Critical care medicine in the 21st century has witnessed remarkable advancements that have significantly improved patient outcomes in intensive care units(ICUs).This abstract provides a concise summary of the latest d...Critical care medicine in the 21st century has witnessed remarkable advancements that have significantly improved patient outcomes in intensive care units(ICUs).This abstract provides a concise summary of the latest developments in critical care,highlighting key areas of innovation.Recent advancements in critical care include Precision Medicine:Tailoring treatments based on individual patient characteristics,genomics,and biomarkers to enhance the effectiveness of therapies.The objective is to describe the recent advancements in Critical Care Medicine.Telemedicine:The integration of telehealth technologies for remote patient monitoring and consultation,facilitating timely interventions.Artificial intelligence(AI):AI-driven tools for early disease detection,predictive analytics,and treatment optimization,enhancing clinical decision-making.Organ Support:Advanced life support systems,such as Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy provide better organ support.Infection Control:Innovative infection control measures to combat emerging pathogens and reduce healthcare-associated infections.Ventilation Strategies:Precision ventilation modes and lung-protective strategies to minimize ventilatorinduced lung injury.Sepsis Management:Early recognition and aggressive management of sepsis with tailored interventions.Patient-Centered Care:A shift towards patient-centered care focusing on psychological and emotional wellbeing in addition to medical needs.We conducted a thorough literature search on PubMed,EMBASE,and Scopus using our tailored strategy,incorporating keywords such as critical care,telemedicine,and sepsis management.A total of 125 articles meeting our criteria were included for qualitative synthesis.To ensure reliability,we focused only on articles published in the English language within the last two decades,excluding animal studies,in vitro/molecular studies,and non-original data like editorials,letters,protocols,and conference abstracts.These advancements reflect a dynamic landscape in critical care medicine,where technology,research,and patient-centered approaches converge to improve the quality of care and save lives in ICUs.The future of critical care promises even more innovative solutions to meet the evolving challenges of modern medicine.展开更多
Gastrointestinal(GI)complications frequently necessitate intensive care unit(ICU)admission.Additionally,critically ill patients also develop GI complications requiring further diagnostic and therapeutic interventions....Gastrointestinal(GI)complications frequently necessitate intensive care unit(ICU)admission.Additionally,critically ill patients also develop GI complications requiring further diagnostic and therapeutic interventions.However,these patients form a vulnerable group,who are at risk for developing side effects and complications.Every effort must be made to reduce invasiveness and ensure safety of interventions in ICU patients.Artificial intelligence(AI)is a rapidly evolving technology with several potential applications in healthcare settings.ICUs produce a large amount of data,which may be employed for creation of AI algorithms,and provide a lucrative opportunity for application of AI.However,the current role of AI in these patients remains limited due to lack of large-scale trials comparing the efficacy of AI with the accepted standards of care.展开更多
Objective:To provide insight into the effects of the coronavirus disease(COVID-19)pandemic on the physical and psychological health of critical care nurses in adult units.Methods:A systematic search through the CINAHL...Objective:To provide insight into the effects of the coronavirus disease(COVID-19)pandemic on the physical and psychological health of critical care nurses in adult units.Methods:A systematic search through the CINAHL,MEDLINE,and EMbase databases were performed.Studies that addressed“critical care nurses,”“COVID-19,”“physical effect,”and“psychological effect”from different perspectives were reviewed.Results:A total of 42 ar ticles were reviewed based on 2 aspects:critical care nurses'psychological and physical health.Negative emotions were the most common conditions:fear,anxiety,depression,and post-traumatic stress disorder(PTSD).Burnout,falling ill and having thoughts of self-harm,fatigue,physical burden,sleeping disorders,and chronic work overload also adversely affected the nurses'health.The nurses'health deteriorated because of the changes in the unfamiliar working environment and processes,colossal workload and chronic exhaustion,worries about themselves and their families,social response,and witnessing the death toll.Conclusions:Critical care nurses experienced adverse effects of the institutional reaction,social response,and individuals'reply to the COVID-19 pandemic upon their psychological and physical health.Suppor ting services and preparation for other unprecedented situations should be sustainably available.展开更多
Thrombocytopenia is a common complication of critical care patients.The rates of bleeding events and mortality are also significantly increased in critical care patients with thrombocytopenia.Therefore,the Critical Ca...Thrombocytopenia is a common complication of critical care patients.The rates of bleeding events and mortality are also significantly increased in critical care patients with thrombocytopenia.Therefore,the Critical Care Medicine Committee of Chinese People’s Liberation Army(PLA)worked with Chinese Society of Laboratory Medicine,Chinese Medical Association to develop this consensus to provide guidance for clinical practice.The consensus includes five sections and 27 items:the definition of thrombocytopenia,etiology and pathophysiology,diagnosis and differential diagnosis,treatment and prevention.展开更多
Artificial intelligence(AI)and digital twin models of various systems have long been used in industry to test products quickly and efficiently.Use of digital twins in clinical medicine caught attention with the develo...Artificial intelligence(AI)and digital twin models of various systems have long been used in industry to test products quickly and efficiently.Use of digital twins in clinical medicine caught attention with the development of Archimedes,an AI model of diabetes,in 2003.More recently,AI models have been applied to the fields of cardiology,endocrinology,and undergraduate medical education.The use of digital twins and AI thus far has focused mainly on chronic disease management,their application in the field of critical care medicine remains much less explored.In neurocritical care,current AI technology focuses on interpreting electroencephalography,monitoring intracranial pressure,and prognosticating outcomes.AI models have been developed to interpret electroencephalograms by helping to annotate the tracings,detecting seizures,and identifying brain activation in unresponsive patients.In this mini-review we describe the challenges and opportunities in building an actionable AI model pertinent to neurocritical care that can be used to educate the newer generation of clinicians and augment clinical decision making.展开更多
Patients with heart failure(HF)may be at a higher risk of coronavirus disease 2019(COVID-19)infection and may have a worse outcome due to their comorbid conditions and advanced age.In this narrative review,we aim to s...Patients with heart failure(HF)may be at a higher risk of coronavirus disease 2019(COVID-19)infection and may have a worse outcome due to their comorbid conditions and advanced age.In this narrative review,we aim to study the interaction between COVID-19 and HF from a critical care perspective.We performed a systematic search for studies that reported HF and critical carerelated outcomes in COVID-19 patients in the PubMed and Medline databases.From a total of 1050 papers,we identified 26 that satisfied the eligibility criteria for our review.Data such as patient demographics,HF,intensive care unit(ICU)admission,management,and outcome were extracted from these studies and analyzed.We reported outcomes in heart-transplant patients with COVID-19 separately.In hospitalized patients with COVID-19,the prevalence of HF varied between 4%and 21%.The requirement for ICU admission was between 8%and 33%.HF patients with COVID-19 had an overall mortality rate between 20%and 40%.We identified that HF is an independent predictor of mortality in hospitalized COVID-19 patients,and patients with HF were more likely to require ventilation,ICU admission and develop complications.Patients with HF with reduced ejection fraction did worse than those with HF with midrange ejection fraction,and HF with preserved ejection fraction.COVID-19 patients with HF should be identified early and managed aggressively in an attempt to improve outcomes in this cohort of patients.展开更多
BACKGROUND A diverse country like India may have variable intensive care units(ICUs)practices at state and city levels.AIM To gain insight into clinical services and processes of care in ICUs in India,this would help ...BACKGROUND A diverse country like India may have variable intensive care units(ICUs)practices at state and city levels.AIM To gain insight into clinical services and processes of care in ICUs in India,this would help plan for potential educational and quality improvement interventions.METHODS The Indian ICU needs assessment research group of diverse-skilled individuals was formed.A pan-India survey"Indian National ICU Needs"assessment(ININ 2018-I)was designed on google forms and deployed from July 23rd-August 25th,2018.The survey was sent to select distribution lists of ICU providers from all 29 states and 7 union territories(UTs).In addition to emails and phone calls,social medial applications-WhatsApp™,Facebook™and LinkedIn™were used to remind and motivate providers.By completing and submitting the survey,providers gave their consent for research purposes.This study was deemed eligible for category-2 Institutional Review Board exempt status.RESULTS There were total 134 adult/adult-pediatrics ICU responses from 24(83%out of 29)states,and two(28%out of 7)UTs in 61 cities.They had median(IQR)16(10-25)beds and most,were mixed medical-surgical,111(83%),with 108(81%)being adult-only ICUs.Representative responders were young,median(IQR),38(32-44)years age and majority,n=108(81%)were males.The consultants were,n=101(75%).A total of 77(57%)reported to have 24 h in-house intensivist.A total of 68(51%)ICUs reported to have either 2:1 or 2≥:1 patient:nurse ratio.More than 80%of the ICUs were open,and mixed type.Protocols followed regularly by the ICUs included sepsis care,ventilator-associated pneumonia(83%each);nutrition(82%),deep vein thrombosis prophylaxis(87%),stress ulcer prophylaxis(88%)and glycemic control(92%).Digital infrastructure was found to be poor,with only 46%of the ICUs reporting high-speed internet availability.CONCLUSION In this large,national,semi-structured,need-assessment survey,the need for improved manpower including;in-house intensivists,and decreasing patient-tonurse ratios was evident.Sepsis was the most common diagnosis and quality and research initiatives to decrease sepsis mortality and ICU length of stay could be prioritized.Additionally,subsequent surveys can focus on digital infrastructure for standardized care and efficient resource utilization and enhancing compliance with existing protocols.展开更多
Background: The importance of the acute phase in hospitals has been increasing. While administering high-level critical care, the working styles of critical care nurses, the types of clinical care they provide, and th...Background: The importance of the acute phase in hospitals has been increasing. While administering high-level critical care, the working styles of critical care nurses, the types of clinical care they provide, and the way in which they prioritize tasks, remain unclear. Aim of this study was to elucidate the characteristic duties of critical care nurses through a comparison with neurological ward nurses. Methods: We recorded the duties of critical care nurses and neurology ward nurses (10 each) using a time-study design. Duties were measured separately by action, classified using a classification table, and differences between the two groups were compared. Results: No differences in the number of actions were observed between the two groups. The top five items that required the most time for critical care nurses were, “Movement”, “Administration and oxygen management”, “Handover process/Doctor’s rounds”, “Preparation for entry and exit management of patients”, and “Bed bathing (for bedbound patients)”. Of the 195 items, significant differences between the groups were noted for 34 items, while the duties of critical care nurses were best characterized by bed bathing (for bedbound patients), changing position, confirmation of infusion tubes, handover process/doctor’s rounds, and preparation for entry and exit management of patients. Conclusion: A characteristic of critical care nurses is that they must remain near patients and perform tasks while moving only a short distance. Moreover, the promotion of tasks while communicating with physicians is presumed to play a role in the promotion of team medicine. Furthermore, much time was spent caring for patients in bed, and a lot of time was devoted to the preparation and finalizing of treatments and care, suggesting the possibility that more time can be spent on caring for patients through a revision of duties.展开更多
Case description:Withdrawal of treatment is a common practice in critical care settings,perticularly when treatment is considered futile.The case study demonstrates an ethical dilemma,in which Danny is unlikely to mak...Case description:Withdrawal of treatment is a common practice in critical care settings,perticularly when treatment is considered futile.The case study demonstrates an ethical dilemma,in which Danny is unlikely to make a functional recovery because of multiple organ dysfunction syndromes.Under such a circumstance,withdrawal of treatment will inevitably be considered,although his family refused to do so.Consequently,acritical question must be answered:Who should make the decision?Ethical dilemma identification:Danny decided to withdraw the use of life-support,whilst his wife and adult children refused to do so.The ethical dilemma is illustrated by the following question:Who decides the withdrawal of treatment in a critical care setting?Analysis:To provide an opotional solution to this case and make the best moral decision,the current study will critically discuss this issue in conjunction with ethical principles,philosophical theories and the values statement of the European and Chinese nurses'codes of ethics.Additionally,the associated literature relative to this case are analysed before the decision-making.Ethical decision-making:The best ethical decision is Danny can decide whether to withhold or withdraw life-sustaining treatment.If his family is involved in the discussion,the medical staff should balance the ethical principles when they make the decision and allocate reasonable resources for patients.Results:In Danny's case,health professionals opted to respect his decision to withdraw treatment.The medical staff maintained an effective communication with the family involved,and provided the appropriate intervention to collaborate with other health care professionals to perfect further care.展开更多
Background Patients undergoing intensive care are exposed to risk factors for hearing impairment.This study assessed the worse changes in pure tone average(PTA)thresholds after intensive care and identified the factor...Background Patients undergoing intensive care are exposed to risk factors for hearing impairment.This study assessed the worse changes in pure tone average(PTA)thresholds after intensive care and identified the factors associated with worse hearing function.Methods We conducted a single-centre retrospective study,and included adult patients admitted to the intensive care unit(ICU)of Kurashiki Central Hospital between January 2014 and September 2019,who had regular pure tone audiometry performed before and after ICU admission.Correlations between changes in PTA threshold and patient characteristics,were evaluated.The included ears were classified as those with worse hearing(>10 dB increase in the PTA threshold)and those without worse hearing,and the baseline characteristics were compared.Results During the study period,125 ears of 71 patients(male:female ratio,35:36;mean age,72.5±12.3 years)met the eligibility criteria.Age,sex,and the use of furosemide were not correlated with changes in PTA threshold.Univariate analysis showed that ears with worse hearing were associated with a lower serum platelet count than ears without worse hearing(153±85×10^(9)/L vs.206±85×10^(9)/L,respectively;P=0.010),and the rate of planned ICU admission(elective surgery)was higher in the worse hearing group(57.1% vs.28.8%,respectively;p=0.011).Conclusions Age,sex,and the use of furosemide did not have adversely affect hearing function.Low serum platelet count and planned admission appear to be risk factors for worse hearing.展开更多
BACKGROUND The novel coronavirus severe acute respiratory syndrome coronavirus 2 is associated with a severe disease known as coronavirus disease 2019(COVID-19).A small percentage of patients with COVID-19 will requir...BACKGROUND The novel coronavirus severe acute respiratory syndrome coronavirus 2 is associated with a severe disease known as coronavirus disease 2019(COVID-19).A small percentage of patients with COVID-19 will require intensive care and possibly mechanical ventilation.The mortality of intensive care interventions in patients with COVID-19 remains unclear.AIM To identify mortality rate of COVID-19 patients receiving different interventions in the critical care unit.METHODS We searched OVID Medline,SCOPUS,MedRxIv,preprints.org,and Centers for Disease Control databases from November 2019 to April 10,2020 for articles on COVID-19.Teams of 2 independent reviewers reviewed titles and abstract for studies that reported mortality of human adults with COVID-19 and exposure to a critical care intervention[Intensive care admission,mechanical ventilation,acute hemodialysis,extracorporeal membrane oxygenation,or cardiopulmonary resuscitation(CPR)].We used a descriptive analysis and unweighted averages of mortality across studies.RESULTS Our search identified 6973 articles and 20 met inclusion:17 for intensive care,13 for mechanical ventilation,5 for hemodialysis,2 for extracorporeal membrane oxygenation,and 1 for CPR.Mortality associated with intensive care admission ranged from 9%-83%,with overall mortality 32.5%(95%CI:32.4%-32.6%).Mortality associated with intubation from 16.7%-100%with overall mortality 64.0%(95%CI:62.4%-65.5%).In patients requiring hemodialysis,mortality ranged from 0%-100%,with average mortality 75.3%(95%CI:72.6%-77.4%).CONCLUSION Patients with COVID-19 requiring intensive care have high mortality rates.Authorities can use this data to establish pharmacoeconomic studies to make decisions about allocation of scarce resources if necessary.展开更多
The purposes of this study were to describe the decision making process and decision activities of critical care nurses in natural clinical settings. An exploratory descriptive approach utilizing both interview and ob...The purposes of this study were to describe the decision making process and decision activities of critical care nurses in natural clinical settings. An exploratory descriptive approach utilizing both interview and observation methods, was used for data collection. The study involved twenty four critical care nurses from three hospitals in Jordan. Participant observation was performed to understand the routine clinical decisions made by Intensive Care nurses. About 150 hours of observations were spent in the involved Intensive Care Units. Nurses were interviewed to elicit information about how they made decisions about patient’s care. The study revealed that the most common model nurses tend to use was intuitive model in order to observe the cues relating to the patient’s situation. Data revealed that the decision making process is continuous and that experience is one of the main factors that determine nurses’ ability to take decisions. Five themes were generated from the data: on-going process, autonomy, experience/power, joint/ethical decisions, and advocacy. Critical care nurses were seen to be sensitive to the patient’s verbal and non-verbal cues;they were able to respond to these evidences to ensure that the patient’s condition did not deteriorate. Critical care nurses are likely to be more confident and effective when dealing with patient’s changing situations with more experience.展开更多
<span style="font-family:Verdana;">The </span><span style="font-family:""><span style="font-family:Verdana;">upsurge of candidemia in the past years has been ...<span style="font-family:Verdana;">The </span><span style="font-family:""><span style="font-family:Verdana;">upsurge of candidemia in the past years has been an immense encumbrance on public health and the number of deaths caused by candidemia particularly in critical care unit patients is devastating. </span><i><span style="font-family:Verdana;">Candida</span></i><span style="font-family:Verdana;"> species harbor a 30</span></span><span style="font-family:Verdana;">% </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">60% mortality rate and compared to stable people or those with less serious illnesses, this ranges from 60</span><span style="font-family:Verdana;">%</span><span style="font-family:Verdana;"> to 80% of those who are chronically ill patients. Grounded on a recent report from a tertiary care hospital in Kenya showing the emergence of previously unobserved species</span><span style="font-family:Verdana;">:</span><span style="font-family:""> <i><span style="font-family:Verdana;">Candida auris</span></i><span style="font-family:Verdana;">, this study aimed to determine the prevalence, species distribution, and antifungal susceptibility profile of candidemia in critical care unit patients of the hospital. 378 Critical Care Unit patients were enrolled for the study from January 2019 to January 2020. Positive archived isolates were sub-cultured using Sa</span><span><span style="font-family:Verdana;">boraud Dextrose Agar. </span><i><span style="font-family:Verdana;">Candida</span></i><span style="font-family:Verdana;"> species were identified utilizing API20C</span></span><span style="font-family:Verdana;"> AUX and Vitek-2. Antifungal susceptibility testing was conducted using the Liofilchem MIC Test strip. Out of 378 patients, thirty-one presented a positive culture for </span><i><span style="font-family:Verdana;">Candida</span></i><span style="font-family:Verdana;"> species. The prevalence of Candidemia was </span><b><span style="font-family:Verdana;">8.2%</span></b><span style="font-family:Verdana;"> with </span><b><span style="font-family:Verdana;">9 (29.03%) </span></b><i><span style="font-family:Verdana;">Candida auris</span></i><span style="font-family:Verdana;">, </span><b><span style="font-family:Verdana;">8 (25.81%)</span></b> <i><span style="font-family:Verdana;">Candida albicans</span></i><span style="font-family:Verdana;">, </span><b><span style="font-family:Verdana;">6 (19.35%) </span></b><i><span style="font-family:Verdana;">Candida parapsilosis</span></i><span style="font-family:Verdana;">, </span><b><span style="font-family:Verdana;">3 (9.68%)</span></b> <i><span style="font-family:Verdana;">Candida famata</span></i><span style="font-family:Verdana;">, </span><b><span style="font-family:Verdana;">3 (9.68%)</span></b><i><span style="font-family:Verdana;"> Candida tropicalis</span></i><span style="font-family:Verdana;">, </span><b><span style="font-family:Verdana;">1 (3.23%)</span></b> <i><span style="font-family:Verdana;">Candida duobushaemolumonii</span></i><span style="font-family:Verdana;">, and </span><b><span style="font-family:Verdana;">1 (3.23%)</span></b> <i><span style="font-family:Verdana;">Candida lusitaniae</span></i><span style="font-family:Verdana;">.</span><i> </i><span style="font-family:Verdana;">A resistance pattern to Fluconazole was observed among </span><i><span style="font-family:Verdana;">Candida auris</span></i><span style="font-family:Verdana;"> and </span><i><span style="font-family:Verdana;">Candida parapsilosis</span></i><span style="font-family:Verdana;">, and resistance to Flucytosine was observed in </span><i><span style="font-family:Verdana;">Candida tropicalis</span></i><span style="font-family:Verdana;">,</span><i> </i><span style="font-family:Verdana;">whereas susceptible MIC values were obtained for the other drugs.</span><i> </i><span style="font-family:Verdana;">There is an increase in candidemia among critical care unit patients in the health facility posing a public health challenge. Moreover, the onset of new species </span><i><span style="font-family:Verdana;">Candida auris </span></i><span style="font-family:Verdana;">which is unprecedented in Kenya warrants enhanced infection control, and the uniform resistance of </span><i><span style="font-family:Verdana;">Candida auris</span></i><span style="font-family:Verdana;">, </span><i><span style="font-family:Verdana;">Candida parapsilosis</span></i><span style="font-family:Verdana;">,</span><i> </i><span style="font-family:Verdana;">and</span><i><span style="font-family:Verdana;"> Candida tropicalis</span></i><span style="font-family:Verdana;"> towards Fluconazole and Flucytosine necessitate constant drug monitoring for empirical treatment regime. In contrast, the high potency of Echinocandins and Amphotericin-B demonstrate them as the drug of choice.展开更多
Objective:To determine the relationship between clinical performance and professional self-concept in critical care nurses.Methods:This study was conducted on 308 critical care nurses.Data gathering instruments were n...Objective:To determine the relationship between clinical performance and professional self-concept in critical care nurses.Methods:This study was conducted on 308 critical care nurses.Data gathering instruments were nurses’clinical performance questionnaire(NCPQ)and nursing professional self-concept measure(NPSCM).Independent sample t-test,one-way analysis of variance(ANOVA),and Pearson correlation coefficient were used for data analyses.Results:The average age of the nurses was 33.74±7.01 years.The clinical performance score of female nurses was significantly higher than male nurses.In the domain of clinical performance,clinical judgment and clinical inquiry had the highest and lowest scores,respectively.In the nurses’professional self-concept,the highest and lowest scores were awarded to the subscales of self-confidence and staff relations,respectively.In addition,there was a significant positive correlation between self-concept and clinical performance of nurses.Conclusions:Increasing professional self-concept improves the clinical performance of critical care nurses.Professional self-concept enhancement measures are recommended to improve the clinical performance of nurses in critical care units.展开更多
BACKGROUND:Life-sustaining treatments(LSTs)may prolong life but greatly decrease the quality of death.One factor influencing decision-making about withholding and withdrawing these treatments is the attitude of nurses...BACKGROUND:Life-sustaining treatments(LSTs)may prolong life but greatly decrease the quality of death.One factor influencing decision-making about withholding and withdrawing these treatments is the attitude of nurses.This study aimed to evaluate the attitude of critical care nurses towards life-sustaining treatments in South East Iran.METHODS:In this cross-sectional study,"Ethnicity and Attitudes towards Advance Care Directives Questionnaire"was used to investigate the attitude of 104 critical care nurses towards lifesustaining treatments in three hospitals affiliated to Kerman University of Medical Sciences.RESULTS:The findings of this study indicated that although a majority of critical care nurses(77%)did not have personal desire for use of LSTs including CPR and mechanical ventilation,they had moderately negative to neutral attitude towards general use of LSTs(2.95 of 5).CONCLUSIONS:These findings suggest that nurses'attitude towards LSTs can be changed by inclusion of specific courses about death,palliative care and life-sustaining treatments in undergraduate and postgraduate nursing curricula.Educating Muslim nurses about religious aspects of LSTs may also improve their attitudes.展开更多
Mortality is a well-established patient-important outcome in critical care studies.In contrast,morbidity is less uniformly reported(given the myriad of critical care illnesses and complications of each)but may have a ...Mortality is a well-established patient-important outcome in critical care studies.In contrast,morbidity is less uniformly reported(given the myriad of critical care illnesses and complications of each)but may have a common end-impact on a patient’s functional capacity and health-related quality-of-life(HRQoL).Survival with a poor quality-of-life may not be acceptable depending on individual patient values and preferences.Hence,as mortality decreases within critical care,it becomes increasingly important to measure intensive care unit(ICU)survivor HRQoL.HRQoL measurements with a preference-based scoring algorithm can be converted into health utilities on a scale anchored at 0(representing death)and 1(representing full health).They can be combined with survival to calculate quality-adjusted life-years(QALY),which are one of the most widely used methods of combining morbidity and mortality into a composite outcome.Although QALYs have been use for health-technology assessment decision-making,an emerging and novel role would be to inform clinical decision-making for patients,families and healthcare providers about what expected HRQoL may be during and after ICU care.Critical care randomized control trials(RCTs)have not routinely measured or reported HRQoL(until more recently),likely due to incapacity of some patients to participate in patient-reported outcome measures.Further differences in HRQoL measurement tools can lead to non-comparable values.To this end,we propose the validation of a gold-standard HRQoL tool in critical care,specifically the EQ-5D-5L.Both combined health-utility and mortality(disaggregated)and QALYs(aggregated)can be reported,with disaggregation allowing for determination of which components are the main drivers of the QALY outcome.Increased use of HRQoL,health-utility,and QALYs in critical care RCTs has the potential to:(1)Increase the likelihood of finding important effects if they exist;(2)improve research efficiency;and(3)help inform optimal management of critically ill patients allowing for decision-making about their HRQoL,in additional to traditional health-technology assessments.展开更多
<strong>Objective: </strong>Critical care nurses work in a challenging intensive care (ICU) environment that results in work-related psychological distress. Our objective was to pilot an in-person or virtu...<strong>Objective: </strong>Critical care nurses work in a challenging intensive care (ICU) environment that results in work-related psychological distress. Our objective was to pilot an in-person or virtual mindfulness-based cognitive therapy (MBCT) program enhanced resilience and a similarly designed attention control group. <strong>Methods: </strong>We randomized ICU nurses with symptoms of burnout syndrome and decreased resilience to an MBCT program or a similarly formatted book club control. Our primary outcome was change in resilience as measured by the Connor-Davidson Resilience Scale (CD-RISC). <strong>Results: </strong>One-hundred one nurses completed study-related procedures. Overall, 70% had baseline symptoms of anxiety and 26% had symptoms of depression. For the in-person cohorts, there was no statistical difference between intervention and control groups regarding the total number of sessions attended (3.85 days ± 1.4 versus 3.75 days ± 0.15;p = 0.64). Using the Client/Patient Satisfaction Questionnaire-8 (CSQ-8), satisfaction scores were higher in the intervention group for weeks two through four of the program: p = 0.03, 0.0003, 0.007 respectively. There was no difference in the change in CD-RISC scores between the two groups (mean difference: treatment = 5.0, control = 7.0;p = 0.30). The online intervention cohort had greater improvements in the change of their median emotional exhaustion burnout scores when compared to the in-person intervention cohorts (-5 [-8 to -1.5] vs. 2 [-5 to 8], p = 0.049). <strong>Conclusions: </strong>We developed a feasible and acceptable in-person and online MBCT-ICU intervention that did not increase resilience scores in ICU nurses when compared to an attention control group. These results could help guide the proper design of larger trials to determine the efficacy of other resilience interventions.展开更多
BACKGROUND There is variability in intensive care unit(ICU)resources and staffing worldwide.This may reflect variation in practice and outcomes across all health systems.AIM To improve research and quality improvement...BACKGROUND There is variability in intensive care unit(ICU)resources and staffing worldwide.This may reflect variation in practice and outcomes across all health systems.AIM To improve research and quality improvement measures administrative leaders can create long-term strategies by understanding the nature of ICU practices on a global scale.METHODS The Global ICU Needs Assessment Research Group was formed on the basis of diversified skill sets.We aimed to survey sites regarding ICU type,availability of staffing,and adherence to critical care protocols.An international survey‘Global ICU Needs Assessment’was created using Google Forms,and this was distributed from February 17^(th),2020 till September 23^(rd),2020.The survey was shared with ICU providers in 34 countries.Various approaches to motivating healthcare providers were implemented in securing submissions,including use of emails,phone calls,social media applications,and WhatsApp^(TM).By completing this survey,providers gave their consent for research purposes.This study was deemed eligible for category-2 Institutional Review Board exempt status.RESULTS There were a total 121 adult/adult-pediatrics ICU responses from 34 countries in 76 cities.A majority of the ICUs were mixed medical-surgical[92(76%)].108(89%)were adult-only ICUs.Total 36 respondents(29.8%)were 31-40 years of age,with 79(65%)male and 41(35%)female participants.89 were consultants(74%).A total of 71(59%)respondents reported having a 24-h inhouse intensivist.A total of 87(72%)ICUs were reported to have either a 2:1 or≥2:1 patient/nurse ratio.About 44%of the ICUs were open and 76%were mixed type(medical-surgical).Protocols followed regularly by the ICUs included sepsis care(82%),ventilator-associated pneumonia(79%);nutrition(76%),deep vein thrombosis prophylaxis(84%),stress ulcer prophylaxis(84%),and glycemic control(89%).CONCLUSION Based on the findings of this international,multi-dimensional,needs-assessment survey,there is a need for increased recruitment and staffing in critical care facilities,along with improved patientto-nurse ratios.Future research is warranted in this field with focus on implementing appropriate health standards,protocols and resources for optimal efficiency in critical care worldwide.展开更多
As editors of World Journal of Critical Care Medicine(WJCCM),it is our great pleasure to take this opportunity to wish all our authors,subscribers,readers,Editorial Board members,independent expert referees,and staff ...As editors of World Journal of Critical Care Medicine(WJCCM),it is our great pleasure to take this opportunity to wish all our authors,subscribers,readers,Editorial Board members,independent expert referees,and staff of the Editorial Office a Very Happy New Year.On behalf of the Editorial Team,we would like to express our gratitude to all authors who have contributed their valuable manuscripts and to the independent referees and our subscribers and readers for their continuous support,dedication,and encouragement.The excellent team effort by our editorial board members and staff of the Editorial Office allowed WJCCM to advance remarkably in 2020.In the future,the Baishideng Publishing Group and WJCCM’s editorial board will continue to increase their communication and collaboration,both internally and involving our external contributors,in order to promote our collective impact on the field of Critical Care Medicine even further.展开更多
BACKGROUND Critically ill patients are at risk of developing stress cardiomyopathy(SC)but can be under-recognized.AIM To describe a case series of patients with SC admitted to critical care units.METHODS We conducted ...BACKGROUND Critically ill patients are at risk of developing stress cardiomyopathy(SC)but can be under-recognized.AIM To describe a case series of patients with SC admitted to critical care units.METHODS We conducted a retrospective observational study at a tertiary care teaching hospital.All adult(≥18 years old)patients admitted to the critical care units with stress cardiomyopathy over 5 years were included.RESULTS Of 24279 admissions to the critical care units[19139 to medical-surgical intensive care units(MSICUs)and 5140 in coronary care units(CCUs)],109 patients with SC were identified.Sixty(55%)were admitted to the coronary care units(CCUs)and forty-nine(45%)to the medical-surgical units(MSICUs).The overall incidence of SC was 0.44%,incidence in CCU and MSICU was 1.16%and 0.25%respectively.Sixty-two(57%)had confirmed SC and underwent cardiac catheterization whereas 47(43%)had clinical SC,and did not undergo cardiac catheterization.Forty-three(72%)patients in the CCUs were diagnosed with primary SC,whereas all(100%)patients in MSICUs developed secondary SC.Acute respiratory failure that required invasive mechanical ventilation and shock developed in twenty-nine(59%)MSICU patients.There were no statistically significant differences in intensive care unit(ICU)mortality,in-hospital mortality,use of inotropic or mechanical circulatory support based on type of unit or anatomical variant.CONCLUSION Stress cardiomyopathy can be under-recognized in the critical care setting.Intensivists should have a high index of suspicion for SC in patients who develop sudden or worsening unexplained hemodynamic instability,arrhythmias or respiratory failure in ICU.展开更多
文摘Critical care medicine in the 21st century has witnessed remarkable advancements that have significantly improved patient outcomes in intensive care units(ICUs).This abstract provides a concise summary of the latest developments in critical care,highlighting key areas of innovation.Recent advancements in critical care include Precision Medicine:Tailoring treatments based on individual patient characteristics,genomics,and biomarkers to enhance the effectiveness of therapies.The objective is to describe the recent advancements in Critical Care Medicine.Telemedicine:The integration of telehealth technologies for remote patient monitoring and consultation,facilitating timely interventions.Artificial intelligence(AI):AI-driven tools for early disease detection,predictive analytics,and treatment optimization,enhancing clinical decision-making.Organ Support:Advanced life support systems,such as Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy provide better organ support.Infection Control:Innovative infection control measures to combat emerging pathogens and reduce healthcare-associated infections.Ventilation Strategies:Precision ventilation modes and lung-protective strategies to minimize ventilatorinduced lung injury.Sepsis Management:Early recognition and aggressive management of sepsis with tailored interventions.Patient-Centered Care:A shift towards patient-centered care focusing on psychological and emotional wellbeing in addition to medical needs.We conducted a thorough literature search on PubMed,EMBASE,and Scopus using our tailored strategy,incorporating keywords such as critical care,telemedicine,and sepsis management.A total of 125 articles meeting our criteria were included for qualitative synthesis.To ensure reliability,we focused only on articles published in the English language within the last two decades,excluding animal studies,in vitro/molecular studies,and non-original data like editorials,letters,protocols,and conference abstracts.These advancements reflect a dynamic landscape in critical care medicine,where technology,research,and patient-centered approaches converge to improve the quality of care and save lives in ICUs.The future of critical care promises even more innovative solutions to meet the evolving challenges of modern medicine.
文摘Gastrointestinal(GI)complications frequently necessitate intensive care unit(ICU)admission.Additionally,critically ill patients also develop GI complications requiring further diagnostic and therapeutic interventions.However,these patients form a vulnerable group,who are at risk for developing side effects and complications.Every effort must be made to reduce invasiveness and ensure safety of interventions in ICU patients.Artificial intelligence(AI)is a rapidly evolving technology with several potential applications in healthcare settings.ICUs produce a large amount of data,which may be employed for creation of AI algorithms,and provide a lucrative opportunity for application of AI.However,the current role of AI in these patients remains limited due to lack of large-scale trials comparing the efficacy of AI with the accepted standards of care.
文摘Objective:To provide insight into the effects of the coronavirus disease(COVID-19)pandemic on the physical and psychological health of critical care nurses in adult units.Methods:A systematic search through the CINAHL,MEDLINE,and EMbase databases were performed.Studies that addressed“critical care nurses,”“COVID-19,”“physical effect,”and“psychological effect”from different perspectives were reviewed.Results:A total of 42 ar ticles were reviewed based on 2 aspects:critical care nurses'psychological and physical health.Negative emotions were the most common conditions:fear,anxiety,depression,and post-traumatic stress disorder(PTSD).Burnout,falling ill and having thoughts of self-harm,fatigue,physical burden,sleeping disorders,and chronic work overload also adversely affected the nurses'health.The nurses'health deteriorated because of the changes in the unfamiliar working environment and processes,colossal workload and chronic exhaustion,worries about themselves and their families,social response,and witnessing the death toll.Conclusions:Critical care nurses experienced adverse effects of the institutional reaction,social response,and individuals'reply to the COVID-19 pandemic upon their psychological and physical health.Suppor ting services and preparation for other unprecedented situations should be sustainably available.
文摘Thrombocytopenia is a common complication of critical care patients.The rates of bleeding events and mortality are also significantly increased in critical care patients with thrombocytopenia.Therefore,the Critical Care Medicine Committee of Chinese People’s Liberation Army(PLA)worked with Chinese Society of Laboratory Medicine,Chinese Medical Association to develop this consensus to provide guidance for clinical practice.The consensus includes five sections and 27 items:the definition of thrombocytopenia,etiology and pathophysiology,diagnosis and differential diagnosis,treatment and prevention.
基金Supported by the National Center for Advancing Translational Sciences,No.UL1 TR002377.
文摘Artificial intelligence(AI)and digital twin models of various systems have long been used in industry to test products quickly and efficiently.Use of digital twins in clinical medicine caught attention with the development of Archimedes,an AI model of diabetes,in 2003.More recently,AI models have been applied to the fields of cardiology,endocrinology,and undergraduate medical education.The use of digital twins and AI thus far has focused mainly on chronic disease management,their application in the field of critical care medicine remains much less explored.In neurocritical care,current AI technology focuses on interpreting electroencephalography,monitoring intracranial pressure,and prognosticating outcomes.AI models have been developed to interpret electroencephalograms by helping to annotate the tracings,detecting seizures,and identifying brain activation in unresponsive patients.In this mini-review we describe the challenges and opportunities in building an actionable AI model pertinent to neurocritical care that can be used to educate the newer generation of clinicians and augment clinical decision making.
文摘Patients with heart failure(HF)may be at a higher risk of coronavirus disease 2019(COVID-19)infection and may have a worse outcome due to their comorbid conditions and advanced age.In this narrative review,we aim to study the interaction between COVID-19 and HF from a critical care perspective.We performed a systematic search for studies that reported HF and critical carerelated outcomes in COVID-19 patients in the PubMed and Medline databases.From a total of 1050 papers,we identified 26 that satisfied the eligibility criteria for our review.Data such as patient demographics,HF,intensive care unit(ICU)admission,management,and outcome were extracted from these studies and analyzed.We reported outcomes in heart-transplant patients with COVID-19 separately.In hospitalized patients with COVID-19,the prevalence of HF varied between 4%and 21%.The requirement for ICU admission was between 8%and 33%.HF patients with COVID-19 had an overall mortality rate between 20%and 40%.We identified that HF is an independent predictor of mortality in hospitalized COVID-19 patients,and patients with HF were more likely to require ventilation,ICU admission and develop complications.Patients with HF with reduced ejection fraction did worse than those with HF with midrange ejection fraction,and HF with preserved ejection fraction.COVID-19 patients with HF should be identified early and managed aggressively in an attempt to improve outcomes in this cohort of patients.
基金This study was deemed eligible for category-2 Institutional Review Board exempt status from Mayo Clinic IRB,Mayo Clinic,Rochester,MN,55905,United States.
文摘BACKGROUND A diverse country like India may have variable intensive care units(ICUs)practices at state and city levels.AIM To gain insight into clinical services and processes of care in ICUs in India,this would help plan for potential educational and quality improvement interventions.METHODS The Indian ICU needs assessment research group of diverse-skilled individuals was formed.A pan-India survey"Indian National ICU Needs"assessment(ININ 2018-I)was designed on google forms and deployed from July 23rd-August 25th,2018.The survey was sent to select distribution lists of ICU providers from all 29 states and 7 union territories(UTs).In addition to emails and phone calls,social medial applications-WhatsApp™,Facebook™and LinkedIn™were used to remind and motivate providers.By completing and submitting the survey,providers gave their consent for research purposes.This study was deemed eligible for category-2 Institutional Review Board exempt status.RESULTS There were total 134 adult/adult-pediatrics ICU responses from 24(83%out of 29)states,and two(28%out of 7)UTs in 61 cities.They had median(IQR)16(10-25)beds and most,were mixed medical-surgical,111(83%),with 108(81%)being adult-only ICUs.Representative responders were young,median(IQR),38(32-44)years age and majority,n=108(81%)were males.The consultants were,n=101(75%).A total of 77(57%)reported to have 24 h in-house intensivist.A total of 68(51%)ICUs reported to have either 2:1 or 2≥:1 patient:nurse ratio.More than 80%of the ICUs were open,and mixed type.Protocols followed regularly by the ICUs included sepsis care,ventilator-associated pneumonia(83%each);nutrition(82%),deep vein thrombosis prophylaxis(87%),stress ulcer prophylaxis(88%)and glycemic control(92%).Digital infrastructure was found to be poor,with only 46%of the ICUs reporting high-speed internet availability.CONCLUSION In this large,national,semi-structured,need-assessment survey,the need for improved manpower including;in-house intensivists,and decreasing patient-tonurse ratios was evident.Sepsis was the most common diagnosis and quality and research initiatives to decrease sepsis mortality and ICU length of stay could be prioritized.Additionally,subsequent surveys can focus on digital infrastructure for standardized care and efficient resource utilization and enhancing compliance with existing protocols.
文摘Background: The importance of the acute phase in hospitals has been increasing. While administering high-level critical care, the working styles of critical care nurses, the types of clinical care they provide, and the way in which they prioritize tasks, remain unclear. Aim of this study was to elucidate the characteristic duties of critical care nurses through a comparison with neurological ward nurses. Methods: We recorded the duties of critical care nurses and neurology ward nurses (10 each) using a time-study design. Duties were measured separately by action, classified using a classification table, and differences between the two groups were compared. Results: No differences in the number of actions were observed between the two groups. The top five items that required the most time for critical care nurses were, “Movement”, “Administration and oxygen management”, “Handover process/Doctor’s rounds”, “Preparation for entry and exit management of patients”, and “Bed bathing (for bedbound patients)”. Of the 195 items, significant differences between the groups were noted for 34 items, while the duties of critical care nurses were best characterized by bed bathing (for bedbound patients), changing position, confirmation of infusion tubes, handover process/doctor’s rounds, and preparation for entry and exit management of patients. Conclusion: A characteristic of critical care nurses is that they must remain near patients and perform tasks while moving only a short distance. Moreover, the promotion of tasks while communicating with physicians is presumed to play a role in the promotion of team medicine. Furthermore, much time was spent caring for patients in bed, and a lot of time was devoted to the preparation and finalizing of treatments and care, suggesting the possibility that more time can be spent on caring for patients through a revision of duties.
文摘Case description:Withdrawal of treatment is a common practice in critical care settings,perticularly when treatment is considered futile.The case study demonstrates an ethical dilemma,in which Danny is unlikely to make a functional recovery because of multiple organ dysfunction syndromes.Under such a circumstance,withdrawal of treatment will inevitably be considered,although his family refused to do so.Consequently,acritical question must be answered:Who should make the decision?Ethical dilemma identification:Danny decided to withdraw the use of life-support,whilst his wife and adult children refused to do so.The ethical dilemma is illustrated by the following question:Who decides the withdrawal of treatment in a critical care setting?Analysis:To provide an opotional solution to this case and make the best moral decision,the current study will critically discuss this issue in conjunction with ethical principles,philosophical theories and the values statement of the European and Chinese nurses'codes of ethics.Additionally,the associated literature relative to this case are analysed before the decision-making.Ethical decision-making:The best ethical decision is Danny can decide whether to withhold or withdraw life-sustaining treatment.If his family is involved in the discussion,the medical staff should balance the ethical principles when they make the decision and allocate reasonable resources for patients.Results:In Danny's case,health professionals opted to respect his decision to withdraw treatment.The medical staff maintained an effective communication with the family involved,and provided the appropriate intervention to collaborate with other health care professionals to perfect further care.
文摘Background Patients undergoing intensive care are exposed to risk factors for hearing impairment.This study assessed the worse changes in pure tone average(PTA)thresholds after intensive care and identified the factors associated with worse hearing function.Methods We conducted a single-centre retrospective study,and included adult patients admitted to the intensive care unit(ICU)of Kurashiki Central Hospital between January 2014 and September 2019,who had regular pure tone audiometry performed before and after ICU admission.Correlations between changes in PTA threshold and patient characteristics,were evaluated.The included ears were classified as those with worse hearing(>10 dB increase in the PTA threshold)and those without worse hearing,and the baseline characteristics were compared.Results During the study period,125 ears of 71 patients(male:female ratio,35:36;mean age,72.5±12.3 years)met the eligibility criteria.Age,sex,and the use of furosemide were not correlated with changes in PTA threshold.Univariate analysis showed that ears with worse hearing were associated with a lower serum platelet count than ears without worse hearing(153±85×10^(9)/L vs.206±85×10^(9)/L,respectively;P=0.010),and the rate of planned ICU admission(elective surgery)was higher in the worse hearing group(57.1% vs.28.8%,respectively;p=0.011).Conclusions Age,sex,and the use of furosemide did not have adversely affect hearing function.Low serum platelet count and planned admission appear to be risk factors for worse hearing.
文摘BACKGROUND The novel coronavirus severe acute respiratory syndrome coronavirus 2 is associated with a severe disease known as coronavirus disease 2019(COVID-19).A small percentage of patients with COVID-19 will require intensive care and possibly mechanical ventilation.The mortality of intensive care interventions in patients with COVID-19 remains unclear.AIM To identify mortality rate of COVID-19 patients receiving different interventions in the critical care unit.METHODS We searched OVID Medline,SCOPUS,MedRxIv,preprints.org,and Centers for Disease Control databases from November 2019 to April 10,2020 for articles on COVID-19.Teams of 2 independent reviewers reviewed titles and abstract for studies that reported mortality of human adults with COVID-19 and exposure to a critical care intervention[Intensive care admission,mechanical ventilation,acute hemodialysis,extracorporeal membrane oxygenation,or cardiopulmonary resuscitation(CPR)].We used a descriptive analysis and unweighted averages of mortality across studies.RESULTS Our search identified 6973 articles and 20 met inclusion:17 for intensive care,13 for mechanical ventilation,5 for hemodialysis,2 for extracorporeal membrane oxygenation,and 1 for CPR.Mortality associated with intensive care admission ranged from 9%-83%,with overall mortality 32.5%(95%CI:32.4%-32.6%).Mortality associated with intubation from 16.7%-100%with overall mortality 64.0%(95%CI:62.4%-65.5%).In patients requiring hemodialysis,mortality ranged from 0%-100%,with average mortality 75.3%(95%CI:72.6%-77.4%).CONCLUSION Patients with COVID-19 requiring intensive care have high mortality rates.Authorities can use this data to establish pharmacoeconomic studies to make decisions about allocation of scarce resources if necessary.
文摘The purposes of this study were to describe the decision making process and decision activities of critical care nurses in natural clinical settings. An exploratory descriptive approach utilizing both interview and observation methods, was used for data collection. The study involved twenty four critical care nurses from three hospitals in Jordan. Participant observation was performed to understand the routine clinical decisions made by Intensive Care nurses. About 150 hours of observations were spent in the involved Intensive Care Units. Nurses were interviewed to elicit information about how they made decisions about patient’s care. The study revealed that the most common model nurses tend to use was intuitive model in order to observe the cues relating to the patient’s situation. Data revealed that the decision making process is continuous and that experience is one of the main factors that determine nurses’ ability to take decisions. Five themes were generated from the data: on-going process, autonomy, experience/power, joint/ethical decisions, and advocacy. Critical care nurses were seen to be sensitive to the patient’s verbal and non-verbal cues;they were able to respond to these evidences to ensure that the patient’s condition did not deteriorate. Critical care nurses are likely to be more confident and effective when dealing with patient’s changing situations with more experience.
文摘<span style="font-family:Verdana;">The </span><span style="font-family:""><span style="font-family:Verdana;">upsurge of candidemia in the past years has been an immense encumbrance on public health and the number of deaths caused by candidemia particularly in critical care unit patients is devastating. </span><i><span style="font-family:Verdana;">Candida</span></i><span style="font-family:Verdana;"> species harbor a 30</span></span><span style="font-family:Verdana;">% </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">60% mortality rate and compared to stable people or those with less serious illnesses, this ranges from 60</span><span style="font-family:Verdana;">%</span><span style="font-family:Verdana;"> to 80% of those who are chronically ill patients. Grounded on a recent report from a tertiary care hospital in Kenya showing the emergence of previously unobserved species</span><span style="font-family:Verdana;">:</span><span style="font-family:""> <i><span style="font-family:Verdana;">Candida auris</span></i><span style="font-family:Verdana;">, this study aimed to determine the prevalence, species distribution, and antifungal susceptibility profile of candidemia in critical care unit patients of the hospital. 378 Critical Care Unit patients were enrolled for the study from January 2019 to January 2020. Positive archived isolates were sub-cultured using Sa</span><span><span style="font-family:Verdana;">boraud Dextrose Agar. </span><i><span style="font-family:Verdana;">Candida</span></i><span style="font-family:Verdana;"> species were identified utilizing API20C</span></span><span style="font-family:Verdana;"> AUX and Vitek-2. Antifungal susceptibility testing was conducted using the Liofilchem MIC Test strip. Out of 378 patients, thirty-one presented a positive culture for </span><i><span style="font-family:Verdana;">Candida</span></i><span style="font-family:Verdana;"> species. The prevalence of Candidemia was </span><b><span style="font-family:Verdana;">8.2%</span></b><span style="font-family:Verdana;"> with </span><b><span style="font-family:Verdana;">9 (29.03%) </span></b><i><span style="font-family:Verdana;">Candida auris</span></i><span style="font-family:Verdana;">, </span><b><span style="font-family:Verdana;">8 (25.81%)</span></b> <i><span style="font-family:Verdana;">Candida albicans</span></i><span style="font-family:Verdana;">, </span><b><span style="font-family:Verdana;">6 (19.35%) </span></b><i><span style="font-family:Verdana;">Candida parapsilosis</span></i><span style="font-family:Verdana;">, </span><b><span style="font-family:Verdana;">3 (9.68%)</span></b> <i><span style="font-family:Verdana;">Candida famata</span></i><span style="font-family:Verdana;">, </span><b><span style="font-family:Verdana;">3 (9.68%)</span></b><i><span style="font-family:Verdana;"> Candida tropicalis</span></i><span style="font-family:Verdana;">, </span><b><span style="font-family:Verdana;">1 (3.23%)</span></b> <i><span style="font-family:Verdana;">Candida duobushaemolumonii</span></i><span style="font-family:Verdana;">, and </span><b><span style="font-family:Verdana;">1 (3.23%)</span></b> <i><span style="font-family:Verdana;">Candida lusitaniae</span></i><span style="font-family:Verdana;">.</span><i> </i><span style="font-family:Verdana;">A resistance pattern to Fluconazole was observed among </span><i><span style="font-family:Verdana;">Candida auris</span></i><span style="font-family:Verdana;"> and </span><i><span style="font-family:Verdana;">Candida parapsilosis</span></i><span style="font-family:Verdana;">, and resistance to Flucytosine was observed in </span><i><span style="font-family:Verdana;">Candida tropicalis</span></i><span style="font-family:Verdana;">,</span><i> </i><span style="font-family:Verdana;">whereas susceptible MIC values were obtained for the other drugs.</span><i> </i><span style="font-family:Verdana;">There is an increase in candidemia among critical care unit patients in the health facility posing a public health challenge. Moreover, the onset of new species </span><i><span style="font-family:Verdana;">Candida auris </span></i><span style="font-family:Verdana;">which is unprecedented in Kenya warrants enhanced infection control, and the uniform resistance of </span><i><span style="font-family:Verdana;">Candida auris</span></i><span style="font-family:Verdana;">, </span><i><span style="font-family:Verdana;">Candida parapsilosis</span></i><span style="font-family:Verdana;">,</span><i> </i><span style="font-family:Verdana;">and</span><i><span style="font-family:Verdana;"> Candida tropicalis</span></i><span style="font-family:Verdana;"> towards Fluconazole and Flucytosine necessitate constant drug monitoring for empirical treatment regime. In contrast, the high potency of Echinocandins and Amphotericin-B demonstrate them as the drug of choice.
文摘Objective:To determine the relationship between clinical performance and professional self-concept in critical care nurses.Methods:This study was conducted on 308 critical care nurses.Data gathering instruments were nurses’clinical performance questionnaire(NCPQ)and nursing professional self-concept measure(NPSCM).Independent sample t-test,one-way analysis of variance(ANOVA),and Pearson correlation coefficient were used for data analyses.Results:The average age of the nurses was 33.74±7.01 years.The clinical performance score of female nurses was significantly higher than male nurses.In the domain of clinical performance,clinical judgment and clinical inquiry had the highest and lowest scores,respectively.In the nurses’professional self-concept,the highest and lowest scores were awarded to the subscales of self-confidence and staff relations,respectively.In addition,there was a significant positive correlation between self-concept and clinical performance of nurses.Conclusions:Increasing professional self-concept improves the clinical performance of critical care nurses.Professional self-concept enhancement measures are recommended to improve the clinical performance of nurses in critical care units.
文摘BACKGROUND:Life-sustaining treatments(LSTs)may prolong life but greatly decrease the quality of death.One factor influencing decision-making about withholding and withdrawing these treatments is the attitude of nurses.This study aimed to evaluate the attitude of critical care nurses towards life-sustaining treatments in South East Iran.METHODS:In this cross-sectional study,"Ethnicity and Attitudes towards Advance Care Directives Questionnaire"was used to investigate the attitude of 104 critical care nurses towards lifesustaining treatments in three hospitals affiliated to Kerman University of Medical Sciences.RESULTS:The findings of this study indicated that although a majority of critical care nurses(77%)did not have personal desire for use of LSTs including CPR and mechanical ventilation,they had moderately negative to neutral attitude towards general use of LSTs(2.95 of 5).CONCLUSIONS:These findings suggest that nurses'attitude towards LSTs can be changed by inclusion of specific courses about death,palliative care and life-sustaining treatments in undergraduate and postgraduate nursing curricula.Educating Muslim nurses about religious aspects of LSTs may also improve their attitudes.
基金Supported by the EuroQol Research Foundation,No. 299-RA
文摘Mortality is a well-established patient-important outcome in critical care studies.In contrast,morbidity is less uniformly reported(given the myriad of critical care illnesses and complications of each)but may have a common end-impact on a patient’s functional capacity and health-related quality-of-life(HRQoL).Survival with a poor quality-of-life may not be acceptable depending on individual patient values and preferences.Hence,as mortality decreases within critical care,it becomes increasingly important to measure intensive care unit(ICU)survivor HRQoL.HRQoL measurements with a preference-based scoring algorithm can be converted into health utilities on a scale anchored at 0(representing death)and 1(representing full health).They can be combined with survival to calculate quality-adjusted life-years(QALY),which are one of the most widely used methods of combining morbidity and mortality into a composite outcome.Although QALYs have been use for health-technology assessment decision-making,an emerging and novel role would be to inform clinical decision-making for patients,families and healthcare providers about what expected HRQoL may be during and after ICU care.Critical care randomized control trials(RCTs)have not routinely measured or reported HRQoL(until more recently),likely due to incapacity of some patients to participate in patient-reported outcome measures.Further differences in HRQoL measurement tools can lead to non-comparable values.To this end,we propose the validation of a gold-standard HRQoL tool in critical care,specifically the EQ-5D-5L.Both combined health-utility and mortality(disaggregated)and QALYs(aggregated)can be reported,with disaggregation allowing for determination of which components are the main drivers of the QALY outcome.Increased use of HRQoL,health-utility,and QALYs in critical care RCTs has the potential to:(1)Increase the likelihood of finding important effects if they exist;(2)improve research efficiency;and(3)help inform optimal management of critically ill patients allowing for decision-making about their HRQoL,in additional to traditional health-technology assessments.
文摘<strong>Objective: </strong>Critical care nurses work in a challenging intensive care (ICU) environment that results in work-related psychological distress. Our objective was to pilot an in-person or virtual mindfulness-based cognitive therapy (MBCT) program enhanced resilience and a similarly designed attention control group. <strong>Methods: </strong>We randomized ICU nurses with symptoms of burnout syndrome and decreased resilience to an MBCT program or a similarly formatted book club control. Our primary outcome was change in resilience as measured by the Connor-Davidson Resilience Scale (CD-RISC). <strong>Results: </strong>One-hundred one nurses completed study-related procedures. Overall, 70% had baseline symptoms of anxiety and 26% had symptoms of depression. For the in-person cohorts, there was no statistical difference between intervention and control groups regarding the total number of sessions attended (3.85 days ± 1.4 versus 3.75 days ± 0.15;p = 0.64). Using the Client/Patient Satisfaction Questionnaire-8 (CSQ-8), satisfaction scores were higher in the intervention group for weeks two through four of the program: p = 0.03, 0.0003, 0.007 respectively. There was no difference in the change in CD-RISC scores between the two groups (mean difference: treatment = 5.0, control = 7.0;p = 0.30). The online intervention cohort had greater improvements in the change of their median emotional exhaustion burnout scores when compared to the in-person intervention cohorts (-5 [-8 to -1.5] vs. 2 [-5 to 8], p = 0.049). <strong>Conclusions: </strong>We developed a feasible and acceptable in-person and online MBCT-ICU intervention that did not increase resilience scores in ICU nurses when compared to an attention control group. These results could help guide the proper design of larger trials to determine the efficacy of other resilience interventions.
文摘BACKGROUND There is variability in intensive care unit(ICU)resources and staffing worldwide.This may reflect variation in practice and outcomes across all health systems.AIM To improve research and quality improvement measures administrative leaders can create long-term strategies by understanding the nature of ICU practices on a global scale.METHODS The Global ICU Needs Assessment Research Group was formed on the basis of diversified skill sets.We aimed to survey sites regarding ICU type,availability of staffing,and adherence to critical care protocols.An international survey‘Global ICU Needs Assessment’was created using Google Forms,and this was distributed from February 17^(th),2020 till September 23^(rd),2020.The survey was shared with ICU providers in 34 countries.Various approaches to motivating healthcare providers were implemented in securing submissions,including use of emails,phone calls,social media applications,and WhatsApp^(TM).By completing this survey,providers gave their consent for research purposes.This study was deemed eligible for category-2 Institutional Review Board exempt status.RESULTS There were a total 121 adult/adult-pediatrics ICU responses from 34 countries in 76 cities.A majority of the ICUs were mixed medical-surgical[92(76%)].108(89%)were adult-only ICUs.Total 36 respondents(29.8%)were 31-40 years of age,with 79(65%)male and 41(35%)female participants.89 were consultants(74%).A total of 71(59%)respondents reported having a 24-h inhouse intensivist.A total of 87(72%)ICUs were reported to have either a 2:1 or≥2:1 patient/nurse ratio.About 44%of the ICUs were open and 76%were mixed type(medical-surgical).Protocols followed regularly by the ICUs included sepsis care(82%),ventilator-associated pneumonia(79%);nutrition(76%),deep vein thrombosis prophylaxis(84%),stress ulcer prophylaxis(84%),and glycemic control(89%).CONCLUSION Based on the findings of this international,multi-dimensional,needs-assessment survey,there is a need for increased recruitment and staffing in critical care facilities,along with improved patientto-nurse ratios.Future research is warranted in this field with focus on implementing appropriate health standards,protocols and resources for optimal efficiency in critical care worldwide.
文摘As editors of World Journal of Critical Care Medicine(WJCCM),it is our great pleasure to take this opportunity to wish all our authors,subscribers,readers,Editorial Board members,independent expert referees,and staff of the Editorial Office a Very Happy New Year.On behalf of the Editorial Team,we would like to express our gratitude to all authors who have contributed their valuable manuscripts and to the independent referees and our subscribers and readers for their continuous support,dedication,and encouragement.The excellent team effort by our editorial board members and staff of the Editorial Office allowed WJCCM to advance remarkably in 2020.In the future,the Baishideng Publishing Group and WJCCM’s editorial board will continue to increase their communication and collaboration,both internally and involving our external contributors,in order to promote our collective impact on the field of Critical Care Medicine even further.
文摘BACKGROUND Critically ill patients are at risk of developing stress cardiomyopathy(SC)but can be under-recognized.AIM To describe a case series of patients with SC admitted to critical care units.METHODS We conducted a retrospective observational study at a tertiary care teaching hospital.All adult(≥18 years old)patients admitted to the critical care units with stress cardiomyopathy over 5 years were included.RESULTS Of 24279 admissions to the critical care units[19139 to medical-surgical intensive care units(MSICUs)and 5140 in coronary care units(CCUs)],109 patients with SC were identified.Sixty(55%)were admitted to the coronary care units(CCUs)and forty-nine(45%)to the medical-surgical units(MSICUs).The overall incidence of SC was 0.44%,incidence in CCU and MSICU was 1.16%and 0.25%respectively.Sixty-two(57%)had confirmed SC and underwent cardiac catheterization whereas 47(43%)had clinical SC,and did not undergo cardiac catheterization.Forty-three(72%)patients in the CCUs were diagnosed with primary SC,whereas all(100%)patients in MSICUs developed secondary SC.Acute respiratory failure that required invasive mechanical ventilation and shock developed in twenty-nine(59%)MSICU patients.There were no statistically significant differences in intensive care unit(ICU)mortality,in-hospital mortality,use of inotropic or mechanical circulatory support based on type of unit or anatomical variant.CONCLUSION Stress cardiomyopathy can be under-recognized in the critical care setting.Intensivists should have a high index of suspicion for SC in patients who develop sudden or worsening unexplained hemodynamic instability,arrhythmias or respiratory failure in ICU.
