Annals of the American Thoracic Society
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Observational Study
Development and preliminary evaluation of a telephone-based mindfulness training intervention for survivors of critical illness.
Persistent symptoms of psychological distress represent an unmet need among intensive care unit (ICU) survivors. ⋯ A new ICU survivor-specific mindfulness training intervention delivered by telephone was acceptable and feasible. Changes in symptoms of distress were correlated with changes in skills that were targeted by the mindfulness program. Controlled trials are needed to further evaluate this promising intervention.
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Time-varying demand for critical care may strain the capacities of intensive care units (ICUs) to provide optimal care. Intensivists and ICU nurses may be the best judges of the strain on their ICU. Yet, it is not clear what ICU and hospital factors contribute to this perceived sense of strain among ICU providers. ⋯ A model containing commonly available metrics of ICU census, average patient acuity, and the proportion of new admissions has validity as a model of ICU nurses' perceived ICU capacity strain. However, only ICU census was associated with increased perceived capacity strain by physicians, highlighting the need for involvement of multiple stakeholder groups to improve our understanding of ICU capacity strain.
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Clinical practice guidelines are usually developed by a group of experts coming together to review the evidence in a field to make evidence-based recommendations on how to integrate new evidence into practice. The development process often draws on strict methodological rules to assess and assign quality grades to the evidence used to underpin the recommendations. Yet the goal of clinical practice guidelines--to help guide clinicians to understand, translate, and apply new evidence into everyday practice--can be thwarted by a lack of diversity and plurality of committee members, by limitations in the published evidence base, and by the design of the randomized controlled trials (RCTs) that largely underpin their pronouncements. ⋯ Although RCTs can adequately demonstrate efficacy of a specific treatment, pragmatic trials and postmarketing observational studies are usually required to evaluate the long-term safety of therapeutic interventions. The practical usefulness of clinical practice guidelines may be enhanced by ensuring representation of a broad stakeholder group within guideline committees (e.g., patients, primary and secondary care clinicians, policy makers, and health insurers) and by integrating effectiveness as well as efficacy data. Only in this way can clinical practice guidelines achieve their goal of guiding the meaningful implementation of new research into practice, for the benefit of all stakeholders.
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Predictions of duration of mechanical ventilation are frequently made by intensivists and influence clinical decisions. ⋯ The accuracy of intensivists' early clinical predictions of duration of mechanical ventilation is limited, particularly for identifying patients who will require prolonged mechanical ventilation.
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Historical Article
The Surgeon Generals' reports and respiratory diseases. From 1964 to 2014.