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Critical care medicine

Andrew R Pines, Aditya Khurana, George M Mastorakos, Kent R Richter, Walker L Asprey
Certain medical schools have begun teaching courses in health systems science (HSS) to train medical students in skills aimed to improve health care in the United States. Although substantial research has been done on the potential benefit of HSS courses, reactions from students have not been reported. In this Invited Commentary, five medical students who have completed the first year of a longitudinal HSS course at the Arizona campus of the Mayo Clinic School of Medicine offer their observations of how early exposure to HSS affected their reactions to subsequent coursework and current events in health care...
July 17, 2018: Academic Medicine: Journal of the Association of American Medical Colleges
Diane K Brown, Ambrose H Wong, Rami A Ahmed
Interprofessional education (IPE) using simulations provides a rich environment for mastery learning and deliberate practice. The debriefing phase is identified as the most valuable by learners, yet investigation into the most effective format for debriefing interprofessional (IP) groups has largely gone unexplored. To determine the best practices in IP simulation debriefing, we compared perceived effectiveness of in-person versus teledebriefing, and single versus IP co-debriefer models according to 404 Debriefing Assessment for Simulation in Healthcare Student-Version (DASH-SV) scores from students in medicine, nursing, and respiratory therapy (n = 135) following three critical care simulations...
July 19, 2018: Journal of Interprofessional Care
Steffen Eychmüller, Sibylle Felber
Anticipation at the end of life - a critical appraisal for the clinical practice Abstract. Advance planning or anticipation in health care is based on prognosis, and that is no more (and no less) than dealing with probabilities. Knowledge about prognostic factors in medicine is needed here, and competencies how to communicate it. In medicine, advance planning is currently more and more regarded as an elementary right as an expression of the implementation of patient autonomy - but what content can or must be discussed and defined? The terminology on the subject of "advance planning" is inconsistent both nationally and internationally...
July 2018: Therapeutische Umschau. Revue Thérapeutique
Saurabh Saluja, Swagoto Mukhopadhyay, Julia R Amundson, Allison Silverstein, Jessica Gelman, Hillary Jenny, Yihan Lin, Anthony Moccia, Ramy Rashad, Rachita Sood, Nakul P Raykar, Mark G Shrime
Purpose: Quality of care is an emerging area of focus in the surgical disciplines. However, much of the emphasis on quality is limited to high-income countries. To address this gap, we conducted a systematic review of the literature on the quality of essential surgical care in low- and middle- income countries (LMIC). Data sources: We searched PubMed, Cinahl, Embase and CAB Abstracts using three domains: quality of care, surgery and LMIC. Study selection: We limited our review to studies of essential surgeries that pertained to all three search domains...
July 18, 2018: International Journal for Quality in Health Care
Kate M Cohen, Rebecca D Minehart, Lisa R Leffert
PURPOSE OF REVIEW: This review summarizes the pathophysiology, peripartum treatment, and anesthetic management of parturients with cardiac disease. Valvular disease, coronary disease, and cardiomyopathy are specifically addressed in the context of the normal physiologic changes of pregnancy. We offer recommendations for anesthetic approaches, hemodynamic goals with an emphasis on interdisciplinary planning between anesthesiologists, cardiologists, cardiothoracic surgeons, obstetricians, maternal fetal medicine specialists, and neonatologists...
July 18, 2018: Current Treatment Options in Cardiovascular Medicine
Krishna Aparanji, Shreedhar Kulkarni, Megan Metzke, Yvonne Schmudde, Peter White, Cassie Jaeger
Delirium is a key quality metric identified by The Society of Critical Care Medicine for intensive care unit (ICU) patients. If not recognised early, delirium can lead to increased length of stay, hospital and societal costs, ventilator days and risk of mortality. Clinical practice guidelines recommend ICU patients be assessed for delirium at least once per shift. An initial audit at our urban tertiary care hospital in Illinois, USA determined that delirium assessments were only being performed 31% of the time...
2018: BMJ Open Quality
Samuel A Tisherman, Antoinette Spevetz, Sandralee A Blosser, Daniel Brown, Cherylee Chang, Philip A Efron, Michael O'Connor, Jonathan E Sevransky, Brian T Wessman
OBJECTIVES: In the United States, physician training in Critical Care Medicine has developed as a subspecialty of different primary boards, despite significant commonality in knowledge and skills. The Society of Critical Care Medicine appointed a multidisciplinary Task Force to examine alternative approaches for future training. DESIGN: The Task Force reviewed the literature and conducted informal discussions with key stakeholders. Specific topics reviewed included the history of critical care training, commonalities among subspecialties, developments since a similar review in 2004, international experience, quality patient care, and financial and workforce issues...
June 28, 2018: Critical Care Medicine
Derek L Isenberg, Katrina M Kissman, Ellie P Salinski, Mark A Saks, Loreen B Evans
Introduction: In 2013 the Society for Critical Care Medicine (SCCM) published guidelines for the management of pain and agitation in the intensive care unit (ICU). These guidelines recommend using an analgesia-first strategy in mechanically ventilated patients as well as reducing the use of benzodiazepines. Benzodiazepines increase delirium in ICU patients thereby increasing ICU length of stay. We sought to determine whether a simple educational intervention for emergency department (ED) staff, as well as two simple changes in workflow, would improve adherence to the SCCM guidelines...
July 2018: Western Journal of Emergency Medicine
Hajer Nouira, Asma Ben Abdelaziz, Meriem Kacem, Habiba Ben Sik Ali, Mohamed Fkih Hassen, Ahmed Ben Abdelaziz
OBJECTIVE: Collect, through a literature review, the indicators recommended for the measurement of performance in the Intensive Care Unit (ICU) and determine their typology. METHODS: This systematic review was conducted in Medline, using the following search strategy: ("Critical Care"[Mesh] OR "Critical Care Nursing"[Mesh] OR "Intensive Care Units"[Mesh]) AND "Quality Indicators, Health Care"[Mesh] AND (hasabstract[text] AND "2012/01/01"[PDat]: "2016/12/31"[PDat] AND "humans"[MeSH Terms] AND (English[lang] OR French[lang]))...
July 13, 2018: Anaesthesia, Critical Care & Pain Medicine
Morgan I Soffler, Dru D Claar, Jakob I McSparron, Daniel N Ricotta, Margaret M Hayes
No abstract text is available yet for this article.
July 16, 2018: Annals of the American Thoracic Society
Xiukun Wu
Aviation medicine is being recognized as a rising star and an indispensable part of the "trinity" medical emergency network composed of land, water and air. The unparalleled mobility and traffic advantages of aircraft, especially rotorcraft (helicopter), are playing an increasingly important role in rescuing the dying and wounded, especially the critical patients, and thus derive a new medical operation mode. How to adapt to the development of the situation and the progress of the times, give full play to the advantages of aviation medical care? The key factors are improvement of the level of service efficiency, strength of learning, practice courage, innovation, and good at summing up to keep pace with the times...
June 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Society Of Critical Care Medicine Chinese Medical Association
No abstract text is available yet for this article.
June 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Lars Bossen, Alessio Gerussi, Vasiliki Lygoura, George F Mells, Marco Carbone, Pietro Invernizzi
Autoimmune liver diseases (AILDs) are complex conditions, which arise from the interaction between a genetic susceptibility and unknown environmental triggers. They represent a relevant cause of liver failure and liver transplantation worldwide. As a testimony of our progress in understanding the biology of AILDs and the disease progression is the overall median survival which has increased over the last decade. However, there are still major challenges such as the lack of therapies and surveillance strategies in primary sclerosing cholangitis (PSC), the management and treatment of non-responders to first-line therapies in primary biliary cholangitis (PBC) and the need for tailoring immunosuppressive drugs in autoimmune hepatitis (AIH)...
July 10, 2018: Autoimmunity Reviews
Yuki Maruchi, Masanobu Tsuda, Hisatake Mori, Nobuyoshi Takenaka, Takayoshi Gocho, Muhammad A Huq, Naoshi Takeyama
BACKGROUND: Recent studies have suggested that excessive formation of neutrophil extracellular traps (NETs) plays a critical role in the pathogenesis of sepsis. Although elevation of the plasma level of cell-free DNA (cf-DNA) has been reported in sepsis patients, there has been little direct measurement of circulating free NETs such as myeloperoxidase-conjugated DNA (MPO-DNA). The objectives of this study were to detect NETs in the bloodstream of patients with septic shock, and to assess the correlations of circulating NET levels with organ dysfunction, disease severity, and mortality...
July 13, 2018: Critical Care: the Official Journal of the Critical Care Forum
Dimitria A Mathys, Dixie F Mollenkopf, Joany C Van Balen, Thomas E Wittum
The dissemination of Enterobacteriaceae expressing resistance to clinically important antibiotics such as extended-spectrum cephalosporins (ESC), carbapenems, and fluoroquinolones is of critical concern to both human and veterinary medicine. In healthcare facilities, the movement of patients, personnel, and equipment provides an opportunity for Enterobacteriaceae carrying antibiotic resistance genes to disseminate in the hospital environment where they pose a threat to patients, staff, and hospital visitors...
July 13, 2018: Vector Borne and Zoonotic Diseases
Steven R Insler
No abstract text is available yet for this article.
July 2018: Cleveland Clinic Journal of Medicine
Karin Mohn Engebretsen
The search for causal explanations in medically unexplained syndromes such as burnout has not been resolved by evidence-based medicine. A biomedical model encourages a reductionist diagnostic practice and a dualist split between physical and psychological symptoms. Therefore, diagnosing and treating these syndromes remains a challenge. Depression is a common aspect in burnout and, as a result, clinicians often diagnose burnout patients as depressed. The Norwegian government expects medical efficiency to reduce sick leaves...
July 12, 2018: Journal of Evaluation in Clinical Practice
Roxana-Maria Amărandi, Diana F Becheru, George M Vlăsceanu, Mariana Ioniță, Jorge S Burns
Regenerative medicine is challenged by the need to conform to rigorous guidelines for establishing safe and effective development and translation of stem cell-based therapies. Counteracting widespread concerns regarding unproven cell therapies, stringent cell-based assays seek not only to avoid harm but also to enhance quality and efficacy. Potency indicates that the cells are functionally fit for purpose before they are administered to the patient. It is a paramount quantitative critical quality attribute serving as a decisive release criterion...
2018: BioMed Research International
Qing Zhang, Jian-Hua Sun, Jia-Tao Liu, Xiao-Ting Wang, Da-Wei Liu
Background: Jejunal feeding tube allows the nutrition of critical care patients more easy and safe. However, its placement remains a challenge. This study aimed to introduce a jejunal feeding tube through an ultrasound-guided antral progressive water injection method and subsequently to examine its efficacy. Methods: Between April 2016 and April 2017, 54 patients hospitalized in the Department of Critical Care Medicine, Peking Union Medical College Hospital, China who needed nutritional support through a jejunal feeding tube were recruited for this study...
July 20, 2018: Chinese Medical Journal
Bara Ricou, Marine Desarmenien, Jérôme Pugin
The progress of intensive care medicine allows the survival of patients with severe critical illness. However, the quality of life of patients with a prolonged stay in intensive care unit (ICU) can be poor. The physical and psychological consequences are due more to the intensive care than the primary diagnoses. Moreover, a stay of a beloved in an ICU impacts heavily on the relatives. The service of Geneva ICU developed a specific model of care for patients with a prolonged stay and seeks to establish a follow-up consultation for these patients...
July 11, 2018: Revue Médicale Suisse
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