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Juffs B, Russo E. Things We Do for No Reason™: Using lactate as our resuscitation guide in sepsis. J Hosp Med 2024; 19:133-135. [PMID: 37455371 DOI: 10.1002/jhm.13168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 05/12/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Affiliation(s)
| | - Emilio Russo
- LSU Rural Family Medicine, New Orleans, Louisiana, USA
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2
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Wong LY, Wheeler MA. Relax into the tension: Paradoxes experienced by emerging leaders in emergency medicine. Emerg Med Australas 2023. [PMID: 37321844 DOI: 10.1111/1742-6723.14266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/06/2023] [Indexed: 06/17/2023]
Affiliation(s)
- Lee Yung Wong
- Emergency Department, Austin Health, Melbourne, Victoria, Australia
- School of Business, Law and Entrepreneurship, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Melissa A Wheeler
- School of Business, Law and Entrepreneurship, Swinburne University of Technology, Melbourne, Victoria, Australia
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3
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Docking S, Gao L, Ademi Z, Bonello C, Buchbinder R. Use of Decision-Analytic Modelling to Assess the Cost-Effectiveness of Diagnostic Imaging of the Spine, Shoulder, and Knee: A Scoping Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:467-475. [PMID: 36940059 PMCID: PMC10119214 DOI: 10.1007/s40258-023-00799-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Limited evidence is available on the cost-effectiveness of diagnostic imaging for back, neck, knee, and shoulder complaints. Decision analytic modelling may be an appropriate method to synthesise evidence from multiple sources, and overcomes issues with trial-based economic evaluations. OBJECTIVE The aim was to describe the reporting of methods and objectives utilised in existing decision analytic modelling studies that assess the cost-effectiveness of diagnostic imaging for back, neck, knee, and shoulder complaints. METHODS Decision analytic modelling studies investigating the use of any imaging modality for people of any age with back, neck, knee, or shoulder complaints were included. No restrictions on comparators were applied, and included studies were required to estimate both costs and benefits. A systematic search (5 January 2023) of four databases was conducted with no date limits imposed. Methodological and knowledge gaps were identified through a narrative summary. RESULTS Eighteen studies were included. Methodological issues were identified relating to the poor reporting of methods, and measures of effectiveness did not incorporate changes in quantity and/or quality of life (cost-utility analysis in only ten of 18 studies). Included studies, particularly those investigating back or neck complaints, focused on conditions that were of low prevalence but have a serious impact on health (i.e. cervical spine trauma, cancer-related back pain). CONCLUSIONS Future models should pay particular attention to the identified methodological and knowledge gaps. Investment in the health technology assessment of these commonly utilised diagnostic imaging services is needed to justify the current level of utilisation and ensure that these services represent value for money.
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Affiliation(s)
- Sean Docking
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Lan Gao
- Deakin Health Economics, Institute for Health Transformation, School of Health & Social Development, Deakin University, Geelong, VIC, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Centre for Medicine Use and Safety, Monash University, Parkville, VIC, Australia
| | - Christian Bonello
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, VIC, Australia
| | - Rachelle Buchbinder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Affiliation(s)
- Ian A Harris
- Liverpool Hospital in Sydney
- School of Public Health, University of Sydney
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, Monash University
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health
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Xu H, Agha-Mir-Salim L, O'Brien Z, Huang DC, Li P, Gómez J, Liu X, Liu T, Yeung W, Thoral P, Elbers P, Zhang Z, Saera MB, Celi LA. Varying association of laboratory values with reference ranges and outcomes in critically ill patients: an analysis of data from five databases in four countries across Asia, Europe and North America. BMJ Health Care Inform 2021; 28:bmjhci-2021-100419. [PMID: 34642176 PMCID: PMC8513264 DOI: 10.1136/bmjhci-2021-100419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 09/17/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Despite wide usage across all areas of medicine, it is uncertain how useful standard reference ranges of laboratory values are for critically ill patients. OBJECTIVES The aim of this study is to assess the distributions of standard laboratory measurements in more than 330 selected intensive care units (ICUs) across the USA, Amsterdam, Beijing and Tarragona; compare differences and similarities across different geographical locations and evaluate how they may be associated with differences in length of stay (LOS) and mortality in the ICU. METHODS A multi-centre, retrospective, cross-sectional study of data from five databases for adult patients first admitted to an ICU between 2001 and 2019 was conducted. The included databases contained patient-level data regarding demographics, interventions, clinical outcomes and laboratory results. Kernel density estimation functions were applied to the distributions of laboratory tests, and the overlapping coefficient and Cohen standardised mean difference were used to quantify differences in these distributions. RESULTS The 259 382 patients studied across five databases in four countries showed a high degree of heterogeneity with regard to demographics, case mix, interventions and outcomes. A high level of divergence in the studied laboratory results (creatinine, haemoglobin, lactate, sodium) from the locally used reference ranges was observed, even when stratified by outcome. CONCLUSION Standardised reference ranges have limited relevance to ICU patients across a range of geographies. The development of context-specific reference ranges, especially as it relates to clinical outcomes like LOS and mortality, may be more useful to clinicians.
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Affiliation(s)
- Haoran Xu
- School of Medicine, Chinese PLA General Hospital, Beijing, China
| | - Louis Agha-Mir-Salim
- Laboratory for Computational Physiology, Harvard-MIT Division of Health Sciences and Technology, Cambridge, Massachusetts, USA .,Institute of Medical Informatics, Charité - Universitätsmedizin Berlin (corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
| | - Zachary O'Brien
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Dora C Huang
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Peiyao Li
- Global Health Drug Discovery Institute, Beijing, China.,Department of Computer Science and Technology, Tsinghua University, Beijing, China
| | - Josep Gómez
- Department of Intensive Care Medicine, Joan XXIII University Hospital in Tarragona, Tarragona, Catalunya, Spain.,Pere Virgili Health Research Institute, Reus, Catalunya, Spain
| | - Xiaoli Liu
- Laboratory for Computational Physiology, Harvard-MIT Division of Health Sciences and Technology, Cambridge, Massachusetts, USA.,School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Tongbo Liu
- Information Department, Chinese PLA General Hospital, Beijing, China
| | - Wesley Yeung
- Laboratory for Computational Physiology, Harvard-MIT Division of Health Sciences and Technology, Cambridge, Massachusetts, USA.,Department of Cardiology, National University Health System, Singapore
| | - Patrick Thoral
- Department of Intensive Care Medicine, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Paul Elbers
- Department of Intensive Care Medicine, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Zhengbo Zhang
- Medical Innovation Research Department, Chinese PLA General Hospital, Beijing, China
| | - María Bodí Saera
- Department of Intensive Care Medicine, Joan XXIII University Hospital in Tarragona, Tarragona, Catalunya, Spain.,Pere Virgili Health Research Institute, Reus, Catalunya, Spain
| | - Leo Anthony Celi
- Laboratory for Computational Physiology, Harvard-MIT Division of Health Sciences and Technology, Cambridge, Massachusetts, USA.,Division of Pulmonary Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Siuba MT, Carroll CL, Farkas JD, Olusanya S, Baker K, Gajic O. The Zentensivist Manifesto. Defining the Art of Critical Care. ATS Sch 2020; 1:225-232. [PMID: 33870290 PMCID: PMC8043314 DOI: 10.34197/ats-scholar.2020-0019ps] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/09/2020] [Indexed: 12/01/2022] Open
Abstract
Evidence-based medicine asks us to integrate the best available evidence with clinical experience and patient values. In the modern intensive care unit, the primary focus is on complex technology and electronic health records, often away from the bedside. Excess interventionism is the norm. The term "intensivist" itself implies an intensive management strategy, which can lead us away from a patient-centered practice and toward iatrogenic harm. Under the hashtag #zentensivist, an international, multiprofessional group of clinicians has begun to discuss via Twitter how to apply key principles of history taking, physical examination, physiology, pharmacology, and clinical research in a competent, compassionate, and minimalist fashion. The term "zentensivist" intentionally combines concepts seemingly at odds-Zen philosophy and intensive care-to describe a holistic approach to the art of caring for the critically ill. We describe the key tenets of zentensivist practice and how we may inspire these actions in those we lead and educate.
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Affiliation(s)
- Matthew T. Siuba
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Joshua D. Farkas
- Department of Pulmonary and Critical Care Medicine, University of Vermont, Burlington, Vermont
| | - Segun Olusanya
- Barts Heart Centre, Barts Health NHS Trust, W Smithfield, London, United Kingdom
| | - Kylie Baker
- Ipswich Emergency Department, Ipswich General Hospital, Ipswich, Queensland, Australia
- University of Queensland, Ipswich, Queensland, Australia; and
| | - Ognjen Gajic
- Division of Pulmonary and Critical Care, Mayo Clinic, Rochester, Minnesota
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Tyler PD, Stone DJ, Geisler BP, McLennan S, Celi LA, Rush B. Racial and Geographic Disparities in Interhospital ICU Transfers. Crit Care Med 2018; 46:e76-e80. [PMID: 29068859 PMCID: PMC5743219 DOI: 10.1097/ccm.0000000000002776] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Interhospital transfer, a common intervention, may be subject to healthcare disparities. In mechanically ventilated patients with sepsis, we hypothesize that disparities not disease related would be found between patients who were and were not transferred. DESIGN Retrospective cohort study. SETTING Nationwide Inpatient Sample, 2006-2012. PATIENTS Patients over 18 years old with a primary diagnosis of sepsis who underwent mechanical ventilation. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We obtained age, gender, length of stay, race, insurance coverage, do not resuscitate status, and Elixhauser comorbidities. The outcome used was interhospital transfer from a small- or medium-sized hospital to a larger acute care hospital. Of 55,208,382 hospitalizations, 46,406 patients met inclusion criteria. In the multivariate model, patients were less likely to be transferred if the following were present: older age (odds ratio, 0.98; 95% CI, 0.978-0.982), black race (odds ratio, 0.79; 95% CI, 0.70-0.89), Hispanic race (odds ratio, 0.79; 95% CI, 0.69-0.90), South region hospital (odds ratio, 0.79; 95% CI, 0.72-0.88), teaching hospital (odds ratio, 0.31; 95% CI, 0.28-0.33), and do not resuscitate status (odds ratio, 0.19; 95% CI, 0.15-0.25). CONCLUSIONS In mechanically ventilated patients with sepsis, we found significant disparities in race and geographic location not explained by medical diagnoses or illness severity.
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Affiliation(s)
- Patrick D Tyler
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - David J Stone
- Departments of Anesthesiology and Neurosurgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Benjamin P Geisler
- Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Stuart McLennan
- Institute for History, Ethics and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
| | - Leo Anthony Celi
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Barret Rush
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Goggs R, De Rosa S, Fletcher DJ. Electrolyte Disturbances Are Associated with Non-Survival in Dogs-A Multivariable Analysis. Front Vet Sci 2017; 4:135. [PMID: 28868302 PMCID: PMC5563317 DOI: 10.3389/fvets.2017.00135] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 08/04/2017] [Indexed: 11/13/2022] Open
Abstract
Electrolyte disorders have been individually associated with mortality in small populations of dogs and cats with specific conditions, but the associations and interactions between electrolyte disturbances and outcome have not been evaluated in a large, heterogeneous population. It was hypothesized that abnormalities of sodium, chloride, potassium, and calcium concentrations would be independently and proportionately associated with death from natural causes and with all-cause mortality in dogs. An electronic database containing 33,117 electrolyte profiles was constructed to retrospectively assess the association between disorders of sodium, potassium, corrected chloride, and ionized calcium concentrations with non-survival and with death excluding euthanasia by multivariable modeling. A second database containing 11,249 records was used to validate the models constructed from the first database. All four electrolytes assessed had non-linear U-shaped associations with case fatality rates, wherein concentrations clustered around the reference interval had the lowest case fatality rates, while progressively abnormal concentrations were associated with proportionately increased risk of non-survival (AUROC 0.624) or death (AUROC 0.678). Multivariable modeling suggested that these electrolyte disturbances were associated with non-survival and with death from natural causes independent of each other. This study suggests that measurement of electrolyte concentrations is an important component of the assessment of dogs in emergency rooms or intensive care units. Future studies should focus on confirming these associations in a prospective manner accounting for disease severity.
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Affiliation(s)
- Robert Goggs
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
| | - Sage De Rosa
- Department of Clinical Studies, University of Pennsylvania School of Veterinary Medicine, Philadelphia, PA, United States
| | - Daniel J Fletcher
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
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Ionized Calcium in the ICU. Chest 2016; 149:846-55. [DOI: 10.1016/j.chest.2015.12.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 11/25/2015] [Accepted: 12/02/2015] [Indexed: 02/07/2023] Open
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Correia LCL, Noya-Rabelo M, Barreto-Filho JA. Ischemia-guided myocardial revascularization: the oculo-ischemic reflex. Arq Bras Cardiol 2014; 102:e40. [PMID: 24838607 PMCID: PMC4028946 DOI: 10.5935/abc.20140047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 11/26/2013] [Indexed: 11/20/2022] Open
Affiliation(s)
- Luis Cláudio Lemos Correia
- Mailing Address: Luis Cláudio Lemos Correia, Av. Princesa
Leopoldina, 19/402, Graça. Postal Code 40150-080, Salvador, BA - Brazil. E-mail:
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