Real-time automated paging and decision support for critical laboratory abnormalities.

Background: For patients with critical laboratory abnormalities, timely clinical alerts with decision support could improve management and reduce adverse events.

Methods: The authors developed a real-time clinical alerting system for critical laboratory abnormalities. The system sent alerts to physicians as text messages to a smartphone or alphanumeric pager.

Real-time clinical alerting: effect of an automated paging system on response time to critical laboratory values--a randomised controlled trial.

Background: Timely and reliable communication of critical laboratory values is a Joint Commission National Patient Safety Goal. The objective was to evaluate the effect of an automated system for paging critical values directly to the responsible physician.

Methods: A randomised controlled trial on the general medicine clinical teaching units at an urban academic hospital was conducted from February to May 2006; the unit of randomisation was the critical laboratory value.

Sepsis-induced myocardial depression is associated with transcriptional changes in energy metabolism and contractile related genes: a physiological and gene expression-based approach.

Background: Increased nitric oxide production and altered mitochondrial function have been implicated in sepsis-induced cardiac dysfunction. The molecular mechanisms underlying myocardial depression in sepsis and the contribution of nitric oxide in this process however, are incompletely understood.

Objectives: To assess the transcriptional profile associated with sepsis-induced myocardial depression in a clinically relevant mouse model, and specifically test the hypothesis that critical transcriptional changes are inducible nitric oxide synthase-dependent.

The intensive care unit work environment: current challenges and recommendations for the future.

Unlabelled: The need for critical care services has grown substantially in the last decade in most of the G8 nations. This increasing demand has accentuated an already existing shortage of trained critical care professionals. Recent studies argue that difficulty in recruiting an appropriate workforce relates to a shortage of graduating professionals and unhealthy work environments in which critical care professionals must work.

Critical care services in Ontario: a survey-based assessment of current and future resource needs.

Purpose: In response to the challenges of an aging population and decreasing workforce, the provision of critical care services has been a target for quality and efficiency improvement efforts. Reliable data on available critical care resources is a necessary first step in informing these efforts. We sought to describe the availability of critical care resources, forecast the future requirement for the highest-level critical care beds and to determine the physician management models in critical care units in Ontario, Canada.

Intensive care outcomes in bone marrow transplant recipients: a population-based cohort analysis.

Introduction: Intensive care unit (ICU) admission for bone marrow transplant recipients immediately following transplantation is an ominous event, yet the survival of these patients with subsequent ICU admissions is unknown. Our objective was to determine the long-term outcome of bone marrow transplant recipients admitted to an ICU during subsequent hospitalizations.

Methods: We conducted a population-based cohort analysis of all adult bone marrow transplant recipients who received subsequent ICU care in Ontario, Canada from 1 January 1992 to 31 March 2002.

Computerised tomography for the detection of pulmonary emboli in intensive care patients--a retrospective cohort study.

Pulmonary emboli are frequently considered as a cause for respiratory deterioration in intensive care unit (ICU) patients, however empirical observation suggests that computerised tomographic (CT) angiography is infrequently positive after the first 24 hours. This study aimed to determine the rate and risk factors for detection of pulmonary emboli by CT angiography in ICU patients. All patients undergoing CT angiography > 24 hours after ICU admission for respiratory deterioration from April 2000 until January 2004 were included.

Development of medical checklists for improved quality of patient care.

Background: Checklists are used in both medical and non-medical industries as cognitive aids to guide users through accurate task completion. Their development requires a systematic and comprehensive approach, particularly when implemented in high intensity fields such as medicine.

Objective: A narrative review of the literature was conducted to outline the methodology to designing and implementing clear and effective medical checklists.

Legislative barriers to outpatient e-prescribing in a randomized trial.

Newer outpatient electronic prescribing software programs produce typewritten paper prescriptions with electronically created signatures. Current Canadian federal legislation forbids static (unchanging) signature images on prescriptions. We conducted a randomized trial of electronic prescribing in outpatients at a university-affiliated hospital.

Sex-and age-based differences in the delivery and outcomes of critical care.

Background: Previous studies have suggested that a patient's sex may influence the provision and outcomes of critical care. Our objective was to determine whether sex and age are associated with differences in admission practices, processes of care and clinical outcomes for critically ill patients.

Methods: We used a retrospective cohort of 466,792 patients, including 24,778 critically ill patients, admitted consecutively to adult hospitals in Ontario between Jan.

Knowledge translation in critical care: factors associated with prescription of commonly recommended best practices for critically ill patients.

Objective: To describe prescription rates of commonly recommended best practices (clinical interventions with a strong base of evidence supporting their implementation) for critically ill patients and determine factors associated with increased rates of prescription.

Design: A retrospective observational study.

Setting: A university-affiliated medical-surgical-trauma intensive care unit over a 1-yr period.

Prioritizing the organization and management of intensive care services in the United States: the PrOMIS Conference.

Objective: Adult critical care services are a large, expensive part of U.S. health care.

Risk factors associated with resistance to ciprofloxacin in clinical bacterial isolates from intensive care unit patients.

Objective: To determine risk factors and outcomes associated with ciprofloxacin resistance in clinical bacterial isolates from intensive care unit (ICU) patients.

Design: Prospective cohort study.

Setting: Twenty-bed medical-surgical ICU in a Canadian tertiary care teaching hospital.

Hospital volume and mortality for mechanical ventilation of medical and surgical patients: a population-based analysis using administrative data.

Objective: In an effort to improve efficiency and quality of care, regionalization of adult critical care services, similar to trauma and neonatal intensive care, has been suggested. However, there is little research to understand if hospitals with higher patient volumes have better outcomes. Our objective is to determine whether hospital volume is associated with improved survival for medical or surgical patients receiving mechanical ventilation.

Pulmonary artery catheters for adult patients in intensive care.

Background: Pulmonary artery catheterization was adopted about 30 years ago and widely disseminated without rigorous evaluation as to whether it benefited critically ill patients. The technique is used to measure cardiac output and pressures in the pulmonary circulation to guide diagnosis and treatment. Clinicians believe these data can improve patients' outcomes, even in the absence of consensus about the specific interpretation of the data.

Intensive care and emergency medicine: progress over the past 25 years.

Over the last quarter of a century, intensive care medicine has developed into an established hospital specialty with its own unique identity and characteristics. Significant advances have occurred, mostly in a succession of small steps rather than any dramatic leap, with many being linked to advances in health care across other disciplines. In addition, many changes have resulted from the scientific identification of the detrimental effects of certain traditional practices once thought to be therapeutic.

Differential inducible nitric oxide synthase activity in circulating neutrophils vs. mononuclears of septic shock patients.

Objective: To compare nitric oxide synthase (NOS) activity in circulating neutrophils and mononuclear cells of patients with septic shock to healthy subjects.

Design And Setting: Prospective study in the general intensive care unit (30 beds) of a university affiliated-hospital and the A.C.

Projected incidence of mechanical ventilation in Ontario to 2026: Preparing for the aging baby boomers.

Objective: The aging baby boomers are expected to have a significant impact on the healthcare system. Mechanical ventilation is an age-dependent, costly, and relatively nondiscretionary medical service that may be particularly affected by the aging population. We forecast the future incidence of mechanical ventilation to the year 2026 to understand the impact of aging baby boomers on critical care resources.

Shockingly complex: the difficult road to introducing new ideas to critical care.

Resuscitation of critically ill patients with trauma or sepsis continues to challenge clinicians. Early imperatives include diagnostic judgment as to the presenting problem - sepsis or trauma. Subsequently, the clinician decides on the phase of resuscitation required for support - 'ebb' versus 'flow'.

Mechanical ventilation in Ontario, 1992-2000: incidence, survival, and hospital bed utilization of noncardiac surgery adult patients.

Objective: Mechanical ventilation is a common therapy used in caring for critically ill patients, but its epidemiology is poorly understood. We describe population-based, temporal trends in the incidence, survival, and hospital bed utilization of mechanically ventilated, noncardiac surgery adult patients.

Design: Retrospective, observational cohort study using linked administrative databases.

Pseudomonas pneumonia-mediated sepsis induces expression of pancreatitis-associated protein-I in rat pancreas.

Severe impairment of exocrine pancreatic secretion has recently been demonstrated in a clinical study in sepsis and septic shock patients. The purpose of this study was to further evaluate involvement of the pancreas in the acute phase reaction in sepsis. Using a normotensive rat model of Pseudomonas pneumonia-induced sepsis, we assessed the expression of PAP-I, amylase and trypsinogen mRNA, PAPI protein levels, and cytokine expression in the pancreas by Northern and Western blot analysis and RT-M PCR, respectively.

Tissue oxygen delivery and the microcirculation.

In health, acute anemia is accompanied by changes in the distribution of blood flows at all of the central, regional, and microcirculatory levels. This redistribution in blood flows provides the capacity to maintain tissue oxygenation with hematocrit as low as 21%. What is not known with certainty is whether the capacity to maintain tissue oxygenation in the presence of acute anemia can be influenced significantly by concurrent disease such as sepsis and cardiac disease.

Transmission of severe acute respiratory syndrome during intubation and mechanical ventilation.

Nosocomial transmission of severe acute respiratory syndrome from critically ill patients to healthcare workers has been a prominent and worrisome feature of existing outbreaks. We have observed a greater risk of developing severe acute respiratory syndrome for physicians and nurses performing endotracheal intubation (relative risk [RR], 13.29; 95% confidence interval [CI], 2.