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Clinically important deep vein thrombosis in the intensive care unit: a survey of intensivists.

https://arctichealth.org/en/permalink/ahliterature180030
Source
Crit Care. 2004 Jun;8(3):R145-52
Publication Type
Article
Date
Jun-2004
Author
Deborah Cook
Maureen Meade
Gordon Guyatt
Lauren Griffith
John Granton
William Geerts
Mark Crowther
Author Affiliation
Department of Medicine, McMaster University, Hamilton, Ontario, Canada. debcook@mcmaster.ca
Source
Crit Care. 2004 Jun;8(3):R145-52
Date
Jun-2004
Language
English
Publication Type
Article
Keywords
Adult
Attitude of Health Personnel
Canada
Critical Illness - classification
Health Care Surveys
Humans
Intensive Care Units
Medical Staff, Hospital - psychology - statistics & numerical data
Physician's Practice Patterns
Probability
Pulmonary Embolism - diagnosis - physiopathology - ultrasonography
Questionnaires
Risk assessment
Risk factors
Severity of Illness Index
Venous Thrombosis - diagnosis - physiopathology - ultrasonography
Abstract
Outside the intensive care unit (ICU), clinically important deep vein thrombosis (DVT) is usually defined as a symptomatic event that leads to objective radiologic confirmation and subsequent treatment. The objective of the present survey is to identify the patient factors and radiologic features of lower limb DVT that intensivists consider more or less likely to make a DVT clinically important in ICU patients.
Our definition of clinically important DVT was a DVT likely to result in short-term or long-term morbidity or mortality if left untreated, as opposed to a DVT that is unlikely to have important consequences. We asked respondents to indicate the likelihood that patient factors and ultrasonographic features make a DVT clinically important using a five-point scale (from 1 = much less likely to 5 = much more likely).
Of the 71 Canadian intensivists who responded, 70 (99%) rated three patient factors as most likely to make a DVT clinically important: clinical suspicion of pulmonary embolism (mean score 4.6), acute or chronic cardiopulmonary morbidity that might limit a patient's ability to tolerate pulmonary embolism (score 4.5), and leg symptoms (score 4.2). Of the ultrasound features, proximal (score 4.7), large (score 4.2), and totally occlusive (score 3.9) thrombi were considered the three most important.
When labeling a DVT as clinically important, intensivists rely on different patient specific factors and thrombus characteristics than are used to assess the clinical importance of DVT outside the ICU. The clinical importance of DVT is influenced by unique factors such as cardiopulmonary reserve among mechanically ventilated patients.
Notes
Cites: Crit Care. 2001 Dec;5(6):336-4211737922
Cites: Lancet. 2001 Jul 7;358(9275):9-1511454370
Cites: Crit Care Med. 2002 Apr;30(4):771-411940743
Cites: J Crit Care. 2002 Jun;17(2):95-10412096372
Cites: Angiology. 2003 Jan;54(1):19-2412593492
Cites: Ann Intern Med. 2003 Dec 2;139(11):893-90014644891
Cites: Lancet. 1969 Aug 2;2(7614):230-24184105
Cites: J Clin Pathol. 1989 Feb;42(2):135-92921354
Cites: J Clin Epidemiol. 1993 Jun;46(6):529-348501479
Cites: JAMA. 1994 Jan 19;271(3):223-58277550
Cites: Med J Aust. 1994 Feb 7;160(3):127-88295579
Cites: Lancet. 1995 May 27;345(8961):1326-307752753
Cites: JAMA. 1995 Jul 26;274(4):335-77609264
Cites: Chest. 1995 Oct;108(4):978-817555172
Cites: Ann Intern Med. 1997 Sep 15;127(6):439-459313000
Cites: J Clin Epidemiol. 1997 Oct;50(10):1129-369368521
Cites: Lancet. 1997 Dec 20-27;350(9094):1795-89428249
Cites: JAMA. 1998 Feb 11;279(6):458-629466640
Cites: Thromb Haemost. 1999 Apr;81(4):493-710235426
Cites: J Clin Epidemiol. 1999 Oct;52(10):997-100510513763
Cites: Lancet. 1960 Jun 18;1(7138):1309-1213797091
Cites: Am J Respir Crit Care Med. 2000 Apr;161(4 Pt 1):1109-1410764298
Cites: J Bone Joint Surg Br. 2000 May;82(4):480-210855865
Cites: J Crit Care. 2000 Dec;15(4):127-3211138871
Cites: Chest. 2001 Jan;119(1 Suppl):132S-175S11157647
Cites: Semin Thromb Hemost. 2001;27(1):3-811288945
Cites: Semin Thromb Hemost. 2001;27(1):41-611288947
Cites: Arch Intern Med. 2001 May 28;161(10):1268-7911371254
Cites: J Crit Care. 2001 Dec;16(4):161-611815901
PubMed ID
15153243 View in PubMed
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Clinically important venous thromboembolism in pediatric critical care: a Canadian survey.

https://arctichealth.org/en/permalink/ahliterature171806
Source
J Crit Care. 2005 Dec;20(4):373-80
Publication Type
Article
Date
Dec-2005
Author
Afrothite Kotsakis
Deborah Cook
Lauren Griffith
Natalie Anton
Patti Massicotte
Kelly MacFarland
Rosemarie Farrell
Jamie Hutchison
Author Affiliation
Department of Critical Care, The Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8.
Source
J Crit Care. 2005 Dec;20(4):373-80
Date
Dec-2005
Language
English
Publication Type
Article
Keywords
Angiography
Canada
Child
Health Care Surveys
Humans
Intensive Care Units, Pediatric
Physician's Practice Patterns
Pulmonary Embolism - diagnosis - prevention & control
Risk factors
Ultrasonography, Doppler, Color
Venous Thrombosis - diagnosis - prevention & control
Abstract
Pediatric venous thromboembolism (VTE) is becoming an increasingly recognized morbidity associated with critical illness. The objective of this survey is to identify the patient factors and radiological features that pediatric intensivists consider more or less likely to make a venous thrombosis (VTE) clinically important in their patients.
Our definition of clinically important VTE was a VTE likely to result in short- or long-term morbidity or mortality if left untreated. We asked respondents to rate the likelihood that patient factors and radiological features make a venous thrombosis clinically important using a 5-point scale (1 = much less likely to 5 = much more likely).
The 38 (58.5%) of 65 pediatric intensivists responding rated 4 patient factors as most likely to make a VTE clinically important: clinical suspicion of pulmonary embolism (mean score, 4.8), symptoms (mean, 4.5), detection by physical exam (mean, 4.4), and the presence of an acute or chronic cardiopulmonary comorbidity that might limit a patient's ability to tolerate pulmonary embolism (mean, 4.3). Of the radiological features, the 2 considered most important were VTE involving the vena cava extending into the right atrium (mean, 5) and central veins (mean, 4.5).
When labeling a VTE as clinically important, pediatric intensivists rely on several specific patient factors and thrombus characteristics.
PubMed ID
16310610 View in PubMed
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Clinical practice guidelines in the intensive care unit: a survey of Canadian clinicians' attitudes.

https://arctichealth.org/en/permalink/ahliterature161579
Source
Can J Anaesth. 2007 Sep;54(9):728-36
Publication Type
Article
Date
Sep-2007
Author
Tasnim Sinuff
Kevin W Eva
Maureen Meade
Peter Dodek
Daren Heyland
Deborah Cook
Author Affiliation
Department of Critical Care Medicine, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, and University of Toronto, Ontario M4N 3M5, Canada. taz.sinuff@sunnybrook.ca
Source
Can J Anaesth. 2007 Sep;54(9):728-36
Date
Sep-2007
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Canada
Guideline Adherence - standards - statistics & numerical data
Health Care Surveys
Humans
Intensive Care - standards
Practice Guidelines as Topic
Abstract
To understand clinicians' perceptions regarding practice guidelines in Canadian intensive care units (ICUs) to inform guideline development and implementation strategies.
We developed a self-administered survey instrument and assessed its clinical sensibility and reliability. The survey was mailed to ICU physicians and nurses in Canada to determine local ICU guideline development and use, and to compare physicians' and nurses' attitudes and preferences towards guidelines.
The survey was completed by 51.6% (565/1095) of potential respondents. Although less than half reported a formal guideline development committee in their ICU, 81.0% reported that guidelines were developed at their institutions. Of clinicians who used guidelines in the ICU, 70.2% of nurses and 42.6% of physicians reported using them frequently or always. Professional society guidelines (with or without local modification) were reportedly used in most ICUs, but physicians were more confident than nurses of their validity (P
PubMed ID
17766740 View in PubMed
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Development and psychometric properties of a questionnaire to assess barriers to feeding critically ill patients.

https://arctichealth.org/en/permalink/ahliterature105823
Source
Implement Sci. 2013;8:140
Publication Type
Article
Date
2013
Author
Naomi E Cahill
Andrew G Day
Deborah Cook
Daren K Heyland
Author Affiliation
Department of Public Health Sciences, Queen's University, Carruthers Hall, Kingston, Ontario, Canada. cahilln@kgh.kari.net.
Source
Implement Sci. 2013;8:140
Date
2013
Language
English
Publication Type
Article
Keywords
Adult
Canada
Critical Illness
Enteral Nutrition - utilization
Factor Analysis, Statistical
Female
Guideline Adherence
Humans
Intensive Care Units
Male
Medical Staff, Hospital - psychology
Middle Aged
Psychometrics
Questionnaires - standards
United States
Young Adult
Abstract
To successfully implement the recommendations of critical care nutrition guidelines, one potential approach is to identify barriers to providing optimal enteral nutrition (EN) in the intensive care unit (ICU), and then address these barriers systematically. Therefore, the purpose of this study was to develop a questionnaire to assess barriers to enterally feeding critically ill patients and to conduct preliminary validity testing of the new instrument.
The content of the questionnaire was guided by a published conceptual framework, literature review, and consultation with experts. The questionnaire was pre-tested on a convenience sample of 32 critical care practitioners, and then field tested with 186 critical care providers working at 5 hospitals in North America. The revised questionnaire was pilot tested at another ICU (n = 43). Finally, the questionnaire was distributed to a random sample of ICU nurses twice, two weeks apart, to determine test retest reliability (n = 17). Descriptive statistics, exploratory factor analysis, Cronbach alpha, intraclass correlations (ICC), and kappa coefficients were conducted to assess validity and reliability.
We developed a questionnaire with 26 potential barriers to delivery of EN asking respondents to rate their importance as barriers in their ICU. Face and content validity of the questionnaire was established through literature review and expert input. The factor analysis indicated a five-factor solution and accounted for 72% of the variance in barriers: guideline recommendations and implementation strategies, delivery of EN to the patient, critical care provider attitudes and behavior, dietitian support, and ICU resources. Overall, the indices of internal reliability for the derived factor subscales and the overall instrument were acceptable (subscale Cronbach alphas range 0.84 - 0.89). However, the test retest reliability was variable and below acceptable thresholds for the majority of items (ICC's range -0.13 to 0.70). The within group agreement, an indices reflecting the reliability of aggregating individual responses to the ICU level was also variable (ICC's range 0.0 to 0.82).
We developed a questionnaire to identify barriers to enteral feeding in critically ill patients. Additional studies are planned to further revise and evaluate the reliability and validity of the instrument.
PubMed ID
24305039 View in PubMed
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Education, ethics, and end-of-life decisions in the intensive care unit.

https://arctichealth.org/en/permalink/ahliterature191094
Source
Crit Care Med. 2002 Feb;30(2):290-6
Publication Type
Article
Date
Feb-2002
Author
Lesley Stevens
Deborah Cook
Gordon Guyatt
Lauren Griffith
Steven Walter
Joseph McMullin
Author Affiliation
Department of Medicine, McMaster University, Hamilton, ON, Canada.
Source
Crit Care Med. 2002 Feb;30(2):290-6
Date
Feb-2002
Language
English
Publication Type
Article
Keywords
Adult
Analysis of Variance
Decision Making
Ethics, Medical - education
Female
Humans
Intensive Care Units
Internship and Residency
Life Support Care
Linear Models
Male
Multivariate Analysis
Ontario
Abstract
To examine the influence of education and clinical experience on residents' attitudes toward withdrawal of life support.
Self-administered survey.
Four Canadian teaching hospitals.
Residents rotating through four intensive care units.
The survey examined ethics education and experience regarding end-of-life care, importance of factors influencing withdrawal of life support, confidence in decisions, and recommendations for enhancing end-of-life education. The response rate was 83.9% (52 of 62). A minority of residents reported an appropriate amount of formal teaching on ethical principles (17.3%), patient-centered education (28.8%), and informal discussion (28.8%) before their intensive care unit rotation. During their rotation, most residents cared for patients in whom withdrawal of life support was considered. Although they usually attended family meetings, residents were never (34.6%) or rarely (42.3%) the primary discussant. Before the intensive care unit rotation, confidence in withdrawal decisions was related to male sex (p =.001) and previous patient-centered ethics education (p =.02). At the end of the intensive care unit rotation, only resident involvement in family meetings (p =.02) and being the primary discussant at such meetings (p =.01) were associated with confidence. After we adjusted for pre-rotation confidence in withdrawal of life support decision-making, the only predictor of post-rotation confidence was family meeting involvement (p
PubMed ID
11889295 View in PubMed
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End of life care in Canada: a report from the Canadian Academy of Health Sciences Forum.

https://arctichealth.org/en/permalink/ahliterature113324
Source
Clin Invest Med. 2013;36(3):E112-3
Publication Type
Article
Date
2013
Author
Deborah Cook
Graeme Rocker
Author Affiliation
Departments of Medicine, Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada L8N 3Z5. debcook@mcmaster.ca
Source
Clin Invest Med. 2013;36(3):E112-3
Date
2013
Language
English
Publication Type
Article
Keywords
Canada
Humans
National Health Programs
Terminal Care
PubMed ID
23739663 View in PubMed
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Enhancing the quality of end-of-life care in Canada.

https://arctichealth.org/en/permalink/ahliterature107076
Source
CMAJ. 2013 Nov 5;185(16):1383-4
Publication Type
Article
Date
Nov-5-2013
Author
Deborah Cook
Graeme Rocker
Daren Heyland
Source
CMAJ. 2013 Nov 5;185(16):1383-4
Date
Nov-5-2013
Language
English
Publication Type
Article
Keywords
Advance Care Planning
Canada
Humans
Patient Participation
Patient Preference
Physician-Patient Relations
Quality Improvement
Terminal Care - standards
Notes
Comment In: CMAJ. 2014 Feb 18;186(3):21324549710
PubMed ID
24062171 View in PubMed
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Factors affecting consent in pediatric critical care research.

https://arctichealth.org/en/permalink/ahliterature129306
Source
Intensive Care Med. 2012 Jan;38(1):153-9
Publication Type
Article
Date
Jan-2012
Author
Kusum Menon
Roxanne E Ward
Isabelle Gaboury
Margot Thomas
Ari Joffe
Karen Burns
Deborah Cook
Author Affiliation
Department of Pediatrics, University of Ottawa, Ottawa, Canada. menon@cheo.on.ca
Source
Intensive Care Med. 2012 Jan;38(1):153-9
Date
Jan-2012
Language
English
Publication Type
Article
Keywords
Biomedical research
Canada
Child, Preschool
Cohort Studies
Humans
Infant
Informed Consent - statistics & numerical data
Intensive Care Units, Pediatric
Prospective Studies
Proxy
Abstract
Consent for research is a difficult and unpredictable process in pediatric critical care populations. The objectives of this study were to describe consent rates in pediatric critical care research and their association with patient, legal guardian, consent process, and study design-related factors.
A prospective, cohort study was conducted from 2009 to 2010 in six tertiary care pediatric intensive care units (PICU) in Canada with legal guardians of patients who were approached for consent for any ongoing PICU research study. Data were recorded on details of the consent process for all consent encounters.
We recorded 271 consent encounters. The overall consent rate was 80.1% (217/271). We observed higher consent rates when the research assistant was introduced by a member of the clinical team prior to approaching the family (89.7 vs. 77.7%; P = 0.04). Legal guardians of cardiac surgery patients were less likely to provide consent than those of all other patients (75.3 vs. 86.0%; P = 0.03). There was no difference in consent rates between therapeutic (117/145, 80.7%) versus non-therapeutic studies (100/126, 79.4%; P = 0.88).
This study provides future researchers with consent data for determination of recruitment rates, sample sizes, budget estimations, and study timelines. Future pediatric critical care studies should consider incorporating the lower consent rates in cardiac surgery patients and routine introduction of the research assistant to the family by a member of the patient's care team into their study designs. The potential influence of parental factors on consent rates in pediatric critical care studies requires further research.
Notes
Comment In: Intensive Care Med. 2012 Jan;38(1):4-622120772
PubMed ID
22120768 View in PubMed
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A framework for resolving disagreement during end of life care in the critical care unit.

https://arctichealth.org/en/permalink/ahliterature141695
Source
Clin Invest Med. 2010;33(4):E240-53
Publication Type
Article
Date
2010
Author
Karen Choong
Cynthia Cupido
Erin Nelson
Donald M Arnold
Karen Burns
Deborah Cook
Maureen Meade
Author Affiliation
Department of Pediatrics and Critical Care, McMaster Children's Hospital, McMaster University, Hamilton, Ontario. choongk@mcmaster.ca
Source
Clin Invest Med. 2010;33(4):E240-53
Date
2010
Language
English
Publication Type
Article
Keywords
Critical Care - legislation & jurisprudence - methods - standards
Decision Making
Dissent and Disputes
Evidence-Based Medicine
Humans
Intensive Care Units
Life Support Care - legislation & jurisprudence - methods - standards
Ontario
Physician-Patient Relations
Professional-Family Relations
Abstract
End-of-life decisions regarding the administration, withdrawal or withholding of life-sustaining therapy in the critical care setting can be challenging. Disagreements between health care providers and family members occur, especially when families believe strongly in preserving life, and physicians are resistant to providing medically "futile" care. Such disagreements can cause tension and moral distress among families and clinicians.
To outline the roles and responsibilities of physicians, substitute decision makers, and the judicial system when decisions must be made on behalf of incapable persons, and to provide a framework for conflict resolution during end-of-life decision-making for physicians practicing in Canada.
We used a case-based example to illustrate our objectives. We employed a comprehensive approach to understanding end-of-life decision making that included: 1) a search for relevant literature; 2) a review of provincial college policies; 3) a review of provincial legislation on consent; 4) a consultation with two bioethicists and 5) a consultation with two legal experts in health law.
In Canada, laws about substitute decision-making for health care are primarily provincial or territorial. Thus, laws and policies from professional regulatory bodies on end-of-life care vary across the country. We tabulated the provincial college policies on end-of-life care and the provincial legislation on consent and advance directives, and constructed a 10-step approach to conflict resolution.
Knowledge of underlying ethical principles, understanding of professional duties, and adoption of a process for mediation and conflict resolution are essential to ensuring that physicians and institutions act responsibly in maintaining a patients' best interests in the context of family-centred care.
Notes
Comment In: Clin Invest Med. 2010;33(4):E219-2220691139
PubMed ID
20691142 View in PubMed
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Fresh frozen plasma transfusion in critically ill patients.

https://arctichealth.org/en/permalink/ahliterature163382
Source
Crit Care Med. 2007 Jul;35(7):1655-9
Publication Type
Article
Date
Jul-2007
Author
François Lauzier
Deborah Cook
Lauren Griffith
Julia Upton
Mark Crowther
Author Affiliation
Department of Medicine, Division of Critical Care, Centre Hospitalier Universitaire Affilié de Québec, Hôpital de l'Enfant-Jésus, Québec, Canada. flauzier760915@hotmail.com
Source
Crit Care Med. 2007 Jul;35(7):1655-9
Date
Jul-2007
Language
English
Publication Type
Article
Keywords
Adult
Aged
Blood Component Transfusion - utilization
Canada
Female
Guideline Adherence
Humans
Intensive Care Units
Logistic Models
Male
Multivariate Analysis
Patient Selection
Plasma
Practice Guidelines as Topic
Retrospective Studies
Abstract
Although guidelines for fresh frozen plasma (FFP) use have been published, many transfusions are considered inappropriate. Current guidelines suggest few circumstances in which FFP transfusion to critically ill patients is warranted. The objectives of this study were to evaluate the consistency of Canadian guidelines for FFP administration to critically ill patients and to examine factors associated with inappropriate FFP transfusions.
Retrospective cohort study.
15-bed medical surgical intensive care unit in a teaching hospital.
254 consecutive adults admitted during 1 yr expected to stay in intensive care for more than 72 hrs.
None.
Patient demographics, illness severity, life support, intensive care and hospital length of stay, and survival were prospectively collected. All FFP orders were identified from the hospital laboratory information system. For each order, coagulation parameters, planned invasive interventions, recent or current bleeding, and bleeding severity were retrospectively collected. Three observers independently adjudicated whether transfusions were consistent with guidelines, inconsistent but appropriate for the intensive care context, or inappropriate. Of 254 patients, 76 (29.9%) received FFP, accounting for 225 orders to transfuse 547 units. Of 225 orders, 73 (32.4%) were consistent with guidelines, 45 (20.0%) were inconsistent but appropriate, and 107 (47.6%) were inappropriate. Considering transfusions clustered within patients, chance-independent agreement on whether transfusions were inappropriate or not was high (phi 0.73, 0.64-0.81). Independent determinants of inappropriate FFP were the presence of less severe coagulopathy as indicated by lower international normalized ratios (p
Notes
Comment In: Crit Care Med. 2007 Jul;35(7):1777-817581362
PubMed ID
17522577 View in PubMed
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23 records – page 1 of 3.