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critical care medicine and Intensive care medicine

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https://www.readbyqxmd.com/read/28097842/in-hospital-capacity-building-in-research-and-management-for-pediatric-professionals
#1
Graciela Demirdjian, Susana Rodríguez, Juan C Vassallo, Vilma Irazola, Josefa Rodríguez
We describe an educational strategy aimed at capacity-building of hospital health care professionals in research and management initiated at a pediatric hospital in 2006, and the results obtained eight years after its implementation. Research and Management in Pediatrics (GIP) is an annual 250-hour course combining meetings and off-site assignments delivered through the Hospital's on-line campus. It provides students with practical tools for research (epidemiology, methodology, bibliographic search, evidencebased medicine, biostatistics) and management (strategic planning, management programs, health services research, quality improvement, health economics)...
February 1, 2017: Archivos Argentinos de Pediatría
https://www.readbyqxmd.com/read/28096296/a-critical-asthma-standardized-clinical-and-management-plan-reduces-duration-of-critical-asthma-therapy
#2
Jackson Wong, Michael S D Agus, Dionne A Graham, Elliot Melendez
BACKGROUND AND OBJECTIVE: Reduction of critical asthma management time can reduce intensive care utilization. The goal of this study was to determine whether a Critical Asthma Standardized Clinical Assessment and Management Plan (SCAMP) can decrease length of critical asthma management time. METHODS: This retrospective study compared critical asthma management times in children managed before and after implementation of a Critical Asthma SCAMP. The SCAMP used an asthma severity score management scheme to guide stepwise escalation and weaning of therapies...
January 17, 2017: Hospital Pediatrics
https://www.readbyqxmd.com/read/28074823/pharmacological-update-new-drugs-in-cardiac-practice-a-critical-appraisal
#3
REVIEW
Rohan Magoon, Arindam Choudhury, Vishwas Malik, Ridhima Sharma, Poonam Malhotra Kapoor
Cardiac practice involves the application of a range of pharmacological therapies. An anesthesiologist needs to keep pace with the rampant drug developments in the field of cardiovascular medicine for appropriate management in both perioperative and intensive care set-up, to strengthen his/her role as a perioperative physician in practice. The article reviews the changing trends and the future perspectives in major classes of cardiovascular medicine.
January 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/28011419/implications-of-the-new-sepsis-definition-on-research-and-practice
#4
EDITORIAL
Brian C Peach
INTRODUCTION: The Society of Critical-Care Medicine and the European Society of Intensive Care Medicine recently announced a marked change in the sepsis definition. A task force of 19 sepsis clinicians and researchers made the change based on advances in the pathobiological understanding of the septic process. SUMMARY OF CHANGE: The task force determined that there were numerous justifications for a revision of the sepsis definition, which are outlined in this article...
November 24, 2016: Journal of Critical Care
https://www.readbyqxmd.com/read/28004327/nutritional-and-bioenergetic-considerations-in-critically-ill-patients-with-acute-neurological-injury
#5
Peter A Abdelmalik, Susan Dempsey, Wendy Ziai
The brain, due to intensive cellular processes and maintenance of electrochemical gradients, is heavily dependent on a constant supply of energy. Brain injury, and critical illness in general, induces a state of increased metabolism and catabolism, which has been proven to lead to poor outcomes. Of all the biochemical interventions undertaken in the ICU, providing nutritional support is perhaps one of the most undervalued, but potentially among the safest, and most effective interventions. Adequate provisions of calories and protein have been shown to improve patient outcomes, and guidelines for the nutritional support of the critically ill patient are reviewed...
December 21, 2016: Neurocritical Care
https://www.readbyqxmd.com/read/28001135/a-survey-of-physicians-attitudes-toward-decision-making-authority-for-initiating-and-withdrawing-va-ecmo-results-and-ethical-implications-for-shared-decision-making
#6
Ellen C Meltzer, Natalia S Ivascu, Meredith Stark, Alexander V Orfanos, Cathleen A Acres, Paul J Christos, Thomas Mangione, Joseph J Fins
OBJECTIVE: Although patients exercise greater autonomy than in the past, and shared decision making is promoted as the preferred model for doctor-patient engagement, tensions still exist in clinical practice about the primary locus of decision-making authority for complex, scarce, and resource-intensive medical therapies: patients and their surrogates, or physicians. We assessed physicians' attitudes toward decisional authority for adult venoarterial extracorporeal membrane oxygenation (VA-ECMO), hypothesizing they would favor a medical locus...
2016: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/27993153/hemodynamic-monitoring-in-the-era-of-evidence-based-medicine
#7
EDITORIAL
Bernd Saugel, Manu L N G Malbrain, Azriel Perel
Hemodynamic instability frequently occurs in critically ill patients. Pathophysiological rationale suggests that hemodynamic monitoring (HM) may identify the presence and causes of hemodynamic instability and therefore may allow targeting therapeutic approaches. However, there is a discrepancy between this pathophysiological rationale to use HM and a paucity of formal evidence (as defined by the strict criteria of evidence-based medicine (EBM)) for its use. In this editorial, we discuss that this paucity of formal evidence that HM can improve patient outcome may be explained by both the shortcomings of the EBM methodology in the field of intensive care medicine and the shortcomings of HM itself...
December 20, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27991798/comfortably-numb-and-back-plasma-metabolomics-reveals-biochemical-adaptations-in-the-hibernating-13-lined-ground-squirrel
#8
Angelo D'Alessandro, Travis Nemkov, Lori K Bogren, Sandra L Martin, Kirk C Hansen
Hibernation is an evolutionary adaptation that affords some mammals the ability to exploit the cold to achieve extreme metabolic depression (torpor) while avoiding ischemia/reperfusion or hemorrhagic shock injuries. Hibernators cycle periodically out of torpor, restoring high metabolic activity. If understood at the molecular level, the adaptations underlying torpor-arousal cycles may be leveraged for translational applications in critical fields such as intensive care medicine. Here, we monitored 266 metabolites to investigate the metabolic adaptations to hibernation in plasma from 13-lined ground squirrels (57 animals, 9 time points)...
December 29, 2016: Journal of Proteome Research
https://www.readbyqxmd.com/read/27977013/acupuncture-in-the-neonatal-intensive-care-unit-using-ancient-medicine-to-help-today-s-babies-a-review
#9
K L Chen, I Quah-Smith, G M Schmölzer, R Niemtzow, J L Oei
Acupuncture has been used for thousands of years in Eastern medicine for a variety of conditions and illnesses, including pain. Neonatal intensive care, on the other hand, is a relatively new branch of medicine that has emerged as the pivotal influence in increasing survival of critically ill newborn infants only within the last 50 years. Unfortunately, pain is an inevitable part of treatment in a neonatal intensive care unit (NICU). The control and prevention of pain remains a major issue for clinicians despite recognition and understanding of the myriad of short- and long-term problems that are associated with both pain and its treatment within the NICU environment...
December 15, 2016: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/27965233/research-in-review-advancing-critical-care-practice
#10
Elizabeth Bridges, Margaret M McNeill, Nancy Munro
Research published in 2016 identified strategies to enhance acute and critical care, initiated discussions on professional roles and responsibilities, clarified complex care issues, and led to robust debate. Some of this important work addressed strategies to prevent delirium and pressure ulcers, considerations for pain management within the context of the opioid abuse crisis, strategies to guide fluid resuscitation in patients with sepsis and heart failure, and ways to enhance care for family members of intensive care patients...
December 2016: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
https://www.readbyqxmd.com/read/27942002/the-impact-of-adding-a-physician-assistant-to-a-critical-care-outreach-team
#11
Hayley B Gershengorn, Yunchao Xu, Carri W Chan, Mor Armony, Michelle N Gong
RATIONALE: Hospitals are increasingly using critical care outreach teams (CCOTs) to respond to patients deteriorating outside intensive care units (ICUs). CCOT staffing is variable across hospitals and optimal team composition is unknown. OBJECTIVES: To assess whether adding a critical care medicine trained physician assistant (CCM-PA) to a critical care outreach team (CCOT) impacts clinical and process outcomes. METHODS: We performed a retrospective study of two cohorts-one with a CCM-PA added to the CCOT (intervention hospital) and one with no staffing change (control hospital)-at two facilities in the same system...
2016: PloS One
https://www.readbyqxmd.com/read/27928193/developing-a-business-plan-for-critical-care-pharmacy-services
#12
Brian L Erstad, Henry J Mann, Robert J Weber
Critical care medicine has grown from a small group of physicians participating in patient care rounds in surgical and medical intensive care units (ICUs) to a highly technical, interdisciplinary team. Pharmacy's growth in the area of critical care is as exponential. Today's ICU requires a comprehensive pharmaceutical service that includes both operational and clinical services to meet patient medication needs. This article provides the elements for a business plan to justify critical care pharmacy services by describing the pertinent background and benefit of ICU pharmacy services, detailing a current assessment of ICU pharmacy services, listing the essential ICU pharmacy services, describing service metrics, and delineating an appropriate timeline for implementing an ICU pharmacy service...
November 2016: Hospital Pharmacy
https://www.readbyqxmd.com/read/27923397/pharmacological-interventions-for-delirium-in-intensive-care-patients-a-protocol-for-an-overview-of-reviews
#13
Marija Barbateskovic, Laura Krone Larsen, Marie Oxenbøll-Collet, Janus Christian Jakobsen, Anders Perner, Jørn Wetterslev
BACKGROUND: The prevalence of delirium in intensive care unit (ICU) patients is high. Delirium has been associated with morbidity and mortality including more ventilator days, longer ICU stay, increased long-term mortality and cognitive impairment. Thus, the burden of delirium for patients, relatives and societies is considerable. Today, reviews of randomised clinical trials are produced in large scales sometimes making it difficult to get an overview of the available evidence. A preliminary search identified several reviews investigating the effects of pharmacological interventions for the management and prevention of delirium in ICU patients...
December 7, 2016: Systematic Reviews
https://www.readbyqxmd.com/read/27923227/optimal-role-of-the-nephrologist-in-the-intensive-care-unit
#14
D J Askenazi, Michael Heung, Michael J Connor, Rajit K Basu, Jorge Cerdá, Kent Doi, Jay L Koyner, Azra Bihorac, Ladan Golestaneh, Anitha Vijayan, Mark D Okusa, Sarah Faubel
As advances in Critical Care Medicine continue, critically ill patients are surviving despite the severity of their illness. The incidence of acute kidney injury (AKI) has increased, and its impact on clinical outcomes as well as medical expenditures has been established. The role, indications and technological advancements of renal replacement therapy (RRT) have evolved, allowing more effective therapies with less complications. With these changes, Critical Care Nephrology has become an established specialty, and ongoing collaborations between critical care physicians and nephrologist have improved education of multi-disciplinary team members and patient care in the ICU...
December 3, 2016: Blood Purification
https://www.readbyqxmd.com/read/27915328/critical-care-nephrology-a-multidisciplinary-approach
#15
Lilia Rizo-Topete, Claudio Ronco
Acute kidney injury (AKI) is a serious medical condition affecting millions of people. Patients in intensive care unit (ICU) who develop AKI have increased morbidity and mortality, prolonged length of stay in ICU and hospital and increased costs, especially when they require renal replacement therapy. In the latter case, morbidity and mortality increase further. In order to meet the needs of the critically ill patients, a multidisciplinary care team is required, combining the efforts of physicians and nurses from different disciplines as well as nephrologists and intensivists...
December 3, 2016: Blood Purification
https://www.readbyqxmd.com/read/27852461/the-development-of-intensive-care-in-the-military-environment
#16
REVIEW
Matthew J Roberts
If the history of critical care is to be addressed, the starting point must be the fundamental and defining qualities of intensive care units. These are the concentration of the sickest patients in a defined area of the hospital, staffed by the personnel most able to care for them (by virtue of specialist training), and the application of the most advanced monitoring or therapeutic techniques available at the time. In the military environment, the ability to provide critical care to ill or injured servicemen has developed in tandem with the civilian experience, but the pressures of the austere environment of the battlefield have, at times, held back military medical services from providing the highest level of care that servicemen might deserve and, indeed, expect in civilian life...
October 2016: Journal of Anesthesia History
https://www.readbyqxmd.com/read/27852414/-survey-of-continuous-renal-replacement-therapy-application-status
#17
C S Yang, Y Yang, L W Huang, X W Zhang, S Q Liu, H B Qiu
Objective: To investigate the condition of implementation of continuous renal replacement therapy (CRRT) in quality control center of critical care medicine. Methods: Questionnaire mails were issued to all of the quality control respondents to survey the application of CRRT in June 2015 from Jiangsu quality control center of critical care medicine. Results: Among the 69 quality control respondents, 62 were equipped with CRRT devices, and in 58 of which patients were treated with CRRT. There were 195 doctors and 253 nurses in 62 quality control respondents attended CRRT training at or above the provincial level; the proportions of hospitals in southern, central and northern regions of Jiangsu were 63%, 79% and 86% respectively with trained doctors (more than 2), and 34%, 38% and 43% respectively with trained nurses (more than 3)...
October 25, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/27852357/a-multifaceted-approach-to-reduction-of-catheter-associated-urinary-tract-infections-in-the-intensive-care-unit-with-an-emphasis-on-stewardship-of-culturing
#18
Katherine M Mullin, Christopher S Kovacs, Cynthia Fatica, Colette Einloth, Elizabeth A Neuner, Jorge A Guzman, Eric Kaiser, Venu Menon, Leticia Castillo, Marc J Popovich, Edward M Manno, Steven M Gordon, Thomas G Fraser
BACKGROUND Catheter-associated urinary tract infections (CAUTIs) are among the most common hospital-acquired infections (HAIs). Reducing CAUTI rates has become a major focus of attention due to increasing public health concerns and reimbursement implications. OBJECTIVE To implement and describe a multifaceted intervention to decrease CAUTIs in our ICUs with an emphasis on indications for obtaining a urine culture. METHODS A project team composed of all critical care disciplines was assembled to address an institutional goal of decreasing CAUTIs...
February 2017: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/27843637/critically-ill-patients-with-cancer-chances-and-limitations-of-intensive-care-medicine-a-narrative-review
#19
REVIEW
Peter Schellongowski, Wolfgang R Sperr, Philipp Wohlfarth, Paul Knoebl, Werner Rabitsch, Herbert H Watzke, Thomas Staudinger
This narrative review deals with the challenge of defining adequate therapy goals and intensive care unit (ICU) admission criteria for critically ill patients with cancer. Several specific complications of critically ill patients with cancer require close collaborations of intensive care and cancer specialists. Intensivists require a basic understanding of the pathophysiology, diagnosis and therapy of common cancer-specific problems. Cancer specialists must be knowledgeable in preventing, detecting and treating imminent or manifest organ failures...
2016: ESMO Open
https://www.readbyqxmd.com/read/27828747/book-reviews-handbook-of-critical-and-intensive-care-medicine-3rd-edn-joseph-varon-springer-2016-price-%C3%A2-42-99-pp-470-isbn-978-3-319-31603-1-introducing-palliative-care-5th-edn-edited-by-robert-twycross-andrew-wilcock-palliativedrugs-com-2016-price-%C3%A2-25-00
#20
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