New Project Dispatch Presentations Available For Viewing

The Project Dispatch — Disseminating Patient-Centered Outcomes Research to Healthcare Professionals — session held during the 43rd Critical Care Congress proved very successful and engaging, giving Society of Critical Care (SCCM) members an opportunity to highlight their successful patient- and family-centered projects. Presentations from the session have been released and are available here.

The release of these sessions comes on the heels of several other new resources supported by Project Dispatch, including:

Project Dispatch is supported by grant number R18HS021940 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.

Webcast to Discuss Obtaining Consent for Research in the ICU

The face of modern medicine has greatly changed over the past few decades. In order to continue to make advances in treating diseases, improving quality of care, and enhancing patient experiences, clinical investigators must find subjects willing to partner in research efforts.

In the webcast, Consent for Research in the ICU, from the Controversies in Critical Care series, Dan Thompson, MD, MA, FCCM, and Alex Kon, MD, FCCM, will discuss the challenges associated with obtaining pediatric and adult consent for complex research in critically ill patients. During the discussion, federal regulations, the SUPPORT study, and the potential impact of consent decisions on the well-being of patients and healthcare personnel will be reviewed.

Learning Objectives

• Discuss the fundamentals of consent for research

• Explain the issues of consent for research when the patients cannot consent for themselves

• Describe the difference between pediatric and adult consent for research

• Explore the problems in consent for complex research in critically ill patients

This webcast will take place on Friday, April 25, 2014, at 1:00 p.m. Central Time.

Register online today. The registration fee for this 60-minute webcast is $30 for SCCM members and $40 for nonmembers. Participants will receive 1 hour of continuing education credit. Please contact SCCM Customer Service at +1 847 827-6888 to inquire about the $200 group rate for institutions that will host multiple participants.

The Controversies in Critical Care webcast series is a joint project of the SCCM Scientific Review Committee and the American College of Critical Care Medicine’s Ethics Committee. This series is intended to provide insight into topics in critical care medicine for which there is no clear consensus or unequivocal evidence for guiding practice decisions.

Critical Care Ultrasound Courses Expected to Sell Out Early

Focused ultrasound examinations in the critical care setting have become an extension of the clinical assessment because of their rapid, precise detection capabilities. Assist in the immediate management of patients by learning or enhancing point-of-care ultrasound skills. SCCM offers three valuable ultrasound courses:

Critical Care Ultrasound

Gain the realistic training needed to perform and interpret ultrasound imaging during this two-day comprehensive course. Participants benefit from guided, focused skill stations featuring live models and interactive presentations to reinforce key learning points. Extensive faculty coverage ensures a significant hands-on experience for each participant.

 

Critical Care Ultrasound – Pediatric

New this year, SCCM’s Critical Care Ultrasound course is also offered in a pediatric format. This new two-day course focuses exclusively on how to perform and interpret pediatric ultrasound imaging. Participants receive a comprehensive, high-quality learning experience that combines hands-on technique through guided, focused skill stations and interactive presentations to reinforce key learning points.

Advanced Critical Care Ultrasound

Expand your fundamental skills and knowledge and focus on the specialty-specific use of echocardiography in the management of the critically ill patient. Participants are provided with important cardiovascular information for the noninvasive management of the hemodynamically unstable patient.

The summer ultrasound courses will be held August 17 to 19, 2014, at the Fairmont Chicago, Millennium Park, in Chicago, Illinois, USA. Space for the live courses is limited. Visit the ultrasound courses Web page and register today to guarantee your seat!

What Is the Potential Impact of Utilizing Donated Kidneys from Newborns Undergoing Circulatory Death?

More than 90,000 patients await kidney transplant, according to the U.S. Organ Procurement and Transplantation Network.  Approximately 16,000 transplants occur every year, but 35,000 patients are added to the list annually.

Because of this growing list of patients with end-stage renal disease who need new kidneys, transplant surgeons are seeking innovative ways to increase the donor pool. Recently, a number of transplant surgeons began utilizing younger and smaller kidney donors by transplanting their organs en bloc into single recipients.  Common reported complications of using smaller kidneys include increased graft thrombosis and hyperfiltration injury.  However, in their report on outcomes utilizing kidneys transplanted from donors weighing less than 15 kg (even some less than 10 kg), Sharma and coworkers reported 5-year graft survival at 92%, statistically no different than standard deceased or living donor kidney transplants.

Read more…

Mortality and Predictors of Death Among Survivors of ARDS

Modern intensive care unit interventions such as low-tidal volume mechanical ventilation may result in short-term improvements in acute respiratory distress syndrome (ARDS) survival, but less is known about the epidemiology of long-term survival. Chen Wang et al conducted a study to quantify the gap between in-hospital and 1-year ARDS mortality rates, and to identify risk factors and causes of death at one year among patients with ARDS.

Patients were selected from an ongoing prospective, multi-unit acute lung injury (ALI) biomarker study (VALID) at a single institution (Vanderbilt University Medical Center, Nashville, TN, USA). Those who met the American European Consensus Committee criteria for ALI/ARDs were included. A sensitivity analysis was also performed to include patients who met the Berlin criteria for ARDS. All were followed until death or for at least 1 year after study enrollment. Logistic regression was used to analyze associations between risk factors and death.
Read more…

Webcast to Review Consent for Research

Researchers are at the forefront of advancing knowledge that can be leveraged to treat disease, to improve quality of care, and to enhance patient experiences and outcomes. In the upcoming webcast, Consent for Research in the ICU, from the Controversies in Critical Care series, John Whitcomb, PhD, RN, CCRN, FCCM, Dan Thompson, MD, MA, FCCM, and Alex Kon, MD, FCCM, will discuss the different challenges in pediatric and adult consent for research and present the difficulties for consent in complex research in critically ill patients.

Learning Objectives

  • Discuss the fundamentals of consent for research
  • Explain the issues of consent for research when the patients cannot consent for themselves
  • Describe the difference between pediatric and adult consent for research
  • Explore the problems for consent in complex research in critically ill patients

This webcast will take place on Friday, April 25, 2014, at 1:00 p.m. Central Time.

Register online today. The registration fee for this 60-minute webcast is $30 for SCCM members and $40 for nonmembers. Participants will receive 1 hour of continuing education credit. Please contact SCCM Customer Service at +1 847 827-6888 to inquire about the $200 group rate for institutions that will host multiple participants.

The Controversies in Critical Care webcast series is a joint project of the SCCM Research Committee and the American College of Critical Care Medicine’s Ethics Committee. This series is intended to provide insight into topics in critical care medicine for which there is no clear consensus or unequivocal evidence for guiding practice decisions.

Participate in an International Study on Mechanical Ventilation

The International Observational Study Investigators are looking at mechanical ventilation (MV) discontinuation practices internationally in intensive care units. The goal of the study is to characterize practice variation in weaning critically ill adults from invasive MV, as well as the influence of selected discontinuation strategies on important outcomes. Each unit  will be asked to collect data on at least 10 consecutive discontinuation events — one event (e.g., tracheostomy, direct extubation, initial successful spontaneous breathing trial) per patient receiving invasive ventilation for at least 24 hours and all patients who die before any attempt at MV discontinuation. Those interested in participating should email ioswean@smh.ca.

Drug Shortage Alert: Electrolyte Medication

The Society of Critical Care Medicine’s Drug Shortages Task Force has produced a comprehensive guide for assessing and responding to shortages of sodium acetate injection, concentrated sodium chloride, potassium acetate and chloride injection, phosphate injection, calcium chloride and gluconate injection, and magnesium sulfate injection. Manufacturers report a number of reasons for these shortages, including increased demand, manufacturing delays, suspended production, and discontinuation by the manufacturer.

The alert Electrolyte Medication Shortages includes information on the shortage’s impact in intensive care units, including suggested management strategies, pharmacotherapeutic considerations, and safety concerns. The recommendations are based on a combination of current evidence, clinical experience from multiple clinicians, and the need for conservation during these shortages.

Visit www.sccm.org/currentissues to access all Drug Shortage Alerts, including those addressing:

  • Intravenous Sodium Bicarbonate
  • Web Resources
  • Intravenous Loop Diuretics
  • General Considerations

John Lewin, MBA, PharmD, and other members of the Drug Shortage Task Force discuss safe and consistent management of drug shortages as well as on additional resources and strategies.

CDC Urges Better Antibiotic Stewardship

A new Vital Signs report from the Centers for Disease Control and Prevention (CDC) shows that clinicians in some hospitals prescribe three times as many antibiotics than clinicians in other hospitals, even though patients were receiving care in similar areas of each hospital. In addition, about one-third of the time, prescribing practices to treat urinary tract infections and prescriptions for the critical and common drug vancomycin included a potential error – given without proper testing or evaluation, or given for too long. The report also found that, in hospitals, a 30% reduction in use of the antibiotics that most often cause deadly diarrheal infections with Clostridium difficile can reduce these infections by more than 25%. The same antibiotics also prime patients for future super-resistant infections.

To help hospitals develop antibiotic stewardship programs, CDC released practical tools that include seven key elements, a self-assessment checklist, and an in-depth implementation document.

The Vital Signs report follows several calls to action from CDC on antibiotic resistance including the Antibiotic Resistance Threats to the United States, 2013 report, the Get Smart about Antibiotics Week, and the upcoming coming Transatlantic Taskforce on Antimicrobial Resistance 2013 report.

ACGME, AOA and AACOM Agree to Single Accreditation for Graduate Medical Education

The Accreditation Council for Graduate Medical Education (ACGME), the American Osteopathic Association (AOA), and the American Association of Colleges of Osteopathic Medicine (AACOM) have agreed to a single accreditation system for graduate medical education (GME) programs in the United States. After months of discussion, the allopathic and osteopathic medical communities have committed to work together to prepare future physicians with the highest quality GME, ultimately helping to ensure the quality and safety of health care delivery.

The single accreditation system will allow graduates of allopathic and osteopathic medical schools to complete residency and/or fellowship education in ACGME-accredited programs and demonstrate achievement of common Milestones and competencies. Currently, the ACGME and AOA maintain separate accreditation systems for allopathic and osteopathic educational programs.

“A single system standardizes the approach to GME accreditation, and ensures that all physicians have access to the primary and sub-specialty training necessary to serve patients,” said AOA President Norman E. Vinn, DO. Under the single accreditation system:

  • AOA and AACOM will become ACGME member organizations and will nominate members to the ACGME Board of Directors.
  • Two new osteopathic Review Committees will be created to evaluate and set standards for the osteopathic aspects of GME programs seeking osteopathic recognition.
  • An extended transition period — July 1, 2015 to June 30, 2020 is set for AOA-accredited programs to apply for and receive ACGME recognition and accreditation.
  • Opportunity is created for MD and DO graduates who have met the prerequisite competencies to access any GME program or transfer from one accredited program to another without being required to repeat education.
  • Efficiencies are realized because institutions need not sponsor “dually accredited” or “parallel accredited” allopathic and osteopathic medical residency programs.

The New Yorker Puts Spotlight on Post-Intensive Care Syndrome

The New Yorker profiled intensive care unit (ICU) patient Charlie Atkinson and his struggle with the long-term outcomes of his care. “After a month in the I.C.U., Atkinson was well enough to leave the hospital. He had ‘made it.’ But he remained dependent on a ventilator and confused—able to recognize his own name and little else. He didn’t know it, but he had crossed an invisible threshold into a territory of protracted sickness and uncertain hope for improvement,” according to the article “The Limbo Between A Life Worth Living and Death.” The article details the challenges patients face after critical illness and signifies a rising awareness about post-intensive care syndrome.

The Society of Critical Care Medicine offers numerous resources to help educate patients about post-intensive care syndrome at www.MyICUCare.org, including several interviews with former ICU patients.

In addition, the Society’s ICU Liberation initiative offers clinicians tools to improve long-term outcomes. A recently added presentation from Alison Clay, MD, recounts her own ICU survivor story.

New Edition of Critical Care Ethics: A Practice Guide

The intensive care unit can be the site of many ethical controversies. Critical Care Ethics: A Practice Guide, Third Edition, explores thought-provoking ethical questions that critical care professionals must face in real life situations.

Topics include:

  • euthanasia
  • artificial nutrition
  • management of drug shortages
  • palliative care
  • religious views of end-of-life care
  • unique considerations in pediatric and neonatal care

The references and suggested readings that accompany each chapter provide resources for further exploration of complicated issues.

Critical Care Ethics: A Practice Guide, Third Edition is available for purchase in the SCCM Store in print and electronic formats.

Practice and Prepare with the Adult and Pediatric Board Review Courses

The Society of Critical Care Medicine’s (SCCM) 2014 Adult and Pediatric Multiprofessional Critical Care Board Review Courses (MCCBRC) set the standard in board preparation. Whether you need to certify, recertify or simply review, MCCBRC provides an excellent update and thorough overview of the field.

Comprehensive Learning Experience
Receive 4.5 days of extensive coverage of core concepts in critical care, including cardiology, endocrinology, gastrointestinal disorders, infectious diseases, monitoring, neurology, nutrition, respiratory care, sepsis, and more. Each comprehensive session is presented by world-class faculty.

Accurate Skills Assessment
Daily interactive board preparation sessions will consist of practice board questions, answers and rationales. Monitor your progress through audience response system technology and receive accurate feedback regarding areas that may need further refinement.

Valuable Study Resources
As a registered participant, you will receive the course syllabus, online access to practice questions, post-course online access to MCCBRC On Demand videos and downloadable MP3 files of all the lectures, and networking opportunities with colleagues and world-renowned experts in critical care.

The 2014 Adult and Pediatric MCCBRC will be held August 12 to 16, 2014, at the Fairmont Chicago, Millennium Park, in Chicago, Illinois, USA. Register online for the Adult or Pediatric MCCBRC using your Customer ID and password, or contact SCCM Customer Service at +1 847 827-6888.

Help Change the Face of Patient Care

Liberate your patients from the harmful effects of pain, agitation and delirium in the ICU and improve their long-term outcomes. Among the resources available at www.ICULiberation.org is a newly added presentation from the 43rd Critical Care Congress from Alison S. Clay, MD, who shares her experience and recovery as an intensive care unit patient.

In addition, the site offers the Pain, Agitation and Delirium Guidelines and numerous tools related to the assessment, treatment and prevention of these conditions.

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