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  • Direct feeding at the breast is associated with breast milk feeding duration among preterm infants

    November 2017 | Nutrients

    A study performed at Sheba Medical Center aimed to investigate the effect of mode (direct feeding at the breast versus expressing) and exclusivity (breast milk combined with formula versus breast milk only) as well as maternal perceptions on the duration of breast milk feeding (BMF) among preterm infants. The MetaVision clinical information system served as a platform for organising the data, which included maternal demographics (age, years of education, income, marital status) and obstetric characteristics (fertility treatment, gestational age, and delivery mode). The authors found that two factors were associated with duration of BMF among infants born before 32 weeks of gestational age: direct feeding at the breast and duration of exclusive BMF. They conclude that “Further studies are needed in order to assess interventions such as early skin to skin and breast milk expression, maternal rooming-in, minimising use of pacifier, test-weighting, as well as consultant availability, during and after discharge, which would encourage mothers of preterm infant to engage in breast milk feeding exclusively and to feed directly at the breast.”

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  • Protective effect of early low-dose hydrocortisone on ventilator-associated pneumonia (VAP) in the cancer patients: a propensity score analysis

    October 2017 | Annals of Intensive Care

    A study performed at Paoli-Calmettes Institute proposed that a low dose of hydrocortisone could help with modulation of immune response in the critically ill population. The authors reported on 190 onco-haematology patients admitted to the ICU and treated with mechanical ventilation over four years. To their knowledge, this is the first study reporting prognosis data with regard to VAP specifically in the cancer population. All data were extracted and analysed by senior physicians from MetaVision ICU. The authors found a positive effect of early low-dose hydrocortisone treatment in preventing VAP and conclude that “Critically ill cancer patients could benefit from the administration of low-dose hydrocortisone in the days surrounding mechanical ventilation initiation. This interesting result should be evaluated in a future large-scale randomized controlled trial.”

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  • Use of Levosimendan in postoperative setting after surgical repair of congenital heart disease in children

    September 2017 | Pediatr Cardiol.

    A retrospective study performed at Centre Hospitalier Universitaire Vaudois (CHUV) in Switzerland aimed to evaluate the effect of Levosimendan on cardiac output parameters in cardiac children with low cardiac output syndrome (LCOS). This study is one of the largest studies relating to the efficacy of Levosimendan in children with LCOS, which remains a major complication after congenital heart surgery. Demographic and clinical data were collected from MetaVision. The authors found that in accordance with other paediatric studies done in similar settings, Levosimendan helps stabilise and can even improve the haemodynamic condition of patients when the usual inotropic treatments have failed. It may prevent the need for mechanical cardiac support, although this should be confirmed by additional studies. They conclude that, “Levosimendan is a cardioprotective drug that will undoubtedly become part of the standard of care of the prevention and management of LCOS.”

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  • Urine flow rate monitoring in hypovolemic multiple trauma patients

    August 2017 | World Journal of Emergency Surgery

    A retrospective and observational study performed at Soroka Medical Center in Israel analysed the minute-to-minute urine flow rate (UFR) and its variability in hypotensive multiple trauma patients during the first 6 hours of their ICU stay, parameters that have not been previously reported. Clinical data were extracted from MetaVision. The authors suggest that UFR variability can serve as a reliable incipient marker of occult hypovolemia and also as an indicator of the end-point of blood volume resuscitation, and propose that it should be one of the parameters used to monitor the hemodynamic status of critically ill multiple trauma patients. Additionally, they suggest that that more comprehensive randomised and prospective studies should be undertaken to evaluate the potential clinical role of UFR variability and its influence on the ICU outcomes of multiple trauma patients.

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  • Pharmacist prescribing in critical care: an evaluation of the introduction of pharmacist prescribing in a single large UK teaching hospital

    July 2017 | Eur J Hosp Pharm

    A retrospective study aimed to describe the current scope and safety of prescribing activity undertaken by critical care pharmacists after the recent introduction of this service in a single large UK teaching hospital. As far as the authors know, this is the first study that has specifically evaluated the practice of prescribing pharmacists in UK critical care units (CCU). All general CCUs used MetaVision for electronic prescribing. The system had been customised and checked by pharmacists and included default doses for most medicines. The authors found that critical care pharmacists undertook significant prescribing activity across a wide range of therapeutic areas and that pharmacist prescribing errors were extremely uncommon. The authors note that "The low error rate in the study may have been positively influenced by the e-prescribing system having default dosing for many drugs."


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  • Heart rate time series characteristics for early detection of infections in critically ill patients

    April 2017 | J Clin Monit Comput.

    A prospective observational study performed at the surgical and medical ICUs of UZ Leuven in Belgium hypothesised that infected ICU patients can be distinguished from non-infected ICU patients based on dynamic features of serum cytokine concentrations and heart rate time series. The authors used simple metrics to quantify these time series to obtain an accurate classification of infected patients. Heart rate measurements were stored in MetaVision. The authors found that heart rate seemed to be a better marker for infection than information captured by cytokine time series when the exact stage of infection is not known. They propose that the predictive value of (expensive) biomarkers should always be weighed against the routinely monitored data, and that these biomarkers have to demonstrate added value.

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  • Effect of goal-directed therapy on outcome after oesophageal surgery: A quality improvement study

    March 2017 | PLoS One

    A Quality Improvement study performed at Academic Medical Center in The Netherlands investigated whether a stroke volume guided goal-directed therapy (GDT) improves the postoperative outcome of patients undergoing oesophageal surgery. The authors initiated a quality improvement program that used GDT as a new standard of care for all patients undergoing oesophagectomy at their institution. Patients’ characteristics, surgical outcome and oncologic results were prospectively collected from the MetaVision Patient Data Management System (PDMS). The authors found that the implementation of GDT during oesophagectomy did not reduce overall morbidity, mortality and hospital length of stay but pneumonia, mediastinal abscesses, the proportion of patients staying more than 48 hours in the ICU and fluid balance were lower in the GDT group. In light of this finding, they suggest that larger (randomised) studies are necessary to reveal possible benefits with a higher reliability, and point out that the economic impact of GDT remains to be determined.

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  • Changes in quality of life after elective surgery: an observational study comparing two measures

    March 2017 | Qual Life Res

    A prospective observational cohort study performed at Barnes Jewish Hospital compared the change in a validated quality of life measure (VR-12) after elective surgery, to a global assessment measure. It also estimated the minimum clinically important difference (MCID) for change in VR-12 quality of life and aimed to describe this change by surgical specialty. Surgical specialty and all other variables were obtained from MetaVision. The results showed the two methods of quality of life assessment to be in poor agreement. The study authors conclude that clinicians should select an instrument based on their goals, using 2.5 points as the MCID for the VR-12. They propose that future studies should confirm the difference in quality of life changes across surgical specialties and explore the reasons for such differences.

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  • Cumulative pain-related stress and developmental outcomes among low-risk preterm infants at one year corrected age

    March 2017 | Early Human Development

    A study examined the relationship between early pain-related stress (PRS) and neurodevelopmental outcomes among low-risk very preterm infants at the age of one year corrected age (CA). The authors hypothesised that increased cumulative exposure to pain would be associated with lower developmental scores. They found that among low-risk, invasive mechanical ventilation (IMV) preterm infants, increased exposure to PRS as measured by the NISS or SBP is directly and significantly associated with lower neurodevelopmental scores at 12.5 months CA. To the best of their knowledge, this is the first study that used both methods to study the correlation between PRS exposure and neurodevelopmental outcomes. Medical records from MetaVision, used in their neonatal department, served as a platform for collecting maternal and infant data.


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  • The effect of implementing an automated oxygen control on oxygen saturation in preterm infants

    February 2017 | Arch Dis Child Fetal Neonatal Ed.

    A study performed in the NICU at Leiden University Medical Centre compared the effectiveness of an automated fraction of inspired oxygen (FiO2) system with manual titration of FiO2 in maintaining oxygen saturation (SpO2) within the intended target range. This is the first study that examines the impact of having automated FiO2 implemented in routine care for longer periods of time. The characteristics of each infant as well as clinical parameters and ventilator settings (including the FiO2 and SpO2) were sampled every minute and routinely collected in MetaVision. The authors conclude that implementation of automated FiO2 control led to an increased compliance of maintaining SpO2 within the intended target range during oxygen therapy, with the study results showing a significant decrease in hyperoxaemia, although no effect on hypoxaemia. The authors suggest that additional randomised studies be performed to confirm the beneficial effects of such automated oxygen control on the outcome for preterm infants.

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