Browsing by Subject "Intensive Care Units"
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Item Chronic critical illness: the limbo between life and death(2015-02-06) Ruggiero, RosechelleItem End of life care in the ICU(2016-05-13) Finklea, David JrItem Ethics of patient care: can we protect patients from ourselves?(2013-10-25) Yarbrough, William, Jr.Item Factors Associated with Posttraumatic Growth in Trauma Patients and ICU Family Members(2017-07-10) Roden-Foreman, Kenleigh; Robinson, Richard C.; Warren, Ann Marie; Roaten, Kimberly Dayle; Bennett, Monica; Petrey, LauraEach year in the United States, over three million people are hospitalized for traumatic injuries and five million are admitted to intensive care units (ICUs) as a result of traumatic injury or critical illness. Although the traditional benchmark for successful care in these settings has been patient survival, there has been an increased awareness of psychosocial issues that continue to impact patients' and family members' quality of life beyond the hospital stay. The experience of a traumatic injury or serious illness, for patients or their families, can be challenging to recover from both physically and psychologically. Extensive literature shows that presence of a psychological disorder can lead to or exacerbate negative physical health outcomes in patients, including increased risk of re-hospitalization, greater healthcare costs, and poorer quality of life. From the perspective of family members, psychological strain may hinder carrying out necessary caregiving activities for the patient, and this strain may continue unchecked since the majority of support and resources are directed at patients, not their caregivers. The primary emphasis of psychology, medicine, and related disciplines tends to be on ways in which traumatic events are precursors to distress and, potentially, severe psychological and physical dysfunction. Although this focus is understandable given the prevalence of research and clinical training on the topic, substantially less literature describes the influence of positive psychological outcomes. Posttraumatic growth (PTG) describes positive change resulting from a struggle with highly challenging events, such as sustaining a traumatic injury or witnessing a family member in the ICU. To date, no studies have examined factors associated with PTG in a heterogeneous sample of trauma patients or in the families of trauma/critical care ICU patients. The present studies sought to fill these gaps in the literature. The first study determined factors associated with PTG in a mixed trauma patient population one year post-injury. The second study did the same, but examined PTG in family members of trauma/critical care ICU patients one year post-hospitalization. By identifying variables related to growth, clinical interventions may be targeted to bolster those areas in hopes of improving outcomes in patients and their family members.Item Families in the ICU(2020-10-16) DeLisle, SylvainItem Impact of Quality Improvement Curriculum on Intensive Care Unit Upgrades by Resident Physicians(2022-05) Bohman, Seth Reid; Reed, W. Gary; Kedia, Raashee S.; Danko, ColinBACKGROUND: Patients admitted to the hospital ward from the emergency department (ED) can decompensate rapidly and require transfer to the intensive care unit (ICU). These patients may benefit from identification of critical illness in the ED and earlier admission to the ICU. This could reduce delays in care, improve patient outcomes, and reduce healthcare expenses. The 66 emergency medicine (EM) residents at a single academic medical center are part of a quality improvement curriculum known as Residents Enhancing Safety and Quality (RES-Q). The "ICU upgrades" group in the curriculum evaluates patients who require transfer from the inpatient floor to the ICU within 12 hours of admission from the ED. For a period of 6 months, residents participate in structured case review of qualifying patient encounters and attempt to determine the root causes for ICU upgrades. LOCAL PROBLEM: The Parkland Hospital ED has one of the largest patient volumes in the country.1 Given the busy nature of the department, learning and following-up on patient visits by the EM residents can take the backburner. A dedicated quality analysis curriculum, called RES-Q, was enacted in 2014 to help improve the residents' education. RES-Q consists of four major groups for review: ICU upgrades, 72-hour patient return visits, intubations, ED mortalities. Two additional groups are added on a year-to-year basis depending on resident interest. Residents evaluate patient cases in these groups each month and determine if there were any issues or learning points. These analyses are then presented during the monthly EM resident conference. Participation in each group is rotated every six months over three-year span of the residents' training to allow involvement in all groups. The ICU upgrades group evaluates patients that are dispositioned to the floor but decompensate within 12 hours and subsequently get "upgraded" to an ICU bed. METHODS: A retrospective analysis was performed to determine the effectiveness of this quality improvement program in reducing the number of clinical ICU upgrades. This took place at a large, urban, county hospital with over 200,000 ED visits per year. The initial analysis compared second-year EM residents who participated in the ICU upgrades curriculum during their first year to second-year EM residents who did not participate in the curriculum during their first year. The method of maximum likelihood was estimated by fitting a generalized Poisson linear regression model to the data. INTERVENTIONS: The primary intervention consisted of a quality improvement curriculum that involved structured case review of qualifying patient encounters, focusing on resident education and exposure to common causes of intensive care unit upgrades. This was complemented by a survey of the resident physicians that participated in the program, providing insight into their perceived value of the program and the general time commitment required to complete the program. RESULTS: Analysis of the 242 qualifying ICU upgrade cases from July 2019 - December 2021 showed 19 second-year EM residents who completed the curriculum were responsible for 19 ICU upgrades, and 26 second-year EM residents who had not yet completed the curriculum were responsible for 40 ICU upgrades. The incidence rate ratio of ICU upgrade cases for second-year residents who didn't complete the curriculum was 1.54 (95% CI: 0.89-2.66; p=0.122) compared to second-year residents who completed the curriculum. CONCLUSION: Initial analysis suggests that completion of the RES-Q ICU upgrades curriculum may improve resident proficiency in recognizing and appropriately dispositioning critical patients from the ED. This is associated with reduced number of patients requiring transfer from the inpatient floor to the ICU within 12 hours of admission. A limitation to this study is that all residents participated in the monthly RES-Q conference which presents data and learning points of all groups. Additional time periods and residency classes are currently under review to better determine the effect of the RES-Q ICU upgrades curriculum.Item The Influence of Demographic Factors, Resilience, and Other Psychological Factors in Predicting Caregiver Burden in Trauma ICU Populations(2020-12-01T06:00:00.000Z) Patel, Sarita; Warren, Ann Marie; Bennett, Monica; Robinson, Richard C.; Howe-Martin, Laura; Foreman, Michael; Petrey, LauraAlthough only a small number of studies specifically focus on caregivers of ICU patients, findings suggest that these caregivers can experience a substantial burden. Although negative psychological states, including depression and posttraumatic stress disorder (PTSD), are gaining attention in the literature following the injury of a family member, less attention has been paid to the role that potentially protective psychological factors, such as resilience, may have in one's response to injury or critical illness in a family member. The purpose of this study is to examine the role of specific demographics factors and resilience in predicting caregiver burden, depression, and PTSD symptoms in caregivers of trauma patients. Eligible individuals were identified based on their family member's medical diagnosis through the trauma service admission list at Baylor University Medical Center (BUMC), a Level I trauma center and part of the Baylor Scott & White Healthcare system. Participants (aged 18-82, N=91, 73.6% female) completed brief self-report measures assessing depression, PTSD and resilience at baseline, and completed brief self-report measures assessing depression, PTSD, and caregiver burden at three-month follow-up. Regression analyses were used to determine the association between resilience and each outcome (caregiver burden, depression, and PTSD). Results illustrated significant associations between resilience and depression and PTSD separately. Exploratory analyses were conducted to determine the role of demographic factors in predicting caregiver burden, depression, and PTSD over time. A series of linear and logistic regressions were conducted to evaluate the intersectionality of the demographic factors and each outcome. Findings suggest that higher levels of resilience may significantly be associated with lower rates of depression and PTSD. Additionally, the interaction of several demographic factors may significantly be associated with higher rates of depression and PTSD. Current study findings suggest that certain demographic factors are associated with higher levels of depression and PTSD in caregivers. Although further exploration is warranted before drawing firm conclusions, this novel information may be used to direct future research, educate caregivers, clinicians and researchers, and inform the development of interventions specific to this population.Item Lessons learned at UCSD about COVID-19 in the ICU(2021-05-28) Malhotra, AtulItem Medicine in the information age: clinical information systems(1996-07-11) Yarbrough, W. C.Item New therapeutic strategies for acute renal failure in the intensive care unit(1992-10-15) Henrich, William L.Item Nutrition in the ICU(1992-09-10) Yarbrough, W. C.Item Paralytic therapy and complications in the ICU(1999-01-28) Pitcher, William DouglasItem Responding to requests for futile or potentially inappropriate treatment(2017-03-14) White, Douglas B.Managing requests for potentially inappropriate treatment is deceptively complex and exposes unanswered questions about the boundaries of good medical practice in patients with advanced illness. This talk will summarize the recent guidelines from five major United States and European critical care societies on how to respond to such requests and how to proceed in the face of intractable conflict.Item Sedation and analgesia in the intensive care unit(2001-03-08) Pitcher, William DouglasItem [UT Southwestern Medical Center News](2007-12-10) Piloto, Connie