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Background: Discomfort experienced by patients admitted to intensive care units (ICUs) is an important indicator of the quality of care provided, but few studies have evaluated the incidence and magnitude of discomfort in critically ill patients. The IPREA (Inconforts des Patients de REAnimation) discomfort questionnaire is a tool developed by French intensivists and validated in the French language with good internal consistency (Cronbach's α, 0.78)., Objectives: To translate and validate in English the IPREA discomfort questionnaire, to evaluate discomfort perceived by patients in intensive care, and to identify predictors of discomfort., Design, Setting and Participants: After translating the IPREA questionnaire using published methods that use principles of good practice for translating and culturally adapting patient-reported outcomes measures, all eligible patients (aged > 18 years, Glasgow Coma Scale score of 15, English speaking) admitted to our ICU over the 6-month period from April 2017 to September 2017 were surveyed within 24 hours of ICU discharge. Patient-perceived discomfort was measured using the translated IPREA questionnaire. The patients were asked to score their discomfort for each of 16 items on a scale of 0 (no discomfort) to 100 (maximum discomfort). An overall discomfort score was computed as the mean score of the 16 individual discomfort scores. Multivariate analysis was performed to identify predictors of discomfort., Main Outcome Measures: Translated questionnaire internal consistency. Individual and overall discomfort scores., Results: A total of 168 patients (58% men; mean age, 60.1 ± 14.8 years; mean APACHE [Acute Physiology and Chronic Health Evaluation] II score, 13.8 ± 5.6) completed the questionnaire. The translated questionnaire had good internal consistency (Cronbach's α, 0.82), and good content and construct validity (average inter-item correlation, 0.23). The mean overall discomfort score was 18.4 ± 12.5, and discomfort scores did not differ between men and women or between types of ICUs (general ICU, cardiothoracic ICU or high dependency unit). On multivariate analysis, increasing age was an independent predictor of a low discomfort score (β, -0.27; 95% CI, -0.42 to -0.12; P = 0.001)., Conclusion: Patients admitted to our ICU reported low overall discomfort. There was an inverse relationship between age and perceived discomfort. The translated questionnaire for measuring discomfort performed well in our setting and could be applied to the Australian population.

A survey was conducted to explore the perception of intensive care registrars on the impact of activities outside the intensive care unit (ICU), particularly in medical emergency teams, on their training and the care of patients. An anonymous mail-out survey was sent to 356 trainees registered with the Joint Faculty of Intensive Care Medicine, half of whom were determined to be involved in ICU duties. No patients were involved and respondents participated voluntarily. The main outcome measures were barriers and predictors of satisfaction with ICU training. One-hundred-and-thirty-six (38%) trainees responded. Seventy-eight percent had participated in a medical emergency team, of whom 99% of respondents stated the medical emergency team included an ICU registrar but rarely (3%) an ICU consultant. Sixty-six percent of respondents reported that medical emergency team involvement had a positive effect on training but 77% reported little or no supervision of team duties. While trainees did not believe they spent too much time performing medical emergency team duties, the time spent on medical emergency teams at night, when ICU staffing levels are at their lowest, was the same as during the day. Serious concern was expressed about the negative impact of medical emergency team activities on their ability to care for ICU patients and the additional stress on ICU medical and nursing staff Overall, ICU trainees regarded participation in a medical emergency team as positive on training and on patient care in wards, but other results have resource implications for the provision of clinical emergency response systems, care of patients in ICUs and the training of the future intensive care workforce.

Background: Cytoreductive surgery (CRS) combined with perioperative intraperitoneal chemotherapy (PIC) for peritoneal surface malignancy is associated with a morbidity rate of 30-50% and a mortality rate of 1-10%. Recently, the St George Hospital in Sydney has been commissioned as the Nationally Funded Center for treatment of peritoneal surface malignancy in Australia., Methods: The clinical and treatment-related data regarding 140 consecutive patients were prospectively collected. A comparison between the initial 70 patients (Group I) and the subsequent 70 patients (Group II) was performed. Univariate and multivariate analyses were conducted to identify the significant risk factors for moderate to severe morbidity., Results: The hospital mortality was 4%. Sixty-one patients (44%) had moderate morbidity. Twenty-eight patients (20%) experienced severe morbidity. The mean hospital stay was 30 days. Twenty-seven patients (19%) were readmitted after initial discharge for management of delayed complications. The severe morbidity rate reduced from 30% to 10%, and the delayed morbidity rate reduced from 29% to 10%, when comparing Groups I and II. There were also reduced transfusion requirement, duration of operation, and intensive care unit stay. In the multivariate analysis, Group I (vs Group II; P = .005), performing small bowel resection (P = .005), and >4 peritonectomy procedures (vs

Objectives: To evaluate the effectiveness of a medical emergency team (MET) in reducing the rates of selected adverse events., Design: Cohort comparison study after casemix adjustment., Patients and Setting: All adult (> or = 14 years) patients admitted to three Australian public hospitals from 8 July to 31 December 1996. INTERVENTION STUDIED: At Hospital 1, a medical emergency team (MET) could be called for abnormal physiological parameters or staff concern. Hospitals 2 and 3 had conventional cardiac arrest teams., Main Outcome Measures: Casemix-adjusted rates of cardiac arrest, unanticipated admission to intensive care unit (ICU), death, and the subgroup of deaths where there was no pre-existing "do not resuscitate" (DNR) order documented., Results: There were 1510 adverse events identified among 50 942 admissions. The rate of unanticipated ICU admissions was less at the intervention hospital in total (casemix-adjusted odds ratios: Hospital 1, 1.00; Hospital 2, 1.59 [95% CI, 1.24-2.04]; Hospital 3, 1.73 [95% CI, 1.37-2.16]). There was no significant difference in the rates of cardiac arrest or total deaths between the three hospitals. However, one of the hospitals with a conventional cardiac arrest team had a higher death rate among patients without a DNR order., Conclusions: The MET hospital had fewer unanticipated ICU/HDU admissions, with no increase in in-hospital arrest rate or total death rate. The non-DNR deaths were lower compared with one of the other hospitals; however, we did not adjust for DNR practices. We suggest that the MET concept is worthy of further study.