The reliability of the College of Intensive Care Medicine of Australia and New Zealand "Hot Case" examination.

Background: High stakes examinations used to credential trainees for independent specialist practice should be evaluated periodically to ensure defensible decisions are made. This study aims to quantify the College of Intensive Care Medicine of Australia and New Zealand (CICM) Hot Case reliability coefficient and evaluate contributions to variance from candidates, cases and examiners.

Methods: This retrospective, de-identified analysis of CICM examination data used descriptive statistics and generalisability theory to evaluate the reliability of the Hot Case examination component.

Too hot to handle? Assessing the validity and reliability of the College of Intensive Care Medicine "Hot Case" examination.

The College of Intensive Care Medicine of Australia and New Zealand is responsible for credentialling trainees for specialist practice in intensive care medicine for the safety of patients and the community. This involves defining trainees' performance standards and testing trainees against those standards to ensure safe practice. The second part examination performed towards the end of the training program is a high-stakes assessment.

The Hematological Effects of Extracorporeal Membrane Oxygenator Exchange.

Membrane oxygenator failure during venovenous (V-V) extracorporeal membrane oxygenation (ECMO) can lead to life-threatening hypoxia, high replacement costs, and may be associated with a hyperfibrinolytic state and bleeding. The current understanding of the underlying mechanisms that drive this is limited. The primary aim of this study therefore is to investigate the hematological changes that occur before and after membrane oxygenator and circuit exchanges (ECMO circuit exchange) in patients with severe respiratory failure managed on V-V ECMO.

Nurses' Responses and Reactions to an Emergent Pediatric Simulation Exercise.

Pediatric nurses' responses and reactions in emergent simulations are understudied. Using authority gradient theory as a guide, the purpose of this study was to examine nurses' reactions during an emergency simulation exercise when directed to give an incorrect medication dose. Ten groups of noncritical care nurses were videotaped from the beginning of the simulation through debriefing.

Very old patients urgently referred to the intensive care unit: long-term outcomes for admitted and declined patients.

Background: Outcomes for very old patients (≥ 80 years) referred but not admitted to an intensive care unit have not been described in Australia and New Zealand.

Objective: To ascertain long-term (12-month) outcomes for very old patients urgently referred for ICU support at a tertiary referral hospital.

Design, Setting And Patients: A retrospective, medical record review of 1240 very old patients (≥ 80 years) who were urgently referred to an Australian, 31-bed ICU over a 40-month period from March 2011 to August 2014.

Management of Cerebellar Tonsillar Herniation following Lumbar Puncture in Idiopathic Intracranial Hypertension.

Lumbar puncture is performed routinely for diagnostic and therapeutic purposes in idiopathic intracranial hypertension, despite lumbar puncture being classically contraindicated in the setting of raised intracranial pressure. We report the case of a 30-year-old female with known idiopathic intracranial hypertension who had cerebellar tonsillar herniation following therapeutic lumbar puncture. Management followed guidelines regarding treatment of traumatic intracranial hypertension, including rescue decompressive craniectomy.

The use of electronic pharmacy data to investigate prescribed medications and fatal motor vehicle crashes in a military population, 2002-2006.

The authors examined the association between prescribed medications and fatal motor vehicle crashes (MVCs) in an active duty military population between 2002 and 2006. Using a case-control design, MVC deaths were ascertained using a military mortality registry, and an integrated health system database provided information on health system eligibility, pharmacy transactions, and medical encounters. Cases and controls were matched on comparable observation time outside periods of deployment.

Magnetic source separation in Earth's outer core.

We present evidence that the source of Earth's axial dipole field is largely independent from the sources responsible for the rest of the geomagnetic field, the so-called nonaxial dipole (NAD) field. Support for this claim comes from correlations between the structure of the historic field and the behavior of the paleomagnetic field recorded in precisely dated lavas at those times when the axial dipole was especially weak or nearly absent. It is argued that a "stratification" of magnetic sources exists in the fluid core such that the axial dipole is the only observed field component that is nearly immune from the influence exerted by the lowermost mantle.

Hepatitis infection in the treatment of opioid dependence and abuse.

Many new and existing cases of viral hepatitis infections are related to injection drug use. Transmission of these infections can result directly from the use of injection equipment that is contaminated with blood containing the hepatitis B or C virus or through sexual contact with an infected individual. In the latter case, drug use can indirectly contribute to hepatitis transmission through the dis-inhibited at-risk behavior, that is, unprotected sex with an infected partner.

Comparison of asymmetry in cerebral blood flow between brain hemispheres using digital subtraction angiography.

Background And Purpose: Recently, endovascular techniques have gained significant therapeutic potential for both treatment and prevention of stroke. Cerebral angiography, which is an essential component of these procedures, has been used to provide morphological information regarding condition of blood vessels. In this study, we propose to determine the possibility of acquiring information regarding cerebral blood flow (CBF) in addition to morphologic information from data routinely available during angiography.

Structural and temporal requirements for geomagnetic field reversal deduced from lava flows.

Reversals of the Earth's magnetic field reflect changes in the geodynamo--flow within the outer core--that generates the field. Constraining core processes or mantle properties that induce or modulate reversals requires knowing the timing and morphology of field changes that precede and accompany these reversals. But the short duration of transitional field states and fragmentary nature of even the best palaeomagnetic records make it difficult to provide a timeline for the reversal process.

Using a structured medical note for determining the safety profile of anthrax vaccine for US soldiers in Korea.

Selected military personnel are immunized with an FDA-licensed anthrax vaccine unless there are clinical contraindications. The objective of this analysis is to capture the experience of soldiers receiving anthrax vaccine to assist in better patient-provider communication and clarify the safety profile of the vaccine in this population as a quality-assurance initiative. Between August 1998 and July 1999, 2824 soldiers immunized against anthrax at one military clinic completed a structured medical note that was reviewed by a clinician.