to be overoptimistic about the likely outcome., Conclusion: The understanding of acutely ill patients of their likely outcomes and benefits of treatment has not been adequately studied and is a major knowledge gap. Limited published literature suggests patients may be able to predict their need for hospital admission. Illness perception may influence help-seeking behaviour, speed of recovery and subsequent quality of life. Knowledge of patients' self-prognosis may enhance communication between patients and their physicians, which improves patient-centred care., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2024
- Full Text
- View/download PDF
26. Breast implant iatrogenics: challenging the safety narrative.
- Author
-
Azahaf S, Spit KA, de Blok CJM, Willging L, Rolfs H, and Nanayakkara PWB
- Abstract
Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
- Published
- 2024
- Full Text
- View/download PDF
27. A Comparative Analysis of Local and Systemic Immunological Biomarkers in Females With Breast Implants and Capsular Contracture.
- Author
-
Spit KA, Azahaf S, de Blok CJM, Bachour Y, Castricum KCM, Thijssen VLJL, Oudejans MAH, Rustemeyer T, and Nanayakkara PWB
- Abstract
Background: The etiology of capsular contracture (CC), the most common complication following breast augmentation, remains unclear. Chronic, fibrotic inflammation resulting in excessive fibrosis has been proposed as a potential mechanism., Objectives: In this study, we aimed to investigate the relation between biomarkers that are associated with inflammation and fibrosis and the severity of CC., Methods: Fifty healthy females were categorized into 3 groups: females with no-to-mild CC (Baker 1-2; n = 15), females with severe CC (Baker 3-4; n = 20), and a control group awaiting breast augmentation ( n = 15). We assessed 5 biomarkers (galectin-1 [Gal-1], interferon-β [INF-β], interferon-γ [INF-γ], interleukin-6 [IL-6], and tumor necrosis factor-α [TNF-α]) in breast implant capsules and serum samples., Results: No significant differences in intracapsular cytokine levels were observed between the Baker 1-2 and the Baker 3-4 groups, as the levels were generally low and, in some cases, almost undetectable. In the blood samples, no significant differences in Gal-1, INF-γ, IL-6, or TNF-α levels were found within the 3 groups. We identified significantly increased levels of INF-β ( P = .009) in the blood samples of females with severe CC, driven mainly by 3 extremely high values., Conclusions: The cytokines assessed in this study did not reflect the degree of CC among females with silicone breast implants. However, 3 females with severe CC, who all had prolonged silicone exposure, showed extremely elevated levels of INF-β in their serum samples. This possible association between prolonged silicone exposure and systemic inflammation in some females should be further investigated., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Aesthetic Society.)
- Published
- 2024
- Full Text
- View/download PDF
28. Silicone Migration from Intact Saline Breast Implants.
- Author
-
Azahaf S, Spit KA, de Blok CJM, Bult P, and Nanayakkara PWB
- Abstract
Breast augmentation is a widely performed surgical procedure worldwide, predominantly using silicone gel-filled implants. Concerns have primarily revolved around ruptures and the potential health risks associated with leaked silicone from silicone gel-filled implants. Cases of silicone migration from the shell of saline breast implants remain scarce. This case report introduces a unique case of a 66-year-old patient with silicone migration from intact saline breast implants. The patient presented with a range of symptoms consistent with breast implant illness. Radiological findings suggested the presence of silicone in the axillary lymph nodes, despite the integrity of the implants, thereby confirming silicone migration. Histopathological evaluation revealed a foreign body reaction and the presence of silicone in the axillary lymph nodes. Given the saline filling, the source is likely the polydimethylsiloxane shell. The rarity of documented silicone migration from intact saline breast implants, especially in patients with breast implant illness, underscores the need for more research into the health implications of leaked silicone particles from breast implants., Competing Interests: The authors have no financial interest to declare in relation to the content of this article. This research was financially supported by the silicone breast implant research program, coordinated by the National Institute of Public Health and the Environment on behalf of the Ministry of Health, Welfare, and Sport., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)
- Published
- 2024
- Full Text
- View/download PDF
29. Detecting changes in the performance of a clinical machine learning tool over time.
- Author
-
Schinkel M, Boerman AW, Paranjape K, Wiersinga WJ, and Nanayakkara PWB
- Subjects
- Adult, Humans, Longitudinal Studies, Time Factors, Emergency Service, Hospital, Benchmarking, Machine Learning
- Abstract
Background: Excessive use of blood cultures (BCs) in Emergency Departments (EDs) results in low yields and high contamination rates, associated with increased antibiotic use and unnecessary diagnostics. Our team previously developed and validated a machine learning model to predict BC outcomes and enhance diagnostic stewardship. While the model showed promising initial results, concerns over performance drift due to evolving patient demographics, clinical practices, and outcome rates warrant continual monitoring and evaluation of such models., Methods: A real-time evaluation of the model's performance was conducted between October 2021 and September 2022. The model was integrated into Amsterdam UMC's Electronic Health Record system, predicting BC outcomes for all adult patients with BC draws in real time. The model's performance was assessed monthly using metrics including the Area Under the Curve (AUC), Area Under the Precision-Recall Curve (AUPRC), and Brier scores. Statistical Process Control (SPC) charts were used to monitor variation over time., Findings: Across 3.035 unique adult patient visits, the model achieved an average AUC of 0.78, AUPRC of 0.41, and a Brier score of 0.10 for predicting the outcome of BCs drawn in the ED. While specific population characteristics changed over time, no statistical points outside the statistical control range were detected in the AUC, AUPRC, and Brier scores, indicating stable model performance. The average BC positivity rate during the study period was 13.4%., Interpretation: Despite significant changes in clinical practice, our BC stewardship tool exhibited stable performance, suggesting its robustness to changing environments. Using SPC charts for various metrics enables simple and effective monitoring of potential performance drift. The assessment of the variation of outcome rates and population changes may guide the specific interventions, such as intercept correction or recalibration, that may be needed to maintain a stable model performance over time. This study suggested no need to recalibrate or correct our BC stewardship tool., Funding: No funding to disclose., Competing Interests: Declaration of interests The authors declare no competing interests regarding this work., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)
- Published
- 2023
- Full Text
- View/download PDF
30. The impact of a sepsis performance improvement program in the emergency department: a before-after intervention study.
- Author
-
Schinkel M, Holleman F, Vleghels R, Brugman K, Ridderikhof ML, Dzelili M, Nanayakkara PWB, and Wiersinga WJ
- Subjects
- Adult, Humans, Emergency Service, Hospital, Length of Stay, Hospitalization, Hospital Mortality, Sepsis diagnosis, Sepsis therapy
- Abstract
Purpose: The latest Surviving Sepsis Campaign guidelines advocate that all hospitals use sepsis performance improvement programs. However, there is a limited evidence about how to structure such programs and what their potential impact is on sepsis management and outcomes in the emergency department (ED). In this study, we evaluated the implementation of a sepsis performance improvement program in the ED including a dedicated sepsis response team and analyzed the management and outcomes of sepsis patients before and after., Methods: We conducted a before-after interventional study in the ED of the Amsterdam University Medical Centers, the Netherlands. The sepsis performance improvement program included regular educational meetings, daily audits and weekly feedback, a screening tool, and a dedicated multidisciplinary sepsis response team. We studied all adult patients who presented to the ED with a suspected infection and a Modified Early Warning Score (MEWS) ≥ 3 during their stay. In the postintervention phase, these patients were seen by the sepsis team. Process-related and patient-related outcomes were measured between November 2019 and February 2020 (preintervention) and December 2021-May 2022 (postintervention)., Results: A total of 265 patients were included in the primary study, 132 patients preintervention and 133 patients postintervention. The postintervention phase was associated with improvements in nearly all process-related outcomes, such as a shorter time to antibiotics (66 vs. 143 min; p < 0.001), increased number of lactate measurements (72.9 vs. 46.2%; p < 0.001), and improved completeness of documented MEWS scores (85.0 vs. 62.9%; p < 0.001). Except for an improvement in the number of immediate versus delayed ICU admissions (100% immediate vs. 64.3% immediate; p = 0.012), there was no improvement in the other patient-related outcomes such as 28 days mortality (14.3 vs. 9.1%; p = 0.261), during the postintervention phase., Conclusion: Our program stimulated physicians to make timely decisions regarding diagnostics and treatment of sepsis in the ED. Implementing the sepsis performance improvement program was associated with significant improvements in most process-related outcomes but with minimal improvements in patient-related outcomes in our cohort., (© 2022. The Author(s).)
- Published
- 2023
- Full Text
- View/download PDF
31. Older patients with nonspecific complaints at the Emergency Department are at risk of adverse health outcomes.
- Author
-
van Dam CS, Peters MJL, Hoogendijk EO, Nanayakkara PWB, Muller M, and Trappenburg MC
- Subjects
- Humans, Female, Aged, Cohort Studies, Length of Stay, Outcome Assessment, Health Care, Emergency Service, Hospital, Hospitalization
- Abstract
Objective: Older adults at the Emergency Department (ED) often present with nonspecific complaints (NSC) such as 'weakness' or 'feeling unwell'. Health care workers may underestimate illness in patients with NSC, leading to adverse health outcomes. This study compares characteristics and outcomes of NSC-patients versus specific complaints (SC) patients., Methods: Cohort study in patients ≥ 70 years in two Dutch EDs. NSC was classified according to the BANC-study-framework based on the medical history in the ED letter, before additional diagnostics took place. A second classification was performed at the end of the ED visit/hospital admission. Primary outcomes were functional decline, institutionalization, and mortality at 30 days., Results: 26% (n = 228) of a total of 888 included patients presented with NSC. Compared with SC-patients, NSC-patients were older, more frail, and more frequently female. NSC-patients had a higher risk of functional decline and institutionalization at 30 days (adjusted ORs 1.84, 95% CI 1.27 - 2.72, and 2.46, 95% CI 1.51-4.00, respectively), but not mortality (adjusted OR 1.26, 95% CI 0.58 - 2.73). Reclassification to a specific complaint after the ED visit or hospital admission occurred in 54% of NSC-patients., Conclusion: NSC occur especially in older, frail female patients and are associated with an increased risk of functional decline and institutionalization, even after adjustment for worse baseline status. In half of the patients, a specific complaint revealed during ED or hospital stay. Physicians at the ED should consider NSC as a red flag needing appropriate observation and evaluation of underlying serious conditions and needs of this vulnerable patient group., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)
- Published
- 2023
- Full Text
- View/download PDF
32. Embracing cohort heterogeneity in clinical machine learning development: a step toward generalizable models.
- Author
-
Schinkel M, Bennis FC, Boerman AW, Wiersinga WJ, and Nanayakkara PWB
- Subjects
- Humans, Machine Learning
- Abstract
This study is a simple illustration of the benefit of averaging over cohorts, rather than developing a prediction model from a single cohort. We show that models trained on data from multiple cohorts can perform significantly better in new settings than models based on the same amount of training data but from just a single cohort. Although this concept seems simple and obvious, no current prediction model development guidelines recommend such an approach., (© 2023. The Author(s).)
- Published
- 2023
- Full Text
- View/download PDF
33. Screening for asymptomatic deep vein thrombosis in COVID-19 patients admitted to the medical ward: a cross-sectional study.
- Author
-
Olgers TJ, Lieveld AWE, Kok B, Heijmans J, Salet D, Assman NL, Postma DF, Bauer MP, Nanayakkara PWB, Meijer K, Bosch FH, and Kooistra H
- Subjects
- Adult, Humans, Cross-Sectional Studies, COVID-19 complications, Venous Thrombosis diagnostic imaging, Venous Thrombosis epidemiology, Venous Thromboembolism diagnostic imaging, Venous Thromboembolism epidemiology, Venous Thromboembolism complications, Pulmonary Embolism diagnostic imaging, Pulmonary Embolism epidemiology
- Abstract
Purpose: Patients with COVID-19 have an increased risk for venous thrombo-embolism (VTE), especially pulmonary embolism. The exact prevalence of asymptomatic DVT is not known, as is the usefulness of screening for DVT in patients admitted to ward with COVID-19. We have studied the prevalence of asymptomatic DVT., Methods: We performed a cross-sectional observational multi-center study at four university medical centers in The Netherlands. All adult patients admitted with COVID-19 to a medical ward were eligible for inclusion, including patients who were transferred back from the ICU to the ward. The study protocol consisted of weekly cross-sectional rounds of compression ultrasound., Results: In total, 125 patients were included in the study. A significant proportion of patients (N = 34 (27%)) had developed a VTE during their admission for COVID-19 before the study ultrasound was performed. In most VTE cases (N = 27 (79%)) this concerned pulmonary embolism. A new asymptomatic DVT was found in 5 of 125 patients (4.0%; 95% CI 1.3-9.1%) (Table 2). Nine patients (7.2%; 95% CI 3.3-13.2%) developed a VTE (all PE) diagnosed within 28 days after the screening US was performed., Conclusion: We have shown a low prevalence (4%) of newly discovered asymptomatic DVT outside the ICU-setting in COVID-19 patients. Despite this low prevalence, nine patients developed PE (7%) within 28 days after ultrasound. This favors the hypothesis of local thrombus formation in the lungs. Based on our findings and literature, we do not recommend US-screening of asymptomatic patients with COVID-19 admitted to the ward., (© 2022. The Author(s).)
- Published
- 2023
- Full Text
- View/download PDF
34. Monitoring of pulmonary involvement in critically ill COVID-19 patients - should lung ultrasound be preferred over CT?
- Author
-
Lieveld AWE, Heldeweg MLA, Schouwenburg J, Veldhuis L, Haaksma ME, van Haaften RM, Teunissen BP, Smit JM, Twisk J, Heunks L, Nanayakkara PWB, and Tuinman PR
- Abstract
Background: It is unclear if relevant changes in pulmonary involvement in critically ill COVID-19 patients can be reliably detected by the CT severity score (CTSS) and lung ultrasound score (LUSS), or if these changes have prognostic implications. In addition, it has been argued that adding pleural abnormalities to the LUSS could improve its prognostic value. The objective of this study was to compare LUSS and CTSS for the monitoring of COVID-19 pulmonary involvement through: first, establishing the correlation of LUSS (± pleural abnormalities) and CTSS throughout admission; second, assessing agreement and measurement error between raters for LUSS, pleural abnormalities, and CTSS; third, evaluating the association of the LUSS (± pleural abnormalities) and CTSS with mortality at different timepoints., Methods: This is a prospective, observational study, conducted during the second COVID-19 wave at the AmsterdamUMC, location VUmc. Adult COVID-19 ICU patients were prospectively included when a CT or a 12-zone LUS was performed at admission or at weekly intervals according to local protocol. Patients were followed 90 days or until death. We calculated the: (1) Correlation of the LUSS (± pleural abnormalities) and CTSS throughout admission with mixed models; (2) Intra-class correlation coefficients (ICCs) and smallest detectable changes (SDCs) between raters; (3) Association between the LUSS (± pleural abnormalities) and CTSS with mixed models., Results: 82 consecutive patients were included. Correlation between LUSS and CTSS was 0.45 (95% CI 0.31-0.59). ICCs for LUSS, pleural abnormalities, and CTSS were 0.88 (95% CI 0.73-0.95), 0.94 (95% CI 0.90-0.96), and 0.84 (95% CI 0.65-0.93), with SDCs of 4.8, 1.4, and 3.9. The LUSS was associated with mortality in week 2, with a score difference between patients who survived or died greater than its SDC. Addition of pleural abnormalities was not beneficial. The CTSS was associated with mortality only in week 1, but with a score difference less than its SDC., Conclusions: LUSS correlated with CTSS throughout ICU admission but performed similar or better at agreement between raters and mortality prognostication. Given the benefits of LUS over CT, it should be preferred as initial monitoring tool., (© 2023. The Author(s).)
- Published
- 2023
- Full Text
- View/download PDF
35. The usefulness of implementing minimum retest intervals in reducing inappropriate laboratory test requests in a Dutch hospital.
- Author
-
Boerman AW, Al-Dulaimy M, Bandt YC, Nanayakkara PWB, and de Jonge R
- Subjects
- Adult, Humans, Retrospective Studies, Costs and Cost Analysis, Netherlands, Magnetic Resonance Imaging, Hospitals
- Abstract
Objectives: Inappropriate use of laboratory testing remains a challenging problem worldwide. Minimum retest intervals (MRI) are used to reduce inappropriate laboratory testing. However, their effectiveness and the usefulness in reducing inappropriate laboratory testing is still a matter of debate. The aim of this study was to evaluate the effectiveness of broadly implemented MRIs as a means of reducing inappropriate laboratory test requests., Methods: We performed a retrospective study in a general care and teaching hospital in the Netherlands, where MRI alerts have been implemented as standard care since June 7th 2017. Clinical chemistry test orders in adult internal medicine patients placed between July 13th 2017 and December 31st 2019 were included. The primary outcome was the effectiveness of MRIs, expressed as percentages of tests ordered and barred as a result of MRIs., Results: Of a total of 218,511 test requests, 4,159 (1.90%) got an MRI alert. These MRIs were overruled by physicians in 21.76% of the cases. As a result of implementing MRIs, 3,254 (1.49%) tests were barred. The financial savings for the department of internal medicine directly related to the included barred laboratory tests during this period were 11,880 euros on a total amount of 636,598 euros for all performed tests., Conclusions: Only a small proportion of laboratory tests are barred after implementation of MRIs, with a limited impact on the annual costs. However, MRIs provide a continuous reminder to focus on appropriate testing and the effectiveness of MRIs is potentially higher than described in this study., (© 2022 the author(s), published by De Gruyter, Berlin/Boston.)
- Published
- 2022
- Full Text
- View/download PDF
36. Sleep in hospitalized pediatric and adult patients - A systematic review and meta-analysis.
- Author
-
Burger P, Van den Ende ES, Lukman W, Burchell GL, Steur LMH, Merten H, Nanayakkara PWB, and Gemke RJBJ
- Abstract
Background: Sleep is essential for recovery from illness. As a result, researchers have shown a growing interest in the sleep of hospitalized patients. Although many studies have been conducted over the past years, an up to date systematic review of the results is missing., Objective: The objective of this systematic review was to assess sleep quality and quantity of hospitalized patients and sleep disturbing factors., Methods: A systematic literature search was conducted within four scientific databases. The search focused on synonyms of 'sleep' and 'hospitalization'. Papers written in English or Dutch from inception to April 25th,2022 were included for hospitalized patients >1 year of age. Papers exclusively reporting about patients receiving palliative, obstetric or psychiatric care were excluded, as well as patients in rehabilitation and intensive care settings, and long-term hospitalized geriatric patients. This review was performed in accordance with the PRISMA guidelines., Results: Out of 542 full text studies assessed for eligibility, 203 were included, describing sleep quality and/or quantity of 17,964 patients. The median sample size of the studies was 51 patients (IQR 67, range 6-1472). An exploratory meta-analysis of the Total Sleep Time showed an average of 7.2 h (95%-CI 4.3, 10.2) in hospitalized children, 5.7 h (95%-CI 4.8, 6.7) in adults and 5.8 h (95%-CI 5.3, 6.4) in older patients (>60y). In addition, a meta-analysis of the Wake After Sleep Onset (WASO) showed a combined high average of 1.8 h (95%-CI 0.7, 2.9). Overall sleep quality was poor, also due to nocturnal awakenings. The most frequently cited external factors for poor sleep were noise and number of patients in the room. Among the variety of internal/disease-related factors, pain and anxiety were most frequently mentioned to be associated with poor sleep., Conclusion: Of all studies, 76% reported poor sleep quality and insufficient sleep duration in hospitalized patients. Children sleep on average 0.7-3.8 h less in the hospital than recommended. Hospitalized adults sleep 1.3-3.2 h less than recommended for healthy people. This underscores the need for interventions to improve sleep during hospitalization to support recovery., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors. Published by Elsevier B.V.)
- Published
- 2022
- Full Text
- View/download PDF
37. Evaluation of Nonpharmacologic Interventions and Sleep Outcomes in Hospitalized Medical and Surgical Patients: A Nonrandomized Controlled Trial.
- Author
-
van den Ende ES, Merten H, Van der Roest L, Toussaint B, van Rijn Q, Keesenberg M, Lodders AM, van Veldhuizen K, Vos IE, Hoekstra S, and Nanayakkara PWB
- Subjects
- Adult, Aged, Ear Protective Devices, Female, Hospitalization, Humans, Male, Polysomnography, Sleep, Sleep Wake Disorders
- Abstract
Importance: Inadequate sleep negatively affects patients' physical health, mental well-being, and recovery. Nonpharmacologic interventions are recommended as first-choice treatment. However, studies evaluating the interventions are often of poor quality and show equivocal results., Objective: To assess whether the implementation of nonpharmacologic interventions is associated with improved inpatient night sleep., Design, Setting, and Participants: In a nonrandomized controlled trial, patients were recruited on the acute medical unit and medical and surgical wards of a Dutch academic hospital. All adults who spent exactly 1 full night in the hospital were recruited between September 1, 2019, and May 31, 2020 (control group), received usual care. Patients recruited between September 1, 2020, and May 31, 2021, served as the intervention group. The intervention group received earplugs, an eye mask, and aromatherapy. Nurses received sleep-hygiene training, and in the acute medical unit, the morning medication and vital sign measurement rounds were postponed from the night shift to the day shift. All interventions were developed in collaboration with patients, nurses, and physicians., Main Outcomes and Measures: Sleep was measured using actigraphy and the Dutch-Flemish Patient-Reported Outcomes Measurement Information System sleep disturbance item bank. Other outcomes included patient-reported sleep disturbing factors and the use of sleep-enhancing tools., Results: A total of 374 patients were included (222 control, 152 intervention; median age, 65 [IQR, 52-74] years). Of these, 331 were included in the analysis (195 [59%] men). Most patients (138 [77%] control, 127 [84%] intervention) were in the acute medical unit. The total sleep time was 40 minutes longer in the intervention group (control: median, 6 hours and 5 minutes [IQR, 4 hours and 55 minutes to 7 hours and 4 minutes]; intervention: 6 hours and 45 minutes [IQR, 5 hours and 47 minutes to 7 hours and 39 minutes]; P < .001). This was mainly due to a 30-minute delay in final wake time (median clock-time: control, 6:30 am [IQR, 6:00 am to 7:22 am]; intervention, 7:00 am [IQR, 6:30-7:30 am]; P < .001). Sleep quality did not differ significantly between groups. For both groups, the main sleep-disturbing factors were noises, pain, toilet visits, and being awakened by hospital staff. Sleep masks (23 of 147 [16%]) and earplugs (17 of 147 [12%]) were used most. Nightly vital sign checks decreased significantly (control: 54%; intervention: 11%; P < .001)., Conclusions and Relevance: The findings of this study suggest that sleep of hospitalized patients may be significantly improved with nonpharmacologic interventions. Postponement of morning vital sign checks and medication administration rounds from the night to the day shift may be a useful way to achieve this., Trial Registration: Netherlands Trial Registry Identifier: NL7995.
- Published
- 2022
- Full Text
- View/download PDF
38. Artificial Intelligence for the Prediction of In-Hospital Clinical Deterioration: A Systematic Review.
- Author
-
Veldhuis LI, Woittiez NJC, Nanayakkara PWB, and Ludikhuize J
- Abstract
To analyze the available literature on the performance of artificial intelligence-generated clinical models for the prediction of serious life-threatening events in non-ICU adult patients and evaluate their potential clinical usage., Data Sources: The PubMed database was searched for relevant articles in English literature from January 1, 2000, to January 23, 2022. Search terms, including artificial intelligence, machine learning, deep learning, and deterioration, were both controlled terms and free-text terms., Study Selection: We performed a systematic search reporting studies that showed performance of artificial intelligence-based models with outcome mortality and clinical deterioration., Data Extraction: Two review authors independently performed study selection and data extraction. Studies with the same outcome were grouped, namely mortality and various forms of deterioration (including ICU admission, adverse events, and cardiac arrests). Meta-analysis was planned in case sufficient data would be extracted from each study and no considerable heterogeneity between studies was present., Data Synthesis: In total, 45 articles were included for analysis, in which multiple methods of artificial intelligence were used. Twenty-four articles described models for the prediction of mortality and 21 for clinical deterioration. Due to heterogeneity of study characteristics (patient cohort, outcomes, and prediction models), meta-analysis could not be performed. The main reported measure of performance was the area under the receiver operating characteristic (AUROC) ( n = 38), of which 33 (87%) had an AUROC greater than 0.8. The highest reported performance in a model predicting mortality had an AUROC of 0.935 and an area under the precision-recall curve of 0.96., Conclusions: Currently, a growing number of studies develop and analyzes artificial intelligence-based prediction models to predict critical illness and deterioration. We show that artificial intelligence-based prediction models have an overall good performance in predicting deterioration of patients. However, external validation of existing models and its performance in a clinical setting is highly recommended., Competing Interests: The authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)
- Published
- 2022
- Full Text
- View/download PDF
39. What is the cause of increased mortality in normothermic patients with suspected infection?
- Author
-
Schinkel M, Nannan Panday RS, and Nanayakkara PWB
- Subjects
- Humans, Infections etiology
- Published
- 2022
- Full Text
- View/download PDF
40. Diagnostic stewardship for blood cultures in the emergency department: A multicenter validation and prospective evaluation of a machine learning prediction tool.
- Author
-
Schinkel M, Boerman AW, Bennis FC, Minderhoud TC, Lie M, Peters-Sengers H, Holleman F, Schade RP, de Jonge R, Wiersinga WJ, and Nanayakkara PWB
- Subjects
- Area Under Curve, Humans, Machine Learning, ROC Curve, Blood Culture, Emergency Service, Hospital
- Abstract
Background: Overuse of blood cultures (BCs) in emergency departments (EDs) leads to low yields and high numbers of contaminated cultures, accompanied by increased diagnostics, antibiotic usage, prolonged hospitalization, and mortality. We aimed to simplify and validate a recently developed machine learning model to help safely withhold BC testing in low-risk patients., Methods: We extracted data from the electronic health records (EHR) for 44.123 unique ED visits with BC sampling in the Amsterdam UMC (locations VUMC and AMC; the Netherlands), Zaans Medical Center (ZMC; the Netherlands), and Beth Israel Deaconess Medical Center (BIDMC; United States) in periods between 2011 and 2021. We trained a machine learning model on the VUMC data to predict blood culture outcomes and validated it in the AMC, ZMC, and BIDMC with subsequent real-time prospective evaluation in the VUMC., Findings: The model had an Area Under the Receiver Operating Characteristics curve (AUROC) of 0.81 (95%-CI = 0.78-0.83) in the VUMC test set. The most important predictors were temperature, creatinine, and C-reactive protein. The AUROCs in the validation cohorts were 0.80 (AMC; 0.78-0.82), 0.76 (ZMC; 0.74-0.78), and 0.75 (BIDMC; 0.74-0.76). During real-time prospective evaluation in the EHR of the VUMC, it reached an AUROC of 0.76 (0.71-0.81) among 590 patients with BC draws in the ED. The prospective evaluation showed that the model can be used to safely withhold blood culture analyses in at least 30% of patients in the ED., Interpretation: We developed a machine learning model to predict blood culture outcomes in the ED, which retained its performance during external validation and real-time prospective evaluation. Our model can identify patients at low risk of having a positive blood culture. Using the model in practice can significantly reduce the number of blood culture analyses and thus avoid the hidden costs of false-positive culture results., Funding: This research project was funded by the Amsterdam Public Health - Quality of Care program and the Dutch "Doen of Laten" project (project number: 839205002)., Competing Interests: Declaration of interests The authors declare no competing interests pertaining to the submitted work., (Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.)
- Published
- 2022
- Full Text
- View/download PDF
41. Polypharmacy, comorbidity and frailty: a complex interplay in older patients at the emergency department.
- Author
-
van Dam CS, Labuschagne HA, van Keulen K, Kramers C, Kleipool EE, Hoogendijk EO, Knol W, Nanayakkara PWB, Muller M, Trappenburg MC, and Peters MJL
- Subjects
- Aged, Comorbidity, Emergency Service, Hospital, Humans, Polypharmacy, Prospective Studies, Frailty epidemiology
- Abstract
Purpose: Older adults at the emergency department (ED) with polypharmacy, comorbidity, and frailty are at risk of adverse health outcomes. We investigated the association of polypharmacy with adverse health outcomes, in relation to comorbidity and frailty., Methods: This is a prospective cohort study in ED patients ≥ 70 years. Non-polypharmacy was defined as 0-4 medications, polypharmacy 5-9 and excessive polypharmacy ≥ 10. Comorbidity was classified by the Charlson comorbidity index (CCI). Frailty was defined by the Identification of Seniors At Risk-Hospitalized Patients (ISAR-HP) score. The primary outcome was 3-month mortality. Secondary outcomes were readmission to an ED/hospital ward and a self-reported fall < 3 months. The association between polypharmacy, comorbidity and frailty was analyzed by logistic regression., Results: 881 patients were included. 43% had polypharmacy and 18% had excessive polypharmacy. After 3 months, 9% died, 30% were readmitted, and 21% reported a fall. Compared with non-polypharmacy, the odds ratio (OR) for mortality ranged from 2.62 (95% CI 1.39-4.93) in patients with polypharmacy to 3.92 (95% CI 1.95-7.90) in excessive polypharmacy. The OR weakened after adjustment for comorbidity: 1.80 (95% CI 0.92-3.52) and 2.32 (95% CI 1.10-4.90). After adjusting for frailty, the OR weakened to 2.10 (95% CI 1.10-4.00) and OR 2.40 (95% CI 1.15-5.02). No significant association was found for readmission or self-reported fall., Conclusions: Polypharmacy is common in older patients at the ED. Polypharmacy, and especially excessive polypharmacy, is associated with an increased risk of mortality. The observed association is complex given the confounding effect of comorbidity and frailty., (© 2022. The Author(s).)
- Published
- 2022
- Full Text
- View/download PDF
42. The host response in different aetiologies of community-acquired pneumonia.
- Author
-
Schuurman AR, Reijnders TDY, van Engelen TSR, Léopold V, de Brabander J, van Linge C, Schinkel M, Pereverzeva L, Haak BW, Brands X, Kanglie MMNP, van den Berk IAH, Douma RA, Faber DR, Nanayakkara PWB, Stoker J, Prins JM, Scicluna BP, Wiersinga WJ, and van der Poll T
- Subjects
- Antiviral Agents, Biomarkers, Humans, Inflammation, SARS-CoV-2, Streptococcus pneumoniae, COVID-19, Community-Acquired Infections, Influenza, Human, Pneumonia etiology
- Abstract
Background: Community-acquired pneumonia (CAP) can be caused by a variety of pathogens, of which Streptococcus pneumoniae, Influenza and currently SARS-CoV-2 are the most common. We sought to identify shared and pathogen-specific host response features by directly comparing different aetiologies of CAP., Methods: We measured 72 plasma biomarkers in a cohort of 265 patients hospitalized for CAP, all sampled within 48 hours of admission, and 28 age-and sex matched non-infectious controls. We stratified the biomarkers into several pathophysiological domains- antiviral response, vascular response and function, coagulation, systemic inflammation, and immune checkpoint markers. We directly compared CAP caused by SARS-CoV-2 (COVID-19, n=39), Streptococcus pneumoniae (CAP-strep, n=27), Influenza (CAP-flu, n=22) and other or unknown pathogens (CAP-other, n=177). We adjusted the comparisons for age, sex and disease severity scores., Findings: Biomarkers reflective of a stronger cell-mediated antiviral response clearly separated COVID-19 from other CAPs (most notably granzyme B). Biomarkers reflecting activation and function of the vasculature showed endothelial barrier integrity was least affected in COVID-19, while glycocalyx degradation and angiogenesis were enhanced relative to other CAPs. Notably, markers of coagulation activation, including D-dimer, were not different between the CAP groups. Ferritin was most increased in COVID-19, while other systemic inflammation biomarkers such as IL-6 and procalcitonin were highest in CAP-strep. Immune checkpoint markers showed distinctive patterns in viral and non-viral CAP, with highly elevated levels of Galectin-9 in COVID-19., Interpretation: Our investigation provides insight into shared and distinct pathophysiological mechanisms in different aetiologies of CAP, which may help guide new pathogen-specific therapeutic strategies., Funding: This study was financially supported by the Dutch Research Council, the European Commission and the Netherlands Organization for Health Research and Development., Competing Interests: Declaration of interests JS was on the Data Safety Monitoring Board of the Pointer trial (ISRCTN33682933), and is the Vice President of the European Society of Gastrointestinal and Abdominal Radiology. All other authors declare no conflict of interests., (Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.)
- Published
- 2022
- Full Text
- View/download PDF
43. Measuring Platinum Levels in Hair in Women with Silicone Breast Implants and Systemic Symptoms.
- Author
-
Spit KA, Azahaf S, de Blok CJM, and Nanayakkara PWB
- Abstract
It has been suggested that compounds present in silicone breast implants (eg, silicone particles or heavy metals such as platinum) migrate into the body and can cause systemic symptoms in susceptible women, causing what is known as breast implant illness. This pilot study investigates possible associations between hair platinum levels in patients with breast implants and breast implant illness, and evaluates its possible use for diagnostic purposes., Methods: Patients were included from the silicone outpatient clinic at Amsterdam University Medical Centre. Platinum concentration in hair samples of 10 women with breast implants and systemic symptoms (group A) was compared with that in 10 women with breast implants but no symptoms (group B), and a control group of 10 women without implants or symptoms (group C), using laser ablation inductively coupled plasma mass spectrometry. Radiological imaging was used to assess implant ruptures or silicone leakage., Results: A median platinum concentration of 0.09 μg per kg [IQR 0.04-0.15] was found in group A, 0.08 μg per kg [IQR 0.04-0.12] in group B, and 0.04 μg per kg [IQR 0.02-0.13] in group C, with no statistical significant difference between the groups (Kruskal-Wallis test, P = 0.43). No correlation between radiologically proven implant leakage and platinum level was found., Conclusions: There was no statistically significant difference in hair platinum levels in women with or without silicone breast implants or breast implant illness. Therefore, based on this pilot study, we do not recommend this test for clinical use. Given the small sample size, more research is required to fully assess its possible use for diagnostic purposes., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)
- Published
- 2022
- Full Text
- View/download PDF
44. Feasibility of a new multifactorial fall prevention assessment and personalized intervention among older people recently discharged from the emergency department.
- Author
-
Hepkema BW, Köster L, Geleijn E, VAN DEN Ende E, Tahir L, Osté J, Prins B, VAN DER Velde N, VAN Hout H, and Nanayakkara PWB
- Subjects
- Aged, Aged, 80 and over, Emergency Service, Hospital, Feasibility Studies, Humans, Risk Assessment methods, Accidental Falls prevention & control, Patient Discharge
- Abstract
Background and Importance: Falls among older people occur frequently and are a leading cause of Emergency department (ED) admissions, disability, death and rising health care costs. Multifactorial fall prevention programs that are aimed to target the population at risk have shown to effectively reduce the rate of falling and fall-related injuries in community-dwelling older people. However, the participation of and adherence to these programs in real life situation is generally low., Objective: To test the feasibility of a transitionally organized fall prevention assessment with accompanying personalized intervention initiated at the ED., Design, Settings and Participants: A process evaluation, of a non-randomized controlled pilot trial for implementing a transitionally organized multifactorial fall prevention intervention, was performed using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework to gain insight into the barriers and facilitators of implementation. Older fallers (>70yrs) presenting at the ED were selected based on ZIP-code and after obtaining informed consent, data for the evaluation was collected through questionnaires and interviews. Furthermore, feedback was collected from the healthcare providers., Main Results: The consent was obtained by 24 (70%) of the patients approached directly at the ED and 17 (26%) of the patients approached later by phone. Adherence to the protocol by the participants, clinical assessors and family practice were all more than 90%. After three months, nine (26%) of the participants had at least one recurrent fall: three (20%) patients in the intervention group and six (32%) in the control group., Conclusion: ED presentation due to a fall in older persons provides a window of opportunity for optimizing adherence to a multifactorial fall prevention program as willingness to participate was higher when the patients were approached at the ED during their stay. Implementing a transitionally organized multidisciplinary fall prevention program was successful with a high protocol adherence., The Netherlands Trial Register: NTR NL8142, November 8, 2019., Competing Interests: The authors declare that they have no competing interests.
- Published
- 2022
- Full Text
- View/download PDF
45. Multi-organ point-of-care ultrasound for detection of pulmonary embolism in critically ill COVID-19 patients - A diagnostic accuracy study.
- Author
-
Lieveld A, Heldeweg MLA, Smit JM, Haaksma ME, Veldhuis L, Walburgh-Schmidt RS, Twisk J, Nanayakkara PWB, Heunks L, and Tuinman PR
- Subjects
- Adult, Critical Illness, Humans, Point-of-Care Systems, Prospective Studies, COVID-19 complications, COVID-19 diagnostic imaging, Pulmonary Embolism diagnostic imaging, Pulmonary Embolism etiology, Venous Thrombosis diagnostic imaging
- Abstract
Purpose: Critically ill COVID-19 patients have an increased risk of developing pulmonary embolism (PE). Diagnosis of PE by point-of-care ultrasound (POCUS) might reduce the need for computed tomography pulmonary angiography (CTPA), while decreasing time-to-diagnosis., Materials & Methods: This prospective, observational study included adult ICU patients with COVID-19. Multi-organ (lungs, deep vein, cardiac) POCUS was performed within 24 h of CTPA, looking for subpleural consolidations, deep venous thrombosis (DVT), and right ventricular strain (RVS). We reported the scan time, and calculated diagnostic accuracy measures for these signs separately and in combination., Results: 70 consecutive patients were included. 23 patients (32.8%) had a PE. Median scan time was 14 min (IQR 11-17). Subpleural consolidations' diagnostic accuracy was: 42.9% (95%CI [34.1-52.0]). DVT's and RVS' diagnostic accuracy was: 75.6% (95%CI [67.1-82.9]) and 74.4% (95%CI [65.8-81.8]). Their sensitivity was: 24.0% (95%CI [9.4-45.1]), and 40.0% (95%CI [21.3-61.3]), while their specificity was: 88.8% (95%CI [80.8-94.3]), and: 83.0% (95%CI [74.2-89.8]), respectively. Multi-organ POCUS sensitivity was: 87.5% (95%CI [67.6-97.3]), and specificity was: 25% (95%CI [16.9-34.7])., Conclusions: Multi-organ rather than single-organ POCUS can be of aid in ruling out PE in critically ill COVID-19 and help select patients for CTPA. In addition, finding RVS can make PE more likely, while a DVT would preclude the need for a CTPA., Registration: www.trialregister.nl: NL8540., Competing Interests: Declaration of Competing Interest The authors have no conflict of interest nor any financial disclosures., (Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.)
- Published
- 2022
- Full Text
- View/download PDF
46. Root Cause Analysis Using the Prevention and Recovery Information System for Monitoring and Analysis Method in Healthcare Facilities: A Systematic Literature Review.
- Author
-
Driesen BEJM, Baartmans M, Merten H, Otten R, Walker C, Nanayakkara PWB, and Wagner C
- Subjects
- Checklist, Delivery of Health Care, Humans, Information Systems, Patient Safety, Root Cause Analysis
- Abstract
Objectives: Unintended events (UEs) are prevalent in healthcare facilities, and learning from them is key to improve patient safety. The Prevention and Recovery Information System for Monitoring and Analysis (PRISMA)-method is a root cause analysis method used in healthcare facilities. The aims of this systematic review are to map the use of the PRISMA-method in healthcare facilities worldwide, to assess the insights that the PRISMA-method offers, and to propose recommendations to increase its usability in healthcare facilities., Methods: PubMed, EMBASE.com, CINAHL, and The Cochrane Library were systematically searched from inception to February 26, 2020. Studies were included if the PRISMA-method for analyzing UEs was applied in healthcare facilities. A quality appraisal was performed, and relevant data based on an appraisal checklist were extracted., Results: The search provided 2773 references, of which 25 articles reporting 10,816 UEs met our inclusion criteria. The most frequently identified root causes were human-related, followed by organizational factors. Most studies took place in the Netherlands (n = 20), and the sample size ranged from 1 to 2028 UEs. The study setting and collected data used for PRISMA varied widely. The PRISMA-method performed by multiple persons resulted in more root causes per event., Conclusions: To better understand UEs in healthcare facilities and formulate optimal countermeasures, our recommendations to further improve the PRISMA-method mainly focus on combining information from patient files and reports with interviews, including multiple PRISMA-trained researchers in an analysis, and modify the Eindhoven Classification Model if needed., Competing Interests: The authors disclose no conflict of interest., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.)
- Published
- 2022
- Full Text
- View/download PDF
47. Optimal use of procalcitonin to rule out bacteremia in patients with possible viral infections.
- Author
-
Azijli K, Minderhoud TC, de Gans CJ, Lieveld AWE, and Nanayakkara PWB
- Abstract
Objective: During the winter, many patients present with suspected infection that could be a viral or a bacterial (co)infection. The aim of this study is to investigate whether the optimal use of procalcitonin (PCT) is different in patients with and without proven viral infections for the purpose of excluding bacteremia. We hypothesize that when a viral infection is confirmed, this lowers the probability of bacteremia and, therefore, influences the appropriate cutoff of procalcitonin., Methods: This study was conducted in the emergency department of an academic medical center in The Netherlands in the winter seasons of 2019 and 2020. Adults (>18 years) with suspected infection, in whom a blood culture and a rapid polymerase chain reaction test for influenza was performed were included., Results: A total of 546 patients were included of whom 47 (8.6%) had a positive blood culture. PCT had an area under the curve of 0.85, 95% confidence interval (95% CI) 0.80-0.91, for prediction of bacteremia. In patients with a proven viral infection (N = 212) PCT < 0.5 μg/L had a sensitivity of 100% (95% CI 63.1-100) and specificity of 81.2% (95% CI 75.1-86.3) to exclude bacteremia. In patients without a viral infection, the procalcitonin cutoff point of < 0.25 μg/L showed a sensitivity of 87.2% (95% CI 72.6-95.7) and specificity of 64.1 % (95% CI 58.3-69.6)., Conclusion: In patients with a viral infection, our findings suggest that a PCT concentration of <0.50 μg/L makes bacteremia unlikely. However, this finding needs to be confirmed in a larger population of patients with viral infections, especially because the rate of coinfection in our cohort was low., Competing Interests: None to declareKaoutar Azijli, Tanca C. Minderhoud, and Prabath W.B. Nanayakkara developed the research plan. Kaoutar Azijli, Tanca C. Minderhoud, Carlijn J. de Gans, and Carlijn J. de Gans designed the study. Carlijn J. de Gans, with the help of Kaoutar Azijli, Arthur W.E. Lievel, and Prabath W.B. Nanayakkara collected the data and created the database. The database was checked by Tanca C. Minderhoud. Carlijn J. de Gans, Tanca C. Minderhoud, and Kaoutar Azijli analyzed the data. Carlijn J. de Gans drafted a first version of the paper. Tanca C. Minderhoud and Kaoutar Azijli wrote the definite version of the paper. All authors critically appraised the paper, revised where appropriate and approved the final version of the manuscript. Tanca C. Minderhoud designed the visual abstract., (© 2022 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians.)
- Published
- 2022
- Full Text
- View/download PDF
48. Patient-nurse agreement on inpatient sleep and sleep disturbing factors.
- Author
-
van den Ende ES, Burger P, Keesenberg M, Merten H, Gemke RJBJ, and Nanayakkara PWB
- Abstract
Background: Sleep is vital for recovery during hospital stay. Many sleep-promoting interventions have been investigated in the past. Nurses seem to overestimate their patients sleep and their perspective is needed for these interventions to be successfully implemented., Objectives: To assess the patient's and nurse's agreement on the patient's sleep and factors disturbing sleep., Methods: The instruments used included 1) five Richard-Campbell Sleep Questionnaire (RCSQ) items plus a rating of nighttime noise and 2) the Consensus Sleep Diary (CSD). The mean of the five RCSQ items comprised a total score, which reflects sleep quality. Once a week, unannounced, nurses and patients were asked to fill in questionnaires concerning last night's sleep. Neither nurses nor patients knew the others' ratings. Patient-nurse agreement was evaluated by using median differences and Bland-Altman plots. Reliability was evaluated by using intraclass correlation coefficients., Results: Fifty-five paired patient-nurse assessments have been completed. For all RCSQ subitems, nurses' scores were higher (indicating "better" sleep) than patients' scores, with a significantly higher rating for sleep depth (median [IQR], 70 [40] vs 50 [40], P = .012). The Bland-Altman plots for the RSCQ Total Score (r = 0.0593, P = .008) revealed a significant amount of variation (bias). The intra-class correlation coefficient (ICC) indicated poor reliability for all 7 measures (range -0.278 - 0.435). Nurses were relatively overestimating their own role in causing sleep disturbances and underestimating patient-related factors., Conclusions: Nurses tend to overestimate patients' sleep quality as well as their own role in causing sleep disturbances., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2022 The Authors. Published by Elsevier B.V.)
- Published
- 2022
- Full Text
- View/download PDF
49. Experiences and perspectives of older patients with a return visit to the emergency department within 30 days: patient journey mapping.
- Author
-
Schouten B, Driesen BEJM, Merten H, Burger BHCM, Hartjes MG, Nanayakkara PWB, and Wagner C
- Subjects
- Aftercare, Aged, 80 and over, Female, Hospitals, Humans, Male, Qualitative Research, Emergency Service, Hospital, Patient Discharge
- Abstract
Purpose: Up to 22% of older patients who visit the emergency department (ED) have a return visit within 30 days. To achieve patient-centered care for this group at the ED it is important to involve the patient perspective and strive to provide the best possible experience. The aim of this study was to gain insight into the experiences and perspectives of older patients from initial to return ED visit by mapping their patient journey., Methods: We performed a qualitative patient journey study with 13 patients of 70 years and older with a return ED visit within 30 days who presented at the Amsterdam UMC, a Dutch academic hospital. We used semi-structured interviews focusing on the patient experience during their journey and developed a conceptual framework for coding., Results: Our sample consisted of 13 older patients with an average age of 80 years, and 62% of them were males. The framework contained a timeline of the patient journey with five chronological main themes, complemented with an 'experience' theme, these were divided into 34 subthemes. Health status, social system, contact with the general practitioner, aftercare, discharge and expectations were the five main themes. The experiences regarding these themes differed greatly between patients. The two most prominent subthemes were waiting time and discharge communication, which were mostly related to a negative experience., Conclusions: This study provides insight into the experiences and perspectives of older patients from initial to return ED visit. The two major findings were that lack of clarity regarding waiting times and suboptimal discharge communication contributed to negative experiences. Recommendations regarding waiting time (i.e. a two-hour time out at the ED), and discharge communication (i.e. checklist for discharge) could contribute to a positive ED experience and thereby potentially improve patient-centered care., (© 2021. The Author(s).)
- Published
- 2022
- Full Text
- View/download PDF
50. Sepsis Performance Improvement Programs: From Evidence Toward Clinical Implementation.
- Author
-
Schinkel M, Nanayakkara PWB, and Wiersinga WJ
- Subjects
- Critical Care, Humans, Emergency Medicine, Sepsis therapy
- Abstract
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2022. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2022 . Further information about the Annual Update in Intensive Care and Emergency Medicine is available from https://link.springer.com/bookseries/8901 ., (© 2022. Schinkel et al.)
- Published
- 2022
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.