Anesthesiology, Author Interviews, Critical Care - Intensive Care - ICUs, Mental Health Research / 04.03.2018

MedicalResearch.com Interview with: Yoanna Skrobik MD FRCP(c) MSc McGill University Health Centre Canada MedicalResearch.com: What is the background for this study? Response: My clinical research interests revolve around critical care analgesia, sedation, and delirium. I validated the first delirium screening tool in mechanically ventilated ICU patients (published in 2001), described ICU delirium risk factors, associated outcomes, compared treatment modalities and described pharmacological exposure for the disorder. I was invited to participate in the 2013 Society of Critical Care Medicine Pain, Anxiety, and Delirium management guidelines, and served as the vice-chair for the recently completed Pain, Agitation, Delirium, Early Mobility and Sleep upcoming guidelines. Until this study, no pharmacological prevention or intervention could convincingly be considered effective in ICU delirium. Although Haloperidol and other antipsychotics are frequently used in practice, their lack of efficacy and possible disadvantages are increasingly being understood. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, NEJM, Vanderbilt / 01.03.2018

MedicalResearch.com Interview with: Todd W. Rice, MD, MSc Associate Professor of Medicine Director, Vanderbilt University Hospital Medical Intensive Care Unit Division of Allergy, Pulmonary, and Critical Care Medicine Nashville, TN   MedicalResearch.com: What is the background for this study? Response: Our study (called the SMART study) evaluates the effects of different types of intravenous fluids used in practice in critically ill patients.  It is very similar to the companion study (called the SALT-ED study and published in the same issue) which compares the effects of different types of intravenous fluids on non-critically ill patients admitted to the hospital.  Saline is the most commonly used intravenous fluid in critically ill patients.  It contains higher levels of sodium and chloride than are present in the human blood.  Balanced fluids contain levels of sodium and chloride closer to those seen in human blood. Large observational studies and studies in animals have suggested that the higher sodium and chloride content in saline may cause or worsen damage to the kidney or cause death.  Only a few large studies have been done in humans and the results are a bit inconclusive. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Kidney Disease, NEJM, Vanderbilt / 01.03.2018

MedicalResearch.com Interview with: Wesley H. Self, MD, MPH Associate Professor Department of Emergency Medicine Vanderbilt University Medical Center Nashville, TN   MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Doctors have been giving IV fluids to patients for more than 100 years. The most common IV fluid during this time has been saline; it has high levels of sodium and chloride in it (similar to table salt).  Balanced fluids are an alternative type of IV fluid that has lower levels of sodium and chloride that are more similar to human blood. Our studies were designed to see if treating patients with these balanced fluids resulted in better outcomes than saline.  We found that patients treated with balanced fluids had lower rates of death and kidney damage than patients treated with saline. (more…)
Author Interviews, Cost of Health Care, Critical Care - Intensive Care - ICUs, JAMA, Kidney Disease / 26.02.2018

MedicalResearch.com Interview with: Rodrigo F. Alban, MD FACS Associate Director Performance Improvement Associate Residency Program Director NSQIP Surgeon Champion Department of Surgery Cedars-Sinai Medical Center  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Continuous Renal Replacement Therapy (CRRT) is a modality of hemodialysis commonly used to manage renal failure in critically ill patients who have significant hemodynamic compromise.  However, it is also resource-intensive and costly and its usage is highly variable and lacks standardization. Our institution organized a multidisciplinary task force to target high value care in critically ill patients requiring CRRT by standardizing its process flow, promoting cross-disciplinary discussions with patients and family members, and increasing visibility/awareness of CRRT use.  After our interventions, the mean duration of CRRT decreased by 11.3% from 7.43 to 6.59 days per patient.  We also saw a 9.8% decrease in the mean direct cost of CRRT from $11642 to $10506 per patient.  Finally, we also saw a decrease in the proportion of patients expiring on CRRT, and an increase in the proportion of patients transitioning to comfort care. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, JAMA, Mental Health Research / 22.02.2018

MedicalResearch.com Interview with: “hospital.” by Bethany Satterfield is licensed under CC BY 2.0Mark van den Boogaard, PhD, RN, CCRN Assistant Professor Department of Intensive Care Medicine Radboud University Medical Center Nijmegen Netherlands  MedicalResearch.com: What is the background for this study? What are the main findings? Response:  Delirium is affecting many of our intensive care unit (ICU) patients which is impacting their recovery on the short-term as well as on the long-term. Therefore we were very interested to investigate if the use prophylactic haloperidol would be beneficial for the ICU patients. Especially because there were indications that it would be effective in ICU delirium prevention and also because this drug is being used in daily practice to prevent ICU delirium although there is no clear evidence. The overall finding of our large-scale well designed study is that we didn’t find any beneficial effect of prophylactic haloperidol in ICU patients. Moreover, this finding is very consistent over all groups of patients.  (more…)
Author Interviews, C. difficile, Critical Care - Intensive Care - ICUs, Infections, JAMA, Outcomes & Safety / 18.10.2017

MedicalResearch.com Interview with: Dr. Robert Hiensch MD Assistant Professor, Medicine, Pulmonary, Critical Care and Sleep Medicine Icahn School of Medicine at Mount Sinai. MedicalResearch.com: What is the background for this study? What are the main findings? Response: New sepsis guidelines that recommend screening and early treatment for sepsis cases appear to have significant positive impacts on patient outcomes. Less research has been published on what potential side effects may result from these guidelines. Antibiotics are a cornerstone of sepsis treatment and early antibiotic administration is strongly recommended.  We examined whether the introduction of an electronic based sepsis initiative changed antibiotic prescribing patterns at our hospital. Antibiotics, even when appropriate, contribute to hospital onset Clostridium difficile infections (HO CDIs).  While the authors do not dispute the importance of antibiotic administration in sepsis, it is valuable to know whether the sepsis initiative coincided with both increased antibiotic administration and HO CDIs. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Emergency Care, Heart Disease / 02.10.2017

MedicalResearch.com Interview with: Alexis Cournoyer MD Université de Montréal Hôpital du Sacré-Cœur de Montréal Institut de Cardiologie de Montréal, Montréal, Québec, Canada.  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Out-of-hospital advanced cardiac life support (ACLS) is frequently provided to patients suffering from cardiac arrest.  This was shown to improve rates of return of spontaneous circulation, but there was no good evidence that it improved any patient-oriented outcomes.  Given the progress of post-resuscitation care, it was important to reassess if ACLS improved survival in out-of-hospital cardiac arrest.  Also, with the advent of extracorporeal resuscitation, a promising technique that needs to be performed relatively early in the course of the resuscitation and which seems to improve patients' outcome, we wanted to evaluate if prolonged prehospital resuscitation with ACLS was effective in extracorporeal resuscitation candidates. In this study, we observed, as was noted in previous study, that prehospital advanced cardiac life support  did not provide a benefit to patients regarding survival to discharge, but increased the rate of prehospital return of spontaneous circulation.  It also prolonged the delay before hospital arrival of around 15 minutes.  In the patients eligible for extracorporeal resuscitation, we observed the same findings. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Heart Disease, JAMA / 15.09.2017

MedicalResearch.com Interview with: Hans Kirkegaard, MD, PhD, DMSci, DEAA, DLS Research Center for Emergency Medicine and Department of Anesthesiology and Intensive Care Medicine Aarhus University Hospital and Aarhus University Aarhus, Denmark  MedicalResearch.com: What is the background for this study? Response: In 2002, two landmark studies demonstrated that mild therapeutic hypothermia (now known as targeted temperature management, TTM) for 12 or 24 hours improves neurological outcome in adult comatose patients suffering from out of hospital cardiac arrest. Accordingly, international guidelines now recommend TTM for at least 24 hours in this patient group. However, there are no studies, only case reports that explore the effect of prolonged cooling. We therefore wanted to set up a trial that could fill out this knowledge gap, we hypothesized that doubling the hypothermia dose to 48 hour would improve neurological outcome without increasing the risk of adverse events considerably. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Infections, JAMA / 15.09.2017

MedicalResearch.com Interview with: Dr. Chanu Rhee MD, Assistant Professor Therapeutics Research and Infectious Disease Epidemiology Group Department of Population Medicine at Harvard Medical School / Harvard Pilgrim Health Care Institute Critical Care and Infectious Disease Physician Transplant/Oncology Infectious Disease service and Medical Intensive Care Unit at Brigham and Women’s Hospital  MedicalResearch.com: What is the background for this study? Response: Multiple studies suggest that the incidence of sepsis, the syndrome of life-threatening organ dysfunction caused by infection, is increasing over time, while mortality rates are decreasing.  However, reliably measuring sepsis incidence and trends is challenging because clinical diagnoses of sepsis are subjective and insurance claims data, the traditional method of surveillance, can be affected by changing diagnosis and coding practices over time. In this study, my colleagues and I estimated the current U.S. burden of sepsis and trends using clinical data from the electronic health record systems of a large number of diverse hospitals. The findings, published in JAMA, challenge the use of claims data for sepsis surveillance and suggest that clinical surveillance using electronic health record data provides more objective estimates of sepsis incidence and outcomes. (more…)
Author Interviews, Biomarkers, Critical Care - Intensive Care - ICUs, PLoS, Surgical Research / 27.07.2017

MedicalResearch.com Interview with: Dr. Joanna Shepherd Centre for Trauma Sciences Blizard Institute Queen Mary, University of London MedicalResearch.com: What is the background for this study? What are the main findings? Response: Recent advances in resuscitation and treatment of life-threatening critical injuries means that patients with previously unsurvivable injuries are now surviving to reach hospital.  However, many of these patients develop Multiple Organ Dysfunction Syndrome (MODS), which is a failure of several organs including the lung, heart, kidney, and liver. We studied immune cell genes in the blood of critically injured patients within the first few minutes to hours after injury, a period called the ‘hyperacute window’. We found a small and specific response to critical injury during this window that then evolved into a widespread immune reaction by 24 hours.  The development of MODS was linked to changes in the hyperacute window, with central roles for innate immune cells (including natural killer cells and neutrophils) and biological pathways associated with cell death and survival.  By 24 hours after injury, there was widespread immune activation present in all critically injured patients, but the MODS signal had either reversed or disappeared. (more…)
Author Interviews, Blood Pressure - Hypertension, Cleveland Clinic, Critical Care - Intensive Care - ICUs, Infections, NEJM / 22.05.2017

MedicalResearch.com Interview with: Ashish Khanna, MD, FCCP Assistant Professor of Anesthesiology, Cleveland Clinic Lerner College of Medicine Staff Intensivist Center for Critical Care and Department of Outcomes Research Cleveland Clinic, Cleveland MedicalResearch.com: How did you become interested in this topic? Response: Anesthesia forms the basis of my training but I also completed a fellowship in critical care and, at the present time, I do more work in critical care than anesthesia. About 75% of my time is spent in the Cleveland Clinic critical care units, including the Medical and surgical ICUs (Intensive Care Units). (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Emergency Care, Infections, NEJM, University of Pittsburgh / 21.05.2017

MedicalResearch.com Interview with: Christopher W. Seymour, M.D., M.Sc. Assistant professor of Critical Care Medicine and Emergency Medicine, and member of Clinical Research Investigation and Systems Modeling of Acute Illness University of Pittsburgh MedicalResearch.com: What is the background for this study? What are the main findings? Response: Following the tragic and widely publicized death of Rory Staunton, 12, from undiagnosed sepsis in 2012, New York became the first state to require that hospitals follow a protocol to quickly identify and treat the condition. The mandate led to widespread controversy in the medical community as to whether such steps would have saved Rory or anyone else’s life. Rory’s Regulations require hospitals to follow protocols for early identification and treatment of sepsis, and submit data on compliance and outcomes. The hospitals can tailor how they implement the protocols, but must include a blood culture to test for infection, measurement of blood lactate (a sign of tissue stress) and administration of antibiotics within three hours of diagnosis—collectively known as the “three-hour bundle.” We analyzed data from nearly 50,000 patients from 149 New York hospitals to scientifically determine if  Rory’s Regulations worked. We found that they did - 83 percent of the hospitals completed the bundle within the required three hours, overall averaging 1.3 hours for completion. For every hour that it took clinicians to complete the bundle, the odds of the patient dying increased by 4 percent. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Electronic Records, Infections / 21.05.2017

MedicalResearch.com Interview with: Faheem Guirgis MD Assistant Professor of Emergency Medicine Department of Emergency Medicine Division of Research UF Health Jacksonville MedicalResearch.com: What is the background for this study? What are the main findings? Response: Sepsis is quite prevalent among hospitals and the incidence is increasing. It is a life-threatening disease that can lead to poor outcomes if patients are not recognized and treated promptly. We recognized that our institution needed a strategic approach to the problem of sepsis, therefore the Sepsis Committee was created with the goal of creating a comprehensive sepsis program. We developed a system for sepsis recognition and rapid care delivery that would work in any area of the hospital. We found that we reduced overall mortality from sepsis, the number of patients requiring mechanical ventilation, intensive care unit length and overall hospital length of stay, and the charges to the patient by approximately $7000 per patient. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Kidney Disease / 29.04.2017

MedicalResearch.com Interview with: Sean Bagshaw MD MSc Director for Research for the Division of Critical Care Medicine School of Public Health University of Alberta, Canada MedicalResearch.com: What is the background for this study? What are the main findings? Response: The rationale for SPARK stemmed from two general observations. First, experimental and pre-clinical data have suggested the timely utilization of loop diuretics in early AKI could provide “kidney protection” largely mediated through reduction in medullary oxygen demand. Yet, this is in apparent paradox with clinical data (largely derived from older observational studies at some risk of bias) suggesting use of loop diuretics in AKI may be associated with increased risk for death and/or non-recovery of kidney function. Second, in AKI, loop diuretics are used exceedingly often. Surveys of healthcare practitioners and observational data suggest more than two-thirds to three-quarters of patients are exposed to diuretics at some point during their course. This represents a significant misalignment between evidence and clinical practice. This would suggest there is need to generate new evidence and knowledge that would ideally help inform best practice in the management of AKI. SPARK was designed as a pilot trial largely aimed at evaluating the feasibility of the approach to use of loop diuretics in early AKI. While SPARK did not find significant differences in risk of worsening AKI, utilization of RRT or mortality, we recognize the trial was underpowered to meaningfully inform about these and other patient-centered outcomes. We did see differences in secondary endpoints (i.e., fluid balance); however, use of loop diuretics in this setting was also associated with greater incidence of electrolyte abnormalities. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Education, Nursing, Pediatrics / 25.04.2017

MedicalResearch.com Interview with: Deborah A. Raines PhD, EdS, RN, ANEF School of Nursing University at Buffalo MedicalResearch.com: What is the background for this study? What are the main findings? Response: This research grew from my experience as a neonatal nurse. I have worked with many families preparing to take their baby home and have seen the anxiety they experience wondering if they will be able to take care of their baby’s medical needs at home. Parents are usually most anxious about emergency situations that may occur. Majority of these parents are able to state what they should do, but have never experienced the actual situation with their baby. This study was designed to see if a simulation experience would fill this gap in parents’ preparation for the discharge of their baby from the NICU. This study had parents participated in a customized simulation to have them experience the care needed by their baby at home following discharge from the NICU. The findings revealed that parents reported a nearly 30 percent increase in confidence in their abilities to care for their baby after participating in the simulation. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Merck / 24.04.2017

MedicalResearch.com Interview with: Eilish McCann, PhD Director, Outcomes Research (Center for Observational and Real-World Evidence) Merck MedicalResearch.com: What is the background for this study? Response: One of the most pressing challenges facing medicine today is the emergence of bacterial resistance to antibiotics. One area of high concern is the increasing prevalence of resistance to powerful antibiotics like carbapenems, as patients with infections due to carbapenem-resistant bacteria have very few alternate effective treatment options. In this study we used real-world data from a Becton, Dickinson and Company electronic research data set to analyze over 140,000 bacterial isolates from patients at 342 hospitals across the United States, so that we could investigate where the burden of carbapenem resistance is most acute. Importantly analysis of real-world data in this way allows us to gain insights from a large number of hospitals, giving a broad and nationally representative picture of the resistance burden. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Dermatology, JAMA / 30.03.2017

MedicalResearch.com Interview with: Prof. Dr. Maja Mockenhaupt Dept. of Dermatology Medical Center - University of Freiburg Deutschland / Germany MedicalResearch.com: What is the background for this study? Response: Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are severe cutaneous adverse reactions that are associated with high morbidity and mortality. Primarily due to their rareness, therapeutic effects are often studied in observational settings. An evidence-based standardized treatment protocol for SJS/TEN is still missing. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Dermatology, Pediatrics / 26.03.2017

MedicalResearch.com Interview with: Dr. Jonathan L. Silverberg MD PhD MPH Assistant Professor in Dermatology Medical Social Sciences and Preventive Medicine Northwestern University, Chicago, Illinois MedicalResearch.com: What is the background for this study? Response: Stevens-Johnson syndrome and Toxic Epidermal Necrolysis (SJS/TEN) are relatively rare and potentially life-threatening disorders. There have been some recent advances in our understanding of the epidemiology and risk factors of SJS/TEN in adults. However, little is known about the epidemiology of pediatric SJS/TEN. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Emergency Care / 19.03.2017

MedicalResearch.com Interview with: Marleen Boerma MD Department of Emergency Medicine Elisabeth-Tweesteden Hospital Tilburg, The Netherlands MedicalResearch.com: What is the background for this study? What are the main findings? Response: Unplanned Intensive Care Unit (ICU) admission has been used as a surrogate marker of adverse events, and is used by the Australian Council of Healthcare Accreditation as a reportable quality indicator. If we can identify independent variables predicting deterioration which require ICU transfer within 24 hours after emergency department (ED) admission, direct ICU admission should be considered. This may improve patient safety and reduce adverse events by appropriate disposition of patients presenting to the ED. This study shows that there were significantly more hypercapnia patients in the ICU admission group (n=17) compared to the non-ICU group (n=5)(p=0.028). There were significantly greater rates of tachypnea in septic patients (p=0.022) and low oxygen saturation for patients with pneumonia (p=0.045). The level of documentation of respiratory rate was poor. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Pediatrics / 10.02.2017

MedicalResearch.com Interview with: Bobbi Pineda, PhD Assistant professor of occupational therapy and of pediatrics Washington University School of Medicine St. Louis  MedicalResearch.com: What is the background for this study? Response: We published findings in 2014 from a study in which we investigated differences in outcome among preterm infants hospitalized in an open ward NICU compared to those hospitalized in a NICU private room.  In this study, we found that infants who were in the open ward had differences in brain structure by the time they were discharged from the hospital, and by age 2 years they had significantly better language outcomes than those in private rooms.  The study NICU is located in an urban area and cares for families who have a high risk of social challenges, resulting in rates of parent engagement that were not optimal.  However, such findings made us question if the sensory exposure, specifically auditory stimulation, may be significantly reduced in the private room and could explain our findings. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Emergency Care, Infections / 07.02.2017

MedicalResearch.com Interview with: Anish Agarwal, MD, MPH The Hospital of the University of Pennsylvania Department of Emergency Medicine Philadelphia, PA MedicalResearch.com: What is the background for this study? What are the main findings? Response: The morbidity and mortality of severe sepsis has been well studied and documented. An aggressive approach to protocolized care for patients suffering from severe sepsis and septic shock has been shown to improve mortality and should be started as early in the time course of a patient's presentation. Emergency departments (ED) are designed to deliver time-sensitive therapies, however, they also may suffer from crowding due to multiple factors. This study aimed to assess the impact of ED crowding upon critical interventions in the treatment of severe sepsis including time to intravenous fluids, antibiotics, and overall delivery of a protocolized bundle of care. The study found that as ED crowding increased, time to critical therapies significantly increased and the overall implementation of procotolized care decreased. More specifically as ED occupancy and total patient hours within the ED increased, time to intravenous fluids decreased and time to antibiotics increased as occupancy, hours, and boarding increased. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, JAMA / 30.01.2017

MedicalResearch.com Interview with: Dr. Hayley B. Gershengorn, MD Associate Professor of Clinical Medicine, Department of Medicine (Critical Care) Assistant Professor, The Saul R. Korey Department of Neurology Montefiore Medical Center Bronx, NY MedicalResearch.com: What is the background for this study? What are the main findings? Response: The patient-to-intensivist ratio across intensive care units is not standardized and whether the patient-to-intensivist ratio impacts patient outcome is not well established. I n this study, we conducted a retrospective cohort analysis including 49,686 adults across 94 United Kingdom intensive care units. In this setting, a patient-to-intensivist ratio of 7.5 was associated with the lowest risk adjusted hospital mortality, with higher mortality at both higher and lower patient-to-intensivist ratios. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Infections, JAMA, University of Pittsburgh / 26.01.2017

MedicalResearch.com Interview with: Sachin Yende, M.D., M.S., Associate professor University of Pittsburgh School of Medicine’s departments of Critical Care Medicine and Clinical and Translational and Vice president of Critical Care at the VA Pittsburgh. Florian B. Mayr, M.D., M.P.H. Faculty member in University of Pittsburgh Department of Critical Care Medicine and the Center for Health Equity Research and Promotion MedicalResearch.com: What is the background for this study? What are the main findings? Response: The Centers for Medicare and Medicaid Services and the Veteran Health Administration currently track readmission rates for pneumonia, acute heart attacks, heart failure and chronic obstructive lung disease for quality purposes and pay for performance. In our study, we were able to demonstrate that unplanned readmissions after sepsis (defined as life threatening organ failure due to the body's response to an overwhelming infection) are more common than readmission for these other conditions stated above and associated with significant excess costs. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Emory, Neurological Disorders / 17.01.2017

MedicalResearch.com Interview with: Andres Rodriguez Ruiz, MD Clinical Neurophysiology and Neurology Emory School of Medicine MedicalResearch.com: What is the background for this study? Response: The Critical Care EEG monitoring research consortium (CCEMRC) was established with the goal of promoting collaboration and research among healthcare institutions highly involved in continuous EEG monitoring of critically ill patients. This group together with the American Clinical Neurophysiology Society (ACNS) established the standardized critical care EEG terminology that allowed uniform reporting of EEG findings in critically ill patients. As part of this effort, a database was developed for collection and clinical reporting of such EEG findings and was adopted for daily clinical use by Yale University, Emory University and Brigham and Women's Hospital. Prior retrospective reports have acknowledged an association between periodic discharges and seizures. However, many of these reports were small series and did not include specific characteristics of these patterns. Our goal was to ascertain whether features of periodic and rhythmic patterns such as location (generalized vs. lateralized), frequency and prevalence influenced seizure risk in a large cohort of critically ill adults. (more…)
Author Interviews, Biomarkers, Critical Care - Intensive Care - ICUs, Infections, JAMA, Pediatrics / 11.01.2017

MedicalResearch.com Interview with: Halden F. Scott MD, Assistant Professor Departments of Pediatrics and Emergency Medicine University of Colorado School of Medicine MedicalResearch.com: What is the background for this study? Response: Sepsis, a dysregulated immune response to infection, is a leading cause of death for children. Survival depends on rapid diagnosis and timely delivery of life-saving resuscitative care, including fluids and antibiotics. However, it can be challenging to make an early diagnosis of sepsis in children. Millions of children present for emergency care of infection and fever every year, most of whom will not develop sepsis. Tools that assist providers in distinguishing the sickest children with infection at an early stage could enable the early delivery of life-saving treatments. Lactate is a clinically-available laboratory test that has played a critical role in improving the diagnosis and treatment of sepsis in adults. Sepsis may cause lactate levels to rise in the blood during sepsis, through reduced delivery of oxygen to the tissues, as well as through changes in how energy is produced and in how lactate is cleared by the kidney and liver. Data about lactate in pediatric sepsis, particularly early levels and whether it is associated with mortality, have been limited. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Exercise - Fitness, PLoS / 31.12.2016

MedicalResearch.com Interview with: Michelle Kho, PT, PhD Canada Research Chair in Critical Care Rehabilitation and Knowledge Translation Assistant Professor School of Rehabilitation Science McMaster University MedicalResearch.com: What is the background for this study? Response: Patients who survive the ICU are at risk for muscle weakness and can experience physical functional disability lasting 5 to 8 years after the ICU. From a study conducted in Belgium, patients who were randomized to receive cycling after being in ICU for 2 weeks walked farther at ICU discharge than those who did not. Other research supported physiotherapy starting within days of starting mechanical ventilation to improve functional outcomes. Our CYCLE research program combines these 2 concepts – Can we start cycling very early in a patient’s ICU stay, and will this improve functional outcomes post-ICU? (more…)
Author Interviews, Cost of Health Care, Critical Care - Intensive Care - ICUs, JAMA / 27.12.2016

MedicalResearch.com Interview with: Dr. Dong W. Chang, MD MS Division of Respiratory and Critical Care Physiology and Medicine Los Angeles Biomed Research Institute at Harbor-University of California Los Angeles, Medical Center Torrance California MedicalResearch.com: What is the background for this study? Response: The study was based on our overall impression that ICU care is often delivered to patients who are unlikely to derive long-term benefit (based on their co-morbidities/severity of illness, etc.). However, what surprised us was the magnitude of this problem. Our study found more than half the patients in ICU at a major metropolitan acute-care hospital could have been cared for in less expensive and invasive settings. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, JAMA, Pediatrics, Pulmonary Disease / 15.12.2016

MedicalResearch.com Interview with: Kristin N. Ferguson, BSc The Royal Women’s Hospital and Deakin University Melbourne, Victoria, Australia MedicalResearch.com: What is the background for this study? Response: Weaning preterm infants from mechanical ventilation, thereby minimising the risks of having an endotracheal tube in situ which may further damage their fragile lungs, is something all neonatal clinicians are keen to do. We provide clinicians with a straightforward list of safe and effective strategies to help them in this task, as well as pointing out some treatments to either avoid or use with caution. (more…)
Alzheimer's - Dementia, Annals Internal Medicine, Author Interviews, Critical Care - Intensive Care - ICUs, Health Care Systems, University of Pittsburgh / 12.12.2016

MedicalResearch.com Interview with: Joshua M. Thorpe, PhD, MPH From the Center for Health Equity Research and Promotion Veterans Affairs Pittsburgh Healthcare System Pittsburgh Pennsylvania, and Center for Health Services Research in Primary Care Department of Pharmacy and Therapeutics University of Pittsburgh School of Pharmacy MedicalResearch.com: What is the background for this study? Response: Care coordination for persons with dementia is challenging for health care systems under the best of circumstances. These coordination challenges are exacerbated in Medicare-eligible veterans who receive care through both Medicare and the Department of Veterans Affairs (VA). Recent Medicare and VA policy changes (e.g., Medicare Part D, Veteran’s Choice Act) expand veterans’ access to providers outside the VA. While access to care may be improved, seeking care across multiple health systems may disrupt care coordination and increase the risk of unsafe prescribing - particularly in veterans with dementia. To see how expanded access to care outside the VA might influence medication safety for veterans with dementia, we studied prescribing safety in Veterans who qualified for prescriptions through the VA as well as through the Medicare Part D drug benefit. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Outcomes & Safety, Sleep Disorders / 28.11.2016

MedicalResearch.com Interview with: Luc Schlangen PhD Principal Scientist at Philips Lighting Research Eindhoven the Netherlands MedicalResearch.com: What is the background for this study? What are the main finding Response: Everyone knows that sleep is critical to one’s overall health and well-being. Yet one-third of the general adult population report difficulties sleeping. Ongoing social commitments and work routines make it difficult to make sleep a priority, also in hospitals. People increasingly recognize that the usage of light emitting electronic devices before bedtime is compromising sleep. Consequently, many people started to use these devices in a more sleep-permissive mode during the evening, using algorithms that automatically dim down the intensity and blue content of their tablet and smart phone screens as the evening progresses. Moreover, there is increasing evidence that brighter daytime light conditions help to improve mood and nighttime sleep quality. These observations inspired us to undertake a joint study with the Maastricht University Medical Center. In the study we explored whether a tunable lighting system with extra daytime brightness and lower light intensities and warmer tones of light in the evening and night, can improve sleep and wellbeing in hospital patients. We found that the system was well appreciated and helped hospital patients to fall asleep more rapidly. Moreover, after 5 days in a room with such a dynamic lighting system patients slept longer by almost 30 minutes as compared to a standardly lit room. (more…)