2,833 publications from this institution
The study provides consensus on a list of core competencies in critical care that non-intensivist medical practitioners managing critically ill patients in healthcare settings in South Africa, especially where intensivists are not readily available, should have. The list can form the core content of training programmes aimed at improving critical care competence of general medical practitioners, and in this way hopefully improve the overall outcomes of critically ill patients in South Africa.
Background: Severe sepsis is defined as sepsis plus organ dysfunction. There is a need to quantify this dysfunction, and several scoring systems have been developed. Method: Review of the pertinent English-language literature. Results: Early scoring of organ failure simply counted the number of failing organs, but the degree of dysfunction is an important variable. The first system to grade dysfunction was the multiple organ dysfunction score (MODS). The drawback of MODS is the variable used to quantify cardiovascular failure. To alleviate this limitation, the Brussels score was developed. However, it, too, was suboptimal and was replaced by the sequential or sepsis-related organ failure assessment (SOFA) score. There is a clear correlation between the total SOFA score and the mortality rate, and in certain studies, the total SOFA score was at least as good as traditional methods of predicting death. A key advantage of these simple scores is that they can be repeated to follow the course of organ dysfunction. The evolution of the SOFA score has been used to demonstrate the effects of various therapeutic interventions. Conclusion: Quantifying organ dysfunction in patients with sepsis can assist in assessing prognosis and determining treatment effectiveness. The simplicity, reliability, and reproducibility of current scores facilitate their widespread use.
There has been considerable development in the field of noninvasive hemodynamic monitoring in recent years. Multiple devices have been proposed to assess blood pressure, cardiac output, and tissue perfusion. All have their own advantages and disadvantages and selection should be based on individual patient requirements and disease severity and adjusted according to ongoing patient evolution.
The learning healthcare system describes a vision of US healthcare that capitalizes on science, information technology, incentives, and care culture to drive improvements in the quality of health care. The inpatient setting, one of the most costly and impactful domains of healthcare, is an ideal setting in which to use data and information technology to foster continuous learning and quality improvement. The rapid digitization of inpatient medicine offers incredible new opportunities to use data from routine care to generate new discovery and thus close the virtuous cycle of learning. We use an object lesson-sepsis care within the 21 hospitals of the Kaiser Permanente Northern California integrated healthcare delivery system-to offer insight into the critical elements necessary for developing a learning hospital system. We then describe how a hospital-wide data-driven approach to inpatient care can facilitate improvements in the quality of hospital care. Journal of Hospital Medicine 2016;11:S11-S17. © 2016 Society of Hospital Medicine.
info:eu-repo/semantics/published
info:eu-repo/semantics/published
The current coronavirus pandemic has impacted heavily on ICUs worldwide. Although many hospitals and healthcare systems had plans in place to manage multiple casualties as a result of major natural disasters or accidents, there was insufficient preparation for the sudden, massive influx of severely ill patients with COVID-19. As a result, systems and staff were placed under immense pressure as everyone tried to optimize patient management. As the pandemic continues, we must apply what we have learned about our response, both good and bad, to improve organization and thus patient care in the future.
