Current opinion in critical care
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Curr Opin Crit Care · Oct 2013
ReviewAssessing the impact of palliative care in the intensive care unit through the lens of patient-centered outcomes research.
Professional organizations, consensus groups, and stakeholders are calling for better palliative care in acute care settings, particularly in ICUs. Our ability to deliver that care is dependent on the outcomes associated with palliative care in the ICU. This review provides a conceptual framework for these outcomes, discusses current and future challenges for work in this field, and advocates for better use of patient-centered outcomes in future studies. ⋯ Delivery of palliative care in the ICU will be hampered until studies incorporate outcomes that are: responsive to and reflective of variations in care, and multi-faceted (with patient-centered components) to reflect the multi-dimensional nature of palliative care and the varied needs of different stakeholders.
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Curr Opin Crit Care · Oct 2013
ReviewVentilator-associated events surveillance: a patient safety opportunity.
The Centers for Disease Control and Prevention recently released new surveillance definitions for ventilator-associated events. The new definitions broaden the focus of surveillance from ventilator-associated pneumonia alone to all significant complications of mechanical ventilation. This review will consider the rationale for the new definitions, the studies supporting their development, and their potential benefits for hospital safety programs. ⋯ Ventilator-associated event surveillance is a promising strategy to improve care for ventilated patients by providing hospitals with a broader picture of their true burden of morbid complications and an objective metric to measure the impact of care improvement initiatives. Prospective studies are now needed to define the best strategies to prevent ventilator-associated events and to quantify the extent to which they are preventable.
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Curr Opin Crit Care · Oct 2013
ReviewSelected insights from application of whole-genome sequencing for outbreak investigations.
The advent of high-throughput whole-genome sequencing has the potential to revolutionize the conduct of outbreak investigation. Because of its ultimate resolution power for differentiating between closely related pathogen strains, whole-genome sequencing could augment the traditional epidemiologic investigations of infectious disease outbreaks. ⋯ When combined with traditional epidemiologic investigation, whole-genome sequencing has proven useful for elucidating the sources and transmission dynamics of disease outbreaks. Development of a fully automated bioinformatics pipeline for the analysis of whole-genome sequence data is much needed to make this powerful tool more widely accessible.