Daren K Heyland

..Critically ill patients have considerable oxidative stress. Glutamine and antioxidant supplementation may offer therapeutic benefit, although current data are conflicting...

..The optimal amount of calories required by critically ill patients continues to be controversial. The objective of this study is to examine the relationship between the amount of calories administered and mortality...

..We hypothesized that exogenous supplementation of trace elements and vitamins could restore antioxidant status, improving clinical outcomes...

..To develop a scoring method for quantifying nutrition risk in the intensive care unit (ICU)...

..We conclude that the CANHELP Questionnaire is a valid and internally consistent instrument to measure satisfaction with end-of-life care...

..The objective of this study was to validate and demonstrate the utility of a novel composite outcome measure, persistent organ dysfunction (POD) plus death, for clinical trials of critically ill patients...

..Satisfaction with care tends to vary based on location of interview and may vary across time with respect to certain aspects of EOL care...

..The purpose of this pilot study is to assess the feasibility, acceptability, and safety of a new feeding protocol designed to enhance the delivery of enteral nutrition (EN)...

..The purpose of this analysis was to evaluate the effect of a procalcitonin-guided antibiotic strategy on clinical and economic outcomes...

..The purpose of this pilot study was to determine whether β-d-glucan (BG) was associated with Candida in the lung and risk of death in patients with suspected ventilator-associated pneumonia (VAP)...

..The objective of this study was to identify aspects of end-of-life care that are high in priority as targets for improvement using feedback elicited from patients and their families...

..The objective of this study was to evaluate the relationship between increasing success with enteral nutrition (EN) and acquired infection in the Intensive Care Unit (ICU)...

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..To develop, validate, and implement a system to reward top performers in critical care nutrition practice and to illuminate characteristics of top-performing intensive care units (ICUs)...

..Subsequently, large, rigorously designed, randomized trials are required to elucidate the efficacy of such doses of zinc supplementation in this patient population...

..To compare a strategy of combination therapy with a strategy of monotherapy with broad-spectrum antibiotics for suspected late ventilator-associated pneumonia...

..The primary purpose of this study was to describe what seriously ill patients in hospital and their family members consider to be the key elements of quality end-of-life care...

..Improvement initiatives to target key elements identified by patients and FCGs have the potential to improve satisfaction with EOL care across care settings...

..The trial will be conducted in approximately twenty tertiary-care ICU in Canada and the first results are expected in 2009...

..When these situations arise, controversy exists whether to start feeding early via the parenteral route or to delay feeding until EN can be provided...

..Adoption of the Canadian clinical practice guidelines should lead to improved nutrition support practice in intensive care units. This may translate into better outcomes for critically ill patients receiving nutrition support...

..Strategies that improve understanding of CPR and foster discussions that involve patients, family members, and physicians in the decision-making process may improve the quantity and quality of communication and decision making about CPR...

..Most deaths in intensive care units (ICUs) follow a withdrawal of life support (LS). Evaluation of this process including the related perspectives of grieving family members is integral to improvement of palliation in the ICU...

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..The newly published data will be used to update the Canadian Clinical Practice Guidelines...

..To describe the substitute decision-makers' perspectives related to decision-making in the intensive care unit (ICU) and to determine those variables associated with their overall satisfaction with decision-making...

..This study was conducted to develop evidence-based clinical practice guidelines for nutrition support (ie, enteral and parenteral nutrition) in mechanically ventilated critically ill adults...

..The significance of Candida species in respiratory tract (RT) secretions in critically ill patients is unclear...

..To identify opportunities for quality improvement, the nutrition adequacy of critically ill surgical patients, in contrast to medical patients, is described...

..Because EN and PN are associated with risks and benefits, we systematically reviewed and critically appraised the literature to compare EN with PN the critically ill patient...

..To evaluate the effect of using supplemental parenteral nutrition compared to early enteral nutrition alone on nutritional and clinical outcomes...

..To evaluate the effect of enteral feeding protocols on key indicators of enteral nutrition in the critical care setting...

..In addition, we studied the impact of the clinical and microbiological components of CSVAP on the processes of care and outcomes...

..We investigated whether supplementing critically ill patients with antioxidants, trace elements, and vitamins improves their survival...

..The purpose of this project was to describe current nutrition support practice in the critical care setting and to identify interventions to target for quality improvement initiatives...

..To describe current nutrition practices in intensive care units and determine "best achievable" practice relative to evidence-based Critical Care Nutrition Clinical Practice Guidelines...

..The aim of this study was to determine factors that are associated with adherence to the Canadian nutrition support clinical practice guidelines (CPGs)...

..The objective of this study was to determine whether auditing practice and providing feedback in the form of benchmarked site reports is an effective strategy to improve adherence to nutrition guidelines...

..DATA SOURCES, SELECTION, AND ABSTRACTION: We conducted a structured search of Ovid Medline for interventional and observational research articles incorporating critical care and end-of-life decision-making terms...

..The purpose of this study was to determine the safety of high doses of glutamine combined with antioxidants in critically ill patients...

..To describe the perspectives of family members to the care provided to critically ill patients who died in the ICU...

..Family members are unlikely to engage in decision making unless professionals identify the decision and address other barriers to family involvement...

..The purpose of this study was to develop a comprehensive framework for understanding adherence to nutrition CPGs in the critical care setting...

..We tested the hypothesis that evidence-based algorithms to improve nutritional support in the ICU would improve patient outcomes...

..New evidence on subglottic secretion drainage as a preventive measure for ventilator-associated pneumonia has been recently published and to consider the evidence in totality, we conducted an updated systematic review and meta-analysis...

..Furthermore, guideline users need to be aware of the dissimilarities in these guidelines before applying the recommendations to their daily practice...

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..The objective of this study was to evaluate prospectively the effect of APC on long-term HRQoL and resource utilization compared with a nonrandomized control group that received standard care...

..We conducted a meta-analysis to update the totality of evidence regarding the influence of intensive insulin therapy compared with conventional insulin therapy on mortality and severe hypoglycemia in the intensive care unit (ICU)...

..Using published data and information from public health care providers, we sought to determine the impact of VAP on the Canadian health care system...

..Accordingly, in patients with CSVAP and timely initiation of empiric antibiotic therapy, we determined the impact of inadequate therapy (IT)...

..CONCLUSIONS: QOL in survivors of ARDS appears to be influenced by the mechanism of lung injury (primary vs. secondary), lending support to the concept that ARDS is a heterogeneous condition...

..To evaluate the current use of strategies to prevent ventilator-associated pneumonia (VAP) and to identify interventions to target for quality-improvement initiatives...

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..The objective of this study was to evaluate the attitudes of critical care practitioners toward the Canadian Critical Care Nutrition Clinical Practice Guidelines (CPGs) and compare them with actual practice...

..Further high quality, multimethod studies are required to improve our understanding of how culture influences guideline implementation, and which organizational change strategies might be most effective in optimizing nutrition therapy...

..Thus, our objective is to describe handover communication patterns used by attending critical care physicians in an academic centre and to compare them with currently popular, standardized schemes for handover communication...

..Using CANHELP, the nurse facilitator was able to identify opportunities for improving EoL care in patients on medical units and for making small improvements in satisfaction with care...

..In critically ill patients, glutamine supplementation may be associated with a reduction in complication and mortality rates. The greatest benefit was observed in patients receiving high-dose, parenteral glutamine...

..To determine the level of satisfaction of family members with the care that they and their critically ill relative received...

..Equivalency studies are possible, but there are sample size implications. The use of time to clinical event end points, especially when combined with mortality, may be the best option for trial in the future...

..Adopting this tailored approach to guideline implementation in future studies may help bridge the current guideline-practice gap and lead to significant improvements in nutrition practices and patient outcomes...

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..The purpose of this systematic review was to evaluate the effect of probiotics in critically ill patients on clinical outcomes...

..This paper systematically reviewed studies that compare EN + PN to enteral nutrition (EN) alone in critically ill patients...

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..However, their impact to date has been modest. This study aimed to identify important barriers and enablers to implementation of these guidelines...

..CONCLUSIONS: The FCI is a better method of measuring comorbidity with physical function as the outcome. This study illustrates the importance of choosing the most appropriate comorbidity index for the outcome of interest...

..The purpose of this paper is to systematically review those studies that compare gastric with small bowel feeding...

..Specifically, we ascertained the seriously ill patients' preferred role in the decision-making process, what factors were associated with this role, and how this stated preference related to physicians' perception of preferred role...

..Documentation of discussions and patient preferences may help to minimize misunderstandings and increase the stability of the decision during subsequent admissions to hospital...

..Concerns about safety and lack of effect on clinically important outcomes preclude strong treatment recommendations...

..There are significant correlations between lung spirometry, pulmonary symptoms, and overall HRQOL, thus suggesting the acute lung injury/ARDS is causally contributing to the observed long-term outcome...