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Article: The FRAIL-FIT 30 Study - Factors influencing 30-day mortality in frail patients admitted to ICU: A retrospective observational cohort study.

Hewitt, David / Ratcliffe, Michael / Booth, Malcolm G

2021 Volume 23, Issue 2, Page(s) 150–161

Abstract: Background: Frailty is a multi-dimensional syndrome of reduced reserve, resulting from overlapping physiological decrements across multiple systems. The contributing factors, temporality and magnitude of frailty's effect on mortality after ICU admission ...

Abstract	Background: Frailty is a multi-dimensional syndrome of reduced reserve, resulting from overlapping physiological decrements across multiple systems. The contributing factors, temporality and magnitude of frailty's effect on mortality after ICU admission are unclear. This study assessed frailty's impact on mortality and life sustaining therapy (LST) use, following ICU admission. Methods: This single-centre retrospective observational cohort study analysed data collected prospectively in Glasgow Royal Infirmary ICU. Of 684 eligible patients, 171 were frail and 513 were non-frail. Frailty was quantified using the Rockwood Clinical Frailty Scale (CFS). All patients were followed up 1-year after ICU admission. The primary outcome was all-cause mortality at 30-days post-ICU admission. Key secondary outcomes included mortality at 1-year and LST use. Results: Frail patients were significantly less likely to survive 30-days post-ICU admission (61.4% vs 81.1%, p < 0.001). This continued to 1-year (48.5% vs 68.2%, p < 0.001). Frailty significantly increased mortality hazards in covariate-adjusted analyses at 30-days (HR 1.56; 95%CI 1.14-2.15; p = 0.006), and 1-year (HR 1.35; 95%CI 1.03-1.76; p = 0.028). Single-point CFS increases were associated with a 30-day mortality hazard of 1.23 (95%CI 1.13-1.34; p < 0.001) in unadjusted analyses, and 1.11 (95%CI 1.01-1.22; p = 0.026) after covariate adjustment. Frail patients received significantly more days of LST (median[IQR]: 5[3,11] vs 4[2,9], p = 0.008). Conclusion: Frailty was significantly associated with greater mortality at all time points studied, but most notably in the first 30-days post-ICU admission. This was despite greater LST use. The accrual effect of frailty increased adverse outcomes. Point-by-point use of frailty scoring could allow for more informed decision making in ICU.
Language	English
Publishing date	2021-01-08
Publishing country	England
Document type	Journal Article
ZDB-ID	2701626-2
ISSN	1751-1437 ; 1751-1437
ISSN (online)	1751-1437
ISSN	1751-1437
DOI	10.1177/1751143720985164
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Article: The value of routine blood-borne virus testing in the intensive care unit.

Yang Tan, Yu / Booth, Malcolm G

Journal of the Intensive Care Society

2021 Volume 23, Issue 3, Page(s) 305–310

Abstract: Background: ICU patients may require renal replacement therapy (RRT). Sharing RRT equipment carries a risk of BBV transmission, which mainly relates to Hepatitis B (HBV), Hepatitis C (HCV) and HIV. Since 2012, all Glasgow Royal Infirmary ICU patients ... ...

Abstract	Background: ICU patients may require renal replacement therapy (RRT). Sharing RRT equipment carries a risk of BBV transmission, which mainly relates to Hepatitis B (HBV), Hepatitis C (HCV) and HIV. Since 2012, all Glasgow Royal Infirmary ICU patients undergo routine BBV screening, with RRT machines allocated for patients with specific BBV statuses. Routine BBV testing is beneficial to both the individual and society. This study aims to determine if routine BBV testing in the ICU contributes to the discovery of undiagnosed BBV infections. Methods: This single-centre retrospective observational study examined prospectively collected clinical data from 1069 ICU admissions. Proportions were compared using a two-proportion z-test and a logistic regression model was carried out to determine if deprivation quintile was independently associated with the seroprevalence of BBVs. Results: The BBV seroprevalence in the cohort studied: 0.45% (HBV), 11.7% (HCV), and 0.91% (HIV). The seroprevalence of HBV in the cohort studied was similar to that of Scotland (p = 0.11), but the seroprevalence of HCV (p < 0.001) and HIV (p = 0.01) were significantly higher than that of Scotland. The relationship between deprivation and BBV seroprevalence was explored for HCV only. The only independent variable associated with a reactive anti-HCV test result was "current or previous illicit drug use" (adjusted odds ratio of 40.2; 95% confidence interval of 21.1-76.4; p < 0.001). Conclusion: This study shows that routine BBV testing in the ICU is useful in discovering new BBV infections. This is the first observational study focusing on the value of routine BBV testing in an ICU setting to our knowledge.
Language	English
Publishing date	2021-04-26
Publishing country	England
Document type	Journal Article
ZDB-ID	2701626-2
ISSN	1751-1437 ; 1751-1437
ISSN (online)	1751-1437
ISSN	1751-1437
DOI	10.1177/17511437211007775
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Article: The FRAIL-FIT study: Frailty's relationship with adverse-event incidence in the longer term, at one year following intensive care unit treatment - A retrospective observational cohort study.

Hewitt, David / Booth, Malcolm G

Journal of the Intensive Care Society

2019 Volume 21, Issue 2, Page(s) 124–133

Abstract: Introduction: Frailty is a syndrome of decreased reserve and heightened vulnerability. Frailty scoring has potential to facilitate more informed decisions in the intensive care unit. To validate this, its relationship with outcomes must be tested ... ...

Abstract	Introduction: Frailty is a syndrome of decreased reserve and heightened vulnerability. Frailty scoring has potential to facilitate more informed decisions in the intensive care unit. To validate this, its relationship with outcomes must be tested extensively. This study aimed to investigate frailty's impact on adverse outcomes after intensive care unit admission, primarily one-year mortality. Methods: This single-centre retrospective observational cohort study examined prospectively collected data from 400 intensive care unit patients. Frailty was assessed using the Clinical Frailty Scale and defined as Clinical Frailty Scale ≥ 5. Unadjusted and adjusted analyses tested the relationships of frailty, covariates and outcomes. Results: Of 400 eligible patients, 111 (27.8%) were frail and 289 (72.3%) were non-frail. Compared to non-frail patients, frail patients were older (62 vs. 56, p < 0.001) and had higher Acute Physiology and Chronic Health Evaluation II scores (22 vs. 19, p < 0.001). Females were more likely to be frail than males (34.1% vs. 22.9% frail, p = 0.018). Frail patients were less likely to survive the intensive care unit (p = 0.03), hospital (p = 0.003) or to one year (p < 0.001). Frailty significantly increased one-year mortality hazards in unadjusted analyses (hazard ratio 1.96; 95% confidence interval 1.41-2.72; p < 0.001) and covariate adjusted analyses (hazard ratio 1.41; 95% confidence interval 1.00-1.98; p = 0.0497). Frail patients had more hospital admissions (p = 0.014) and longer hospital stays within both one year before (p = 0.002) and one year after intensive care unit admission (p = 0.012). Conclusions: Frailty was common and associated with greater age, female gender, higher sickness severity and more healthcare use. Frailty was significantly associated with greater risks of mortality in both unadjusted and adjusted analyses. Frailty scoring is a promising tool which could improve decision making in intensive care.
Language	English
Publishing date	2019-05-14
Publishing country	England
Document type	Journal Article
ZDB-ID	2701626-2
ISSN	1751-1437 ; 1751-1437
ISSN (online)	1751-1437
ISSN	1751-1437
DOI	10.1177/1751143719838212
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Article: Informed consent in emergency research: a contradiction in terms.

Booth, Malcolm G

Science and engineering ethics

2007 Volume 13, Issue 3, Page(s) 351–359

Abstract: Improving the treatment of life threatening emergency illness or disease requires that new or novel therapies be assessed in clinical trials. As most subjects for these trials will be incapacitated there is some controversy about they might best ... ...

Abstract	Improving the treatment of life threatening emergency illness or disease requires that new or novel therapies be assessed in clinical trials. As most subjects for these trials will be incapacitated there is some controversy about they might best protected whilst still allowing research to continue. Recent European and UK clinical trials legislation, which has effectively stopped research into emergency conditions, is discussed. Possible changes to these regulations are proposed.
MeSH term(s)	Emergency Medicine/ethics ; Ethics, Research ; Europe ; Human Experimentation/ethics ; Human Experimentation/legislation & jurisprudence ; Humans ; Informed Consent/ethics ; Public Opinion ; United Kingdom
Language	English
Publishing date	2007-08-03
Publishing country	England
Document type	Journal Article
ZDB-ID	2136491-6
ISSN	1471-5546 ; 1353-3452
ISSN (online)	1471-5546
ISSN	1353-3452
DOI	10.1007/s11948-007-9028-3
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Article ; Online: Ultrasound-guided placement of an anchor wire or injection of methylene blue to aid in the intraoperative localization and excision of peripheral lymph nodes in dogs and cats.

Rossanese, Matteo / Pierini, Alessio / Pisani, Guido / Freeman, Alistair / Burrow, Rachel / Booth, Malcolm / Marchetti, Veronica / Finotello, Riccardo

Journal of the American Veterinary Medical Association

2021 Volume 260, Issue S1, Page(s) S75–S82

Abstract: Objective: To evaluate ultrasound-guided placement of an anchor wire (AW) or injection of methylene blue (MB) to aid in the intraoperative localization of peripheral lymph nodes in dogs and cats.: Animals: 125 dogs and 10 cats with a total of 171 ... ...

Abstract	Objective: To evaluate ultrasound-guided placement of an anchor wire (AW) or injection of methylene blue (MB) to aid in the intraoperative localization of peripheral lymph nodes in dogs and cats. Animals: 125 dogs and 10 cats with a total of 171 lymphadenectomies. Procedures: Medical records of dogs and cats that underwent peripheral lymphadenectomies with or without (N) the AW or MB localization technique were reviewed. Data retrieved included clinical, surgical, and histologic findings. The proportions of successful lymphadenectomies, lymph node characteristics, and complications among the 3 groups were analyzed. Results: 143 (84%) lymph nodes were successfully excised. Lymphadenectomy success was significantly affected by the localization technique, with 94% for group AW, 87% for group MB, and 72% for group N. Lymph node size was smaller in groups AW and MB, compared with group N. Duration of lymphadenectomy was shorter in group AW, compared with groups MB and N, and in group MB, compared with group N. Intra- (7%) and postoperative (10%) complications and final diagnosis did not significantly differ among groups. Conclusions and clinical relevance: Both lymph node localization techniques were highly successful and reduced surgery time, compared with unassisted lymphadenectomy. Specifically, these techniques were effective for localization of normal-sized and nonpalpable lymph nodes and were efficient and practical options for peripheral lymphadenectomies, particularly for those that were small or nonpalpable.
MeSH term(s)	Animals ; Cat Diseases/pathology ; Cats ; Dog Diseases/pathology ; Dog Diseases/surgery ; Dogs ; Lymph Nodes/pathology ; Lymph Nodes/surgery ; Lymphatic Metastasis/pathology ; Methylene Blue ; Sentinel Lymph Node Biopsy/methods ; Sentinel Lymph Node Biopsy/veterinary ; Ultrasonography, Interventional/veterinary
Chemical Substances	Methylene Blue (T42P99266K)
Language	English
Publishing date	2021-12-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	390811-2
ISSN	1943-569X ; 0003-1488
ISSN (online)	1943-569X
ISSN	0003-1488
DOI	10.2460/javma.20.09.0499
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Article: Details behind the dots: How different intensive care units used common and contrasting methods to prevent ventilator associated pneumonia.

Daniel, Malcolm / Booth, Malcolm / Ellis, Kirsteen / Maher, Shaun / Longmate, Andrew

BMJ quality improvement reports

2015 Volume 4, Issue 1

Abstract: Care bundles promote delivery of effective care and improve patient outcomes. The understanding of how to improve delivery of care bundles is incomplete. The Scottish Patient Safety Programme is a national collaborative with the aim of improving the ... ...

Abstract	Care bundles promote delivery of effective care and improve patient outcomes. The understanding of how to improve delivery of care bundles is incomplete. The Scottish Patient Safety Programme is a national collaborative with the aim of improving the delivery of care to patients in acute hospitals in Scotland. Critical care is one of five workstreams in the programme. A programme goal is to reduce incidence of ventilator-associated pneumonia (VAP) to zero or 300 calendar days between events through use of a VAP Prevention bundle. We studied two ICUs participating in this programme. Each ICU had established infection surveillance system prior to the programme starting. Both units had an appreciable incidence of VAP. Initial VAP prevention bundle adherence was low in each ICU (35% and 41%). Comparing time periods before and after 80% bundle VAP prevention bundle adherence was achieved showed a similar reduction in VAP incidence (from 6.9 to 1.0, and from 7.8 to 1.4/1000 ventilation days). When compared each ICU used common and contrasting approaches to accomplish this improvement. We describe the five improvement knowledge systems used to improve bundle adherence to bundle elements in each hospital. The insights gained from these front-line clinical teams can be used as a template for improvement efforts in a variety of other healthcare settings.
Language	English
Publishing date	2015-03-12
Publishing country	England
Document type	Journal Article
ZDB-ID	2677829-4
ISSN	2050-1315
ISSN	2050-1315
DOI	10.1136/bmjquality.u207660.w3069
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Article ; Online: Mortality in intensive care: The impact of bacteremia and the utility of systemic inflammatory response syndrome.

Brooks, Daniel / Smith, Andrew / Young, Douglas / Fulton, Rachael / Booth, Malcolm G

American journal of infection control

2016 Volume 44, Issue 11, Page(s) 1291–1295

Abstract: Background: The purpose of this study was to determine the impact of bacteremia on intensive care unit (ICU) mortality and to develop a bacteremia prediction tool using systemic inflammatory response syndrome (SIRS) criteria.: Methods: Patients ... ...

Abstract	Background: The purpose of this study was to determine the impact of bacteremia on intensive care unit (ICU) mortality and to develop a bacteremia prediction tool using systemic inflammatory response syndrome (SIRS) criteria. Methods: Patients included those aged >18 years who had blood cultures taken in the ICU from January 1, 2011-December 31, 2013. Eligible patients were identified from microbiology records of the Glasgow Royal Infirmary, Scotland. Clinical and outcome data were gathered from ICU records. Patients with clinically significant bacteremia were matched to controls using propensity scores. SIRS criteria were gathered and used to create decision rules to predict the absence of bacteremia. The main outcome was mortality at ICU discharge. The utility of the decision tools was measured using sensitivity and specificity. Results: One hundred patients had a clinically significant positive blood culture and were matched to 100 controls. Patients with bacteremia had higher ICU mortality (odds ratio [OR], 2.35; P = .001) and longer ICU stay (OR, 17.0 vs 7.8 days; P ≤ .001). Of 1,548 blood culture episodes, 1,274 met ≥2 SIRS criteria (106 significant positive cultures and 1,168 negative cultures). There was no association between SIRS criteria and positive blood cultures (P = .11). A decision rule using 3 SIRS criteria had optimal predictive performance (sensitivity, 56%; specificity, 50%) but low accuracy. Conclusions: ICU patients with bacteremia have increased mortality and length of ICU stay. SIRS criteria cannot be used to identify patients at low risk of bacteremia.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bacteremia/diagnosis ; Bacteremia/mortality ; Critical Care ; Decision Support Techniques ; Female ; Humans ; Male ; Middle Aged ; Scotland/epidemiology ; Sensitivity and Specificity ; Systemic Inflammatory Response Syndrome/diagnosis ; Systemic Inflammatory Response Syndrome/pathology ; Young Adult
Language	English
Publishing date	2016-06-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	392362-9
ISSN	1527-3296 ; 0196-6553
ISSN (online)	1527-3296
ISSN	0196-6553
DOI	10.1016/j.ajic.2016.04.214
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Article ; Online: Central line insertion bundle: experiences and challenges in an adult ICU.

McPeake, Joanne / Cantwell, Shelia / Booth, Malcolm G / Daniel, Malcolm

Nursing in critical care

2012 Volume 17, Issue 3, Page(s) 123–129

Abstract: Background: Central venous catheters are used frequently in the intensive care unit (ICU). However, there is an associated morbidity, mortality and cost derived from their infectious and mechanical complications. The Scottish Patient Safety Programme ( ... ...

Abstract	Background: Central venous catheters are used frequently in the intensive care unit (ICU). However, there is an associated morbidity, mortality and cost derived from their infectious and mechanical complications. The Scottish Patient Safety Programme (SPSP) has developed a multi faceted care bundle, with the aim of reducing catheter-related blood stream infections. Aim: This paper aims to identify and describe the experience and challenges in implementing the SPSP central line insertion bundle in one adult ICU, in a large inner city teaching hospital. Interventions: 'Plan-Do-Study-Act' cycles, checklists for insertion and a standardized trolley were adopted to implement the central line insertion bundle in clinical practice. Conclusion/implications: Improving the reliability of the central line insertion bundle has reduced infections. Key steps in the process were setting clear aims and ensuring staff understand the change process and measurement of results. This is fundamental to the success of any quality improvement process.
MeSH term(s)	Adult ; Bacteremia/etiology ; Bacteremia/prevention & control ; Catheter-Related Infections/microbiology ; Catheter-Related Infections/prevention & control ; Catheterization, Central Venous/adverse effects ; Catheterization, Central Venous/methods ; Catheterization, Central Venous/standards ; Checklist/utilization ; Critical Care/methods ; Disinfection/methods ; Documentation/methods ; Efficiency, Organizational ; Evidence-Based Medicine ; Hospitals, Urban ; Humans ; Interprofessional Relations ; Outcome and Process Assessment (Health Care)/methods ; Patient Safety/standards ; Preoperative Care/methods ; Program Development ; Protective Devices ; Quality Improvement/standards ; Reproducibility of Results ; Scotland
Language	English
Publishing date	2012-05
Publishing country	England
Document type	Journal Article
ZDB-ID	2011956-2
ISSN	1478-5153 ; 1362-1017
ISSN (online)	1478-5153
ISSN	1362-1017
DOI	10.1111/j.1478-5153.2012.00491.x
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Article ; Online: Anthrax infection in drug users.

Booth, Malcolm G / Hood, John / Brooks, Timothy J G / Hart, Andrew

Lancet (London, England)

2010 Volume 375, Issue 9723, Page(s) 1345–1346

MeSH term(s)	Anthrax/diagnosis ; Anthrax/epidemiology ; Anthrax/therapy ; Anthrax/transmission ; Heroin Dependence/microbiology ; Humans ; Injections ; Scotland/epidemiology ; Substance Abuse, Intravenous/microbiology
Language	English
Publishing date	2010-04-17
Publishing country	England
Document type	Letter
ZDB-ID	3306-6
ISSN	1474-547X ; 0023-7507 ; 0140-6736
ISSN (online)	1474-547X
ISSN	0023-7507 ; 0140-6736
DOI	10.1016/S0140-6736(10)60573-9
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Article ; Online: Unsuitable for the intensive care unit: what happens next?

McKeown, Alistair / Booth, Malcolm G / Strachan, Laura / Calder, Alyson / Keeley, Paul W

Journal of palliative medicine

2011 Volume 14, Issue 8, Page(s) 899–903

Abstract: Context: In recent years numbers of referrals to intensive care units (ICU) throughout the United Kingdom has been increasing. A number of referrals to the ICU are considered to be inappropriate for a variety of reasons, including those patients who are ...

Abstract	Context: In recent years numbers of referrals to intensive care units (ICU) throughout the United Kingdom has been increasing. A number of referrals to the ICU are considered to be inappropriate for a variety of reasons, including those patients who are felt to be either too well for admission, or have comorbidities making survival unlikely and aggressive interventions unsuitable. Objectives: This study aims to examine the outcomes and symptoms in those patients who are unsuitable for admission to ICU. By looking at this population we hope to ascertain if this is an at-risk group in terms of symptomatic or care needs at the end of life. Methods: This was as an observational prospective study with the sample population identified via the ICU referrals process. All patients referred to the ICU for admission but deemed unsuitable were recorded and followed up by researchers on the wards. Results: Fifty patients were identified between January and April 2009. Outcomes at one week were split between "death" (34%), "discharge" (24%), and ongoing illness/rehabilitation (40%). Levels of comorbidity were high, with a corresponding prevalence of severe breathlessness in all outcome groups. Conclusion: The results suggest there are small numbers of patients with uncontrolled symptoms who could benefit from specialist input from the palliative care team. The identification of the imminently dying should facilitate appropriate communication of this by clinical staff and allow the relevant social, psychological, and spiritual preparations for death that are the hallmark of good care of the dying.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Decision Making ; Female ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Patient Admission/standards ; Prospective Studies ; Referral and Consultation ; Young Adult
Language	English
Publishing date	2011-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	1427361-5
ISSN	1557-7740 ; 1096-6218
ISSN (online)	1557-7740
ISSN	1096-6218
DOI	10.1089/jpm.2011.0064
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