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Identifying barriers and facilitators to therapeutic cuddling in the paediatric intensive care unit: A survey guided by the theoretical domains framework 识别障碍和促进治疗拥抱在儿科重症监护室:由理论领域框架指导的调查。
IF 2.7 3区 医学 Q2 CRITICAL CARE MEDICINE Pub Date : 2025-11-01 Epub Date: 2025-10-01 DOI: 10.1016/j.aucc.2025.101440
Laurie A. Lee NP, PhD , Karla D. Krewulak PhD , Elaine Gilfoyle MD, MMEd, FRCPC , Karen Choong MB, MSc, FRCPC , Katie O'Hearn MSc , Mark Todd HBSc, RRT , Jennifer R. Foster MD, FRCPC , Kathryn A. Birnie RPsych, PhD , Christopher James Doig MD, MSc, MA , Nicole Letourneau RN, PhD , Kirsten M. Fiest PhD , the Canadian Critical Care Trials Group

Objective

The objective of this study was to describe barriers and facilitators to paediatric intensive care unit (PICU) therapeutic cuddling (TC) perceived by healthcare professionals (HCPs).

Background

TC is a potential intervention to prevent/manage pain, agitation, delirium, and analgosedation exposure in PICUs. However, it is not widely practiced. Given the complexity of TC in critically ill children, PICU HCPs’ perspectives of barriers and facilitators are essential to inform implementation and evaluation.

Methods

A cross-sectional survey, guided by the Theoretical Domains Framework, was administered to PICU HCPs between December 2023 and July 2024. Items were asked based on age groups of patients (<1, 1–2, 3–4, 5–8, 9–12, and >12 years) and severity of illness. Nominal data were summarised using frequencies (percentage) based on the number of responses received per item. Subgroup analyses were conducted for professions with five or more respondents for items related to professional role and TC. Free-text responses were analysed utilising inductive and deductive content analysis.

Results

Respondents (n = 228) were predominantly women (88.6%), nurses (60.1%), physicians (17.1%), or respiratory therapists (11.8%). Most respondents (67.9%–86.4% depending on patient age group) agreed it was possible to provide TC to all PICU patients. However, respondents reported rarely (4.3%–52.6%) or never (0.5%–35.6%) observing/participating in TC, depending on child age group, with a larger proportion reporting rarely or never as age group increased. Potential determinants affecting the implementation of TC in PICUs were identified for all 14 domains of the Theoretical Domains Framework. Concerns about patient safety, staffing, and lack of supportive unit culture were identified as key barriers. Family engagement and partnership and beliefs about positive consequences were key facilitators.

Conclusions

Most PICU HCPs believe that TC can be implemented for all critically ill children. Important barriers include concerns about safety, staffing, and lack of a cuddling-supportive culture. Leveraging patient and family engagement is a key facilitator to support implementation of this intervention.
目的:本研究的目的是描述卫生保健专业人员(HCPs)对儿科重症监护病房(PICU)治疗性拥抱(TC)的障碍和促进因素。背景:TC是预防/控制picu中疼痛、躁动、谵妄和镇静暴露的潜在干预措施。然而,它并没有被广泛实践。鉴于危重儿童TC的复杂性,PICU HCPs对障碍和促进因素的看法对实施和评估至关重要。方法:在理论领域框架的指导下,于2023年12月至2024年7月对PICU HCPs进行横断面调查。问题是根据患者的年龄组(12岁)和疾病的严重程度提出的。根据每个项目收到的回复数量,使用频率(百分比)对标称数据进行汇总。对于有5名或更多受访者的专业,进行了与专业角色和TC相关的项目的亚组分析。利用归纳和演绎内容分析分析自由文本响应。结果:受访者(n = 228)主要是女性(88.6%),护士(60.1%),医生(17.1%)或呼吸治疗师(11.8%)。大多数受访者(67.9%-86.4%,取决于患者年龄组)同意为所有PICU患者提供TC是可能的。然而,受访者报告很少(4.3%-52.6%)或从未(0.5%-35.6%)观察/参与TC,这取决于儿童年龄组,随着年龄组的增加,报告很少或从未的比例更大。在理论领域框架的所有14个领域中,确定了影响picu中TC实施的潜在决定因素。对患者安全、人员配备和缺乏支持性单位文化的担忧被认为是主要障碍。家庭参与和伙伴关系以及对积极后果的信念是关键的促进因素。结论:大多数PICU HCPs认为TC可以在所有危重患儿中实施。重要的障碍包括对安全、人员配备和缺乏拥抱支持文化的担忧。促进患者和家属的参与是支持实施这一干预措施的关键促进因素。
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引用次数: 0
Letter to “Incidence of pressure injuries and effectiveness of a prevention care bundle in critically ill Vietnamese patients: A prospective cohort study” 致“越南危重病人压伤发生率和预防护理包的有效性:一项前瞻性队列研究”的信。
IF 2.7 3区 医学 Q2 CRITICAL CARE MEDICINE Pub Date : 2025-11-01 Epub Date: 2025-09-18 DOI: 10.1016/j.aucc.2025.101419
Lili Pan RN, BN (Registered Nurse, Bachelor of Nursing), Xia Luo RN, BN (Registered Nurse, Bachelor of Nursing), Jie Peng Associate Chief Physician, MB (Bachelor of Medicine)
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引用次数: 0
Reply to Letter to the Editor 回复给编辑的信。
IF 2.7 3区 医学 Q2 CRITICAL CARE MEDICINE Pub Date : 2025-11-01 Epub Date: 2025-09-18 DOI: 10.1016/j.aucc.2025.101412
Meredith Heily RN, M.Ed, Rebecca Jarden RN, PhD, Celene Y.L. Yap B.Pharm., PhD, Marie Gerdtz RN, PhD
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引用次数: 0
Intensive care virtual visiting practices in Australia and New Zealand following the COVID-19 pandemic: A binational survey 2019冠状病毒病大流行后澳大利亚和新西兰重症监护虚拟就诊实践:一项两国调查
IF 2.7 3区 医学 Q2 CRITICAL CARE MEDICINE Pub Date : 2025-11-01 Epub Date: 2025-09-20 DOI: 10.1016/j.aucc.2025.101436
Rachael Parke RN, PhD , Louise Rose RN, PhD , Thomas Buckley RN, PhD , Alexis Tabah MD , Jeffrey Presneill MBBS, PhD , Kathleen Mason BHSc , Kyly Mills PhD , Andrea P. Marshall RN, PhD

Background

Family members of patients admitted to an intensive care unit (ICU) may experience adverse physical, psychological, and social impacts. Although flexible in-person visiting aims to reduce these adverse family experiences, some families encounter challenges due to geographical distances and their own frailty and work/caregiving commitments. Virtual visiting (VV), as an adjunct or alternative to in-person visiting, is a strategy that could address inequities of access.

Objectives

To inform future research, our objectives were to document current (post-COVID-19 pandemic) ICU visiting practices and policies specific to VV in ICUs across Australia and New Zealand (ANZ).

Methods

We conducted a multicentre, cross-sectional, self-administered electronic survey sent to the lead medical director or nurse unit manager of adult/mixed ICUs in public and private hospitals across ANZ. Survey development was informed by the evidence base, our experience, and surveys conducted during the pandemic. Descriptive statistics were used to report survey results.

Results

In total, survey responses were received from 51 ICUs, comprising 26 of 31 (84%) of requested New Zealand sites and 25 of 162 (15%) of Australian sites (overall 26% ANZ response rate). While unrestricted visiting (no restriction on time or duration of visit) occurred in 53% of ICUs, only six (12%) offered 24 h/day family access. Thirty ICUs (59%) reported some use of VV although 15 of 30 (50%) reported this occurred only rarely. Ten ICUs that used VV during the pandemic now no longer provide this option. Challenges to VV included limited availability of hardware, organisational restrictions on software, and limited access to training on how to conduct a VV.

Conclusions

Currently, in Australian and New Zealand ICUs, in-person visiting is often restricted by duration of visiting hours. The use of VV to support patients and their families in adult/mixed ICUs appears limited and may be declining. The impact of reduced access and whether use of VV improves patient- and family-centred outcomes, addresses access inequities, and should be part of future pandemic preparedness should be explored in future research.
入住重症监护病房(ICU)患者的家庭成员可能会经历不利的身体、心理和社会影响。虽然灵活的亲自探访旨在减少这些不利的家庭经历,但由于地理距离和他们自身的虚弱以及工作/照顾承诺,一些家庭遇到了挑战。虚拟访问(VV)是一种辅助或替代亲自访问的策略,可以解决访问不公平的问题。为了为未来的研究提供信息,我们的目标是记录当前(covid -19大流行后)澳大利亚和新西兰(ANZ) ICU中针对VV的ICU就诊实践和政策。方法我们进行了一项多中心、横断面、自我管理的电子调查,调查对象是澳新银行公立和私立医院成人/混合icu的首席医学主任或护士单元经理。调查的开展参考了证据基础、我们的经验和大流行期间进行的调查。采用描述性统计方法报告调查结果。结果总共收到了51个icu的调查回复,包括31个请求站点中的26个(84%)新西兰站点和162个请求站点中的25个(15%)澳大利亚站点(总体澳新银行响应率为26%)。虽然53%的icu发生了无限制访问(不限制访问时间或持续时间),但只有6家(12%)提供每天24小时的家庭访问。30个icu(59%)报告了一些VV的使用,尽管30个icu中有15个(50%)报告这种情况很少发生。在大流行期间使用VV的10个icu现在不再提供这种选择。VV面临的挑战包括硬件的有限可用性,软件的组织限制,以及如何进行VV的培训有限。结论目前,在澳大利亚和新西兰的icu中,面对面的探视往往受到探视时间长短的限制。在成人/混合icu中,使用VV来支持患者及其家属似乎有限,并且可能正在下降。减少获得疫苗的影响以及使用疫苗是否能改善以病人和家庭为中心的结果,是否能解决获得疫苗的不平等问题,是否应成为未来大流行病防范工作的一部分,应在今后的研究中加以探讨。
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引用次数: 0
The experiences and challenges of caring for a healthcare professional patient in intensive and acute care settings: A cross-sectional exploratory survey 在重症和急性护理环境中护理医疗保健专业患者的经验和挑战:一项横断面探索性调查
IF 2.7 3区 医学 Q2 CRITICAL CARE MEDICINE Pub Date : 2025-11-01 Epub Date: 2025-10-31 DOI: 10.1016/j.aucc.2025.101453
Lynne Hunt RN, BN(Hons), Melissa Riegel RN, PhD, Robyn Gallagher RN, PhD, Thomas Buckley RN, PhD

Background

Hospital admission can be a stressful experience for patients and their families. Although healthcare professionals can also be patients, there is limited understanding of nurses’ experiences when caring for them in hospital settings.

Aim

The aims of this study were to explore the challenges nurses encounter while caring for hospitalised healthcare professionals and to compare experiences between participants in intensive care unit and acute care settings.

Methods

A cross-sectional exploratory study was conducted in July 2022 using an online survey via Research Electronic Data Capture (REDCap) with registered nurses who had cared for a healthcare professional-patient within the previous 3 years.

Results

Sixty-nine participants were included, with a mean age of 44.8 years and a mean of 18.8 years of experience as a registered nurse; 49% worked in intensive care and 51% in acute care settings, including surgery, emergency, and cardiology. A substantial 63.7% reported that caring for healthcare professional-patients was more challenging, while 49.3% found it more stressful than caring for non–healthcare professional-patients. Only 3% had received prior education that supported them in this role, despite 87% feeling prepared to deliver care and 75% feeling comfortable doing so. Open-ended questions reflecting on their experience caring for healthcare professional-patients generated three themes: enhanced support and knowledge needed to facilitate the role reversal of healthcare professionals becoming patients, recognising and respecting the evolving dynamics in caring for healthcare professionals as patients, and tailoring communication to align with individual needs and prior knowledge. There were no differences between intensive care unit participants and acute care participants regarding feeling prepared, experiencing stress, or feeling challenged caring for health professional-patients.

Conclusion

In conclusion, many nurses face significant challenges and heightened stress while caring for hospitalised healthcare professionals, whether in intensive care or acute care environments. The findings highlight a critical need for enhanced training and support to address the unique dynamics and communication requirements of these situations.
住院对病人和他们的家人来说是一段压力很大的经历。虽然医疗保健专业人员也可能是病人,但对护士在医院照顾他们时的经验了解有限。目的本研究的目的是探讨护士在照顾住院医疗保健专业人员时遇到的挑战,并比较重症监护病房和急性护理环境参与者之间的经验。方法于2022年7月通过研究电子数据采集(REDCap)进行在线调查,对在过去3年内照顾过医疗保健专业患者的注册护士进行横断面探索性研究。结果共纳入69人,平均年龄44.8岁,注册护士年龄18.8岁;49%在重症监护室工作,51%在急症护理机构工作,包括外科、急诊和心脏病学。63.7%的受访者表示,照顾医疗保健专业患者更具挑战性,而49.3%的受访者认为照顾非医疗保健专业患者的压力更大。只有3%的人接受过支持他们担任这一角色的先前教育,尽管87%的人觉得准备好提供护理,75%的人觉得这样做很舒服。开放式问题反映了他们照顾医疗保健专业人员患者的经验,产生了三个主题:加强支持和知识,以促进医疗保健专业人员成为患者的角色转换,认识和尊重护理医疗保健专业人员作为患者的不断变化的动态,以及根据个人需求和先前的知识定制沟通。重症监护室的参与者和急症护理的参与者在照顾健康专业患者的感觉准备、经历压力或感觉挑战方面没有差异。总之,无论是在重症监护室还是在急症监护室,许多护士在照顾住院医疗保健专业人员时都面临着重大挑战和更高的压力。调查结果强调,迫切需要加强培训和支助,以解决这些情况的独特动态和沟通需求。
{"title":"The experiences and challenges of caring for a healthcare professional patient in intensive and acute care settings: A cross-sectional exploratory survey","authors":"Lynne Hunt RN, BN(Hons),&nbsp;Melissa Riegel RN, PhD,&nbsp;Robyn Gallagher RN, PhD,&nbsp;Thomas Buckley RN, PhD","doi":"10.1016/j.aucc.2025.101453","DOIUrl":"10.1016/j.aucc.2025.101453","url":null,"abstract":"<div><h3>Background</h3><div>Hospital admission can be a stressful experience for patients and their families. Although healthcare professionals can also be patients, there is limited understanding of nurses’ experiences when caring for them in hospital settings.</div></div><div><h3>Aim</h3><div>The aims of this study were to explore the challenges nurses encounter while caring for hospitalised healthcare professionals and to compare experiences between participants in intensive care unit and acute care settings.</div></div><div><h3>Methods</h3><div>A cross-sectional exploratory study was conducted in July 2022 using an online survey via Research Electronic Data Capture (REDCap) with registered nurses who had cared for a healthcare professional-patient within the previous 3 years.</div></div><div><h3>Results</h3><div>Sixty-nine participants were included, with a mean age of 44.8 years and a mean of 18.8 years of experience as a registered nurse; 49% worked in intensive care and 51% in acute care settings, including surgery, emergency, and cardiology. A substantial 63.7% reported that caring for healthcare professional-patients was more challenging, while 49.3% found it more stressful than caring for non–healthcare professional-patients. Only 3% had received prior education that supported them in this role, despite 87% feeling prepared to deliver care and 75% feeling comfortable doing so. Open-ended questions reflecting on their experience caring for healthcare professional-patients generated three themes: enhanced support and knowledge needed to facilitate the role reversal of healthcare professionals becoming patients, recognising and respecting the evolving dynamics in caring for healthcare professionals as patients, and tailoring communication to align with individual needs and prior knowledge. There were no differences between intensive care unit participants and acute care participants regarding feeling prepared, experiencing stress, or feeling challenged caring for health professional-patients.</div></div><div><h3>Conclusion</h3><div>In conclusion, many nurses face significant challenges and heightened stress while caring for hospitalised healthcare professionals, whether in intensive care or acute care environments. The findings highlight a critical need for enhanced training and support to address the unique dynamics and communication requirements of these situations.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 6","pages":"Article 101453"},"PeriodicalIF":2.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The development and feasibility of a psychologist-led screening and modular-based psychological intervention in an Australian intensive care unit: A pilot study. 心理学家主导的筛选和基于模块的心理干预在澳大利亚重症监护病房的发展和可行性:一项试点研究。
IF 2.7 3区 医学 Q2 CRITICAL CARE MEDICINE Pub Date : 2025-11-01 Epub Date: 2025-08-07 DOI: 10.1016/j.aucc.2025.101301
Jessica M Hampton, Elizabeth C Ward, Lynette Morrison, Kellie Sosnowski, James Banham, Marilia Libera, Chanelle Louwen, Hayden White, Rachael Watson, Melissa A Day

Background: Psychological distress is common among intensive care unit (ICU) patients and can lead to long-term adverse psychological sequelae. While early psychological interventions may help mitigate these effects, their feasibility within critical care settings remains largely unexplored. Additionally, the role of psychologists in delivering such interventions in Australia remains unclear, particularly given inconsistencies in workforce availability and integration into standard care.

Aims/objectives: The aim of this study was to (i) outline the development of a psychologist-led screening and intervention protocol in an Australian ICU and (ii) evaluate its preliminary feasibility. It also examined the suitability of a potential outcome measure to inform future trial design.

Methods: The Medical Research Council's framework for developing complex interventions in health was applied. The intervention was designed for an Australian metropolitan ICU. It consisted of a modular-based psychological intervention tailored to the patient's level of psychological distress. A single-arm prospective pilot study was conducted, and 30 patients were recruited. Feasibility was assessed based on recruitment rates, patient engagement, and outcome measure completion.

Results: Recruitment challenges were observed, with a low eligibility screening rate. Staffing constraints and consent-related barriers further limited recruitment. Intervention engagement was high, with 96% of consenting participants completing at least one intervention component. Outcome measure completion rates supported the feasibility of a larger trial, with preliminary findings suggesting a significant reduction in negative emotional affect over time. Consistent with the Medical Research Council's framework, refinements to the intervention are recommended.

Conclusions: The findings support the feasibility of a psychologist-led intervention in the ICU, though refinements are necessary to improve recruitment, streamline delivery, and enhance engagement. This study highlights the potential of early psychological interventions to improve patients' emotional well-being. Addressing staffing limitations and consent barriers could enhance accessibility and effectiveness in future trials.

Registration: This trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12623000619640), with the first participant recruited on 4/07/2023.

背景:心理困扰在重症监护病房(ICU)患者中很常见,并可导致长期的不良心理后遗症。虽然早期心理干预可能有助于减轻这些影响,但其在重症监护环境中的可行性在很大程度上仍未得到探索。此外,心理学家在澳大利亚提供此类干预措施方面的作用尚不清楚,特别是考虑到劳动力可用性和融入标准护理的不一致性。目的/目的:本研究的目的是(i)概述澳大利亚ICU中心理学家主导的筛查和干预方案的发展,(ii)评估其初步可行性。它还检查了潜在结果测量的适用性,以告知未来的试验设计。方法:采用医学研究理事会制定的制定复杂卫生干预措施的框架。该干预措施是为澳大利亚大都市ICU设计的。它包括一个基于模块的心理干预量身定制的病人的心理困扰水平。进行了一项单臂前瞻性先导研究,招募了30名患者。可行性根据招募率、患者参与度和结果测量完成情况进行评估。结果:观察到招募困难,合格筛选率低。人员配备限制和与同意有关的障碍进一步限制了征聘。干预的参与度很高,96%的同意参与者完成了至少一个干预部分。结果测量完成率支持更大规模试验的可行性,初步结果表明,随着时间的推移,负面情绪影响显著减少。根据医学研究理事会的框架,建议对干预措施进行改进。结论:研究结果支持在ICU进行心理学家主导的干预的可行性,尽管需要改进以改善招募、简化交付和增强参与。这项研究强调了早期心理干预对改善患者情绪健康的潜力。解决人员配备限制和同意障碍可以提高未来试验的可及性和有效性。注册:该试验已在澳大利亚新西兰临床试验注册中心注册(ACTRN12623000619640),第一位受试者于2023年7月4日招募。
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引用次数: 0
Intensive care unit nurses’ understanding and experience of clinical debriefing: A focus group 重症监护室护士对临床汇报的理解和经验:焦点小组。
IF 2.7 3区 医学 Q2 CRITICAL CARE MEDICINE Pub Date : 2025-11-01 Epub Date: 2025-10-04 DOI: 10.1016/j.aucc.2025.101439
Annabel Levido BSN, M Applied Management (Nurs), RN , Fiona Coyer RN, PhD , Samantha Keogh RN, PhD , Liz Crowe BSocWk, PhD

Background

Intensive care nurses frequently request clinical debriefing with a goal to learn, develop, and process the sometimes confronting and distressing work environment. The literature and application of clinical debriefing can be confusing and difficult to navigate with a paucity of evidence in the intensive care environment. This creates uncertainty for how and what events should be debriefed and what would be beneficial for nurses working in the intensive care unit (ICU).

Aims

The aim of this study was to explore the perceptions, attitudes, and experiences of clinical debriefing for nurses working in an ICU.

Study design

This study utilised an interpretative qualitative design involving semistructured focus groups. Nurses employed within the ICU of a large metropolitan hospital in Australia were invited to participate. The focus groups were audio-recorded, transcribed verbatim, and analysed using an inductive thematic approach.

Results

A total of 31 ICU nurses participated in five semistructured focus groups. Four themes were identified: (i) uncertainty of definition and logistics; (ii) clinical debriefing requires psychological safety; (iii) the value of clinical debriefing; and (iv) clinical debriefing as a form of organisational acknowledgement.

Conclusion

This study identified four themes that outlined the potential importance and meaning of clinical debriefing for ICU nurses. Despite several perceived barriers to implementing regular clinical debriefing, ICU nurses advocated for the opportunity participate in regular clinical debriefing for learning and support.
背景:重症监护护士经常要求临床汇报,目的是学习、发展和处理有时面对和痛苦的工作环境。临床述职报告的文献和应用在重症监护环境中缺乏证据,可能令人困惑和难以导航。这就造成了不确定性,不确定应该如何汇报和汇报哪些事件,也不确定哪些事件对在重症监护病房(ICU)工作的护士有益。目的:本研究的目的是探讨在ICU工作的护士对临床汇报的看法、态度和经验。研究设计:本研究采用解释性定性设计,涉及半结构化焦点小组。澳大利亚一家大城市医院ICU的护士被邀请参加。对焦点小组进行录音,逐字抄录,并采用归纳专题方法进行分析。结果:共31名ICU护士参加了5个半结构化焦点小组。确定了四个主题:(i)定义和后勤的不确定性;(ii)临床汇报需要心理安全;(iii)临床汇报的价值;(iv)临床汇报作为组织认可的一种形式。结论:本研究确定了四个主题,概述了临床述职对ICU护士的潜在重要性和意义。尽管实施定期临床汇报存在一些障碍,但ICU护士主张有机会参加定期临床汇报,以获得学习和支持。
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引用次数: 0
Exploring explainable machine learning techniques to aid dysphagia risk identification: A feasibility study 探索可解释的机器学习技术,以帮助识别吞咽困难的风险:可行性研究
IF 2.7 3区 医学 Q2 CRITICAL CARE MEDICINE Pub Date : 2025-11-01 Epub Date: 2025-08-13 DOI: 10.1016/j.aucc.2025.101307
Melanie L. McIntyre BHSc SpPath, GradCertClinEd , Yuxi Liu BEng, PhD , Joanne Murray PhD, BAppSc(Speech Pathology), CPSP , Shaowen Qin BEng, MEng, MS(Applied Mathematics), PhD , Timothy Chimunda MBChB, FCICM, AMC, MCC, MACEM , Sebastian H. Doeltgen MSLT, PhD

Background

Machine learning offers opportunities to identify complex risk patterns in large data sets. We explored the methodological feasibility, and proof of concept, of applying machine learning techniques to dysphagia (swallowing difficulty) risk identification for adult patients who required endotracheal intubation within an intensive care unit (ICU).

Aim

The aim of this study was to explore the methodological feasibility and proof of concept of developing machine learning models for dysphagia risk identification for adult patients who required endotracheal intubation within an ICU.

Methods

In this cohort study, two large healthcare databases were linked using deterministic logic. All participants received invasive mechanical ventilation in an ICU. Several machine learning model candidates were explored. Insights into the model decision-making have been provided using SHapley Additive exPlanation values.

Results

A total of 59 811 patients from 42 sites were included in the study. The top five most influential factors in determining the presence or absence of dysphagia at a cohort level were duration of mechanical ventilation, age, cardiac admission, neurological admission, and Acute Physiology and Chronic Health Evaluation III score.

Conclusion

There is a promising prospect of machine learning in dynamic dysphagia risk screening, which we propose should be considered for clinical use in the future. The patient-specific influence of each risk factor in determining the presence or absence of dysphagia highlights the importance of determining risk based on the individual patient's unique combination of risk factors, and not on cohort means, as has been done previously.
机器学习为识别大型数据集中的复杂风险模式提供了机会。我们探讨了将机器学习技术应用于重症监护病房(ICU)内需要气管插管的成年患者吞咽困难(吞咽困难)风险识别的方法学可行性和概念证明。目的本研究的目的是探索开发机器学习模型的方法可行性和概念的证明,以识别ICU内需要气管插管的成年患者吞咽困难的风险。方法在本队列研究中,使用确定性逻辑将两个大型医疗数据库联系起来。所有参与者在ICU接受有创机械通气。探讨了几种机器学习候选模型。使用SHapley加性解释值提供了对模型决策的见解。结果共纳入42个部位的59 811例患者。在队列水平上决定是否存在吞咽困难的前五个最具影响力的因素是机械通气时间、年龄、心脏住院、神经住院和急性生理和慢性健康评估III评分。结论机器学习在动态吞咽困难风险筛查中具有广阔的应用前景,值得临床推广应用。每个风险因素在确定是否存在吞咽困难方面的患者特异性影响突出了基于个体患者独特的风险因素组合来确定风险的重要性,而不是像以前那样通过队列方法来确定风险。
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引用次数: 0
Medical emergency team stand-down decision-making: Characteristics, documented decisions, and outcomes documented between single and repeat medical emergency team patients—A retrospective review 医疗急救小组停止决策:单个和重复医疗急救小组患者之间的特征、记录的决策和记录的结果-回顾性回顾
IF 2.7 3区 医学 Q2 CRITICAL CARE MEDICINE Pub Date : 2025-11-01 Epub Date: 2025-08-14 DOI: 10.1016/j.aucc.2025.101310
Natalie A. Kondos RN, BNurs, BBiomedSci(Hons) , Jonathan Barrett MBBs, MPH, FRACP, FCICM , Jo McDonall RN, PhD , Tracey Bucknall RN, FAAN, GAICD, PhD

Introduction

Decisions to end a medical emergency team (MET) call have been infrequently studied. Premature ending of MET calls may compromise patient outcomes. The aim of the study was to describe clinicians' documentation practices upon ending MET calls and to compare patients with single and repeat MET call activation on the initial call.

Methods

A retrospective review was conducted at a metropolitan hospital in Melbourne, Victoria, from Oct 1st, 2018, to September 30th, 2019. From a total of 8648 initial MET calls, 500 were included in the sample, 250 single and 250 repeated (≥2) MET calls. Data from patients’ index MET call were analysed using univariate analyses and descriptive statistics. Variables included documentation of the MET call stand-down decision and associated decision-making elements, demographic and admission characteristics, and patient outcomes. We compared documentation of MET call stand-down decision-making with expert consensus on essential MET call stand-down decision-making elements.

Results

Key differences in the documentation of the essential MET call stand-down decision-making elements were that repeat MET patients had a higher proportion of care outcomes (post-MET call) documented (72%) than single MET patients (48.8%). Treatment decisions were documented over 75% of the time and an escalation plan was documented less than 50% of the time for both MET call patient groups. Repeat MET call patients were twice as likely to die in hospital (15.2% versus 7.6%, p = 0.01), had double the hospital length of stay (21 versus 10 days, p = 0.031), and were three times more likely to be discharged to rehabilitation services rather than home (28% versus 9.6%, p = 0.001).

Conclusion

There were differences at the index MET call in documentation and outcomes between patients who required a single MET call and those who required repeat MET calls. Prospective observational research is recommended to better understand the MET call stand-down decision-making process at the patient bedside, environmental influences, and the impact on further patient deterioration.
结束医疗急救小组(MET)呼叫的决定很少被研究。过早结束MET呼叫可能会损害患者的预后。该研究的目的是描述临床医生在结束MET呼叫时的记录实践,并比较初次呼叫时单一和重复MET呼叫激活的患者。方法回顾性分析2018年10月1日至2019年9月30日在维多利亚州墨尔本一家大都会医院进行的临床研究。从8648个初始MET呼叫中,500个被纳入样本,250个是单一的MET呼叫,250个是重复的(≥2)MET呼叫。使用单变量分析和描述性统计分析患者索引MET呼叫的数据。变量包括MET呼叫停止决定和相关决策因素的文件,人口统计学和入院特征以及患者结果。我们比较了MET呼叫停机决策的文件与专家共识的基本MET呼叫停机决策要素。结果基本MET呼叫停止决策要素记录的关键差异是,重复MET患者记录的护理结果(MET呼叫后)比例(72%)高于单一MET患者(48.8%)。两个MET呼叫患者组的治疗决定记录率超过75%,升级计划记录率不到50%。重复MET呼叫的患者在医院死亡的可能性是前者的两倍(15.2%对7.6%,p = 0.01),住院时间是后者的两倍(21天对10天,p = 0.031),出院到康复服务中心而不是回家的可能性是后者的三倍(28%对9.6%,p = 0.001)。结论:单次MET呼叫与多次MET呼叫的患者在MET呼叫的记录和结果上存在差异。建议进行前瞻性观察研究,以更好地了解患者床边的MET呼叫停药决策过程、环境影响以及对患者进一步恶化的影响。
{"title":"Medical emergency team stand-down decision-making: Characteristics, documented decisions, and outcomes documented between single and repeat medical emergency team patients—A retrospective review","authors":"Natalie A. Kondos RN, BNurs, BBiomedSci(Hons) ,&nbsp;Jonathan Barrett MBBs, MPH, FRACP, FCICM ,&nbsp;Jo McDonall RN, PhD ,&nbsp;Tracey Bucknall RN, FAAN, GAICD, PhD","doi":"10.1016/j.aucc.2025.101310","DOIUrl":"10.1016/j.aucc.2025.101310","url":null,"abstract":"<div><h3>Introduction</h3><div>Decisions to end a medical emergency team (MET) call have been infrequently studied. Premature ending of MET calls may compromise patient outcomes. The aim of the study was to describe clinicians' documentation practices upon ending MET calls and to compare patients with single and repeat MET call activation on the initial call.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted at a metropolitan hospital in Melbourne, Victoria, from Oct 1st, 2018, to September 30th, 2019. From a total of 8648 initial MET calls, 500 were included in the sample, 250 single and 250 repeated (≥2) MET calls. Data from patients’ index MET call were analysed using univariate analyses and descriptive statistics. Variables included documentation of the MET call stand-down decision and associated decision-making elements, demographic and admission characteristics, and patient outcomes. We compared documentation of MET call stand-down decision-making with expert consensus on essential MET call stand-down decision-making elements.</div></div><div><h3>Results</h3><div>Key differences in the documentation of the essential MET call stand-down decision-making elements were that repeat MET patients had a higher proportion of care outcomes (post-MET call) documented (72%) than single MET patients (48.8%). Treatment decisions were documented over 75% of the time and an escalation plan was documented less than 50% of the time for both MET call patient groups. Repeat MET call patients were twice as likely to die in hospital (15.2% versus 7.6%, <em>p</em> = 0.01), had double the hospital length of stay (21 versus 10 days, <em>p</em> = 0.031), and were three times more likely to be discharged to rehabilitation services rather than home (28% versus 9.6%, <em>p</em> = 0.001).</div></div><div><h3>Conclusion</h3><div>There were differences at the index MET call in documentation and outcomes between patients who required a single MET call and those who required repeat MET calls. Prospective observational research is recommended to better understand the MET call stand-down decision-making process at the patient bedside, environmental influences, and the impact on further patient deterioration.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 6","pages":"Article 101310"},"PeriodicalIF":2.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Response to letter to the editor by Chen et al. regarding early psychiatric intervention assessment and intervention service pilot study 回复Chen等人关于早期精神病学干预评估和干预服务试点研究的致编辑信
IF 2.7 3区 医学 Q2 CRITICAL CARE MEDICINE Pub Date : 2025-11-01 Epub Date: 2025-10-24 DOI: 10.1016/j.aucc.2025.101452
Dylan Flaws PhD, FRANZCP, Stuart Baker MBBS, FCICM, Adrian Barnett PhD, AStat FASSA, Kylie Jacobs RN, MNr, Olivia Metcalf BA/BSc(Hons), PhD, Sue Patterson PhD, Hamish Pollock BM, FCICM, Emma Proctor BSN, BBehSci Psychol, Mahesh Ramanan PhD, FCICM, Alexis Tabah MD, FCICM, Tracey Varker BSc(Hons), PGradDip Statistics, PhD
{"title":"Response to letter to the editor by Chen et al. regarding early psychiatric intervention assessment and intervention service pilot study","authors":"Dylan Flaws PhD, FRANZCP,&nbsp;Stuart Baker MBBS, FCICM,&nbsp;Adrian Barnett PhD, AStat FASSA,&nbsp;Kylie Jacobs RN, MNr,&nbsp;Olivia Metcalf BA/BSc(Hons), PhD,&nbsp;Sue Patterson PhD,&nbsp;Hamish Pollock BM, FCICM,&nbsp;Emma Proctor BSN, BBehSci Psychol,&nbsp;Mahesh Ramanan PhD, FCICM,&nbsp;Alexis Tabah MD, FCICM,&nbsp;Tracey Varker BSc(Hons), PGradDip Statistics, PhD","doi":"10.1016/j.aucc.2025.101452","DOIUrl":"10.1016/j.aucc.2025.101452","url":null,"abstract":"","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 6","pages":"Article 101452"},"PeriodicalIF":2.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145361580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Australian Critical Care
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