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Article ; Online: Extraneous Load, Patient Census, and Patient Acuity Correlate With Cognitive Load During ICU Rounds.

Held, Natalie / Neumeier, Anna / Amass, Timothy / Harry, Elizabeth / Pomponio, Raymond / Peterson, Ryan A / Huie, Tristan J / Moss, Marc

Chest

2024

Abstract: Background: Cognitive load theory asserts that learning and performance degrade when cognitive load exceeds working memory capacity. This is particularly relevant in the learning environment of ICU rounds, when multidisciplinary providers integrate ... ...

Abstract	Background: Cognitive load theory asserts that learning and performance degrade when cognitive load exceeds working memory capacity. This is particularly relevant in the learning environment of ICU rounds, when multidisciplinary providers integrate complex decision-making and teaching in a noisy, high-stress environment prone to cognitive distractions. Research question: What features of ICU rounds correlate with high provider cognitive load? Study design and methods: This was an observational, multisite study of multidisciplinary providers during ICU rounds. Investigators recorded rounding characteristics and hourly extraneous cognitive load events during rounds (defined as distractions, episodes of split-attention or repetition, and deviations from standard communication format). After rounds, investigators measured each provider's cognitive load using the provider task load (PTL), an instrument derived from the National Aeronautics and Space Administration Task Load Index survey that assesses perceived workload associated with complex tasks. Relationships between rounding characteristics, extraneous load, and PTL score were evaluated using mixed-effects modeling. Results: A total of 76 providers were observed during 32 rounds from December 2020 to May 2021. The mean rounding census ± SD was 12.5 ± 2.9 patients. The mean rounding time ± SD was 2 h 17 min ± 49 min. The mean extraneous load ± SD was 20.5 ± 4.5 events per hour, or one event every 2 min 51 s. This included 8.6 ± 3.4 distractions, 8.2 ± 4.2 communication deviations, 1.9 ± 1.4 repetitions, and 1.8 ± 1.3 episodes of split-attention per hour. Controlling for covariates, the hourly extraneous load events, number of new patients, and number of higher acuity patients were each associated with increased PTL score (slope, 2.40; 95% CI, 0.76-4.04; slope, 5.23; 95% CI, 2.02-8.43; slope, 3.35; 95% CI, 1.34-5.35, respectively). Interpretation: Increased extraneous load, new patients, and patient acuity were associated with higher cognitive load during ICU rounds. These results can help direct how the ICU rounding structure may be modified to reduce workload and optimize provider learning and performance.
Language	English
Publishing date	2024-01-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	1032552-9
ISSN	1931-3543 ; 0012-3692
ISSN (online)	1931-3543
ISSN	0012-3692
DOI	10.1016/j.chest.2023.12.029
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Article ; Online: Engaging Australian men in disease prevention - priorities and opportunities from a national survey.

Smith, Ben J / Moss, Timothy / Marshall, Bernie / Halim, Nicole / Palmer, Robert / von Saldern, Simon

Public health research & practice

2023

Abstract: Objective and importance of the study: In Australia, preventable causes of morbidity and mortality are common among men. The National Men's Health Strategy 2021-2030 highlights the need to successfully engage men in disease prevention; hence, we aimed to ...

Abstract	Objective and importance of the study: In Australia, preventable causes of morbidity and mortality are common among men. The National Men's Health Strategy 2021-2030 highlights the need to successfully engage men in disease prevention; hence, we aimed to examine the prevention priorities, attitudes and information sources reported by Australian men. Study type: Population survey. Methods: Men aged 18 years and over were recruited from the nationally representative Life in Australia panel. Participants completed an online survey that measured the prevention issues of greatest concern, attitudes to prevention behaviours and services, and the health information sources considered most useful. Results: Among 1282 respondents, mental health issues, followed by those pertaining to chronic disease and relationships, were rated of highest concern. Weight management, physical activity, and fruit and vegetable consumption were most often considered as important for personal health. Being 65 years and older and having adequate health literacy were strongly associated with positive attitudes towards prevention practices. More than three-quarters of men rated their doctor as the most useful information source, followed by health websites, internet searching, and their partner. Conclusions: Psychological and social issues are of high concern to men, and their attitudes toward preventive behaviours and services often do not align with public health recommendations. Understanding the topics of greatest concern to men and their preferred sources of information can inform communication and engagement strategies to improve health-related practices among men.
Language	English
Publishing date	2023-10-26
Publishing country	Australia
Document type	Journal Article
ISSN	2204-2091
ISSN (online)	2204-2091
DOI	10.17061/phrp33342310
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Article ; Online: Postnatal steroids as lung protective and anti-inflammatory in preterm lambs exposed to antenatal inflammation.

Papagianis, Paris C / Noble, Peter B / Ahmadi-Noorbakhsh, Siavash / Savigni, Donna / Moss, Timothy J M / Pillow, J Jane

Pediatric research

2023 Volume 95, Issue 4, Page(s) 931–940

Abstract: Background: Lung inflammation and impaired alveolarization precede bronchopulmonary dysplasia (BPD). Glucocorticoids are anti-inflammatory and reduce ventilator requirements in preterm infants. However, high-dose glucocorticoids inhibit alveolarization. ...

Abstract	Background: Lung inflammation and impaired alveolarization precede bronchopulmonary dysplasia (BPD). Glucocorticoids are anti-inflammatory and reduce ventilator requirements in preterm infants. However, high-dose glucocorticoids inhibit alveolarization. The effect of glucocorticoids on lung function and structure in preterm newborns exposed to antenatal inflammation is unknown. We hypothesise that postnatal low-dose dexamethasone reduces ventilator requirements, prevents inflammation and BPD-like lung pathology, following antenatal inflammation. Methods: Pregnant ewes received intra-amniotic LPS (E.coli, 4 mg/mL) or saline at 126 days gestation; preterm lambs were delivered 48 h later. Lambs were randomised to receive either tapered intravenous dexamethasone (LPS/Dex, n = 9) or saline (LPS/Sal, n = 10; Sal/Sal, n = 9) commencing <3 h after birth. Respiratory support was gradually de-escalated, using a standardised protocol aimed at weaning from ventilation towards unassisted respiration. Tissues were collected at day 7. Results: Lung morphology and mRNA levels for inflammatory mediators were measured. Respiratory support requirements were not different between groups. Histological analyses revealed higher tissue content and unchanged alveolarization in LPS/Sal compared to other groups. LPS/Dex lambs exhibited decreased markers of pulmonary inflammation compared to LPS/Sal. Conclusion: Tapered low-dose dexamethasone reduces the impact of antenatal LPS on ventilation requirements throughout the first week of life and reduces inflammation and pathological thickening of the preterm lung IMPACT: We are the first to investigate the combination of antenatal inflammation and postnatal dexamethasone therapy in a pragmatic study design, akin to contemporary neonatal care. We show that antenatal inflammation with postnatal dexamethasone therapy does not reduce ventilator requirements, but has beneficial maturational impacts on the lungs of preterm lambs at 7 days of life. Appropriate tapered postnatal dexamethasone dosing should be explored for extuabtion of oxygen-dependant neonates.
MeSH term(s)	Humans ; Infant, Newborn ; Infant ; Animals ; Sheep ; Female ; Pregnancy ; Lipopolysaccharides ; Infant, Premature ; Anti-Inflammatory Agents/pharmacology ; Glucocorticoids/pharmacology ; Lung ; Inflammation ; Bronchopulmonary Dysplasia/prevention & control ; Steroids ; Sheep, Domestic ; Dexamethasone/pharmacology
Chemical Substances	Lipopolysaccharides ; Anti-Inflammatory Agents ; Glucocorticoids ; Steroids ; Dexamethasone (7S5I7G3JQL)
Language	English
Publishing date	2023-12-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	4411-8
ISSN	1530-0447 ; 0031-3998
ISSN (online)	1530-0447
ISSN	0031-3998
DOI	10.1038/s41390-023-02911-9
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Zs.A 564: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Inflammation in reproduction, pregnancy and development.

Hedger, Mark / Hodyl, Nicolette A / Moss, Timothy J

Journal of reproductive immunology

2018 Volume 130, Page(s) 23–24

MeSH term(s)	Allergy and Immunology ; Australia ; Congresses as Topic ; Disease Susceptibility/immunology ; Embryonic Development/immunology ; Female ; Fetal Development/immunology ; Humans ; Inflammation/immunology ; Pregnancy ; Prenatal Exposure Delayed Effects/immunology ; Reproduction/immunology
Language	English
Publishing date	2018-09-27
Publishing country	Ireland
Document type	Editorial ; Introductory Journal Article
ZDB-ID	424421-7
ISSN	1872-7603 ; 0165-0378
ISSN (online)	1872-7603
ISSN	0165-0378
DOI	10.1016/j.jri.2018.09.051
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Zs.A 1483: Show issues

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Article ; Online: Bronchopulmonary dysplasia: Pathophysiology and potential anti-inflammatory therapies.

Papagianis, Paris C / Pillow, J J / Moss, Timothy J

Paediatric respiratory reviews

2018 Volume 30, Page(s) 34–41

Abstract: Inflammation of the preterm lungs is key to the pathogenesis of bronchopulmonary dysplasia (BPD), whether it arises as a consequence of intrauterine inflammation or postnatal respiratory management. This review explores steroidal and non-steroidal ... ...

Abstract	Inflammation of the preterm lungs is key to the pathogenesis of bronchopulmonary dysplasia (BPD), whether it arises as a consequence of intrauterine inflammation or postnatal respiratory management. This review explores steroidal and non-steroidal therapies for reducing neonatal pulmonary inflammation, aimed at treating or preventing BPD.
MeSH term(s)	Anti-Inflammatory Agents/therapeutic use ; Bronchopulmonary Dysplasia/drug therapy ; Bronchopulmonary Dysplasia/immunology ; Bronchopulmonary Dysplasia/physiopathology ; Chorioamnionitis/immunology ; Dexamethasone/therapeutic use ; Female ; Fetal Organ Maturity ; Glucocorticoids/therapeutic use ; Humans ; Infant, Extremely Premature ; Infant, Newborn ; Infant, Premature ; Inflammation ; Interleukin 1 Receptor Antagonist Protein/therapeutic use ; NLR Family, Pyrin Domain-Containing 3 Protein/antagonists & inhibitors ; Neonatal Sepsis/immunology ; Pentoxifylline/therapeutic use ; Pregnancy ; Prenatal Care
Chemical Substances	Anti-Inflammatory Agents ; Glucocorticoids ; Interleukin 1 Receptor Antagonist Protein ; NLR Family, Pyrin Domain-Containing 3 Protein ; Dexamethasone (7S5I7G3JQL) ; Pentoxifylline (SD6QCT3TSU)
Language	English
Publishing date	2018-07-29
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2147664-0
ISSN	1526-0550 ; 1526-0542
ISSN (online)	1526-0550
ISSN	1526-0542
DOI	10.1016/j.prrv.2018.07.007
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Zs.A 5919: Show issues

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Article ; Online: Intrauterine inflammation exacerbates maladaptive remodeling of the immature myocardium after preterm birth in lambs.

Vrselja, Amanda / Pillow, J Jane / Bensley, Jonathan G / Ellery, Stacey J / Ahmadi-Noorbakhsh, Siavash / Moss, Timothy J / Black, M Jane

Pediatric research

2022 Volume 92, Issue 6, Page(s) 1555–1565

Abstract: Background: Antenatal conditions that are linked with preterm birth, such as intrauterine inflammation, can influence fetal cardiac development thereby rendering the heart more vulnerable to the effects of prematurity. We aimed to investigate the effect ...

Abstract	Background: Antenatal conditions that are linked with preterm birth, such as intrauterine inflammation, can influence fetal cardiac development thereby rendering the heart more vulnerable to the effects of prematurity. We aimed to investigate the effect of intrauterine inflammation, consequent to lipopolysaccharide exposure, on postnatal cardiac growth and maturation in preterm lambs. Methods: Preterm lambs (~129 days gestational age) exposed antenatally to lipopolysaccharide or saline were managed according to contemporary neonatal care and studied at postnatal day 7. Age-matched fetal controls were studied at ~136 days gestational age. Cardiac tissue was sampled for molecular analyses and assessment of cardiac structure and cardiomyocyte maturation. Results: Lambs delivered preterm showed distinct ventricular differences in cardiomyocyte growth and maturation trajectories as well as remodeling of the left ventricular myocardium compared to fetal controls. Antenatal exposure to lipopolysaccharide resulted in further collagen deposition in the left ventricle and a greater presence of immune cells in the preterm heart. Conclusions: Adverse impacts of preterm birth on cardiac structure and cardiomyocyte growth kinetics within the first week of postnatal life are exacerbated by intrauterine inflammation. The maladaptive remodeling of the cardiac structure and perturbed cardiomyocyte growth likely contribute to the increased vulnerability to cardiac dysfunction following preterm birth. Impact: Preterm birth induces maladaptive cardiac remodeling and adversely impacts cardiomyocyte growth kinetics within the first week of life in sheep. These effects of prematurity on the heart are exacerbated when preterm birth is preceded by exposure to intrauterine inflammation, a common antecedent of preterm birth. Inflammatory injury to the fetal heart coupled with preterm birth consequently alters neonatal cardiac growth and maturation and thus, may potentially influence long-term cardiac function and health.
MeSH term(s)	Infant, Newborn ; Humans ; Animals ; Sheep ; Pregnancy ; Female ; Premature Birth ; Lipopolysaccharides/pharmacology ; Myocardium ; Inflammation ; Myocytes, Cardiac ; Fetal Heart
Chemical Substances	Lipopolysaccharides
Language	English
Publishing date	2022-03-11
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	4411-8
ISSN	1530-0447 ; 0031-3998
ISSN (online)	1530-0447
ISSN	0031-3998
DOI	10.1038/s41390-022-01955-7
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Zs.A 564: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Characterizing human movement patterns using GPS data loggers in an area of persistent malaria in Zimbabwe along the Mozambique border.

Hast, Marisa / Mharakurwa, Sungano / Shields, Timothy M / Lubinda, Jailos / Searle, Kelly / Gwanzura, Lovemore / Munyati, Shungu / Moss, William J

BMC infectious diseases

2022 Volume 22, Issue 1, Page(s) 942

Abstract: Background: Human mobility is a driver for the reemergence or resurgence of malaria and has been identified as a source of cross-border transmission. However, movement patterns are difficult to measure in rural areas where malaria risk is high. In ... ...

Abstract	Background: Human mobility is a driver for the reemergence or resurgence of malaria and has been identified as a source of cross-border transmission. However, movement patterns are difficult to measure in rural areas where malaria risk is high. In countries with malaria elimination goals, it is essential to determine the role of mobility on malaria transmission to implement appropriate interventions. Methods: A study was conducted in Mutasa District, Zimbabwe, to investigate human movement patterns in an area of persistent transmission along the Mozambique border. Over 1 year, a convenience sample of 20 participants/month was recruited from active malaria surveillance cohorts to carry an IgotU Results: From June 2016-May 2017, 184 participants provided movement tracks encompassing > 350,000 data points and nearly 8000 person-days. Malaria prevalence at logger distribution was 3.7%. Participants traveled a median of 2.8 km/day and spent a median of 4.6 h/day away from home. Movement was widespread within and outside the study area, with participants traveling up to 500 km from their homes. Indices of mobility were higher in the dry season than the rainy season (median km traveled/day = 3.5 vs. 2.2, P = 0.03), among male compared to female participants (median km traveled/day = 3.8 vs. 2.0, P = 0.0008), and among adults compared to adolescents (median total km traveled = 104.6 vs. 59.5, P = 0.05). Half of participants traveled outside the study area, and 30% traveled into Mozambique, including 15 who stayed in Mozambique overnight. Conclusions: Study participants in Mutasa District, Zimbabwe, were highly mobile throughout the year. Many participants traveled long distances from home, including overnight trips into Mozambique, with clear implications for malaria control. Interventions targeted at mobile populations and cross-border transmission may be effective in preventing malaria introductions in this region.
MeSH term(s)	Adult ; Adolescent ; Humans ; Male ; Female ; Geographic Information Systems ; Zimbabwe/epidemiology ; Mozambique/epidemiology ; Malaria/prevention & control ; Travel
Language	English
Publishing date	2022-12-15
Publishing country	England
Document type	Journal Article
ZDB-ID	2041550-3
ISSN	1471-2334 ; 1471-2334
ISSN (online)	1471-2334
ISSN	1471-2334
DOI	10.1186/s12879-022-07903-4
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Article ; Online: The cerebral haemodynamic response to somatosensory stimulation in preterm newborn lambs is reduced following intrauterine inflammation and dopamine infusion.

Inocencio, Ishmael M / Tran, Nhi T / Wiersma, Manon / Stoecker, Katja / Nakamura, Shinji / Moss, Timothy J / Walker, David W / Wong, Flora Y

Experimental neurology

2022 Volume 352, Page(s) 114049

Abstract: Background: Neurovascular coupling leads to an increase in local cerebral blood flow and oxygenation in response to increased neural activity. Reduced cerebral functional responses may predispose to tissue hypoxia when neural activity is increased. ... ...

Abstract	Background: Neurovascular coupling leads to an increase in local cerebral blood flow and oxygenation in response to increased neural activity. Reduced cerebral functional responses may predispose to tissue hypoxia when neural activity is increased. Intrauterine inflammation, identified clinically as chorioamnionitis, is a major contributor to the neuropathology arising after preterm birth. The impact of chorioamnionitis on the preterm cerebral functional haemodynamic response is unknown. Previously, we have reported that somatosensory stimulation produces predominantly positive cerebral haemodynamic responses (i.e., increased cerebral oxygenation) in preterm lambs, which are reduced with dopamine treatment. As preterm infants born after chorioamnionitis often suffer from hypotension and are treated with dopamine, we aimed to investigate how chorioamnionitis with and without dopamine treatment affect the cerebral haemodynamic response in preterm lambs. Methods: At 119 days of gestation, intrauterine inflammation was induced by intra-amniotic injection of lipopolysaccharide (LPS) in pregnant ewes. At 126-7 days of gestation (term is ~147 days), these LPS-exposed lambs were delivered and mechanically ventilated. The cerebral functional response was assessed by near infrared spectroscopy as changes in cerebral oxy- and deoxyhaemoglobin (ΔoxyHb, ΔdeoxyHb), following left median nerve stimulation of 1.8, 4.8 and 7.8 s durations without dopamine; and 4.8 and 7.8 s stimulations with intravenous dopamine infusion. Results: Stimulation for 1.8, 4.8 and 7.8 s durations led to negative functional responses (decreased ΔoxyHb) in 5 (62.5%), 5 (62.5%) and 4 (50%) of 8 preterm lambs respectively, while other lambs showed positive responses (increased ∆oxyHb). Dopamine infusion increased baseline tissue oxygenation index (TOI), oxyHb and total Hb. In lambs with a positive functional response, dopamine decreased the evoked ΔoxyHb response, increasing the overall incidence of negative cerebral haemodynamic responses. Conclusions: Somatosensory stimulation produced mostly negative responses with decreased cerebral oxygenation in preterm lambs exposed to intrauterine inflammation, contrasting with our previous findings of predominantly positive responses in non-inflamed, control, preterm lambs. Dopamine increased baseline cerebral oxygenation, but further increased the incidence of negative functional responses. Impaired neurovascular coupling leading to intermittent localised tissue hypoxia may therefore contribute to the neuropathy in infants with chorioamnionitis, with the risk of injury exacerbated with dopamine treatment.
MeSH term(s)	Animals ; Animals, Newborn ; Chorioamnionitis/drug therapy ; Dopamine ; Female ; Hemodynamics/physiology ; Humans ; Hypoxia ; Infant, Newborn ; Infant, Premature ; Inflammation ; Lipopolysaccharides ; Pregnancy ; Premature Birth ; Sheep
Chemical Substances	Lipopolysaccharides ; Dopamine (VTD58H1Z2X)
Language	English
Publishing date	2022-03-17
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	207148-4
ISSN	1090-2430 ; 0014-4886
ISSN (online)	1090-2430
ISSN	0014-4886
DOI	10.1016/j.expneurol.2022.114049
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Article ; Online: Effectiveness and safety of cold snare polypectomy and cold endoscopic mucosal resection for nonpedunculated colorectal polyps of 10-19 mm: a multicenter observational cohort study.

Mangira, Dileep / Raftopoulos, Spiro / Vogrin, Sara / Hartley, Imogen / Mack, Alexandra / Gazelakis, Kathryn / Nalankilli, Kumanan / Trinh, Andrew / Metz, Andrew J / Appleyard, Mark / Grimpen, Florian / Elliott, Timothy / Brown, Gregor / Moss, Alan

Endoscopy

2023 Volume 55, Issue 7, Page(s) 627–635

Abstract: BACKGROUND : Cold snare polypectomy (CSP) is the standard of care for the resection of small (< 10 mm) colonic polyps. Limited data exist for its efficacy for medium-sized (10-19 mm) nonpedunculated polyps, especially conventional adenomas. This study ... ...

Abstract	BACKGROUND : Cold snare polypectomy (CSP) is the standard of care for the resection of small (< 10 mm) colonic polyps. Limited data exist for its efficacy for medium-sized (10-19 mm) nonpedunculated polyps, especially conventional adenomas. This study evaluated the effectiveness and safety of CSP/cold endoscopic mucosal resection (C-EMR) for medium-sized nonpedunculated colonic polyps. METHODS : A prospective multicenter observational study was conducted of all morphologically suitable nonpedunculated colonic polyps of 10-19 mm removed by CSP/C-EMR between May 2018 and June 2021. Once resection was complete, multiple biopsies were taken of the margins circumferentially and centrally. The primary outcome was the incomplete resection rate (IRR), based on residual polyp in these biopsy specimens. Secondary outcomes were recurrence rate at first surveillance colonoscopy and rates of adverse events (AEs). RESULTS : CSP/C-EMR was performed for 350 polyps (median size 15 mm; 266 [76.0 %] Paris 0-IIa classification) in 295 patients. Submucosal injection was used for 87.1 % (n = 305) of polyps. Histology showed 68.6 % adenomas, 26.0 % sessile serrated lesions (SSLs) without dysplasia, 4.0 % SSL with dysplasia, and 1.4 % hyperplastic polyps. The IRRs based on margin or central biopsies being positive were 1.7 % (n = 6) and 0.3 % (n = 1), respectively. The polyp recurrence rate was 1.7 % (n = 4) at first surveillance colonoscopy - completed for 65.4 % (n = 229) of polyps at a median interval of 9.7 months. AEs occurred in 3.4 % (n = 10) of patients: four with post-polypectomy pain; three self-limiting post-polypectomy bleeds; two post-polypectomy-syndrome-like presentations; and one intraprocedural bleed treated with clips. There were no perforations. CONCLUSION : CSP/C-EMR for morphologically suitable nonpedunculated colonic polyps of 10-19 mm is effective and safe, including for conventional adenomas. Rates of incomplete resection and recurrence were low, with few AEs. Studies directly comparing this method with hot snare resection are required.
MeSH term(s)	Humans ; Colonic Polyps/surgery ; Colonic Polyps/pathology ; Colonoscopy/adverse effects ; Colonoscopy/methods ; Prospective Studies ; Endoscopic Mucosal Resection/adverse effects ; Endoscopic Mucosal Resection/methods ; Adenoma/surgery ; Adenoma/pathology ; Intestinal Polyposis/etiology ; Colorectal Neoplasms/pathology
Language	English
Publishing date	2023-02-07
Publishing country	Germany
Document type	Observational Study ; Multicenter Study ; Clinical Trial ; Journal Article
ZDB-ID	80120-3
ISSN	1438-8812 ; 0013-726X
ISSN (online)	1438-8812
ISSN	0013-726X
DOI	10.1055/a-2029-9539
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Zs.A 669: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Responsiveness of Critically Ill Adults With Multimorbidity to Rehabilitation Interventions: A Patient-Level Meta-Analysis Using Individual Pooled Data From Four Randomized Trials.

Jones, Jennifer R A / Karahalios, Amalia / Puthucheary, Zudin A / Berry, Michael J / Files, D Clark / Griffith, David M / McDonald, Luke A / Morris, Peter E / Moss, Marc / Nordon-Craft, Amy / Walsh, Timothy / Berney, Sue / Denehy, Linda

Critical care medicine

2023 Volume 51, Issue 10, Page(s) 1373–1385

Abstract: Objective: To explore if patient characteristics (pre-existing comorbidity, age, sex, and illness severity) modify the effect of physical rehabilitation (intervention vs control) for the coprimary outcomes health-related quality of life (HRQoL) and ... ...

Abstract	Objective: To explore if patient characteristics (pre-existing comorbidity, age, sex, and illness severity) modify the effect of physical rehabilitation (intervention vs control) for the coprimary outcomes health-related quality of life (HRQoL) and objective physical performance using pooled individual patient data from randomized controlled trials (RCTs). Data sources: Data of individual patients from four critical care physical rehabilitation RCTs. Study selection: Eligible trials were identified from a published systematic review. Data extraction: Data sharing agreements were executed permitting transfer of anonymized data of individual patients from four trials to form one large, combined dataset. The pooled trial data were analyzed with linear mixed models fitted with fixed effects for treatment group, time, and trial. Data synthesis: Four trials contributed data resulting in a combined total of 810 patients (intervention n = 403, control n = 407). After receiving trial rehabilitation interventions, patients with two or more comorbidities had HRQoL scores that were significantly higher and exceeded the minimal important difference at 3 and 6 months compared with the similarly comorbid control group (based on the Physical Component Summary score (Wald test p = 0.041). Patients with one or no comorbidities who received intervention had no HRQoL outcome differences at 3 and 6 months when compared with similarly comorbid control patients. No patient characteristic modified the physical performance outcome in patients who received physical rehabilitation. Conclusions: The identification of a target group with two or more comorbidities who derived benefits from the trial interventions is an important finding and provides direction for future investigations into the effect of rehabilitation. The multimorbid post-ICU population may be a select population for future prospective investigations into the effect of physical rehabilitation.
MeSH term(s)	Humans ; Adult ; Multimorbidity ; Critical Illness/rehabilitation ; Randomized Controlled Trials as Topic ; Quality of Life ; Critical Care
Language	English
Publishing date	2023-05-30
Publishing country	United States
Document type	Meta-Analysis ; Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	197890-1
ISSN	1530-0293 ; 0090-3493
ISSN (online)	1530-0293
ISSN	0090-3493
DOI	10.1097/CCM.0000000000005936
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In stock of ZB MED Cologne/Königswinter

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More links

Kategorien

In stock of ZB MED Cologne/Königswinter

Order via subito