Other bulletins in this series include:

Breast Surgery

Tuesday, 11 March 2008

Evaluation of ICU Admission Criteria and Diagnostic Methods for Patients With Severe Community - Acquired Pneumonia : Current Practice Survey

Author(s): Marcos I . Restrepo
ISSUE: 2008 ; VOL 133 ; PART 3 (2008-March)
Journal Title:Access Chest ( Formerly : Diseases of the Chest ) From Free Medical Journals . com (/1995 - /Embargo: 1 year) Customer Notes: 1997 v111/1
Print Location: Macclesfield

From Proquest NHS (01/1997 - 11/2006)
Page: 828 - 829

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Family Member Satisfaction With End - of - Life Decision Making in the ICU

Author(s): Cynthia J . Gries
ISSUE: 2008 ; VOL 133 ; PART 3 (2008-March)
Journal Title:Access Chest ( Formerly : Diseases of the Chest ) From Free Medical Journals . com (/1995 - /Embargo: 1 year) Customer Notes: 1997 v111/1
Print Location: Macclesfield

From Proquest NHS (01/1997 - 11/2006)
Page: 704 - 712
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Respiratory Sleep Medicine : A Coming of Age

Author(s): Bradley , T . D .
ISSUE: 2008 ; VOL 177 ; PART 4
Journal Title:Access American Journal of Respiratory and Critical Care Medicine From Free Medical Journals . com (/1997 - /Embargo: 1 year)

From Proquest NHS (02/2003 - /)
Page: 363

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MRSA hospitalizations double : Another troubling study points to an `epidemic phenomenon'

ISSUE: 2008 ; VOL 35 ; PART 1
Journal Title:Access Hospital Infection Control Hospital Infection Control
Page: 8


Multicomponent Geriatric Intervention for Elderly Inpatients With Delirium : Effects on Costs and Health - Related Quality of Life

Author(s): Pitkala , K . H . ; Laurila , J . V . ; Strandberg , T . E . ; Kautiainen , H . ; Sintonen , H . ; Tilvis , R . S . ISSUE: 2008 ; VOL 63 ; PART 1
Journal Title:Journals of Gerontology : Series A , Biological Sciences and Medical Sciences ( Formerly : Journal of Gerontology , the ) From Proquest NHS (05/1995 - 12/2007)

Abstract (Summary)
Delirium is a common syndrome with poor prognosis affecting elderly inpatients. Treatment is mainly based on common sense with wide variations in practice. We investigated whether intensified, multicomponent geriatric treatment could improve the prognosis of delirious patients. We performed a randomized, controlled trial of 174 patients with delirium in six general medicine units from an acute hospital in Helsinki, Finland. The intervention group received individually tailored geriatric treatment. The primary endpoint was the sum of those deceased individuals and the patients permanently institutionalized. Secondary endpoints included the number of days in hospitals and other institutions, delirium intensity, and cognition. The mean age of patients was 83 years, and 31% had previous dementia. The intervention group (N = 87) received significantly more acetylcholinesterase inhibitors (58.6% vs 9.2%), atypical antipsychotics (69.8% vs 30.2%), specialist consultations (49.4% vs 28.7%), hip protectors (88.5% vs 3.4%), physiotherapy (87.4% vs 47.1%), and fewer conventional neuroleptics (8.0% vs 23.0%) than did the control group (N = 87). During the 1-year follow-up, 60.9% of the intervention group and 64.4% of controls were either deceased or permanently institutionalized (p = .638). The intervention group spent a mean of 126 days in institutions, and the control group 140 days (p = .688). Delirium was, however, alleviated more rapidly during hospitalization, and cognition improved significantly at 6 months in the intervention group. Faster alleviation of delirium and improved cognition justify good, comprehensive geriatric care for these patients although treatment produced no significant improvements in hard endpoints of prognosis.

Critical Care Medicine for the Hospitalist

Author(s): Linderman D . J . ; Janssen W . J .
ISSUE: 2008 ; VOL 92 ; PART 2 (03-2008)
Journal Title:Access Medical Clinics of North America Medical Clinics of North America
Page: 467-479
ISSN: Print: 0025-7125
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Mechanical ventilation in Intensive Care

specialized equipment required - dangers of high pressure gas
flows .... NB mechanical ventilation may not necessarily rest respiratory muscles ...


This is a comprehensive online resource. Possibly useful as teaching aid.

Monday, 10 March 2008

Nutrition Management in the ICU*


Samuel Chan, MD; Karen C. McCowen, MB; and George L. Blackburn, MD, PhD

Malnutrition is an alteration of body composition in which deficiencies of macronutrients and
micronutrients result in reduced body cell mass, organ dysfunction, and abnormal serum chemistry values. Nutrition support plays a vital role in the prevention and treatment of nutritional deficiencies in appropriately selected, at-risk, critically ill patients in the ICU.1 Patients most likely to benefit from nutritional support are those with baseline malnutrition
in whom a protracted period of starvation would otherwise occur. In well-nourished persons with
short (, 1 week) anticipated duration of nil per os status, it is very difficult to demonstrate improvement in outcome with nutrition support.

Intensive care unit (ICU) palliative care:

Intensive care unit (ICU) palliative care: percent of 4-hour intervals (on Day Zero and Day One of ICU admission) for which the documented pain score was less than or equal to 3.

SOURCE(S) VHA Inc. TICU care and communication bundle: care and communication quality measures. Irving (TX): VHA Inc.; 2006 Sep 15. 8 p.

This measure is used to assess the percent of 4-hour intervals (on Day Zero and Day One of intensive care unit [ICU] admission) for which the documented pain score was less than or equal to 3 on a scale of 0-10.

Palliative care focuses on prevention and relief of suffering, improving communication, promoting concordance between treatment and individual preferences, and facilitating transitions across care settings for patients with life threatening illness and their families. As such, it is increasingly accepted as an integral component of comprehensive intensive care unit (ICU) care for all critically ill patients, including those pursuing every reasonable treatment to prolong life. At the same time, evidence has accumulated that the quality of ICU palliative care needs improvement: patients experience high levels of pain and other distressing symptoms; families fail to understand basic information about diagnosis, prognosis, or critical care treatments and experience high levels of depression and anxiety; care plans diverge from patients' and families' preferences; and conflict among ICU clinicians, patients, and families is common.

The Institute of Medicine identified improvement of palliative care in the ICU and other care settings as a national health priority. For all healthcare providers and fields, it has also prioritized "closing the gap" between the current knowledge of optimal care and current clinical practice.
This measure is one of ten measures included in a palliative care bundle intended to close the "quality gap" between existing best evidence and current daily practice.

Assorted ICU articles from the BMJ

Early treatment strategies in sepsis Mohammed A Butt, A K Coulson, J H Hull, and T B L Ho


Healthcare Commission will publicise NHS trusts’ levels of infection control
Rebecca Coombes


Surveillance of new infectious diseases focuses on wrong areas
Susan Mayor


Number of deaths involving C difficile rose by 72% in a year
Henry Creagh