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  1. Article ; Online: Assessment of knowledge regarding tracheostomy care and management of early complications among healthcare professionals.

    Khanum, Tooba / Zia, Sadaf / Khan, Tahseer / Kamal, Saima / Khoso, Muhammad Nasir / Alvi, Javeria / Ali, Arif

    Brazilian journal of otorhinolaryngology

    2021  Volume 88, Issue 2, Page(s) 251–256

    Abstract: Introduction: Tracheostomy is commonly performed surgical procedure in ENT practice. Postoperative care is the most important aspect for achieving good patient outcomes. Unavailability of standard guidelines on tracheostomy management and inadequate ... ...

    Abstract Introduction: Tracheostomy is commonly performed surgical procedure in ENT practice. Postoperative care is the most important aspect for achieving good patient outcomes. Unavailability of standard guidelines on tracheostomy management and inadequate training can make this basic practice complex. The nursing staff and doctors play a very important role in bedside management, both in the ward and in the intensive care unit (ICU) setup. Therefore, it is crucial that all healthcare providers directly involved in providing postoperative care to such patients can do this efficiently.
    Objectives: The objective of this study is to assess the knowledge regarding identification and management of tracheostomy-related emergencies and early complications among healthcare professionals so as to improve practice and further standardization.
    Methods: Cross-sectional observational study included two hundred and fifty-four doctors and nurses from four large tertiary care hospitals. The questions used were simple and straightforward regarding tracheostomy suctioning, cuff care, cuff management, tube blockage, and feeding management in patients with tracheostomy.
    Results: Based on evidence from our study, knowledge level regarding tracheostomy care ranges from 48% to 52% with knowledge scores above 50% being considered satisfactory. Significant gaps in knowledge exist in various aspects of tracheostomy care and management among healthcare professionals.
    Conclusion: Our findings demonstrated an adequate knowledge level among health care professionals ranging from 48% to 52% with knowledge scores above 50% being considered satisfactory and revealed that gaps in knowledge still exist in various aspects of tracheostomy care and management.
    MeSH term(s) Cross-Sectional Studies ; Delivery of Health Care ; Health Personnel ; Humans ; Intensive Care Units ; Tracheostomy/adverse effects
    Language English
    Publishing date 2021-08-06
    Publishing country Brazil
    Document type Journal Article ; Observational Study
    ZDB-ID 2428110-4
    ISSN 1808-8686 ; 1808-8694
    ISSN (online) 1808-8686
    ISSN 1808-8694
    DOI 10.1016/j.bjorl.2021.06.011
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Intravenous Vitamin C for Patients Hospitalized With COVID-19: Two Harmonized Randomized Clinical Trials.

    Adhikari, Neill K J / Hashmi, Madiha / Tirupakuzhi Vijayaraghavan, Bharath Kumar / Haniffa, Rashan / Beane, Abi / Webb, Steve A / Angus, Derek C / Gordon, Anthony C / Cook, Deborah J / Guyatt, Gordon H / Berry, Lindsay R / Lorenzi, Elizabeth / Mouncey, Paul R / Au, Carly / Pinto, Ruxandra / Ménard, Julie / Sprague, Sheila / Masse, Marie-Hélène / Huang, David T /
    Heyland, Daren K / Nichol, Alistair D / McArthur, Colin J / de Man, Angelique / Al-Beidh, Farah / Annane, Djillali / Anstey, Matthew / Arabi, Yaseen M / Battista, Marie-Claude / Berry, Scott / Bhimani, Zahra / Bonten, Marc J M / Bradbury, Charlotte A / Brant, Emily B / Brunkhorst, Frank M / Burrell, Aidan / Buxton, Meredith / Cecconi, Maurizio / Cheng, Allen C / Cohen, Dian / Cove, Matthew E / Day, Andrew G / Derde, Lennie P G / Detry, Michelle A / Estcourt, Lise J / Fagbodun, Elizabeth O / Fitzgerald, Mark / Goossens, Herman / Green, Cameron / Higgins, Alisa M / Hills, Thomas E / Ichihara, Nao / Jayakumar, Devachandran / Kanji, Salmaan / Khoso, Muhammad Nasir / Lawler, Patrick R / Lewis, Roger J / Litton, Edward / Marshall, John C / McAuley, Daniel F / McGlothlin, Anna / McGuinness, Shay P / McQuilten, Zoe K / McVerry, Bryan J / Murthy, Srinivas / Parke, Rachael L / Parker, Jane C / Reyes, Luis Felipe / Rowan, Kathryn M / Saito, Hiroki / Salahuddin, Nawal / Santos, Marlene S / Saunders, Christina T / Seymour, Christopher W / Shankar-Hari, Manu / Tolppa, Timo / Trapani, Tony / Turgeon, Alexis F / Turner, Anne M / Udy, Andrew A / van de Veerdonk, Frank L / Zarychanski, Ryan / Lamontagne, François

    JAMA

    2023  Volume 330, Issue 18, Page(s) 1745–1759

    Abstract: Importance: The efficacy of vitamin C for hospitalized patients with COVID-19 is uncertain.: Objective: To determine whether vitamin C improves outcomes for patients with COVID-19.: Design, setting, and participants: Two prospectively harmonized ... ...

    Abstract Importance: The efficacy of vitamin C for hospitalized patients with COVID-19 is uncertain.
    Objective: To determine whether vitamin C improves outcomes for patients with COVID-19.
    Design, setting, and participants: Two prospectively harmonized randomized clinical trials enrolled critically ill patients receiving organ support in intensive care units (90 sites) and patients who were not critically ill (40 sites) between July 23, 2020, and July 15, 2022, on 4 continents.
    Interventions: Patients were randomized to receive vitamin C administered intravenously or control (placebo or no vitamin C) every 6 hours for 96 hours (maximum of 16 doses).
    Main outcomes and measures: The primary outcome was a composite of organ support-free days defined as days alive and free of respiratory and cardiovascular organ support in the intensive care unit up to day 21 and survival to hospital discharge. Values ranged from -1 organ support-free days for patients experiencing in-hospital death to 22 organ support-free days for those who survived without needing organ support. The primary analysis used a bayesian cumulative logistic model. An odds ratio (OR) greater than 1 represented efficacy (improved survival, more organ support-free days, or both), an OR less than 1 represented harm, and an OR less than 1.2 represented futility.
    Results: Enrollment was terminated after statistical triggers for harm and futility were met. The trials had primary outcome data for 1568 critically ill patients (1037 in the vitamin C group and 531 in the control group; median age, 60 years [IQR, 50-70 years]; 35.9% were female) and 1022 patients who were not critically ill (456 in the vitamin C group and 566 in the control group; median age, 62 years [IQR, 51-72 years]; 39.6% were female). Among critically ill patients, the median number of organ support-free days was 7 (IQR, -1 to 17 days) for the vitamin C group vs 10 (IQR, -1 to 17 days) for the control group (adjusted proportional OR, 0.88 [95% credible interval {CrI}, 0.73 to 1.06]) and the posterior probabilities were 8.6% (efficacy), 91.4% (harm), and 99.9% (futility). Among patients who were not critically ill, the median number of organ support-free days was 22 (IQR, 18 to 22 days) for the vitamin C group vs 22 (IQR, 21 to 22 days) for the control group (adjusted proportional OR, 0.80 [95% CrI, 0.60 to 1.01]) and the posterior probabilities were 2.9% (efficacy), 97.1% (harm), and greater than 99.9% (futility). Among critically ill patients, survival to hospital discharge was 61.9% (642/1037) for the vitamin C group vs 64.6% (343/531) for the control group (adjusted OR, 0.92 [95% CrI, 0.73 to 1.17]) and the posterior probability was 24.0% for efficacy. Among patients who were not critically ill, survival to hospital discharge was 85.1% (388/456) for the vitamin C group vs 86.6% (490/566) for the control group (adjusted OR, 0.86 [95% CrI, 0.61 to 1.17]) and the posterior probability was 17.8% for efficacy.
    Conclusions and relevance: In hospitalized patients with COVID-19, vitamin C had low probability of improving the primary composite outcome of organ support-free days and hospital survival.
    Trial registration: ClinicalTrials.gov Identifiers: NCT04401150 (LOVIT-COVID) and NCT02735707 (REMAP-CAP).
    MeSH term(s) Humans ; Female ; Middle Aged ; Male ; COVID-19 ; Ascorbic Acid/therapeutic use ; Critical Illness/therapy ; Critical Illness/mortality ; Hospital Mortality ; Bayes Theorem ; Randomized Controlled Trials as Topic ; Vitamins/therapeutic use ; Sepsis/drug therapy
    Chemical Substances Ascorbic Acid (PQ6CK8PD0R) ; Vitamins
    Language English
    Publishing date 2023-10-26
    Publishing country United States
    Document type Journal Article ; Comment
    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.2023.21407
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: PRICE COVID19 Data Report December 2021 Pakistan Registry of Intensive Care

    farooq, Ahmed / Arsalan, Rahatullah / Aisha, Mufti Kulsoom / Muhammad, Asim / Hayat, Muhammad / Altaf, Aneela / Taqi, Arshad / Kumar, Ashok / Rehman, Attaur / Haidri, Fakhir Raza / Hussain, Iqbal / Chaudhry, Mobin / Rehman, Safdar / Malik, Irfan / Saleem, Jodat / Ali, Liaquat / Zia, Muhammad Ashraf / Khan, Maria Ali / Sheikh, Mohiuddin /
    Ashraf, Muhammad Sheharyar / Rana, Muhammad Asim / Khoso, Muhammad Nasir / Rizvi, Saadiya / Shaikh, Naseem Ali / Salahuddin, Nawal / Khan, Qurat-ul-Ain / Sikander, Rana Imran / Ali, Syed Muneeb / Khan, Rashid Nasim / Babar, Sairah / Beane, Abigail / Dondorp, Arjen M / Kodippily, Chamira / Priyadarshani, Dilanthi / Udayanga, Ishara / Ishani, Pramodya / Darshana, Sri / Rashan, Thalha / Haniffa, Rashan / Murthy, Srinivas / Hashmi, Madiha

    medRxiv

    Abstract: Abstract Pakistan Registry of Intensive Care (PRICE) is a platform that has enabled standardized COVID-19 clinical data collection based on ISARIC/WHO Clinical Characterization Protocol. The near real-time data platform includes epidemiology, severity of ...

    Abstract Abstract Pakistan Registry of Intensive Care (PRICE) is a platform that has enabled standardized COVID-19 clinical data collection based on ISARIC/WHO Clinical Characterization Protocol. The near real-time data platform includes epidemiology, severity of illness, microbiology, treatment and outcomes of patients admitted with suspected or laboratory confirmed COVID19 infection to 67 intensive care and high dependency units across the country. Data has been extracted and analysed at regular intervals to inform stakeholders and improve care practices. This is our 28th report including all patients with suspected or confirmed COVID-19 from 26th March 2020 to 26th December 2021. Key findings from 8624 patients who met eligibility criteria, are as follows: ● Median age of 60 years (IQR 50-70). ● The most common symptoms were shortness of breath (n = 6428, 77.8%), fever (n = 6091, 73.8%), and Cough (n = 3354, 38.9%) ● The most common comorbidity was hypertension followed by diabetes. ● During the course of illness 2804 (32.6%) patients received non-invasive ventilation, whereas 2474 (28.8%) patients had mechanical ventilation as their highest organ support. In addition, 2246 (26.1%) patients needed haemodynamic support and 1249 (14.7%) patients required renal replacement therapy as their highest organ support. ● Median APACHE II score was 18 ● Overall mortality at ICU discharge was 39.2% ● Increasing age and requirement for invasive mechanical ventilation were independent risk factors for mortality increased the risk of death
    Keywords covid19
    Language English
    Publishing date 2022-01-23
    Publisher Cold Spring Harbor Laboratory Press
    Document type Article ; Online
    DOI 10.1101/2022.01.20.22269202
    Database COVID19

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