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Breast Surgery

Tuesday 24 February 2009

Continuity of care and intensive care unit use at the end of life.

Continuity of care and intensive care unit use at the end of life.
Sharma G, Freeman J, Zhang D, Goodwin JS.
Arch Intern Med. 2009 Jan 12;169(1):81-6.
PMID: 19139328 [PubMed - indexed for MEDLINE]

BACKGROUND: There is increasing concern about discontinuity of care across transitions (eg, from home to the hospital) and how it might affect appropriate medical management.

METHODS: We examined changes over time in outpatient-to-inpatient continuity of care in individuals hospitalized with advanced lung cancer and its relationship to end-of-life intensive care unit (ICU) use via retrospective analysis of the linked Surveillance, Epidemiology, and End Results-Medicare database. Patients were 21 183 Medicare beneficiaries 66 years or older and diagnosed as having stage IIIB or IV lung cancer between January 1, 1992, and December 31, 2002, who died within a year of diagnosis. Outpatient-to-inpatient continuity of care was defined as an inpatient visit by the patient's usual care provider during the last hospitalization. The primary outcome measure was ICU use during the last hospitalization.

RESULTS: Outpatient-to-inpatient continuity decreased from 60.1% in 1992 to 51.5% in 2002 (P < .001). Factors associated with decreased continuity included male sex, black race, low socioeconomic status, being unmarried, treatment by a hospitalist, and treatment in a teaching hospital. Use of the ICU increased by 5.8% per year from 1993 to 2002. After adjustment for patient characteristics, patients with outpatient-to-inpatient continuity of care had a 25.1% reduced odds of entering the ICU during their terminal hospitalization.

CONCLUSIONS: Outpatient-to-inpatient continuity of care declined during the 1990s and early 2000s. Patients with terminal lung cancer who experienced outpatient-to-inpatient continuity of care were less likely to spend time in the ICU before death.


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A new era for sedation in ICU patients.

A new era for sedation in ICU patients.
Wunsch H, Kress JP.
JAMA. 2009 Feb 4;301(5):542-4.
Epub 2009 Feb 2. No abstract available.
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Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial.

Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial.

Riker RR, Shehabi Y, Bokesch PM, Ceraso D, Wisemandle W, Koura F, Whitten P, Margolis BD, Byrne DW, Ely EW, Rocha MG;

SEDCOM (Safety and Efficacy of Dexmedetomidine Compared With Midazolam)
Study Group. JAMA. 2009 Feb 4;301(5):489-99.
Epub 2009 Feb 2. PMID: 19188334 [PubMed - indexed for MEDLINE]
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Mechanical ventilation: epidemiological insights into current practices.

Curr Opin Crit Care. 2009
Feb;15(1):44-51.
LinkOut

Mechanical ventilation: epidemiological insights into current practices.
Goligher E, Ferguson ND.

Interdepartmental Division of Critical Care Medicine, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada.

PURPOSE OF REVIEW: To describe the trends in the results of epidemiological studies of mechanical ventilation.

RECENT FINDINGS: Changes in population demographics have increased the incidence of mechanical ventilation. Higher age and comorbidity rates portend poorer outcomes of mechanical ventilation. The most common indication for initiation of mechanical ventilation is acute respiratory failure, including postoperative respiratory failure, pneumonia, sepsis, and acute respiratory distress syndrome. Patients with sepsis and acute respiratory distress syndrome have a much higher mortality risk than the rest of this population. Changes over time in the selection of modes of ventilation, tidal volumes, positive end-expiratory pressure levels, weaning strategies, and tracheostomy timing appear to accord with data from randomized controlled trials in the literature. However, despite these changes, observational studies have not detected a statistically significant change in adjusted mortality over time.

SUMMARY: The burden of critical illness will likely continue to increase in the future. Evidence from randomized trials appears to have affected the management of mechanical ventilation, but adherence to evidence-based practices may not be ideal.
PMID: 19186409 [PubMed - in process]

The role of MRSA in healthcare-associated pneumonia.

Semin Respir Crit Care Med. 2009
Feb;30(1):52-60.
Epub 2009 Feb 6.
LinkOut

The role of MRSA in healthcare-associated pneumonia.
Lam AP, Wunderink RG.

Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.

An important continued trend in healthcare-associated infection, including healthcare-associated pneumonia (HCAP), is the rise of methicillin-resistant Staphylococcus aureus (MRSA). The emergence of community-acquired strains of MRSA has complicated the management further. We review likely risk factors for MRSA HCAP, which include prior antibiotic therapy, nasal colonization, poor infection control practices, and antecedent viral infection. The multiple mechanisms of antibiotic resistance are also described, and virulence factors that may affect antibiotic choices are discussed. The limitations of vancomycin and evidence for superior outcomes with linezolid are reviewed. Alternatives for community-acquired strains and future options are mentioned.

PMID: 19199187 [PubMed - in process]
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Clostridium difficile: the increasingly difficult pathogen.

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VOL 12; NUMBER 1; 2008
ISSN 1364-8535

p. 114
Clostridium difficile: the increasingly difficult pathogen.
Pop-Vicas, A.; Neill, M. A.
http://zetoc.mimas.ac.uk/wzgw?db=etoc&terms=PM018304376&field=zid

Knowledge Management: Organizing Nursing Care Knowledge.

CRITICAL CARE NURSING QUARTERLY
VOL 32; NUMB 1; 2009
ISSN 0887-9303

pp. 10-13
The Use of Hypertonic Saline for Fluid Resuscitation in Sepsis: A Review.
Singh, A.; Carlin, B.W.; Shade, D.; Kaplan, P.D.
http://zetoc.mimas.ac.uk/wzgw?db=etoc&terms=RN243950893&field=zid

American Journal of Critical Care articles

Health Care-Associated Infection.
http://zetoc.mimas.ac.uk/wzgw?db=etoc&terms=RN243792056&field=zid

pp. 73-76
Feeding Tube Placement in Adults: Safe Verification Method for Blindly Inserted Tubes.
Bourgault, A.M.; Halm, M.A.
http://zetoc.mimas.ac.uk/wzgw?db=etoc&terms=RN243792069&field=zid
pp. 77-80

Current Controversies in Critical Care What Is Documentation for?
Day, L.
http://zetoc.mimas.ac.uk/wzgw?db=etoc&terms=RN243792070&field=zid

Editorial Assessing ICU Transfers at Night: A Call to Reduce Mortality and Readmission Risk.

AMERICAN JOURNAL OF CRITICAL CAREVOL 18;
NUMB 1; 2009
ISSN 1062-3264

pp. 6-8
Editorial Assessing ICU Transfers at Night: A Call to Reduce Mortality and Readmission Risk.
Morris, P.E.
http://zetoc.mimas.ac.uk/wzgw?db=etoc&terms=RN243792033&field=zid

Community-Acquired Methicillin-Resistant Staphylococcus Aureus Epidural Abscess With Bacteremia

AMERICAN JOURNAL OF CRITICAL CAREVOL 18;
NUMB 1; 2009
ISSN 1062-3264


Community-Acquired Methicillin-Resistant Staphylococcus Aureus Epidural Abscess With Bacteremia and Multiple Lung Abscesses: Case Report.
Bruns, A.S.; Sood, N.
http://zetoc.mimas.ac.uk/wzgw?db=etoc&terms=RN243792023&field=zid

Autonomic Nervous System Function and Depth of Sedation in Adults Receiving Mechanical Ventilation.

pp. 42-51
Unoki, T.; Grap, M.J.; Sessler, C.N.; Best, A.M.; Wetzel, P.; Hamilton, A.; Mellott, K.; Munro, C.L.
http://zetoc.mimas.ac.uk/wzgw?db=etoc&terms=RN243791983&field=zid

Patients' Bath Basins as Potential Sources of Infection:

AMERICAN JOURNAL OF CRITICAL CAREVOL 18;
NUMB 1; 2009
ISSN 1062-3264

pp. 31-41
A Multicenter Sampling Study.
Johnson, D.; Lineweaver, L.; Maze, L.M.
http://zetoc.mimas.ac.uk/wzgw?db=etoc&terms=RN243791973&field=zid
AMERICAN JOURNAL OF CRITICAL CARE
VOL 18; NUMB 1; 2009
ISSN 1062-3264

pp. 21-30
Intensive Care Units, Communication Between Nurses and Physicians, and Patients' Outcomes.
Manojlovich, M.; Antonakos, C.L.; Ronis, D.L.
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Recently published papers: Sepsis, glucose control and patient–doctor relationships.

Critical Care
VOL 12; NUMBER 1; 2008
ISSN 1364-8535
p. 112
Recently published papers: Sepsis, glucose control and patient–doctor relationships.
Bouch, C.; Williams, G.
http://zetoc.mimas.ac.uk/wzgw?db=etoc&terms=PM018279533&field=zid

Targeting RAGE in sepsis.

Critical Care
VOL 12; NUMBER 1; 2008
ISSN 1364-8535

p. 103
Targeting RAGE in sepsis.
van Zoelen, M. A.; van der Poll, T.
http://zetoc.mimas.ac.uk/wzgw?db=etoc&terms=PM018254937&field=zid