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Castellanos-Ortega Á, Broch MJ, Palacios-Castañeda D, Gómez-Tello V, Valdivia M, Vicent C, Madrid I, Martinez N, Párraga MJ, Sancho E, Fuentes-Dura MDC, Sancerni-Beitia MD, García-Ros R. Competency assessment of residents of Intensive Care Medicine through a simulation-based objective structured clinical evaluation (OSCE). A multicenter observational study. Med Intensiva 2022; 46:491-500. [PMID: 36057440 DOI: 10.1016/j.medine.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/22/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES The current official model of training in Intensive Care Medicine (ICM) in Spain is based on exposure to experiences through clinical rotations. The main objective was to determine the level of competency (I novice to V independent practitioner) achieved by the residents at the end of the 3rd year of training (R3) in ICM through a simulation-based OSCE. Secondary objectives were: (1) To identify gaps in performance, and (2) To investigate the reliability and feasibility of conducting simulation-based assessment at multiple sites. DESIGN Observational multicenter study. SETTING Thirteen Spanish ICU Departments. PARTICIPANTS Thirty six R3. INTERVENTION The participants performed on five, 15-min, high-fidelity crisis scenarios in four simulation centers. The performances were video recorded for later scoring by trained raters. MAIN VARIABLES OF INTEREST Via a Delphi technique, an independent panel of expert intensivists identified critical essential performance elements (CEPE) for each scenario to define the levels of competency. RESULTS A total of 176 performances were analyzed. The internal consistency of the check-lists were adequate (KR-20 range 0.64-0.79). Inter-rater reliability was strong [median Intraclass Correlation Coefficient across scenarios: 0.89 (0.65-0.97)]. Competency levels achieved by R3 were: Level I (18.8%), II (35.2%), III (42.6%), IV/V (3.4%). Overall, a great heterogeneity in performance was observed. CONCLUSION The expected level of competency after one year in the ICU was achieved only in half of the performances. A more evidence-based educational approach is needed. Multiple center simulation-based assessment showed feasibility and reliability as an evaluation method of competency. TRIAL REGISTRATION COBALIDATION. NCT04278976. (https://register. CLINICALTRIALS gov).
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Affiliation(s)
- Á Castellanos-Ortega
- Intensive Care Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - M J Broch
- Intensive Care Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - V Gómez-Tello
- Intensive Care Department, University Hospital Moncloa, Madrid, Spain
| | - M Valdivia
- Intensive Care Department, Hospital Puerta de Hierro-Majadahonda, Spain
| | - C Vicent
- Intensive Care Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - I Madrid
- Intensive Care Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - N Martinez
- Intensive Care Department, Hospital Puerta de Hierro-Majadahonda, Spain
| | - M J Párraga
- Intensive Care Department, Hospital Universitario Morales Meseguer, Murcia, Spain
| | - E Sancho
- Intensive Care Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - M D C Fuentes-Dura
- Department of Methodology of the Behavioral Sciences, University of Valencia, Spain
| | - M D Sancerni-Beitia
- Department of Methodology of the Behavioral Sciences, University of Valencia, Spain
| | - R García-Ros
- Department of Developmental and Educational Psychology, University of Valencia, Spain.
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Murray N, Palermo C, Batt A, Bell K. Does patient and public involvement influence the development of competency frameworks for the health professions? A systematic review. Front Med (Lausanne) 2022; 9:918915. [PMID: 35957861 PMCID: PMC9360578 DOI: 10.3389/fmed.2022.918915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/04/2022] [Indexed: 12/03/2022] Open
Abstract
Competency frameworks typically describe the perceived knowledge, skills, attitudes and other characteristics required for a health professional to practice safely and effectively. Patient and public involvement in the development of competency frameworks is uncommon despite delivery of person-centered care being a defining feature of a competent health professional. This systematic review aimed to determine how patients and the public are involved in the development of competency frameworks for health professions, and whether their involvement influenced the outcome of the competency frameworks. Studies were identified from six electronic databases (MEDLINE, CINAHL, PsycINFO, EMBASE, Web of Science and ERIC). The database search yielded a total of 8,222 citations, and 43 articles were included for data extraction. Most studies were from the United Kingdom (27%) and developed through multidisciplinary collaborations involving two or more professions (40%). There was a large variation in the number of patients and members of the public recruited (range 1–1,398); recruitment sources included patients and carers with the clinical condition of interest (30%) or established consumer representative groups (22%). Common stages for involving patients and the public were in generation of competency statements (57%) or reviewing the draft competency framework (57%). Only ten studies (27%) took a collaborative approach to the engagement of patients and public in competency framework development. The main ways in which involvement influenced the competency framework were validation of health professional-derived competency statements, provision of desirable behaviors and attitudes and generation of additional competency statements. Overall, there was a lack of reporting regarding the details and outcome of patient and public involvement. Further research is required to optimize approaches to patient and public involvement in competency framework development including guidance regarding who, how, when and for what purposes they should be engaged and the requirements for reporting.
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Affiliation(s)
- Nicole Murray
- Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- *Correspondence: Nicole Murray
| | - Claire Palermo
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Alan Batt
- Department of Paramedicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Paramedic Programs, Faculty of Health Sciences and Human Services, Fanshawe College, London, ON, Canada
| | - Kristie Bell
- Department of Dietetics and Foodservices, Queensland Children's Hospital, Brisbane, QLD, Australia
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Castellanos-Ortega Á, Broch M, Palacios-Castañeda D, Gómez-Tello V, Valdivia M, Vicent C, Madrid I, Martinez N, Párraga M, Sancho E, Fuentes-Dura M, Sancerni-Beitia M, García-Ros R. Competency assessment of residents of Intensive Care Medicine through a simulation-based objective structured clinical evaluation (OSCE). A multicenter observational study. Med Intensiva 2022. [DOI: 10.1016/j.medin.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Chanchalani G, Arora N, Nasa P, Sodhi K, Bahrani MJA, Tayar AA, Hashmi M, Jaiswal V, Kantor S, Lopa AJ, Mansour B, Mudalige AD, Nadeem R, Shrestha GS, Taha AR, Türkoğlu M, Weeratunga D. Visiting and Communication Policy in Intensive Care Units during COVID-19 Pandemic: A Cross-sectional Survey from South Asia and the Middle East. Indian J Crit Care Med 2022; 26:268-275. [PMID: 35519910 PMCID: PMC9015923 DOI: 10.5005/jp-journals-10071-24091] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The coronavirus disease-2019 (COVID-19) pandemic had affected the visiting or communicating policies for family members. We surveyed the intensive care units (ICUs) in South Asia and the Middle East to assess the impact of the COVID-19 pandemic on visiting and communication policies. MATERIALS AND METHOD A web-based cross-sectional survey was used to collect data between March 22, 2021, and April 7, 2021, from healthcare professionals (HCP) working in COVID and non-COVID ICUs (one response per ICU). The topics of the questionnaire included current and pre-pandemic policies on visiting, communication, informed consent, and end-of-life care in ICUs. RESULTS A total of 292 ICUs (73% of COVID ICUs) from 18 countries were included in the final analysis. Most (92%) of ICUs restricted their visiting hours, and nearly one-third (32.3%) followed a "no-visitor" policy. There was a significant change in the daily visiting duration in COVID ICUs compared to the pre-pandemic times (p = 0.011). There was also a significant change (p <0.001) in the process of informed consent and end-of-life discussions during the ongoing pandemic compared to pre-pandemic times. CONCLUSION Visiting and communication policies of the ICUs had significantly changed during the COVID-19 pandemic. Future studies are needed to understand the sociopsychological and medicolegal implications of revised policies. HOW TO CITE THIS ARTICLE Chanchalani G, Arora N, Nasa P, Sodhi K, Al Bahrani MJ, Al Tayar A, et al. Visiting and Communication Policy in Intensive Care Units during COVID-19 Pandemic: A Cross-sectional Survey from South Asia and the Middle East. Indian J Crit Care Med 2022;26(3):268-275.
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Affiliation(s)
- Gunjan Chanchalani
- Department of Critical Care Medicine, Cumballa Hill Hospital, Mumbai, Maharashtra, India
| | - Nitin Arora
- Department of Intensive Care, University Hospitals Birmingham, Birmingham, West Midlands, United Kingdom
| | - Prashant Nasa
- Department of Critical Care Medicine, NMC Specialty Hospital, Dubai, United Arab Emirates
- Prashant Nasa, Department of Critical Care Medicine, NMC Specialty Hospital, Dubai, United Arab Emirates, Phone: +971501425022, e-mail:
| | | | - Maher J Al Bahrani
- Department of Anesthesiology and Critical Care Medicine, Royal Hospital, Muscat, Oman
| | - Ashraf Al Tayar
- Department of ICU, Security Force Hospital, Dammam, Saudi Arabia
| | - Madiha Hashmi
- Department of Critical Care Medicine, Ziauddin University and Dr Ziauddin Hospital, Karachi, Pakistan
| | - Vinod Jaiswal
- Department of Critical Care Medicine, Amina Hospital, Ajman, United Arab Emirates
| | - Sandeep Kantor
- Department of Critical Care Medicine, Royal Hospital, Muscat, Oman
| | - Ahsina J Lopa
- Department of Intensive Care Unit, MH Samorita Hospital and Medical College, Tejgaon, Dhaka, Bangladesh
| | - Bassam Mansour
- Department of Pulmonary Medicine and Critical Care Medicine, Zahraa Hospital University Medical Center/Lebanese University, Faculty of Medical Science, Beirut, Lebanon
| | - Anushka D Mudalige
- Department of Critical Care Medicine, North Colombo Teaching Hospital, Ragama, Sri Lanka
| | - Rashid Nadeem
- Department of Critical Care Medicine, Dubai Hospital, Dubai, United Arab Emirates
| | - Gentle S Shrestha
- Department of Critical Care Medicine, Tribhuvan University Teaching Hospital, Lalitpur, Nepal
| | - Ahmed R Taha
- Department of Critical Care Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Melda Türkoğlu
- Department of Internal Medicine, Division of Critical Care, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Dameera Weeratunga
- Department of Critical Care Medicine, National Hospital of Sri Lanka, Colombo, Sri Lanka
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Castellanos-Ortega A, Broch M, Barrios M, Fuentes-Dura M, Sancerni-Beitia M, Vicent C, Gimeno R, Ramírez P, Pérez F, García-Ros R. Análisis de la aceptación y validez de los métodos utilizados para la implementación de un programa de formación basado en competencias en un servicio de Medicina Intensiva de un hospital universitario de referencia. Med Intensiva 2021. [DOI: 10.1016/j.medin.2019.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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6
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Castellanos-Ortega A, Broch MJ, Barrios M, Fuentes-Dura MC, Sancerni-Beitia MD, Vicent C, Gimeno R, Ramírez P, Pérez F, García-Ros R. Acceptance and validity of the methods used to implement a competency based medical education programme in an Intensive Care Department of a teaching referral center. Med Intensiva 2021; 45:411-420. [PMID: 34563341 DOI: 10.1016/j.medine.2019.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 12/02/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES 1. To determine the satisfaction of tutors and residents with a specific methodology used to implement CoBaTrICE. 2. To determine the reliability and validity of the global rating scales designed ad hoc to assess the performance of the residents for training purposes. DESIGN Prospective cohort study. PARTICIPANTS All the residents and tutors of the ICU Department of the Hospital Universitario y Politécnico la Fe de Valencia. INTERVENTION CoBaTrICE implementation started in March 2016, it was based on: (1) Training the tutors in feedback techniques; (2) Performing multiple objective and structured work based assessments to achieve the competences of the program; and (3) The use of an electronic portfolio to promote learning reflection and to collect the evidence that learning was taking place. METHODS The acceptance of CoBaTrICE was explored through a satisfaction survey conducted after 9 months of implementation of the training program. The 15 residents and 5 tutors of the ICU Department were asked about the methodology of the formative assessments, the quality of the feedback, self-learning regulation and the electronic portfolio usefulness. The validity of the global rating scales was assessed through the tests alfa de Cronbach, reliability and generalizability indexes, and intraclass correlation coefficient. RESULTS The implementation of CoBaTrICE was satisfactory in all the dimensions studied. The global rating scales used for formative purposes showed reliability and validity. CONCLUSIONS The methodology used to implement CoBaTrICE was highly valued by tutors and residents. The global rating scales used for formative purposes showed reliability and validity.
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Affiliation(s)
- A Castellanos-Ortega
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - M J Broch
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - M Barrios
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - M C Fuentes-Dura
- Departamento de Metodología de Ciencias del Comportamiento, Universidad de Valencia, Valencia, Spain
| | - M D Sancerni-Beitia
- Departamento de Metodología de Ciencias del Comportamiento, Universidad de Valencia, Valencia, Spain
| | - C Vicent
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - R Gimeno
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - P Ramírez
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - F Pérez
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - R García-Ros
- Departamento de Psicología Evolutiva y de la Educación, Universidad de Valencia, Valencia, Spain.
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Society of Critical Care Medicine 50th Anniversary Review Series: Critical Care Education. Crit Care Med 2021; 49:1241-1253. [PMID: 34261924 DOI: 10.1097/ccm.0000000000005130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pedreros C. Competencias y habilidades del médico en cuidados críticos en Chile. REVISTA MÉDICA CLÍNICA LAS CONDES 2019. [DOI: 10.1016/j.rmclc.2018.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Ersson A, Beckman A, Jarl J, Borell J. Effects of a multifaceted intervention QI program to improve ICU performance. BMC Health Serv Res 2018; 18:838. [PMID: 30404646 PMCID: PMC6223055 DOI: 10.1186/s12913-018-3648-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 10/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To benefit from the increasing clinical evidence, organisational changes have been among the main drivers behind the reduction of ICU mortality during the last decade. Increasing demand, costs and complexity, amplifies the need for optimisation of clinical processes and resource utilisation. Thus, multidisciplinary teamwork and critical care processes needs to be adapted to profit from increased availability of human skill and technical resources in a cost-effective manner. Inadequate clinical performance and outcome data compelled us to design a quality improvement project to address current work processes and competence utilisation. METHODS During revision period, clinical processes, professional performance and clinical competence were targeted using "scientific production management methodology" approach. As part of the project, an intensivist training program was instituted, and full time intensivist coverage was obtained in the process of creating multi-professional teams, composed of certified intensivists, critical care nurses, assistant nurses, physiotherapists and social counsellors. The use of staff resources and clinical work-processes were optimised in accordance with the outcome of a "value stream mapping". In this process, efforts to enhance the personal dynamics and performance within the teams were paramount. Clinical and economic outcome data were analysed during a seven year follow up period. RESULTS • Consecutive reduced overall ICU (24%) and long-term (600 days) mortality. The effect on ICU mortality was especially pronounced in the subgroup of patients > 65 years (30%) • Consecutive reduced length of stay (43%, septic patients) and time on ventilator (for septic patients and patients > 65 years of age (23 resp.52%). • Substantial increase in life years gained (13,140 life years) as well as quality-adjusted life-years (9593 QALY: s) over the study period. • High cost-effectiveness as ICU costs were reduced while patient outcomes were improved. Disregarding the cost reduction in ICU, the intervention is highly cost effective with cost- effectiveness ratios of (75€/QALY) and (55€ / life year) CONCLUSIONS: We have shown favourable results of a QI project aiming to improve the clinical performance and quality through the development of multi-professional interaction, teamwork and systematic revisions of work processes. The economic evaluation shows that the intervention is highly cost-effective and potentially dominating.
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Affiliation(s)
- Anders Ersson
- Department of Intensive Care and Perioperative medicine, Skåne University Hospital, Malmö, Sweden
| | - Anders Beckman
- Department of Clinical Sciences Malmö, Family Medicine, Lund University, Jan Waldenströms gata 35, 205 02, Malmö, Sweden.
| | - Johan Jarl
- Department of Clinical Sciences Malmö, Health Economics, Lund University, Malmö, Sweden
| | - Jonas Borell
- Department of Design Sciences, Faculty of Engineering, Lund University, Lund, Sweden
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Castanhel FD, Grosseman S. Quality of Communication Questionnaire for COPD patients receiving palliative care: translation and cross-cultural adaptation for use in Brazil. J Bras Pneumol 2018; 43:357-362. [PMID: 29160381 PMCID: PMC5790653 DOI: 10.1590/s1806-37562016000000199] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 05/04/2017] [Indexed: 11/21/2022] Open
Abstract
Objective: To translate the Quality of Communication Questionnaire (QOC) to Portuguese and adapt it for use in Brazil in COPD patients receiving palliative care. Methods: After approval from the first author of the original QOC and the local research ethics committee, the original, 13-item version of the questionnaire was independently translated to Brazilian Portuguese by two Brazilian translators fluent in English. The two translations were analyzed by a bilingual physician and the two Brazilian translators, who reached a consensus and produced another Portuguese version of the QOC. That version was back-translated to English by two translators originally from English-speaking countries and fluent in Portuguese. In order to resolve any discrepancies, an expert panel compared the original version of the QOC with all five versions produced up to that point, the “prefinal” version of the QOC for use in Brazil being thus arrived at. A total of 32 patients admitted to any of three public hospital ICUs in the greater metropolitan area of Florianopolis, in southern Brazil, participated in the pretesting phase of the study, which was aimed at assessing the clarity and cultural acceptability of the prefinal version of the QOC for use in Brazil. Results: Mean patient age was 48.5 ± 18.8 years. Most of the items were well understood and accepted, being rated 8 or higher. One item, regarding death, was considered difficult to understand by the participants in the pretesting phase. After analyzing the back-translated version of the QOC, the first author of the original questionnaire requested that the items “Caring about you as a human being” and “Talking about what death might be like” be changed to “Caring about you as a person” and “Talking about how dying might be”, respectively. The final version of the QOC for use in Brazil was thus arrived at. Conclusions: The QOC was successfully translated to Portuguese and adapted for use in Brazil.
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Affiliation(s)
- Flávia Del Castanhel
- . Programa de Pós-Graduação em Ciências Médicas - PPGCM - Universidade Federal de Santa Catarina - UFSC - Florianópolis (SC) Brasil
| | - Suely Grosseman
- . Departamento de Pediatria, Universidade Federal de Santa Catarina - UFSC - Florianópolis (SC) Brasil
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Dijkstra IS, Brand PLP, Pols J, Delwig H, Jaarsma DADC, Tulleken JE. Are graduated intensivists prepared for practice? A case study from The Netherlands. J Crit Care 2017; 42:47-53. [PMID: 28679114 DOI: 10.1016/j.jcrc.2017.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 12/12/2016] [Accepted: 01/22/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE An evaluation of the alignment between intensive care medicine (ICM) training and practice provides valuable information for the development of ICM training. Therefore this study examines how well recently licensed intensivists feel prepared for practice and whether intensivists from different background specialties attain comparable preparedness rates. METHODS An inventory was developed to cover the tasks that constitute ICM practice. Two hundred five recently licensed Dutch intensivists received a questionnaire in which they could indicate how well their ICM training programme prepared them for these tasks on a 5-point Likert scale. RESULTS Ninety-one respondents returned the questionnaire (response 45%). Respondents felt excellently prepared for 67 tasks, well prepared for 16 tasks, marginally sufficiently prepared for 6 tasks and insufficiently prepared for 15 tasks. Intensivists from anaesthesiology felt better prepared for IC specific activities (mean 4.25, SD 0.38) than those from internal medicine (mean 4.01, SD 0.40, P=.02).Average scores on tasks related to medical expertise were relatively high while tasks relating to management and leadership, science and professional development scored lower. CONCLUSIONS Although recently licensed intensivists are well prepared for most tasks in ICM, lower preparedness scores on tasks related to leadership and management, science, and professional development call for re-evaluation of the current curriculum.
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Affiliation(s)
- Ids S Dijkstra
- Wenckebach Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Paul L P Brand
- Wenckebach Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Princess Amalia Children's Centre, Isala Hospital, Zwolle, The Netherlands
| | - Jan Pols
- Center for Educational Development and Research in Health Professions, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hans Delwig
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Debbie A D C Jaarsma
- Center for Educational Development and Research in Health Professions, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jaap E Tulleken
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Holanda Peña MS, Talledo NM, Ots Ruiz E, Lanza Gómez JM, Ruiz Ruiz A, García Miguelez A, Gómez Marcos V, Domínguez Artiga MJ, Hernández Hernández MÁ, Wallmann R, Llorca Díaz J. Satisfaction in the Intensive Care Unit (ICU). Patient opinion as a cornerstone. Med Intensiva 2016; 41:78-85. [PMID: 27793389 DOI: 10.1016/j.medin.2016.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/15/2016] [Accepted: 06/17/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To study the agreement between the level of satisfaction of patients and their families referred to the care and attention received during admission to the ICU. DESIGN A prospective, 5-month observational and descriptive study was carried out. SETTING ICU of Marqués de Valdecilla University Hospital, Santander (Spain). SUBJECTS Adult patients with an ICU stay longer than 24h, who were discharged to the ward during the period of the study, and their relatives. INTERVENTION Instrument: FS-ICU 34 for assessing family satisfaction, and an adaptation of the FS-ICU 34 for patients. The Cohen kappa index was calculated to assess agreement between answers. RESULTS An analysis was made of the questionnaires from one same family unit, obtaining 148 pairs of surveys (296 questionnaires). The kappa index ranged between 0.278-0.558, which is indicative of mild to moderate agreement. CONCLUSIONS The families of patients admitted to the ICU cannot be regarded as good proxies, at least for competent patients. In such cases, we must refer to these patients in order to obtain first hand information on their feelings, perceptions and experiences during admission to the ICU. Only when patients are unable to actively participate in the care process should their relatives be consulted.
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Affiliation(s)
- M S Holanda Peña
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España.
| | - N Marina Talledo
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - E Ots Ruiz
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - J M Lanza Gómez
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - A Ruiz Ruiz
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - A García Miguelez
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - V Gómez Marcos
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - M J Domínguez Artiga
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - M Á Hernández Hernández
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España; Medicina Preventiva y Salud Pública, Universidad de Cantabria, Santander, España
| | - R Wallmann
- Medicina Preventiva y Salud Pública, Universidad de Cantabria, Santander, España
| | - J Llorca Díaz
- Medicina Preventiva y Salud Pública, Universidad de Cantabria, Santander, España
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Kalfon P, Mimoz O, Loundou A, Geantot MA, Revel N, Villard I, Amour J, Azoulay E, Garrouste-Orgeas M, Martin C, Sharshar T, Baumstarck K, Auquier P. Reduction of self-perceived discomforts in critically ill patients in French intensive care units: study protocol for a cluster-randomized controlled trial. Trials 2016; 17:87. [PMID: 26880373 PMCID: PMC4754872 DOI: 10.1186/s13063-016-1211-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 02/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is now well documented that critically ill patients are exposed to stressful conditions and experience discomforts from multiple sources. Improved identification of the discomforts of patients in intensive care units (ICUs) may have implications for managing their care, including consideration of ethical issues, and may assist clinicians in choosing the most appropriate interventions. The primary objective of this study was to assess the effectiveness of a multicomponent program of discomfort reduction in critically ill patients. The secondary objectives were to assess the sustainability of the impact of the program and the potential seasonality effect. METHODS/DESIGN We conducted a multicenter, cluster-randomized, controlled, single (patient)-blind study involving 34 French adult ICUs. The experimental intervention was a 6-month period during which the multicomponent program was implemented in the ICU and included the following steps: identification of discomforts, immediate feedback to the healthcare team, and implementation of targeted interventions. The control intervention was a 6-month period during which any program was implemented. The primary endpoint was the monthly overall score of self-reported discomfort from the French questionnaire on discomforts in ICU patients (IPREA). The secondary endpoints were the scores of the discomfort items of IPREA. The sample size was 660 individuals to obtain 80% power to detect a 25% difference in the overall discomfort score of IPREA between the two groups (design effect: 2.9). DISCUSSION The results of this cluster-randomized controlled study are expected to confirm that a multicomponent program of discomfort reduction may be a new strategy in the management of care for critically ill patients. TRIAL REGISTRATION ClinicalTrials.gov NCT02442934, registered 11 May 2015.
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Affiliation(s)
- Pierre Kalfon
- Service de réanimation, Centre Hospitalier Louis Pasteur, Chartres, France.
| | - Olivier Mimoz
- Centre Hospitalier Universitaire (CHU) La Miletrie, Poitiers, France.
| | - Anderson Loundou
- EA3279 Self-perceived Health Assessment Research Unit Aix-Marseille University, Marseille, France.
| | | | | | - Isabelle Villard
- CHU Beaujon, Assistance Publique - Hôpitaux de Paris (APHP), Clichy, France.
| | | | | | | | - Claude Martin
- CHU Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France.
| | | | - Karine Baumstarck
- EA3279 Self-perceived Health Assessment Research Unit Aix-Marseille University, Marseille, France.
| | - Pascal Auquier
- EA3279 Self-perceived Health Assessment Research Unit Aix-Marseille University, Marseille, France.
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14
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Castellanos-Ortega A, Rothen HU, Franco N, Rayo LA, Martín-Loeches I, Ramírez P, Cuñat de la Hoz J. Training in intensive care medicine. A challenge within reach. Med Intensiva 2014; 38:305-10. [PMID: 24589154 DOI: 10.1016/j.medin.2013.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 12/30/2013] [Indexed: 11/30/2022]
Abstract
The medical training model is currently immersed in a process of change. The new paradigm is intended to be more effective, more integrated within the healthcare system, and strongly oriented towards the direct application of knowledge to clinical practice. Compared with the established training system based on certification of the completion of a series or rotations and stays in certain healthcare units, the new model proposes a more structured training process based on the gradual acquisition of specific competences, in which residents must play an active role in designing their own training program. Training based on competences guarantees more transparent, updated and homogeneous learning of objective quality, and which can be homologated internationally. The tutors play a key role as the main directors of the process, and institutional commitment to their work is crucial. In this context, tutors should receive time and specific formation to allow the evaluation of training as the cornerstone of the new model. New forms of objective summative and training evaluation should be introduced to guarantee that the predefined competences and skills are effectively acquired. The free movement of specialists within Europe is very desirable and implies that training quality must be high and amenable to homologation among the different countries. The Competency Based training in Intensive Care Medicine in Europe program is our main reference for achieving this goal. Scientific societies in turn must impulse and facilitate all those initiatives destined to improve healthcare quality and therefore specialist training. They have the mission of designing strategies and processes that favor training, accreditation and advisory activities with the government authorities.
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Affiliation(s)
- A Castellanos-Ortega
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España.
| | - H U Rothen
- Department of Intensive Care Medicine, University Hospital of Bern, Berna, Suiza
| | - N Franco
- Servicio de Medicina Intensiva, Hospital Universitario de Móstoles, Móstoles, Madrid, España
| | - L A Rayo
- Servicio de Medicina Intensiva, Hospital Son Espases, Palma de Mallorca, España
| | - I Martín-Loeches
- Servicio de Medicina Intensiva, Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, España
| | - P Ramírez
- Servicio de Medicina Intensiva, Hospital La Fe, Valencia, España
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Bion J, Rothen HU. Models for Intensive Care Training. A European Perspective. Am J Respir Crit Care Med 2014; 189:256-62. [DOI: 10.1164/rccm.201311-2058cp] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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16
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Gill FJ, Leslie GD, Grech C, Latour JM. Health consumers' experiences in Australian critical care units: postgraduate nurse education implications. Nurs Crit Care 2013; 18:93-102. [PMID: 23419185 DOI: 10.1111/j.1478-5153.2012.00543.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To explore critical care patients and families experiences and seek their input into nurses' postgraduate educational preparation and practice. BACKGROUND There is an inconsistency in the expected standard of practice to 'qualify' Australian critical care nurses. There has also been a lack of health consumer input in the development of postgraduate course curriculum and content. METHOD Following institutional ethics committee approval, purposive sampling was used to select participants for focus groups and individual interviews who had experienced intensive care or coronary care. FINDINGS Seventeen participants provided data which created two main thematic categories; the role of the critical care nurse and; minimum practice standards for postgraduate critical care course graduates. Both physical patient care and socio-emotional support of patients and family were identified as important for the critical care nurse role. The level of socio-emotional support provided by nurses was reported to be inconsistent. Components of socio-emotional support included communication, people skills, facilitating family presence and advocacy. These components were reflected in participants' concepts of minimum practice standards for postgraduate critical care course graduates; talking and listening skills, relating to and dealing with stressed people, individualizing care and patient and family advocacy. CONCLUSION Health consumers' views emphasize that socio-emotional skills and behaviours need to be explicitly described in postgraduate critical care nursing course curricula and instruments developed to consistently assess these core competencies.
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Affiliation(s)
- Fenella J Gill
- Princess Margaret Hospital for Children, Child & Adolescent Health Services, Perth, WA, Australia.
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17
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Couper K, Salman B, Soar J, Finn J, Perkins GD. Debriefing to improve outcomes from critical illness: a systematic review and meta-analysis. Intensive Care Med 2013; 39:1513-23. [DOI: 10.1007/s00134-013-2951-7] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 05/03/2013] [Indexed: 02/06/2023]
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Blanch L, Annane D, Antonelli M, Chiche JD, Cuñat J, Girard TD, Jiménez EJ, Quintel M, Ugarte S, Mancebo J. The future of intensive care medicine. Med Intensiva 2013; 37:91-8. [PMID: 23398846 DOI: 10.1016/j.medin.2012.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 12/19/2012] [Indexed: 02/04/2023]
Abstract
Intensive care medical training, whether as a primary specialty or as secondary add-on training, should include key competences to ensure a uniform standard of care, and the number of intensive care physicians needs to increase to keep pace with the growing and anticipated need. The organisation of intensive care in multiple specialty or central units is heterogeneous and evolving, but appropriate early treatment and access to a trained intensivist should be assured at all times, and intensivists should play a pivotal role in ensuring communication and high-quality care across hospital departments. Structures now exist to support clinical research in intensive care medicine, which should become part of routine patient management. However, more translational research is urgently needed to identify areas that show clinical promise and to apply research principles to the real-life clinical setting. Likewise, electronic networks can be used to share expertise and support research. Individuals, physicians and policy makers need to allow for individual choices and priorities in the management of critically ill patients while remaining within the limits of economic reality. Professional scientific societies play a pivotal role in supporting the establishment of a defined minimum level of intensive health care and in ensuring standardised levels of training and patient care by promoting interaction between physicians and policy makers. The perception of intensive care medicine among the general public could be improved by concerted efforts to increase awareness of the services provided and of the successes achieved.
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Affiliation(s)
- L Blanch
- Critical Care Center, Hospital de Sabadell, Corporacio Sanitaria Universitària Parc Taulí, Sabadell, Spain.
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19
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Family satisfaction in an interdisciplinary ICU: a quality audit. Crit Care 2012. [PMCID: PMC3363914 DOI: 10.1186/cc11103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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20
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Thüm S, Janssen C, Pfaff H, Lefering R, Neugebauer EA, Ommen O. The association between psychosocial care by physicians and patients' trust: a retrospective analysis of severely injured patients in surgical intensive care units. PSYCHO-SOCIAL MEDICINE 2012; 9:Doc04. [PMID: 23049644 PMCID: PMC3461762 DOI: 10.3205/psm000082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Trust is an essential element in physician-patient interaction fostering in general adherence and improving patient- and physician-reported outcomes. Regarding severely injured patients, trust-building behaviour is important because of the severity of injuries and therefore potential associated physical and psychological consequences. The objective of this study was to identify significant and relevant determinants on trust of severely injured patients in their physicians in surgical intensive care units. METHODS Ninety-one severely injured patients completed a self-administered questionnaire after being transferred from surgical intensive care unit to surgical unit. All patients were treated in four hospitals of maximal care in North Rhine-Westphalia between 2001 and 2005. To assess different aspects of trust the "trust in physician" scale of the Cologne Patient Questionnaire (CPQ) was used. "Psychosocial care by physicians" is measured through: support, devotion, information and shared-decision making provided by physicians. Patient- and trauma related control variables are also included in a logistic regression model. RESULTS Stepwise logistic regression identified "psychosocial care provided by physicians" as a significant contributor to severely injured patients' trust (Nagelkerke's R(2): 41%). "Trust in physicians" is correlated with all four dimensions of "psychosocial care by physicians": support (0.546), devotion (0.443), information (0.396), and shared-decision making behaviour (0.342) provided by physicians in surgical intensive care units. CONCLUSIONS This finding confirms the importance of supportive communication style in physician-patient interaction concerning reported trust of severely injured patients on surgical intensive care units. Medical education should integrate sound knowledge about psychosocial aspects of interaction to provide effective emotional and informational support to build up and maintain patient trust.
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Affiliation(s)
- Sonja Thüm
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Germany
| | - Christian Janssen
- Faculty of Applied Social Sciences, University of Applied Sciences Munich, Germany
| | - Holger Pfaff
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine, Faculty of Medicine, University of Witten/Herdecke, Campus Cologne-Merheim, Cologne, Germany
| | - Edmund A. Neugebauer
- Institute for Research in Operative Medicine, Faculty of Medicine, University of Witten/Herdecke, Campus Cologne-Merheim, Cologne, Germany
| | - Oliver Ommen
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Germany
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21
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Bernat-Adell MD, Ballester-Arnal R, Abizanda-Campos R. [Is the critical patient competent for decision taking? Psychological and psychopathological reasons of cognitive impairment]. Med Intensiva 2012; 36:416-22. [PMID: 22257435 DOI: 10.1016/j.medin.2011.11.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 11/22/2011] [Accepted: 11/23/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Emotional factors may lead to cognitive impairment that can adversely affect the capacity of patients to reason, and thereby, limit their participation in decision taking. PURPOSES To analyze critical patient aptitude for decision taking, and to identify variables that may influence competence. DESIGN An observational descriptive study was carried out. SETTING Intensive care unit. PATIENTS Participants were 29 critically ill patients. MAIN VARIABLES Social, demographic and psychological variables were analyzed. Functional capacities and psychological reactions during stay in the ICU were assessed. RESULTS The patients are of the firm opinion that they should have the last word in the taking of decisions; they prefer bad news to be given by the physician; and feel that the presence of a psychologist would make the process easier. Failure on the part of the professional to answer their questions is perceived as the greatest stress factor. Increased depression results in lesser cognitive capacity, and for patients with impaired cognitive capacity, participation in the decision taking process constitutes a burden. The variables anxiety and depression are significantly related to decision taking capacity.
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Affiliation(s)
- M D Bernat-Adell
- Servicio de Medicina Intensiva, Hospital Universitario Asociado General de Castellón, España. bernat
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Physicians just need to be better trained to provide the best care at the end-of-life. Intensive Care Med 2012; 38:342-4. [PMID: 22222567 DOI: 10.1007/s00134-011-2432-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 11/05/2011] [Indexed: 10/14/2022]
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23
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International standards for programmes of training in intensive care medicine in Europe. Intensive Care Med 2010; 37:385-93. [DOI: 10.1007/s00134-010-2096-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Accepted: 11/08/2010] [Indexed: 11/28/2022]
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25
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26
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The educational environment for training in intensive care medicine: structures, processes, outcomes and challenges in the European region. Intensive Care Med 2009; 35:1575-83. [DOI: 10.1007/s00134-009-1514-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Accepted: 04/30/2009] [Indexed: 11/24/2022]
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Bouch C, Williams G. Recently published papers: Sepsis, glucose control and patient-doctor relationships. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2008; 12:112. [PMID: 18279533 PMCID: PMC2374594 DOI: 10.1186/cc6769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Sepsis is the leading cause of admission to critical care units worldwide, with increasing research and publications reflecting this. Tight control of the blood glucose concentration can reduce morbidity and mortality but the obtained values can be influenced by the method of measurement. Increasing awareness of interactions with patients and relatives can make or break relationships between staff and patients/families.
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28
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Pronovost PJ, Rodriguez-Paz J, Mohammad Z. Creating competent and caring physicians: ensuring patients are our North Star. Intensive Care Med 2007; 33:1873-5. [PMID: 17701163 DOI: 10.1007/s00134-007-0800-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2007] [Accepted: 07/04/2007] [Indexed: 10/23/2022]
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