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Resource Intensivist

Moninne Howlett, Michael Curtin, Dermot Doherty, Paula Gleeson, Michelle Sheerin, Cormac Breatnach
AIM: Wide scale implementation of paediatric standardised concentration infusions (SCIs) and the use of smart pump technology has been slow despite international safety agency recommendations. Implementation rates in European hospitals fall far below those in the United States, where for the last decade accreditation has been linked to implementation.1 2 Multidisciplinary collaboration is essential, with pharmacy input and the creation of a smart pump drug library recognised as often being limiting, yet crucial factors, to implementation...
September 2016: Archives of Disease in Childhood
N Chrimes
Factors influencing performance during emergency airway management can be broadly divided into issues with preparation and those with implementation. Effective design of resources that provide guidance on management requires consideration of the context in which they are to be used. Many of the major airway guidelines do not specify whether they are intended to be used during preparation or implementation and may not take the context for use into account in their design. This can produce tools which may be not only ineffective but actively disruptive to team function in an emergency...
September 2016: British Journal of Anaesthesia
Marcio Soares, Fernando A Bozza, Luciano C P Azevedo, Ulysses V A Silva, Thiago D Corrêa, Fernando Colombari, André P Torelly, Pedro Varaschin, William N Viana, Marcos F Knibel, Moyzés Damasceno, Rodolfo Espinoza, Marcus Ferez, Juliana G Silveira, Suzana A Lobo, Ana Paula P Moraes, Ricardo A Lima, Alexandre G R de Carvalho, Pedro E A A do Brasil, Jeremy M Kahn, Derek C Angus, Jorge I F Salluh
PURPOSE: To investigate the impact of organizational characteristics and processes of care on hospital mortality and resource use in patients with cancer admitted to intensive care units (ICUs). PATIENTS AND METHODS: We performed a retrospective cohort study of 9,946 patients with cancer (solid, n = 8,956; hematologic, n = 990) admitted to 70 ICUs (51 located in general hospitals and 19 in cancer centers) during 2013. We retrieved patients' clinical and outcome data from an electronic ICU quality registry...
September 20, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Lluís Blanch, Fayez François Abillama, Pravin Amin, Michael Christian, Gavin M Joynt, John Myburgh, Joseph L Nates, Paolo Pelosi, Charles Sprung, Arzu Topeli, Jean-Louis Vincent, Susan Yeager, Janice Zimmerman
Demand for intensive care unit (ICU) resources often exceeds supply, and shortages of ICU beds and staff are likely to persist. Triage requires careful weighing of the benefits and risks involved in ICU admission while striving to guarantee fair distribution of available resources. We must ensure that the patients who occupy ICU beds are those most likely to benefit from the ICU's specialized technology and professionals. Although prognosticating is not an exact science, preference should be given to patients who are more likely to survive if admitted to the ICU but unlikely to survive or likely to have more significant morbidity if not admitted...
June 22, 2016: Journal of Critical Care
C Saillard, D Blaise, D Mokart
The outcome of allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients has significantly improved over the past decade. Still, a significant number of patients require intensive care unit (ICU) management because of life-threatening complications. Literature from the 1990s reported extremely poor prognosis for critically ill allo-HSCT patients requiring ICU management. Recent data justify the use of ICU resources in hematologic patients. Yet, allo-HSCT remains an independent variable associated with mortality...
August 2016: Bone Marrow Transplantation
Zaher Fanari, Sumaya Hammami, Armin Barekatain
There are many changes in the demographics of patients admitted to Cardiac Care Unit (CCU) due to the aging of US population and coexistence of chronic illnesses, such as diabetes mellitus, hypertension, renal dysfunction, and obstructive lung disease. There is increasing evidence that intensivist staffing in the critical care settings is associated with not only improvements in both Intensive Care Unit (ICU) and in-hospital mortality, but also with better medical resource use. Evidence for decreased mortality has led to increased involvement of critical care trained physicians in multidisciplinary care teams in both medical and surgical ICUs, a trend that has not been adopted to any significant extent in CCUs...
February 2016: Delaware Medical Journal
Eduardo Casaroto, Tatiana Mohovic, Lilian Moreira Pinto, Tais Rodrigues de Lara
The echocardiography has become a vital tool in the diagnosis of critically ill patients. The use of echocardiography by intensivists has been increasing since the 1990's. This tool has become a common procedure for the cardiovascular assessment of critically ill patients, especially because it is non-invasive and can be applied in fast and guided manner at the bedside. Physicians with basic training in echocardiography, both from intensive care unit or emergency department, can assess the left ventricle function properly with good accuracy compared with assessment made by cardiologists...
October 2015: Einstein
Rebecca C Bell, Phoebe H Yager, Maureen E Clark, Serguei Roumiantsev, Heather L Venancio, Daniel W Chipman, Robert M Kacmarek, Natan N Noviski
BACKGROUND: Mechanical ventilation is one of the most important therapeutic interventions in neonatal and pediatric ICUs. Telemedicine has been shown to reliably extend pediatric intensivist expertise to facilities where expertise is limited. If reliable, telemedicine may extend the reach of pediatric respiratory therapists (RTs) to facilities where expertise does not exist or free up existing RT resources for important face-to-face activities in facilities where expertise is limited...
February 2016: Respiratory Care
Chae-Man Lim, Sang-Hyun Kwak, Gee Young Suh, Younsuck Koh
Critical (or intensive) care medicine (CCM) is a branch of medicine concerned with the care of patients with potentially reversible life-threatening conditions. Numerous studies have demonstrated that adequate staffing is of crucial importance for patient outcome. Adequate staffing also showed favorable cost-effectiveness in terms of ICU stay, decreased use of resources, and lower re-admission rates. The current status of CCM of our country is not comparable to that of advanced countries. The global pandemic episodes in the past decade showed that our society is not well prepared for severe illnesses or mass casualty...
November 2015: Journal of Korean Medical Science
David M Axelrod, Jeffrey A Alten, John T Berger, Mark W Hall, Ravi Thiagarajan, Ronald A Bronicki
Since the inception of the Pediatric Cardiac Intensive Care Society (PCICS) in 2003, remarkable advances in the care of children with critical cardiac disease have been developed. Specialized surgical approaches, anesthesiology practices, and intensive care management have all contributed to improved outcomes. However, significant morbidity often results from immunologic or infectious disease in the perioperative period or during a medical intensive care unit admission. The immunologic or infectious illness may lead to fever, which requires the attention and resources of the cardiac intensivist...
October 2015: World Journal for Pediatric & Congenital Heart Surgery
Paul W G Elbers, Niels Van Regenmortel, Rainer Gatz has been serving the critical care community for over a decade. The backbone of this online resource consists of Peter Stewart's original text "How to understand Acid-Base" which is freely available to everyone. In addition, Stewart's Textbook of Acid Base, which puts the theory in today's clinical context is available for purchase from the website. However, many intensivists use on a daily basis for its educational content and in particular for its analysis module. This review provides an overview of the history of the website, a tutorial and descriptive statistics of over 10,000 queries submitted to the analysis module...
2015: Anaesthesiology Intensive Therapy
Michael D Sharpe, Carrie Jeffreys, Claudio Martin, Michael Barrett, Fran Priestap, Michelle Pierce, Judy Kojlak
Timely consultation with an intensivist will promote early and appropriate management of critically ill patients. We determined whether implementing a call roster of intensivists who did not have on-call responsibilities in an intensive care unit (ICU) and who received referrals from community physicians would improve access to critical care services. This program created efficiencies to critical care services by: timely access to consultation with an intensivist (<10 minutes) and/or subspecialist, timely referral to an appropriate institution (<30 minutes) and optimal resource utilization by determining the availability of ICU beds at non-tertiary care hospitals capable of providing the care needs of the patient, thus relieving pressure on the neighbouring tertiary/quaternary care centre...
2015: Healthcare Quarterly
Andrew M Naidech
No abstract text is available yet for this article.
December 2015: Neurocritical Care
Jessica M Turnbull
No abstract text is available yet for this article.
July 2015: Hastings Center Report
Michelle M A Kip, Ron Kusters, Maarten J IJzerman, Lotte M G Steuten
OBJECTIVE: Procalcitonin (PCT) is a specific marker for differentiating bacterial from non-infective causes of inflammation. It can be used to guide initiation and duration of antibiotic therapy in intensive care unit (ICU) patients with suspected sepsis, and might reduce the duration of hospital stay. Limiting antibiotic treatment duration is highly important because antibiotic over-use may cause patient harm, prolonged hospital stay, and resistance development. Several systematic reviews show that a PCT algorithm for antibiotic discontinuation is safe, but upfront investment required for PCT remains an important barrier against implementation...
2015: Journal of Medical Economics
Michael H Chan, Frederick Boop, Ibrahim Qaddoumi
PURPOSE: As the morbidity and mortality associated with communicable diseases continue to decrease in the developing world, the medical burden of childhood cancer continues to expand. Although international aid and relief groups such as the World Health Organization recognize the importance of childhood cancer, their main emphasis is on the more easily treated malignancies, such as leukemias and lymphomas, and not pediatric brain tumors, which are the second most common malignancy in children and the leading cause of cancer-related deaths in the pediatric population...
August 2015: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Amjad Al-Rajhi, Louay Mardini, Dev Jayaraman
BACKGROUND: Rapid response teams (RRTs) were developed to promote assessment of and early intervention for clinically deteriorating hospitalized patients. Although the ideal composition of RRTs is not known, their implementation does require significant resources. OBJECTIVE: To test the effectiveness of a dedicated daytime/weekday intensive care unit (ICU) consult service without formal training of ward teams. METHODS: Pre- and postintervention study with weekends/nights during implementation period acting as a concurrent control...
August 2016: Journal of Intensive Care Medicine
R Eliot Fagley, Michael F Haney, Anne-Sophie Beraud, Thomas Comfere, Benjamin Adam Kohl, Matthias Johannes Merkel, Aliaksei Pustavoitau, Peter von Homeyer, Chad Edward Wagner, Michael H Wall
OBJECTIVE: In this review, we define learning goals and recommend competencies concerning focused basic critical care ultrasound (CCUS) for critical care specialists in training. DESIGN: The narrative review is, and the recommendations contained herein are, sponsored by the Society of Critical Care Anesthesiologists. Our recommendations are based on a structured literature review by an expert panel of anesthesiology intensivists and cardiologists with formal training in ultrasound...
May 2015: Anesthesia and Analgesia
J J Dalal, T Alexander, P S Banerjee, V Dayasagar, S S lyengar, P G Kerkar, A Mullasari, S P Sathe, G S Wander
UNLABELLED: In India, the prevalence of ST elevation myocardial infarction (STEMI) is rising exponentially leading to cardiovascular morbidity and mortality. Despite advancement in reperfusion therapy (pharmacologic and interventional), the overall utilization, system of care and timely reperfusion remains suboptimal. JUSTIFICATION AND PURPOSE: Alarming treatment delays exist in patients presenting with chest pain observed in real-world and published evidences. Time to diagnose STEMI and initiation of reperfusion therapy at various first medical contacts in India is variable mandating immediate attention...
June 2014: Journal of the Association of Physicians of India
Daniel W Johnson, James N Sullivan, Craig A Piquette, Angela L Hewlett, Kristina L Bailey, Philip W Smith, Andre C Kalil, Steven J Lisco
OBJECTIVE: This report will describe the preparations for and the provision of care of two patients with Ebola virus disease in the biocontainment unit at the University of Nebraska Medical Center. DATA SOURCES: Patient medical records. STUDY SELECTION: Not applicable. DATA EXTRACTION: Not applicable. DATA SYNTHESIS: Not applicable. CONCLUSIONS: Safe and effective care of patients with Ebola virus disease requires significant communication and planning...
June 2015: Critical Care Medicine
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