Dr. med. Sebastian Berger

Research Project  | 3 Project Members

Background: Assessment of the pupils regarding symmetry and reactivity to light are important parts of the neurological evaluation of critically ill patients treated in intensive care units. Thereby, anisocoria can be found in up to 60% of patients with acute neurologic injuries(2). Furthermore, anisocoria or pupillary areflexia can be signs of increasing intracranial hypertension with brain herniation, ischemia in traumatic brain injury, cerebrovascular accidents, intoxication with psychotropic and neurotropic drugs including anticholinergic, opioids, and cannabinoids. While anisocoria or impaired pupillary reactivity may result from such devastating cerebral injuries, they can also be caused by more benign and potentially reversible scenarios, such as pharmacological effects (e.g. agents such as ipatroprium bromide) or as part of the Horner’s syndrome following jugular central venous cannulation. Despite these well-known underlying pathomechanisms of pupillary anomalias, data on the prevalence and associated clinical consequences of anisocoria in non-selected general ICU populations is scarce. Due to the lack of data on the prognostic implications of anisocoria or changes in pupillary reactivity for non-neurological ICU patients, the new onset of any pupillary abnormality necessitates a rapid and thorough evaluation usually including clinical neurological examination and the performance of neuroimaging, such as a cerebral computed tomography (CT) or magnetic resonance imaging (MRI). Considering the the variety of more benign and reversible causes of pupillary abnormalities, alongside the potential for missed underlying pathomechanisms with severe clinical implications, it is highly probable that a significant number of unremarkable CT or MRI scans are conducted to investigate acute pupillary abnormalities. This practice may expose patients to unnecessary risks and contribute to increased healthcare costs. While quantitative pupillometry with dynamic pupil assessments after light has shown some promise to distinguish between clinically relevant anisocoria and benign variations, further validation is still lacking. Unfortunately, studies elucidating to what extent a cerebral CT or MRI detects clinically relevant findings in specific patient groups with particular clinical contexts, and in which clinical scenarios CTs are likely to provide no clinical relevance beyond exposing the patient to radiation are still pending.

Objectives: This retrospective single-center cohort study has four primary objectives. 

-   First, it aims to determine the prevalence of acute "new onset" pupillary abnormalities (anisocoria and/or impaired light-reactive pupillary response) in adult ICU patients. 

-   Second, it seeks to assess the clinical impact of these abnormalities, particularly in terms of the frequency of diagnostic tests ordered, such as neuroimaging (i.e., head CT or MRI scans, and ophthalmologic and neurologic consultations. 

-   Third, the study aims to identify specific clinical contexts in which significant pathological findings lead to treatment modifications, as well as those scenarios where no clinically relevant findings are detected.

-   Finally, it evaluates the prognostic implications of these pupillary abnormalities on patient outcomes.

Research Project  | 3 Project Members

The aim of this retrospective observational single-center cohort study is to investigate the factors associated with palliative care (PC) referral, examine intensive care unit (ICU) involvement before, during, or after the referral, and evaluate patient outcomes such as mortality, hospital and ICU length of stay, mdischarge destination, functional status, symptom management, and the content of PC consultation reports.

Research Project  | 3 Project Members

Background: According to the International Labor Organization, workplace violence is defined as any action, incident or behavior that departs from reasonable conduct in which a person is assaulted, threatened, harmed, injured in the course of, or as a direct result of his or her work (4). Healthcare workers are at the highest risk of experiencing workplace violence of any occupational group (5). Workplace violence is a common and widespread occurrence and is of growing concern in the health care industry because of the additional burden it places on the health care system and staff (6-8). Violence can occur in a wide variety, ranging from verbal or physical offenses to sexual harassment (9, 10). Workplace violence has been studied primarily in psychiatric and emergency departments but is believed to be understudied and underreported in other settings such as the intensive care unit (8). Very little is known about its prevalence and potential risk factors, resulting in a lack of awareness and established preventative and intervention strategies (11, 12). 

Workplace violence can be an additional burden on staff in addition to long working hours, shift work and understaffing. It has been shown to be associated with an increased likelihood of poor mental and general health and risk of burnout (13). This may further exacerbate the ongoing shortage of ICU professionals as violence leads healthcare workers to leave their field due to the adverse working conditions (14, 15). Importantly, workplace violence might lead to lower levels of nurse patient safety competence (16). Since the problem is not limited to the ICU but is common to all of healthcare, the knowledge gained from studying this issue can most likely be transferred to other areas of healthcare to improve the work environment and safety of both staff members and patients.

This study aims to investigate the perceptions, experiences, and responses of healthcare professionals working in the intensive care units in Switzerland concerning patient violence. It will examine the frequency, context, and underlying factors contributing to violent incidents, as well as the measures taken by staff to manage these situations. Additionally, the study will explore how personal, educational, and professional backgrounds influence healthcare professionals' understanding and handling of patient violence. The research will also assess the impact of such incidents on staff well-being, job satisfaction, and patient care, with the goal of identifying effective measures for prevention and intervention.

To achieve the objectives of this study, we will administer a online questionnaire-based multi-center survey in REDcap and a paper questionnaire (participants may choose their preferred way of answering) to consenting nurses and physicians working in the ICU. The questionnaire will cover various aspects, including personal background (such as education and professional role), the frequency and nature of past incidents of workplace violence, the responses and measures taken following these incidents, any psychological or professional consequences experienced, and current strategies for preventing violence. Additionally, the survey will seek participants' suggestions for improving safety and creating a more supportive work environment in the ICU. Participating in this study will create no additional risk or burden for patients and is therefore classified under category A according to HRO Art. 7.(1)

Objectives: To gather insights into the experiences, characteristics, and attitudes of healthcare professionals working in the ICU at the University Hospital Basel in Switzerland, regarding workplace violence from patients. This study will focus on incidents where patients or relatives exhibited violent behaviour towards ICU staff members and aims to explore factors such as the context of these incidents, their impact, and the aftermath of it.

The following hypotheses will be tested: Healthcare professionals working in the ICU will perceive workplace violence from patients or relatives in various ways, with differing views on its frequency, manifestations, context, and impact. The study will explore how often such incidents occur, the characteristics of the incidents, how they are reported (if at all), and the aftermath of these incidents, including any personal or professional consequences.

Methods: The primary endpoints of this study will be to compile information on healthcare professionals' perceptions, experiences, and attitudes regarding workplace violence from patients or relatives in the ICU, including the frequency, context, impact, and reporting of such incidents.

The secondary endpoints will explore associations between specific demographics, personal, educational, and professional backgrounds, as well as prior experiences, with healthcare professionals' perceptions of and responses to workplace violence, including factors influencing reporting and the aftermath of violent incidents.

We therefore will employ a multi-center survey design using a questionnaire-based approach. The questionnaire will be distributed to consenting nurses and physicians working in the ICU at the participating hospitals (planned inclusion at University Hospital Basel, Kantonsspital Aarau, Inselspital Bern, Spitalzentrum Biel, Universitätsspital Zürich and others). Based on the results and feasibility of our initial survey, we aim to broaden the scope to include additional Swiss intensive care units, transforming the study into a multi-center survey. This approach would allow for a more comprehensive analysis of the issue, capturing diverse perspectives and increasing the generalizability of the findings. Consent is given by participants by filling out the questionnaire, as the participants will be prompted about the further use of the data they enter during the questionnaire.

References

1.         Council TSF. Ordinance on Human Research with the Exception of Clinical Trials (HRO)2013.

2.         Council TSF. Ordinance on Clinical Trials in Human Research (HRA)2013.

3.         World Medical A. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. Jama. 2013;310(20):2191-4.

4.         ILO. Code of practice on workplace violence in services sectors and measures to combat this phenomenon. International Labour Review. 2003;143(October):20.

5.         U.S. Bureau of Labor Statistics. Workplace Violence in healthcare. 2018.

6.         Liu J, Gan Y, Jiang H, Li L, Dwyer R, Lu K, et al. Prevalence of workplace violence against healthcare workers: a systematic review and meta-analysis. Occup Environ Med. 2019;76(12):927-37.

7.         Vento S, Cainelli F, Vallone A. Violence Against Healthcare Workers: A Worldwide Phenomenon With Serious Consequences. Front Public Health. 2020;8:570459.

8.         Berger S, Grzonka P, Frei A, Hunziker S, Baumann S, Amacher S, et al. Violence against healthcare professionals in intensive care units: a systematic review and meta-analysis of frequency, risk factors, interventions, and preventive measures. Critical Care. 2024.

9. Spector PE, Zhou ZE, Che XX. Nurse exposure to physical and nonphysical violence, bullying, and sexual harassment: a quantitative review. Int J Nurs Stud. 2014;51(1):72-84.

10. Shafran-Tikva S, Zelker R, Stern Z, Chinitz D. Workplace violence in a tertiary care Israeli hospital - a systematic analysis of the types of violence, the perpetrators and hospital departments. Israel Journal of Health Policy Research. 2017;6(1):43.

11. Hahn S, Müller M, Hantikainen V, Kok G, Dassen T, Halfens RJ. Risk factors associated with patient and visitor violence in general hospitals: results of a multiple regression analysis. Int J Nurs Stud. 2013;50(3):374-85.

12. Slack RJ, French C, McGain F, Bates S, Gao A, Knowles S, et al. Violence in intensive care: a point prevalence study. Crit Care Resusc. 2022;24(3):272-9.

13. Stahl-Gugger A, Hämmig O. Prevalence and health correlates of workplace violence and discrimination against hospital employees - a cross-sectional study in German-speaking Switzerland. BMC Health Serv Res. 2022;22(1):291.

14. Poon Y-SR, Lin YP, Griffiths P, Yong KK, Seah B, Liaw SY. A global overview of healthcare workers’ turnover intention amid COVID-19 pandemic: a systematic review with future directions. Human Resources for Health. 2022;20(1):70.

15. LeClaire M, Poplau S, Linzer M, Brown R, Sinsky C. Compromised Integrity, Burnout, and Intent to Leave the Job in Critical Care Nurses and Physicians. Critical Care Explorations. 2022;4(2):e0629.

16. Lanctôt N, Guay S. The aftermath of workplace violence among healthcare workers: A systematic literature review of the consequences. Aggression and violent behavior. 2014;19(5):492-501.

Research Project  | 2 Project Members

This study aims to investigate the perceptions, experiences, and responses of healthcare professionals working in intensive care units in Switzerland concerning patient violence.

Research Project  | 4 Project Members

Background: Brain death is the irreversible loss of brain function necessary to sustain life. Its diagnosis is based on the absence of brainstem reflexes, unresponsiveness to endo- or exogenous stimuli, apnea, and the exclusion of factors confounding the clinical presentation(4). While other organ functions may be preserved, the identification of brain death raises the question of whether viable organs can and should be transplanted to save the lives of critically ill patients in need of organ support.

 

With advancements in critical care techniques enabling the maintenance of organ function beyond brain death, as well as the intricate legal and regulatory frameworks surrounding organ donation, healthcare professionals in intensive care units are increasingly faced with complex clinical scenarios, considerations, and challenges related to the concept and diagnosis of brain death and ethical and legal aspects associated with organ donation. Studies investigating the individual conceptual understanding of brain death and organ donation of health care professionals on Intensive Care Units (ICUs) as well as their experiences and opinions related to these topics, are scarce(5-8).

 

Objectives: The study aims to gather information regarding the individual perceptions, opinions, beliefs, and conceptual understanding of healthcare professionals working in the intensive care units at the University Hospital Basel and to determine associations of individual beliefs, personal, educational, and professional experiences with individual perceptions, opinions, and conceptual understanding regarding brain death and organ donation. 

To achieve the study objectives, we will employ a questionnaire-based survey administered to the consenting/participating nurses and physicians. The questionnaire will address various aspects related to personal background, religious affiliation, beliefs about life after death, the conceptual understanding of brain death and organ donation, as well as experiences and opinions related to these topics.

Participating in this study will create no additional risk or burden for patients and is therefore classified under category A according to HRO Art. 7.(1)

The primary objective of this study is to gather insights into the individual perceptions, opinions, beliefs, and conceptual understanding regarding brain death and organ donation of healthcare professionals working in the ICU at the University Hospital Basel in Switzerland. 

The following hypotheses will be tested: Individual perceptions, opinions, beliefs, and conceptual understanding regarding brain death and organ donation vary between the different professions and in dependence of specific aspects regarding personal, educational and professional experiences.

The primary endpoints of this study will be information on individual perceptions, opinions, beliefs, and conceptual understanding of healthcare professionals in the ICU regarding brain death and organ donation and the identification ofinterprofessional variations.

The secondary endpoints will be associations of specific demographics, beliefs, personal, educational, social and professional experiences with individual perceptions, opinions, and conceptual understanding regarding brain death and organ donation.

References

1.         Council TSF. Ordinance on Human Research with the Exception of Clinical Trials (HRO)2013.

2.         Council TSF. Ordinance on Clinical Trials in Human Research (HRA)2013.

3.         World Medical A. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. Jama. 2013;310(20):2191-4.

4.         Wijdicks EF. The diagnosis of brain death. N Engl J Med. 2001;344(16):1215-21.

5.         Ferhatoglu SY, Ferhatoglu MF, Gurkan A. Approach of the Clinicians Practicing in Intensive Care Units to Brain Death Diagnosis and Training Expectations in Turkey: A Web-Based Survey. Transplant Proc. 2020;52(10):2916-22.

6.         Al-Mousawi M, Abdul-Razzak M, Samhan M. Attitude of ICU staff in Kuwait regarding organ donation and brain death. Transplant Proc. 2001;33(5):2634-5.

7.         Ong JS, James Foong W, Oo WL, Vallapil MK, Hossain MM, Hossain H, et al. Does knowledge and attitude of healthcare professionals working in critical care areas affect their willingness to offer the option of organ donation? results of a tertiary hospital survey. Med J Malaysia. 2022;77(3):347-56.

8.         Camut S, Baumann A, Dubois V, Ducrocq X, Audibert G. Non-therapeutic intensive care for organ donation: A healthcare professionals' opinion survey. Nurs Ethics. 2016;23(2):191-202.

Research Project  | 2 Project Members

The aim of this retrospective observational single-center cohort study is to (1) examine the frequency of physical restraint use in a Swiss intensive care unit, (2) identify related adverse events, and (3) determine risk factors associated with their use and complications in critically ill adult patients.