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  1. Article ; Online: Limitations of life-sustaining therapies in South Africa.

    Feldman, Charles / Joynt, Gavin M / Mentzelopoulos, Spyros D / Sprung, Charles L / Avidan, Alexander / Richards, Guy A

    Journal of critical care

    2024  Volume 82, Page(s) 154797

    Abstract: Purpose: Limitations of life sustaining therapies (LLST) are frequent in intensive care units (ICUs), but no previous studies have examined end-of-life (EOL) care and LLST in South Africa (SA).: Materials and methods: This study evaluated LLST in SA ... ...

    Abstract Purpose: Limitations of life sustaining therapies (LLST) are frequent in intensive care units (ICUs), but no previous studies have examined end-of-life (EOL) care and LLST in South Africa (SA).
    Materials and methods: This study evaluated LLST in SA from the data of a prospective, international, multicentre, observational study (Ethicus-2) and compared practices with countries in the rest of the world.
    Results: LLST was relatively common in SA, and withholding was more frequent than withdrawing therapy. However, withdrawing and withholding therapy were less common, while failed CPR was more common, than in many other countries. No patients had an advance directive. Primary reasons for LLST in SA were poor quality of life, multisystem organ failure and patients' unresponsiveness to maximal therapy. Primary considerations for EOL decision-making were good medical practice and patients' best-interest, with the need for an ICU bed only rarely considered.
    Conclusions: Withholding was more common than withdrawing treatment both in SA and worldwide, although both were significantly less frequent in SA compared with the world average.
    Language English
    Publishing date 2024-03-29
    Publishing country United States
    Document type Journal Article
    ZDB-ID 632818-0
    ISSN 1557-8615 ; 0883-9441
    ISSN (online) 1557-8615
    ISSN 0883-9441
    DOI 10.1016/j.jcrc.2024.154797
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    Zs.A 2152: Show issues Location:
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  2. Article ; Online: Understanding COVID-19: what does viral RNA load really mean?

    Joynt, Gavin M / Wu, William Kk

    The Lancet. Infectious diseases

    2020  Volume 20, Issue 6, Page(s) 635–636

    MeSH term(s) Betacoronavirus ; COVID-19 ; Coronavirus Infections ; Europe ; Humans ; Pandemics ; Pneumonia, Viral ; RNA, Viral ; SARS-CoV-2
    Chemical Substances RNA, Viral
    Keywords covid19
    Language English
    Publishing date 2020-03-27
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 2061641-7
    ISSN 1474-4457 ; 1473-3099
    ISSN (online) 1474-4457
    ISSN 1473-3099
    DOI 10.1016/S1473-3099(20)30237-1
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    Zs.A 5743: Show issues Location:
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  4. Article ; Online: Understanding COVID-19

    Joynt, Gavin M / Wu, William KK

    The Lancet Infectious Diseases

    what does viral RNA load really mean?

    2020  Volume 20, Issue 6, Page(s) 635–636

    Keywords Infectious Diseases ; covid19
    Language English
    Publisher Elsevier BV
    Publishing country us
    Document type Article ; Online
    ZDB-ID 2061641-7
    ISSN 1474-4457 ; 1473-3099
    ISSN (online) 1474-4457
    ISSN 1473-3099
    DOI 10.1016/s1473-3099(20)30237-1
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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    Zs.A 5743: Show issues Location:
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  5. Article ; Online: The trajectory of very old critically ill patients.

    Guidet, Bertrand / Vallet, Helene / Flaatten, Hans / Joynt, Gavin / Bagshaw, Sean M / Leaver, Susannah K / Beil, Michael / Du, Bin / Forte, Daniel N / Angus, Derek C / Sviri, Sigal / de Lange, Dylan / Herridge, Margaret S / Jung, Christian

    Intensive care medicine

    2024  Volume 50, Issue 2, Page(s) 181–194

    Abstract: The demographic shift, together with financial constraint, justify a re-evaluation of the trajectory of care of very old critically ill patients (VIP), defined as older than 80 years. We must avoid over- as well as under-utilisation of critical care ... ...

    Abstract The demographic shift, together with financial constraint, justify a re-evaluation of the trajectory of care of very old critically ill patients (VIP), defined as older than 80 years. We must avoid over- as well as under-utilisation of critical care interventions in this patient group and ensure the inclusion of health care professionals, the patient and their caregivers in the decision process. This new integrative approach mobilises expertise at each step of the process beginning prior to intensive care unit (ICU) admission and extending to long-term follow-up. In this review, several international experts have contributed to provide recommendations that can be universally applied. Our aim is to define a minimum core dataset of information to be shared and discussed prior to ICU admission and to facilitate the shared-decision-making process with the patient and their caregivers, throughout the patient journey. Documentation of uncertainty may contribute to a tailored level of care and ultimately to discussions around possible limitations of life sustaining treatments. The goal of ICU care is not only to avoid death, but more importantly to maintain an acceptable quality of life and functional autonomy after hospital discharge. Societal consideration is important to highlight, together with alternatives to ICU admission. We discuss challenges for the future and potential areas of research. In summary, this review provides a state-of-the-art current overview and aims to outline future directions to address the challenges in the treatment of VIP.
    MeSH term(s) Humans ; Critical Illness/therapy ; Quality of Life ; Critical Care ; Health Personnel ; Hospitalization
    Language English
    Publishing date 2024-01-18
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 80387-x
    ISSN 1432-1238 ; 0340-0964 ; 0342-4642 ; 0935-1701
    ISSN (online) 1432-1238
    ISSN 0340-0964 ; 0342-4642 ; 0935-1701
    DOI 10.1007/s00134-023-07298-z
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  6. Article ; Online: Relative survival in adults with new delirium, cerebrovascular events or both after cardiac surgery: A prospective cohort study.

    Lee, Anna / Yau, Derek K W / Ng, Floria F / Underwood, Malcolm J / Joynt, Gavin M

    European journal of anaesthesiology

    2021  Volume 38, Issue 5, Page(s) 558–560

    MeSH term(s) Adult ; Cardiac Surgical Procedures/adverse effects ; Delirium/diagnosis ; Delirium/epidemiology ; Delirium/etiology ; Humans ; Postoperative Complications/diagnosis ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Prospective Studies ; Risk Factors
    Language English
    Publishing date 2021-04-06
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 605770-6
    ISSN 1365-2346 ; 0265-0215
    ISSN (online) 1365-2346
    ISSN 0265-0215
    DOI 10.1097/EJA.0000000000001241
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  7. Article ; Online: Understanding cardiovascular physiology of ageing.

    Flaatten, Hans / Skaar, Elisabeth / Joynt, Gavin M

    Intensive care medicine

    2018  Volume 44, Issue 6, Page(s) 932–935

    MeSH term(s) Aged ; Aging ; Cardiovascular Physiological Phenomena ; Humans
    Language English
    Publishing date 2018-03-09
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80387-x
    ISSN 1432-1238 ; 0340-0964 ; 0342-4642 ; 0935-1701
    ISSN (online) 1432-1238
    ISSN 0340-0964 ; 0342-4642 ; 0935-1701
    DOI 10.1007/s00134-018-5119-7
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  8. Article: Early intubation versus late intubation for COVID-19 patients: An in situ simulation identifying factors affecting performance and infection control in airway management.

    Lee, Christopher P / Yip, Yu-Yeung / Chan, Albert Km / Ko, Chun P / Joynt, Gavin M

    Anaesthesia and intensive care

    2021  Volume 49, Issue 4, Page(s) 284–291

    Abstract: COVID-19 poses an infectious risk to healthcare workers especially during airway management. We compared the impact of early versus late intubation on infection control and performance in a randomised in situ simulation, using fluorescent powder as a ... ...

    Abstract COVID-19 poses an infectious risk to healthcare workers especially during airway management. We compared the impact of early versus late intubation on infection control and performance in a randomised in situ simulation, using fluorescent powder as a surrogate for contamination. Twenty anaesthetists and intensivists intubated a simulated patient with COVID-19. The primary outcome was the degree of contamination. The secondary outcomes included the use of bag-valve-mask ventilation, the incidence of manikin cough, intubation time, first attempt success and heart rate variability as a measure of stress. The contamination score was significantly increased in the late intubation group, mean (standard deviation, SD) 17.20 (6.17), 95% confidence intervals (CI) 12.80 to 21.62 versus the early intubation group, mean (SD) 9.90 (5.13), 95% CI 6.23 to 13.57,
    MeSH term(s) Airway Management ; COVID-19 ; Humans ; Infection Control ; Intubation, Intratracheal ; Laryngoscopy ; SARS-CoV-2
    Language English
    Publishing date 2021-05-26
    Publishing country United States
    Document type Journal Article
    ZDB-ID 187524-3
    ISSN 1448-0271 ; 0310-057X
    ISSN (online) 1448-0271
    ISSN 0310-057X
    DOI 10.1177/0310057X211007862
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    Zs.A 1017: Show issues Location:
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  9. Article ; Online: COVID-19: A critical care perspective informed by lessons learnt from other viral epidemics.

    Ling, Lowell / Joynt, Gavin M / Lipman, Jeff / Constantin, Jean-Michel / Joannes-Boyau, Olivier

    Anaesthesia, critical care & pain medicine

    2020  Volume 39, Issue 2, Page(s) 163–166

    MeSH term(s) Betacoronavirus ; COVID-19 ; Coronavirus Infections/diagnosis ; Coronavirus Infections/epidemiology ; Coronavirus Infections/therapy ; Critical Care ; Disease Progression ; Epidemics ; Humans ; Pandemics ; Pneumonia, Viral/diagnosis ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/therapy ; Risk Factors ; SARS-CoV-2
    Keywords covid19
    Language English
    Publishing date 2020-02-20
    Publishing country France
    Document type Editorial
    ISSN 2352-5568
    ISSN (online) 2352-5568
    DOI 10.1016/j.accpm.2020.02.002
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  10. Article: Scoping review on diagnostic criteria and investigative approach in sepsis of unknown origin in critically ill patients.

    Ling, Lowell / Mui, Oliver Oi Yat / Laupland, Kevin B / Lefrant, Jean-Yves / Roberts, Jason A / Gopalan, Pragasan Dean / Lipman, Jeffrey / Joynt, Gavin M

    Journal of intensive care

    2022  Volume 10, Issue 1, Page(s) 44

    Abstract: Background: Up to 11% of critically ill patients with sepsis have an unknown source, where the pathogen and site of infection are unclear. The aim of this scoping review is to document currently reported diagnostic criteria of sepsis of unknown origin ( ... ...

    Abstract Background: Up to 11% of critically ill patients with sepsis have an unknown source, where the pathogen and site of infection are unclear. The aim of this scoping review is to document currently reported diagnostic criteria of sepsis of unknown origin (SUO) and identify the types and breadth of existing evidence supporting diagnostic processes to identify the infection source in critically ill patients with suspected SUO.
    Methods: A literature search of Embase, MEDLINE and PubMed for published studies from 1910 to August 19, 2021 addressing the topic of SUO was performed. Study type, country of origin according to World Bank classification, diagnostic criteria of sepsis of unknown origin, and investigative approaches were extracted from the studies.
    Results: From an initial 722 studies, 89 unique publications fulfilled the inclusion and exclusion criteria and were included for full text review. The most common publication type was case report/series 45/89 (51%). Only 10/89 (11%) of studies provided a diagnostic criteria of SUO, but a universally accepted diagnostic criterion was not identified. The included studies discussed 30/89 (34%) history, 23/89 (26%) examination, 57/89 (64%) imaging, microbiology 39/89 (44%), and special tests 32/89 (36%) as part of the diagnostic processes in patients with SUO.
    Conclusions: Universally accepted diagnostic criteria for SUO was not found. Prospective studies on investigative processes in critically ill patients managed as SUO across different healthcare settings are needed to understand the epidemiology and inform the diagnostic criteria required to diagnose SUO.
    Language English
    Publishing date 2022-09-11
    Publishing country England
    Document type Journal Article
    ZDB-ID 2739853-5
    ISSN 2052-0492
    ISSN 2052-0492
    DOI 10.1186/s40560-022-00633-4
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