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Critical care medicines

Daniel J Beckett, Elaine Thomson, Lindsay Em Reid, Robert C Lloyd
Although there are national recommendations on the function of Acute Medicine Units (AMUs), there is no single agreed best model of care. Additionally, robust data is not always available to determine whether system changes have resulted in improvement. We designed an Excel file to interface with the hospital patient management system to provide real-time data on a number of metrics including AMU length of stay (AMULOS), mortality and readmissions. This demonstrated that improving consultant continuity of care was associated with a reduction in AMULOS and reduced variation in AMULOS...
2016: Acute Medicine
Mark E Deyo-Svendsen, Michael R Phillips, Jill K Albright, Keith A Schilling, Karl B Palmer
PURPOSE: Clinical provider peer review (CPPR) is a process for evaluating a patient's experience in encounters of care. It is part of ongoing professional practice evaluation and focused professional practice evaluation-important contributors to provider credentialing and privileging. Critical access hospitals are hindered in CPPR by having a limited number of providers, shortages of staff resources, and relationships among staff members that make unbiased review difficult. Small departments within larger institutions may face similar challenges...
October 2016: Quality Management in Health Care
Julie C Fitzgerald, Scott L Weiss, Niranjan Kissoon
OBJECTIVE: To review important articles in the field of pediatric shock and pediatric septic shock published subsequent to the Fifth Edition of the Rogers' Textbook of Pediatric Intensive Care. DATA SOURCES: The U.S. National Library of Medicine PubMed ( was searched for combination of the term "pediatric" and the following terms: "sepsis, septic shock, shock, antibiotics, extracorporeal membrane oxygenation, and steroid." The abstract lists generated by these searches were screened for potential inclusion...
September 30, 2016: Pediatric Critical Care Medicine
Paul E Farmer, Joseph J Rhatigan
Shortages of trained health care workers plague low- and middle-income countries around the world. When resources are scarce, the ability to support medical education is severely constrained. While there are many important "building blocks" of health systems that need to be bolstered in low- and middle-income countries, the authors propose that U.S. academic medicine can make unique contributions in the realm of human resource development-specifically, increasing the supply of physicians who directly provide health care to the populations they serve and who often manage and lead these health systems...
October 4, 2016: Academic Medicine: Journal of the Association of American Medical Colleges
Johannes Bircher, Eckhart G Hahn
This paper explores the diagnostic and therapeutic potential of a new concept of health. Investigations into the nature of health have led to a new definition that explains health as a complex adaptive system (CAS) and is based on five components (a-e). Humans like all biological creatures must satisfactorily respond to (a) the demands of life. For this purpose they need (b) a biologically given potential (BGP) and (c) a personally acquired potential (PAP). These properties of individuals are embedded within (d) social and (e) environmental determinants of health...
2016: F1000Research
Panagis Galiatsatos
No abstract text is available yet for this article.
September 22, 2016: Journal of Critical Care
Xiaoyun Hu, Xiuming Xi, Penglin Ma, Haibo Qiu, Kaijiang Yu, Yaoqing Tang, Chuanyun Qian, Qiang Fang, Yushan Wang, Xiangyou Yu, Yuan Xu, Bin Du
BACKGROUND: The aim of this study is to develop consensus on core competencies required for postgraduate training in intensive care medicine. METHODS: We used a combination of a modified Delphi method and a nominal group technique to create and modify the list of core competencies to ensure maximum consensus. Ideas were generated modified from Competency Based Training in Intensive Care Medicine in Europe collaboration (CoBaTrICE) core competencies. An online survey invited healthcare professionals, educators, and trainees to rate and comment on these competencies...
October 16, 2016: Critical Care: the Official Journal of the Critical Care Forum
Ambrose Hon-Wai Wong, Joan Combellick, Beth Ann Wispelwey, Allison Squires, Maureen Gang
OBJECTIVES: The emergency department (ED) has been recognized as a high-risk environment for workplace violence. Acutely agitated patients who perpetrate violence against healthcare workers represent a complex care challenge in the ED. Recommendations to improve safety are often based on expert opinion rather than empirical data. In this study we aim to describe the lived experience of staff members caring for this population in order to provide a broad perspective of ED patient violence...
October 15, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Barbara Stetson, Karl E Minges, Caroline R Richardson
Accelerating diabetes rates have resulted in a global public health epidemic. Lifestyle change is a cornerstone of care, yet regimen demands may result in adherence difficulties. Distress, depression, and other psychosocial concerns are higher in those with diabetes. While interventions, such as the Diabetes Prevention Program appear to be effective, further research is needed to support the translation of interventions to prevent diabetes. Studies assessing optimal approaches to promoting effective decision making, coping and adherence are needed...
October 14, 2016: Journal of Behavioral Medicine
Curtis H Weiss, Jerry A Krishnan, David H Au, Bruce G Bender, Shannon S Carson, Adithya Cattamanchi, Michelle M Cloutier, Colin R Cooke, Karen Erickson, Maureen George, Joe K Gerald, Lynn B Gerald, Christopher H Goss, Michael K Gould, Robert Hyzy, Jeremy M Kahn, Brian S Mittman, Erika M Mosesón, Richard A Mularski, Sairam Parthasarathy, Sanjay R Patel, Cynthia S Rand, Nancy S Redeker, Theodore F Reiss, Kristin A Riekert, Gordon D Rubenfeld, Judith A Tate, Kevin C Wilson, Carey C Thomson
BACKGROUND: Many advances in health care fail to reach patients. Implementation science is the study of novel approaches to mitigate this evidence-to-practice gap. METHODS: The American Thoracic Society (ATS) created a multidisciplinary ad hoc committee to develop a research statement on implementation science in pulmonary, critical care, and sleep medicine. The committee used an iterative consensus process to define implementation science and review the use of conceptual frameworks to guide implementation science for the pulmonary, critical care, and sleep community and to explore how professional medical societies such as the ATS can promote implementation science...
October 15, 2016: American Journal of Respiratory and Critical Care Medicine
Amy H Farkas, Sarah Tilstra, Sonya Borrero, Melissa McNeil
BACKGROUND: Internal medicine residents are expected to be able to provide gender-specific care. The objective of this study was to develop a consensus list of core topics and procedural skills in women's health to allow residency program directors to prioritize and standardize educational efforts in women's health. METHODS: We conducted a two-round Delphi of women's health experts. Participants were given a list of topics and asked to: (1) rank each topic based on how important they felt each topic was for internal medicine residents to be proficient in upon graduation, and (2) identify which topics were critical for a women's health curriculum...
October 12, 2016: Journal of Women's Health
Nicole A Sitkin, John E Pachankis
PURPOSE: Sexual and gender minorities (SGMs) in medicine experience unique stressors in training. However, little is known about SGM specialty choice. This study examined predictors of SGM specialty choice, associations between specialty prestige and perceived SGM inclusion, and self-reported influences on specialty choice. METHODS: Medical trainees and practitioners (358 SGM, 1528 non-SGM) were surveyed online. We operationalized specialty choice at the individual level as respondents' specialty of practice; at the specialty level, as a percentage of SGM respondents in each specialty...
October 11, 2016: LGBT Health
Nils Kunze-Szikszay, Lennart A Krack, Pauline Wildenauer, Saskia Wand, Tim Heyne, Karoline Walliser, Christopher Spering, Martin Bauer, Michael Quintel, Markus Roessler
BACKGROUND: Hyperfibrinolysis (HF) is a major contributor to coagulopathy and mortality in trauma patients. This study investigated (i) the rate of HF during the pre-hospital management of patients with multiple injuries and (ii) the effects of pre-hospital tranexamic acid (TxA) administration on the coagulation system. METHODS: From 27 trauma patients with pre-hospital an estimated injury severity score (ISS) ≥16 points blood was obtained at the scene and on admission to the emergency department (ED)...
October 10, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Marine Desarmenien, Anne Laure Blanchard-Courtois, Bara Ricou
Advances in intensive care medicine have created a new disease called the chronic critical illness. While a significant proportion of severely ill patients who twenty years ago would have died survive the acute phase, they remain heavily dependent on intensive care for a prolonged period of time. These patients, who can be called "Patient Long Séjour" in French (PLS) or Prolonged Length of Stay patients in English, develop specific health issues that are still poorly recognised. They require special care, which differs from treatments that are given during the acute phase of their illness...
2016: Swiss Medical Weekly
David A Moore, Elisabeth S Markman, Cori E McMahon, Maurie Markman
In the ever expanding realm of cancer care, the psychosocial impact of disease and medical treatments has been garnering increased attention. To address these needs, the integration of behavioral medicine services into inpatient and outpatient medical settings has added a unique resource available to oncologists. Psycho-oncologists may assist providers via the provision of psychological assessment and intervention, supplying valuable consultation to members of the medical team and much needed clinical services to patients...
May 2016: Case Reports in Oncology
Helen M Ryan, Sumedha Sharma, Laura A Magee, J Mark Ansermino, Karen MacDonell, Beth A Payne, Keith R Walley, Peter von Dadelszen
OBJECTIVE: To assess the performance of the Acute Physiology and Chronic Health Evaluation II (APACHE II) mortality prediction model in pregnant and recently pregnant women receiving critical care in low-, middle-, and high-income countries during the study period (1985-2015), using a structured literature review. DATA SOURCES: Ovid MEDLINE, Embase, Web of Science, and Evidence-Based Medicine Reviews, searched for articles published between 1985 and 2015. STUDY SELECTION: Twenty-five studies (24 publications), of which two were prospective, were included in the analyses...
October 2016: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
Jennifer A Price, Ana I F Sousa Soares, Augustine D Asante, Joao S Martins, Kate Williams, Virginia L Wiseman
BACKGROUND: Despite public health care being free at the point of delivery in Timor-Leste, wealthier patients access hospital care at nearly twice the rate of poorer patients. This study seeks to understand the barriers driving inequitable utilisation of hospital services in Timor-Leste from the perspective of community members and health care managers. METHODS: This multisite qualitative study in Timor-Leste conducted gender segregated focus groups (n = 8) in eight districts, with 59 adults in urban and rural settings, and in-depth interviews (n = 8) with the Director of community health centres...
September 30, 2016: BMC Health Services Research
Alejandro Suarez De La Rica, Fernando Gilsanz, Emilio Maseda
Since the American College of Chest Physicians (ACCP) and the Society of Critical care Medicine (SCCM) published the first consensus definition of syndromes related to sepsis in 1992, the knowledge of epidemiology of sepsis has clearly improved, although no prospective studies have been performed to analyse the incidence of sepsis in general population. There are differences in epidemiologic trends in sepsis between western countries and low-income and middle-income countries. In the United States (US), most of epidemiologic studies have been based on large, administrative databases, reporting an increase in the incidence of severe sepsis over years...
September 2016: Annals of Translational Medicine
Paul A Checchia
The growth of Pediatric Cardiovascular Intensive Care as a subspecialty has been incredible. Outcomes have improved, care delivery has matured, and research has made advances. Within this review, we take the opportunity to examine the subspecialty's past accomplishments with pride, take stock in its current state, and look forward with excitement to its future. While outcomes in general have improved dramatically, we must always be aware of the outcomes that matter to families and patients. Additionally, we must constantly ask ourselves to improve...
July 2016: Translational pediatrics
Fernando Maria de Benedictis, Andrew Bush
Wheeze is a common symptom in young children and is usually associated with viral illnesses. It is a major source of morbidity and is responsible for a high consumption of healthcare and economic resources worldwide. A few children have a condition resembling classical asthma. Rarer specific conditions may have a wheezy component and should be considered in the differential diagnosis. Over the last half century, there have been many circular discussions about the best way of managing preschool wheeze. In general, intermittent wheezing should be treated with intermittent bronchodilator therapy, and a controller therapy should be prescribed for a young child with recurrent wheezing only if positively indicated, and only then if carefully monitored for efficacy...
October 4, 2016: Archives of Disease in Childhood
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