Browsing by Author "Cuthbertson, Brian"

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Burnout in the ICU : potential consequences for staff and patient well-being
(Springer, 2008-01) Reader, Tom; Cuthbertson, Brian; Decruyenaere, Johan; University of Aberdeen, School of Medicine & Dentistry, Division of Applied Health Sciences; University of Aberdeen, School of Psychology, Psychology
Effectiveness and cost-effectiveness of arthroscopic lavage in the treatment of osteoarthritis of the knee: a mixed methods study of the feasibility of conducting a surgical placebo-controlled trial (the KORAL study)
(2010-01-01) Campbell, Marion Kay; Skea, Zoe Christina; Sutherland, Alasdair George; Cuthbertson, Brian; Entwistle, Vikki Ann; McDonald, Alison Mary; Norrie, John David Taylor; Carlson, R V; Bridgman, S; KORAL study group; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Institute of Applied Health Sciences; University of Aberdeen.Applied Medicine; University of Aberdeen.Aberdeen Centre for Evaluation
Evidence-based selection of theories for designing behaviour change interventions : using methods based on theoretical construct domains to understand clinicians' blood transfusion behaviour
(2009-11) Francis, Jillian; Stockton, Charlotte; Eccles, Martin P.; Johnston, Marie; Cuthbertson, Brian; Grimshaw, Jeremy M.; Hyde, Chris; Tinmouth, Alan; Stanworth, Simon J.; University of Aberdeen.Other Applied Health Sciences
Hydrocortisone therapy for patients with septic shock
(Massachusetts Medical Society., 2008-01-10) Sprung, Charles L.; Annane, Djillali; Keh, Didier; Moreno, Rui; Singer, Mervyn; Freivogel, Klaus; Weiss, Yoram G.; Benbenishy, Julie; Kalenka, Armin; Forst, Helmuth; Laterre, Pierre-Francois; Reinhart, Konrad; Cuthbertson, Brian; Payen, Didier; Briegel, Josef; CORTICUS Study Group; University of Aberdeen, School of Medicine & Dentistry, Division of Applied Health Sciences
Background Hydrocortisone is widely used in patients with septic shock even though a survival benefit has been reported only in patients who remained hypotensive after fluid and vasopressor resuscitation and whose plasma cortisol levels did not rise appropriately after the administration of corticotropin. Methods In this multicenter, randomized, double-blind, placebo-controlled trial, we assigned 251 patients to receive 50 mg of intravenous hydrocortisone and 248 patients to receive placebo every 6 hours for 5 days; the dose was then tapered during a 6-day period. At 28 days, the primary outcome was death among patients who did not have a response to a corticotropin test. Results Of the 499 patients in the study, 233 (46.7%) did not have a response to corticotropin (125 in the hydrocortisone group and 108 in the placebo group). At 28 days, there was no significant difference in mortality between patients in the two study groups who did not have a response to corticotropin (39.2% in the hydrocortisone group and 36.1% in the placebo group, P=0.69) or between those who had a response to corticotropin (28.8% in the hydrocortisone group and 28.7% in the placebo group, P=1.00). At 28 days, 86 of 251 patients in the hydrocortisone group (34.3%) and 78 of 248 patients in the placebo group (31.5%) had died (P=0.51). In the hydrocortisone group, shock was reversed more quickly than in the placebo group. However, there were more episodes of superinfection, including new sepsis and septic shock. Conclusions Hydrocortisone did not improve survival or reversal of shock in patients with septic shock, either overall or in patients who did not have a response to corticotropin, although hydrocortisone hastened reversal of shock in patients in whom shock was reversed. (ClinicalTrials.gov number, NCT00147004 [ClinicalTrials.gov] .)
Implementing selective digestive tract decontamination in the intensive care unit : A qualitative analysis of nurse-identified considerations
(2014-01) Marshall, Andrea P; Weisbrodt, Leonie; Rose, Louise; Duncan, Eilidh; Prior, Maria; Todd, Laura; Wells, Elisabeth; Seppelt, Ian; Cuthbertson, Brian; Francis, Jill; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Aberdeen Health Psychology Group
Interdisciplinary communication in the intensive care unit
(OUP, 2007-03) Reader, Tom; Flin, Rhona; Mearns, Kathryn; Cuthbertson, Brian; University of Aberdeen, School of Psychology, Psychology; University of Aberdeen, School of Medicine & Dentistry, Division of Applied Health Sciences
BACKGROUND: Patient safety research has shown poor communication among intensive care unit (ICU) nurses and doctors to be a common causal factor underlying critical incidents in intensive care. This study examines whether ICU doctors and nurses have a shared perception of interdisciplinary communication in the UK ICU. METHODS: Cross-sectional survey of ICU nurses and doctors in four UK hospitals using a previously established measure of ICU interdisciplinary collaboration. RESULTS: A sample of 48 doctors and 136 nurses (47% response rate) from four ICUs responded to the survey. Nurses and doctors were found to have differing perceptions of interdisciplinary communication, with nurses reporting lower levels of communication openness between nurses and doctors. Compared with senior doctors, trainee doctors also reported lower levels of communication openness between doctors. A regression path analysis revealed that communication openness among ICU team members predicted the degree to which individuals reported understanding their patient care goals (adjR2 = 0.17). It also showed that perceptions of the quality of unit leadership predicted open communication. CONCLUSIONS: Members of ICU teams have divergent perceptions of their communication with one another. Communication openness among team members is also associated with the degree to which they understand patient care goals. It is necessary to create an atmosphere where team members feel they can communicate openly without fear of reprisal or embarrassment.
The PRaCTICaL study of nurse led, intensive care follow-up programmes for improving long term outcomes from critical illness : a pragmatic randomised controlled trial
(BMJ, 2009) Cuthbertson, Brian; Rattray, J; Campbell, Marion Kay; Gager, M; Roughton, S; Smith, A; Hull, A; Breeman, S; Norrie, John David; Jenkinson, David James; Hernández, Rodolfo Andrés; Johnston, Marie; Wilson, E; Waldman, C; PRaCTICaL Study Group; University of Aberdeen, School of Medicine & Dentistry, Division of Applied Health Sciences
Objectives To test the hypothesis that nurse led follow-up programmes are effective and cost effective in improving quality of life after discharge from intensive care. Design A pragmatic, non-blinded, multicentre, randomised controlled trial. Setting Three UK hospitals (two teaching hospitals and one district general hospital). Participants 286 patients aged ≥18 years were recruited after discharge from intensive care between September 2006 and October 2007. Intervention Nurse led intensive care follow-up programmes versus standard care. Main outcome measure(s) Health related quality of life (measured with the SF-36 questionnaire) at 12 months after randomisation. A cost effectiveness analysis was also performed. Results 286 patients were recruited and 192 completed one year follow-up. At 12 months, there was no evidence of a difference in the SF-36 physical component score (mean 42.0 (SD 10.6) v 40.8 (SD 11.9), effect size 1.1 (95% CI −1.9 to 4.2), P=0.46) or the SF-36 mental component score (effect size 0.4 (−3.0 to 3.7), P=0.83). There were no statistically significant differences in secondary outcomes or subgroup analyses. Follow-up programmes were significantly more costly than standard care and are unlikely to be considered cost effective. Conclusions A nurse led intensive care follow-up programme showed no evidence of being effective or cost effective in improving patients’ quality of life in the year after discharge from intensive care. Further work should focus on the roles of early physical rehabilitation, delirium, cognitive dysfunction, and relatives in recovery from critical illness. Intensive care units should review their follow-up programmes in light of these results.
A pragmatic multi-centre randomised controlled trial of fluid loading and level of dependency in high-risk surgical patients undergoing major elective surgery : trial protocol
(2010-04-16) Cuthbertson, Brian; Campbell, Marion Kay; Stott, S.a.; Vale, Luke David; Norrie, John David; Kinsella, John; Cook, Jonathan Alistair; Brittenden, Julie; Grant, Adrian Maxwell; Foccus Study Group; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Applied Medicine; University of Aberdeen.Institute of Applied Health Sciences
A pragmatic randomised, controlled trial of intensive care follow up programmes in improving longer-term outcomes from critical illness : the PRACTICAL study
(2007-07-23) Cuthbertson, Brian; Rattray, Janice; Johnston, Marie; Wildsmith, J Anthony; Wilson, Edward; Hernandez, Rodolfo; Ramsay, Craig; Hull, Alastair M; Norrie, John; Campbell, Marion; PRaCTICaL Study Group; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Institute of Applied Health Sciences
Predicting death and readmission after intensive care discharge
(Oxford Journals, 2008-06) Campbell, Alison J.; Cook, Jonathan Alistair; Adey, Gillian; Cuthbertson, Brian; University of Aberdeen, School of Medicine & Dentistry, Division of Applied Health Sciences
Background: Despite initial recovery from critical illness, many patients deteriorate after discharge from the intensive care unit (ICU). We examined prospectively collected data in an attempt to identify patients at risk of readmission or death after intensive care discharge. Methods: This was a secondary analysis of clinical audit data from patients discharged alive from a mixed medical and surgical (non-cardiac) ICU. Results: Four hundred and seventy-five patients (11.2%) died in hospital after discharge from the ICU. Increasing age, time in hospital before intensive care admission, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and discharge Therapeutic Intervention Scoring System (TISS) score were independent risk factors for death after intensive care discharge. Three hundred and eighty-five patients (8.8%) were readmitted to intensive care during the same hospital admission. Increasing age, time in hospital before intensive care, APACHE II score, and discharge to a high dependency unit were independent risk factors for readmission. One hundred and forty-three patients (3.3%) were readmitted within 48 h of intensive care discharge. APACHE II scores and discharge to a high dependency or other ICU were independent risk factors for early readmission. The overall discriminant ability of our models was moderate with only marginal benefit over the APACHE II scores alone. Conclusions: We identified risk factors associated with death and readmission to intensive care. It was not possible to produce a definitive model based on these risk factors for predicting death or readmission in an individual patient.
Preoperative neutrophil-lymphocyte ratio and outcome from coronary artery bypass grafting
(Elsevier, 2007-11) Gibson, Patrick H.; Croal, Bernard L.; Small, Gary R.; Ifezulike, Ada I.; Gibson, George; Jeffrey, Robert R.; Buchan, Keith G.; El-Shafei, Hussein; Hillis, Graham S.; Cuthbertson, Brian; University of Aberdeen, School of Medicine & Dentistry, Division of Applied Medicine; University of Aberdeen, School of Medicine & Dentistry, Division of Applied Health Sciences
Background: An elevated preoperative white blood cell count has been associated with a worse outcome after coronary artery bypass grafting (CABG). Leukocyte subtypes, and particularly the neutrophil-lymphocyte (N/L) ratio, may however, convey superior prognostic information. We hypothesized that the N/L ratio would predict the outcome of patients undergoing surgical revascularization. Methods: Baseline clinical details were obtained prospectively in 1938 patients undergoing CABG. The differential leukocyte was measured before surgery, and patients were followed-up 3.6 years later. The primary end point was all-cause mortality. Results: The preoperative N/L ratio was a powerful univariable predictor of mortality (hazard ratio [HR] 1.13 per unit, P < .001). In a backward conditional model, including all study variables, it remained a strong predictor (HR 1.09 per unit, P = .004). In a further model, including the European system for cardiac operative risk evaluation, the N/L ratio remained an independent predictor (HR 1.08 per unit, P = .008). Likewise, it was an independent predictor of cardiovascular mortality and predicted death in the subgroup of patients with a normal white blood cell count. This excess hazard was concentrated in patients with an N/L ratio in the upper quartile (>3.36). Conclusion: An elevated N/L ratio is associated with a poorer survival after CABG. This prognostic utility is independent of other recognized risk factors.
Quality of life in the five years after intensive care : a cohort study
(2010-01-20) Cuthbertson, Brian; Roughton, Sian; Jenkinson, David James; MacLennan, Graeme Stewart; Vale, Luke David; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Institute of Applied Health Sciences
Renal function, revascularization and risk
(OUP, 2007) Hillis, Graham S.; Cuthbertson, Brian; Croal, Bernard L.; University of Aberdeen, School of Medicine & Dentistry, Division of Applied Medicine; University of Aberdeen, School of Medicine & Dentistry, Division of Applied Health Sciences
Systematic review of the clinical effectiveness and cost-effectiveness of oesophageal Doppler monitoring in critically ill and high-risk surgical patients
(National Institute for Health Research, 2009-01) Mowatt, Graham; Houston, G.; Hernández, Rodolfo Andrés; De Verteuil, Robyn; Fraser, Cynthia Mary; Cuthbertson, Brian; Vale, Luke David; University of Aberdeen, School of Medicine & Dentistry, Division of Applied Health Sciences
Objectives: To assess the effectiveness and costeffectiveness of oesophageal Doppler monitoring (ODM) compared with conventional clinical assessment and other methods of monitoring cardiovascular function. Data sources: Electronic databases and relevant websites from 1990 to May 2007 were searched. Review methods: This review was based on a systematic review conducted by the US Agency for Healthcare Research and Quality (AHRQ), supplemented by evidence from any additional studies identified. Comparator interventions for effectiveness were standard care, pulmonary artery catheters (PACs), pulse contour analysis monitoring and lithium or thermodilution cardiac monitoring. Data were extracted on mortality, length of stay overall and in critical care, complications and quality of life. The economic assessment evaluated strategies involving ODM compared with standard care, PACs, pulse contour analysis monitoring and lithium or thermodilution cardiac monitoring. Results: The AHRQ report contained eight RCTs and was judged to be of high quality overall. Four comparisons were reported: ODM plus central venous pressure (CVP) monitoring plus conventional assessment vs CVP monitoring plus conventional assessment during surgery; ODM plus conventional assessment vs CVP monitoring plus conventional assessment during surgery; ODM plus conventional assessment vs conventional assessment during surgery; and ODM plus CVP monitoring plus conventional assessment vs CVP monitoring plus conventional assessment postoperatively. Five studies compared ODM plus CVP monitoring plus conventional assessment with CVP monitoring plus conventional assessment during surgery. There were fewer deaths [Peto odds ratio (OR) 0.13, 95% CI 0.02–0.96], fewer major complications (Peto OR 0.12, 95% CI 0.04–0.31), fewer total complications (fixed-effects OR 0.43, 95% CI 0.26–0.71) and shorter length of stay (pooled estimate not presented, 95% CI –2.21 to –0.57) in the ODM group. The results of the meta analysis of mortality should be treated with caution owing to the low number of events and low overall number of patients in the combined totals. Three studies compared ODM plus conventional assessment with conventional assessment during surgery. There was no evidence of a difference in mortality (fixed-effects OR 0.81, 95% CI 0.23–2.77). Length of hospital stay was shorter in all three studies in the ODM group. Two studies compared ODM plus CVP monitoring plus conventional assessment vs CVP monitoring plus conventional assessment in critically ill patients. The patient groups were quite different (cardiac surgery and major trauma) and neither study, nor a meta-analysis, showed a statistically significant difference in mortality (fixed-effects OR 0.84, 95% CI 0.41–1.70). Fewer patients in the ODM group experienced complications (OR 0.49, 95% CI 0.30–0.81) and both studies reported a statistically significant shorter median length of hospital stay in that group. No economic evaluations that met the inclusion criteria were identified from the existing literature so a series of balance sheets was constructed. The results show that ODM strategies are likely to be cost-effective. Conclusions: More formal economic evaluation would allow better use of the available data. All identified studies were conducted in unconscious patients. However, further research is needed to evaluate new ODM probes that may be tolerated by awake patients. Given the paucity of the existing economic evidence base, any further primary research should include an economic evaluation or should provide data suitable for use in an economic model.
Utility of B-type natriuretic peptide in predicting medium-term mortality in patients undergoing major non-cardiac surgery
(Elsevier, 2007) Cuthbertson, Brian; Amiri, Amir R.; Croal, Bernard L.; Rajagopalan, Sriram; Brittenden, Julie; Hillis, Graham S.; University of Aberdeen, School of Medicine & Dentistry, Division of Applied Health Sciences; University of Aberdeen, School of Medicine & Dentistry, Division of Applied Medicine
We assessed the ability of pre-operative B-type natriuretic peptide (BNP) levels to predict medium-term mortality in patients undergoing major noncardiac surgery. During a median 654 days follow-up 33 patients from a total cohort of 204 patients (16%) died. The optimal cut-off in this cohort, determined using a receiver operating characteristic curve, was >35pg.mL-1. This was associated with a 3.47-fold increase in the hazard of death (p=0.001) and had a sensitivity of 70% and a specificity of 68% for this outcome. These findings extend recent work demonstrating that BNP levels obtained before major noncardiac surgery can be used to predict peri-operative morbidity, and indicate that they also forecast medium-term mortality.
The utility of B-type natriuretic peptide in predicting postoperative cardiac events and mortality in patients undergoing major emergency non-cardiac surgery
(Blackwell, 2007-09) Cuthbertson, Brian; Card, Gemma; Croal, Bernard L.; McNeilly, Jane; Hillis, Graham; University of Aberdeen, School of Medicine & Dentistry, Division of Applied Health Sciences
B-type natriuretic peptide (BNP) levels predict cardiovascular risk in several settings. We hypothesized that they would identify individuals at increased risk of complications and mortality following major emergency non-cardiac surgery.Forty patients were studied with a primary end-point of a new post-operative cardiac event, and/or development of significant ECG changes, and/or cardiac death. The main secondary outcome was all cause mortality at 6 months. Preoperative BNP levels were higher in 11 patients who suffered a new postoperative cardiac event (p=0.001) and predicted this outcome with an area under the receiver operating characteristic curve of 0.85 (CI=0.72-0.98,p=0.001). A pre-operative BNP value >170pg.ml-1 has a sensitivity of 82% and a specificity of 79% for the primary end-point. In this small study, pre-operative BNP levels identify patients undergoing major emergency non-cardiac surgery who are at increased risk of early post-operative cardiac events. Larger studies are required to confirm these data.
A warning on early-warning scores!
(Oxford University Press, 2007-06) Cuthbertson, Brian; Smith, G.B.; University of Aberdeen, School of Medicine & Dentistry, Division of Applied Health Sciences