Citation classics in critical care medicine

Objective: The number of citations an article receives after its publication reflects its impact on the scientific community. Our purpose was to identify and examine the characteristics of the most frequently cited articles in the field of critical care medicine. Design: The 74 top-cited articles in critical care journals were identified by a computer search using the database of the Science Citation Index Expanded (SCI-EXPANDED, 1945 to present) and the Web of SCIENCE. The 45 top-cited critical care articles in all other biomedical journals were identified using the database SciSearch (1974 to present) with the key word "Critical Care”. Results: The most cited articles received 3402 and 2860 citations, respectively. The citation classics in critical care journals were published between 1968 and 1999 in six high-impact journals, led by Critical Care Medicine (37 articles), followed by the Journal of Trauma (21), and American Journal of Respiratory and Critical Care Medicine (9). Seventy articles were original publications, two were reviews or guidelines, and two were editorials. The top 45 classic articles in non-critical care journals were published in 13 different journals, led by the New England Journal of Medicine (11 articles), followed by JAMA and Lancet (6 articles each). The United States of America contributed most of the classic articles. Pathophysiology of the lung, sepsis and scoring systems were the primary focus of classic publications. Conclusions: Our analysis gives a historical perspective on the scientific progress of critical care medicine and allows for recognition of important advances in this specialt

"It isn't just consultants that need a BSc": student experiences of an Intercalated BSc

More medical schools are moving towards a compulsory intercalated BSc. These courses have not traditionally been aimed at those students interested in general practice and have tended to have limited clinical relevance. This paper explores the perceptions of students who undertook a BSc in primary health care using qualitative methodology comprising semi-structured interviews with students just before completion of their course. Interviews were undertaken with 24 of the 26 students who started the course over a 4-year period. All the students have finished the course and have graduated with good honours degrees. Students refine existing skills and develop new, relevant skills for medicine. The students discussed the prestige (or lack) of a BSc in this field and how the course has impacted on their career decisions. A Primary Health Care BSc such as this appears to give students an in depth and to some, a positive view of general practice and primary care. The course allowed students to develop a more critical approach to medicine and enabled them to develop skills in addition to those acquired from their undergraduate medicine course. They perceived that these skills will serve them throughout their career in whatever branch of medicine they choose

Teaching paediatric critical care medicine to paediatric residents

Critical care training during paediatric residency provides an ideal opportunity to learn and refine the skills needed in the early recognition and prompt treatment of the acutely ill paediatric patients. Paediatric critical care medicine is a relatively young sub-specialty in Pakistan. The aim of this study is to describe our experience of teaching paediatric residents in paediatric critical care medicine during paediatric intensive care unit rotation. Our paediatric critical care teaching curriculum for residents is based on the spectrum of our common critical care problems along with basic principal of critical care. The clinical rotation in our paediatric intensive care unit is very dynamic, thrilling, enjoyable and provides a lot of learning opportunities. During the rotation, the residents were exposed to all major critical care illnesses in infants and children. We use four traditional models of learning in our Paediatric Intensive Care Unit (PICU): bedside rounds, direct patient care, didactic learning and self-study. Our curriculum enhances the resident\u27s educational and clinical experience of paediatric intensive care medicine

Exercise rehabilitation for recovery from critical illness (Protocol)

Queen Margaret University, Edinburgh, UK. As part of an ongoing research education programme.This is the protocol for a review and there is no abstract. The objectives are as follows: The objective of this systematic review is to assess the effectiveness of exercise rehabilitation programmes, initiated after ICU discharge, on improving functional exercise capacity and quality of life in adult ICU survivors who have been mechanically ventilated for more than 24 hours. We will compare an exercise intervention to any other intervention or a control or 'usual care' programme. Exercise includes any structured or taught programmes. Respiratory or inspiratory muscle training is excluded due to it being initiated within the ICU environment, for example with weaning from a ventilator, and not as post-discharge rehabilitation as required for this review.sch_phyAngus 1997 Angus, DC. Understanding the incidence and long-term outcomes of ARDS. In: Gullo, A editor(s). Anaesthesia, pain, intensive care and emergency medicine: a scientific report. Berlin Heidelberg New York: Springer, 1997:289-98. Angus 2003 Angus DC, Carlet J, Brussels Roundtable 2002 Participants. Surviving intensive care: a report from the 2002 Brussels Roundtable. Intensive Care Medicine 2003;29(3):368-77. [PUBMED: 12536269 ] Baumgartner 1999 Baumgartner WA,Walinsky PL, Salazar JD, Tseng EE, Brock MV, Doty JR, et al.Assessing the impact of cerebral injury after cardiac surgery: will determining the mechanism reduce the injury?. The Annals of Thoracic Surgery 1999;67(6):1871-3. [PUBMED: 10391329] Brown 1990 Brown AB, McCartney N, Sale DG. Positive adaptation to weightlifting in the elderly. Journal of Applied Physiology 1990;69(5): 1725-33. [PUBMED: 2272965] Burtin 2009 Burtin C, Clerckx B, Robbeets C, Ferdinande P, Langer D, Troosters T, et al.Early exercise in critically ill patients enhances short-term functional recovery. Critical Care Medicine 2009;37(9): 2499-505. [PUBMED: 19623052] Chaboyer 2003 Chaboyer W, Grace J. Following the path of ICU survivors: a quality improvement activity. Nursing in Critical Care 2003;8(4): 149-55. [PUBMED: 12940690] Eddleston 2000 Eddleston J, White P, Guthrie E. Survival, morbidity, and quality of life after discharge from intensive care. Critical Care Medicine 2000; 28(7):2293-9. [PUBMED: 10921555] Elliott 2006 Elliott D, McKinley S, Alison J, Aitken L, King M. Study protocol: Home-based rehabilitation for survivors of a critical illness. Critical Care 2006;10(3):R90. [PUBMED: 16792792 ] Fiatarone 1994 Fiatarone MA, O'Neill EF, Ryan ND, Clements KM, Solares GR, Nelson ME, et al.Exercise training and nutritional supplementation for physical frailty in very elderly people. New England Journal of Medicine 1994;330(25):1769-75. [PUBMED: 8190152] Fletcher 2003 Fletcher S, Kennedy D, Ghosh I, Misra V, Kiff K, et al.Persistant neuromuscular and neurophysiological abnormalities in long-term survivors of prolonged critical illness. Critical Care Medicine 2003; 31(4):1012-6. [PUBMED: 12682465] Frank 2000 Frank M, Schlapfer H, Otte B, Yasikoff N, Conzelmann M. Results of neurorehabilitation. An outcome study 20 months after stroke. Praxis 2000;89(44):1799-808. [PUBMED: 11109917] Gill 2002 Gill TM, Baker DI, Gottschalk M, Peduzzi PN, Allore H, Byers A. A program to prevent functional decline in physically frail, elderly persons who live at home. New England Journal of Medicine 2002; 347(14):1068-74. [PUBMED: 12362007] Grimby 1986 Grimby G. Physical activity and muscle training in the elderly. Acta Medica Scandinavica. Supplementum. 1986;711:233-7. [PUBMED: 3535411] Guyatt 2008 Guyatt GH, Oxman AD, Kunz R, Vist GE, Falck-Ytter Y, Schunemann HJ, et al.What is quality of evidence- and why is it important to clinicians?. BMJ 2008;336:995-8. [PUBMED: 18456631] Higgins 2008 Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 [updated September 2008]. Available from www.cochrane-handbook.org: The Cochrane Collaboration, 2008. Iversen 2003 Iversen MD, Fossel AH, Katz JN. Enhancing function in older adults with chronic low back pain: a pilot study of endurance training. Archives of Physical Medicine and Rehabilitation 2003;84 (9):1324-31. [PUBMED: 13680569] Jolliffe 2001 Jolliffe J, Rees K, Taylor RRS, Thompson DR, Oldridge N, Ebrahim S. Exercise-based rehabilitation for coronary heart disease. Cochrane Database of Systematic Reviews 2001, Issue 1. [DOI: 10.1002/14651858.CD001800.] King 1998 King J, Crowe J. Mobilisation practices in Canadian critical care units. Physiotherapy Canada 1998;50(3):206-11. [MEDLINE: 0346574] Kouidi 2002 Kouidi E. Exercise training in dialysis patients: why, when, and how?. Artificial Organs 2002;26(12):1009-13. [PUBMED: 12460377] Krishnan 2002 Krishnan KR, Delong M, Kraemer H, Carney R, Spiegel D, Gordon C, et al.Comorbidity of depression with other medical diseases in the elderly. Biological Psychiatry 2002;52(6):559-88. [PUBMED: 12361669] Lavie 2009 Lavie CJ, Thomas RJ, Squires RW, Allison TG, Milani RV. Exercise training and cardiac rehabilitation in primary and secondary prevention of coronary heart disease. Mayo Clinic Proceedings 2009; 84(4):373-83. [PUBMED: 19339657] Lewis 2003 Lewis M. Intensive care unit rehabilitation within the United Kingdom: a review. Physiotherapy 2003;89(9):531-8. [DOI: 10.1016/S0031-9406(05)60179-4] Martin 2005 Martin M, Salim A, Murray J, Demetriades D, Belzberg H, Rhee P. The decreasing incidence and mortality of acute respiratory distress syndrome after injury: a 5-year observational study. Journal of Trauma 2005;50(5):1107-13. [PUBMED: 16385287] Mazzeo 2001 Mazzeo RS, Tanaka H. Exercise prescription for the elderly: current recommendations. Sports Medicine 2001;31(11):809-18. [PUBMED: 11583105] Miller 2002 Miller MD, Crotty M, Giles LC, Bannerman E, Whitehead C, Cobiac L, et al.Corrected arm muscle area: an independent predictor of long-term mortality in community dwelling older adults?. Journal of the America Geriatrics Society 2002;50(7): 1272-7. [PUBMED: 12133024] Paffenbarger 1986 Paffenbarger RS, Hyde RT, Wing AL, Hseih CC. Physical activity, all-cause mortality, and longevity of college alumni. New England Journal of Medicine 1986;314(10):605-13. [PUBMED: 3945246] Puhan 2006 Puhan MA, Busching G, Schunemann HJ, VanOort E, Zaugg C, Frey M. Interval versus continuous high-intensity exercise in chronic obstructive pulmonary disease: a randomized trial. Annals of Internal Medicine 2006;145(11):816-25. [PUBMED: 17146066] Rantanen 2000 Rantanen T, Harris T, Leveille SG, Visser M, Foley D, et al.Muscle strength and body mass index as long-term predictors of mortality in initially healthy men. Journal of Gerontology. Series A: Biological Sciences and Medical Sciences 2000;55(3):M168-73. [PUBMED: 10795731] RevMan 5.0 The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). 5.0. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2008. Schweickert 2009 Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al.Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 2009;373(epub):1874-82. [PUBMED: 19446324] Smith 2006 Smith TP, Kennedy SL, Smith M, Orent S, Fleshner M. Physiological improvements and health benefits during an exercisebased comprehensive rehabilitation program in medically complex patients. Exercise Immunology Review 2006;12:86-96. [PUBMED: 17201074] Stiller 2000 Stiller K. Physiotherapy in intensive care: toward an evidence-based practice. Chest 2000;118(6):1801-13. [PUBMED: 11115476] Storch 2008 Storch EK, Kruszynski DM. From rehabilitation to optimal function: role of clinical exercise therapy. Current Opinion in Critcal Care 2008;14(4):451-5. [PUBMED: 18614911] Wiles 2009 Wiles L, Stiller K. Passive limb movements for patients in an intensive care unit: A survey of physiotherapy practice in Australia. Journal of Critical Care 2009;epub:ahead of print. [PUBMED: 19819105] Yoshida 1999 Yoshida T, Kohzuki M, Yoshida K, Hiwatari M, Kamimoto M, Yamamoto C, et al.Physical and psychological improvements after phase II cardiac rehabilitation in patients with myocardial infarction. Nursing & Health Sciences 1999;1(3):163-70. [PUBMED: 10894639] Indicates the major publication for the study8pub1756pubArt.

An Evaluation of Risk Attitudes and Risk Tolerance in Emergency Medicine Residents

An underlying issue to our current healthcare system is how decisions made in the emergency department affect patients. This is paramount for underserved populations, which are more likely to have poor physical and mental health, lack of primary care, greater use of health services, and be generally dissatisfied with their medical care.1,2 What should the emergency physician (EP) do for these patients? These decisions are largely based upon individual risk tolerance. While risk is a indelible part of emergency medicine (EM), a risk profile of EM residents has not been compiled. Knowledge of risk taking tendencies among this niche of medical professionals could be critical. If EM residents have great risk aversion, they might practice defensive medicine, thereby incurring crippling costs4. On the other hand, if emergency medicine residents are greatly risk tolerant, they may make decisions that lead to significant morbidity and mortality. It is essential to establish a baseline risk profile before any corrective measures can be advanced. This study attempted to accomplish precisely that using Risk Type CompassTM.https://jdc.jefferson.edu/cwicposters/1023/thumbnail.jp

Comparing the effectiveness of small-particle versus large-particle inhaled corticosteroid in COPD

Dirkje S Postma,1 Nicolas Roche,2 Gene Colice,3 Elliot Israel,4 Richard J Martin,5 Willem MC van Aalderen,6 Jonathan Grigg,7 Anne Burden,8 Elizabeth V Hillyer,8 Julie von Ziegenweidt,8 Gokul Gopalan,9 David Price8,10 1University of Groningen, Department of Pulmonary Medicine and Tuberculosis, University Medical Center Groningen, Groningen, the Netherlands; 2Respiratory and Intensive Care Medicine, Cochin Hospital Group, APHP, Paris-Descartes University (EA2511), Paris, France; 3Pulmonary, Critical Care and Respiratory Services, Washington Hospital Center and George Washington University School of Medicine, Washington DC, USA; 4Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; 5Department of Medicine, National Jewish Health, Denver, CO, USA; 6Dept of Pediatric Respiratory Medicine and Allergy, Emma Children's Hospital AMC, Amsterdam, the Netherlands; 7Blizard Institute, Queen Mary University London, London, UK; 8Research in Real Life, Ltd, Cambridge, UK; 9Respiratory, Global Scientific Affairs, Teva Pharmaceuticals, Frazer, PA, USA; 10Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK Purpose: Small airway changes and dysfunction contribute importantly to airway obstruction in chronic obstructive pulmonary disease (COPD), which is currently treated with inhaled corticosteroids (ICS) and long-acting bronchodilators at Global initiative for Obstructive Lung Disease (GOLD) grades 2–4. This retrospective matched cohort analysis compared effectiveness of a representative small-particle ICS (extrafine beclomethasone) and larger-particle ICS (fluticasone) in primary care patients with COPD. Patients and methods: Smokers and ex-smokers with COPD ≥40 years old initiating or stepping-up their dose of extrafine beclomethasone or fluticasone were matched 1:1 for demographic characteristics, index prescription year, concomitant therapies, and disease severity during 1 baseline year. During 2 subsequent years, we evaluated treatment change and COPD exacerbations, defined as emergency care/hospitalization for COPD, acute oral corticosteroids, or antibiotics for lower respiratory tract infection. Results: Mean patient age was 67 years, 57%–60% being male. For both initiation (n=334:334) and step-up (n=189:189) patients, exacerbation rates were comparable between extrafine beclomethasone and fluticasone cohorts during the 2 year outcome period. Odds of treatment stability (no exacerbation or treatment change) were significantly greater for patients initiating extrafine beclomethasone compared with fluticasone (adjusted odds ratio 2.50; 95% confidence interval, 1.32–4.73). Median ICS dose exposure during 2 outcome years was significantly lower (P<0.001) for extrafine beclomethasone than fluticasone cohorts (315 µg/day versus 436 µg/day for initiation, 438 µg/day versus 534 µg/day for step-up patients). Conclusion: We observed that small-particle ICS at significantly lower doses had comparable effects on exacerbation rates as larger-particle ICS at higher doses, whereas initiation of small-particle ICS was associated with better odds of treatment stability during 2-years' follow-up. Keywords: COPD exacerbation, extrafine particle, matched cohort analysis, real life, small airway

To Give or Not To Give - Is that the Question?: The Changing Face of Emergency Oxygen Therapy.

Oxygen's image, together with its reputation, is changing. No longer is it regarded as a benign panacea for all clinical presentations; indeed it is now increasingly evident that oxygen has the potential to contribute to clinical deterioration and mortality. There is an emerging recognition that oxygen is a drug when administered as a therapeutic intervention and should be used with caution. Contemporary guidelines offer criteria and directives for administration and prescription of oxygen, dependant on the patient's condition, acuity and care setting, yet clinical audit and gathering evidence repeatedly demonstrates that poor practice persists. There is a need to raise awareness of the importance of maintaining normal oxygen levels and be aware of the detrimental effects of both over and under oxygenation. Clearly more research is needed but in the meantime titration to normal or near normal levels seems a pragmatic solution

Nitric oxide (NO) levels in exhaled air, sputum, serum, saliva, and urine of bronchiectasis subjects: a comparision study

Session - Respiratory & Critical Care Medicine: no. S-RC-1published_or_final_versio