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Critical care, intensive care

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https://www.readbyqxmd.com/read/29240847/characterizing-hospitalist-practice-and-perceptions-of-critical-care-delivery
#1
Joseph R Sweigart, David Aymond, Alfred Burger, Andy Kelly, Nick Marzano, Thomas McIlraith, Peter Morris, Mark V Williams, Eric M Siegal
BACKGROUND: Intensivist shortages have led to increasing hospitalist involvement in critical care delivery. OBJECTIVE: To characterize the practice of hospitalists practicing in the intensive care unit (ICU) setting. DESIGN: Survey of hospital medicine physicians. SETTING: This survey was conducted as a needs assessment for the ongoing efforts of the Critical Care Task Force of the Society of Hospital Medicine Education Committee...
December 6, 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/29239978/picu-length-of-stay-factors-associated-with-bed-utilization-and-development-of-a-benchmarking-model
#2
Murray M Pollack, Richard Holubkov, Ron Reeder, J Michael Dean, Kathleen L Meert, Robert A Berg, Christopher J L Newth, John T Berger, Rick E Harrison, Joseph Carcillo, Heidi Dalton, David L Wessel, Tammara L Jenkins, Robert Tamburro
OBJECTIVES: ICU length of stay is an important measure of resource use and economic performance. Our primary aims were to characterize the utilization of PICU beds and to develop a new model for PICU length of stay. DESIGN: Prospective cohort. The main outcomes were factors associated with PICU length of stay and the performance of a regression model for length of stay. SETTING: Eight PICUs. PATIENTS: Randomly selected patients (newborn to 18 yr) from eight PICUs were enrolled from December 4, 2011, to April 7, 2013...
December 12, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29239951/the-clinical-utility-of-noninvasive-pulse-co-oximetry-hemoglobin-measurements-in-dark-skinned-critically-ill-patients
#3
Susan M Murphy, Shahed Omar
BACKGROUND: The primary objective of this study was to assess the clinical usefulness of a point-of-care device which measures hemoglobin noninvasively (SpHb) in a group of critically ill participants with dark skin pigmentation. METHODS: One hundred forty-six adult and pediatric participants from a multidisciplinary intensive care unit had intermittent readings of noninvasive hemoglobin measurements performed at a minimum of 4 hourly intervals. A total of 371 readings were analyzed...
December 11, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29239683/managing-cancer-care-through-service-delivery-networks-the-role-of-professional-collaboration-in-two-european-cancer-networks
#4
Joan Prades, Verdiana Morando, Valeria D Tozzi, Didier Verhoeven, Jose R Germà, Josep M Borras
Background The study examines two meso-strategic cancer networks, exploring to what extent collaboration can strengthen or hamper network effectiveness. Unlike macro-strategic networks, meso-strategic networks have no hierarchical governance structures nor are they institutionalised within healthcare services' delivery systems. This study aims to analyse the models of professional cooperation and the tools developed for managing clinical practice within two meso-strategic, European cancer networks. Methods Multiple case study design based on the comparative analysis of two cancer networks: Iridium, in Antwerp, Belgium and the Institut Català d'Oncologia in Catalonia, Spain...
January 1, 2017: Health Services Management Research
https://www.readbyqxmd.com/read/29238423/an-epistemological-view-on-risk-exposure-assessment-a-case-study
#5
Daniele Chiffi, Paola Berchialla, Dario Gregori
Background: Research in Health Risk Assessment is increasingly covering a preeminent role in health care studies. However, risk assessment faces the issue of properly measuring risk exposure. Objective: The aim of the study has been to tackle some methodological issues regarding the risk assessment analysis in the health field, giving more emphasis to a philosophical and epistemological approach in order to show the difficulties in adopting suitable exposure assessment techniques...
2017: Open Nursing Journal
https://www.readbyqxmd.com/read/29236864/biomarkers-as-predictors-of-mortality-in-critically-ill-patients-with-solid-tumors
#6
Audrey M Dos Reis, Ana V G Fruchtenicht, Luiza C DE Athaydes, Sérgio Loss, Luis Fernando Moreira
Biochemical markers produced by the affected organ or body in response to disease have gained high clinical value due to assess disease development and being excellent predictors of morbidity and mortality. The aim of this study is to analyze different biochemical markers in critically cancer patients and to determine which of them can be used as predictors of mortality. This is a prospective, cross-sectional study conducted at a University Hospital in Porto Alegre - RS. Screening was done to include patients in the study...
December 11, 2017: Anais da Academia Brasileira de Ciências
https://www.readbyqxmd.com/read/29234525/invasive-candida-infection-after-upper-gastrointestinal-tract-surgery-for-gastric-cancer
#7
Evgeni Brotfain, Gilbert Sebbag, Michael Friger, Boris Kirshtein, Abraham Borer, Leonid Koyfman, Dmitry Frank, Yoav Bichovsky, Jochanan G Peiser, Moti Klein
Upper gastrointestinal tract (GIT) surgical procedures are more likely to cause nosocomial Candida peritonitis than lower GIT procedures and they thus constitute an independent risk factor for mortality. Because of the severity of postsurgical fungal infections complications, intensivists and surgeons need to be extremely aware of their clinical importance in critically ill postsurgical intensive care unit (ICU) patients. We analyzed the clinical and microbiological data of 149 oncologic patients who were hospitalized in the ICU at Soroka Medical Center between January 2010 and January 2015 after undergoing upper GIT surgery for gastric cancer...
2017: International Journal of Surgical Oncology
https://www.readbyqxmd.com/read/29234503/study-protocol-for-a-phase-ii-dose-evaluation-randomized-controlled-trial-of-cholecalciferol-in-critically-ill-children-with-vitamin-d-deficiency-vitdal-picu-study
#8
Dayre McNally, Karin Amrein, Katharine O'Hearn, Dean Fergusson, Pavel Geier, Matt Henderson, Ali Khamessan, Margaret L Lawson, Lauralyn McIntyre, Stephanie Redpath, Hope A Weiler, Kusum Menon
Background: Clinical research has recently demonstrated that vitamin D deficiency (VDD) is highly prevalent in the pediatric intensive care unit (PICU) and associated with worse clinical course. Multiple adult ICU trials have suggested that optimization of vitamin D status through high-dose supplementation may reduce mortality and improve other clinically relevant outcomes; however, there have been no trials of rapid normalization in the PICU setting. The objective of this study is to evaluate the safety and efficacy of an enteral weight-based cholecalciferol loading dose regimen in critically ill children with VDD...
2017: Pilot and Feasibility Studies
https://www.readbyqxmd.com/read/29234370/electroacupuncture-improves-gastric-emptying-in-critically-ill-neurosurgical-patients-a-pilot-study
#9
Man-Ling Kao, Yao-Li Chen, Shu-Ching Lee, Sung-Yen Huang, Ping-Yi Lin
Objective: To compare the efficacy of combined electroacupuncture and metoclopramide treatment with that of metoclopramide only in improving gastric emptying in critically ill neurosurgical patients. Methods: In this prospective case-control pilot study, a total of 16 adult critically ill mechanically ventilated patients who were treated in the surgical intensive care unit were enrolled. Electrical stimulation was applied to 4 pairs of points (maximum intensity < 9...
2017: Evidence-based Complementary and Alternative Medicine: ECAM
https://www.readbyqxmd.com/read/29233441/professional-and-pre-professional-pharmacy-students-perceptions-of-team-based-learning-tbl-at-a-private-research-intensive-university
#10
Danielle M Miller, Karen Khalil, Olivia Iskaros, Jenny A Van Amburgh
BACKGROUND AND PURPOSE: Pharmacy students need to develop critical thinking and problem-solving skills as well as be a valuable team member. The use of team based learning (TBL) fosters effective team collaboration, enables continuous active and self-directed learning, and requires both individual and team accountability. The purpose was to evaluate pharmacy students' perceptions and experiences related to TBL in different years of the pharmacy curriculum. EDUCATIONAL ACTIVITY AND SETTING: Two classes, Introduction to the Profession of Pharmacy (intro), a required course, and Self-Care/Non-Prescription Medications (self-care), an elective course, utilize the TBL approach...
July 2017: Currents in Pharmacy Teaching & Learning
https://www.readbyqxmd.com/read/29232903/pediatric-thermal-burns-and-treatment-a-review-of-progress-and-future-prospects
#11
REVIEW
Elton Mathias, Madhu Srinivas Murthy
Burn injuries are a devastating critical care problem. In children, burns continue to be a major epidemiologic problem around the globe resulting in significant morbidity and death. Apparently, treating these burn injuries in children and adults remains similar, but there are significant physiological and psychological differences. The dermal layer of the skin is generally thinner in neonates, infants, and children than in adults. Enhanced evaporative loss and need for isotonic fluids increases the risk of hypothermia in the pediatric population...
December 11, 2017: Medicines (Basel, Switzerland)
https://www.readbyqxmd.com/read/29232173/tele-pediatric-intensive-care-for-critically-ill-children-in-syria
#12
Muhammad Bakr Ghbeis, Katherine M Steffen, Elizabeth A Braunlin, Gregory J Beilman, Jay Dahman, Waseem Ostwani, Marie E Steiner
BACKGROUND: Armed conflicts can result in humanitarian crises and have major impacts on civilians, of whom children represent a significant proportion. Usual pediatric medical care is often disrupted and trauma resulting from war-related injuries is often devastating. High pediatric mortality rates are thus experienced in these ravaged medical environments. INTRODUCTION: Using simple communication technology to provide real-time management recommendations from highly trained pediatric personnel can provide substantive clinical support and have a significant impact on pediatric morbidity and mortality...
December 12, 2017: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
https://www.readbyqxmd.com/read/29228951/hypovitaminosis-c-and-vitamin-c-deficiency-in-critically-ill-patients-despite-recommended-enteral-and-parenteral-intakes
#13
Anitra C Carr, Patrice C Rosengrave, Simone Bayer, Steve Chambers, Jan Mehrtens, Geoff M Shaw
BACKGROUND: Vitamin C is an essential water-soluble nutrient which cannot be synthesised or stored by humans. It is a potent antioxidant with anti-inflammatory and immune-supportive roles. Previous research has indicated that vitamin C levels are depleted in critically ill patients. In this study we have assessed plasma vitamin C concentrations in critically ill patients relative to infection status (septic shock or non-septic) and level of inflammation (C-reactive protein concentrations)...
December 11, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29228939/the-ethics-of-caring-for-hospital-dependent-patients
#14
Calvin Sung, Jennifer L Herbst
BACKGROUND: Hospital-dependent patients are individuals who are repeatedly readmitted to the hospital because their acute medical needs cannot be met elsewhere. Unlike the chronically critically ill, these patients do not have a continuous need for life-sustaining equipment and can experience periods of relative stability where they have a good quality of life. However, some end up spending months or even years in the hospital receiving resource-intensive care because they are unable to be safely discharged, despite an initial optimistic prognosis...
December 11, 2017: BMC Medical Ethics
https://www.readbyqxmd.com/read/29228858/common-patterns-of-regional-brain-injury-detectable-by-dti-in-otherwise-normal-appearing-white-matter-in-patients-with-early-moderate-to-severe-traumatic-brain-injury
#15
Kristine O'Phelan, Chad Kuniyuki Otoshi, Thomas M Ernst, Linda Chang
Traumatic brain injury (TBI) alters the lives of millions of people every year. Although mortality rates have improved, due to better prehospital care and reduction of secondary injury in the critical care setting, improvements in functional outcomes after TBI have been difficult to achieve. Diffusion-tensor imaging (DTI) allows detailed measurement of microstructural damage in regional brain tissue after TBI, thus improving our understanding of the extent and severity of TBI. METHODS: Twenty subjects were recruited from a Neurological Intensive Care Unit, and compared to 18 healthy control subjects...
December 11, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/29228380/elderly-versus-nonelderly-patients-with-invasive-aspergillosis-in-the-icu-a-comparison-and-risk-factor-analysis-for-mortality-from-the-aspicu-cohort
#16
D K Matthaiou, G Dimopoulos, F S Taccone, P Bulpa, A M Van den Abeele, B Misset, W Meersseman, H Spapen, T Cardoso, P E Charles, D Vogelaers, S Blot
Data regarding the epidemiology and diagnosis of invasive aspergillosis in the critically ill population are limited, with data regarding elderly patients (≥75 years old) even scarcer. We aimed to further compare the epidemiology, characteristics and outcome of elderly versus nonelderly critically ill patients with invasive aspergillosis (IA) Prospective, international, multicenter observational study (AspICU) including adult intensive care unit (ICU) patients, with a culture and/or direct examination and/or histopathological sample positive for Aspergillus spp...
December 8, 2017: Medical Mycology: Official Publication of the International Society for Human and Animal Mycology
https://www.readbyqxmd.com/read/29228133/regional-epidemiology-of-methicillin-resistant-staphylococcus-aureus-among-adult-intensive-care-unit-patients-following-state-mandated-active-surveillance
#17
Michael Y Lin, Mary K Hayden, Rosie D Lyles, Karen Lolans, Louis F Fogg, Alexander J Kallen, Stephen G Weber, Robert A Weinstein, William E Trick
Background: In 2007, Illinois became the first state in the United States to mandate active surveillance of methicillin-resistant Staphylococcus aureus (MRSA). The Illinois law applies to intensive care unit (ICU) patients; contact precautions are required for patients found to be MRSA-colonized. However, the effectiveness of a legislated "search and isolate" approach to reduce MRSA burden among critically ill patients is uncertain. We evaluated whether the prevalence of MRSA colonization declined in the 5 years after the start of mandatory active surveillance...
December 7, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/29225790/update-on-ventilator-associated-pneumonia
#18
REVIEW
Jean-Francois Timsit, Wafa Esaied, Mathilde Neuville, Lila Bouadma, Bruno Mourvllier
Ventilator-associated pneumonia (VAP) is the most frequent life-threatening nosocomial infection in intensive care units. The diagnostic is difficult because radiological and clinical signs are inaccurate and could be associated with various respiratory diseases. The concept of infection-related ventilator-associated complication has been proposed as a surrogate of VAP to be used as a benchmark indicator of quality of care. Indeed, bundles of prevention measures are effective in decreasing the VAP rate. In case of VAP suspicion, respiratory secretions must be collected for bacteriological secretions before any new antimicrobials...
2017: F1000Research
https://www.readbyqxmd.com/read/29224906/horse-related-injuries-in-children-unmounted-injuries-are-more-severe-a-retrospective-review
#19
Grace E L Wolyncewicz, Cameron S Palmer, Helen E Jowett, John M Hutson, Sebastian K King, Warwick J Teague
INTRODUCTION: Horse-related injuries account for one quarter of all paediatric sports fatalities. It is not known whether the pattern of injury spectrum and severity differ between children injured whilst mounted, compared with those injured unmounted around horses. We aimed to identify any distinctions between the demographic features, spectrum and severity of injuries for mounted versus unmounted patients. PATIENTS AND METHODS: Trauma registry data were reviewed for 505 consecutive paediatric patients (aged<16years) admitted to a large paediatric trauma centre with horse-related injuries over a 16-year period...
December 6, 2017: Injury
https://www.readbyqxmd.com/read/29224825/head-and-neck-free-flap-reconstruction-what-is-the-appropriate-post-operative-level-of-care
#20
Varun V Varadarajan, Hassan Arshad, Peter T Dziegielewski
Patients undergoing head and neck reconstruction require complex, multidisciplinary postoperative care which may include wound care, flap monitoring, tracheostomy management, and management of comorbid conditions. Historically, patients undergoing major resection of a head and neck or aerodigestive tract malignancy with regional or free flap reconstruction were routinely admitted to the ICU. Although head and neck cancer patients may have multiple medical comorbidities that may require postoperative critical care, the current trend in many institutions is to transfer stable and less medically complex patients to non-intensive care-level units with specialty trained nursing staff...
December 2017: Oral Oncology
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