The Rhode Island ICU collaborative: a model for reducing central line-associated bloodstream infection and ventilator-associated pneumonia statewide.

Background: Implementing bundles of best practices has been shown to provide patients with recommended care and reduce medical errors. Rhode Island's (RI) hospital leaders, quality organisations and insurers discussed the results of a quality improvement initiative in Michigan, the Keystone project, and explored the possibility of replicating these results statewide in RI.

Design: Hospital executives and intensive care unit (ICU) staff, RI's quality organisations, RI Quality Institute, Quality Partners of RI, and Hospital Association of RI and consultants from Johns Hopkins University, worked together to implement evidence-based interventions and change safety culture in RI's ICUs.

Lactic acidosis. Lactic acidosis associated with metformin use in treatment of type 2 diabetes mellitus.

Metformin, an antihyperglycemic, is widely used in the treatment of type 2 diabetes mellitus (DM). A rare, but important complication associated with this drug is the development of lactic acidosis: Overall mortality of lactic acidosis is approximately 50%. Certain subsets of patients taking metformin are at greater risk of developing lactic acidosis.

Respiratory muscle evaluation of the patient with neuromuscular disease.

This review presents clinically relevant issues regarding the assessment of respiratory muscles in individuals with neuromuscular disorders, and discusses the advantages and disadvantages of methods generally available to the clinician. Vital capacity (VC) and total lung capacity (TLC) are routinely measured in pulmonary function laboratories and are typically reduced in the context of severe respiratory muscle weakness, but the sensitivity and specificity of these measures are limited. Better measures of respiratory muscle weakness are maximal static inspiratory and expiratory pressures (PI max and PE max).

Intensive care in patients with HIV infection in the era of highly active antiretroviral therapy.

Study Objectives: The use of highly active antiretroviral therapy (HAART) has dramatically improved morbidity and mortality in patients with HIV infection. The types of critical illness and their outcomes in HIV-infected patients in recent years is unknown.

Design: We reviewed the medical records of all patients admitted to the Medical ICU of Beth Israel Medical Center, NY, from January to June 2001 and compared their characteristics with patients admitted to the same unit from November 1991 to October 1992.

Respiratory muscle strength training with nonrespiratory maneuvers.

The diaphragm and abdominal muscles can be recruited during nonrespiratory maneuvers. With these maneuvers, transdiaphragmatic pressures are elevated to levels that could potentially provide a strength-training stimulus. To determine whether repeated forceful nonrespiratory maneuvers strengthen the diaphragm, four healthy subjects performed sit-ups and biceps curls 3-4 days/wk for 16 wk and four subjects served as controls.

Do-not-resuscitate and stratification-of-care forms in Rhode Island.

Congress passed the Patient Self-Determination Act of 1990 to ensure that patients are informed of their rights to express healthcare preferences in advance of loss of capacity. Thus, a patient may elect to forgo cardiopulmonary resuscitation in favor of a treatment approach that favors comfort over survival. Do-not-resuscitate and stratification-of-care forms provide a means for expression of healthcare preferences in hospitals.