Critical care medicine
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Critical care medicine · Feb 2017
Multicenter Study Observational StudyReadmissions to Intensive Care: A Prospective Multicenter Study in Australia and New Zealand.
To determine factors independently associated with readmission to ICU and the independent association of readmission with subsequent mortality. ⋯ In this large prospective study, readmission to ICU was not an independent risk factor for mortality.
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Critical care medicine · Feb 2017
Comparative StudyA Comparison of Usage and Outcomes Between Nurse Practitioner and Resident-Staffed Medical ICUs.
To compare usage patterns and outcomes of a nurse practitioner-staffed medical ICU and a resident-staffed physician medical ICU. ⋯ We found no difference in mortality between an nurse practitioner-staffed medical ICU and a resident-staffed physician medical ICU. Our study adds further evidence that advanced practice providers can render safe and effective ICU care.
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Critical care medicine · Feb 2017
Observational StudyQuality Improvement Initiative for Severe Sepsis and Septic Shock Reduces 90-Day Mortality: A 7.5-Year Observational Study.
To investigate the impact of a quality improvement initiative for severe sepsis and septic shock focused on the resuscitation bundle on 90-day mortality. Furthermore, effects on compliance rates for antiinfective therapy within the recommended 1-hour interval are evaluated. ⋯ The continuous quality improvement initiative focused on the resuscitation bundle was associated with increased compliance and a persistent reduction in 90-day mortality over a 7.5-year period. Based on the observational study design, a causal relationship cannot be proven, and respective limitations need to be considered.
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Critical care medicine · Feb 2017
Global Collaboration in Acute Care Clinical Research: Opportunities, Challenges, and Needs.
The most impactful research in critical care comes from trials groups led by clinician-investigators who study questions arising through the day-to-day care of critically ill patients. The success of this model reflects both "necessity"-the paucity of new therapies introduced through industry-led research-and "clinical reality"-nuanced modulation of standard practice can have substantial impact on clinically important outcomes. Success in a few countries has fueled efforts to build similar models around the world and to collaborate on an unprecedented scale in large international trials. ⋯ Patient and family engagement in research is variable and typically inadequate. Funders are poorly equipped to evaluate and fund international collaborative efforts. Yet despite or perhaps because of these challenges, the discipline of critical care is leading the world in crafting new models of clinical research collaboration that hold the promise of not only improving the care of the most vulnerable patients in the healthcare system but also transforming the way that we conduct clinical research.