Multilingual Analysis of the Quality and Readability of Online Health Information on the Adverse Effects of Breast Cancer Treatments.

This quality improvement study assesses the quality and readability of online health information that patients may encounter when seeking information on adverse effects of breast cancer treatment.

Initiation and Assessment of Timekeeping Roles During In-Hospital Cardiac Arrests to Track Rhythm Checks and Epinephrine Dosing.

Objectives: Compliance to advanced cardiac life support algorithm is low and associated with worse outcomes from in-hospital cardiac arrests. This study aims to improve algorithm compliance by delegation of two separate code team members for timing rhythm check and epinephrine administration in accordance to the advanced cardiac life support algorithm.

Design: Prospective intervention with historical controls.

Withholding or withdrawing invasive interventions may not accelerate time to death among dying ICU patients.

Background: Critically ill patients may die despite invasive intervention. In this study, we examine trends in the application of two such treatments over a decade, namely, endotracheal ventilation and vasopressors and inotropes administration, as well as the impact of these trends on survival durations in patients who die within a month of ICU admission.

Methods: We considered observational data available from the MIMIC-III open-access ICU database and collected within a study period between year 2002 up to 2011.

Quantifying the Mortality Impact of Do-Not-Resuscitate Orders in the ICU.

Objectives: We quantified the 28-day mortality effect of preexisting do-not-resuscitate orders in ICUs.

Design: Longitudinal, retrospective study of patients admitted to five ICUs at a tertiary university medical center (Beth Israel Deaconess Medical Center, BIDMC, Boston, MA) between 2001 and 2008.

Intervention: None.

Improving Resident Communication in the Intensive Care Unit. The Proceduralization of Physician Communication with Patients and Their Surrogates.

Effective communication between providers and patients and their surrogates in the intensive care unit (ICU) is crucial for delivery of high-quality care. Despite the identification of communication as a key education focus by the American Board of Internal Medicine, little emphasis is placed on teaching trainees how to effectively communicate in the ICU. Data are conflicting on the best way to teach residents, and institutions vary on their emphasis of communication as a key skill.

Considering cognition. Current challenges and future directions in pulmonary and critical care fellowship training.

Fellowship training in pulmonary and critical care has evolved substantially over the past decade. Training programs are increasingly focused on a rigorous, multifaceted assessment of an individual trainee's progress toward achieving specific curricular milestones, and their ability to independently manage a series of entrustable professional activities. This new system has provided programs with an enormous amount of detailed information related to the specific goals and outcomes of training.

When policy gets it right: variability in u.s. Hospitals' diagnosis of ventilator-associated pneumonia*.

Objective: The Centers for Disease Control has recently proposed a major change in how ventilator-associated pneumonia is defined. This has profound implications for public reporting, reimbursement, and accountability measures for ICUs. We sought to provide evidence for or against this change by quantifying limitations of the national definition of ventilator-associated pneumonia that was in place until January 2013, particularly with regard to comparisons between, and ranking of, hospitals and ICUs.

Noninvasive ventilation for acute respiratory failure: a review of the literature and current guidelines.

Noninvasive ventilation, both continuous positive airway pressure and noninvasive positive pressure ventilation, has been used increasingly for acute respiratory failure over the past several years. Noninvasive ventilation has been proven to be beneficial for some causes of acute respiratory failure, most clearly for acute exacerbations of chronic obstructive pulmonary disease, while its use in other forms of acute respiratory failure remains more controversial. In this article, the evidence for the use of noninvasive ventilation in various kinds of acute respiratory failure will be examined.

Distinct and replicable genetic risk factors for acute respiratory distress syndrome of pulmonary or extrapulmonary origin.

Background: The role of genetics in the development of acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) from direct or indirect lung injury has not been specifically investigated. The aim of this study was to identify genetic variants contributing to ALI/ARDS from pulmonary or extrapulmonary causes.

Methods: We conducted a multistage genetic association study.

Simulation training and its effect on long-term resident performance in central venous catheterization.

Introduction: Simulation is a safe alternative to practicing procedural skills on patients. However, few published studies have examined the long-term effect of simulation technology on bedside procedures such as central venous catheter (CVC) insertion.

Methods: To determine whether simulation-based teaching improves procedural comfort, performance, and clinical events in CVC insertion, over traditional methods of procedural teaching, and to assess the long-term effect of this training, we conducted a prospective, randomized controlled trial with 53 postgraduate year-1 and postgraduate year-2 medical residents at a tertiary-care teaching hospital.

Clinical characteristics and outcomes of sepsis-related vs non-sepsis-related ARDS.

Background: ARDS may occur after either septic or nonseptic injuries. Sepsis is the major cause of ARDS, but little is known about the differences between sepsis-related and non-sepsis-related ARDS.

Methods: A total of 2,786 patients with ARDS-predisposing conditions were enrolled consecutively into a prospective cohort, of which 736 patients developed ARDS.

Procedural competence in internal medicine residents: validity of a central venous catheter insertion assessment instrument.

Purpose: Despite mandates from accreditation bodies for programs to ensure procedural competence, standardized measures do not exist to assess residents' skills in performing central venous catheter (CVC) insertion. The objective of the present study was to develop an instrument to assess residents in subclavian (SC) CVC insertion, to set performance standards, and to validate the tool using performance data.

Method: In 2007, the authors convened experts to create an assessment tool for CVC insertion using a modified Delphi method.

Statin therapy is associated with decreased mortality in patients with infection.

Objectives: The objective was to investigate the association between statin therapy and mortality in emergency department (ED) patients with suspected infection.

Methods: A secondary analysis of a prospective, observational cohort study was conducted at an urban, academic ED with approximately 50,000 annual visits. Data were collected between December 2003 and September 2004.

Klebsiella pneumoniae liver abscess: an emerging problem in North America.

Background: Before the 1980s, Escherichia coli was the most common cause of pyogenic liver abscess, but more recently, Klebsiella pneumoniae has emerged as the most common organism in the United States and Taiwan.

Objective: Our goal is to present a case of K. pneumoniae liver abscess (KLA) and review the risk factors, presenting symptoms, complications, and treatment of this disease that is emerging in North America.

Occult hypoperfusion and mortality in patients with suspected infection.

Objective: To determine, in the early stages of suspected clinically significant infection, the independent relationship of the presenting venous lactate level to 28-day in-hospital mortality.

Design: Prospective, observational cohort study.

Setting: Urban, university tertiary-care hospital.

Performance of severity of illness scoring systems in emergency department patients with infection.

Objectives: To validate the Mortality in Emergency Department Sepsis (MEDS) score, the Confusion, Urea nitrogen, Respiratory rate, Blood pressure, 65 years of age and older (CURB-65) score, and a modified Rapid Emergency Medicine Score (mREMS) in patients with suspected infection.

Methods: This was a prospective cohort study. Adult patients with clinically suspected infection admitted from December 10, 2003, to September 30, 2004, in an urban emergency department with approximately 50,000 annual visits were eligible.