Critical care trainees' career goals and needs: A Canadian survey.

Background: For training programs to meet the needs of trainees, an understanding of their career goals and expectations is required.

Objectives: Canadian critical care medicine (CCM) trainees were surveyed to understand their career goals in terms of clinical work, research, teaching, administration and management; and to identify their perceptions regarding the support they need to achieve their goals.

Methods: The online survey was sent to all trainees registered in a Canadian adult or pediatric CCM program.

Predicting neurologic outcome after targeted temperature management for cardiac arrest: systematic review and meta-analysis.

Objectives: Targeted temperature management improves survival and neurologic outcomes for adult out-of-hospital cardiac arrest survivors but may alter the accuracy of tests for predicting neurologic outcome after cardiac arrest.

Data Sources: We systematically searched Medline, Embase, CINAHL, and CENTRAL from database inception to September 2012.

Study Selection: Citations were screened for studies that examined diagnostic tests to predict poor neurologic outcome or death following targeted temperature management in adult cardiac arrest survivors.

The rewards and challenges of becoming a clinical instructor.

Frontline nurses working in the clinical area are a vital component to nursing education. Taking on the role of adjunct clinical instructor can be a rewarding way to increase one's own knowledge while performing the important task of educating the next generation of nurses.

Variation of arterial and central venous catheter use in United States intensive care units.

Background: Arterial catheters (ACs) and central venous catheters (CVCs) are common in intensive care units (ICUs). Few data describe which patients receive these devices and whether variability in practice exists.

Methods: The authors conducted an observational cohort study on adult patients admitted to ICU during 2001-2008 by using Project IMPACT to determine whether AC and CVC use is consistent across U.

Tracheostomy timing in traumatic brain injury: a propensity-matched cohort study.

Background: The optimal timing of tracheostomy in patients with severe traumatic brain injury (TBI) is controversial; observational studies have been challenged through confounding by indication, and interventional studies have rarely enrolled patients with isolated TBI.

Methods: We included a cohort of adults with isolated TBI who underwent tracheostomy within 1 of 135 participating centers in the American College of Surgeons' Trauma Quality Improvement Program, during 2009 to 2011. Patients were classified as having undergone early tracheostomy (ET, ≤8 days) versus late tracheostomy (>8 days).

Quantifying the effect of media limitations on outbreak data in a global online web-crawling epidemic intelligence system, 2008-2011.

Background: This is the first study quantitatively evaluating the effect that media-related limitations have on data from an automated epidemic intelligence system.

Methods: We modeled time series of HealthMap's two main data feeds, Google News and Moreover, to test for evidence of two potential limitations: first, human resources constraints, and second, high-profile outbreaks "crowding out" coverage of other infectious diseases.

Results: Google News events declined by 58.

Syrian refugees, between rocky crisis in Syria and hard inaccessibility to healthcare services in Lebanon and Jordan.

Around 3% of the world's population (n = 214 million people) has crossed international borders for various reasons. Since March 2011, Syria has been going through state of political crisis and instability resulting in an exodus of Syrians to neighbouring countries. More than 1 million Syrian refugees are residents of Lebanon, Jordan, Turkey, Egypt and North Africa.

Validity of physician billing claims to identify deceased organ donors in large healthcare databases.

Objective: We evaluated the validity of physician billing claims to identify deceased organ donors in large provincial healthcare databases.

Methods: We conducted a population-based retrospective validation study of all deceased donors in Ontario, Canada from 2006 to 2011 (n = 988). We included all registered deaths during the same period (n = 458,074).

Knowledge translation interventions for critically ill patients: a systematic review*.

Objective: We systematically reviewed ICU-based knowledge translation studies to assess the impact of knowledge translation interventions on processes and outcomes of care.

Data Sources: We searched electronic databases (to July, 2010) without language restrictions and hand-searched reference lists of relevant studies and reviews.

Study Selection: Two reviewers independently identified randomized controlled trials and observational studies comparing any ICU-based knowledge translation intervention (e.

Predictive score for estimating cancer after venous thromboembolism: a cohort study.

Background: Venous thromboembolism (VTE) has been associated with a higher risk of developing malignancy and mortality, and patients with VTE may therefore benefit from increased surveillance. We aimed to construct a clinical predictive score that could classify patients with VTE according to their risk for developing these outcomes.

Methods: Observational cohort study using an existing clinical registry in a tertiary academic teaching hospital in Buenos Aires, Argentina.

Intracranial pressure monitoring in severe traumatic brain injury: results from the American College of Surgeons Trauma Quality Improvement Program.

Although existing guidelines support the utilization of intracranial pressure (ICP) monitoring in patients with traumatic brain injury (TBI), the evidence suggesting benefit is limited. To evaluate the impact on outcome, we determined the relationship between ICP monitoring and mortality in centers participating in the American College of Surgeons Trauma Quality Improvement Program (TQIP). Data on 10,628 adults with severe TBI were derived from 155 TQIP centers over 2009-2011.

Entry and exit screening of airline travellers during the A(H1N1) 2009 pandemic: a retrospective evaluation.

Objective: To evaluate the screening measures that would have been required to assess all travellers at risk of transporting A(H1N1)pdm09 out of Mexico by air at the start of the 2009 pandemic.

Methods: Data from flight itineraries for travellers who flew from Mexico were used to estimate the number of international airports where health screening measures would have been needed, and the number of travellers who would have had to be screened, to assess all air travellers who could have transported the H1N1 influenza virus out of Mexico during the initial stages of the 2009 A(H1N1) pandemic.

Findings: Exit screening at 36 airports in Mexico, or entry screening of travellers arriving on direct flights from Mexico at 82 airports in 26 other countries, would have resulted in the assessment of all air travellers at risk of transporting A(H1N1)pdm09 out of Mexico at the start of the pandemic.

Organ donation after death in Ontario: a population-based cohort study.

Background: Shortfalls in deceased organ donation lead to shortages of solid organs available for transplantation. We assessed rates of deceased organ donation and compared hospitals that had clinical services for transplant recipients (transplant hospitals) to those that did not (general hospitals).

Methods: We conducted a population-based cohort analysis involving patients who died from traumatic brain injury, subarachnoid hemorrhage, intracerebral hemorrhage or other catastrophic neurologic conditions in Ontario, Canada, between Apr.

Scarcity: the context of rationing in an Ontario ICU.

Objectives: Clinicians' perceptions of scarcity influence rationing of critical care resources, which may lead to serious adverse outcomes for patients who are denied access. We sought to better understand the phenomenon of scarcity in the critical care setting.

Design: Qualitative research methods.

Competition in collaborative clothing: a qualitative case study of influences on collaborative quality improvement in the ICU.

Background: Multiorganisational quality improvement (QI) collaborative networks are promoted for improving quality within healthcare. Recently, several large-scale QI initiatives have been conducted in the intensive care unit (ICU) environment with successful quantitative results. However, the mechanisms through which such networks lead to QI success remain uncertain.

Determination of neurologic prognosis and clinical decision making in adult patients with severe traumatic brain injury: a survey of Canadian intensivists, neurosurgeons, and neurologists.

Objectives: Accurate prognostic information in patients with severe traumatic brain injury remains limited, but mortality following the withdrawal of life-sustaining therapies is high and variable across centers. We designed a survey to understand attitudes of physicians caring for patients with severe traumatic brain injury toward the determination of prognosis and clinical decision making on the level of care.

Design, Setting, And Participants: We conducted a cross-sectional study of intensivists, neurosurgeons, and neurologists that participate in the care of patients with severe traumatic brain injury at all Canadian level 1 and level 2 trauma centers.

Preventing pandemics via international development: a systems approach.

Tiffany Bogich and colleagues find that breakdown or absence of public health infrastructure is most often the driver in pandemic outbreaks, whose prevention requires mainstream development funding rather than emergency funding.

Integrating mortality and morbidity outcomes: using quality-adjusted life years in critical care trials.

Rationale: Outcome measures that integrate mortality and morbidity, like quality-adjusted life years (QALYs), have been proposed for critical care clinical trials.

Objectives: We sought to describe the distribution of QALYs in critically ill patients and estimate sample size requirements for a hypothetical trial using QALYs as the primary outcome.

Methods: We used data from a prospective cohort study of survivors of acute respiratory distress syndrome to generate utility values and calculate QALYs at 6 and 12 months.

Prophylactic magnesium for improving neurologic outcome after aneurysmal subarachnoid hemorrhage: systematic review and meta-analysis.

Purpose: Neurologic disability is common after aneurysmal subarachnoid hemorrhage (aSAH). Our objective was to systematically review the prophylactic use of magnesium to improve neurologic outcomes in these patients.

Methods: We searched MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials to June 2012 for randomized and quasi-randomized controlled trials of intravenous magnesium in adults after aSAH, given before radiologic vasospasm or delayed cerebral ischemia (DCI) and compared with any control group.

Improving intensive care unit quality using collaborative networks.

Collaborative networks of intensive care units can help promote a quality-improvement agenda across an entire system or region. Proposed advantages include targeting a greater number of patients, sharing of resources, and common measurement systems for audit and feedback or benchmarking. This review focuses on elements that are essential for the success and sustainability of these collaborative networks, using as examples networks in Michigan and Ontario.