Chest
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Burnout syndrome is an increasingly common phenomenon that threatens our critical care workforce and the well-being of its members. Burnout syndrome can be conceived of as a workforce manifestation of chronic workload and workforce capacity imbalance. This study explores the role of workload management tools that can address workload as a complement to the resilience-based countermeasures that seek to increase worker capacity. ⋯ Our ICU workforce efficiency was calculated as the ratio of mandatory task time to scheduled time. Comparing this ratio vs a well-established industrial standard for equipment efficiency made us realize that our average workload seemed excessive and placed our staff at risk of burnout syndrome. It is difficult to conceive that our resilience-based countermeasures to prevent and treat burnout would not be more effective when combined with measures that reduce the time our staff members spend on mandatory ICU tasks.
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Chronic inflammatory diseases of the lung are often life-threatening and are a leading cause of morbidity in our communities. MicroRNAs (miRs) are now recognized to play critical roles in a wide range of cellular functions, including the regulation of immunologic processes, which are often dysregulated in chronic respiratory diseases. ⋯ Furthermore, experimental evidence suggests that pharmacologic inhibition of miR function or delivery of mimics may have therapeutic potential. The review also therefore discusses the potential utility and limitations of therapeutically targeting these molecules and their downstream pathways.
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Patients requiring mechanical circulatory support (MCS) constitute a heterogeneous group whose needs have guided the development of a broad range of MCS devices. Appropriate patient and device selection are important for maximizing the potential benefit of these therapies. ⋯ In the critical care setting, patients with the highest acuity have the worst outcomes when receiving an implantable long-term ventricular assist device (VAD); therefore, shorter-term devices should be considered for stabilization and optimization prior to implantation of a long-term device. In this focused review for the critical care clinician, we discuss important considerations for identifying VAD candidates, identifying the range of devices available to support them, bridging strategies that may improve outcomes for patients who are critically ill, and identifying areas of ongoing research.
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Nearly 50% of physicians report symptoms of clinical burnout. Occupational factors and personal health play substantial roles in physician burnout. The role of sleep in physician burnout is not well understood. ⋯ Early detection and early intervention to improve both sleep deprivation and burnout are warranted in health-care professionals. Interventions should be directed not only at individuals but also at the entire health system. This review highlights the latest developments and emerging concepts concerning the role of sleep and circadian disorders in physician burnout.
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COPD has a substantial burden seen in both patient quality of life and health-care costs. One method of minimizing this burden is the implementation of clinical pathways (CPWs). CPWs bring the best available evidence to a range of health-care professionals by adapting guidelines to a local context and detailing essential steps in care. ⋯ This systematic review reveals evidence to suggest that CPWs for COPD have the potential to reduce complications, readmissions, and length of stay without negatively influencing mortality or quality of life. However, quality of evidence was generally low. The authors therefore acknowledge that results should be interpreted with caution and note the need for additional research in this area.