Does the use of a thoracic impedance device during resuscitation improve patient outcomes compared to resuscitations without use of such a device?

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There is some evidence that use of an impedance threshold device added to active compression-decompression device  may result in small improvement in survival but impedance device added to standard cardiopulmonary resuscitation (CPR) does not improve survival.

Aufderheide TP, et al. Standard cardiopulmonary resuscitation versus active compression-decompression cardiopulmonary resuscitation with augmentation of negative intrathoracic pressure for out-of-hospital cardiac arrest: a randomised trial. Lancet. 2011 Jan 22;377(9762):301-11. RESQ Trial
1,653 adult patients with out-of-hospital cardiac arrest randomized to resuscitation with compression-decompression device plus impedance threshold device compared to standard CPR. RESULTS:  Survival to discharge without neurologic impairment was similar for both groups.

Aufderheide TP, et al. A trial of an impedance threshold device in out-of-hospital cardiac arrest. N Engl J Med. 2011 Sep 1;365(9):798-806. ROC PRIMED Trial
9,220 patients with out-of-hospital cardiac arrest randomized to standard CPR with active impedance threshold device (ITD) compared to standard CPR with sham ITD. RESULTS:  Survival to hospital discharge with normal Rankin score was 6% for the sham ITD group compared to 5.8% for the active ITD group.  Rates for return of spontaneous circulation and survival to hospital admission were also similar for both groups.

Also see Cardiac Arrest (Treatment>Other Management>Prehospital care>Improving chest compressions).  In:  DynaMed

Cabrini L, et al. Impact of impedance threshold devices on cardiopulmonary resuscitation: a systematic review and meta-analysis of randomized controlled studies. Crit Care Med. 2008 May;36(5):1625-32.
Systematic review of older, RCTs

Reviewed JKN 4/14

How do postsurgical outcomes compare for general v. local anesthesia for implantation and testing of implantable cardioverter defibrillators (ICD)?

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A search of PubMed for “Defibrillators, Implantable”[MAJR] AND (local anesthesia OR sedation) AND (outcome OR complications OR safety OR satisfaction) identified several studies.

Studies comparing local anesthesia/sedation v. general anesthesia

Can we implant cardioverter defibrillator under minimal sedation?
Marquié C, Duchemin A, Klug D, Lamblin N, Mizon F, Cordova H, Boulo M, Lacroix D, Pol A, Kacet S.
Europace. 2007 Jul;9(7):545-50.
Measured patient-reported level of pain.

Electrophysiologist-implanted transvenous cardioverter defibrillators using local versus general anesthesia.
Manolis AS, Maounis T, Vassilikos V, Chiladakis J, Cokkinos DV.
Pacing Clin Electrophysiol. 2000 Jan;23(1):96-105.
Measured rate of post-surgical complications

Local anaesthesia versus general anaesthesia for cardioverter-defibrillator implantation.
Stix G, Anvari A, Podesser B, Pernerstorfer T, Mayer C, Laufer G, Schmidinger H.
Wien Klin Wochenschr. 1999 May 21;111(10):406-9.
Measured rate of post-surgical complications

Intravenous sedation for placement of automatic implantable cardioverter-defibrillators.
Pinosky ML, Reeves ST, Fishman RL, Alpert CC, Dorman BH, Kratz JM.
J Cardiothorac Vasc Anesth. 1996 Oct;10(6):764-6.
Measured length of stay and rate of post-surgical complications

Studies describing outcomes for procedures performed under locatl anesthetic/sedation

Safety and acceptability of implantation of internal cardioverter-defibrillators under local anesthetic and conscious sedation.
Fox DJ, Davidson NC, Royle M, Bennett DH, Clarke B, Garratt CJ, Hall MC, Zaidi AM, Patterson K, Fitzpatrick AP.
Pacing Clin Electrophysiol. 2007 Aug;30(8):992-7. Erratum in: Pacing Clin Electrophysiol. 2007 Nov;30(11):1423

Additional descriptive studies

Reviewed JKN 4/14

How do acuity-based nurse staffing models affect patient safety and overall nurse staffing?

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Searching CINAHL, PubMed and Joanna Briggs, for the concepts of nurse, staffing, (acuity OR “patient classification”), safety, and outcomes, identifies the following resources:

General information on acuity systems:

Choi J, et al. Power up your staffing model with patient acuity. Nurs Manage. 2011 Sep;42(9):40-3.

Acuity systems dialogue and patient classification system essentials. Nursing administration quarterly 2007 vol:31 iss:4 pg:284

On patient safety and quality

PubMed:  “Nursing Staff, Hospital”[majr] AND (acuity OR “patient classification”) AND (safety OR mortality) which includes references such as

  • Kiekkas P, et al.   Association between nursing workload and mortality of intensive care unit patients.  J Nurs Scholarsh. 2008;40(4):385-90.
  • Massey D, et al. What factors influence suboptimal ward care in the acutely ill ward patient? Aust Crit Care. 2008 Aug;21(3):127-40.

CINAHL:   nurse staffing AND (acuity OR “patient classification”) AND (safety OR mortality OR quality OR outcome)    which includes references such as:

  • Butler M, et al.  Hospital nurse staffing models and patient and staff-related outcomes.  Cochrane Database of Systematic Reviews, 2011 (7).

Revision of post from Dec 13, 2011. JKN

What is the correlation of cancer and persons on plant based diets?

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A search of CINAHL and PubMed on the concepts of cancer and plant based diets located these articles. The general conclusion was that genetics may play a part in some individuals not receiving the same cancer prevention benefits from a plant based diet as others.

Lampe, Johanna. Interindividual differences in phytochemical metabolism and disposition. Seminars in cancer biology 2007 vol:17 iss:5 pg:347 -353

Lampe, Johanna, Interindividual differences in response to plant-based diets: implications for cancer risk. The American journal of clinical nutrition 2009 vol:89 iss:5 pg:1553S -1557S

Lampe, Johanna, Brassica, biotransformation and cancer risk: genetic polymorphisms alter the preventive effects of cruciferous vegetables. The Journal of nutrition 2002 vol:132 iss:10 pg:2991 -2994

Higdon, Jane, Cruciferous vegetables and human cancer risk: epidemiologic evidence and mechanistic basis. Pharmacological research 2007 vol:55 iss:3 pg:224 -236

Reviewed JKN 4/14

What are the most recent guidelines supporting noninvasive positive pressure?

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A search of Joanna Briggs, CINAHL and PubMed for the concept of Noninvasive positive pressure ventilation and guidelines produced the following articles.

Yifan Xue MBBS MPH, Endotracheal tube: Extubation General Medicine, Infection Control, Surgical Services 18/04/2011

Sinuff T ; Keenan SP Clinical practice guideline for the use of noninvasive positive pressure ventilation in COPD patients with acute respiratory failure. Journal of Critical Care, 2004 Jun; 19(2): 82-91

Sinuff T ; Cook DJ ; Randall J ; Allen CJ. Evaluation of a practice guideline for noninvasive positive-pressure ventilation for acute respiratory failure. CHEST, 2003 Jun; 123(6): 2062-73

Keenan, Sean, Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting. Canadian Medical Association. Journal; CMAJ 2011 vol:183 iss:3 pg:E195 -E214

Bersten, Andrew, Best practices for noninvasive ventilation. Canadian Medical Association. Journal; CMAJ 2011 vol:183 iss:3 pg:293 -294

Hess, Dean, How to initiate a noninvasive ventilation program: bringing the evidence to the bedside. Respiratory care 2009 vol:54 iss:2 pg:232 -43

Reviewed JKN 4/14

Are there studies demonstrating it to be safe for children visiting adults in the ICU in terms of spreading infections?

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Searches were conducted in PubMed & CINAHL on the concepts of children, infection, and ICU. The following guidelines, surveys, policies, and other articles all discuss children visiting and the spread of infection

Vint, Pauline, Children visiting adults in ITU-what support is available? A descriptive survey. Nursing in critical care 2005 vol:10 iss:2 pg:64 -71

Knutsson, Susanne E M, Visits of children to patients being cared for in adult ICUs: policies, guidelines and recommendations. Intensive and critical care nursing 2004 vol:20 iss:5 pg:264 -274

Johnstone, M Children visiting members of their family receiving treatment in ICUs: a literature review. Intensive and critical care nursing 1994 vol:10 iss:4 pg:289 -292

Ward, D, Practical tips from clinical nurses: opinions about children visiting. Dimensions of critical care nursing 1994 vol:13 iss:3 pg:155 -156

Spreen, Afien, Visiting policies in the adult intensive care units: a complete survey of Dutch ICUs. Intensive and critical care nursing 2011 vol:27 iss:1 pg:27 -30

Anzoletti, Antonio. Access to intensive care units: a survey in North-East Italy. Intensive and critical care nursing 2008 vol:24 iss:6 pg:366 -374

Falk, Jane, Using an evidence-based practice process to change child visitation guidelines. Clinical journal of oncology nursing 2012 vol:16 iss:1 pg:21 -23

Malacarne, Paolo Health care-associated infections and visiting policy in an intensive care unit. American journal of infection control 2011 vol:39 iss:10 pg:898 -900

Reviewed JKN 4/14

What is the effectiveness, training requirements, and benefits of nursing preceptor programs?

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These are from Joanna Briggs. A systematic review and systematic review protocal:

Edwards D, Hawker C, Carrier J, Rees C . The effectiveness of strategies and interventions that aim to assist the transition from student to newly qualified nurse. Vol 9 Issue 53 2215-2323 29/09/2011

Lee Xin Yu Jasmine, Registered nurses’ perception of their preceptor role towards pre-registration nursing students during clinical placement: A systematic review. Health Management and Assessment 14/01/2011

Three searches from CINAHL. Click the links to run.

Click here to run a CINAHL search on the concepts of preceptorship and new grads (limited to evidence based practice)

Click here to run a CINAHL search on guidelines and importance in the training of preceptors

Click here to run a CINAHL search on the benefits of preceptorship

Reviewed by John Nemeth 4/14