Critical care medicine
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In recent years, there has been a great deal of attention paid to preparing the healthcare system to handle disasters, in particular terrorist events. Most of the attention has focused on the first responders and the initial emergency management. Depending on the nature of the disaster, however, large numbers of patients may be critically ill. ⋯ The Society of Critical Care Medicine (SCCM) can provide valuable expertise and educational programs to facilitate the needed disaster management planning.
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To evaluate factors which may influence the economic future of academic medical centers (AMCs). ⋯ Increasing economic stress will require AMCs to make efforts both to increase revenue through a variety of mechanisms and to minimize expenses without compromising their mission or impairing worker morale.
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Critical care medicine · Mar 2006
Intensive care unit physician staffing: financial modeling of the Leapfrog standard.
To evaluate from a hospital's perspective the costs and savings, over a 1-yr period, of implementing The Leapfrog Group's Intensive Care Unit Physician Staffing (IPS) standard compared with the existing standard of nonintensivist staffing in adult intensive care units. ⋯ Financial modeling of implementation of the IPS standard using conservative assumptions demonstrated cost savings to hospitals. Only under worst-case scenario assumptions did intensivist staffing result in additional cost to hospitals. These economic findings must be interpreted in the context of significant reductions in patient morbidity and mortality rates also associated with intensivist staffing. Given the magnitude of its clinical and financial impact, hospital leaders should be asking "how to" rather than "whether to" implement The Leapfrog Group's ICU Physician Staffing standard.
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Critical care medicine · Mar 2006
Randomized Controlled TrialEffects of atorvastatin on systemic inflammatory response after coronary bypass surgery.
Systemic inflammatory response occurs frequently after coronary artery bypass surgery, and it is strongly correlated with the risk of postoperative morbidity and mortality. Recent studies demonstrate that treatment with statin is associated with a significant and marked decrease in inflammation-associated variables such as the C-reactive protein, cytokines, and adhesion molecules. Therefore, we investigated the effects of preoperative atorvastatin treatment on systemic inflammatory response and perioperative morbidity after cardiopulmonary bypass. ⋯ Pretreatment with atorvastatin significantly reduces cytokine release and neutrophil adhesion to the venous endothelium in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass.
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Critical care medicine · Mar 2006
ReviewThe critical care clinical pharmacist: evolution of an essential team member.
To review the history, training requirements, contributions to patient care outcomes, and workforce issues of critical care pharmacists. ⋯ Critical care pharmacists are recognized as essential members of the critical care team as a result of contributions to medication safety, improved patient outcomes, and reduced drug costs and as a source of drug information and provider of education. A growing number of pharmacists practice in critical care. Additional opportunities exist and can be met if an adequate supply of trained specialists can be developed.