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  1. Article ; Online: Behind the Mask of Intensive Care Unit Healthcare Workers.

    Wozniak, Hannah / Douflé, Ghislaine / Hamilton, Mika / Santangelo, Erminio / Urner, Martin / Parotto, Matteo / Herridge, Margaret / Dragoi, Laura

    American journal of respiratory and critical care medicine

    2024  

    Language English
    Publishing date 2024-03-14
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1180953-x
    ISSN 1535-4970 ; 0003-0805 ; 1073-449X
    ISSN (online) 1535-4970
    ISSN 0003-0805 ; 1073-449X
    DOI 10.1164/rccm.202402-0350VP
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Moral Orientation, Moral Decision-Making, and Moral Distress Among Critical Care Physicians: A Qualitative Study.

    Piquette, Dominique / Burns, Karen E A / Carnevale, Franco / Sarti, Aimée J / Hamilton, Mika / Dodek, Peter M

    Critical care explorations

    2023  Volume 5, Issue 3, Page(s) e0879

    Abstract: Moral distress is common among critical care physicians and can impact negatively healthcare individuals and institutions. Better understanding inter-individual variability in moral distress is needed to inform future wellness interventions.: ... ...

    Abstract Moral distress is common among critical care physicians and can impact negatively healthcare individuals and institutions. Better understanding inter-individual variability in moral distress is needed to inform future wellness interventions.
    Objectives: To explore when and how critical care physicians experience moral distress in the workplace and its consequences, how physicians' professional interactions with colleagues affected their perceived level of moral distress, and in which circumstances professional rewards were experienced and mitigated moral distress.
    Design: Interview-based qualitative study using inductive thematic analysis.
    Setting and participants: Twenty critical care physicians practicing in Canadian ICUs who expressed interest in participating in a semi-structured interview after completion of a national, cross-sectional survey of moral distress in ICU physicians.
    Results: Study participants described different ways to perceive and resolve morally challenging clinical situations, which were grouped into four clinical moral orientations: virtuous, resigned, deferring, and empathic. Moral orientations resulted from unique combinations of strength of personal moral beliefs and perceived power over moral clinical decision-making, which led to different rationales for moral decision-making. Study findings illustrate how sociocultural, legal, and clinical contexts influenced individual physicians' moral orientation and how moral orientation altered perceived moral distress and moral satisfaction. The degree of dissonance between individual moral orientations within care team determined, in part, the quantity of "negative judgments" and/or "social support" that physicians obtained from their colleagues. The levels of moral distress, moral satisfaction, social judgment, and social support ultimately affected the type and severity of the negative consequences experienced by ICU physicians.
    Conclusions and relevance: An expanded understanding of moral orientations provides an additional tool to address the problem of moral distress in the critical care setting. Diversity in moral orientations may explain, in part, the variability in moral distress levels among clinicians and likely contributes to interpersonal conflicts in the ICU setting. Additional investigations on different moral orientations in various clinical environments are much needed to inform the design of effective systemic and institutional interventions that address healthcare professionals' moral distress and mitigate its negative consequences.
    Language English
    Publishing date 2023-03-06
    Publishing country United States
    Document type Journal Article
    ISSN 2639-8028
    ISSN (online) 2639-8028
    DOI 10.1097/CCE.0000000000000879
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  3. Article ; Online: Moral Distress in Canadian Intensivists: A Complex Interplay of Contextual and Relational Factors.

    Piquette, Dominique / Burns, Karen E A / Carnevale, Franco / Sarti, Aimée J / Hamilton, Mika / Dodek, Peter M

    Chest

    2022  Volume 163, Issue 5, Page(s) 1101–1108

    Abstract: Background: Health care professionals experience moral distress when they cannot act based on their moral beliefs because of perceived constraints. Moral distress prevalence is high among critical care (ICU) clinicians, but varies significantly between ... ...

    Abstract Background: Health care professionals experience moral distress when they cannot act based on their moral beliefs because of perceived constraints. Moral distress prevalence is high among critical care (ICU) clinicians, but varies significantly between and within professions.
    Research question: How can the interindividual variability in moral distress of Canadian ICU physicians be explained to inform future system-based interventions?
    Study design and methods: We analyzed 135 free-text comments written by 83 of the 225 ICU physicians who participated in an online cross-sectional wellness survey. An interdisciplinary team of five investigators completed the thematic analysis of anonymized survey comments according to published guidelines.
    Results: Physicians identified contextual and relational factors that contributed to moral distress and work-related stress. Combined sources of distress created high work-related demands that were not always matched by equally high resources or mitigated by work-related rewards. An imbalance between demands and rewards could lead to undesirable individual and collective consequences.
    Interpretation: Moral distress is experienced variably by ICU physicians and is linked to contextual and relational factors. Future studies should evaluate modifiable factors such as team interactions and the role of professional rewards as mitigators of distress to bring new insights into strategies to improve ICU clinician wellness and patient care.
    MeSH term(s) Humans ; Canada ; Cross-Sectional Studies ; Critical Care ; Physicians ; Morals ; Surveys and Questionnaires ; Stress, Psychological/etiology ; Attitude of Health Personnel
    Language English
    Publishing date 2022-12-24
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1032552-9
    ISSN 1931-3543 ; 0012-3692
    ISSN (online) 1931-3543
    ISSN 0012-3692
    DOI 10.1016/j.chest.2022.12.022
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  4. Article ; Online: Dexmedetomidine to Reduce Intubation Time in Patients With Agitated Delirium.

    Hamilton, Mika / Amaral, Andre

    JAMA

    2016  Volume 316, Issue 7, Page(s) 772–773

    MeSH term(s) Delirium ; Dexmedetomidine/therapeutic use ; Humans ; Hypnotics and Sedatives/therapeutic use ; Intubation ; Psychomotor Agitation/drug therapy
    Chemical Substances Hypnotics and Sedatives ; Dexmedetomidine (67VB76HONO)
    Language English
    Publishing date 2016-08-16
    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.2016.8599
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  5. Article ; Online: Parental calculation of pediatric paracetamol dose: a randomized trial comparing the Parental Analgesia Slide with product information leaflets.

    Hixson, Richard / Franke, Uwe / Mittal, Rohit / Hamilton, Mika

    Paediatric anaesthesia

    2010  Volume 20, Issue 7, Page(s) 612–619

    Abstract: Objectives: To compare the ability of parents to calculate and demonstrate the correct paracetamol (acetaminophen) dose, interval, and frequency for their child when using either product information leaflets or the Parental Analgesia Slide.: ... ...

    Abstract Objectives: To compare the ability of parents to calculate and demonstrate the correct paracetamol (acetaminophen) dose, interval, and frequency for their child when using either product information leaflets or the Parental Analgesia Slide.
    Background: Prescribing information provided with over-the-counter medication may be a source of confusion for parents delivering analgesics to children at home. Accurate administration is essential to ensure safe and effective treatment of children's pain or fever. The Parental Analgesia Slide is a new device developed with the objective of improving parental dosing accuracy.
    Methods: In this prospective, randomized study, 160 parents accompanying children aged between one and 13 years old were randomly allocated to complete a paracetamol dose calculation and administration questionnaire using one of two sources of prescribing information. Absolute percentage dose error and the number of correct dosage intervals, frequencies, and demonstrated drug volumes were compared.
    Results: Use of the Parental Analgesia Slide resulted in a reduction in the absolute percentage dose error from a median of 33.3 to 0% (P < 0.001) and an increase in the number of correct dosage intervals and frequencies (59/80 to 70/80, P = 0.046). There was no difference in the number of correctly demonstrated drug volumes (P = 0.082) despite a greater number of parents opting to use an oral syringe rather than a dosing spoon when using the Slide (24/80 to 44/80, P = 0.002).
    Conclusions: The Parental Analgesia Slide resulted in improved parental ability to calculate paracetamol dose, interval, and frequency while preserving their ability to demonstrate an accurate drug volume.
    MeSH term(s) Acetaminophen/administration & dosage ; Adolescent ; Analgesics, Non-Narcotic/administration & dosage ; Child ; Child, Preschool ; Drug Administration Schedule ; Drug Labeling/methods ; Humans ; Infant ; Medication Errors/prevention & control ; Parents ; Prospective Studies ; Surveys and Questionnaires
    Chemical Substances Analgesics, Non-Narcotic ; Acetaminophen (362O9ITL9D)
    Language English
    Publishing date 2010-07
    Publishing country France
    Document type Journal Article ; Randomized Controlled Trial
    ZDB-ID 1086049-6
    ISSN 1460-9592 ; 1155-5645
    ISSN (online) 1460-9592
    ISSN 1155-5645
    DOI 10.1111/j.1460-9592.2010.03332.x
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Determinants of Depressive Symptoms at 1 Year Following ICU Discharge in Survivors of ≥ 7 Days of Mechanical Ventilation: Results From the RECOVER Program, a Secondary Analysis of a Prospective Multicenter Cohort Study.

    Hamilton, Mika / Tomlinson, George / Chu, Leslie / Robles, Priscila / Matte, Andrea / Burns, Stacey / Thomas, Claire / Lamontagne, Francois / Adhikari, Neill K J / Ferguson, Niall / Friedrich, Jan O / Rudkowski, Jill C / Skrobik, Yoanna / Meggison, Hilary / Cameron, Jill / Herridge, Margaret

    Chest

    2019  Volume 156, Issue 3, Page(s) 466–476

    Abstract: Background: Moderate to severe depressive symptoms occur in up to one-third of patients at 1 year following ICU discharge, negatively affecting patient outcomes. This study evaluated patient and caregiver factors associated with the development of these ...

    Abstract Background: Moderate to severe depressive symptoms occur in up to one-third of patients at 1 year following ICU discharge, negatively affecting patient outcomes. This study evaluated patient and caregiver factors associated with the development of these symptoms.
    Methods: This study used the Rehabilitation and Recovery in Patients after Critical Illness and Their Family Caregivers (RECOVER) Program (Phase 1) cohort of 391 patients from 10 medical/surgical university-affiliated ICUs across Canada. We determined the association between patient depressive symptoms (captured by using the Beck Depression Inventory II [BDI-II]), patient characteristics (age, sex, socioeconomic status, Charlson score, and ICU length of stay [LOS]), functional independence measure (FIM) motor subscale score, and caregiver characteristics (Caregiver Assistance Scale and Center for Epidemiologic Studies-Depression Scale) by using linear mixed models at time points 3, 6, and 12 months.
    Results: BDI-II data were available for 246 patients. Median age at ICU admission was 56 years (interquartile range, 45-65 years), 143 (58%) were male, and median ICU LOS was 19 days (interquartile range, 13-32 days). During the 12-month follow-up, 67 of 246 (27.2%) patients had a BDI-II score ≥ 20, indicating moderate to severe depressive symptoms. Mixed models showed worse depressive symptoms in patients with lower FIM motor subscale scores (1.1 BDI-II points per 10 FIM points), lower income status (by 3.7 BDI-II points; P = .007), and incomplete secondary education (by 3.8 BDI-II points; P = .009); a curvilinear relation with age (P = .001) was also reported, with highest BDI-II at ages 45 to 50 years. No associations were found between patient BDI-II and comorbidities (P = .92), sex (P = .25), ICU LOS (P = .51), or caregiver variables (Caregiver Assistance Scale [P = .28] and Center for Epidemiologic Studies Depression Scale [P = .74]).
    Conclusions: Increased functional dependence, lower income, and lower education are associated with increased severity of post-ICU depressive symptoms, whereas age has a curvilinear relation with symptom severity. Knowledge of risk factors may inform surveillance and targeted mental health follow-up. Early mobilization and rehabilitation aiming to improve function may serve to modify mood disorders.
    MeSH term(s) Aged ; Canada ; Caregivers ; Cohort Studies ; Critical Care ; Depression/diagnosis ; Depression/epidemiology ; Female ; Humans ; Length of Stay ; Male ; Middle Aged ; Motor Activity ; Patient Discharge ; Recovery of Function ; Respiration, Artificial ; Risk Factors ; Socioeconomic Factors ; Time Factors
    Language English
    Publishing date 2019-05-15
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1032552-9
    ISSN 1931-3543 ; 0012-3692
    ISSN (online) 1931-3543
    ISSN 0012-3692
    DOI 10.1016/j.chest.2019.04.104
    Database MEDical Literature Analysis and Retrieval System OnLINE

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