Alyson Takaoka

McMaster University | McMaster · Department of Clinical Epidemiology and Biostatistics

Introduction: We aimed to analyze intensive care unit (ICU)-acquired pneumonia according to 7 definitions, estimating associated hospital mortality. Methods: This cohort study was nested within an international randomized trial, evaluating the effect of probiotics on ICU-acquired pneumonia in 2650 mechanically ventilated adults. Each clinically...

Purpose To categorize, quantify and interpret findings documented in feedback letters of monitoring or auditing visits for an investigator-initiated, peer-review funded multicenter randomized trial testing probiotics for critically ill patients. Materials & methods In 37 Canadian centers, monitoring and auditing visits were performed by 3 trained...

Purpose: To study the incidence, predictors, and outcomes of diarrhea during the stay in the intensive care unit (ICU). Methods: Prospective cohort of consecutive adults in the ICU for > 24 h during a 10-week period across 12 intensive care units (ICUs) internationally. The explored outcomes were: (1) incidence of diarrhea, (2) Clostridioides di...

Background Physical rehabilitation (PR) interventions can improve physical function for adults with frailty; however, participant retention rates in randomized controlled trials (RCTs) are unknown. Objective is to summarize participant retention rates in RCTs of PR for adults with frailty. Design is a systematic review and meta-analysis (DOI:10.176...

Background: Infection control protocols, including visitor restrictions, implemented during the COVID-19 pandemic threatened the ability to provide compassionate, family-centered care to patients dying in the hospital. In response, clinicians used videoconferencing technology to facilitate conversations between patients and their families. Object...

There is growing interest in conceptualizing and diagnosing frailty. Less is understood, however, about older adults’ perceptions of the term “frail”, and the implications of being classified as “frail”. The purpose of this scoping review was to map the breadth of primary studies; and describe the meaning, perceptions, and perceived implications of...

Background Scaling-up and sustaining healthcare interventions can be challenging. Our objective was to describe how the 3 Wishes Project (3WP), a personalized end-of-life intervention, was scaled-up and sustained in an intensive care unit (ICU). Methods In a longitudinal mixed-methods study from January 12,013 - December 31, 2018, dying patients a...

Background: Physical therapy initiated early in an ICU stay may reduce functional deficits in critically ill patients; however, the association of frailty with outcomes in those receiving early in-ICU rehabilitation is unknown. Objective: To estimate the association between frailty and 3 outcomes in patients enrolled in an ICU randomized clinica...

Importance Although family members of patients who die in the intensive care unit commonly experience long-term psychological distress, end-of-life bereavement support programs for such relatives are uncommon. Whether art influences the grief experience of families is largely unexplored. Objective To explore the influence of personalized paintings...

Diagnosing and responding to frailty in older adult populations is of growing interest for health care professionals, researchers and policymakers. Preventing frailty has the potential to improve health outcomes for older adults, which in turn has significant implications for health care systems. However, little is known about how older people unde...

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has affected the hospital experience for patients, visitors, and staff. Objective: To understand clinician perspectives on adaptations to end-of-life care for dying patients and their families during the pandemic. Design: Mixed-methods embedded study. (Clinic...

Background A recent randomized trial of bereaved family members of patients who died in an intensive care unit identified symptoms of depression and posttraumatic stress in recipients of semistructured condolence letters. Objectives To explore family member and clinician experiences with receiving or sending handwritten sympathy cards upon the dea...

Background Healthcare organisations are increasingly interested in improving the work life of their employees. By encouraging individualised acts of compassion for dying patients and their families, the 3 Wishes Project (3WP) has been shown to ease grief for both families and clinicians. Purpose The objective of this study was to explore the persp...

Background: Scaling-up and sustaining healthcare interventions can be challenging. Our objective was to describe how the 3 Wishes Project (3WP), a personalized end-of-life intervention, was scaled-up and sustained in an intensive care unit (ICU). Methods: In a longitudinal mixed-methods study from January 1,2013 - December 31, 2018, dying patients...

Objectives: To describe the importance of critical care clinical research that is not pandemic-focused during pandemic times; outline principles to assist in the prioritization of nonpandemic research during pandemic times; and propose a guiding framework for decisions about whether, when and how to continue nonpandemic research while still honori...

Background: Survivors of critical illness may experience physical function deficits following intensive care unit (ICU) discharge. In-ICU cycle ergometry may facilitate early mobilization and decrease functional impairment. Objective: We conducted a systematic review and meta-analyses to understand the effect of in-ICU leg cycle ergometry on pat...

Background: The 3 Wishes Project (3WP) is an end-of-life program that honors the dignity of dying patients by fostering meaningful connections among patients, families, and clinicians. Since 2013, it has become embedded in the culture of end-of-life care in over 20 ICUs across North America. The purpose of the current study is to describe the vari...

Background The 3 Wishes Project is a semistructured program that improves the quality of care for patients dying in the intensive care unit by eliciting and implementing wishes. This simple intervention honors the legacy of patients and eases family grief, forging human connections between family members and clinicians. Aim To examine how the 3 Wi...

Context Keepsakes are a relatively unexplored form of bereavement support that is frequently provided as part of the 3 Wishes Project (3WP). The 3WP is a palliative care intervention in which individualized wishes are implemented in the adult intensive care unit for dying patients and their families. Objectives We aimed to characterize and enumera...

This scoping review synthesized perceptions of frailty language, classification, the meaning of the term frailty and potential implications amongst community-dwelling older adults. Eight studies were included in the review and three core themes were identified: 1) understanding frailty as a multi-dimensional concept and inevitable consequence of a...

Purpose The 3 Wishes Project (3WP) promotes holistic end-of-life care in the intensive care unit (ICU) to honor dying patients, support families, and encourage clinician compassion. Organ donation is a wish that is sometimes made by, or on behalf of, critically ill patients. Our objective was to describe the interface between the 3WP and organ dona...

Background: The 3 Wishes Project (3WP) is an end-of-life program that aims to honor the dignity of dying patients by creating meaningful patient- and family-centered memories while promoting humanistic interprofessional care. Objective: To determine whether this palliative intervention could be successfully implemented-defined as demonstrating v...

Objectives The objectives of this mixed-methods study were to assess the uptake, sustainability and influence of the Footprints Project. Setting Twenty-two-bed university-affiliated ICU in Hamilton, Canada. Participants ICU patients admitted and their families, as well as clinicians. Interventions We developed a personalised patient Footprints F...

Introduction Diarrhoea is a frequent concern in the intensive care unit (ICU) and is associated with prolonged mechanical ventilation, increased length of ICU stay, skin breakdown and renal dysfunction. However, its prevalence, aetiology and prognosis in the critically ill have been poorly studied. The primary objectives of this study are to determ...

Purpose To describe pre-ICU frailty in critically ill patients using the Clinical Frailty Scale (CFS). Methods We included patients ≥18 years admitted to 2 ICUs in Hamilton, Canada. The ICU Research Coordinator (RC) generated 3 CFS scores using: 1) chart review, 2) family interview, 3) patient interview. Subsequently, an overall impression was cap...