Articles: intensive-care-units.
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Eur J Trauma Emerg Surg · Feb 2025
Meta AnalysisEffectiveness of antibiotic prophylaxis in polytrauma patients: a systematic review and meta-analysis.
The use of antibiotic prophylaxis in trauma patients, particularly to prevent ventilator-associated pneumonia (VAP), is debated due to rising antibiotic resistance. Therefore, this systematic review evaluated the safety and effectiveness of antibiotic prophylaxis compared to placebo or standard care on clinical outcomes in adult polytrauma patients. ⋯ The results indicate that antibiotic prophylaxis has no significant effect on mortality and clinical status compared with placebo or standard care in adult polytrauma patients but may reduce the risk of VAP. However, the evidence is outdated and of very low certainty, with insufficient data to draw definitive conclusions regarding efficacy. Therefore, high-quality, up-to-date research is urgently needed to support clinical decision-making, and current interpretations should be treated with caution.
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Nocturnists are the principal means by which hospital medicine groups currently ensure continuous overnight coverage of hospitalized patients within academic medical centers and community hospitals. Yet despite their involvement in most aspects of overnight care, a comprehensive review of the impact of nocturnists in the hospital is absent. Here we examine the physiologic effects of overnight work on clinicians, the quality of medical care delivered by nocturnists in floor and intensive care units, the impact of nocturnist presence on trainee supervision and graduated autonomy in academic settings, and prevalent staffing models. ⋯ Compensation is typically greater for nocturnists, but the role's sustainability and impact on overall group retention remain unknown. Nocturnist programs are essential to provide continuous care of hospitalized patients and meet trainee supervision mandates, yet their full impact on patient and educational outcomes requires further investigation. Future research should aim to optimize staffing models to enhance patient care, trainee education, and clinician well-being.
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This study aimed to assess the organization, infrastructure, workforce, and adherence to protocols in neurocritical care across low- and middle-income countries (LMICs), with the goal of identifying key gaps and opportunities for improvement. ⋯ The study highlights critical gaps in infrastructure, workforce, and technology across LMICs, yet it also underscores the potential for improvement. Strategic investments in neurointensive care unit capacity, workforce development, and affordable technologies are an unmet need in resource-limited settings. These findings offer a road map for policymakers and global health stakeholders to prioritize neurocritical care and reduce the disparities in patient outcomes globally.
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Hospital-acquired infections (HAIs) during community disease outbreaks threaten vulnerable hospitalized patients. This study compares the outcomes of hospitalized patients who had COVID-19 as either a HAI or a community-acquired infection (CAI). ⋯ Patients with COVID-19 as a HAI face a higher risk of death compared to patients hospitalized with COVID-19 acquired in the community and are less likely to be admitted to the ICU. Strict infection control measures are needed during community outbreaks to protect hospitalized patients.