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https://www.readbyqxmd.com/read/28724143/potentially-avoidable-surgical-intensive-care-unit-admissions-and-disposition-delays
#1
Navpreet K Dhillon, Ara Ko, Eric J T Smith, Mayumi Kharabi, Joseph Castongia, Michael Nurok, Bruce L Gewertz, Eric J Ley
Importance: High health care costs encourage initiatives that avoid overuse of resources and identify opportunities to promote appropriate care. Objective: To investigate the causes of potentially avoidable surgical intensive care unit (SICU) admissions and disposition delays to determine whether targeted interventions could decrease these stays. Design, Setting, and Participants: This prospective, observational study focused on potentially avoidable SICU days, as determined by observers with input from the rounding intensivists at a 24-bed open SICU at an urban, academic hospital...
July 19, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28707845/clinical-ethics-what-the-anaesthesiologist-and-the-intensivist-need-to-know
#2
Marco Vergano, Emma Magavern, Nereo Zamperetti
Clinical ethics if often perceived as an intuitive understanding of what is right versus wrong. This is insufficient for healthcare workers in general, but particularly for anesthesiologists and intensivists, who often must weigh up complex and emergent life or death decisions and subsequently justify these decisions to their team and patients, as well as patient's families. Articulating the rationale for such decisions is an arduous task. Thus, a brief introduction to the basic conceptual framework and vocabulary of clinical ethics may be useful to this population of physicians...
July 12, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28705304/clinical-practice-of-acute-respiratory-distress-syndrome-in-japan-a-nationwide-survey-and-scientific-evidences
#3
Sadatomo Tasaka, Koichiro Tatsumi
BACKGROUND: There has been limited information about epidemiology and clinical practice of acute respiratory distress syndrome (ARDS) in Japan. METHODS: An invitation letter to the web-based survey was mailed to all 871 board certified hospitals of the Japanese Respiratory Society. The questionnaires were designed to collect data on epidemiology and clinical practice of ARDS, including diagnostic measures and therapeutics. RESULTS: Within 4 months of the survey period, valid responses were obtained from 296 (34%) hospitals...
July 2017: Respiratory Investigation
https://www.readbyqxmd.com/read/28694197/feasibility-safety-and-utility-of-advanced-critical-care-transesophageal-echocardiography-performed-by-pulmonary-critical-care-fellows-in-a-medical-intensive-care-unit
#4
Yunuen Aguilera Garcia, Luis Quintero, Karan Singh, Viera Lakticova, AnnaMaria Iakovou, Seth Koenig, Mangala Narasimhan, Paul H Mayo
BACKGROUND: Competence in advanced critical care transesophageal echocardiography allows the intensivist to diagnose and manage cardiopulmonary failure when transthoracic echocardiography is not sufficient to answer the clinical question. This report describes the feasibility, safety, and utility of transesophageal echocardiography in mechanically ventilated critically ill patients performed by pulmonary and critical care fellows in a medical intensive care unit. METHODS: This is a longitudinal descriptive study of advanced transesophageal echocardiography performed in mechanically ventilated patients...
July 7, 2017: Chest
https://www.readbyqxmd.com/read/28693778/advanced-critical-care-echocardiography-the-intensivist-as-the-acce-of-hearts
#5
EDITORIAL
Paul H Mayo, Mangala Narasimhan, Seth Koenig
No abstract text is available yet for this article.
July 2017: Chest
https://www.readbyqxmd.com/read/28682859/multidisciplinary-interventions-and-continuous-quality-improvement-to-reduce-unplanned-extubation-in-adult-intensive-care-units-a-15-year-experience
#6
Chien-Ming Chao, Chih-Cheng Lai, Khee-Siang Chan, Kuo-Chen Cheng, Chung-Han Ho, Chin-Ming Chen, Willy Chou
We conduct a retrospective study of patients with unplanned extubation (UE) in adult intensive care units (ICU) at a medical center. In 2001, a multidisciplinary team of intensivists, senior residents, nurses, and respiratory therapists was established at Chi Mei Medical Center. The improvement interventions, implemented between 2001 and 2015, were organized around 8 key areas: standardizing procedures, improving communication skills, revising sedation and weaning protocols, changing strategies for restraints, establishing a task force for identifying and managing high-risk patients, using new quality-improvement models as breakthrough series and team resource management, using the strategy of accountability without assigning blame, and changing a new method to secure endotracheal tube...
July 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28679114/are-graduated-intensivists-prepared-for-practice-a-case-study-from-the-netherlands
#7
Ids S Dijkstra, Paul L P Brand, Jan Pols, Hans Delwig, Debbie A D C Jaarsma, Jaap E Tulleken
PURPOSE: An evaluation of the alignment between intensive care medicine (ICM) training and practice provides valuable information for the development of ICM training. Therefore this study examines how well recently licensed intensivists feel prepared for practice and whether intensivists from different background specialties attain comparable preparedness rates. METHODS: An inventory was developed to cover the tasks that constitute ICM practice. Two hundred five recently licensed Dutch intensivists received a questionnaire in which they could indicate how well their ICM training programme prepared them for these tasks on a 5-point Likert scale...
February 15, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28675982/oncologists-and-intensivists-attitudes-toward-the-care-of-critically-ill-patients-with-cancer
#8
Antonio Paulo Nassar, Aldo Lourenço Abadde Dettino, Cristina Prata Amendola, Rodrigo Alves Dos Santos, Daniel Neves Forte, Pedro Caruso
BACKGROUND: Patients with cancer represent an important proportion of intensive care unit (ICU) admissions. Oncologists and intensivists have distinct knowledge backgrounds, and conflicts about the appropriate management of these patients may emerge. METHODS: We surveyed oncologists and intensivists at 2 academic cancer centers regarding their management of 2 hypothetical patients with different cancer types (metastatic pancreatic cancer and metastatic breast cancer with positive receptors for estrogen, progesterone, and HER-2) who develop septic shock and multiple organ failure...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28671150/emerging-trends-of-nosocomial-pneumonia-in-intensive-care-unit-of-a-tertiary-care-public-teaching-hospital-in-western-india
#9
Rakesh Bhadade, Minal Harde, Rosemarie deSouza, Ashwini More, Ramesh Bharmal
BACKGROUND: Nosocomial pneumonia poses great challenge to an intensivist. Detailed information about hospital-acquired pneumonia (HAP) and ventilator-acquired pneumonia (VAP) is crucial for prevention and optimal management, thus improving quality Intensive Care Unit (ICU) care. Hence, we aimed to study the current trend of nosocomial pneumonia in ICU. MATERIALS AND METHODS: It was a prospective observational cohort study, conducted in the ICU of a tertiary care teaching public hospital over a period of 18 months...
July 2017: Annals of African Medicine
https://www.readbyqxmd.com/read/28669830/drivers-and-impact-of-antifungal-therapy-in-critically-ill-patients-with-aspergillus-positive-respiratory-tract-cultures
#10
J A Paiva, P Mergulhão, A Gomes, F S Taccone, A-M Van den Abeele, P Bulpa, B Misset, W Meersseman, G Dimopoulos, J Rello, D Vogelaers, S Blot
BACKGROUND: Invasive pulmonary aspergillosis (IPA) is an increasingly recognized problem in critically ill patients. Little is known about how intensivists react to a Aspergillus-positive respiratory sample and about the efficacy of antifungals. Our goal was to identify drivers of antifungal therapy (AFT) prescription and diagnostic workup in patients with Aspergillus isolation in respiratory specimens as well as the impact of AFT in these patients. METHODS: ICU patients with a Aspergillus-positive respiratory sample from the database of a previous observational multicenter study were analysed...
June 29, 2017: International Journal of Antimicrobial Agents
https://www.readbyqxmd.com/read/28668217/-non-invasive-ventilation-and-pediatric-palliative-care-a-french-survey
#11
B Ringuier, F Troussier, G Boussicault, C Chapotte, P Rachieru
OBJECTIVES: The benefits of non-invasive ventilation (NIV) have been clearly demonstrated in pediatrics. In palliative care, NIV can improve the level of comfort and quality of life and can decrease dyspnea. The objective was to survey pediatricians' opinions and practices regarding NIV in palliative care in France. DESIGN: A mail survey was conducted among pediatric pneumologists, intensivists and palliative medicine consultants from February 2015 to March 2015...
June 28, 2017: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
https://www.readbyqxmd.com/read/28666601/impact-of-a-cardiac-intensivist-on-mortality-in-patients-with-cardiogenic-shock
#12
Soo Jin Na, Taek Kyu Park, Ga Yeon Lee, Yang Hyun Cho, Chi Ryang Chung, Kyeongman Jeon, Gee Young Suh, Joong Hyun Ahn, Keumhee C Carriere, Young Bin Song, Jin-Oh Choi, Joo-Yong Hahn, Seung-Hyuk Choi, Hyeon-Cheol Gwon, Jeong Hoon Yang
BACKGROUND: This study aimed to evaluate the association between high-intensity staffing by a dedicated cardiac intensivist and clinical outcomes in CS. METHODS: We enrolled 2923 consecutive patients admitted to a cardiac care unit (CCU) from January 1, 2012 to December 31, 2015. In January 2013, the CCU changed from a low-intensity to high-intensity staffing unit managed by a dedicated cardiac intensivist. Patients were eligible if they required inotropes or vasopressors to maintain a systolic blood pressure>90mmHg, and had serum lactate≥2...
June 24, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28665202/changing-intensivists-behaviors-a-challenge-in-need-of-new-solutions
#13
Meeta Prasad Kerlin, Scott D Halpern
No abstract text is available yet for this article.
July 1, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28664445/pediatric-cardiology-provider-attitudes-about-palliative-care-a-multicenter-survey-study
#14
Emily Morell Balkin, James N Kirkpatrick, Beth Kaufman, Keith M Swetz, Lynn A Sleeper, Joanne Wolfe, Elizabeth D Blume
While availability of palliative care consultation for children with advanced heart disease increases, little is known about cardiologist attitudes towards palliative care. We sought to describe perspectives of cardiologists regarding palliative care and to characterize their perceived competence in palliative care concepts. A cross-sectional survey of pediatric cardiologists and cardiac surgeons from 19 pediatric medical centers was performed. Overall response rate was 31% (183/589). Respondents had a median of 18 years of experience since medical school (range 2-49) and most practiced at academic centers (91%)...
June 29, 2017: Pediatric Cardiology
https://www.readbyqxmd.com/read/28661973/determinants-of-antibiotic-tailoring-in-pediatric-intensive-care-a-national-survey
#15
Patricia S Fontela, Caroline Quach, Mohammad E Karim, Douglas F Willson, Elaine Gilfoyle, James Dayre McNally, Milagros Gonzales, Jesse Papenburg, Steven Reynolds, Jacques Lacroix
OBJECTIVES: To describe the criteria that currently guide empiric antibiotic treatment in children admitted to Canadian PICUs. DESIGN: Cross-sectional survey. SETTING: Canadian PICUs. SUBJECTS: Pediatric intensivists and pediatric infectious diseases specialists. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We used focus groups and literature review to design the survey questions and its four clinical scenarios (sepsis, pneumonia, meningitis, and intra-abdominal infections)...
June 28, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28661969/structural-nursing-and-physician-characteristics-and-30-day-mortality-for-patients-undergoing-cardiac-surgery-in-pennsylvania
#16
Meghan B Lane-Fall, Tara S Ramaswamy, Sydney E S Brown, Xu He, Jacob T Gutsche, Lee A Fleisher, Mark D Neuman
OBJECTIVE: Cardiac surgery ICU characteristics and clinician staffing patterns have not been well characterized. We sought to describe Pennsylvania cardiac ICUs and to determine whether ICU characteristics are associated with mortality in the 30 days after cardiac surgery. DESIGN: From 2012 to 2013, we conducted a survey of cardiac surgery ICUs in Pennsylvania to assess ICU structure, care practices, and clinician staffing patterns. ICU data were linked to an administrative database of cardiac surgery patient discharges...
June 28, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28661790/selected-use-of-telemedicine-in-intensive-care-units-based-on-severity-of-illness-improves-cost-effectiveness
#17
Byung-Kwang Yoo, Minchul Kim, Tomoko Sasaki, Jeffrey S Hoch, James P Marcin
BACKGROUND: Telemedicine in the intensive care unit (tele-ICU) is expected to address geographic health disparities through more efficient resource allocation. Our previous economic evaluation demonstrated tele-ICU to be cost-effective in most cases and cost saving in some cases, compared to conventional intensive care unit (ICU) care without adequate intensivist coverage. INTRODUCTION: This study's objective is to examine how to optimize the cost-effectiveness of tele-ICU use by selecting highest risk (i...
June 29, 2017: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
https://www.readbyqxmd.com/read/28658198/professional-responsibility-consensus-and-conflict-a-survey-of-physician-decisions-for-the-chronically-critically-ill-in-neonatal-and-pediatric-intensive-care-units
#18
Miriam C Shapiro, Pamela K Donohue, Sapna R Kudchadkar, Nancy Hutton, Renee D Boss
OBJECTIVE: To describe neonatologist and pediatric intensivist attitudes and practices relevant to high-stakes decisions for children with chronic critical illness, with particular attention to physician perception of professional duty to seek treatment team consensus and to disclose team conflict. DESIGN: Self-administered online survey. SETTING: U.S. neonatal ICUs and PICUs. SUBJECTS: Neonatologists and pediatric intensivists...
June 27, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28643979/-acute-pancreatitis-new-aspects-for-the-management
#19
Olivier Windisch, Toni Raffoul, Catrina Hansen, Jean-Louis Frossard, Philippe Morel, Léo Bühler
Acute pancreatitis is a frequent disease, with a simple course in 80 % of the cases but a high morbidity and mortality in its severe form. Biliary origin and alcohol represent 80 % of the etiologies. Except endoscopic removal of gallstone for biliary origin, treatment remains symptomatic and focuses on fluid resuscitation, effective antalgia and adapted management of nutrition. This article focuses on the novelties introduced by the revision of the Classification of Atlanta in 2012 and details current guidelines for the management of the disease...
June 14, 2017: Revue Médicale Suisse
https://www.readbyqxmd.com/read/28643577/an-assessment-of-advance-relatives-approach-for-brain-death-organ-donation
#20
Carine Michaut, Antoine Baumann, Hélène Gregoire, Corinne Laviale, Gérard Audibert, Xavier Ducrocq
BACKGROUND: Advance announcement of forthcoming brain death has developed to enable intensivists and organ procurement organisation coordinators to more appropriately, and separately from each other, explain to relatives brain death and the subsequent post-mortem organ donation opportunity. Research aim: The aim was to assess how potentially involved healthcare professionals perceived ethical issues surrounding the strategy of advance approach. RESEARCH DESIGN: A multi-centre opinion survey using an anonymous self-administered questionnaire was conducted in the six-member hospitals of the publicly funded East of France regional organ and tissue procurement network called 'Prélor'...
January 1, 2017: Nursing Ethics
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