Journal of critical care
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The desire to provide continuous intensivist management for all intensive care unit (ICU) patients in the face of a massive shortfall of available intensivists prompted the introduction of remote ICU care programs in 1999. The past several years have seen a dramatic increase in the number of health systems adopting this care model. ⋯ Health systems have begun to expand the scope of activities of the remote care team, capitalizing on the potential of this new operational and technology platform to leverage scarce personnel and achieve increases in both clinical effectiveness and provider efficiency. This review summarizes the current state of remote ICU care programs in the United States.
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Journal of critical care · Sep 2006
ReviewThe checklist--a tool for error management and performance improvement.
Levels of cognitive function are often compromised with increasing levels of stress and fatigue, as is often the norm in certain complex, high-intensity fields of work. Aviation, aeronautics, and product manufacturing have come to rely heavily on checklists to aid in reducing human error. ⋯ Despite demonstrated benefits of checklists in medicine and critical care, the integration of checklists into practice has not been as rapid and widespread as with other fields. This narrative is a guide to the evolution of medical and critical care checklists, and a discussion of the barriers and risks to the implementation of checklists.
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Journal of critical care · Mar 2006
ReviewThe evolution of intensive care unit performance assessment.
Intensive care units (ICUs) share the problems experienced by the health care system at large. Various approaches to define and manage the quality of care patients receive in the ICU have been proposed. ⋯ Successful performance assessment requires the quantification of relevant indexes of performance. Although these indexes are increasingly being developed, it will be some time before widely recognized, validated systems are available.
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Journal of critical care · Sep 2005
ReviewStruggle for implementation of new strategies in intensive care medicine: anticoagulation, insulin, and lower tidal volumes.
The management of intensive care patients have changed dramatically in the last years: from merely supportive care, it has moved to evidence-based strategies that have been demonstrated to reduce mortality of the severely ill patients. Clinical research have brought numerous positive clinical trials offering intensive care physicians specific therapies to improve outcome of intensive care patients. ⋯ Although results of these trials were sufficiently strong to, at least, consider implementation of these strategies in critical care medicine, published and yet unpublished reports show that there is significant struggle with implementation of these therapies. This manuscript focuses on the potential reasons that underlie this problem.
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Estimating the required sample size for a study is necessary during the design phase to ensure that it will have maximal efficiency to answer the primary question of interest. Clinicians require a basic understanding of the principles underlying sample size calculation to interpret and apply research findings. This article reviews the critical components of sample size calculation, including the selection of a primary outcome, specification of the acceptable types I and II error rates, identification of the minimal clinically important difference, and estimation of the error associated with measuring the primary outcome. The relationship among confidence intervals, precision, and study power is also discussed.