Extended drotrecogin alfa (activated) therapy in patients with persistent requirement for vasopressor support after 96-hour infusion with commercial drotrecogin alfa (activated)

Dhainaut, Jean François; Antonelli, Massimo; Wright, Patrick E.; Belger, Mark; Cobas-Meyer, M.; Mignini, Mariano Alejandro; Janes, Jonathan

doi:10.1186/cc6426

Cited by 4 publications

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“…‘Even when the concept of RRS [rapid response systems] is believed to be advantageous, the actual implementation entails overcoming a myriad of barriers: political, financial, educational, cultural, logistic, anthropological, and emotional.’ [26]…”

Section: Resultsmentioning

confidence: 99%

Challenges to evaluating complex interventions: a content analysis of published papers

2013

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BackgroundThere is continuing interest among practitioners, policymakers and researchers in the evaluation of complex interventions stemming from the need to further develop the evidence base on the effectiveness of healthcare and public health interventions, and an awareness that evaluation becomes more challenging if interventions are complex.We undertook an analysis of published journal articles in order to identify aspects of complexity described by writers, the fields in which complex interventions are being evaluated and the challenges experienced in design, implementation and evaluation. This paper outlines the findings of this documentary analysis.MethodsThe PubMed electronic database was searched for the ten year period, January 2002 to December 2011, using the term “complex intervention*” in the title and/or abstract of a paper. We extracted text from papers to a table and carried out a thematic analysis to identify authors’ descriptions of challenges faced in developing, implementing and evaluating complex interventions.ResultsThe search resulted in a sample of 221 papers of which full text of 216 was obtained and 207 were included in the analysis. The 207 papers broadly cover clinical, public health and methodological topics. Challenges described included the content and standardisation of interventions, the impact of the people involved (staff and patients), the organisational context of implementation, the development of outcome measures, and evaluation.ConclusionsOur analysis of these papers suggests that more detailed reporting of information on outcomes, context and intervention is required for complex interventions. Future revisions to reporting guidelines for both primary and secondary research may need to take aspects of complexity into account to enhance their value to both researchers and users of research.

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Section: Resultsmentioning

confidence: 99%

Challenges to evaluating complex interventions: a content analysis of published papers

2013

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“…However, EWS recordings were frequently incomplete which is of concern, as monitoring is essential for triage to an appropriate level of care [2]. Adopting an RRS is a complex process that needs time to become established as an integral part of the ward care system [14,27-29]. Even though we found a remarkable improvement in detecting and treating critically ill patients, our results show that further implementation strategies should be developed to improve adherence of the ward nurses and doctors to the RRS procedures and to stimulate the MET to refer the patient to the ICU at an earlier stage of deterioration.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, this study was conducted in a single hospital; data may therefore be less applicable to other study populations and settings. However, implementation of an RRS poses challenges in change of behavior, and only progressive accumulation of evidence and experience from different settings and situations will fill the gaps of knowledge in order to adjust the system to the specific needs of a certain setting [14]. …”

Section: Discussionmentioning

confidence: 99%

Incidence of cardiac arrests and unexpected deaths in surgical patients before and after implementation of a rapid response system

et al. 2012

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BackgroundRapid response systems (RRSs) are considered an important tool for improving patient safety. We studied the effect of an RRS on the incidence of cardiac arrests and unexpected deaths.MethodsRetrospective before- after study in a university medical centre. We included 1376 surgical patients before (period 1) and 2410 patients after introduction of the RRS (period 2). Outcome measures were corrected for the baseline covariates age, gender and ASA.ResultsThe number of patients who experienced a cardiac arrest and/or who died unexpectedly decreased non significantly from 0.50% (7/1376) in period 1 to 0.25% (6/2410) in period 2 (odds ratio (OR) 0.43, CI 0.14-1.30). The individual number of cardiac arrests decreased non-significantly from 0.29% (4/1367) to 0.12% (3/2410) (OR 0.38, CI 0.09-1.73) and the number of unexpected deaths decreased non-significantly from 0.36% (5/1376) to 0.17% (4/2410) (OR 0.42, CI 0.11-1.59). In contrast, the number of unplanned ICU admissions increased from 2.47% (34/1376) in period 1 to 4.15% (100/2400) in period 2 (OR 1.66, CI 1.07-2.55). Median APACHE ll score at unplanned ICU admissions was 16 in period 1 versus 16 in period 2 (NS). Adherence to RRS procedures. Observed abnormal early warning scores ≤72 h preceding a cardiac arrest, unexpected death or an unplanned ICU admission increased from 65% (24/37 events) in period 1 to 91% (91/101 events) in period 2 (p < 0.001). Related ward physician interventions increased from 38% (9/24 events) to 89% (81/91 events) (p < 0.001). In period 2, ward physicians activated the medical emergency team in 65% of the events (59/91), although in 16% (15/91 events) activation was delayed for one or two days. The overall medical emergency team dose was 56/1000 admissions.ConclusionsIntroduction of an RRS resulted in a 50% reduction in cardiac arrest rates and/or unexpected death. However, this decrease was not statistically significant partly due to the low base-line incidence. Moreover, delayed activation due to the two-tiered medical emergency team activation procedure and suboptimal adherence of the ward staff to the RRS procedures may have further abated the positive results.

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Extended drotrecogin alfa (activated) treatment in patients with prolonged septic shock

et al. 2009

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Extended drotrecogin alfa (activated) therapy in patients with persistent requirement for vasopressor support after 96-hour infusion with commercial drotrecogin alfa (activated)

Cited by 4 publications

References 0 publications

Challenges to evaluating complex interventions: a content analysis of published papers

Challenges to evaluating complex interventions: a content analysis of published papers

Incidence of cardiac arrests and unexpected deaths in surgical patients before and after implementation of a rapid response system

Extended drotrecogin alfa (activated) treatment in patients with prolonged septic shock

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