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  1. Article ; Online: Giving Doctors' Daily Progress Notes to Hospitalized Patients and Families to Improve Patient Experience.

    Weinert, Craig

    American journal of medical quality : the official journal of the American College of Medical Quality

    2017  Volume 32, Issue 1, Page(s) 58–65

    Abstract: Hospital quality includes excellent physician-patient communication. The objective was to determine effects of distributing physicians' notes to patients. Hospitalized patients or family members on 6 wards at a university hospital received daily a ... ...

    Abstract Hospital quality includes excellent physician-patient communication. The objective was to determine effects of distributing physicians' notes to patients. Hospitalized patients or family members on 6 wards at a university hospital received daily a printed copy of their medical team's progress note. Surveys were completed about the benefits and adverse effects of reading the physician notes. In all, 74% to 86% of patients or family members responded favorably that receiving doctors' notes improved understanding of their health condition or gave them more control over their hospital course. Patient concerns about privacy or offense were uncommon, although 16% thought notes were confusing or caused worry. Note distribution had minor effects on physician note writing practice. Having patients and family members read their physicians' progress notes is feasible and enhances patients' understanding of their diagnostic and treatment plan. Notes supplement traditional physician-patient verbal communication practice and have the potential to improve the hospitalized patient experience.
    Language English
    Publishing date 2017-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1131772-3
    ISSN 1555-824X ; 1062-8606
    ISSN (online) 1555-824X
    ISSN 1062-8606
    DOI 10.1177/1062860615610424
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  2. Article ; Online: Physicians' Clinical Behavior During Fluid Evaluation Encounters.

    Syed, Muhammad K Hayat / Pendleton, Kathryn / Park, John / Weinert, Craig

    Critical care explorations

    2023  Volume 5, Issue 7, Page(s) e0933

    Abstract: We sought to identify factors affecting physicians' cognition and clinical behavior when evaluating patients that may need fluid therapy.: Background: Proponents of dynamic fluid responsiveness testing advocate measuring cardiac output or stroke ... ...

    Abstract We sought to identify factors affecting physicians' cognition and clinical behavior when evaluating patients that may need fluid therapy.
    Background: Proponents of dynamic fluid responsiveness testing advocate measuring cardiac output or stroke volume after a maneuver to prove that further fluids will increase cardiac output. However, surveys suggest that fluid therapy in clinical practice is often given without prior responsiveness testing.
    Design: Thematic analysis of face-to-face structured interviews.
    Setting: ICUs and medical-surgical wards in acute care hospitals.
    Subjects: Intensivists and hospitalist physicians.
    Interventions: None.
    Measurements and main results: We conducted 43 interviews with experienced physicians in 19 hospitals. Hospitalized patients with hypotension, tachycardia, oliguria, or elevated serum lactate are commonly seen by physicians who weigh the risks and benefits of more fluid therapy. Encounters are often with unfamiliar patients and evaluation and decisions are completed quickly without involving other physicians. Dynamic testing for fluid responsiveness is used much less often than static methods and fluid boluses are often ordered with no testing at all. This approach is rationalized by factors that discourage dynamic testing: unavailability of equipment, time to obtain test results, or lack of expertise in obtaining valid data. Two mental calculations are particularly influential: physicians' estimate of the base rate of fluid responsiveness (determined by physical examination, chart review, and previous responses to fluid boluses) and physicians' perception of patient harm if 500 or 1,000 mL fluid boluses are ordered. When the perception of harm is low, physicians use heuristics that rationalize skipping dynamic testing.
    Limitations: Geographic limitation to hospitals in Minnesota, United States.
    Conclusions: If dynamic responsiveness testing is to be used more often in routine clinical practice, physicians must be more convinced of the benefits of dynamic testing, that they can obtain valid results quickly and believe that even small fluid boluses harm their patients.
    Language English
    Publishing date 2023-06-27
    Publishing country United States
    Document type Journal Article
    ISSN 2639-8028
    ISSN (online) 2639-8028
    DOI 10.1097/CCE.0000000000000933
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  3. Article ; Online: Rapid Deployment of International Tele-Intensive Care Unit Services in War-Torn Syria.

    Moughrabieh, Anas / Weinert, Craig

    Annals of the American Thoracic Society

    2016  Volume 13, Issue 2, Page(s) 165–172

    Abstract: The conflict in Syria has created the largest humanitarian emergency of the twenty-first century. The 4-year Syrian conflict has destroyed hospitals and severely reduced the capacity of intensive care units (ICUs) and on-site intensivists. The crisis has ...

    Abstract The conflict in Syria has created the largest humanitarian emergency of the twenty-first century. The 4-year Syrian conflict has destroyed hospitals and severely reduced the capacity of intensive care units (ICUs) and on-site intensivists. The crisis has triggered attempts from abroad to support the medical care of severely injured and acutely ill civilians inside Syria, including application of telemedicine. Within the United States, tele-ICU programs have been operating for more than a decade, albeit with high start-up costs and generally long development times. With the benefit of lessons drawn from those domestic models, the Syria Tele-ICU program was launched in December 2012 to manage the care of ICU patients in parts of Syria by using inexpensive, off-the-shelf video cameras, free social media applications, and a volunteer network of Arabic-speaking intensivists in North America and Europe. Within 1 year, 90 patients per month in three ICUs were receiving tele-ICU services. At the end of 2015, a network of approximately 20 participating intensivists was providing clinical decision support 24 hours per day to five civilian ICUs in Syria. The volunteer clinicians manage patients at a distance of more than 6,000 miles, separated by seven or eight time zones between North America and Syria. The program is implementing a cloud-based electronic medical record for physician documentation and a medication administration record for nurses. There are virtual chat rooms for patient rounds, radiology review, and trainee teaching. The early success of the program shows how a small number of committed physicians can use inexpensive equipment spawned by the Internet revolution to support from afar civilian health care delivery in a high-conflict country.
    MeSH term(s) Critical Care/organization & administration ; Europe ; Health Services Needs and Demand ; Humans ; Intensive Care Units/organization & administration ; Needs Assessment ; Syria ; Telemedicine/organization & administration ; Time Factors ; United States ; Warfare
    Language English
    Publishing date 2016-02
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Video-Audio Media
    ZDB-ID 2717461-X
    ISSN 2325-6621 ; 1943-5665 ; 2325-6621
    ISSN (online) 2325-6621 ; 1943-5665
    ISSN 2325-6621
    DOI 10.1513/AnnalsATS.201509-589OT
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  4. Article ; Online: Study protocol to test the efficacy of self-administration of dexmedetomidine sedative therapy on anxiety, delirium, and ventilator days in critically ill mechanically ventilated patients: an open-label randomized clinical trial.

    Chlan, Linda L / Weinert, Craig R / Tracy, Mary Fran / Skaar, Debra J / Gajic, Ognjen / Ask, Jessica / Mandrekar, Jay

    Trials

    2022  Volume 23, Issue 1, Page(s) 406

    Abstract: Background: Administration of sedative and opioid medications to patients receiving mechanical ventilatory support in the intensive care unit is a common clinical practice.: Methods: A two-site randomized open-label clinical trial will test the ... ...

    Abstract Background: Administration of sedative and opioid medications to patients receiving mechanical ventilatory support in the intensive care unit is a common clinical practice.
    Methods: A two-site randomized open-label clinical trial will test the efficacy of self-management of sedative therapy with dexmedetomidine compared to usual care on anxiety, delirium, and duration of ventilatory support after randomization. Secondary objectives are to compare self-management of sedative therapy to usual care on level of alertness, total aggregate sedative and opioid medication exposure, and ventilator-free days up to day 28 after study enrolment. Exploratory objectives of the study are to compare self-management of sedative therapy to usual care on 3- and 6-month post-discharge physical and functional status, psychological well-being (depression, symptoms of post-traumatic stress disorder), health-related quality of life, and recollections of ICU care. ICU patients (n = 190) who are alert enough to follow commands to self-manage sedative therapy are randomly assigned to self-management of sedative therapy or usual care. Patients remain in the ICU sedative medication study phase for up to 7 days as long as mechanically ventilated.
    Discussion: The care of critically ill mechanically ventilated patients can change significantly over the course of a 5-year clinical trial. Changes in sedation and pain interventions, oxygenation approaches, and standards related to extubation have substantially impacted consistency in the number of eligible patients over time. In addition, the COVID-19 pandemic resulted in mandated extended pauses in trial enrolment as well as alterations in recruitment methods out of concern for study personnel safety and availability of protective equipment. Patient triaging among healthcare institutions due to COVID-19 cases also has resulted in inconsistent access to the eligible study population. This has made it even more imperative for the study team to be flexible and innovative to identify and enrol all eligible participants. Patient-controlled sedation is a novel approach to the management of patient symptoms that may be able to alleviate mechanical ventilation-induced distress without serious side effects. Findings from this study will provide insight into the efficacy of this approach on short- and long-term outcomes in a subset of mechanically ventilated patients.
    Trial registration: ClinicalTrials.gov NCT02819141. Registered on June 29, 2016.
    MeSH term(s) Aftercare ; Analgesics, Opioid ; Anxiety/diagnosis ; Anxiety/therapy ; COVID-19 ; Critical Illness ; Delirium/diagnosis ; Delirium/drug therapy ; Delirium/etiology ; Dexmedetomidine/adverse effects ; Humans ; Hypnotics and Sedatives/adverse effects ; Intensive Care Units ; Pandemics ; Patient Discharge ; Quality of Life ; Randomized Controlled Trials as Topic ; Respiration, Artificial/adverse effects ; Respiration, Artificial/methods ; Ventilators, Mechanical
    Chemical Substances Analgesics, Opioid ; Hypnotics and Sedatives ; Dexmedetomidine (67VB76HONO)
    Language English
    Publishing date 2022-05-16
    Publishing country England
    Document type Clinical Trial Protocol ; Journal Article
    ZDB-ID 2040523-6
    ISSN 1745-6215 ; 1468-6694 ; 1745-6215
    ISSN (online) 1745-6215
    ISSN 1468-6694 ; 1745-6215
    DOI 10.1186/s13063-022-06391-w
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  5. Article ; Online: Study protocol to test the efficacy of self-administration of dexmedetomidine sedative therapy on anxiety, delirium, and ventilator days in critically ill mechanically ventilated patients

    Linda L. Chlan / Craig R. Weinert / Mary Fran Tracy / Debra J. Skaar / Ognjen Gajic / Jessica Ask / Jay Mandrekar

    Trials, Vol 23, Iss 1, Pp 1-

    an open-label randomized clinical trial

    2022  Volume 14

    Abstract: Abstract Background Administration of sedative and opioid medications to patients receiving mechanical ventilatory support in the intensive care unit is a common clinical practice. Methods A two-site randomized open-label clinical trial will test the ... ...

    Abstract Abstract Background Administration of sedative and opioid medications to patients receiving mechanical ventilatory support in the intensive care unit is a common clinical practice. Methods A two-site randomized open-label clinical trial will test the efficacy of self-management of sedative therapy with dexmedetomidine compared to usual care on anxiety, delirium, and duration of ventilatory support after randomization. Secondary objectives are to compare self-management of sedative therapy to usual care on level of alertness, total aggregate sedative and opioid medication exposure, and ventilator-free days up to day 28 after study enrolment. Exploratory objectives of the study are to compare self-management of sedative therapy to usual care on 3- and 6-month post-discharge physical and functional status, psychological well-being (depression, symptoms of post-traumatic stress disorder), health-related quality of life, and recollections of ICU care. ICU patients (n = 190) who are alert enough to follow commands to self-manage sedative therapy are randomly assigned to self-management of sedative therapy or usual care. Patients remain in the ICU sedative medication study phase for up to 7 days as long as mechanically ventilated. Discussion The care of critically ill mechanically ventilated patients can change significantly over the course of a 5-year clinical trial. Changes in sedation and pain interventions, oxygenation approaches, and standards related to extubation have substantially impacted consistency in the number of eligible patients over time. In addition, the COVID-19 pandemic resulted in mandated extended pauses in trial enrolment as well as alterations in recruitment methods out of concern for study personnel safety and availability of protective equipment. Patient triaging among healthcare institutions due to COVID-19 cases also has resulted in inconsistent access to the eligible study population. This has made it even more imperative for the study team to be flexible and innovative to identify and enrol ...
    Keywords Mechanical ventilation ; Sedation ; Anxiety ; Clinical trial ; Intensive care ; Medicine (General) ; R5-920
    Subject code 610
    Language English
    Publishing date 2022-05-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  6. Article ; Online: Operationalizing Ethical Guidance for Ventilator Allocation in Minnesota: Saving the Most Lives or Exacerbating Health Disparities?

    Kesler, Sarah M / Wu, Joel T / Kalland, Krystina R / Peter, Logan G / Wothe, Jillian K / Needle, Jennifer K / Wang, Qi / Weinert, Craig R

    Critical care explorations

    2021  Volume 3, Issue 6, Page(s) e0455

    Abstract: A statewide working group in Minnesota created a ventilator allocation scoring system in anticipation of functioning under a Crisis Standards of Care declaration. The scoring system was intended for patients with and without coronavirus disease 2019. ... ...

    Abstract A statewide working group in Minnesota created a ventilator allocation scoring system in anticipation of functioning under a Crisis Standards of Care declaration. The scoring system was intended for patients with and without coronavirus disease 2019. There was disagreement about whether the scoring system might exacerbate health disparities and about whether the score should include age. We measured the relationship of ventilator scores to in-hospital and 3-month mortality. We analyzed our findings in the context of ethical and legal guidance for the triage of scarce resources.
    Design: Retrospective cohort study.
    Setting: Multihospital within a single healthcare system.
    Patients: Five-hundred four patients emergently intubated and admitted to the ICU.
    Interventions: None.
    Measurements and main results: The Ventilator Allocation Score was positively associated with higher mortality (
    Conclusions: The Ventilator Allocation Score can accurately identify patients with high rates of short-term mortality. However, these high mortality patients only represent 27% of all the patients who died, limiting the utility of the score for allocation of scarce resources. The score may unfairly prioritize older patients and inadvertently exacerbate racial health disparities through the inclusion of specific comorbidities such as end stage renal disease. Triage frameworks that include age should be considered. Purposeful efforts must be taken to ensure that triage protocols do not perpetuate or exacerbate prevailing inequities. Further work on the allocation of scarce resources in critical care settings would benefit from consensus on the primary ethical objective.
    Language English
    Publishing date 2021-06-11
    Publishing country United States
    Document type Journal Article
    ISSN 2639-8028
    ISSN (online) 2639-8028
    DOI 10.1097/CCE.0000000000000455
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  7. Article: Epidemiology and treatment of psychiatric conditions that develop after critical illness.

    Weinert, Craig

    Current opinion in critical care

    2005  Volume 11, Issue 4, Page(s) 376–380

    Abstract: Purpose: As a greater number of patients survive critical illness, there is increasing interest in accelerating patients' recovery after intensive care unit discharge. There is compelling evidence that psychiatric illnesses such as depression impair ... ...

    Abstract Purpose: As a greater number of patients survive critical illness, there is increasing interest in accelerating patients' recovery after intensive care unit discharge. There is compelling evidence that psychiatric illnesses such as depression impair functional status in patients with chronic medical illnesses. Therefore, psychiatric conditions that develop after critical illness are a logical target for treatment or prevention strategies to improve recovery after critical illness.
    Recent findings: This is a new area of investigation for intensive care unit researchers. To date, most studies have focused on descriptive epidemiology of psychiatric conditions at varying times after intensive care unit discharge. Small randomized trials have shown that depression and posttraumatic stress symptoms can be reduced by interventions during or after mechanical ventilation, although the causal mechanisms leading to these improved outcomes are obscure. Promising results must be confirmed in additional trials. After acute myocardial infarction, large trials have found that psychosocial interventions started after hospital discharge are ineffective at preventing psychosocial impairment.
    Summary: Psychiatric symptoms and disorders affect 15%-35% of patients months after intensive care unit discharge. There is no consistent evidence that antidepressant medications are safe or effective in critically ill patients. Understanding the causal pathways that lead from acute medical stress to neuronal alterations and subsequent psychiatric symptoms will allow more precise targeting of preventive interventions.
    MeSH term(s) Comorbidity ; Critical Care/statistics & numerical data ; Critical Illness/epidemiology ; Depression/diagnosis ; Depression/epidemiology ; Depression/physiopathology ; Global Health ; Humans ; Mental Disorders/epidemiology ; Mental Disorders/physiopathology ; Mental Disorders/therapy ; Stress Disorders, Post-Traumatic/diagnosis ; Stress Disorders, Post-Traumatic/epidemiology ; Stress Disorders, Post-Traumatic/physiopathology
    Language English
    Publishing date 2005-03-28
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1235629-3
    ISSN 1531-7072 ; 1070-5295
    ISSN (online) 1531-7072
    ISSN 1070-5295
    DOI 10.1097/01.ccx.0000168529.23078.64
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  8. Article ; Online: Quality improvement interventions in intensive care units.

    Nagamatsu, Soichiro / Weinert, Craig R

    JAMA

    2011  Volume 305, Issue 17, Page(s) 1764; author reply 1764–5

    MeSH term(s) Education, Medical, Continuing ; Education, Nursing, Continuing ; Hospitals, Community ; Humans ; Intensive Care Units/standards ; Ontario ; Patient Care Team ; Quality Improvement
    Language English
    Publishing date 2011-05-04
    Publishing country United States
    Document type Comment ; Letter
    ZDB-ID 2958-0
    ISSN 1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
    ISSN (online) 1538-3598
    ISSN 0254-9077 ; 0002-9955 ; 0098-7484
    DOI 10.1001/jama.2011.558
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  9. Article ; Online: Clinical and Sociocultural Factors Associated With Failure to Escalate Care of Deteriorating Patients.

    Elmufdi, Firas S / Burton, Susan L / Sahni, Nishant / Weinert, Craig R

    American journal of medical quality : the official journal of the American College of Medical Quality

    2017  Volume 33, Issue 4, Page(s) 391–396

    Abstract: In-hospital medical emergencies occur frequently. Understanding how clinicians respond to deteriorating patients outside the intensive care unit (ICU) could improve "rescue" interventions and rapid response programs. This was a qualitative study with ... ...

    Abstract In-hospital medical emergencies occur frequently. Understanding how clinicians respond to deteriorating patients outside the intensive care unit (ICU) could improve "rescue" interventions and rapid response programs. This was a qualitative study with interviews with 40 clinicians caring for patients who had a "Code Blue" activation or an unplanned ICU admission at teaching hospitals over 7 months. Four study physicians independently analyzed interview transcripts; refined themes were linked to the transcript using text analysis software. Nine themes were found to be associated with clinicians' management of deteriorating patients. Multiple human biases influence daily care for deteriorating hospitalized patients. A novel finding is that "moral distress" affects escalation behavior for patients with poor prognosis. Most themes indicate that ward culture influences clinicians to wait until the last minute to escalate care despite being worried about the patients' condition.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Attitude of Health Personnel ; Clinical Decision-Making ; Clinical Deterioration ; Female ; Hospital Mortality ; Hospital Rapid Response Team/organization & administration ; Hospitals, Teaching/organization & administration ; Humans ; Interviews as Topic ; Judgment ; Male ; Middle Aged ; Organizational Culture ; Patient Care Team ; Prognosis ; Qualitative Research
    Language English
    Publishing date 2017-12-19
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1131772-3
    ISSN 1555-824X ; 1062-8606
    ISSN (online) 1555-824X
    ISSN 1062-8606
    DOI 10.1177/1062860617748739
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  10. Article ; Online: Metabolomics in COPD Acute Respiratory Failure Requiring Noninvasive Positive Pressure Ventilation.

    Fortis, Spyridon / Lusczek, Elizabeth R / Weinert, Craig R / Beilman, Greg J

    Canadian respiratory journal

    2017  Volume 2017, Page(s) 9480346

    Abstract: We aimed to investigate whether metabolomic analysis can discriminate acute respiratory failure due to COPD exacerbation from respiratory failure due to heart failure and pneumonia. Since COPD exacerbation is often overdiagnosed, we focused on those COPD ...

    Abstract We aimed to investigate whether metabolomic analysis can discriminate acute respiratory failure due to COPD exacerbation from respiratory failure due to heart failure and pneumonia. Since COPD exacerbation is often overdiagnosed, we focused on those COPD exacerbations that were severe enough to require noninvasive mechanical ventilation. We enrolled stable COPD subjects and patients with acute respiratory failure requiring noninvasive mechanical ventilation due to COPD, heart failure, and pneumonia. We excluded subjects with history of both COPD and heart failure and patients with obstructive sleep apnea and obstructive lung disease other than COPD. We performed metabolomics analysis using NMR. We constructed partial least squares discriminant analysis (PLS-DA) models to distinguish metabolic profiles. Serum (
    MeSH term(s) Aged ; Aged, 80 and over ; Case-Control Studies ; Discriminant Analysis ; Disease Progression ; Female ; Heart Failure/metabolism ; Heart Failure/therapy ; Humans ; Least-Squares Analysis ; Magnetic Resonance Spectroscopy ; Male ; Metabolomics ; Middle Aged ; Noninvasive Ventilation ; Pneumonia/metabolism ; Pneumonia/therapy ; Positive-Pressure Respiration ; Pulmonary Disease, Chronic Obstructive/metabolism ; Pulmonary Disease, Chronic Obstructive/therapy ; Respiratory Insufficiency/metabolism ; Respiratory Insufficiency/therapy
    Language English
    Publishing date 2017-12-17
    Publishing country Egypt
    Document type Journal Article
    ZDB-ID 1213103-9
    ISSN 1916-7245 ; 1198-2241
    ISSN (online) 1916-7245
    ISSN 1198-2241
    DOI 10.1155/2017/9480346
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