Critical care medicine
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Critical care medicine · Sep 2015
Clinical TrialBrief Versus Full Alcohol Use Disorders Identification Test in National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome Network Clinical Trials.
Alcohol use disorders are common among patients admitted to an ICU, yet systematic screening is rarely performed. We sought to confirm the construct validity of the full Alcohol Use Disorders Identification Test and to evaluate the performance of the brief three-item Alcohol Use Disorders Identification Test-C using the full Alcohol Use Disorders Identification Test as a proxy gold standard in a population of patients with a medical critical illness. ⋯ Although a three-factor structure for the Alcohol Use Disorders Identification Test was confirmed in ICU patients with acute respiratory distress syndrome, the first three questions focusing on alcohol consumption provide information that is comparable with the full 10-item Alcohol Use Disorders Identification Test screening questionnaire. This study is limited by the lack of a true gold standard, and the performance of the Alcohol Use Disorders Identification Test -C is likely overestimated due to this limitation.
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Critical care medicine · Sep 2015
Anticholinergic Medication Use and Transition to Delirium in Critically Ill Patients: A Prospective Cohort Study.
Although cholinergic deficiency is presumed to increase delirium risk and use of medication with anticholinergic properties in the ICU is frequent, the relationship between anticholinergic medication use and delirium in this setting remains unclear. We investigated whether exposure to medication with anticholinergic properties increases the probability of transitioning to delirium in critically ill adults and whether this relationship is affected by age or the presence of acute systemic inflammation. ⋯ Exposure to medication with anticholinergic properties, as defined by the Anticholinergic Drug Scale, does not increase the probability of delirium onset in patients who are awake and not delirious in the ICU.
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Critical care medicine · Sep 2015
Unplanned Readmissions After Hospitalization for Severe Sepsis at Academic Medical Center-Affiliated Hospitals.
In the United States, national efforts to reduce hospital readmissions have been enacted, including the application of substantial insurance reimbursement penalties for hospitals with elevated rates. Readmissions after severe sepsis remain understudied and could possibly signify lapses in care and missed opportunities for intervention. We sought to characterize 7- and 30-day readmission rates following hospital admission for severe sepsis as well as institutional variations in readmission. ⋯ Severe sepsis readmission places a substantial burden on the healthcare system, with one in 15 and one in five severe sepsis discharges readmitted within 7 and 30 days, respectively. Hospitals and clinicians should be aware of this important sequela of severe sepsis.
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Critical care medicine · Sep 2015
Editorial CommentTeamwork in the ICU: From Training Camp to the Super Bowl.
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Critical care medicine · Sep 2015
Observational StudyBeyond the Team: Understanding Interprofessional Work in Two North American ICUs.
To examine the ways in which healthcare professionals work together in the ICU setting, through a consideration of the contextual, organizational, processual, and relational factors that impact their interprofessional collaboration. ⋯ A singular notion of team is too reductive to account for the ways in which work happens in the ICU and therefore cannot be taken for granted in quality improvement initiatives or among healthcare professionals in this setting. Adapting interventions to the complex nature of interprofessional work and each ICUs unique local context is an important and necessary step to ensure the delivery of safe and effective patient care.