American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Aug 2014
ReviewA Universal Decision Support System: Addressing the Decision Making Needs of Patients, Families, and Clinicians in the Setting of Critical Illness.
In the setting of a complex critical illness, preference-sensitive decision making-choosing between two or more reasonable treatment options-can be difficult for patients, families, and clinicians alike. A common challenge to making high-quality decisions in this setting is a lack of critical information access and sharing among participants. Decision aids-brochures, web applications, and videos-are a major focus of current research because mounting evidence suggests they can improve decision-making quality and enhance collaborative shared decision making. ⋯ The format and content of the system could be adapted to decisional participants' unique characteristics, abilities, and needs. Universal decision support can better standardize a decisional approach and also allow a unique degree of personalization within a framework of shared decision making. We also discuss potential criticisms of this approach as well as strategies that can overcome them in a critical illness setting.
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Am. J. Respir. Crit. Care Med. · Aug 2014
A Functional Anatomic Defect of the Cystic Fibrosis Airway.
The mechanisms underlying cystic fibrosis (CF) lung disease pathogenesis are unknown. ⋯ An inherent defect in CF airway surface liquid contributes to delayed MCT beyond that caused by airway dehydration alone and identifies a fundamental mechanism underlying the pathogenesis of CF lung disease in the absence of antecedent infection or inflammation.
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Am. J. Respir. Crit. Care Med. · Aug 2014
Randomized Controlled Trial Clinical TrialAcute outcomes and 1-year mortality of ICU-acquired weakness: A cohort study and propensity matched analysis.
Intensive care unit (ICU)-acquired weakness is a frequent complication of critical illness. It is unclear whether it is a marker or mediator of poor outcomes. ⋯ After careful matching the data suggest that ICU-acquired weakness worsens acute morbidity and increases healthcare-related costs and 1-year mortality. Persistence and severity of weakness at ICU discharge further increased 1-year mortality. Clinical trial registered with www.clinicaltrials.gov (NCT 00512122).