Epidemiology and outcomes of in-hospital cardiac arrest in critically ill children across hospitals of varied center volume: A multi-center analysis

Objective

To describe epidemiology and outcomes associated with cardiac arrest among critically ill children across hospitals of varying center volumes.

Methods

Patients <18 years of age in the Virtual PICU Systems (VPS, LLC) Database (2009–2013) were included. Patients with both cardiac and non-cardiac diagnoses were included. Data on demographics, patient diagnosis, cardiac arrest, severity of illness and outcomes were collected. Hierarchical cluster analysis was performed to categorize all the participating centers into low, low-medium, high-medium, and high volume groups using the center volume characteristics (annual hospital discharges per center, annual extracorporeal membrane oxygenation per center, and annual mechanical ventilators per center). Multivariable models were used to evaluate association of center volume with incidence of cardiac arrest, and mortality after cardiac arrest, adjusting for patient and center characteristics.

Results

Of 329,982 patients (108 centers), 2.2% (n = 7390) patients had cardiac arrest with an associated mortality of 35% (n = 2586). In multivariable models controlling for patient and center characteristics, center volume was not associated with either the incidence of cardiac arrest (OR: 1.00; 95% CI: 0.95–1.06; p = 0.98), or mortality in those with cardiac arrest (OR: 0.93; 95% CI: 0.82–1.06; p = 0.27). These associations were similar across cardiac and non-cardiac disease categories. Furthermore, we demonstrated that there was no correlation between incidence of cardiac arrest and mortality in those with cardiac arrest across different study hospitals in adjusted models.

Conclusions

Both incidence of cardiac arrest, and mortality in those with cardiac arrest vary substantially across hospitals. However, center volume is not associated with either of these outcomes, after adjusting for patient and center characteristics.     

Effects of a mandatory basic life support training programme on the no-flow fraction during in-hospital cardiac resuscitation: An observational study

Aim of the study

Many hospitals have basic life support (BLS) training programmes, but the effects on the quality of chest compressions are unclear. This study aimed to evaluate the no-flow fraction (NFF) during BLS provided by standard care nursing teams over a five-year observation period during which annual participation in the BLS training was mandatory.

Methods

All healthcare professionals working at Dresden University Hospital were instructed in BLS and automated external defibrillator (AED) use according to the current European Resuscitation Council guidelines on an annual basis. After each cardiac arrest occurring on a standard care ward, AED data were analyzed. The time without chest compressions during the period without spontaneous circulation (i.e., the no-flow fraction) was calculated using thoracic impedance data.

Results

For each year of the study period (2008–2012), a total of 1454, 1466, 1487, 1432, and 1388 health care professionals, respectively, participated in the training. The median no-flow fraction decreased significantly from 0.55 [0.42; 0.57] (median [25‰; 75‰]) in 2008 to 0.3 [0.28; 0.35] in 2012. Following revision of the BLS curriculum after publication of the 2010 guidelines, cardiac arrest was associated with a higher proportion of patients achieving ROSC (72% vs. 48%, P = 0.025) but not a higher survival rate to hospital discharge (35% vs. 19%, P = 0.073).

Conclusion

The NFF during in-hospital cardiac resuscitation decreased after establishment of a mandatory annual BLS training for healthcare professionals. Following publication of the 2010 guidelines, more patients achieved ROSC after in-hospital cardiac arrest.     

The effect of adherence to ACLS protocols on survival of event in the setting of in-hospital cardiac arrest

Aim

Advanced Cardiac Life Support (ACLS) algorithms are the default standard of care for in-hospital cardiac arrest (IHCA) management. However, adherence to published guidelines is relatively poor. The records of 149 patients who experienced IHCA were examined to begin to understand the association between overall adherence to ACLS protocols and successful return of spontaneous circulation (ROSC).

Methods

A retrospective chart review of medical records and code team worksheets was conducted for 75 patients who had ROSC after an IHCA event (SE group) and 74 who did not survive an IHCA event (DNS group). Protocol adherence was assessed using a detailed checklist based on the 2005 ACLS Update protocols. Several additional patient characteristics and circumstances were also examined as potential predictors of ROSC.

Results

In unadjusted analyses, the percentage of correct steps performed was positively correlated with ROSC from an IHCA (p < 0.01), and the number of errors of commission and omission were both negatively correlated with ROSC from an IHCA (p < 0.01). In multivariable models, the percentage of correct steps performed and the number of errors of commission and omission remained significantly predictive of ROSC (p < 0.01 and p < 0.0001, respectively) even after accounting for confounders such as the difference in age and location of the IHCAs.

Conclusions

Our results show that adherence to ACLS protocols throughout an event is correlated with increased ROSC in the setting of cardiac arrest. Furthermore, the results suggest that, in addition to correct actions, both wrong actions and omissions of indicated actions lead to decreased ROSC after IHCA.     

安宁疗护咨询在危重症患者中的应用进展

ICU与安宁疗护的结合,有助于提高ICU患者的生命质量,减少过度医疗。ICU安宁疗护咨询是以ICU临终患者和家属为中心,由安宁疗护咨询者提供有关症状控制、医疗决策制订和安宁疗护转诊信息的共享照护实践,是整合安宁疗护和ICU护理的有效途径。该文对ICU安宁疗护咨询的概念和内容、实施效果及障碍进行综述,为国内ICU开展安宁疗护咨询提供参考。     

Chronic hepatitis C in the state prison system: insights into the problems and possible solutions

The prevalence of chronic hepatitis C virus (HCV) within the correctional system is estimated to be 10–20-times greater than that which is reported in the general population. High-risk behavioral patterns probably account for the greater estimates in this population. Recent observations of more than 780 patient-inmates infected with HCV within the California Department of Corrections suggest a very high prevalence of advanced fibrosis in this population. Observational studies performed in Texas have shown that the rates of chronic liver disease-related deaths have increased significantly between 1989 and 2003, especially among Hispanic patient-inmates. Viral hepatitis accounts for a significant number of these chronic liver disease-related deaths. Identification of high-risk patient-inmates infected with HCV, as well as appropriation of funds for their treatment, should result in a decreased rate of liver-related complications. This should translate into reduced morbidity and cost to correctional institutions, as well as to improved public health and safety.     

Training and maintaining motivational interviewing skills in a clinical trial

Motivational interviewing (MI) is an evidence-based practice that is being implemented in a wide range of settings. Research supports the importance of ongoing coaching and feedback sessions following initial training in MI to implement and sustain MI-adherent competencies. This article describes the development and preliminary testing of a group feedback and consultation process where clinicians code each others’ clinical samples of MI sessions and provide feedback to each other regarding the level of adherence to MI fidelity measures. Preliminary results suggest that group feedback may help clinicians develop and sustain MI skills.     

Adaptation and use of health services by primiparous women with urinary incontinence

OBJECTIVES: To describe the use of health services by primiparous women with urinary incontinence by (a) examining the quality of life of these women and (b) describing the different predictors associated with their use of health services. DESIGN AND SETTING: This correlative study is a secondary analysis of a broader epidemiologic study. PARTICIPANTS: The 382 women identified as having urinary incontinence in the main epidemiologic study in Quebec, Canada. MAIN OUTCOME MEASURES: Consultation rate; quality of life, predictors of quality of life, and use of health services; treatments received; and reasons for not seeking help. RESULTS: Consultation rate was 11.1%. Many sociodemographic, clinical, and urinary incontinence factors were significantly associated with a decreased quality of life. Only frequency of nocturia, severe urinary incontinence, use of sanitary protection, and lower scores on the quality-of-life scale were significantly associated with differences in consultation rates. Physiotherapy was the most popular treatment received (71.4%). Most women with urinary incontinence did not consult because they considered urinary incontinence to be normal (47.3%). CONCLUSIONS: Few women with urinary incontinence used health services for their urinary incontinence problem despite a decreased quality of life. Health professionals need to intervene early and promptly to help women with urinary incontinence deal more adequately with urinary incontinence and to inform women on how and where to seek help.     

Place du psycho-oncologue dans la démarche oncogénétique: accompagnement de la phase de réalisation du test génétique

Résumé: Le caractère multidisciplinaire de la démarche d’oncogénétique, son caractère prédictif autant que les possibles répercussions familiales ou psychologiques ont favorisé d’emblée la participation d’un psychologue dès la phase de réalisation des tests. Les récentes revues de la littérature rapportent pourtant un relativement faible retentissement émotionnel à court et moyen terme, mais soulignent la possibilité d’un impact au long cours ou de modifications plus complexes que celles qui sont appréhendées par l’évaluation de sympt?mes émotionnels, de la détresse psychologique ou de la perception du risque. De la même fa?on, le r?le du psychologue va dépasser le cadre de la prévention, de l’évaluation et de la gestion du retentissement émotionnel lors de la phase de réalisation du test. Parmi ses missions, le soutien du demandeur, qui passe par l’évaluation des motivations et du contexte de la démarche, l’accompagnement à la transmission familiale de l’information, l’aide à la gestion de l’information et de l’incertitude; autant d’objectifs qui passent par la possibilité d’un contact réel avec un patient qui n’a pas toujours ni le désir, ni la compréhension de cette rencontre avec le psychologue. Comment en pratique organiser cette consultation psychologique lors de la réalisation du test? Avant, pendant ou après la remise des résultats? Avec le généticien ou de fac?on distincte? Systématique ou ciblée, mais sur quels critères? En l’absence d’évaluation comparative stricte à ce jour de ces différentes organisations, nous tenterons de dégager les avantages et inconvénients de chacune—en considérant les souhaits des patients, mais aussi la possibilité pour le psychologue de structurer un espace suffisant pour que parallèlement au soutien émotionnel et cognitif puisse s’y inscrire l’ampleur des dimensions personnelles et familiales de la question oncogénétique. Dossier: ?Oncogénétique?     

The Role of Consultation Clinics in Services for Children and Young People with Learning Disabilities and/or Autism

Background:  Consultation and supervision are familiar to many professionals, and their relevance to those working with children with learning disabilities and autism is discussed.
Method:  Consultation Clinics for Community Learning Disability Nurses and others were set up by a specialist Child and Adolescent Mental Health team servicing an area with a general population of 750,000. They were provided by a clinical psychologist and a psychiatrist, and data on their use were collected over a 16 month period.
Results:  There were differences in frequency of use between nurses based in more rural teams and those in city teams. The number of children discussed increased over time, and approximately half continued to be supported by the discussant, rather than being referred to the Tier 3 service.
Conclusions:  Suggestions are made as to the possible impact and benefits, with discussion also considering the role of professional responsibilities in consultative services.