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Article ; Online: Treatment Fidelity in 94 Randomized Controlled Trials of Physical Rehabilitation in the ICU: A Scoping Review.

Farley, Christopher / Newman, Anastasia N L / Hoogenes, Jen / Brooks, Dina / Duffett, Mark / Kho, Michelle E

2024 Volume 52, Issue 5, Page(s) 717–728

Abstract: Objectives: Recent reviews demonstrated discordant effects of ICU-based physical rehabilitation on physical function. These inconsistencies may be related to differences in treatment fidelity-the extent to which a protocol is delivered as planned. ... ...

Abstract	Objectives: Recent reviews demonstrated discordant effects of ICU-based physical rehabilitation on physical function. These inconsistencies may be related to differences in treatment fidelity-the extent to which a protocol is delivered as planned. Before evaluating the association of fidelity with outcomes, we must first understand the extent of treatment fidelity reporting in ICU-based physical rehabilitation randomized controlled trials (RCTs). Data sources: Six electronic databases from inception to December 2022. Study selection: We included RCTs enrolling adults or children admitted to the ICU, if greater than or equal to 50% were invasively mechanically ventilated greater than 24 hours, and underwent an ICU-based physical rehabilitation intervention, with no limitation to comparators or outcomes. Data extraction: We screened and extracted data independently and in duplicate, with a third reviewer as needed. Extracted data included study characteristics, treatment descriptions, and the presence of National Institutes of Health Behaviour Change Consortium (NIH-BCC) treatment fidelity tool components. Treatment fidelity scores were calculated as the proportion of reported (numerator) out of total NIH-BCC components (denominator). We calculated scores across studies and by treatment group (intervention vs. comparator). We used linear regression to assess for a time trend in study treatment fidelity scores. Data synthesis: Of 20,433 citations, 94 studies met inclusion criteria. Authors reported a median (first-third quartiles) of 19% (14-26%) of treatment fidelity components across studies. Intervention group scores were higher than comparator groups (24% [19-33%] vs. 14% [5-24%], p < 0.01). We found a mean increase in study treatment fidelity scores by 0.7% (0.3 points) per year. Conclusions: Only 19% of treatment fidelity components were reported across studies, with comparator groups more poorly reported. Future research could investigate ways to optimize treatment fidelity reporting and determine characteristics associated with treatment fidelity conduct in ICU-based physical rehabilitation RCTs.
MeSH term(s)	United States ; Adult ; Child ; Humans ; Randomized Controlled Trials as Topic ; Hospitalization ; Intensive Care Units
Language	English
Publishing date	2024-01-24
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	197890-1
ISSN	1530-0293 ; 0090-3493
ISSN (online)	1530-0293
ISSN	0090-3493
DOI	10.1097/CCM.0000000000006192
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Article ; Online: Fluid volume used for medication delivery in critically ill adults.

Ignacy, Teegan / Carlin, Stephanie / Duffett, Mark

Canadian journal of anaesthesia = Journal canadien d'anesthesie

2021 Volume 68, Issue 3, Page(s) 432–433

MeSH term(s)	Adult ; Critical Illness ; Fluid Therapy ; Humans ; Intensive Care Units
Language	English
Publishing date	2021-01-06
Publishing country	United States
Document type	Letter
ZDB-ID	91002-8
ISSN	1496-8975 ; 0832-610X
ISSN (online)	1496-8975
ISSN	0832-610X
DOI	10.1007/s12630-020-01889-w
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Zs.A 109: Show issues

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Article ; Online: Patient engagement: What partnering with patient in research is all about.

Duffett, Lisa

Thrombosis research

2017 Volume 150, Page(s) 113–120

Abstract: The inclusion of patients on important decision related to healthcare has marked a significant ...

Abstract	The inclusion of patients on important decision related to healthcare has marked a significant 'patient revolution' during the last several decades. Patients now played active roles in personal health decisions, healthcare delivery and policy making, and the development of clinical practice guidelines. Such inclusion of patients' values has resulted in largely positive effects. The next wave of this 'patient revolution' is active and meaningful engagement with patients in health related research. Similar to other aspects of healthcare, it is increasingly recognized that experienced patients, their families, and caregivers, have a wealth of knowledge that comes from living and experiencing a medical condition. By understanding and valuing this experience-based knowledge, research priority setting, research study design, trial conduct, analysis of results and knowledge dissemination can be positively influenced. Patients can challenge our assumptions, align research with the needs of patients, increase transparency and trust in research, and lead to research that has a greater impact on the ultimate care of patients. This new approach to research is timed well with a larger movement towards simple, pragmatic clinical trials better reflecting realistic patient care. While there is still much to be learned about the best methods and exact impacts of patient engagement in research, preliminary results are promising and future venous thromboembolism research will likely benefit from the adoption of patient engagement in research.
MeSH term(s)	Biomedical Research/methods ; Clinical Trials as Topic/methods ; Humans ; Patient Participation ; Venous Thromboembolism/complications ; Venous Thromboembolism/therapy
Language	English
Publishing date	2017-02
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	121852-9
ISSN	1879-2472 ; 0049-3848
ISSN (online)	1879-2472
ISSN	0049-3848
DOI	10.1016/j.thromres.2016.10.029
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Zs.A 863: Show issues

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Article ; Online: Sedative Medications for Critically Ill Children during and after Mechanical Ventilation: A Retrospective Observational Study.

Caldwell, Deanna / Wong, Jonathan / Duffett, Mark

The Canadian journal of hospital pharmacy

2020 Volume 73, Issue 2, Page(s) 125–132

Abstract: Background: Providing safe and effective sedation to critically ill children is challenging. The assessment, prevention, and treatment of symptoms of iatrogenic withdrawal are critical aspects of sedation practice.: Objective: To describe the use of ... ...

Abstract	Background: Providing safe and effective sedation to critically ill children is challenging. The assessment, prevention, and treatment of symptoms of iatrogenic withdrawal are critical aspects of sedation practice. Objective: To describe the use of sedative medications in critically ill children at McMaster Children's Hospital. Methods: This retrospective observational study included children admitted over a 12-month period who survived their illness and who received sedation and at least 48 h of invasive ventilation. We collected data from the time of admission to the pediatric intensive care unit to 3 days after discontinuation of sedation. Results: We included 67 children. The median age was 1.6 (interquartile range [IQR] 0.2-6.2) years, and respiratory illnesses were the most common reason for admission (41 [61%]). The children received invasive ventilation for a median of 7 (IQR 4-11) days and sedation for a median of 12 (IQR 6-20) days. Sixty-six children (99%) received an opioid, and all received a benzodiazepine, with median cumulative doses of 14 (IQR 5-27) mg/kg morphine equivalents and 15 (IQR 6-32) mg/kg midazolam equivalents. Dexmedetomidine was given to 31 children (46%), for a median of 8 (IQR 4-12) days. Most children (67%) received sedation after extubation (median duration 7 [IQR 4-14] days). In addition, 32 children (48%) continued to receive sedative medications after transfer to the ward, for a median of 6 (IQR 4-13) days. Forty-two children (63%) had at least one Withdrawal Assessment Tool-1 (WAT-1) score indicative of iatrogenic withdrawal. Children who experienced withdrawal were exposed to more opioids and more benzodiazepines, both per day and overall, and for longer periods. Conclusions: The children in this study were exposed to multiple sedatives, and many continued to receive these medications for an extended period after discontinuation of mechanical ventilation. Iatrogenic withdrawal was common and represents an important opportunity to improve children's recovery after critical illness.
Language	English
Publishing date	2020-04-01
Publishing country	Canada
Document type	Journal Article
ZDB-ID	413450-3
ISSN	1920-2903 ; 0008-4123
ISSN (online)	1920-2903
ISSN	0008-4123
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Article ; Online: Ketamine sedation in the intensive care unit: a survey of Canadian intensivists.

Sharif, Sameer / Munshi, Laveena / Burry, Lisa / Mehta, Sangeeta / Gray, Sara / Chaudhuri, Dipayan / Duffett, Mark / Siemieniuk, Reed A / Rochwerg, Bram

Canadian journal of anaesthesia = Journal canadien d'anesthesie

2023 Volume 71, Issue 1, Page(s) 118–126

Abstract: Purpose: We sought to understand the beliefs and practices of Canadian intensivists regarding their use of ketamine as a sedative in critically ill patients and to gauge their interest in a randomized controlled trial (RCT) examining its use in the ... ...

Title translation	Sédation à la kétamine aux soins intensifs : un sondage auprès des intensivistes du Canada.
Abstract	Purpose: We sought to understand the beliefs and practices of Canadian intensivists regarding their use of ketamine as a sedative in critically ill patients and to gauge their interest in a randomized controlled trial (RCT) examining its use in the intensive care unit (ICU). Methods: We designed and validated an electronic self-administered survey examining the use of ketamine as a sedative infusion for ICU patients. We surveyed 400 physician members of the Canadian Critical Care Society (CCCS) via email between February and April 2022 and sent three reminders at two-week intervals. The survey was redistributed in January 2023 to improve the response rate. Results: We received 87/400 (22%) completed questionnaires. Most respondents reported they rarely use ketamine as a continuous infusion for sedation or analgesia in the ICU (52/87, 58%). Physicians reported the following conditions would make them more likely to use ketamine: asthma exacerbation (73/87, 82%), tolerance to opioids (68/87, 77%), status epilepticus (44/87, 50%), and severe acute respiratory distress syndrome (33/87, 38%). Concern for side-effects that limited respondents' use of ketamine include adverse psychotropic effects (61/87, 69%) and delirium (47/87, 53%). The majority of respondents agreed there is need for an RCT to evaluate ketamine as a sedative infusion in the ICU (62/87, 71%). Conclusion: This survey of Canadian intensivists illustrates that use of ketamine as a continuous infusion for sedation is limited, and is at least partly driven by concerns of adverse psychotropic effects. Canadian physicians endorse the need for a trial investigating the safety and efficacy of ketamine as a sedative for critically ill patients.
MeSH term(s)	Humans ; Ketamine/adverse effects ; Critical Illness ; Canada ; Intensive Care Units ; Hypnotics and Sedatives ; Surveys and Questionnaires
Chemical Substances	Ketamine (690G0D6V8H) ; Hypnotics and Sedatives
Language	English
Publishing date	2023-10-26
Publishing country	United States
Document type	Randomized Controlled Trial ; Journal Article
ZDB-ID	91002-8
ISSN	1496-8975 ; 0832-610X
ISSN (online)	1496-8975
ISSN	0832-610X
DOI	10.1007/s12630-023-02608-x
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Zs.A 109: Show issues

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Article ; Online: Pharmacological agents for procedural sedation and analgesia in the emergency department and intensive care unit: a systematic review and network meta-analysis of randomised trials.

Sharif, Sameer / Kang, Jasmine / Sadeghirad, Behnam / Rizvi, Fayyaz / Forestell, Ben / Greer, Alisha / Hewitt, Mark / Fernando, Shannon M / Mehta, Sangeeta / Eltorki, Mohamed / Siemieniuk, Reed / Duffett, Mark / Bhatt, Maala / Burry, Lisa / Perry, Jeffrey J / Petrosoniak, Andrew / Pandharipande, Pratik / Welsford, Michelle / Rochwerg, Bram

British journal of anaesthesia

2024 Volume 132, Issue 3, Page(s) 491–506

Abstract: Background: We aimed to evaluate the comparative effectiveness and safety of various i.v. pharmacologic agents used for procedural sedation and analgesia (PSA) in the emergency department (ED) and ICU. We performed a systematic review and network meta- ... ...

Abstract	Background: We aimed to evaluate the comparative effectiveness and safety of various i.v. pharmacologic agents used for procedural sedation and analgesia (PSA) in the emergency department (ED) and ICU. We performed a systematic review and network meta-analysis to enable direct and indirect comparisons between available medications. Methods: We searched Medline, EMBASE, Cochrane, and PubMed from inception to 2 March 2023 for RCTs comparing two or more procedural sedation and analgesia medications in all patients (adults and children >30 days of age) requiring emergent procedures in the ED or ICU. We focused on the outcomes of sedation recovery time, patient satisfaction, and adverse events (AEs). We performed frequentist random-effects model network meta-analysis and used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to rate certainty in estimates. Results: We included 82 RCTs (8105 patients, 78 conducted in the ED and four in the ICU) of which 52 studies included adults, 23 included children, and seven included both. Compared with midazolam-opioids, recovery time was shorter with propofol (mean difference 16.3 min, 95% confidence interval [CI] 8.4-24.3 fewer minutes; high certainty), and patient satisfaction was better with ketamine-propofol (mean difference 1.5 points, 95% CI 0.3-2.6 points, high certainty). Regarding AEs, compared with midazolam-opioids, respiratory AEs were less frequent with ketamine (relative risk [RR] 0.55, 95% CI 0.32-0.96; high certainty), gastrointestinal AEs were more common with ketamine-midazolam (RR 3.08, 95% CI 1.15-8.27; high certainty), and neurological AEs were more common with ketamine-propofol (RR 3.68, 95% CI 1.08-12.53; high certainty). Conclusion: When considering procedural sedation and analgesia in the ED and ICU, compared with midazolam-opioids, sedation recovery time is shorter with propofol, patient satisfaction is better with ketamine-propofol, and respiratory adverse events are less common with ketamine.
MeSH term(s)	Adult ; Child ; Humans ; Propofol/adverse effects ; Midazolam/adverse effects ; Ketamine/adverse effects ; Network Meta-Analysis ; Pain/drug therapy ; Analgesics, Opioid/therapeutic use ; Analgesia ; Emergency Service, Hospital ; Intensive Care Units ; Conscious Sedation/adverse effects ; Conscious Sedation/methods ; Randomized Controlled Trials as Topic
Chemical Substances	Propofol (YI7VU623SF) ; Midazolam (R60L0SM5BC) ; Ketamine (690G0D6V8H) ; Analgesics, Opioid
Language	English
Publishing date	2024-01-06
Publishing country	England
Document type	Meta-Analysis ; Systematic Review ; Journal Article ; Review
ZDB-ID	80074-0
ISSN	1471-6771 ; 0007-0912
ISSN (online)	1471-6771
ISSN	0007-0912
DOI	10.1016/j.bja.2023.11.050
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Article: Gender and Authorship in Pediatric Critical Care Randomized Control Trials.

Xu, Grace M / Zavalkoff, Samara / de Wildt, Saskia N / Duffett, Mark

Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

2020 Volume 21, Issue 12, Page(s) 1035–1041

Abstract: Objectives: To examine the gender distribution of authorship of pediatric critical care randomized control trials.: Data sources: The 415 randomized control trials in pediatric critical care published before 2019.: Study selection: We included all ...

Abstract	Objectives: To examine the gender distribution of authorship of pediatric critical care randomized control trials. Data sources: The 415 randomized control trials in pediatric critical care published before 2019. Study selection: We included all randomized control trials enrolling children in a PICU. We used PICUtrials.net, which uses comprehensive search strategies of multiple databases, to identify published randomized control trials. Data extraction: We manually extracted the name and profession of each listed author from each publication and classified each author as male or female based on their name. Results: We included 2,146 authors and were able to classify 1,888 (88%) as men or women. Overall, 38% of authors were women, this varied with the authorship position: 37% of first, 38% of middle, and 25% of last authors were women (p < 0.001). The three most common professions were physician (63%), nonclinician (11%), and nurse (6%)-of which 30%, 45%, and 97%, respectively, were women. The percentage of female authorship overall has increased from 28% in 1985-1989 to 39% in 2015-2018 (p for trend = 0.004). There were no significant differences in the characteristics of randomized control trials published with a female first or last author versus those with both male first and last authors with respect to the median number of children randomized (60 vs. 50; p = 0.41), multicentred trials (17% vs. 24%; p = 0.12), trials at low risk of bias (50% vs. 66%; p = 0.26), reporting any funding (55% vs. 51%; p = 0.66), or median number of citations per year (1.5 vs. 2.4; p = 0.09). Conclusions: Although increasing over time, the percentage of researchers publishing pediatric critical care randomized control trials who are women still lags behind the percentage clinicians who are women. Trials that female researchers publish are similar in characteristics and impact as male researchers. Further work should identify barriers to gender diversity and potential solutions in pediatric critical care research.
MeSH term(s)	Authorship ; Child ; Critical Care ; Female ; Humans ; Male ; Publishing ; Research Personnel
Language	English
Publishing date	2020-06-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	2052349-X
ISSN	1947-3893 ; 1529-7535
ISSN (online)	1947-3893
ISSN	1529-7535
DOI	10.1097/PCC.0000000000002437
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Zs.A 5600: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 472: Show issues

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Article: Medications for Children: A Survey of Community Pharmacists.

Rashid, Alina R / Duffett, Mark

The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG

2016 Volume 21, Issue 3, Page(s) 213–223

Abstract: Background: Seamless and safe discharge of children from hospital requires successful collaboration with community pharmacists, for whom pediatrics is often a small part of their practice.: Objectives: The purpose of this study was to understand ... ...

Abstract	Background: Seamless and safe discharge of children from hospital requires successful collaboration with community pharmacists, for whom pediatrics is often a small part of their practice. Objectives: The purpose of this study was to understand community pharmacists' comfort level and confidence in providing care for children. Methods: We conducted a self-administered online survey of community pharmacists in Ontario, Canada. Respondents rated their comfort and confidence on a scale of 1 to 7 in each of 3 scenarios: oral morphine, prednisone, and amoxicillin. We also evaluated the relationship between participants' comfort level and demographics. Results: We included 622 responses (377 completed and 245 partially completed surveys). A total of 182 participants (48%) were female, 271 participants (72%) had children of their own, and they had practiced pharmacy for a median (interquartile range) of 19 (5-28) years. The percentage of respondents who were comfortable (5-7 on a 7-point scale) with filling the prescriptions as written was 64% for morphine, 58% for prednisone, and 61% for amoxicillin and was not different among the scenarios. Having children was associated with increased comfort (p = 0.02), whereas other demographic variables were not. Compared to the amoxicillin scenario, pharmacists reported being significantly more likely to choose another course of action for prednisone (p = 0.01) but not for morphine (p = 0.25). Although 428 pharmacists (70%) agreed that they maintained adequate knowledge of pediatric topics, 558 (91%) were interested in more education. Conclusions: Variability exists in the confidence and comfort levels of community pharmacists when dealing with children, and many are not comfortable with the common prescriptions in this survey.
Language	English
Publishing date	2016-03-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	3028543-4
ISSN	1551-6776
ISSN	1551-6776
DOI	10.5863/1551-6776-21.3.213
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Article: Levetiracetam Versus Phenytoin or Fosphenytoin for Second-Line Treatment of Pediatric Status Epilepticus: A Meta-Analysis.

Klowak, Jennifer Ann / Hewitt, Mark / Catenacci, Vanessa / Duffett, Mark / Rochwerg, Bram / Jones, Kevin / Choong, Karen

Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

2021 Volume 22, Issue 9, Page(s) e480–e491

Abstract: Objective: To synthesize the available evidence examining the efficacy and safety of levetiracetam compared with phenytoin or fosphenytoin in benzodiazepine-refractory pediatric status epilepticus.: Data sources: We searched (from inception until ... ...

Abstract	Objective: To synthesize the available evidence examining the efficacy and safety of levetiracetam compared with phenytoin or fosphenytoin in benzodiazepine-refractory pediatric status epilepticus. Data sources: We searched (from inception until April 27, 2020) Ovid MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials. Study selection: Two reviewers, independently and in duplicate, screened citations and manuscripts for eligible randomized controlled trials. Data extraction and synthesis: Independently and in duplicate, we performed data abstraction, risk of bias assessment, and certainty assessment using Grading of Recommendations, Assessment, Development, and Evaluation. We performed meta-analyses using random-effect models or, if insufficient data, presented findings narratively. Results: We identified seven randomized controlled trials (n = 1,575). Pooled analysis demonstrated low certainty evidence for no difference of levetiracetam on time to seizure cessation (mean difference, -3.11 min; 95% CI, -6.67 to 0.45), early seizure cessation (relative risk, 1.09, 95% CI, 0.95-1.26), or late seizure cessation (relative risk, 1.05; 95% CI, 0.93-1.18). Adverse event outcomes were limited by low event numbers. We found low certainty evidence for less respiratory depression with levetiracetam (relative risk, 0.28; 95% CI, 0.12-0.69). Conclusions: The efficacy of levetiracetam is comparable with phenytoin or fosphenytoin in children with benzodiazepine-refractory status epilepticus (low certainty evidence). Levetiracetam may cause less respiratory depression. Clinicians and guideline developers should weigh safety profiles when choosing between these agents.
MeSH term(s)	Anticonvulsants/adverse effects ; Child ; Humans ; Levetiracetam/therapeutic use ; Phenytoin/adverse effects ; Phenytoin/analogs & derivatives ; Status Epilepticus/drug therapy
Chemical Substances	Anticonvulsants ; Levetiracetam (44YRR34555) ; Phenytoin (6158TKW0C5) ; fosphenytoin (B4SF212641)
Language	English
Publishing date	2021-03-11
Publishing country	United States
Document type	Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't
ZDB-ID	2052349-X
ISSN	1947-3893 ; 1529-7535
ISSN (online)	1947-3893
ISSN	1529-7535
DOI	10.1097/PCC.0000000000002703
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Zs.A 5600: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 472: Show issues

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Book ; Online: Music and Spirituality

Smith, Thérèse / Smith, Fr. Innocent / Schubert, Emery / Moody, Ivan / Heaney, Maeve Louise / Foley, Edward / Duffett, Mark / Bertoglio, Chiara / Bannister, Peter / Atkins, Peter / Taylor, William Harrison / Westermeyer, Paul / OConnor, Michael

2015

Abstract: Across time and geography people have known the power of music for evoking the gods and acquiring spiritual insight. Whether arising as a textless chant by a single voice or a percussive auditory context for ritual dance, music in its various modes is a ... ...

Abstract	Across time and geography people have known the power of music for evoking the gods and acquiring spiritual insight. Whether arising as a textless chant by a single voice or a percussive auditory context for ritual dance, music in its various modes is a virtually ubiquitous companion to religious and spiritual practices. The apparently intangible, insubstantial nature of sound is one of the reasons why music has so effectively symbolized the mysterious and wholly other since the dawn of creation. Not only an accompaniment to one's spiritual trek, musical compositions from the great oratorios of Handel to the soundtrack to the movie Lord of the Rings also serve as powerful metaphors and inspirations for that journey
Keywords	Music ; Religion (General)
Size	1 electronic resource (208 p.)
Publisher	MDPI - Multidisciplinary Digital Publishing Institute
Document type	Book ; Online
Note	English ; Open Access
HBZ-ID	HT020089967
ISBN	9783038421023 ; 9783038420996 ; 3038421022 ; 3038420999
Database	ZB MED Catalogue: Medicine, Health, Nutrition, Environment, Agriculture

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