title: Neurological assessment with validated tools in general ICU: multicenter, randomized, before and after, pragmatic study to evaluate the effectiveness of an e-learning platform for continuous medical education.
abstract: BACKGROUND
  International guidelines recommend systematic assessment of pain, agitation/sedation and delirium with validated scales for all ICU patients. However, these evaluations are often not done. We have created an e-learning training platform for the continuous medical education, and assessed its efficacy in increasing the use of validated tools by all medical and nursing staff of the participating ICUs during their daily practice.
  
  
  METHODS
  Multicenter, randomized, before and after study. The eight participating centers were randomized in two groups, and received training at different times. The use of validated tools (Verbal Numeric Rating or Behavioral Pain Scale for pain; Richmond Agitation-Sedation Scale for agitation; Confusion Assessment Method for the ICU for delirium) was evaluated from clinical data recorded in medical charts during a week, with follow-up up to six months after the training. All the operators were invited to complete a questionnaire, at baseline and after the training.
  
  
  RESULTS
  Among the 374 nurses and physicians involved, 140 (37.4%) completed at least one of the three courses. The assessment of pain (38.1 vs. 92.9%, P<0.01) and delirium (0 vs. 78.6%, P<0.01) using validated tools significantly increased after training. Observation in the follow-up showed further improvement in delirium monitoring, with no signs of extinction for pain and sedation/agitation measurements.
  
  
  CONCLUSIONS
  This e-learning program shows encouraging effectiveness, and the increase in the use of validated tools for neurological monitoring in critically ill patients lasts over time.
authors.affiliation: Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy - giovanni.mistraletti@unimi.it.|Department of Anesthesia and Intensive Care, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy - giovanni.mistraletti@unimi.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mistraletti
authors.affiliation: Department of Anesthesia and Intensive Care, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Umbrello
authors.affiliation: Department of Anesthesia and Intensive Care, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Anania
authors.affiliation: Department of Anesthesia and Intensive Care, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Andrighi
authors.affiliation: Department of Anesthesia and Intensive Care, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: DI Carlo
authors.affiliation: Department of Anesthesia and Intensive Care, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Martinetti
authors.affiliation: Department of Anesthesia and Intensive Care, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Barello
authors.affiliation: Department of Anesthesia and Intensive Care, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Sabbatini
authors.affiliation: Department of Anesthesia and Intensive Care, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Formenti
authors.affiliation: Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Maraffi
authors.affiliation: Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Marrazzo
authors.affiliation: Unit of Anesthesia and Intensive Care 1, I.R.C.C.S. San Matteo, Pavia, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Palo
authors.affiliation: Department of Health Sciences, University of Milano Bicocca, A.O. San Gerardo, Monza, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Bellani
authors.affiliation: Resuscitation and Intensive Care Unit, Fondazione I.R.C.C.S. Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Riccarda
authors.initials: R
authors.lastname: Russo
authors.affiliation: Anesthesia and Intensive Care Unit, Ospedale Civile di Desio, ASST Monza, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Francesconi
authors.affiliation: Anesthesia and Intensive Care Unit, Ospedale Civile di Legnano, ASST Ovest Milanese, Milan, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Valdambrini
authors.affiliation: Anesthesia and Intensive Care Unit, Ospedale Fatebenefratelli e Oftalmico, ASST Fatebenefratelli-Sacco, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Cigada
authors.affiliation: Unit of Anesthesia and Intensive Care 2, I.R.C.C.S. San Matteo, Pavia, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Riccardi
authors.affiliation: Department of Health Sciences, University of Milan, Milan, Italy.
authors.forename: Egidio A
authors.initials: EA
authors.lastname: Moja
authors.affiliation: Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.|Department of Anesthesia and Intensive Care, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Iapichino
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003194:Computer-Assisted Instruction; D065187:Controlled Before-After Studies; D003422:Critical Care / Q000379:methods*; D003693:Delirium / Q000175:diagnosis; D020375:Education, Distance; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000592:standards; D010147:Pain Measurement