Sensitivity and Specificity of the Yale Swallow Protocol in Recently Extubated Patients.

Purpose: The purpose of this study was to determine the sensitivity and specificity of the Yale Swallow Protocol (YSP) in detecting aspiration in recently extubated patients.

Method: One hundred fifty-four participants referred for swallowing evaluation underwent the YSP and fiberoptic endoscopic evaluation of swallowing (FEES) in random order within 48 hr of extubation. The YSP included orientation questions, an oral motor exam, and a 3-oz water swallow test.

Case report: isolation of from septic blood culture following near-death drowning in lakewater.

A patient suffered a non-fatal wet drowning in a freshwater lake and developed bacteraemia several days later. Blood culture grew a Gram-negative rod that could not be identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). 16S ribosomal RNA sequencing of the isolate identified the microbe as - an environmental microbe commonly found in freshwater.

The Critical Care Nurse Communicator Program: An Integrated Primary Palliative Care Intervention.

Twenty percent of Americans die in an intensive care unit (ICU), often incapacitated or requiring assisted decision making. Surrogates are often required to make urgent, complex, high-stakes decisions. Communication among patients, families, and clinicians is often delayed and inefficient with frequent missed opportunities to support the emotional and psychological needs of surrogates, particularly at the end of life.

Association Between Sepsis and Microvascular Brain Injury.

Objectives: Many survivors of sepsis suffer long-term cognitive impairment, but the mechanisms of this association remain unknown. The objective of this study was to determine whether sepsis is associated with cerebral microinfarcts on brain autopsy.

Design: Retrospective cohort study.

Factors Nurses in the Intensive Care Unit Consider When Making Decisions About Patient Mobility.

Background: Early mobility interventions in the intensive care unit can improve patients' outcomes, yet they are not routinely implemented in many intensive care units. In an effort to identify opportunities to implement and sustain evidence-based practice, prior work has demonstrated that understanding the decision-making process of health professionals is critical for identifying opportunities to improve program implementation. Nurses are often responsible for mobilizing patients, but how they overcome barriers and make decisions to mobilize patients in the intensive care unit is not understood.

Association Between Postextubation Dysphagia and Long-Term Mortality Among Critically Ill Older Adults.

Background: Dysphagia following extubation is common in intensive care unit (ICU) patients. Diagnosing postextubation dysphagia allows identification of patients who are at highest risk for aspiration and its associated adverse outcomes. Older adults are at an increased risk of postextubation dysphagia and its complications due to multiple comorbidities, a higher baseline risk of dysphagia, and increased risk of pneumonia.

Post-extubation Dysphagia: Does Timing of Evaluation Matter?

Swallowing evaluations are often delayed at least 24 h following extubation with the assumption that swallow function improves over time. The purpose of this prospective cohort study was to determine if dysphagia, as measured by aspiration and need for diet modification, declines over the first 24-h post-extubation, whereby providing evidence-based evaluation guidelines for this population. Forty-nine patients completed FEES at 2-4 h post-extubation and 24-26 h post-extubation.

Sepsis Survivors Admitted to Skilled Nursing Facilities: Cognitive Impairment, Activities of Daily Living Dependence, and Survival.

Objective: Severe sepsis survivors frequently experience cognitive and physical functional impairment. The degree of impairment and its association with mortality is understudied, particularly among those discharged to a skilled nursing facility. Our objective was to quantify the cognitive and physical impairment among severe sepsis survivors discharged to a skilled nursing facility and to investigate the relationship between impairment and long-term mortality.

Manifestations of HIV stigma and their impact on retention in care for people transitioning from prisons to communities.

Background: While most people living with HIV who are incarcerated in United States receive appropriate HIV care while they are in prison, interruptions in antiretroviral therapy and virologic failure are extremely common after they are released. The purpose of this study was to describe whether and how HIV stigma influences continuity of care for people living with HIV while they transition from prison to community settings.

Methods: We conducted semi-structured, telephone-based interviews with 32 adults who received HIV care while residing in a Wisconsin state prison, followed by a second interview 6 months after they returned to their home community.

Using database linkages to monitor the continuum of care for hepatitis C virus among syringe exchange clients: Experience from a pilot intervention.

Background: Because many people who inject drugs (PWID) are at high risk of hepatitis C virus (HCV) and have poor access to medical care, many HCV-infected PWID remain undiagnosed and unaccounted for in surveillance systems. Syringe exchange programs (SEPs) are an under-utilized resource for collecting information missing from surveillance systems. Partnerships with public health agencies represent a potentially innovative approach to studying the HCV epidemic for PWID.

Emergency Department Patients' Perceptions of Radiation From Medical Imaging.

Objective: To evaluate emergency department patients' knowledge of radiation exposure and subsequent risks from computed tomography (CT) and magnetic resonance imaging (MRI) scans.

Methods: This is a cross-sectional survey study of adult, English-speaking patients from June to August 2011 at 2 emergency departments--1 academic and 1 community-based--in the upper Midwest. The survey consisted of 2 sets of 3 questions evaluating patients' knowledge of radiation exposure from medical imaging and subsequent radiation-induced malignancies and was based on a previously published survey.

Trends in the Use of Medical Imaging to Diagnose Appendicitis at an Academic Medical Center.

Objective: To quantify the trends in imaging use for the diagnosis of appendicitis.

Methods: A retrospective study covering a 22-year period was conducted at an academic medical center. Patients were identified by International Classification of Diseases-9 diagnosis code for appendicitis.

Prospective evaluation of the ability of clinical scoring systems and physician-determined likelihood of appendicitis to obviate the need for CT.

Objective: To determine whether clinical scoring systems or physician gestalt can obviate the need for computed tomography (CT) in patients with possible appendicitis.

Methods: Prospective, observational study of patients with abdominal pain at an academic emergency department (ED) from February 2012 to February 2014. Patients over 11 years old who had a CT ordered for possible appendicitis were eligible.

Trajectories and Prognosis of Older Patients Who Have Prolonged Mechanical Ventilation After High-Risk Surgery.

Objectives: Surgical patients often receive routine postoperative mechanical ventilation with excellent outcomes. However, older patients who receive prolonged mechanical ventilation may have a significantly different long-term trajectory not fully captured in 30-day postoperative metrics. The objective of this study is to describe patterns of mortality and hospitalization for Medicare beneficiaries 66 years old and older who have major surgery with and without prolonged mechanical ventilation.

Systematic review and meta-analysis of the accuracy of MRI to diagnose appendicitis in the general population.

Purpose: To perform a systematic review and meta-analysis of all published studies since 2005 that evaluate the accuracy of magnetic resonance imaging (MRI) for the diagnosis of acute appendicitis in the general population presenting to emergency departments.

Materials And Methods: All retrospective and prospective studies evaluating the accuracy of MRI to diagnose appendicitis published in English and listed in PubMed, Web of Science, Cinahl Plus, and the Cochrane Library since 2005 were included. Excluded studies were those without an explicitly stated reference standard, with insufficient data to calculate the study outcomes, or if the population enrolled was limited to pregnant women or children.

Physical Function and Disability After Acute Care and Critical Illness Hospitalizations in a Prospective Cohort of Older Adults.

Objectives: To investigate associations between acute care and critical illness hospitalizations and performance on physical functional measures and activities of daily living (ADLs).

Design: Prospective cohort study.

Setting: Large health maintenance organization.

Considering age when making treatment decisions in the ICU: too little, too much, or just right?

There are a number of studies providing evidence that age is associated with treatment decisions for critically ill adults, although most of these studies have been unable to fully account for both prehospital health status and severity of acute illness. In the previous issue of Critical Care, Turnbull and colleagues present a well-executed study analyzing data from a prospective cohort study of critically ill patients with acute respiratory distress syndrome to investigate the association between age and new limitations in life-sustaining therapy. They report a strong association between age and new limitations in life support in this cohort, even after adjusting for comorbidities, prehospital functional status, and severity of illness including daily organ dysfunction scores.

An official American Thoracic Society policy statement: managing conscientious objections in intensive care medicine.

Rationale: Intensive care unit (ICU) clinicians sometimes have a conscientious objection (CO) to providing or disclosing information about a legal, professionally accepted, and otherwise available medical service. There is little guidance about how to manage COs in ICUs.

Objectives: To provide clinicians, hospital administrators, and policymakers with recommendations for managing COs in the critical care setting.

The influence of hospitalization or intensive care unit admission on declines in health-related quality of life.

Rationale: Survivors of critical illness report impaired health-related quality of life (HRQoL) after hospital discharge, but the degree to which these impairments are attributable to critical illness is unknown.

Objectives: We sought to examine changes in HRQoL associated with an intensive care unit (ICU) stay and the differential association of type of hospitalization (critical illness versus noncritical illness) on changes in HRQoL.

Methods: We identified 11,243 participants in the Ambulatory Care Quality Improvement Project (a multicenter randomized trial of Veterans conducted March 1997 to August 2000) completing at least two Medical Outcomes Study Short-Form 36 questionnaires over 2 years, and categorized patients by hospitalization status during the interval between measures.

Neighborhood socioeconomic disadvantage and 30-day rehospitalization: a retrospective cohort study.

Background: Measures of socioeconomic disadvantage may enable improved targeting of programs to prevent rehospitalizations, but obtaining such information directly from patients can be difficult. Measures of U.S.

Long-term outcomes after in-hospital CPR in older adults with chronic illness.

Background: Outcomes after in-hospital CPR in older adults with chronic illness are unclear.

Methods: We examined inpatient Medicare data from 1994 through 2005 to identify CPR recipients. We grouped beneficiaries aged ≥ 67 years by severity of six chronic diseases-COPD, congestive heart failure (CHF), chronic kidney disease (CKD), malignancy, diabetes, and cirrhosis-and investigated survival to discharge, discharge destination, rehospitalizations, and long-term survival.