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Biomedical subjects

Ken Hillman

Publications and source records attributed to Ken Hillman.

12 recordsLinked to original sources
PubMed2006

Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. I. Definitions.

OBJECTIVE: Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) have been increasingly recognized in the critically ill over the past decade. The variety of definitions proposed has led to confusion and difficulty in comparing one study to another. DESIGN: An international consensus group of critical care specialists convened at the second World Congress on Abdominal Compartment Syndrome to standardize definitions for IAH and ACS based upon the current understanding of the pathophysiology surrounding these two syndromes. METHODS: Prior to the conference the authors developed a blueprint for the various definitions, which was further refined both during and after the conference. The present article serves as the final report of the 2004 International ACS Consensus Definitions Conference and is endorsed by the World Society of Abdominal Compartment Syndrome (WSACS). RESULTS: IAH is redefined as an intra-abdominal pressure (IAP) at or above 12 mmHg. ACS is redefined as an IAP above 20 mmHg with evidence of organ dysfunction/failure. ACS is further classified as either primary, secondary, or recurrent based upon the duration and cause of the IAH-induced organ failure. Standards for IAP monitoring are set forth to facilitate accuracy of IAP measurements from patient to patient. CONCLUSIONS: State-of-the-art definitions for IAH and ACS are proposed based upon current medical evidence as well as expert opinion. The WSACS recommends that these definitions be used for future clinical and basic science research. Specific guidelines and recommendations for clinical management of patients with IAH/ACS are published in a separate review.

Abdomen↗
PubMed2005

Guidelines for the uniform reporting of data for Medical Emergency Teams.

It is more than 15 years since the first Medical Emergency Team (MET) system was introduced to identify patients at risk and prevent serious adverse events in Liverpool Hospital, Sydney, Australia. Since then the MET system has been introduced to many other hospitals in Australia and around the world. Standardised and complete reporting of data related to MET activity is increasingly important to identify the role and benefits of the system and to facilitate quality improvement in health care in general. A uniform method for reporting data related to MET activity will aid interpretation of results, comparisons, review and changes to the MET system. The guidelines for uniform reporting of data in relation to MET activities used in our group of hospitals are presented. Future refinement and consensus agreement on the reporting of MET data internationally should enable comparisons between MET systems in several countries.

Australia↗
PubMed2004

A comparison of antecedents to cardiac arrests, deaths and emergency intensive care admissions in Australia and New Zealand, and the United Kingdom--the ACADEMIA study.

Many patients have physiological deterioration prior to cardiac arrest, death and intensive care unit (ICU) admission, that are detected and documented by medical and nursing staff. Appropriate early response to detected deterioration is likely to benefit patients. In a multi-centre, prospective, observational study over three consecutive days, we studied the incidence of antecedents (serious physiological abnormalities) preceding primary events (defined as in-hospital deaths, cardiac arrests, and unanticipated ICU admissions) in 90 hospitals (69 United Kingdom [UK]; 19 Australia and 2 New Zealand [ANZ]). 68 hospitals reported primary events during the three-day study period (50 United Kingdom, 16 Australia and 2 New Zealand). Data on the availability of ICU/HDU beds and cardiac arrest teams and Medical Emergency Teams were also collected. Of 638 primary events, there were 308 (48.3%) deaths, 141 (22.1%) cardiac arrests, and 189 (29.6%) unplanned ICU admissions. There were differences in the pattern of primary events between the UK and ANZ (P < 0.001). There were proportionally more deaths in the UK (52.3% versus 35.3%) and a higher number of unplanned ICU admissions in ANZ (47.3% versus 24.2%). Sixty percent (383) of primary events had a total of 1032 documented antecedents. The most common antecedents were hypotension and a fall in Glasgow Coma Scale. The proportion of ICU/HDU to general hospital beds was greater in ANZ (0.034 versus 0.016, P < 0.001) and medical emergency teams were more common in ANZ (70.0% versus 27.5%, P = 0.001). The data confirm antecedents are common before death, cardiac arrest, and unanticipated ICU admission. The study also shows differences in patterns of primary events, the provision of ICU/HDU beds and resuscitation teams, between the UK and ANZ. Future research, focusing upon the relationship between service provision and the pattern of primary events, is suggested.

Adolescent↗
PubMed2003

Expanding intensive care medicine beyond the intensive care unit.

Intensive care medicine probably requires the artificial boundaries of an intensive care unit to nurture and legitimize the specialty. The next major step in intensive care medicine is to explore ways of optimizing the outcome of seriously ill patients by recognizing and resuscitating them at an earlier stage. Some of these ways include better education of existing staff; earlier consultation; and automatic calling by intensive care staff to abnormalities identifying at-risk patients. Some of these interventions are currently being evaluated and results should soon indicate their relative effectiveness.

Acute Disease↗
PubMed2003

A clinical model for Health Services Research-the Medical Emergency Team.

Health Services Research (HSR) is a relatively recent discipline which describes how health care delivery occurs and the evaluation of that care. The implementation of a Medical Emergency Team (MET) is an example of a health service intervention. The aim of the MET is to extend the expertise of Intensive Care across the hospital to all at-risk patients. The MET criteria for calling are based on simple abnormalities in vital signs with an extra "worried" category to empower junior medical and nursing staff to call for help. The concept is based on early intervention and resuscitation of the seriously ill, hopefully leading to improved outcomes from intensive care and perhaps even avoiding admission to an intensive care unit. The problems of implementing major health service change and evaluating the effectiveness of that change presents a different challenge to evaluating a new drug or procedure and is approached within different research frameworks.

Emergency Treatment↗
PubMed2003

Capacity of screening questionnaires to predict psychiatric morbidity 18 months after motor vehicle accidents.

Motor vehicle accidents are one of the most common causes of trauma-related psychiatric morbidity. Previous studies have suggested that symptom screening instruments may be useful in predicting risk of longer-term psychiatric morbidity, but results have varied. The present study is based on 83 of an eligible 102 consecutive hospital-admitted survivors of road trauma who completed a structured clinical interview at baseline and 18-month follow-up. A subsample returned symptom questionnaires within 2 weeks of the accident, with between 60 and 66 completing the questionnaire. Receiver Operator Characteristic curve analyses were applied to obtain optimal predictive scores on each screening measure. Combining the derived cutoff scores on the Impact of Event Scale (measuring posttraumatic stress disorder symptoms) and the Beck Depression Inventory yielded an odds ratio of 82.9 in predicting any psychiatric morbidity at 18 months, with a specificity of 95%, and high positive (89%) and negative (91%) predictive indices. If these exploratory findings are confirmed by future studies, the case will be strengthened for routine screening of motor vehicle accident survivors to allow ongoing monitoring and selective early interventions for the high-risk subgroup. Compliance with completing and returning questionnaires remains a major challenge in this population, however, as indicated by the level of attrition in our study.

Accidents, Traffic↗
PubMed2002

Clinical examination is an inaccurate predictor of intraabdominal pressure.

This study was designed to establish if clinical examination can accurately predict intraabdominal pressure (IAP). Between August 1998 and March 2000 a prospective blinded observational study of postoperative intensive care unit patients was undertaken at a major trauma center. IAP was measured using an intravesicular technique and compared with clinical evaluation. An IAP of at least 18 mmHg was considered elevated. The sensitivity, specificity, positive predicative value (ppv), negative predictive value (npv), kappa score, and reliability analysis were calculated. A total of 110 patients provided 150 estimates of IAP, which was elevated in 21%. The kappa score was 0.37; sensitivity, 60.9%; specificity, 80.5%; ppv, 45.2%; npv, 88.6%. The mean difference in IAP values between intravesicular readings and clinical estimates was -1.0 +/- 4.1. Prediction of IAP using clinical examination is not accurate enough to replace intravesicular IAP measurements.

Abdominal Injuries↗
PubMed2002

Patterns and characteristics of ethnic Australian women utilising ethno-specific maternal and child health services.

Few studies have explored the socio-economic profile, service utilisation, obstetric history and pregnancy outcomes of ethnic women who utilise ethno-specific obstetric services in Australia. The purpose of this study was to form a profile of women who accessed the Ethnic Obstetric Liaison Services (EOLO) in South Western Sydney Area Health Service (SWSAHS), New South Wales and explore their beliefs about using maternal and infant health services. We found that the prevalence of risks and special needs varied significantly by language groups in this study sample. Our results suggest that equity of access to quality care for this group of mothers and infants can be assured if models similar to the EOLO in SWSAHS are thoroughly planned and developed, and take account of cultural appropriateness for the population served.

Adult↗
PubMed2002

Critical care without walls.

Critical care medicine is a relatively young specialty that was developed in response to potentially reversible life-threatening illness and was facilitated by developments such as new drugs, support equipment, and monitoring technology. It has been largely practiced within the four walls of an intensive care unit (ICU). However, now there are increasing numbers of critically ill and at-risk patients in acute hospitals who are suffering potentially preventable, serious complications that may result in death because of a lack of appropriate systems, skills, and expertise outside of the ICU. Critical care specialists are expanding their roles beyond the four walls of their ICUs and becoming involved with strategies such as the medical emergency team, a concept designed to recognize critical illness early and to respond rapidly to resuscitate patients wherever they are in the hospital.

Critical Care↗
PubMedDate not supplied

Can structured interviews for posttraumatic stress disorder assist clinical decision-making after motor vehicle accidents? An exploratory analysis.

Motor vehicle accidents (MVAs) represent one of the most common causes of posttraumatic stress disorder (PTSD) worldwide. Predicting those MVA survivors who are likely to experience PTSD in the longer-term has attracted substantial research attention, but most investigators have concluded that early traumatic stress symptoms have only moderate predictive power. The present study focuses on a decision-tree approach that might be useful to clinicians attempting to identify subgroups of MVA survivors with graduated degrees of risk. Eighty-three consecutive MVA admissions (response rate, 65%) were assessed by structured clinical interview within 2 weeks of the accident and at 18 months follow-up. Meeting full criteria for PTSD (other than the time criterion) at baseline achieved a positive predictive power of 0.92 in identifying those who had PTSD over the following 18 months. For the remainder, the PTSD "arousal" domain achieved a positive predictive power of 0.81 for predicting those with either subthreshold PTSD or full PTSD over the 18-month follow-up period. The implications for further research into a stepped approach to intervention and monitoring are discussed.

Accidents, Traffic↗
PubMedDate not supplied

Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial.

BACKGROUND: Patients with cardiac arrests or who die in general wards have often received delayed or inadequate care. We investigated whether the medical emergency team (MET) system could reduce the incidence of cardiac arrests, unplanned admissions to intensive care units (ICU), and deaths. METHODS: We randomised 23 hospitals in Australia to continue functioning as usual (n=11) or to introduce a MET system (n=12). The primary outcome was the composite of cardiac arrest, unexpected death, or unplanned ICU admission during the 6-month study period after MET activation. Analysis was by intention to treat. FINDINGS: Introduction of the MET increased the overall calling incidence for an emergency team (3.1 vs 8.7 per 1000 admissions, p=0.0001). The MET was called to 30% of patients who fulfilled the calling criteria and who were subsequently admitted to the ICU. During the study, we recorded similar incidence of the composite primary outcome in the control and MET hospitals (5.86 vs 5.31 per 1000 admissions, p=0.640), as well as of the individual secondary outcomes (cardiac arrests, 1.64 vs 1.31, p=0.736; unplanned ICU admissions, 4.68 vs 4.19, p=0.599; and unexpected deaths, 1.18 vs 1.06, p=0.752). A reduction in the rate of cardiac arrests (p=0.003) and unexpected deaths (p=0.01) was seen from baseline to the study period for both groups combined. INTERPRETATION: The MET system greatly increases emergency team calling, but does not substantially affect the incidence of cardiac arrest, unplanned ICU admissions, or unexpected death.

Emergency Service, Hospital↗