When Should Children in Pediatric Intensive Care Receive Parenteral Nutrition?

MedicalResearch.com Interview with:

Sascha Verbruggen, MD, PhD Pediatric intensivist Erasmus MC-Sophia Children's Hospital

Dr. Verbruggen

Sascha Verbruggen, MD, PhD
Pediatric intensivist
Erasmus MC-Sophia Children’s Hospital

MedicalResearch.com: What is the background for this study?

Response: In critically ill children treated in the pediatric intensive care unit (PICU) are often difficult to feed. The subsequent macronutrient deficit was found to be associated with impaired outcomes in the PICU. Furthermore, being undernourished in the PICU has also been associated with poor outcome of critical illness in children.

These associations formed the basis for guidelines recommending initiation of parenteral nutritional support early when enteral feeding is insufficient. However, the multicenter randomised controlled trial (RCT) ‘Pediatric Early versus Late Parenteral Nutrition in Critical Illness’ (PEPaNIC), including 1440 critically ill children, showed that withholding PN for one week (Late-PN) resulted in fewer new infections and reduced the duration of PICU stay as compared to initiating PN at day 1 (Early-PN). However, withholding PN for one week in critically ill children, who are already undernourished upon admission to the PICU, raised concerns among experts.

Therefore we set out to investigate the impact of withholding supplemental PN in a subgroup of critically ill children who were acutely undernourished upon admission to the PICU.  Continue reading

First Trial Compares Treatment Options For Serious Infections Caused by ESBL-Producers

MedicalResearch.com Interview with:

Patrick Harris FRACP Staff Specialist Microbiology | Pathology Queensland | Health Support Queensland Postdoctoral Research Fellow University of Queensland, UQ Centre for Clinical Research (Paterson Group)

Dr. Harris

Patrick Harris FRACP
Staff Specialist
Microbiology | Pathology Queensland | Health Support Queensland
Postdoctoral Research Fellow
University of Queensland, UQ Centre for Clinical Research (Paterson Group

MedicalResearch.com: What is the background for this study?

Response: Increasingly, common bacterial pathogens such as E. coli or Klebsiella have acquired genes known as extended-spectrum beta-lactamases (ESBLs), which mediate resistance to many of our most important antibiotics. Despite their clinical importance, we have limited information derived from randomised clinical trials on the best antibiotic treatments for life-threatening infections caused by these ESBL-producers.

We aimed to compare two readily available antibiotics, meropenem (a carbapenem drug, as the “standard of care”) and piperacillin-tazobactam (which may be an alternative to meropenem). Many ESBL-producing bacteria test susceptible to piperacillin-tazobactam in the laboratory, yet clinical efficacy has been uncertain.  Some observational studies have suggested that piperacillin-tazobactam may be effective against ESBL-producers, but the data have been contradictory.  The theory has been that piperacillin-tazobactam may be less likely to select for resistance to carbapenems – which, when it occurs, can result in infection with bacteria that are almost untreatable.

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Daily Chest X-Rays Still Overused in Mechanically Ventilated Patients

MedicalResearch.com Interview with:

Hayley B. Gershengorn, MD Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida Division of Critical Care Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York

Dr. Gershengorn

Hayley B. Gershengorn, MD
Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
Division of Critical Care Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Beginning in December, 2011, professional guidelines have recommended against the practice of daily chest radiography (CXRs) for mechanically ventilated patients.  However, we hypothesized that this practice was still commonplace in the US and varied from hospital to hospital.

To address this question, we performed a retrospective cohort study of >500,000 mechanically ventilated adults across 416 US hospitals. We found that 63% of these patients received daily CXRs and that, while use has been decreasing, this decrease is small (a 3% relative reduction in the odds of daily CXR receipt per discharge quarter starting in 2012).

Moreover, the hospital at which a patient received care greatly impacted the likelihood of daily CXR receipt.

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“Rory’s Regulations” Improves Pediatric Sepsis Care

MedicalResearch.com Interview with:

Idris V.R. Evans, M.D.,MA Assistant Professor Department of Critical Care Medicine University of Pittsburgh

Dr. Evans

Idris V.R. Evans, M.D.,MA
Assistant Professor
Department of Critical Care Medicine
University of Pittsburgh

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: New York State issued a state-wide mandate in 2013 for all hospitals to develop protocols for sepsis recognition and treatment. This mandate was called “Rory’s Regulations” in honor of Rory Staunton, a boy who died from sepsis in 2012.

Pediatric protocols involved a bundle of care that included blood cultures, antibiotics, and an intravenous fluid bolus within 1–hour. We analyzed data collected by the NYS Department of Health on 1,179 patients from 54 hospitals and found that the completion of the pediatric bundle within 1 hour was associated with a 40% decrease in the odds of mortality.  Continue reading

Ultra-Early Deterioration Predicts Poor Outcome in Stroke

MedicalResearch.com Interview with:

Kristina Shkirkova

Kristina Shkirkova

Kristina Shkirkova
Doctoral Student in Neuroscience
Zilkha Neurogenetic Institute
University of Southern California
Los Angeles, CA

MedicalResearch.com: What is the background for this study?

Response: Stroke is the second leading cause of death and a leading cause of adult disability worldwide. Stroke onset is sudden with symptoms progressing rapidly in the first hours after onset. The course of symptom progression after stroke is not well studied in the ultra-early window before hospital arrival and during early postarrival period.

There is an urgent need to characterize the frequency, predictors, and outcomes of neurologic deterioration among stroke patients in the earliest time window.

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How Doctors Communicate Empathy Critical to Family-Physician Partnership

MedicalResearch.com Interview with:

Dr. Tessie W. October. MD, MPH Critical Care Specialist Children’s National Health System

Dr. October

Dr. Tessie W. October. MD, MPH
Critical Care Specialist
Children’s National Health System 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: This is a qualitative study that examines the impact of empathetic statements made by doctors on the ensuing conversation with families of critically ill children. We know families are more satisfied when doctors show empathy, but until this study, we did not know how these empathetic statements are received by families. In this study we found that doctors frequently respond to a family’s emotions by responding with empathy, but how the doctor presented that empathetic statement mattered. When doctors made an empathetic statement, then paused to allow time for a family’s response, the family was 18 times more likely to share additional information about their fears, hopes or values. Conversely, when doctors buried the empathetic statement within medical talk or if a second doctor interrupted, the empathetic statement frequently went unheard by the family.

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Family-Support Intervention in ICUs Increased Patient Comfort and Reduced Costs

MedicalResearch.com Interview with:

Douglas B. White, M.D., M.A.S. Director of the Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center’s Program on  Ethics and Decision Making in  Department of Critical Care Medicine University of Pittsburgh 

Dr. White

Douglas B. White, M.D., M.A.S.
Director of the Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center’s Program on
Ethics and Decision Making in  Department of Critical Care Medicine
University of Pittsburgh 

MedicalResearch.com: What is the background for this study? 

Response: We set out to test the effectiveness of PARTNER (PAiring Re-engineered ICU Teams with Nurse-driven Emotional Support and Relationship-building). PARTNER is delivered by the interprofessional team in the ICU, consisting of nurses, physicians, spiritual care providers, social workers and others who play a part in patient care. The program is overseen by nurse-leaders in each ICU who receive 12 hours of advanced communication skills training to support families. The nurses meet with the families daily and arrange interdisciplinary clinician-family meetings within 48 hours of a patient coming to the ICU. A quality improvement specialist helps to incorporate the family support intervention into the clinicians’ workflow.

PARTNER was rolled out at five UPMC ICUs with different patient populations and staffing. It was implemented in a staggered fashion so that every participating ICU would eventually get PARTNER. Before receiving PARTNER, the ICUs continued their usual methods of supporting families of hospitalized patients. None of the ICUs had a set approach to family communication or required family meetings at regular intervals before receiving PARTNER. A total of 1,420 adult patients were enrolled in the trial, and 1,106 of these patients’ family members agreed to be a part of the study and its six-month follow-up surveys. The patients were very sick, with about 60 percent dying within six months of hospitalization and less than 1 percent living independently at home at that point.

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Reducing Opioids Near End of Hospital Stay May Limit Outpatient Use

MedicalResearch.com Interview with:

Jason Kennedy, MS Research project manager Department of Critical Care Medicine University of Pittsburgh

Jason Kennedy

Jason Kennedy, MS
Research project manager
Department of Critical Care Medicine
University of Pittsburgh

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Most previous studies of opioid use in health care have focused on the outpatient setting. But opioids are often introduced during hospitalization. That’s something clinicians can control, so we looked at inpatient prescription of these drugs to identify targets that may reduce opioid use once patients are out of the hospital.

We analyzed the medical records of 357,413 non-obstetrical adults hospitalized between 2010 and 2014 at 12 University of Pittsburgh Medical Center (UPMC) hospitals in southwestern Pennsylvania. The region is one of the areas of the country where opioid addiction is a major public health problem. We focused on the 192,240 patients who had not received an opioid in the year prior to their hospitalization – otherwise known as “opioid naïve” patients.

Nearly half (48 percent) of these patients received an opioid while hospitalized.  After discharge, those patients receiving hospital opioids were more than twice as likely to report outpatient opioid use within 90-days (8.4 percent vs. 4.1 percent). Patients who receive an opioid for most of their hospital stay and patients who are still taking an opioid within 12 hours of being discharged from the hospital appear more likely to fill a prescription for opioids within 90 days of leaving the hospital.  Continue reading

Pneumonia Patients on Ventilators May Benefit from New Ceftolozane/Tazobactam Antibiotics

MedicalResearch.com Interview with:

Dr. Elizabeth Rhee MD Director, Infectious Disease Clinical Research at Merck

Dr. Rhee

Dr. Elizabeth Rhee MD
Director, Infectious Disease Clinical Research Merck

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: High-risk patients, such as the critically ill, with suspected bacterial infections require prompt treatment with appropriate empiric therapy to improve survival. Given the high prevalence of multidrug-resistant (MDR) Pseudomonas aeruginosa in the ICU setting, new safe and broadly effective treatment options are needed for critically ill patients requiring antipseudomonal agents.

Ceftolozane/tazobactam (C/T) is an antipseudomonal cephalosporin/beta-lactamase inhibitor combination with broad in vitro activity against Gram-negative pathogens, including MDR P. aeruginosa and many extended-spectrum beta-lactamase (ESBL) producers. It is FDA approved for complicated intra-abdominal and urinary tract infections in adults at 1.5g (1g/0.5g) q8h. C/T is currently being studied at 3g (2g/1g) q8h, for the treatment of ventilated nosocomial pneumonia, in the ASPECT-NP Phase 3 trial.

This Phase 1 pharmacokinetic (PK) study investigated the penetration of a 3g dose of C/T in the epithelial lining fluid (ELF) of ventilated patients with proven or suspected pneumonia. This is the dose and patient population being evaluated in ASPECT-NP. ELF lines the alveoli, and investigators took samples in a group of 26 patients to see what amount of C/T was in the lung and what was circulating in the plasma during the dosing intervals.

In mechanically ventilated critically ill patients, the 3g dose of C/T achieved ≥50% lung penetration (relative to free plasma) and sustained levels in ELF above the target concentrations for the entire dosing interval. These findings support the 3g dose that is included in the ASPECT-NP Phase 3 trial.  Continue reading

New Cephalosporin Combination Tested for Complicated Sepsis Patients

MedicalResearch.com Interview with:

Becky Jayakumar, PharmD College of Pharmacy Assistant Professor of Pharmacy Practice Roseman University of Health Sciences

Dr. Jayakumar

Becky Jayakumar, PharmD
College of Pharmacy
Assistant Professor of Pharmacy Practice
Roseman University of Health Sciences

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Bacteremia (bloodstream infections) due to Gram-negative (GN) bacteria are a frequent cause of severe sepsis and pose serious therapeutic challenges due to multidrug-resistance (MDR). Ceftolozane/tazobactam (C/T) is a novel antipseudomonal cephalosporin combined with an established β-lactamase inhibitor.

This retrospective, observational study evaluated the clinical outcomes of C/T real-world use in severely ill patients. Twenty-two patients with sepsis and/or bacteremia were included; 95% of whom had Pseudomonas aeruginosa that was resistant to almost all antibacterials with the exception of colistin. C/T successfully treated the majority of these complicated patients. In this real-world study, 77% of patients had a clinical response with C/T and 75% had a microbiological response. Clinical success rates were high and mortality rates were similar to other studies in this severely ill population. Continue reading

Merck Tests New Antibiotic Combination For Hard to Treat Bacterial Infections

MedicalResearch.com Interview with:

Amanda Paschke, MD, MSCE Senior principal scientist Infectious disease clinical research Merck Research Laboratories

Dr.Amanda  Paschke

Amanda Paschke, MD, MSCE
Senior principal scientist
Infectious disease clinical research
Merck Research Laboratories

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This study sought to evaluate a new beta-lactam/beta-lactamase inhibitor antibacterial combination, imipenem/relebactam (IMI/REL), compared with colistin plus imipenem for the treatment of infections caused by resistant Gram-negative bacteria.

Patients enrolled in the trial had hospital-acquired or ventilator-associated bacterial pneumonia (HABP/VABP), complicated intra-abdominal infections (cIAI), or complicated urinary tract infections (cUTI) caused by pathogens that were non susceptible to imipenem, a carbapenem antibacterial.

In this study, the primary outcome was a favorable overall response to treatment, which was comparable between the IMI/REL vs colistin + IMI arms. Colistin (often combined with a carbapenem) is currently among the standard of care treatment regimens for MDR infections.  A key secondary endpoint of the study was safety.  IMI/REL was well tolerated; among all treated patients, drug-related adverse events (AEs) occurred in 16.1% of IMI/REL and 31.3% of colistin + IMI patients with treatment-emergent nephrotoxicity observed in 10% (3/29 patients) and 56% (9/16 patients), respectively (p=0.002). Results of the trial support the use of imipenem-relebactam (IMI/REL) as an efficacious and well-tolerated treatment option for carbapenem-resistant infections.  Continue reading

Dexmedetomidine Reduced Risk of Delirium

MedicalResearch.com Interview with:

Yoanna Skrobik MD FRCP(c) MSc McGill University Health Centre Canada

Dr. Skrobik

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.

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Balanced IV Fluids Can Reduce Kidney Damage and Death in Critically Ill Patients

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  

Dr. Rice

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.

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For Most Patients Balanced IV Fluids Better Than Saline

MedicalResearch.com Interview with:

Wesley H. Self, MD, MPH Associate Professor Department of Emergency Medicine Vanderbilt University Medical Center Nashville, TN 

Dr. Self

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.

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Standardization and Collaboration Reduced Use of Costly CRRT Treatment for Critically Ill Patients

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

Dr. Alban

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.

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Does Pre-Hospital Advanced Life Support Improve Survival in Out-of-Hospital Cardiac Arrest?

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.

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Incidence of Sepsis Stable, But Mortality Remains High

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

Dr. Rhee

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.

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Blood Biomarkers Signal Multiple Organ Dysfunction Syndrome After Critical Injuries

MedicalResearch.com Interview with:

Dr. Joanna Shepherd Centre for Trauma Sciences Blizard Institute Queen Mary, University of London

Dr. Shepherd

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.

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Rory’s Regulations: Faster Is Better When It Comes To Sepsis Care

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

Dr. Seymour

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.

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Resistance to Carbapenem Antibiotics Doubled in Intensive Care Units

MedicalResearch.com Interview with:

Eilish McCann, PhD</strong> Director, Outcomes Research (Center for Observational and Real-World Evidence) Merck

Dr. Eilish McCann

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.

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Review of Systemic Immunomodulating Therapies for Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

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.
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More Talking, Less Machine Noise Important To Infant Brain in NICUs

MedicalResearch.com Interview with:

Bobbi Pineda, PhD Assistant professor of occupational therapy and of pediatrics Washington University School of Medicine St. Louis

Dr. Bobbi Pineda

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.

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How Does Emergency Room Crowding Affect Care of Septic Patients?

MedicalResearch.com Interview with:

Anish Agarwal, MD, MPH The Hospital of the University of Pennsylvania Department of Emergency Medicine Philadelphia, PA

Dr. Anish Agarwal

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.

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What Is Right Ratio of Patients to Critical Care Specialists in ICUs?

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

Dr. Hayley Gershengorn

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.

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Sepsis Linked To High Rate of Hospital Readmissions

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.

Dr. Yende

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

Dr. Mayr

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.

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