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At least 19 recordsLinked to original sources
PubMed1983

Society of Critical Care Medicine Critical Care Self-Assessment Program III.

Critical Care Medicine encompasses an extremely broad scope. Examination questions were, therefore, chosen to cover a wide variety of critical care topics. A near Gaussian distribution of scores was found for all physician groups studied. We believe the low mean score of 15% reflects the general difficulty of the examination as well as the tendency of many critical care practitioners to master knowledge poorly outside his or her primary specialty. Hopefully, this examination with rationales and references will expose the practitioner to topics and literature with which he or she has not been previously familiar. Only by integrating knowledge from each of the primary specialities can the practitioner provide optimal care for the critically ill. It is our hope that this examination represents a positive learning experience for its past and future participants. If we have stimulated thought, discussion, and further study in the area of critical care medicine, then our efforts in the preparation of this program have been worthwhile.

Adult↗
PubMed2002

The pulmonary physician in critical care . 3: critical care management of community acquired pneumonia.

Severe community acquired pneumonia carries a high mortality. Early recognition of the severity of the illness, rapid and appropriate resuscitation, targeted antibiotic treatment, and the critical care support of multiple failing organ systems are all important in this group of patients. Only by improving all these aspects of care is it likely that survival will increase.

Anti-Bacterial Agents↗
PubMed1995

Telematics and protocols of care in critical care environments.

The paper discusses the potential roles for protocols of care within critical care environments from the perspective of providing real-time support for their application. The discussion is based around a conceptual model of care in critical care environments. This model has been developed in the wider context of developing information technology systems to support clinical care in critical care environments. The conceptual model of care is a three layer model which demonstrates both the hierarchical and temporal aspects of the care delivered to patients. It is proposed that if the value of protocols of care is to be realised in critical care environments then they must be seamlessly integrated into the routine data management associated with the care of patients. In order to demonstrate this and to evaluate the utility of this concept in the clinical environment, the systems from the AIM TANIT (Telematics in Anaesthesia and Intensive Therapy) project have been used as prototype platforms. The application of the concepts developed are described in two critical care environments: the anaesthesia department and the intensive care unit. Problems in using protocols of care in intensive care units suggest that integrating these with a problem solving methodology to create an integrated care plan may be a more appropriate approach to patient management.

Anesthesia Department, Hospital↗
PubMed1991

Improving the quality and utilization of critical care.

Critical care units have proliferated over the past three decades and the cost of care in these units has increased dramatically during that period. These units have flourished despite a surprising lack of adequate data to support their overall efficacy, and indeed a number of studies suggest that many patients admitted to these units are either too ill or too healthy to benefit. Dr Luce reviews recent changes in the organization and delivery of critical care and argues that the utilization and quality of critical care units can be improved through a combination of strategies. He advocates two strategies to decrease the demand for, or increase the supply of, critical care beds: more efficient use of intermediate care units and the development of clear institutional guidelines regarding the termination of treatment. In addition, although nominally eschewing the use of "formal" rationing policies, he advocates the development of admission and discharge policies to guide physicians during periods of low bed availability. Finally, he advocates greater leadership roles for professional critical care unit directors. This final suggestion has great merit but, as Dr Luce recognizes, a heightened role for critical care unit directors raises ethical and legal issues about the autonomy of both patients and physicians that need to be explored thoroughly.

Costs and Cost Analysis↗
PubMed2003

Nursing's role in complementary and alternative therapy use in critical care.

Critical care nurses can expect to encounter more patients using CAT and increasing opportunities and requests for CAT use in their critical care environments. This provides an opportunity for nurses' involvement to shape proactively how the use of these therapies will unfold in critical care. This can be accomplished in various ways. Actively ask patients and families about use of CAT. Initiate discussions with colleagues and peers about professional and personal use of therapies. Explore the knowledge and education needed to administer specific CAT. Engage in research regarding the use of CAT in critical care. Identify experts in the institution and surrounding community. Encourage critical care units and institutions to consider how CAT should be implemented across the institution. From a broader perspective, nurses may become part of professional political processes shaping patient accessibility to CAT and the use of CAT in the discipline, across disciplines, and in healthcare settings and public domains. It is crucial that nurses not relinquish their role as traditional providers of CAT in providing safe, effective, and holistic care at the bedside of critically ill patients.

Attitude of Health Personnel↗
PubMed1992

Future of critical care.

Critical care, as a specialty in both nursing and medicine, is well recognized and the number of people requiring hospitalization for critical illnesses continues to increase. The purpose of this paper is to examine the future and the changes that lie ahead in critical care. New and expanding roles for nurses are projected along with a continued refinement and expansion of the critical care medicine subspecialty for physicians. A variety of changes in critical care are anticipated that reflect our increasing abilities in biotechnology, basic and clinical research, and data management. These changes are viewed for their obvious impact on cost, ethical controversies, and patient care and outcome.

Critical Care↗
PubMed2002

The pulmonary physician in critical care. 11: critical care management of respiratory failure resulting from COPD.

Survival to hospital discharge of patients suffering exacerbations of COPD is better than other medical causes for ICU admission. Although non-invasive ventilation (NIV) may prevent progression to tracheal intubation, its failure in most cases should lead to a period of controlled mechanical ventilation aiming for early extubation, possibly supported by NIV and tracheostomy if this fails. A greater understanding of the physiological principles behind ventilatory support of patients with COPD should reduce patient-ventilator disharmony and avoid the excessive use of sedation. The risk of nosocomial infection increases with the length of time the patient remains in the ICU and commonly further prolongs the period of ventilator dependency. Weaning centres with an emphasis on general rehabilitation may offer the best support for such individuals.

Critical Care↗
PubMed2002

An update on cost-effectiveness analysis in critical care.

Critical care providers are under increasing pressure to be attentive to cost concerns. The ICU consumes a significant amount of resources and, as such, is a frequently identified target of efforts to limit escalating healthcare costs. Attempts to reduce costs need not progress in a haphazard fashion. Rather, they can proceed in a logical, systematic manner with the assistance of formal economic studies. Cost-effectiveness analysis is one tool for these projects-it allows physicians to compare the financial consequences of different approaches to resource allocation. ICU physicians, therefore, must become familiar with the basic concepts that underlie cost-effectiveness analysis. Cost-effectiveness analyses that address many different aspects of critical care delivery are now commonly found in the critical care literature. With a framework for evaluating these studies, clinicians can better apply their findings to their own institutions.

Cost Control↗
PubMed1998

Technologic competence as caring in critical care nursing.

The article describes technologic competence as caring in critical care nursing, a framework grounded in the perspective of nursing as caring. The achievement of technologic competence is an exercise in the process of knowing the wholeness of persons in the moment. Nurturing persons toward well-being is the focus of nursing. Technology, caring, and competence are core concepts that constitute the framework of technologic competence as caring in critical care nursing. Technologic competence epitomizes critical care nursing and assumes an indispensable position in contemporary nursing practice.

Clinical Competence↗
PubMed2005

The future of critical care.

Critical care has become an important part of the health care system; however, it still is provided in a heterogeneous, and likely suboptimal, fashion. Future challenges will include providing an adequate workforce; ensuring critical care is delivered to the right patients at the right time; converting advances in our understanding of the biology of critical illness into improved care and outcomes; and partnering successfully with patients, families, and society in forging the critical care of the future.

Critical Care↗
PubMed2003

Teaching palliative care to critical care medicine trainees.

OBJECTIVES: Palliative care is an important component of critical care medicine. Few fellowship programs have developed a curriculum designed to teach palliative care precepts to trainees. We describe our 2-yr experience in teaching palliative care to multidisciplinary critical care medicine fellows. DESIGN: Two-consecutive-year palliative care training for unselected critical care medicine fellows at a large, urban, university, tertiary care medical center. INTERVENTIONS: We 1) identified palliative care skills and knowledge that first-year critical care fellows should acquire; 2) developed a curriculum to teach those skills and knowledge, including required readings, small group lectures and skills sessions that included role-playing to modify skills and attitudes, and (in year 2) experiential learning on a hospital-based palliative care rotation; and 3) attempted to evaluate the curriculum with attitude and knowledge assessments. RESULTS: A total of 35 fellows participated in the palliative care training during the 2 yrs reported. Seven fellows participated in a clinical rotation in palliative care. Fellows evaluated usefulness of the small group sessions between 4.4 and 4.9 on a 5-point Likert scale. Four of seven fellows rated the clinical rotation quality at 3/5. Pretest and posttest knowledge mean scores were 58% and 69%, respectively. Problems included providing time for fellows to participate in the clinical rotation and negative attitudes regarding the relevance of palliative care to their future in critical care. CONCLUSIONS: Palliative care training for critical care fellows is feasible. Fellows value skills training more than a clinical rotation in palliative care. Baseline knowledge of palliative care is low.

Attitude of Health Personnel↗
PubMed1999

Critical care services and personnel: recommendations based on a system of categorization into two levels of care. American College of Critical Care Medicine of the Society of Critical Care Medicine.

OBJECTIVES: To recommend hospital services and personnel requirements for the provision of optimal care to critically ill patients. Requirements for hospitals with comprehensive resources, as well as for hospitals with limited resources, are addressed. DATA SOURCES: a) Consensus opinion of critical care physicians, nurses, and pharmacists; and b) published guidelines of organizational and administrative topics addressing the provision of critical care by physicians and nurses, the pharmacologic approach to the critically ill patient, and diagnostic and laboratory testing in the management of critically ill patients. CONCLUSION: By combining the strengths and expertise of multidisciplinary critical care specialists, these guidelines provide a framework in which hospitals of varying resources may optimize the care of critically ill patients.

Critical Care↗