Curricular Reform in Serious Illness Communication and Palliative Care: Using Medical Students' Voices to Guide Change.

Purpose: To gather and leverage the voices of students to drive creation of required, integrated palliative care curricula within undergraduate medical education in Massachusetts, which is lacking in a majority of U.S. medical schools.

A Call to Action: Using Curriculum Mapping at Four Medical Schools in Massachusetts to Advance Serious Illness Communication Training in Undergraduate Medical Education.

Practicing physicians require serious illness communication (SIC) skills to ensure high-quality, humanistic care for patients and families as they face life-changing medical decisions. However, a majority of U.S.

Differences in directives to limit treatment and discontinue mechanical ventilation between elderly and very elderly patients: a substudy of a multinational observational study.

Purpose: The aim of this study was to characterize differences in directives to limit treatments and discontinue invasive mechanical ventilation (IMV) in elderly (65-80 years) and very elderly (> 80 years) intensive care unit (ICU) patients.

Methods: We prospectively described new written orders to limit treatments, IMV discontinuation strategies [direct extubation, direct tracheostomy, spontaneous breathing trial (SBT), noninvasive ventilation (NIV) use], and associations between initial failed SBT and outcomes in 142 ICUs from 6 regions (Canada, India, United Kingdom, Europe, Australia/New Zealand, United States).

Results: We evaluated 788 (586 elderly; 202 very elderly) patients.

Variation in the practice of discontinuing mechanical ventilation in critically ill adults: study protocol for an international prospective observational study.

Introduction: Research supports the use of specific strategies to discontinue mechanical ventilation (MV) in critically ill patients. Little is known about how clinicians actually wean and discontinue MV in practice or the association between different discontinuation strategies and outcomes. The primary objective of this study is to describe international practices in the use of (1) daily screening for readiness to discontinue MV, (2) modes of MV used before initial discontinuation attempts, (3) weaning and spontaneous breathing trial (SBT) protocols, (4) SBT techniques and (5) sedation and mobilisation practices to facilitate weaning and discontinuation.

Analgesia-first sedation in critically ill adults: A U.S. pilot, randomized controlled trial.

Purpose: To determine the feasibility of conducting a multicenter ICU RCT of AFS compared to either protocol-directed sedation (PDS) or both PDS and daily sedation interruption (DSI) in North America.

Materials And Methods: This single-center RCT compared AFS [fentanyl (bolus ± infusions) to reach CPOT ≤2; if RASS ≥1, CPOT ≤2 and additional fentanyl failed to reach RASS goal (-2 to 0), low-dose propofol (up to 6 h) was given] with either PDS or both PDS and DSI daily in adults mechanically ventilated (MV) ≥48 h. Relevant feasibility, safety, and clinical outcomes were defined and evaluated.

International Practice Variation in Weaning Critically Ill Adults from Invasive Mechanical Ventilation.

Rationale: Randomized trials and meta-analyses have informed several aspects of weaning. Results are rarely replicated in practice, as evidence is applied in intensive care units that differ from the settings in which it was generated.

Objectives: We aimed to: 1) describe weaning practice variation (identifying weaning candidates, conducting spontaneous breathing trials, using ventilator modes, and other aspects of care during weaning); 2) characterize regional differences in weaning practices; and 3) identify factors associated with practice variation.

Liberation From Mechanical Ventilation in Critically Ill Adults: An Official American College of Chest Physicians/American Thoracic Society Clinical Practice Guideline: Inspiratory Pressure Augmentation During Spontaneous Breathing Trials, Protocols Minimizing Sedation, and Noninvasive Ventilation Immediately After Extubation.

Background: An update of evidence-based guidelines concerning liberation from mechanical ventilation is needed as new evidence has become available. The American College of Chest Physicians (CHEST) and the American Thoracic Society (ATS) have collaborated to provide recommendations to clinicians concerning liberation from the ventilator.

Methods: Comprehensive evidence syntheses, including meta-analyses, were performed to summarize all available evidence relevant to the guideline panel's questions.

Liberation From Mechanical Ventilation in Critically Ill Adults: Executive Summary of an Official American College of Chest Physicians/American Thoracic Society Clinical Practice Guideline.

Background: This clinical practice guideline addresses six questions related to liberation from mechanical ventilation in critically ill adults. It is the result of a collaborative effort between the American Thoracic Society (ATS) and the American College of Chest Physicians (CHEST).

Methods: A multidisciplinary panel posed six clinical questions in a population, intervention, comparator, outcomes (PICO) format.

Official Executive Summary of an American Thoracic Society/American College of Chest Physicians Clinical Practice Guideline: Liberation from Mechanical Ventilation in Critically Ill Adults.

Background: This clinical practice guideline addresses six questions related to liberation from mechanical ventilation in critically ill adults. It is the result of a collaborative effort between the American Thoracic Society and the American College of Chest Physicians.

Methods: A multidisciplinary panel posed six clinical questions in a Population, Intervention, Comparator, and Outcomes format.

An Official American Thoracic Society/American College of Chest Physicians Clinical Practice Guideline: Liberation from Mechanical Ventilation in Critically Ill Adults. Rehabilitation Protocols, Ventilator Liberation Protocols, and Cuff Leak Tests.

Background: Interventions that lead to earlier liberation from mechanical ventilation can improve patient outcomes. This guideline, a collaborative effort between the American Thoracic Society and the American College of Chest Physicians, provides evidence-based recommendations to optimize liberation from mechanical ventilation in critically ill adults.

Methods: Two methodologists performed evidence syntheses to summarize available evidence relevant to key questions about liberation from mechanical ventilation.

How we launched a developmental student-as-teacher (SAT) program for all medical students.

Introduction: Teaching is a necessary skill for medical trainees and physicians. We designed and launched a developmental Student-as-Teacher program for all students, beginning with the class of 2016.

Methods: A task force of faculty and students designed the program.

Efficiency is not enough; you have to prove that you care: role modelling of compassionate care in an innovative resident-as-teacher initiative.

Introduction: The current emphasis on providing holistic competent and efficient healthcare has revealed a need to nurture providers' compassionate and relationship-centred care throughout the continuum of medical education.

Methods: Our resident-as-teacher programme trained 41 residents from core clerkships at six clinical sites in the United States of America (USA) to teach and practice compassionate care through role-modelling. The programme focused on resident's demonstrations or failures to demonstrate compassionate care with peers, students and healthcare providers, and engaged residents in disseminating their experience to their colleagues.

Characterizing the learning curve of the VBLaST-PT(©) (Virtual Basic Laparoscopic Skill Trainer).

Background: Mastering laparoscopic surgical skills requires considerable time and effort. The Virtual Basic Laparoscopic Skill Trainer (VBLaST-PT(©)) is being developed as a computerized version of the peg transfer task of the Fundamentals of Laparoscopic Surgery (FLS) system using virtual reality technology. We assessed the learning curve of trainees on the VBLaST-PT(©) using the cumulative summation (CUSUM) method and compared them with those on the FLS to establish convergent validity for the VBLaST-PT(©).

Effect of educational interventions and medical school policies on medical students' attitudes toward pharmaceutical marketing practices: a multi-institutional study.

Purpose: To determine the effect of educational interventions on medical students' attitudes toward pharmaceutical industry marketing practices and whether restrictive medical school policies governing medicine-industry interactions are associated with student support for banning such interactions.

Method: Prospective cohort study involving the graduating classes of 2009 (intervention, n=474) and 2010 (control, n=459) at four U.S.

Characteristics and outcomes of ventilated patients according to time to liberation from mechanical ventilation.

Rationale: A new classification of patients based on the duration of liberation of mechanical ventilation has been proposed.

Objectives: To analyze outcomes based on the new weaning classification in a cohort of mechanically ventilated patients.

Methods: Secondary analysis included 2,714 patients who were weaned and underwent scheduled extubation from a cohort of 4,968 adult patients mechanically ventilated for more than 12 hours.

How often does patient-ventilator asynchrony occur and what are the consequences?

Mechanical ventilation can be life-saving for patients with acute respiratory failure. In between the 2 extremes of complete and no ventilatory support, both patient and machine contribute to ventilatory work. Ideally, ventilator gas delivery would perfectly match patient demand.

Lessons learned from the introduction of personalized genotyping into a medical school curriculum.

Purpose: There is an expanding gap between the availability of direct-to-consumer whole genome testing and physician knowledge regarding interpretation of test results. Advances in the genomic literacy of health care providers will be necessary for genomics to exert its potential to affect clinical practice. However, implementation of a major shift in medical education to include genomics is not easily done.

Using decentralized medical education to address the workforce needs of a rural state: a partnership between Maine Medical Center and Tufts University school of medicine.

Context: In February 2008, a new partnership between Maine Medical Center and Tufts University School of Medicine was formed to create a model medical school program.

Issue: Major forces for change included: the increasing physician workforce needs of Maine, the need to increase access for medical education for Maine students, the opportunity for educational innovation, the societal imperative to increase the number of primary care physicians, and the desire for clinical and research collaborations.

Lessons Learned: The authors describe the process for exploring this partnership, and establishing a separate track and campus for 36 students per year.

Predictors for daily interruption of sedation therapy by nurses: a prospective, multicenter study.

Purpose: The aim of the study was to identify the nurse and patient-related factors predicting daily interruption of sedation (DIS) performance by nurses in the intensive care unit (ICU).

Methods: Nurses, caring for a mechanically ventilated patient receiving 24 hours or more of a continuously infused sedative, were interviewed at the bedside to determine their willingness to perform DIS on this patient and to determine the influence of 20 nurse- and 47 patient-related factors on DIS completion.

Results: The 57 (44%) of 130 of nurses willing to perform DIS had performed DIS at least once in the past (P < .

Can we identify patients at high risk for unplanned extubation? A large-scale multidisciplinary survey.

Background: Unplanned extubation represents a threat to patient safety, and risk factors and prevention strategies for unplanned extubation have not been fully explored.

Objectives: To define high-risk patients for unplanned extubation and determine clinicians' beliefs on perceived risks for unplanned extubation

Methods: With a Web-based survey instrument we surveyed critical care clinician members of the American Association for Respiratory Care, the American Association of Critical Care Nurses, and the Society of Critical Care Medicine.

Results: Surveys were completed by 1,976 clinicians, including 419 respiratory therapists, 870 critical care nurses, and 605 critical care physicians.