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  1. Article ; Online: Modifications to rapid response team (medical emergency team) activation criteria and its impact on patient safety.

    Chinthamuneedi, Raja M / Phaltane, Sandeep / Chinthamuneedi, Meher P / Kondalsamy-Chennakesavan, Srinivas / K Cheung, Benjamin

    Internal medicine journal

    2022  Volume 53, Issue 7, Page(s) 1212–1217

    Abstract: Background: Modifications to rapid response team (RRT) activation criteria occur commonly in Australian hospitals without evidence to define their use.: Aims: To evaluate the effectiveness of RRT activation criteria modifications in preventing RRT ... ...

    Abstract Background: Modifications to rapid response team (RRT) activation criteria occur commonly in Australian hospitals without evidence to define their use.
    Aims: To evaluate the effectiveness of RRT activation criteria modifications in preventing RRT activation and differences in adverse events associated with treatment delays caused by modifications.
    Methods: A prospective chart audit of hospital patients with RRT activation criteria modifications admitted during a 12-month period in a large regional hospital in Toowoomba, Australia. The incidence of RRT activation criteria modifications, RRT activations and rates of adverse events following criteria modifications were investigated. Adverse events were defined as a delayed treatment on the ward, unplanned intensive care unit admission, cardiac arrest and unexpected death. Differences in patient outcomes among medical and surgical patients were also investigated.
    Results: A total of 271 patients out of 4009 admitted patients had modifications to their RRT activation criteria. There was no difference in rates of RRT activation in patients with modified criteria compared with patients with unmodified criteria (P = 0.37). In patients with RRT activation criteria modifications, rates of adverse events were higher in patients who met their modified RRT criteria (93.3%) compared with those who did not meet modified RRT criteria (3.8%; P < 0.001). Additionally, in patients with modifications, rates of adverse events were higher in medical patients (27.6%; n = 50) compared with surgical patients (15.6%; n = 14; P = 0.03).
    Conclusions: The results strongly suggest that RRT criteria modification is associated with no difference in rates of RRT activation and with detrimental impacts on patient safety, particularly in medical patients.
    MeSH term(s) Humans ; Hospital Rapid Response Team ; Patient Safety ; Prospective Studies ; Australia/epidemiology ; Hospitalization ; Hospital Mortality
    Language English
    Publishing date 2022-05-27
    Publishing country Australia
    Document type Journal Article ; Comment
    ZDB-ID 2045436-3
    ISSN 1445-5994 ; 1444-0903
    ISSN (online) 1445-5994
    ISSN 1444-0903
    DOI 10.1111/imj.15705
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 792: Show issues Location:
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  2. Article ; Online: Measuring the intensive care experience: A cross-sectional survey of patient and family experiences of critical care.

    Williams, Helen / Gow, Jeff / Rana, Rezwanul / Rouse, Alan / Chinthamuneedi, Meher / Beccaria, Gavin / Ralph, Nicholas

    Journal of clinical nursing

    2021  Volume 30, Issue 23-24, Page(s) 3623–3633

    Abstract: Aims and objectives: To report patient and family intensive care experiences using the Measuring the Intensive Care Experience (MICE) tool across two intensive care units (ICU).: Background: The patient and family experience of care is an important ... ...

    Abstract Aims and objectives: To report patient and family intensive care experiences using the Measuring the Intensive Care Experience (MICE) tool across two intensive care units (ICU).
    Background: The patient and family experience of care is an important indicator for quality improvement of ICUs, yet few studies evaluate both patient and family experiences in relation to overall care quality as well as specifically measuring quality of medical care, nursing care and organisational care as well as overall experience of the quality of intensive care.
    Design: A cross-sectional survey.
    Methods: A 23 item survey was administered to ICU patients and their family members across two ICUs, a regional 189-bed hospital and a metropolitan 227-bed hospital in Queensland, Australia. The response rate was 272 of 394 ICU patients (36.4%). STROBE guidelines were used in reporting this study.
    Results: Findings indicate a highly positive overall experience of ICU care among patients and families. However, patients reported areas of unmet needs following their stay in ICU broadly related to (1) symptom management, education and information support, and (2) improving the incorporation of patient and family care ICU-related shared decision-making.
    Conclusions: Supportive interventions are needed that target improve symptom management and inform and education ICU patients.
    Relevance to clinical practice: The MICE survey facilitated the identification of a range of areas requiring quality improvement. Improving the integration of patients and families into shared decision-making and support is a key aspect for quality improvement.
    MeSH term(s) Critical Care ; Cross-Sectional Studies ; Family ; Humans ; Intensive Care Units ; Palliative Care
    Language English
    Publishing date 2021-06-06
    Publishing country England
    Document type Journal Article
    ZDB-ID 1159483-4
    ISSN 1365-2702 ; 0962-1067 ; 1752-9816
    ISSN (online) 1365-2702
    ISSN 0962-1067 ; 1752-9816
    DOI 10.1111/jocn.15884
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: A Case Report of Preeclampsia Causing Severe Hyponatremia: Rare or Rarely Reported?

    Grimmett, Wallace / Lee, Julie / Doherty, James / Cheung, Benjamin / Chinthamuneedi, Meher

    A&A practice

    2018  Volume 12, Issue 8, Page(s) 261–263

    Abstract: Preeclampsia presenting as severe hyponatremia is an enigma of modern obstetric practice. The hyponatremia can cause severe maternal neurological morbidity, including cerebral edema and seizures. Neonates, with serum sodium reflecting maternal levels, ... ...

    Abstract Preeclampsia presenting as severe hyponatremia is an enigma of modern obstetric practice. The hyponatremia can cause severe maternal neurological morbidity, including cerebral edema and seizures. Neonates, with serum sodium reflecting maternal levels, are also at risk. Despite this, the literature remains ambiguous about its incidence, the pathophysiology is poorly understood, and guidelines on preeclampsia (including those of the American College of Obstetricians and Gynecologists) do not discuss the issue. This case of preeclampsia associated with severe hyponatremia in a laboring woman highlights these issues.
    MeSH term(s) Adult ; Female ; Humans ; Hyponatremia/etiology ; Pre-Eclampsia/blood ; Pregnancy ; Sodium/blood
    Chemical Substances Sodium (9NEZ333N27)
    Language English
    Publishing date 2018-09-27
    Publishing country United States
    Document type Case Reports ; Journal Article
    ISSN 2575-3126
    ISSN (online) 2575-3126
    DOI 10.1213/XAA.0000000000000904
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: Diseases of the aorta in the critically ill.

    Chinthamuneedi, M

    Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine

    2000  Volume 2, Issue 2, Page(s) 117–124

    Abstract: Objective: To review diseases of the aorta that commonly require management in the critical care unit.: Data sources: Articles and published reviews on aortic dissection, traumatic aortic rupture and aortic aneurysm.: Summary of review: The aorta ... ...

    Abstract Objective: To review diseases of the aorta that commonly require management in the critical care unit.
    Data sources: Articles and published reviews on aortic dissection, traumatic aortic rupture and aortic aneurysm.
    Summary of review: The aorta is the largest arterial vessel of the body and disorders that can lead to rupture (e.g. aortic dissection, traumatic aortic rupture and aortic aneurysm) are life threatening. Aortic dissections are usually classified for surgical purposes as those that involve the ascending aorta (i.e. type A dissections) which are usually managed surgically and all other dissections (i.e. type B dissections) which are usually managed non surgically. Recently, endoluminal aortic stents have been used to manage type B dissections. Traumatic aortic rupture usually follows an antero-posterior thoracic injury with 60% occurring just distal to the origin of the left subclavian artery and 25% at the ascending aorta. Treatment consists of open surgical repair ensuring that the aortic cross clamp times are less than 30 minutes to reduce the development of ischaemic cord lesions. Aortic aneurysm commonly occurs in the abdominal aorta and is usually surgically resected if > 5 cm in diameter. Post-operative care is commonly undertaken in the intensive care unit to monitor haemodynamic, respiratory and fluid and electrolyte status to reduce the incidence of renal and respiratory failure. While angiography is often used to diagnose these disorders, transoesophageal echocardiography, helical computed tomography (CT) and magnetic resonance imaging are becoming more commonly used and in selected conditions are recommended as the investigations of choice.
    Conclusions: Aortic dissection, aortic aneurysm and aortic trauma may lead to aortic rupture with exsanguination and management commonly requires surgical intervention and postoperative care in a critical care unit.
    Language English
    Publishing date 2000-06
    Publishing country Australia
    Document type Journal Article
    ZDB-ID 2401976-8
    ISSN 1441-2772
    ISSN 1441-2772
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 6672: Show issues Location:
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  5. Article: Aspergillus flavus endocarditis--to prevaricate is to posture.

    Fraser, J F / Mullany, D / Natani, S / Chinthamuneedi, M / Hovarth, R

    Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine

    2006  Volume 8, Issue 1, Page(s) 46–49

    Abstract: Fungal endocarditis represents both a diagnostic and therapeutic challenge to the treating team. The critical care physician will see a rising incidence as older and more immuno-compromised patients are being supported in their intensive care units. ... ...

    Abstract Fungal endocarditis represents both a diagnostic and therapeutic challenge to the treating team. The critical care physician will see a rising incidence as older and more immuno-compromised patients are being supported in their intensive care units. Aspergillus sp. endocarditis represents less than 25% of all cases of fungal endocarditis and is associated with a mortality of around 80%. Early diagnosis may assist with definitive management. We review a case of Aspergillus endocarditis, and review the literature as to optimal methods of detection, imaging modalities of choice, and management, both surgical and medical.
    MeSH term(s) Aspergillosis ; Aspergillus flavus ; Endocarditis, Bacterial/diagnosis ; Endocarditis, Bacterial/diagnostic imaging ; Endocarditis, Bacterial/surgery ; Endocarditis, Bacterial/therapy ; Fatal Outcome ; Female ; Humans ; Middle Aged ; Ultrasonography
    Language English
    Publishing date 2006-03
    Publishing country Australia
    Document type Case Reports ; Journal Article
    ZDB-ID 2401976-8
    ISSN 1441-2772
    ISSN 1441-2772
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    Zs.A 6672: Show issues Location:
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  6. Article: The association between preoperative eGFR and outcomes in cardiac surgical patients.

    Foot, Carole L / Chinthamuneedi, Meher / Fraser, John F / Smith, Susan E / Fayers, Trevor / Tesar, Peter / Mullany, Daniel V

    Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine

    2009  Volume 11, Issue 3, Page(s) 184–190

    Abstract: Aim: To study the relationship between preoperative renal function and outcomes in patients undergoing cardiac surgery.: Design, setting and participants: A retrospective descriptive study was performed on all patients who had coronary artery bypass, ...

    Abstract Aim: To study the relationship between preoperative renal function and outcomes in patients undergoing cardiac surgery.
    Design, setting and participants: A retrospective descriptive study was performed on all patients who had coronary artery bypass, cardiac valve surgery and/or aortic arch surgery at a tertiary-referral hospital between January 2002 and December 2007.
    Main outcome measures: Clinical and demographic variables were compared across renal dysfunction categories, defined by glomerular filtration rate (eGFR) calculated using the modified Modification of Diet in Renal Disease (MDRD) equation. Logistic regression was used to assess the association between eGFR and outcomes, primarily in-hospital mortality.
    Results: 7440 patients were included, with a mean age of 64 years and overall mortality of 1.6%. Across worsening renal function states, excluding patients receiving dialysis, patients were older, more likely to be women and to have comorbidities (particularly diabetes and vascular disease), as well as ventricular dysfunction, and to require emergency or more complex surgery. Unadjusted outcomes, as well as univariate and multivariate analysis, consistently demonstrated that odds ratios for adverse events increased with worsening renal function, even at moderate levels of dysfunction.
    Conclusions: Preoperative renal dysfunction is independently associated with mortality after cardiac surgery. This is consistent with the accumulating evidence supporting preoperative renal dysfunction as a powerful predictor of adverse outcomes.
    MeSH term(s) Aged ; Cardiac Surgical Procedures/methods ; Coronary Care Units ; Female ; Follow-Up Studies ; Glomerular Filtration Rate/physiology ; Heart Diseases/mortality ; Heart Diseases/surgery ; Hospital Mortality/trends ; Humans ; Male ; Middle Aged ; Prognosis ; Queensland/epidemiology ; Retrospective Studies ; Survival Rate/trends
    Language English
    Publishing date 2009-09
    Publishing country Australia
    Document type Comparative Study ; Journal Article
    ZDB-ID 2401976-8
    ISSN 1441-2772
    ISSN 1441-2772
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 6672: Show issues Location:
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  7. Article: The use of recombinant activated factor VII for refractory bleeding post complex cardiothoracic surgery.

    Walsham, J / Fraser, J F / Mullany, D / Ziegenfus, M / Chinthamuneedi, M / Dunning, J / Tesar, P

    Anaesthesia and intensive care

    2006  Volume 34, Issue 1, Page(s) 13–20

    Abstract: We reviewed the outcome following use of recombinant activated factor VII (rVIIa) in patients with major bleeding post cardiothoracic surgery in our unit between January 2002 and July 2004. The unit consists of 16 cardiothoracic intensive care beds in a ... ...

    Abstract We reviewed the outcome following use of recombinant activated factor VII (rVIIa) in patients with major bleeding post cardiothoracic surgery in our unit between January 2002 and July 2004. The unit consists of 16 cardiothoracic intensive care beds in a public metropolitan teaching hospital which serves as a referral centre for heart and lung transplant surgery. Patients with refractory bleeding following cardiothoracic surgical procedures who were treated with rVIIa were identified. A total of 12 episodes of rVIIa use were recorded in ten patients, including three episodes with ventricular assist devices, and 5 heart and/or lung transplants. The median dose used was 85 microg/kg. Chest tube drainage decreased in all patients following administration of rVlIIa; median chest tube drainage decreased from 445 ml/h to 171 ml/h (P = 0.03). Despite cessation of bleeding, mortality was high when rVIIa was used after more than 24 hours. In six episodes, despite early rVIIa use (within six hours), continued bleeding necessitated return to theatre, where a surgical source of bleeding was found. In this small retrospective study, rVIIa significantly reduced bleeding that was refractory to standard blood product transfusion. In this series of patients, those that did not respond to rVIIa early in the postoperative phase were found to have a surgical source of bleeding.
    MeSH term(s) Adult ; Cardiac Surgical Procedures/adverse effects ; Cardiac Surgical Procedures/methods ; Cohort Studies ; Coronary Care Units ; Dose-Response Relationship, Drug ; Drainage/methods ; Factor VIIa/therapeutic use ; Female ; Follow-Up Studies ; Heart Transplantation/adverse effects ; Heart Transplantation/methods ; Humans ; Infusions, Intravenous ; Lung Transplantation/adverse effects ; Lung Transplantation/methods ; Male ; Middle Aged ; Postoperative Hemorrhage/diagnosis ; Postoperative Hemorrhage/drug therapy ; Postoperative Hemorrhage/mortality ; Queensland ; Reoperation ; Retrospective Studies ; Risk Assessment ; Severity of Illness Index ; Survival Rate ; Thoracic Surgical Procedures/adverse effects ; Thoracic Surgical Procedures/methods ; Treatment Outcome
    Chemical Substances Factor VIIa (EC 3.4.21.21)
    Language English
    Publishing date 2006-02
    Publishing country United States
    Document type Comparative Study ; Journal Article
    ZDB-ID 187524-3
    ISSN 1448-0271 ; 0310-057X
    ISSN (online) 1448-0271
    ISSN 0310-057X
    DOI 10.1177/0310057X0603400115
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