Critical care : the official journal of the Critical Care Forum
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Multicenter Study
The impact of the introduction of critical care outreach services in England: a multicentre interrupted time-series analysis.
Critical care outreach services (CCOS) have been widely introduced in England with little rigorous evaluation. We undertook a multicentre interrupted time-series analysis of the impact of CCOS, as characterised by the case mix, outcome and activity of admissions to adult, general critical care units in England. ⋯ The observational nature of the study limits its ability to infer causality. Although associations were observed with characteristics of patients admitted to critical care units, there was no clear evidence that CCOS have a big impact on the outcomes of these patients, or for characteristics of what should form the optimal CCOS.
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Comparative Study Clinical Trial
Liquid versus gel handrub formulation: a prospective intervention study.
Hand hygiene is one of the cornerstones of the prevention of health care-associated infection, but health care worker (HCW) compliance with good practices remains low. Alcohol-based handrub is the new standard for hand hygiene action worldwide and usually requires a system change for its successful introduction in routine care. Product acceptability by HCWs is a crucial step in this process. ⋯ Facilitated access to an alcohol-based gel formulation leads to improved compliance with hand hygiene and better skin condition in HCWs.
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This review summarizes key research papers published in the fields of cardiology and intensive care during 2006 in Critical Care and, where relevant, in other journals within the field. The papers have been grouped into categories: haemodynamic monitoring, vascular access in intensive care, microvascular assessment and manipulation, and impact of metabolic acidosis on outcome.
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Sepsis is the leading cause of death in critically ill patients and often affects individuals with community-acquired pneumonia. To overcome the limitations of earlier mathematical models used to describe sepsis and predict outcomes, we designed an empirically based Monte Carlo model that simulates the progression of sepsis in hospitalized patients over a 30-day period. ⋯ An empiric simulation model of sepsis can predict complex longitudinal patterns in the progression of sepsis, most accurately by models that contain data representing both organ-system levels of and duration of illness. This work supports the incorporation into mathematical models of disease of the clinical intuition that the history of disease in an individual matters, and represents an advance over several prior simulation models that assume a constant rate of disease progression.
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Patients receiving total parenteral nutrition (TPN) are at high risk for bloodstream infections (BSI). The notion that intravenous calories and glucose lead to hyperglycemia, which in turn contributes to BSI risk, is widely held but is unproven. We therefore sought to determine the role that hyperglycemia and parenteral calories play in the development of BSI in hospitalized patients receiving TPN. ⋯ Increased parenteral caloric intake is an independent risk factor for BSI in patients receiving TPN. This association appears unrelated to hyperglycemia. Based upon our observations, we suggest that parenteral caloric intake be prescribed and adjusted judiciously with care taken to account for all intravenous caloric sources and to avoid even short periods of increased intake.