Telemedicine in critical care

2016 ◽  
Author(s):  
Bela Patel ◽  
Eric J. Thomas
Keyword(s):  
Critical Care ◽  
Best Practices ◽  
Bloodstream Infections ◽  
Ventilator Associated Pneumonia ◽  
Care Model ◽  
Stress Ulcers ◽  
Care Environment ◽  
The Past ◽  
The Usa ◽  
The Impact

The majority of critically-ill patients are admitted to hospitals that do not have physician intensivist coverage, despite strong evidence that clinical outcomes are improved with intensivist staffing. Telemedicine can leverage clinical resources by providing critical care expertise to patients in intensive care units (ICUs) by off-site clinicians using video, audio, and electronic links. In the past 10 years, telemedicine in critical care has seen tremendous growth in the number of ICU patients being supported by this care model across the USA. The impact of ICU telemedicine coverage has been studied rigorously only in a few studies and the outcomes have been mixed and inconsistent. Telemedicine has been shown in some studies to improve adherence to ICU best practices for the prevention of deep venous thrombosis, stress ulcers, ventilator-associated pneumonia, and catheter-related bloodstream infections. Further research in ICU telemedicine is required to understand the variability of outcomes among the telemedicine programmes studied and to effectively implement the technology to consistently improve outcomes and reduce costs in the critical care environment.

scholarly journals Review of Best Practices for CLABSI Prevention and the Impact of Recent Legislation on CLABSI Reporting

SAGE Open ◽  
2016 ◽  
Vol 6 (4) ◽  
pp. 215824401667774 ◽  
Author(s):  
Benjamin Woodward ◽  
Reba Umberger
Keyword(s):  
Best Practices ◽  
Healthcare Providers ◽  
Bloodstream Infections ◽  
Central Line ◽  
Mandatory Reporting ◽  
Future Research ◽  
Common Source ◽  
Healthcare Associated Infection ◽  
Extrinsic Factors ◽  
The Impact

Central line-associated bloodstream infections (CLABSI) are a very common source of healthcare-associated infection (HAI). Incidence of CLABSI has been significantly reduced through the efforts of nurses, healthcare providers, and infection preventionists. Extrinsic factors such as recently enacted legislation and mandatory reporting have not been closely examined in relation to changes in rates of HAI. The following review will examine evidence-based practices related to CLABSI and how they are reported, as well as how the Affordable Care Act, mandatory reporting, and pay-for-performance programs have affected these best practices related to CLABSI prevention. There is a disconnect in the methods and guidelines for reporting CLABSI between these programs, specifically among local monitoring agencies and the various federal oversight organizations. Future research will focus on addressing the gap in what defines a CLABSI and whether or not these programs to incentivize hospital to reduce CLABSI rates are effective.

scholarly journals The expected future super-eruption of the Yellowstone super volcano (USA) is “cancelled” by the Pleistocene glaciation and by the inversion of caldera complex development

2019 ◽  
pp. 18-36
Author(s):  
I. V. Melekestsev
Keyword(s):  
Ice Sheets ◽  
Evolutionary Stage ◽  
Pleistocene Glaciation ◽  
Eruptive Activity ◽  
Magmatic Source ◽  
The Past ◽  
Complex Development ◽  
The Usa ◽  
The Impact ◽  
Yellowstone Caldera

The review of the reconstructions of the eruptive activity of the Yellowstone Caldera Complex (YCC) in the USA allows to suggests three groups of arguments supporting that the “volcanic super-eruption of Yellowstone” is not likely to occur in the coming hundreds or thousands of years. First is the gradual weakening of the volcanic potential of the magmatic source (which is the frontal lobe of the magmatic super-flow, and not the mantle plume) during the last 2 million yeats. Second is the impact of the repeated occurrence of ice sheets in the YCC area during the past 640 thousand years. Finally, the equivalent super-eruption, in terms of energy released and the mass of exploded material, had already occurred at about 70 thousand years ago, and since that time, the YCC has passed from the volcanic to the hydrothermal evolutionary stage.

Educating researchers in the metadiscipline of foresight

foresight ◽  
2020 ◽  
Vol 22 (5/6) ◽  
pp. 703-715
Author(s):  
James P. Kahan
Keyword(s):  
Higher Education ◽  
Best Practices ◽  
Educational Innovations ◽  
Content Type ◽  
Disciplinary Boundaries ◽  
American Higher Education ◽  
The Past ◽  
Scientific Disciplines ◽  
Logical Type ◽  
The Usa

Purpose The science of Foresight differs from the commonplace notion of what a science is because it is a metadiscipline – a logical type of science higher than the logical type of disciplinary sciences. It is practical, uses transdisciplinary processes that combine scientific disciplines and often examines counterfactuals in a scientific manner. This study aims to demonstrate that Foresight is a science, by presenting a number of best practices and potential innovations in higher education that could facilitate obtaining skills for Foresight science. Design/methodology/approach The methods of scientific education that have served us well in the past are inadequate for metadisciplinary sciences such as Foresight. The paper discusses what metadisciplinarity is, using a variety of examples, and distinguishes it from disciplines and ways of crossing disciplinary boundaries. Understanding the essential characteristics of Foresight as a metadisciplinary science leads to identifying current best practices and possible educational innovations in undergraduate education that will facilitate obtaining Foresight skills. Throughout the paper, examples are drawn from the education and professional experience of the author in the USA and Europe. Findings This paper demonstrates that Foresight is a science and presents a number of best practices and potential innovations in higher education that could facilitate obtaining skills for Foresight science. It identifies barriers to those innovations and approaches to overcome them. Originality/value This viewpoint paper clarifies the meaning of the terms interdisciplinarity, transdisciplinarity and metadisciplinarity to identify the essential characteristics of Foresight as a science. Then, it identifies and advocates needed changes in North American higher education to provide earlier and more efficient opportunities for Foresight researchers and users to obtain the skills they need.

Normal physiology of the renal system

2016 ◽  
Author(s):  
Bruce Andrew Cooper
Keyword(s):  
Critical Care ◽  
Critical Illness ◽  
Renal Dysfunction ◽  
Critical Role ◽  
Renal Physiology ◽  
Electrolyte Balance ◽  
Care Environment ◽  
System P ◽  
Urine Production ◽  
The Impact

Patients with critical illness often have renal dysfunction, either primary or secondary, that can both complicate and prolong their medical management. Therefore, an understanding of normal renal physiology can help recognize the process or processes that caused the renal dysfunction, and determine the most appropriate corrective and supportive care. The kidney has many important roles other than just urine production. The impact of kidney disease is often predictable. The kidney plays a critical role in fluid and electrolyte balance via many specialized transmembrane pathways. The kidney is also involved in the production and modification of two key hormones and one enzyme. Understanding normal renal physiology can help determine clinical management.This chapter summarizes the important aspects of renal physiology relevant to those who work in a critical care environment.

The critical care environment

2017 ◽  
Author(s):  
Sheila Adam ◽  
Sue Osborne ◽  
John Welch
Keyword(s):  
Critical Care ◽  
Clinical Information ◽  
Electronic Patient Records ◽  
Care Environment ◽  
Team Working ◽  
Use Of Technology ◽  
Design Structure ◽  
Key Factor ◽  
The Impact ◽  
Location Design

This chapter details the optimal location, design, structure, staffing, and equipment required to support high quality critical care. The chapter covers the impact of the critical care environment on patients, family, and staff themselves. The use of technology, including clinical information systems and electronic patient records, is described. Staffing numbers and roles and the importance of team working and collaboration as a key factor in the effectiveness of the critical care environment are also covered. The impact of cleanliness and infection control features as part of the design. The role that the environment has in mitigating the impact on patients in critical care as well as improving outcomes is described as well as other aspects of safety within critical care.

Assessing the impact of Sr/Ca-SST calibrations on coral-based seawater δ18O reconstructions - First results from PAGES CoralHydro2k

2021 ◽  
Author(s):  
Rachel Walter ◽  
Keyword(s):  
Best Practices ◽  
Climate Information ◽  
Tropical Ocean ◽  
Methodological Choices ◽  
Surface Ocean ◽  
The Past ◽  
Tropical Oceans ◽  
Calibration Methods ◽  
First Results ◽  
The Impact

<p>Corals are distributed throughout the tropical oceans, making them useful for resolving climate information covering time before the satellite era when instrumental data is often scarce. Coral δ<sup>18</sup>O has been used to reconstruct changes in both sea surface temperature (SST) and hydrology, while coral Sr/Ca is thought to mainly record SST. Coral δ<sup>18</sup>O data, when used in conjunction with Sr/Ca, can therefore be used to reconstruct seawater δ<sup>18</sup>O (δ<sup>18</sup>O<sub>sw</sub>), an indicator of the local precipitation-evaporation balance as well as other surface ocean hydrological changes. Coral Sr/Ca-SST relationships are critical for reconstructing δ<sup>18</sup>O<sub>sw</sub> from paired Sr/Ca and δ<sup>18</sup>O records, but vary across existing literature. Some of this variation is due to existing natural differences between corals, but variation also stems from differences in calibration methods or SST products used to determine the Sr/Ca-SST relationship. Such methodological differences complicate the comparison of results across studies and slow efforts to create a global picture of reconstructed tropical ocean hydroclimate.</p><p>Here, we use the PAGES CoralHydro2k database - a collection of 45 paired coral Sr/Ca-δ<sup>18</sup>O records and 70 coral δ<sup>18</sup>O records - to assess different methodological choices such as SST product and regression method and develop a calibration framework to use as a set of “best practices” moving forward. We also examine the sensitivity of δ<sup>18</sup>O<sub>sw</sub> to our calibration framework and to existing δ<sup>18</sup>O<sub>sw</sub> calculation methods. The PAGES CoralHydro2k project aims to leverage its coral database and apply these best practices and insights to a global reconstruction of tropical marine hydrology over the past 200 years.</p>

Research in the Critical Care Environment

2021 ◽  
pp. 345-372
Author(s):  
Dorothy Wade ◽  
Deborah Smyth ◽  
David C. J. Howell
Keyword(s):  
Critical Care ◽  
Recovery Period ◽  
Psychological Impact ◽  
Psychological Research ◽  
Psychology Research ◽  
Patient Centered ◽  
Care Environment ◽  
The Past ◽  
Research Areas ◽  
Hospital Rehabilitation

Research into the psychological impact of critical care has burgeoned over the past 20 years. This chapter outlines the major areas of psychological and rehabilitation research being conducted in critical care, as well as the gaps that remain to be filled. The authors review research areas corresponding to the early acute critical care phase, the in-hospital rehabilitation phase, and the post-hospital recovery period. The focus is on patient-centered research. The authors also review how clinicians can set themselves up to conduct psychological research, what kind of teams they need to assemble, and the challenges they could face working in critical care environments. The authors draw on their own experiences conducting linked, critical care psychology research studies, and compare this to methods used by other researchers.

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