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Wednesday, 30 April 2008

BioMed Central articles - 30 April 2008

Review Bench-to-bedside review: The evaluation of complex interventions in critical care
Delaney A, Angus DC, Bellomo R, Cameron P, Cooper DJ, Finfer S, Harrison DA, Huang DT, Myburgh JA, Peake SL, Reade MC, Webb SAR, Yealy DM, the Australian Resuscitation in Sepsis Evaluation (ARISE), Protocolized Care for Early Septic Shock (ProCESS) and Protocolised Management In Sepsis (ProMISe) investigators Critical Care 2008, 12:210 (14 April 2008)[Abstract] [Full text] [PDF]

Research article Interventions designed to improve the quality and efficiency of medication use in managed care: A critical review of the literature – 2001–2007
Lu CY, Ross-Degnan D, Soumerai SB, Pearson SABMC Health Services Research 2008, 8:75 (7 April 2008)
[Abstract] [Full text] [PDF] [PubMed] [Related articles]

Commentary Myocardial infarction on the ICU: can we do better?
Webb I, Coutts JCritical Care 2008, 12:129 (3 April 2008)
[Abstract] [Full text] [PDF] [PubMed] [Related articles]

Research Risk factors for the development of nosocomial pneumonia and mortality on intensive care units: application of competing risks models
Wolkewitz M, Vonberg RP, Grundmann H, Beyersmann J, Gastmeier P, Bärwolff S, Geffers C, Behnke M, Rüden H, Schumacher MCritical Care 2008, 12:R44 (2 April 2008)
[Abstract] [Full text] [PDF] [PubMed] [Related articles] [Cited on BioMed Central]

Economic Aspects of Severe Sepsis: A Review of Intensive Care Unit Costs, Cost of Illness and Cost Effectiveness of Therapy

InfoHilmar Burchardi (Department of Anaesthesiology, Emergency and Intensive Care Medicine, University Hospital Gottingen, Gottingen, Germany)Heinz Schneider (HealthEcon AG, Basel, Switzerland)


Severe sepsis remains both an important clinical challenge and an economic burden in intensive care. An estimated 750 Sepsis patients are generally treated in intensive care units (ICUs) where close supervision and intensive care treatment by a competent team with adequate equipment can be provided. Staffing costs represent from 40% to >60% of the total ICU budget. Because of the high proportion of fixed costs in ICU treatment, the total cost of ICU care is mainly dependent on the length of ICU stay (ICU-LOS). The average total cost per ICU day is estimated at approximately Patients with infections and severe sepsis require a prolonged ICU-LOS, resulting in higher costs of treatment compared with other ICU patients. US cost-of-illness studies focusing on direct costs per sepsis patient have yielded estimates of Because of increasing healthcare cost pressures worldwide, economic issues have become important for the introduction of new innovations.
This is evident when introducing new biotechnology products, such as drotrecogin-alpha (activated protein C), into specific therapy for severe sepsis. Data so far suggest that when drotrecogin-alpha treatment is targeted to those patients most likely to achieve the greatest benefit, the drug is cost effective by the standards of other well accepted life-saving interventions.

Monday, 28 April 2008

Eosinopenia is a reliable marker of sepsis on admission in medical intensive care units

Eosinopenia is a reliable marker of sepsis on admission in medical intensive care units
from Critical Care - Latest articles by Khalid K Abidi, Ibtissam I Khoudri, Jihane J Belayachi, Naoufel N Madani, Aicha A Zekraoui, Amine Ali AA Zeggwagh and Redouane R Abouqal
Eosinopenia is a cheap and "forgotten" marker of acute infection that has never been evaluated before in intensive care units (ICUs). The aim of this study was to test the value of eosinopenia in the diagnosis of sepsis in patients admitted to ICUs.
Methods: A prospective study of consecutive adult patients admitted to a 12-bed medical ICU. Eosinophils were measured at ICU admission. Two intensivists blinded to eosinophils classified patients as negative, systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, and septic shock.
Results: A total of 177 patients were enrolled. In discriminating non-infected (negative+SIRS) and infected (sepsis+severe sepsis+septic shock) groups, the area under the Receiver Operating Characteristic (ROC) curve was 0.89 (95%Confidence Interval [CI]; 0.83-0.94). Eosinophils <50cells/mm^3 yielded a sensitivity 80% (95%CI; 71-86%), specificity 91% (95%CI; 79-96%), positive likelihood ratio (LR+) 9.12(95%CI; 3.9-21), and negative likelihood ratio (LR-) 0.21(95%CI; 0.15-0.31). In discriminating SIRS and infected groups, the area under ROC curve was 0.84(95%CI; 0.74-0.94). Eosinophils<40cells/mm^3 yielded a sensitivity 80%(95%CI; 71-86%), specificity 80%(95%CI; 55-93%), LR+ 4(95%CI; 1.65-9.65), and LR- 0.25(95%CI; 0.17-0.36).

Conclusions: Eosinopenia is a good diagnostic marker in distinguishing between non-infection and infection, but is a moderate marker in discriminating between SIRS and infection in newly admitted critically ill patients. Eosinopenia may become a helpful clinical tool in ICU practices.

Critical Care Nurse, April 2008 (2)

Lateral hostility between critical care nurses: a survey report.
Alspach G Critical Care Nurse, Apr 2008; 28 (2): 13-6, 19 (journal article) ISSN: 0279-5442 CINAHL AN: 2009885317
PDF Full Text

Hospital discharge education for patients with heart failure: what really works and what is the evidence?
Paul S Critical Care Nurse, Apr2008; 28 (2): 66-72, 74-82 (journal article) ISSN: 0279-5442 CINAHL AN: 2009885321
PDF Full Text

End-of-life care in the critical care unit for patients with heart failure.
Wingate S; Wiegand DL Critical Care Nurse, Apr2008; 28 (2): 84-8, 90-6 (journal article)
ISSN: 0279-5442 CINAHL AN: 2009885322
PDF Full Text

Journal of Advanced Nursing: May 2008 Vol 62 Iss 3

Short- and long-term impact of critical illness on relatives: literature review
Fiona Paul, BN MPhil RN; Janice Rattray, PhD RN RM

‘As required’ medication regimens for seriously mentally ill people in hospital
Emily Caruana, BHSc BSSc

RESEARCH PAPER: Original Research 295–306
Nurses' leaving intentions: antecedents and mediating factors
Miyuki Takase, PhD RN; Noriko Yamashita, MSc RN RM; Keiko Oba, BEd RN

318–326 Types of nursing knowledge used to guide care of hospitalized patients
Stefanos Mantzoukas, PhD RN; Melanie Jasper, PhD RN

327–335 Music improves sleep quality in students
László Harmat, MSc; Johanna Takács, MSc; Róbert Bódizs, PhD

346–353 Night duty as an opportunity for learning
Ann-Mari Campbell, RN; Kerstin Nilsson, PhD RN; Ewa Pilhammar Andersson, PhD RN

354–364 Re-examination of risk factors for non-Clostridium difficile-associated diarrhoea in hospitalized patients
Melissa A.L. Thorson, MS RN CCNS; Donna Zimmaro Bliss, PhD RN FAAN; Kay Savik, MS

Volume 62, Number 4, May 2008

BMJ Learning: Severe sepsis and septic shock: diagnosis and management

You may be interested in this module for hospital doctors. It outlines the latest guidelines on the management of this dangerous condition.
Severe sepsis and septic shock: diagnosis and management

ToC Critical Care Nursing Clinics of North America (Vol 20, No 2) is now available:

Contents: pages v-vii