Publications by authors named "Peter M Dodek"
Article Synopsis
- The study investigates how often to screen critically ill adults on ventilators and the best method for conducting spontaneous breathing trials (SBT) to successfully extubate them.
- It involves a randomized clinical trial with 797 participants who required mechanical ventilation, comparing once-daily and more frequent screenings alongside two SBT techniques: pressure-supported and T-piece.
- Results show no significant differences in the time to successful extubation based on screening frequency or SBT technique, indicating that both methods may be similarly effective.
Unlabelled: 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.
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.
Objectives: Few surveys have focused on physician moral distress, burnout, and professional fulfilment. We assessed physician wellness and coping during the COVID-19 pandemic.
Design: Cross-sectional survey using four validated instruments.
Purpose: To test a new approach to address moral distress in intensive care unit (ICU) personnel.
Methods: Using principles of participatory action research, we developed an eight-step moral conflict assessment (MCA) that guides participants in describing the behaviour that they have to implement, the effects this has on them, their current coping strategies, their values in conflict, any other concerns related to the situation, what helps and hinders the situation, new coping strategies, and the effect of the preceding steps on participants. This assessment was tested with eight ICU providers in an 11-bed community ICU.
Understanding the magnitude of moral distress and its associations may point to solutions. To understand the magnitude of moral distress and other measures of wellness in Canadian critical care physicians, to determine any associations among these measures, and to identify potentially modifiable factors. This was an online survey of Canadian critical care physicians whose e-mail addresses were registered with either the Canadian Critical Care Society or the Canadian Critical Care Trials Group.
View Article and Find Full Text PDFObjectives: To examine adverse events and associated factors and outcomes during transition from ICU to hospital ward (after ICU discharge).
Design: Multicenter cohort study.
Setting: Ten adult medical-surgical Canadian ICUs.
Article Synopsis
- A study was conducted to see if time-sensitive biological indicators could forecast sepsis mortality risk and create individual risk profiles for patients.
- The research involved 356 septic patients in nine Canadian ICUs, where clinical data and biomarker levels were tracked over time.
- Using a special statistical model, the study successfully developed a tool that predicts death probability in septic patients and outlines how various biological indicators contribute to mortality risk.
Background: Pain, agitation, and delirium are associated with negative outcomes in critically ill patients. Reducing variation in pain, agitation, and delirium management among institutions could improve care.
Objectives: To define opportunities to improve pain, agitation, and delirium management in intensive care units in British Columbia, Canada.
Purpose: To assess the association between moral distress and general workplace distress in intensive care unit (ICU) personnel.
Materials And Methods: We administered the Moral Distress Scale Revised and the Job Content Questionnaire to all clinicians (870 nurses, 68 physicians, 452 other health professionals) in 13 ICUs (3 tertiary, 3 large community, 7 small community) in British Columbia, Canada. We used mixed effects regression, treating ICUs as clusters, to examine the association between the Moral Distress Score and each Job Content Questionnaire scale (decision latitude, psychological stressors, social support, psychological strain) after adjusting for age, sex, and years of experience of respondents; separate analyses were done for each profession.
Background: Transfer of patient care from an intensive care unit (ICU) to a hospital ward is often challenging, high risk and inefficient. We assessed patient and provider perspectives on barriers and facilitators to high-quality transfers and recommendations to improve the transfer process.
Methods: We conducted semistructured interviews of participants from a multicentre prospective cohort study of ICU transfers conducted at 10 hospitals across Canada.
Background: Little is known about documentation during transitions of patient care between clinical specialties. Therefore, we examined the focus, structure and purpose of physician progress notes for patients transferred from the intensive care unit (ICU) to hospital ward to identify opportunities to improve communication breaks.
Methods: This was a prospective cohort study in ten Canadian hospitals.
Purpose: To determine whether invasive pneumococcal disease (IPD) due to serotype 5, which occurred as a local outbreak in 2006 to 2007, is associated with intensive care unit (ICU) admission, hospital mortality, or organ supports in those who are critically ill.
Materials And Methods: Retrospective review of patients who presented with IPD to 2 tertiary hospitals in Vancouver, Canada, from July 2004 to June 2007. We compared patient characteristics, interventions, and outcomes between patients who had serotype 5 and other serotypes using bivariate and multivariate analyses.
Purpose: To provide a 360-degree description of ICU-to-ward transfers.
Methods: Prospective cohort study of 451 adults transferred from a medical-surgical ICU to a hospital ward in 10 Canadian hospitals July 2014-January 2016. Transfer processes documented in the medical record.
Background: Moral distress is common among personnel in the intensive care unit, but the consequences of this distress are not well characterized.
Objective: To examine the consequences of moral distress in personnel in community and tertiary intensive care units in Vancouver, Canada.
Methods: Data for this study were obtained from focus groups and analysis of transcripts by themes and sub-themes in 2 tertiary care intensive care units and 1 community intensive care unit.
Purpose: Very elderly (over 80 yr of age) critically ill patients admitted to medical-surgical intensive care units (ICUs) have a high incidence of mortality, prolonged hospital length of stay, and dependent living conditions should they survive. The primary purpose of this study is to describe the outcomes and differences in outcomes between very elderly medical patients and their surgical counterparts admitted to Canadian ICUs, thereby informing decision-making for clinicians and substitute decision-makers.
Methods: This was a prospective multicentre cohort study of very elderly medical and surgical patients admitted to 22 Canadian academic and non-academic ICUs.
Background: Very elderly (80 years of age and above) critically ill patients admitted to medical intensive care units (ICUs) have a high incidence of mortality, prolonged hospital length of stay, and living in a dependent state should they survive.
Objective: The objective was to develop a clinical prediction tool for hospital mortality to improve future end-of-life decision making for very elderly patients who are admitted to Canadian ICUs.
Design: This was a prospective, multicenter cohort study.
Purpose: The purpose of the study is to examine the causes of moral distress in diverse members of the intensive care unit (ICU) team in both community and tertiary ICUs.
Materials And Methods: We used focus groups and coding of transcripts into themes and subthemes in 2 tertiary care ICUs and 1 community ICU.
Results: Based on input from 19 staff nurses (3 focus groups), 4 clinical nurse leaders (1 focus group), 13 physicians (3 focus groups), and 20 other health professionals (3 focus groups), the most commonly reported causes of moral distress were concerns about the care provided by other health care workers, the amount of care provided (especially too much care at end of life), poor communication, inconsistent care plans, and issues around end of life decision making.
Background: Probiotics are live microorganisms that may confer health benefits when ingested. Randomized trials suggest that probiotics significantly decrease the incidence of ventilator-associated pneumonia (VAP) and the overall incidence of infection in critically ill patients. However, these studies are small, largely single-center, and at risk of bias.
View Article and Find Full Text PDFPurpose: Stress ulcer prophylaxis (SUP) using histamine-2-receptor antagonists has been a standard of care in intensive care units (ICUs) for four decades. Proton pump inhibitors (PPIs) are increasingly used despite apparently lower background rates of gastrointestinal bleeding and growing concerns about PPI-associated complications. Our objective was to understand the views and prescribing habits amongst Canadian physicians regarding SUP in the ICU and to gauge interest in a future randomized-controlled trial (RCT).
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