Critical care medicine
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Critical care medicine · Dec 2013
Eighteen Years of Experience With Acinetobacter baumannii in a Tertiary Care Hospital.
To characterize the descriptive and molecular epidemiology of Acinetobacter baumannii in our hospital. ⋯ This constitutes the largest experience with A. baumannii reported to date from a single center. Half of all isolates were respiratory specimens and were from adult ICUs, especially trauma. Even though this was a polyclonal process, a single clone was identified in the hospital through a 6-year span.
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Critical care medicine · Dec 2013
Frequency, Risk Factors, and Outcomes of Early Unplanned Readmissions to PICUs.
To determine the rate of unplanned PICU readmissions, examine the characteristics of index admissions associated with readmission, and compare outcomes of readmissions versus index admissions. ⋯ Unplanned PICU readmissions were relatively uncommon, but were associated with worse outcomes. Several patient and admission characteristics were associated with readmission. These data help identify high-risk patient groups and inform risk-adjustment for standardized readmission rates.
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Critical care medicine · Dec 2013
Critical Care Medicine in the United States: Addressing the Intensivist Shortage and Image of the Specialty.
Intensivists are increasingly needed to care for the critically ill and manage ICUs as ICU beds, utilization, acuity of illness, complexity of care and costs continue to rise. However, there is a nationwide shortage of intensivists that has occurred despite years of well publicized warnings of an impending workforce crisis from specialty societies and the federal government. The magnitude of the intensivist shortfall, however, is difficult to determine because there are many perspectives of optimal ICU administration, patient coverage and intensivist availability and a lack of national data on intensivist practices. ⋯ National and local organizations are mandating that hospitals comply with resource intensive and arguably unproven initiatives to monitor and improve patient safety and quality, and informatics systems. Lastly, there is an ongoing sense of professional dissatisfaction among intensivists and a lack of public awareness that critical care medicine is even a distinct specialty. This article offers proposals to increase the adult intensivist workforce through expansion and enhancements of internal medicine based critical care training programs, incentives for recent graduates to enter the critical care medicine field, suggestions for improvements in the critical care profession and workplace to encourage senior intensivists to remain in the field, proactive marketing of critical care, and expanded engagement by the critical care societies in the challenges facing intensivists.
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Critical care medicine · Dec 2013
Observational StudyIndependent External Validation of the Status Epilepticus Severity Score.
A clinical scoring system for patients with status epilepticus was developed for predicting outcome, planning the level of monitoring needed, and guiding treatment. The aim was to confirm the external validity and transportability of the Status Epilepticus Severity Score prediction functions for outcome in adult patients with status epilepticus. ⋯ This study is the first independent external validation of the predictive accuracy of the Status Epilepticus Severity Score and its transportability to ICU patients with status epilepticus. Measures of discrimination and calibration indicated that Status Epilepticus Severity Score performed reasonably well on our cohort of ICU patients with status epilepticus. However, the specific optimal cutoff point for survival versus death in our cohort was different than proposed.
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Critical care medicine · Dec 2013
Observational StudyPredictors of 30-Day Readmission After Intracerebral Hemorrhage: A Single-Center Approach for Identifying Potentially Modifiable Associations With Readmission.
To determine whether patient's demographics or severity of illness predict hospital readmission within 30 days following spontaneous intracerebral hemorrhage, to identify readmission associations that may be modifiable at the single-center level, and to determine the impact of readmission on outcomes. ⋯ Severity of illness and hospital complications were not associated with 30-day readmission. The most common indication for readmission was infection after discharge, and readmission was associated with worse functional outcomes at 3 months. Preventing readmission after intracerebral hemorrhage may depend primarily on optimizing care after discharge and may improve functional outcomes at 3 months.