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PubMed2005

Development of a framework with specific reference to exit-level outcomes for the education and training of South African undergraduate physiotherapy students.

The aim of the study was to develop a framework for undergraduate programmes for the education and training of physiotherapists in South Africa. The research comprised a literature survey, interviews with United Kingdom physiotherapy educators and departmental workshops in South Africa. The Delphi technique was employed as research method to evaluate the proposed framework. The measuring instrument was a questionnaire comprising of amongst others, statements related to exit-level outcomes, which were rated on a five-point rating scale. Two rounds of the Delphi technique were required before acceptable consensus was reached and a framework for the development of a physiotherapy education and training programme was compiled. The framework has been designed as a benchmark for the development of innovative physiotherapy curricula in South Africa. This paper provides information of the exit-level outcomes specified in the framework.

Competency-Based Education↗

PubMed2006

Consistency in endovascular aneurysm repair suitability assessment requires group decision audit.

INTRODUCTION: Proper selection of patient and stent-graft combinations in endovascular aneurysm repair (EVAR) depends on knowledge and experience with the different types of stents that have to be adapted to the patient's unique abdominal aortoiliac anatomy. The aim of this study was to analyze the consistency and variance in EVAR suitability assessment between clinicians. METHODS: Worksheets that contained anatomic data derived from computed tomography scans and angiography were compiled for 202 patients. Five clinicians, all experienced in EVAR surgery, assessed the anatomic data on the worksheets for suitability for three types of stent-grafts. The obtained 3030 assessments represented a quantification of the likelihood of success the clinician expected for effective and durable sealing and fixation of the stent-graft in EVAR. The Delphi method was used to determine consensus in the thinking process among clinicians, and kappa analysis was used to determine the proportion of variances in the assessment result between clinicians. RESULTS: With the Delphi method, Cronbach alpha values of 0.87, 0.87, and 0.90 were reached for the three types of stent-grafts in the second assessment round. The individual clinician-group correlation in round two was between 0.69 and 0.86 for clinicians 1, 2, 3, and 4. Between clinician 5 and the others, correlation varied between 0.43 and 0.64. The kappa values ranged between 0.32 and 0.51 among clinicians 1, 2, and 3. Between clinician 5 and the others, kappa values between 0.08 and 0.29 were reached. CONCLUSION: EVAR suitability estimation in a cohort of patients is highly consistent in a group of experienced clinicians. The EVAR suitability estimation at the individual patient level varies substantially between clinicians, however. Aggregating expert opinions in abdominal aortic aneurysm anatomic suitability assessment for EVAR had the opportunity to replace individual clinician decision diversification in a more solid and consistent group decision process.

Aged↗

PubMed2001

Identification and classification of consumer food-handling behaviors for food safety education.

OBJECTIVE: To identify key behaviors associated with major food safety pathogen control factors. DESIGN: World Wide Web-based descriptive study with 4 tasks: compile a list of food-handling behaviors from the literature; use Delphi process to build consensus, rank order, and edit lists of behaviors; assess content and construct validity; and review results of Delphi process at a summit meeting of selected experts to make final recommendations for a food safety behavior list. SUBJECTS/SETTING: A convenience sample of 10 epidemiologists, 11 food microbiologists, 10 food safety educators, and 10 food safety policy makers was recruited from lists of nationally known experts. Twenty-four experts completed 4 rounds of surveys presented to them via a Web site. Six experts attended a face-to-face meeting to finalize behavior lists. Statistical analyses performed Descriptive statistics and sum of observation data were used to determine rank order and validity. RESULTS: Twenty-nine key food-handling behaviors for maintaining the safety of food and reducing the number of cases and outbreaks of foodborne illness were identified. These were rank-ordered within 5 pathogen control factors: practice personal hygiene, cook foods adequately, avoid cross-contamination, keep foods at safe temperatures, and avoid foods from unsafe sources. APPLICATIONS/CONCLUSIONS: This list of rank-ordered behaviors grouped by pathogen control factor should help dietitians and educators confidently teach food safety guidance that will be most effective in preventing illness.

Consumer Product Safety↗

PubMed1999

Exploration of the structural features defining the conduction properties of a synthetic ion channel.

The finite-difference Poisson-Boltzmann methodology was applied to a series of parallel, alpha-helical bundle models of the designed ion channel peptide Ac-(LSSLLSL)3-CONH2. This method is able to fully describe the current-voltage curves for this channel and quantitatively explains their cation selectivity and rectification. We examined a series of energy-minimized models representing different aggregation states, side-chain rotamers, and helical rotations, as well as an ensemble of structures from a molecular dynamics trajectory. Potential energies were computed for single, permeating K+ and Cl- ions at a series of positions along a central pathway through the models. A variable-electric-field Nernst-Planck electrodiffusion model was used, with two adjustable parameters representing the diffusion coefficients of K+ and Cl- to scale the individual ion current magnitudes. The ability of a given DelPhi potential profile to fit the experimental data depended strongly on the magnitude of the desolvation of the permeating ion. Below a pore radius of 3.8 A, the predicted profiles showed large energy barriers, and the experimental data could be fit only with unrealistically high values for the K+ and Cl- diffusion coefficients. For pore radii above 3.8 A, the desolvation energies were 2kT or less. The electrostatic calculations were sensitive to positioning of the Ser side chains, with the best fits associated with maximum exposure of the Ser side-chain hydroxyls to the pore. The backbone component was shown to be the major source of asymmetry in the DelPhi potential profiles. Only two of the energy-minimized structures were able to explain the experimental data, whereas an average of the dynamics structures gave excellent agreement with experimental results. Thus this method provides a promising approach to prediction of current-voltage curves from three-dimensional structures of ion channel proteins.

Cations↗

PubMed2003

The use of a non-lethal tool for evaluating toxicological hazard of organochlorine contaminants in Mediterranean cetaceans: new data 10 years after the first paper published in MPB.

In the Mediterranean Sea, top predators, and particularly cetacean odontocetes, accumulate high concentrations of organochlorine contaminants and toxic metals, incurring high toxicological risk. In this paper we investigate the use of the skin biopsies as a non-lethal tool for evaluating toxicological hazard of organochlorines in Mediterranean cetaceans, presenting new data 10 years after the paper published by Fossi and co-workers [Mar. Poll. Bull. 24 (9) (1992) 459] in which this new methodology was first presented. Some organochlorine compounds, now with worldwide distribution, are known as endocrine disrupting chemicals (EDCs). Here the unexplored hypothesis that Mediterranean cetaceans are potentially at risk due to organochlorines with endocrine disrupting capacity is investigated. High concentrations of DDT metabolites and PCB congeners (known as EDCs) were found in the different Mediterranean species (Stenella coeruleoalba, Delphinus delphis, Tursiops truncatus and Balaenoptera physalus). In this paper we also propose benzo(a)pyrene monooxygenase (BPMO) activity in marine mammal skin biopsies (non-lethal biomarker) as a potential indicator of exposure to organochlorines, with special reference to the compounds with endocrine disrupting capacity. A statistically significant correlation was found between BPMO activity and organochlorine levels (DDTs, pp(')DDT, op(')DDT, PCBs and PCB99) in skin biopsies of males of B. physalus. Moreover a statistical correlation was also found between BPMO activity and DDT levels in skin biopsies of the endangered Mediterranean population of D. delphis. These results suggest that BPMO induction may be an early sign of exposure to organochlorine EDCs and can be used for periodic monitoring of Mediterranean marine mammal toxicological status.

Animals↗

PubMedDate not supplied

Skin biopsy of Mediterranean cetaceans for the investigation of interspecies susceptibility to xenobiotic contaminants.

Various studies on Mediterranean cetaceans have revealed bioaccumulation of contaminants such as organochlorines (OCs) and heavy metals. The susceptibility of these animals to organic pollutants and the relationship between bioaccumulation and population decline (as in the case of Delphinus delphis) are unexplored fields. In this study, we used a non-destructive approach (skin biopsy) to explore OC bioaccumulation processes and mixed-function oxidase activity (BPMO) in four species of cetaceans: striped dolphin (Stenella coeruleoalba), bottlenose dolphin (Tursiops truncatus), common dolphin (D. delphis) and fin whale (Balaenoptera physalus). Significant differences in BPMO induction and OC levels were found between odontocetes and mysticetes, the former having mixed-function oxidase activities four times higher than the latter, binding with levels of OCs one order of magnitude higher in odontocetes. A significant correlation (P < 0.05) between BPMO activities and OC levels was found in B. physalus. In an ongoing project, fibroblast cultures have been used as an alternative in vitro method of evaluating interspecies susceptibility to contaminants such as OCs and polycyclic aromatic hydrocarbons (PAHs). These results suggest that cetacean skin biopsies are a powerful non-invasive tool for assessing ecotoxicological risk to Mediterranean marine mammals species.

Animals↗

PubMed2003

Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales.

PURPOSE: To develop consensus regarding clinical disease severity classification systems for diabetic retinopathy and diabetic macular edema that can be used around the world, and to improve communication and coordination of care among physicians who care for patients with diabetes. DESIGN: Report regarding the development of clinical diabetic retinopathy disease severity scales. PARTICIPANTS: A group of 31 individuals from 16 countries, representing comprehensive ophthalmology, retina subspecialties, endocrinology, and epidemiology. METHODS: An initial clinical classification system, based on the Early Treatment Diabetic Retinopathy Study and the Wisconsin Epidemiologic Study of Diabetic Retinopathy publications, was circulated to the group in advance of a workshop. Each member reviewed this using e-mail, and a modified Delphi system was used to stratify responses. At a later workshop, separate systems for diabetic retinopathy and macular edema were developed. These were then reevaluated by group members, and the modified Delphi system was again used to measure degrees of agreement. MAIN OUTCOME MEASURES: Consensus regarding specific classification systems was achieved. RESULTS: A five-stage disease severity classification for diabetic retinopathy includes three stages of low risk, a fourth stage of severe nonproliferative retinopathy, and a fifth stage of proliferative retinopathy. Diabetic macular edema is classified as apparently present or apparently absent. If training and equipment allow the screener to make a valid decision, macular edema is further categorized as a function of its distance from the central macula. CONCLUSIONS: There seems to be a genuine need for consistent international clinical classification systems for diabetic retinopathy and diabetic macular edema that are supported with solid evidence. The proposed clinical classification systems provide a means of appropriately categorizing diabetic retinopathy and macular edema. It is hoped that these systems will be valuable in improving both screening of individuals with diabetes and communication and discussion among individuals caring for these patients.

Diabetic Retinopathy↗

PubMedDate not supplied

[Identification of problems and needs in health: description of a participative experience in primary care].

OBJECTIVE: To identify health problems and needs from a Health area population. To detect inequalities in relation with sociodemographic variables. METHODS: An observational descriptive study, cross-sectional study, qualitative research. SETTING: A Health area in Cordoba divided in three different areas: residential, inner city and rural area. We select three different groups of population and the following instruments of measurements: a) general population older than 15 years old (survey by interview completed door-to-door and personally) (N = 12,801) (coverage = 96.6%); b) Representatives of the community (N = 47), by Delphi technique (answering rate = 62.5%) and Nominal Group technique applied to participants in Health Councils (answering rate = 65.4%); c) Health workers (N = 45), by Delphi Process (answering rate = 58.5%). RESULTS: The people consider pains in their joints and allergies as the priority health problems, for the representatives of the community and the health workers the most important problems were dental hygiene and some chronic diseases. The needs detected as most important were, for the people from residential area, the lack of public gardens and cultural sites, for people from the inner city area it was the lack of public safety and in the rural area it was the lack of proper health resources. CONCLUSIONS: Although the different groups we study maintain a close agreement on what are the most important health problems and needs, we observed several interesting disagreement that could be explained by the different point of view that each group has on the process of health-disease, on perceiving problems and needs and on the sociodemographic differences among them.

Adolescent↗

PubMed2003

The International Confederation of Midwives' study of essential competencies of midwifery practice.

OBJECTIVE: To delineate the knowledge, skills, and behaviours that would characterise the domain of competencies of the midwife who is educated according to the international definition of the profession. DESIGN: Phase I: a qualitative Delphi study; Phase II: a descriptive survey research process. PARTICIPANTS: A stratified random sample of member organisations of the International Confederation of Midwives (ICM) and regulatory representatives from these same countries. FINDINGS: A list of basic (essential) and additional competencies for midwives who have been educated in keeping with the ICM/WHO/FIGO international definition of the midwife was developed through an interative Delphi process, and then affirmed, using a survey research method. The final list includes 214 individual task statements within six domains of midwifery practice. IMPLICATIONS FOR PRACTICE: This list of competencies can serve as a basis for educational curriculum design, as a guideline for regulatory policy development, as a reference document for individual practitioners in an assessment of their initial and continued competency and by the ICM and its member associations as a resource for advocating for the role of midwifery within health-care systems world-wide.

Adult↗

PubMed2026

Challenges in identifying paediatric cancer predisposition syndromes: international SCOPE survey and SIOPE expert consensus recommendations.

Cancer Predisposition Syndromes (CPS) are heritable genetic conditions associated with an increased risk of developing various cancers throughout life. While early identification and tumour surveillance can improve outcomes, CPS are often underdiagnosed in clinical practice. To evaluate clinicians' perspectives and identify barriers to CPS identification and care across Europe, we conducted the SCOPE study: a three-part cross-sectional survey of paediatric haematology/oncology professionals, followed by a modified Delphi consensus process with members of the SIOP Europe Host Genome Working Group. A total of 185 paediatric oncologists from 22 countries participated in the survey. More than 40% of participants reported low or uncertain confidence across different CPS-related tasks, particularly in counselling families (64.3%) and interpreting germline genetic findings (57.3%). Access to clinical geneticists and dedicated CPS clinics were predictors of higher confidence for some domains, while individual experience and institutional patient volume had limited influence. Regular use of universal CPS screening tools was low (42.3%), with most clinicians relying on personal judgement rather than structured criteria. The most cited barriers were lack of screening guidelines (57%) and difficulties in interpreting results (35.1%). Regular training and workshops, availability of genetic counsellors or educators for patient support, and patient-friendly education material were most cited as areas of improvement. The Delphi process led to three recommendations: (1) improve clinician training and communication strategies, (2) integrate CPS screening into standard treatment plans, and (3) develop accessible, patient-centred educational materials. These recommendations highlight opportunities to enhance CPS care through structured support, interdisciplinary collaboration, and systematic screening approaches.

Humans↗

PubMed2004

Tetraplegia Hand Activity Questionnaire (THAQ): the development, assessment of arm-hand function-related activities in tetraplegic patients with a spinal cord injury.

STUDY DESIGN: Development of Tetraplegia Hand Activity Questionnaire (THAQ). SETTING: Patients and spinal cord injury (SCI) professionals from five rehabilitation centres in the Netherlands and Belgium. OBJECTIVE: To construct a disease-specific questionnaire to evaluate interventions to the arm-hand of tetraplegics in terms of gained and lost activities relevant to the patient. METHODS: All arm-hand function-related activities were inventoried by examining existing scales and interviewing spinal cord injury patients and professionals in the field. Subsequently, item reduction was achieved; first, in the technical construction by incorporating all activities in an item list, then reducing the list by selecting the items most likely to be sensitive to change after surgical or functional electro stimulation interventions on the arm-hand as judged by an expert panel, using a Delphi method. RESULTS: The arm-hand-related activity inventory comprised 652 activities. The technical construction of the items and the Delphi procedure resulted in a questionnaire with 153 items. The experts considered many of the 'new' activities more relevant for the evaluation of hand function interventions than those found in scales studied in the literature. This is reflected in a relatively large proportion of new activities (69%) for the item list of the THAQ, and even more in the domains work/admin/telecom (88%) and leisure (100%). CONCLUSION: The questionnaire constructed to assess hand function-related activities contains relevant activities to evaluate arm-hand function-related interventions for tetraplegic SCI patients.

Activities of Daily Living↗

PubMed2000

Influence of methodology on outcomes of randomised clozapine trials.

The aim of this study was to clarify the impact of various methodological quality factors on reported outcome of randomised clozapine trials. Trials comparing the atypical antipsychotic clozapine with other antipsychotic drugs were identified in extensive electronic searches. Two independent reviewers extracted data on methodology and primary outcomes, and assessed trial quality by use of three sets of criteria (Cochrane, Delphi, and Jadad). There was no association between trial quality, as measured by any of the criteria sets, and primary measures of outcome. Trials with the best score for randomisation and concealment according to the Delphi scale had a significantly lower relative risk for relapse in clozapine-treated groups, and studies with well reported random order generation according to Jadad criteria tended to have better odds ratios for clinical improvement on clozapine. These findings strengthen the evidence of true clozapine superiority in these aspects. No other quality items correlated to the primary outcomes. Inadequate randomisation techniques may be a source of bias in clozapine studies, but much more research is needed on the connections between trial quality and trial outcome.

Antipsychotic Agents↗

PubMed2006

Endocrine Disruptors in Mediterranean top marine predators.

BACKGROUND, AIMS AND SCOPE: Man-made Endocrine Disruptors (EDs) range across all continents and oceans. Some geographic areas are potentially more threatened than others: one of these is the Mediterranean Sea. Levels of some xenobiotics are much higher here than in other seas and oceans. In this paper we review the final results of a project in which the hypothesis that Mediterranean top predator species (such as large pelagic fish and marine mammals) are potentially at risk due to EDs was investigated. METHODS: In a four-year survey on the Mediterranean population of swordfish (Xiphias gladius), the potential toxicological effects of organochlorine compounds (OCs) on specimens of swordfish and tuna fish (Thunnus thynnus thynnus), caught in the spawning seasons from 1999 to 2002 in the Straits of Messina, Sicily (Italy), were investigated using vitellogenin (Vtg), Zona radiata proteins (Zrp), and cytochrome P4501A (CYP1A) activities (EROD, BPMO). Tissues (skin and blubber) were obtained from Stenella coeruleoalba, Tursiops truncatus, Delphinus delphis and Balaenoptera physalus from the western Ligurian Sea, between Corsica and the French-Italian coast, and Ionic Sea using biopsy darts launched with a crossbow. Benzo(alpha)pyrene monoxigenase (BPMO) activity was mesured in biopsies and cholrinated hydrocarbon levels were detected. RESULTS AND DISCUSSION: We illustrate the need to develop and apply sensitive methodological tools, such as biomarkers (Vitellogenin, Zona Radiata proteins and CYP1A activities) for evaluation of toxicological risk in Xiphias gladius and Thunnus thynnus thynnus), and nondestructive biomarkers (CYP1A activities and fibroblast cell culture in skin biopsy), for the hazard assessment of threatened marine mammals species (Stenella coeruleoalba, Tursiops truncatus, Delphinus delphis and Balaenoptera physalus) exposed to EDs. CONCLUSION: The present research shows that: a) Vtg and Zrp can be used as diagnostic tools for fish stocks hazard assessment in the Mediterranean Sea; b) that CYP1A1 (BPMO) induction in cetaceans skin biopsy may be an early sign of exposure to EDs such as OCs and a potential alert for transgenerational effects. RECOMMENDATION AND OUTLOOK: This research represents a warning signal of the potential reproductive alterations in marine top predators and suggest the need for continuous monitoring to avoid reductions in population and biodiversity in the Mediterranean Sea.

Animals↗

PubMed2002

The Delphic oracle: a multidisciplinary defense of the gaseous vent theory.

Ancient historical references consistently describe an intoxicating gas, produced by a cavern in the ground, as the source of the power at the oracle of Delphi. These ancient writings are supported by a series of associated geological findings. Chemical analysis of the spring waters and travertine deposits at the site show these gases to be the light hydrocarbon gases methane, ethane, and ethylene. The effects of inhaling ethylene, a major anesthetic gas in the mid-20th century, are similar to those described in the ancient writings. We believe the probable cause of the trancelike state of the Priestess (the Pythia) at the oracle of Delphi during her mantic sessions was produced by inhaling ethylene gas or a mixture of ethylene and ethane from a naturally occurring vent of geological origin.

Amnesia↗

PubMed1992

Advancing social work practice in the health field: a collaborative research partnership.

This article describes and analyzes the development of a collaborative research model by one university faculty of social work and 10 health care settings. Established working relationships for educating students were the foundation of a research partnership formed to study questions of mutual interest. This article discusses the developmental stage of the research consortium, including needs assessment, workshop, identification of a common theme and research topic, preliminary funding, and literature review. This stage resulted in the decision to develop and test an instrument to screen for high social risk that would be capable of identifying the need for social work involvement with families to provide effective and efficient management of patients. The Delphi methodology was chosen in the first phase of the research design, and reasons for the choice of this methodology, the results from the two Delphi rounds, and a preliminary screening instrument are presented. Finally, issues in collaboration, such as institutional factors, dynamics of the working group, and leadership roles, are analyzed to identify facilitating features and problematic issues in such partnerships.

Academies and Institutes↗

PubMedDate not supplied

Genetic differentiation among recently diverged delphinid taxa determined using AFLP markers.

In the mid-1990s, a new common dolphin species (Delphinus capensis) was defined in the northeast Pacific using morphological characters and mitochondrial DNA (mtDNA) sequences. This species is sympatric with a second species, Delphinus delphis; morphological differences between the two are slight and it is clear they are closely related. Does the phenotypic distinction result from only a few important genes or from large differences between their nuclear genomes? We used amplified fragment length polymorphism (AFLP) markers to broadly survey the nuclear genomes of these two species to examine the levels of nuclear divergence and genetic diversity between them. Furthermore, to create an evolutionary context in which to compare the level of interspecific divergence found between the two Delphinus taxa, we also examined two distinct morphotypes of the bottlenose dolphin (Tursiops truncatus). A nonmetric multidimensional scaling analysis clearly differentiated both Delphinus species, indicating that significant nuclear genetic differentiation has arisen between the species despite their morphological similarity. However, the AFLP data indicated that the two T. truncatus morphotypes exhibit greater divergence than D. capensis and D. delphis, suggesting that they too should be considered different species.

Animals↗

PubMed1976

The reliability and application of clinical judgment in evaluating the use of hospital beds.

A technique is described which circumvents the difficulty in obtaining reliable judgments by clinicians on cases of inappropriate use of hospital beds. By application of the Delphi method of measuring group expert opinion, convergence was achieved in the estimate, by four physicians, of the total number of bed days wasted on a medical ward during a period of two weeks. Cases of possible misutilization were identified by the author and a second study was designed to measure the effect on the physicans' behavior of her presence on the ward (Hawthorne effect). It is suggested that review of cases of misutilization by the Delphi method could be used in the continuing education of physicians.

Education, Medical, Continuing↗

PubMed2004

Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock.

OBJECTIVE: In 2003, critical care and infectious disease experts representing 11 international organizations developed management guidelines for severe sepsis and septic shock that would be of practical use for the bedside clinician, under the auspices of the Surviving Sepsis Campaign, an international effort to increase awareness and improve outcome in severe sepsis. DESIGN: The process included a modified Delphi method, a consensus conference, several subsequent smaller meetings of subgroups and key individuals, teleconferences, and electronic-based discussion among subgroups and among the entire committee. METHODS: We used a modified Delphi methodology for grading recommendations, built on a 2001 publication sponsored by the International Sepsis Forum. We undertook a systematic review of the literature graded along five levels to create recommendation grades from A to E, with A being the highest grade. Pediatric considerations were provided to contrast adult and pediatric management. RESULTS: Key recommendations, listed by category and not by hierarchy, include early goal-directed resuscitation of the septic patient during the first 6 hrs after recognition; appropriate diagnostic studies to ascertain causative organisms before starting antibiotics; early administration of broad-spectrum antibiotic therapy; reassessment of antibiotic therapy with microbiology and clinical data to narrow coverage, when appropriate; a usual 7-10 days of antibiotic therapy guided by clinical response; source control with attention to the method that balances risks and benefits; equivalence of crystalloid and colloid resuscitation; aggressive fluid challenge to restore mean circulating filling pressure; vasopressor preference for norepinephrine and dopamine; cautious use of vasopressin pending further studies; avoiding low-dose dopamine administration for renal protection; consideration of dobutamine inotropic therapy in some clinical situations; avoidance of supranormal oxygen delivery as a goal of therapy; stress-dose steroid therapy for septic shock; use of recombinant activated protein C in patients with severe sepsis and high risk for death; with resolution of tissue hypoperfusion and in the absence of coronary artery disease or acute hemorrhage, targeting a hemoglobin of 7-9 g/dL; appropriate use of fresh frozen plasma and platelets; a low tidal volume and limitation of inspiratory plateau pressure strategy for acute lung injury and acute respiratory distress syndrome; application of a minimal amount of positive end-expiratory pressure in acute lung injury/acute respiratory distress syndrome; a semirecumbent bed position unless contraindicated; protocols for weaning and sedation/analgesia, using either intermittent bolus sedation or continuous infusion sedation with daily interruptions/lightening; avoidance of neuromuscular blockers, if at all possible; maintenance of blood glucose <150 mg/dL after initial stabilization; equivalence of continuous veno-veno hemofiltration and intermittent hemodialysis; lack of utility of bicarbonate use for pH > or =7.15; use of deep vein thrombosis/stress ulcer prophylaxis; and consideration of limitation of support where appropriate. Pediatric considerations included a more likely need for intubation due to low functional residual capacity; more difficult intravenous access; fluid resuscitation based on weight with 40-60 mL/kg or higher needed; decreased cardiac output and increased systemic vascular resistance as the most common hemodynamic profile; greater use of physical examination therapeutic end points; unsettled issue of high-dose steroids for therapy of septic shock; and greater risk of hypoglycemia with aggressive glucose control. CONCLUSION: Evidence-based recommendations can be made regarding many aspects of the acute management of sepsis and septic shock that are hoped to translate into improved outcomes for the critically ill patient. The impact of these guidelines will be formally tested and guidelines updated annually and even more rapidly as some important new knowledge becomes as available.

Adult↗