1,721,014 research outputs found
1026: U.S. opioid prescribing practices after ICU hospitalizations requiring mechanical ventilation
No full textMetricsIntroduction: Opioids, frequently initiated during ICU admissions requiring invasive mechanical ventilation (IMV), are often continued after hospital discharge despite important concerns re: this use. Current U.S. post-hospital use of opioids in ICU survivors who required IMV and factors associated with this use remain unclear.Methods: Using the U.S. IQVIA PharMetrics Plus claims database we identified adults in 2021 admitted to an ICU requiring IMV and discharged directly to home with insurance coverage ≥30 days. We excluded patients with OUD or a recent ICU admission. We collected data on age, sex, comorbidity (CCI), frailty (HFRS), admission diagnoses, and full opioid agonist prescriptions in the two months before-and-after the ICU hospitalization and conducted a 5-variable logistic regression analysis to identify factors associated with post-hospitalization opioid prescribing in patients opioid-naive prior to ICU hospitalization.Results: Among 2707 patients included, 2341(86.5%) were opioid-naïve [age 67(57-76), male(56.3%), CCI 5(3,8), HDRI 11(6,18) and surgical(14.4%] and 364(13.5%) were opioid-experienced. A total of 197(8.4%) opioid-naive patients were prescribed ≥1 opioid in the 2-months after ICU hospitalization. First-prescribed opioids included oxycodone 115(58.3%), hydrocodone 70(35.5%), codeine 16(8.1%) and transdermal fentanyl 1(0.5%)]; acetaminophen-containing opioid formulations made up 56.7% of these prescriptions. In the opioid-naïve group, a surgical (vs. medical) diagnosis (aOR 6.41 95%CI 4.67,8.79) was associated with greater post-hospital opioid prescribing and age (aOR 0.98 95%CI 0.97,0.99], male gender (aOR 0.74 95%CI 0.87,1.40), and baseline comorbidity (aOR 0.99 95%CI 0.94,1.04) were associated with less. Opioids were not prescribed post-hospitalization in 168/364(48.7%) of the opioid-experienced patients. The total 2-month oral MME prescribed was greater in the 177 opioid-experienced patients prescribed opioids post-hospitalization than the 364 opioid-experienced patients before hospitalization [1350(341,2535) vs 815(150,2062),p=0.01]Conclusions: Post-hospital opioid prescribing after an ICU admission requiring IMV appears to be lower in the U.S. than that reported in other countries for both opioid-naive and opioid-experienced patients.<br/
Impact of continuous intravenous opioid in mechanically ventilated adults: a systematic review and meta-analysis
No full textIntroduction: continuous intravenous (IV) opioids are widely used in ICU adults for pain, sedation, and facilitate mechanical ventilation despite persistent questions on efficacy and increasing safety concerns (1). We aimed to systematically review and summarize evidence on efficacy and safety of continuous IV opioids in mechanically ventilated ICU adults.Methods: we included randomized-controlled trials (RCT) of mechanically ventilated ICU adults comparing continuous IV full opioid agonists versus non-continuous IV opioids. The primary outcome was mechanical ventilationduration. Secondary efficacy outcomes were ICU length of stay (LOS), ICU pain reduction and short-term mortality. The secondary safety outcome was ICU delirium incidence. We performed inverse variance random effects meta-analyses using the Grading of Recommendations of Assessment, Development and Evaluating Approach.Results: we included 10 RCTs enrolling 945 patients. Continuous IV opioids use may increase mechanical ventilation time (3 RCTs, 421 patients, standard mean difference (SMD)=3.63 hours, 95% confidence interval (CI) 2.27 to 4.99, very low certainty), but do not affect ICU LOS (3 RCTs, 358 patients, SMD=0 days, 95% CI -0.03 to 0.04, very low certainty) or ICU pain reduction (5 RCTs, 583 patients, no difference, low certainty). Continuous IV opioids may reduce short-term mortality (3 RCTs, 315 patients, odds ratio (OR)=0.46, 95% CI 0.23-0.92, low certainty) and delirium incidence (3 RCTs, 315 patients, OR=0.28, 95% CI 0.16–0.47, low certainty). Subgroup analysis was not feasible.Conclusion: in this review, we found that continuous IV opioids use may increase mechanical ventilation time but reduce short-term mortality and delirium in mechanically ventilated ICU adults. We observed low or very low certaintyevidence for outcomes of interest. Large prospective RCTs are required to evaluate the efficacy and safety of continuous IV opioids in ventilated ICU adults.<br/
Survey of sedation practices during noninvasive positive-pressure ventilation to treat acute respiratory failure
No full textOBJECTIVES:
Noninvasive positive-pressure ventilation (NPPV) is increasingly used in patients with acute respiratory failure, but few data exist regarding current sedation practices during NPPV. We sought to characterize current practices and attitudes regarding sedation during NPPV.
DESIGN:
Cross-sectional Web-based survey.
SETTING:
Medical institutions.
PARTICIPANTS:
Physician members of the American College of Chest Physician's Critical Care Network (n = 2,656) and the European Respiratory Society's Assembly of Critical Care (n = 339).
INTERVENTIONS:
Survey.
MEASUREMENTS AND MAIN RESULTS:
Of the 790 of 2,985 (27%) of physicians who responded, 15%, 6%, and 28% never used sedation, analgesia, or hand restraints any of the time for NPPV patients, respectively, and the large majority reported using these interventions in < or =25% of patients. Sedation, analgesia, and hand restraints were more commonly used by North Americans than Europeans (41% vs. 24% for sedation, 48% vs. 35% for analgesia, and 27% vs. 16% for hand restraints, all p < .01) and critical care vs. noncritical care physicians (42% vs. 24% for sedation and 50% vs. 34% for analgesia, all p < .01). A benzodiazepine alone was the most preferred (33%), followed by an opioid alone (29%). Europeans were less likely to use a benzodiazepine alone (25% vs. 39%, p < .001) but more likely to use an opioid alone (37% vs. 26%, p < .009). Sedation was usually administered as an intermittent intravenous bolus, outside of a protocol, and was assessed by nurses using clinical end points rather than a sedation scale.
CONCLUSIONS:
Most physicians infrequently use sedation and analgesic therapy for NPPV to treat acute respiratory failure, but practices vary widely within and between specialties and geographic regions
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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