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Bilbao, Spain

Al-Qahtani S.,King Saud bin Abdulaziz University for Health Sciences | Al-Dorzi H.M.,King Saud bin Abdulaziz University for Health Sciences | Tamim H.M.,King Abdullah International Medical Research Center | Hussain S.,King Saud bin Abdulaziz University for Health Sciences | And 4 more authors.
Critical Care Medicine | Year: 2013

OBJECTIVE: The effectiveness of rapid response teams remains controversial. However, many studied rapid response teams were not intensivist-led, had limited involvement beyond the initial activations, and did not provide post-ICU follow-up. The objective of this study was to examine the impact of implementing an intensivist-led multidisciplinary extended rapid response team on hospital-wide cardiopulmonary arrests and mortality. DESIGN: This was a pre-post rapid response team implementation study. SETTING: Tertiary care academic center in Saudi Arabia. PATIENTS: A total of 98,391 patients in the 2-yr pre-rapid response team and 157,804 patients in the 3-yr post-rapid response team implementation were evaluated. INTERVENTION: The rapid response team was activated by any health care provider based on pre-defined criteria and a four-member intensivist-led multidisciplinary rapid response team responded to provide the necessary management and disposition. The rapid response team function was extended to provide follow-up until clinical stabilization. In addition, the rapid response team provided a mandatory post-ICU follow-up for a minimum of 48 hrs. MEASUREMENTS AND MAIN RESULTS: The primary outcomes were cardiopulmonary arrests and mortality. After rapid response team implementation, non-ICU cardiopulmonary arrests decreased from 1.4 to 0.9 per 1,000 hospital admissions (relative risk, 0.68; 95% confidence interval, 0.53-0.86; p = 0.001) and total hospital mortality decreased from 22.5 to 20.2 per 1,000 hospital admissions (relative risk, 0.90; 95% confidence interval, 0.85-0.95; p < 0.0001). For patients who required admission to the ICU, there was a significant reduction in the Acute Physiology and Chronic Health Evaluation II scores after rapid response team implementation from 29.3 ± 9.3 to 26.9 ± 8.5 (p < 0.0001), with reduction in hospital mortality from 57.4% to 48.7% (relative risk, 0.85; 95% confidence interval, 0.78-0.92; p < 0.0001). Do-not-resuscitate orders for ward referrals increased from 0.7 to 1.7 per 1,000 hospital admissions (relative risk, 2.58; 95% confidence interval, 1.95-3.42; p < 0.0001) and decreased for patients admitted to ICU from the wards from 30.5% to 26.1% (relative risk, 0.86; 95% confidence interval, 0.74-0.99; p = 0.03). Additionally, ICU readmission rate decreased from 18.6 to 14.3 per 100 ICU alive discharges (relative risk, 0.77; 95% confidence interval, 0.66-0.89; p < 0.0001) and post-ICU hospital mortality from 18.2% to 14.8% (relative risk, 0.85; 95% confidence interval, 0.72-0.99; p = 0.04). CONCLUSION: The implementation of rapid response team was effective in reducing cardiopulmonary arrests and total hospital mortality for ward patients, improving the outcomes of patients who needed ICU admission and reduced readmissions and mortality of patients who were discharged from the ICU. Copyright © 2013 by the Society of Critical Care Medicine and Lippincott Williams &Wilkins.

Taitz J.,Medical Services
Healthcare Papers | Year: 2013

In their paper "Front-Line Ownership: Generating a Cure Mindset for Patient Safety," Zimmerman and her colleagues introduce us to the novel concept of FLO - front-line ownership - within the quality and safety arena. Based on their 18-month study of nosocomial infections within five Canadian hospitals, the authors highlight the benefits of allowing front-line staff to own and manage patient safety problems as opposed to imposing programs on them that were created by leaders who did not consult them in developing appropriate solutions. Their paper highlights many of the benefits of FLO, particularly around social networking, interdisciplinary team work and clinician engagement. But how does FLO measure up in the context of other more technical methods of managing adverse events within healthcare organizations? What are the benefits and weakness of FLO? Is FLO consistent with external accreditation requirements and the drive for greater standardization? Will its necessarily longer time frame consign it to a few small-scale research projects or is there real potential to use FLO techniques for other quality and safety problems beyond nosocomial infections?

Chancellor A.M.,Medical Services
Practical Neurology | Year: 2013

A sporadic seasonal neurotoxic food poisoning, unique to northern parts of New Zealand, especially The Bay of Plenty, has recurred-with implications for our primary produce industry, as well as human health.

Manu P.,Medical Services
European Journal of Internal Medicine | Year: 2010

Background: In the obese, the metabolic syndrome (MetS) is assumed to reflect insulin resistance. Objective: To determine the predictors of insulin resistance in obese subjects with MetS. Design: We used the 90th percentile of the homeostasis model assessment (HOMA) to define insulin resistance in 4958 nondiabetic adults evaluated in the National Health and Nutrition Examination Surveys, 1999-2004, and compared the 373 obese subjects who were insulin-resistant (HOMA 9.52 ± 5.73) to a control group of 373 obese who had the highest sensitivity to insulin (HOMA 1.79 ± 0.44). Measurements: MetS was present in 312 (83.6%) obese with insulin resistance and in 156 (41.8%) obese from the insulin-sensitive control group. Demographic, metabolic, and lifestyle variables were analyzed with logistic regression. Results: In a logistic model of insulin resistance given the presence of MetS, the significant predictors were triglycerides (P = 0.0021), body mass index (P = 0.0096), HDL-cholesterol (P = 0.0098), age (P = 0.0242) and smoking (P = 0.0366). Limitations: Cross-sectional design prevents elucidation of causality for the association between insulin resistance and MetS. Conclusions: Insulin resistance is not an obligatory correlate of MetS in the obese. Its likelihood can be predicted by cigarette smoking and by the severity of obesity and dyslipidemia. © 2010 European Federation of Internal Medicine.

Assefa Y.,Medical Services | Van Damme W.,Institute of Tropical Medicine | Hermann K.,Institute of Tropical Medicine
Current Opinion in HIV and AIDS | Year: 2010

Purpose of view: To illustrate and critically assess what is currently being published on the human resources for health dimension of antiretroviral therapy (ART) delivery models. Recent findings: The use of human resources for health can have an effect on two crucial aspects of successful ART programmes, namely the scale-up capacity and the long-term retention in care. Task shifting as the delegation of tasks from higher qualified to lower qualified cadres has become a widespread practice in ART delivery models in low-income countries in recent years. It is increasingly shown to effectively reduce the workload for scarce medical doctors without compromising the quality of care. At the same time, it becomes clear that task shifting can only be successful when accompanied by intensive training, supervision and support from existing health system structures. Summary: Although a number of recent publications have focussed on task shifting in ART delivery models, there is a lack of accessible information on the link between task shifting and patient outcomes. Current ART delivery models do not focus sufficiently on retention in care as arguably one of the most important issues for the long-term success of ART programmes. There is a need for context-specific re-designing of current ART delivery models in order to increase access to ART and improve long-term retention. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.

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