Browsing by Author "Castro-Avila, Ana"
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Item Effect of early rehabilitation during intensive care unit stay on functional status: systematic review and meta-analysis(PLoS, 2015) Castro-Avila, Ana; Seron, Pamela; Fan, Eddy; Gaete, Monica; Mickan, SharonBACKGROUND AND AIM: Critically ill survivors may have functional impairments even five years after hospital discharge. To date there are four systematic reviews suggesting a beneficial impact for mobilisation in mechanically ventilated and intensive care unit (ICU) patients, however there is limited information about the influence of timing, frequency and duration of sessions. Earlier mobilisation during ICU stay may lead to greater benefits. This study aims to determine the effect of early rehabilitation for functional status in ICU/high-dependency unit (HDU) patients. DESIGN: Systematic review and meta-analysis. MEDLINE, EMBASE, CINALH, PEDro, Cochrane Library, AMED, ISI web of science, Scielo, LILACS and several clinical trial registries were searched for randomised and non-randomised clinical trials of rehabilitation compared to usual care in adult patients admitted to an ICU/HDU. Results were screened by two independent reviewers. Primary outcome was functional status. Secondary outcomes were walking ability, muscle strength, quality of life, and healthcare utilisation. Data extraction and methodological quality assessment using the PEDro scale was performed by primary reviewer and checked by two other reviewers. The authors of relevant studies were contacted to obtain missing data. RESULTS: 5733 records were screened. Seven articles were included in the narrative synthesis and six in the meta-analysis. Early rehabilitation had no significant effect on functional status, muscle strength, quality of life, or healthcare utilisation. However, early rehabilitation led to significantly more patients walking without assistance at hospital discharge (risk ratio 1.42; 95% CI 1.17-1.72). There was a non-significant effect favouring intervention for walking distance and incidence of ICU-acquired weakness. CONCLUSIONS: Early rehabilitation during ICU stay was not associated with improvements in functional status, muscle strength, quality of life or healthcare utilisation outcomes, although it seems to improve walking ability compared to usual care. Results from ongoing studies may provide more data on the potential benefits of early rehabilitation in critically ill patients.Item Factibilidad de la evaluación de la fragilidad clínica basal reportada por sobrevivientes al egreso de la unidad de cuidados intensivos(Universidad del Desarrollo. Facultad de Medicina, 2022) González Tapia, Eduardo; González-Seguel, Felipe; Castro-Avila, AnaObjetivo: evaluar la factibilidad de medir la Escala Clínica de Fragilidad (ECF) basal considerando únicamente el reporte retrospectivo de los propios sobrevivientes al egreso de la Unidad de Cuidados Intensivos (UCI). Diseño: análisis secundario del estudio observacional, prospectivo, multicéntrico “Impact on Mental, Physical and Cognitive functioning of a Critical care sTay during the COVID-19 pandemic” (IMPACCT-COVID19). Entorno: Siete centros asistenciales chilenos Participantes: entre octubre 2020 y abril 2021, se incluyeron todos los usuarios mayores de 18 años que ingresaron a las UCI’s participantes y que requirieron ventilación mecánica invasiva por más de 48 horas. Medidas de resultado: se evaluaron los 5 objetivos propuestos por Orsmond & Cohn para estudios de factibilidad. Resultados: durante los 6 meses de estudio, 1317 usuarios egresaron de las UCIs participantes y 405 cumplieron los criterios de inclusión. Tuvimos la pérdida de 90 usuarios por falta de evaluadores, 18 no aceptaron participar, 45 no pudieron ser evaluados por delirium (20 [6%]) o falta de cooperación (25 [8%]). Fue factible evaluar la ECF en 252 usuarios al egreso de la UCI. La mediana de edad fue de 57 (RIC 47–67) años, y el 64,7% fueron hombres. Un 5,2% de los pacientes tuvieron fragilidad clínica (ECF>4). Encontramos correlaciones débiles entre el nivel de fragilidad reportada por el usuario al egreso de la UCI con la edad (rho=0,27 p<0,001), nivel educacional (rho=-0,21 p<0,001), empleabilidad (rho=-0,38 p<0,001) y el índice de comorbilidades de Charlson (rho=0,37 p<0,001). Los usuarios frágiles tuvieron mayor riesgo de desarrollar debilidad adquirida en UCI (OR[IC del 95%]: 4,62 [1,17–18,12], p=0,028). Conclusiones: fue factible evaluar la ECF utilizando únicamente el reporte retrospectivo del paciente al egreso de UCI. Este método de aplicación de la ECF se suma como alternativa a la entrevista de familiares o cuidadores y a la revisión de los registros clínicos electrónicos.Item Support and follow-up needs of patients discharged from intensive care after severe COVID-19: a mixed-methods study of the views of UK general practitioners and intensive care staff during the pandemic's first wave(2021) Castro-Avila, Ana; Jefferson, Laura; Dale, Verónica; Bloor, KarenObjectives: To identify follow-up services planned for patients with COVID-19 discharged from intensive care unit (ICU) and to explore the views of ICU staff and general practitioners (GPs) regarding these patients' future needs and care coordination. Design: This is a sequential mixed-methods study using online surveys and semistructured interviews. Interview data were inductively coded and thematically analysed. Survey data were descriptively analysed. Setting: GP surgeries and acute National Health Service Trusts in the UK. Participants: GPs and clinicians leading care for patients discharged from ICU. Primary and secondary outcomes: Usual follow-up practice after ICU discharge, changes in follow-up during the pandemic, and GP awareness of follow-up and support needs of patients discharged from ICU. Results: We obtained 170 survey responses and conducted 23 interviews. Over 60% of GPs were unaware of the follow-up services generally provided by their local hospitals and whether or not these were functioning during the pandemic. Eighty per cent of ICUs reported some form of follow-up services, with 25% of these suspending provision during the peak of the pandemic and over half modifying their provision (usually to provide the service remotely). Common themes relating to barriers to provision of follow-up were funding complexities, remit and expertise, and communication between ICU and community services. Discharge documentation was described as poor and lacking key information. Both groups mentioned difficulties accessing services in the community and lack of clarity about who was responsible for referrals and follow-up. Conclusions: The pandemic has highlighted long-standing issues of continuity of care and complex funding streams for post-ICU follow-up care. The large cohort of ICU patients admitted due to COVID-19 highlights the need for improved follow-up services and communication between specialists and GPs, not only for patients with COVID-19, but for all those discharged from ICU.Item The effect of external inspections on safety in acute hospitals in the National Health Service in England: A controlled interrupted time-series analysis(2019) Castro-Avila, Ana; Bloor, Karen; Thompson, CarlObjectives: To evaluate the effect of Care Quality Commission (CQC) external inspections of acute trusts on adverse event rates in the English National Health Service (NHS). Methods: Interrupted time series analysis including all acute NHS trusts in England (n=155) using two control groups (new versus historical inspection regime and trusts not inspected). Multilevel random-coefficients modelling of 1) rates of falls with harm and 2) pressure ulcers, from April 2012 to June 2016, was undertaken using the new, resource-intensive regime of CQC inspections as an intervention. Data used in the model included dates and type of inspection, patient safety indicators, demographic characteristics and financial risk of hospitals. Results: In one year, CQC inspected 66 acute trusts (42% of all English trusts) using their new regime and 46 (30%) using their previous one. Prior to inspections being announced, rates of falls with harm and pressure ulcers were improving in both intervention and control hospitals. The announcement of an inspection did not affect either indicator. After inspections, rates of falls with harm improved more slowly and pressure ulcers rates no longer improved for trusts inspected using both regimes. Conclusions: Neither form of external inspection was associated with positive, clinically significant effects on adverse event rates. Any improvement happening before the announced CQC inspections slowed after the inspection.