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News Article | November 8, 2016

EBSCO Health is strengthening its evidence-based content with the appointment of Terence K. Trow, M.D., FACP, FAACP as the Deputy Editor of Pulmonary, Critical Care and Sleep Medicine. Dr. Trow brings nearly 30 years of medical, teaching, research and editorial experience to EBSCO Health’s evidence-based clinical reference tool, DynaMed Plus®. Dr. Trow is an Associate Professor of Medicine at the Yale University School of Medicine where he served as the Director of the Yale Pulmonary Vascular Disease Program prior to assuming the position with EBSCO Health. Dr. Trow is board certified by the American Board of Internal Medicine in Pulmonary and Critical Care Medicine. He is a Fellow of the American College of Physicians and the American College of Chest Physicians (ACCP). A graduate of Dartmouth Medical School, he completed his internal medicine residency training at the Hospital of the University of Pennsylvania and The New York Hospital Cornell program before his post-graduate fellowship training in pulmonary and critical care medicine at the Yale-New Haven Hospital. Dr. Trow has received numerous teaching awards, has served on the ACCP Pulmonary Vascular Disease Network Planning Committee and served as the state of Connecticut Governor on the U.S. and Canadian Governors Council for the ACCP. He is currently on the Scientific Leadership Council of the National Pulmonary Hypertension Association. Senior Vice President of Medical Product Management Betsy Jones says the addition of Dr. Trow will be an asset to the DynaMed team." Dr. Trow has an impressive level of experience that will enhance an already solid editorial team of physicians who evaluate the best evidence and guidelines to provide medical professionals what they need to know in clinical practice.DynaMed Plus team. “” As a deputy editor, Dr. Trow oversees the integration of pulmonary, critical care and sleep medicine content for DynaMed Plus. He supervises medical writers and editors along with external peer reviewers to ensure that physicians and healthcare professionals have access to the most current, relevant, evidence-based clinical information available. EBSCO Health maintains a rigorous editorial process that includes subject-specific experts reviewing topics using the DynaMed Plus proprietary, evidence-based methodology and quality assurance process. For more information about Dynamed Plus and its editorial team, visit: About EBSCO Health EBSCO Health, part of EBSCO Information Services, is a leading provider of clinical decision support solutions, healthcare business intelligence, and medical research information for the healthcare industry. EBSCO Health users include professionals in medicine, nursing, and allied health. Flagship products include CINAHL®, DynaMed Plus™, Nursing Reference Center™, clinical e-books and e-journals, EBSCO Discovery Service™, licensed databases (such as MEDLINE®), plus EBSCONET®. EBSCO databases are powered by EBSCOhost®, the electronic resource favored by libraries around the world.

Ward N.S.,Critical Care and Sleep Medicine | Read R.,Critical Care and Sleep Medicine | Afessa B.,Mayo Medical School | Kahn J.M.,University of Pittsburgh
Critical Care Medicine | Year: 2012

Background: Increases in the size and number of American intensive care units have not been accompanied by a comparable increase in the critical care physician workforce, raising concerns that intensivists are becoming overburdened by workload. This is especially concerning in academic intensive care units where attending physicians must couple teaching duties with patient care. Methods: We performed an in-person and electronic survey of the membership of the Association of Pulmonary and Critical Care Medicine Program Directors, soliciting information about patient workload, other hospital and medical education duties, and perceptions of the workplace and teaching environment of their intensive care units. Results: Eighty-four out of a total 121 possible responses were received from program directors or their delegates, resulting in a response rate of 69%. The average daily (SD) census (as perceived by the respondents) was 18.8 ± 8.9 patients, and average (SD) maximum service size recalled was 24.1 ± 9.9 patients. Twenty-seven percent reported no policy setting an upper limit for the daily census. Twenty-eight percent of respondents felt the average census was "too many" and 71% felt the maximum size was "too many." The median (interquartile range) patient-to-attending physician ratio was 13 (10-16). When categorized according to this median, respondents from intensive care units with high patient/physician ratios (n = 31) perceived significantly more time constraints, more stress, and difficulties with teaching trainees than respondents with low patient/physician ratios (n = 40). The total number of non-nursing healthcare workers per patient was similar in both groups, suggesting that having more nonattending physician staff does not alleviate perceptions of overwork and stress in the attending physician. Conclusions: Academic intensive care unit physicians that direct fellowship programs frequently perceived being overburdened in the intensive care unit. Understaffing intensive care units with attending physicians may have a negative impact on teaching, patient care, and workforce stability. Copyright © 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.

Narasimhan M.,Critical Care and Sleep Medicine | Koenig S.J.,Critical Care and Sleep Medicine | Mayo P.H.,Critical Care and Sleep Medicine
Chest | Year: 2014

This is the first of a two-part series that reviews advanced critical care echocardiography (CCE) techniques designed for critical care physicians. In this section, we review training in basic and advanced CCE. This is followed by a review of Doppler principles, including pulsed wave, continuous wave, and color flow Doppler. Included are Doppler measurement techniques that are useful for assessing the patient with cardiopulmonary failure and the common pitfalls of Doppler. This section ends with a review of the quantitative and semiquantitative measurements of stroke volume, as well as problems with measurement of stroke volume in the ICU and its useful clinical applications. Video-based examples will help demonstrate the techniques that are described in the text. © 2014 American College of Chest Physicians.

Narasimhan M.,Critical Care and Sleep Medicine | Koenig S.J.,Critical Care and Sleep Medicine | Mayo P.H.,Critical Care and Sleep Medicine
Chest | Year: 2014

This article is the second part of a series that describes practical techniques in advanced critical care echocardiography and their use in the management of hemodynamic instability. Measurement of left ventricular function and segmental wall motion abnormalities, evaluation of left ventricular filling pressures, assessment of right-sided heart function, and determination of preload sensitivity, including passive leg raising, are discussed. Video examples help to demonstrate techniques described in the text. © 2014 American College of Chest Physicians.

Skloot G.S.,Critical Care and Sleep Medicine
Current Opinion in Pulmonary Medicine | Year: 2016

Purpose of review Asthma is quite common and is better described as a syndrome with a heterogeneous presentation than as a single disease. Although most individuals can be effectively managed using a guideline-directed approach to care, those with the most severe illness may benefit from a more targeted therapy. The review describes our current understanding of how asthma phenotypes (observable characteristics) and endotypes (specific biologic mechanisms) can be employed to gain insight into asthma pathobiology and personalized therapy. Recent findings Our understanding of the heterogeneity of asthma is increasing. The concept of asthma phenotype has become more complex, incorporating both clinical and biologic features. Several asthma endotypes (e.g., allergic bronchopulmonary mycosis, aspirin-exacerbated respiratory disease, severe late-onset hypereosinophilic asthma, etc.) have been proposed, but further research is needed to delineate specific mechanisms underlying asthma pathogenesis. Several biologic therapies targeting certain phenotypes are in development and are expected to broaden our armamentarium for treatment of severe asthma. Summary Asthma is a heterogeneous condition with diverse characteristics and biologic mechanisms. Severe asthma is associated with significant morbidity and even mortality and represents a major unmet need. Stratification of asthma subtypes into phenotypes and endotypes should move the field forward in terms of more effective and personalized treatment. © 2015 Wolters Kluwer Health, Inc. All rights reserved.

Ralls F.M.,Critical Care and Sleep Medicine | Ralls F.M.,University of New Mexico | Grigg-Damberger M.,University of New Mexico
Current Opinion in Pulmonary Medicine | Year: 2012

PURPOSE OF REVIEW: Review recent research on the roles of gender, race/ethnicity, residential socioeconomics and age in obstructive sleep apnea syndromes (OSA) and their treatment. RECENT FINDINGS: Men have a higher prevalence of OSA than women and require higher continuous positive airway pressure (CPAP) pressures for treatment, given similar severity of OSA. When comparing age, women have less severe apnea at all ages. Menopause, pregnancy and polycystic ovarian syndrome increase the risk for OSA in women. Neck fat and BMI influence apnea-hypopnea index (AHI) severity in women; abdominal fat and neck-to-waist ratio do so in men. Obesity, craniofacial structure, lower socioeconomic status and neighborhood disadvantage may better explain ethnic/racial differences in the prevalence and severity of OSA. Ethnicity was no longer significantly associated with OSA severity when WHO criteria for obesity were used. SUMMARY: OSA has a male predominance; women have a lower AHI than men during certain stages of sleep; women require less CPAP pressure for treatment of similar severity of OSA, and there are ethnic/racial differences in the prevalence and severity of OSA but these may be due to environmental factors, such as living in disadvantaged neighborhoods. © 2012 Wolters Kluwer Health | Lippincott Williams &Wilkins.

Wang J.,Critical Care and Sleep Medicine | Greenberg H.,Critical Care and Sleep Medicine
Journal of Clinical Sleep Medicine | Year: 2013

Status cataplecticus is a rare manifestation of narcolepsy with cataplexy episodes recurring for hours or days, without a refractory period, in the absence of emotional triggers. This case highlights a narcoleptic patient who developed status cataplecticus after abrupt withdrawal of venlafaxine.

Greenstein Y.Y.,Critical Care and Sleep Medicine
Critical Care Medicine | Year: 2016

OBJECTIVE:: Current guidelines recommend the use of intraosseous access when IV access is not readily attainable. The pediatric literature reports an excellent safety profile, whereas only small prospective studies exist in the adult literature. We report a case of vasopressor extravasation and threatened limb perfusion related to intraosseous access use and our management of the complication. We further report our subsequent systematic review of intraosseous access in the adult population. DATA SOURCES:: Ovid Medline was searched from 1946 to January 2015. STUDY SELECTION:: Articles pertaining to intraosseous access in the adult population (age greater than or equal to 14 years) were selected. Search terms were “infusion, intraosseous” (all subfields included), and intraosseous access” as key words. DATA EXTRACTION:: One author conducted the initial literature review. All authors assessed the methodological quality of the studies and consensus was used to ensure studies met inclusion criteria. DATA SYNTHESIS:: The case of vasopressor extravasation was successfully treated with pharmacologic interventions, which reversed the effects of the extravasated vasopressors: intraosseous phentolamine, topical nitroglycerin ointment, and intraarterial verapamil and nitroglycerin. Our systematic review of the adult literature found 2,332 instances of intraosseous insertion. A total of 2,106 intraosseous insertion attempts were made into either the tibia or the humerus; 192 were unsuccessful, with an overall success rate of 91%. Five insertions were associated with serious complications. A total of 226 insertion attempts were made into the sternum; 54 were unsuccessful, with an overall success rate of 76%. CONCLUSIONS:: Intraosseous catheter insertion provides a means for rapid delivery of medications to the vascular compartment with a favorable safety profile. Our systematic literature review of adult intraosseous access demonstrates an excellent safety profile with serious complications occurring in 0.3% of attempts. We report an event of vasopressor extravasation that was potentially limb threatening. Therapy included local treatment and injection of intraarterial vasodilators. Intraosseous access complications should continue to be reported, so that the medical community will be better equipped to treat them as they arise. Copyright © by 2016 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

Silverberg M.J.,Critical Care and Sleep Medicine | Kory P.,Critical Care and Sleep Medicine
Annals of the American Thoracic Society | Year: 2014

RATIONALE: Recent studies on video laryngoscopy have demonstrated improvements in both safety and success of endotracheal intubation in the critically ill.OBJECTIVES: We assessed the use of video laryngoscopy among internal medicine fellowship programs training physicians in critical care medicine.METHODS: A 19-question survey was e-mailed to program directors of pulmonary/critical care and internal medicine critical care fellowship training programs.MEASUREMENTS AND MAIN RESULTS: A completed survey was returned by 36% of invited program directors. Sixty-nine percent of respondents reported a change in their approach to intubation training over the prior 3 years, with 56% of changes attributed to the adoption of a video laryngoscope. Other reported changes include new training methods (23%) and adoption of a checklist (10%). A video laryngoscope is available for clinical use in 89% of the responding programs. The video scope is used as the primary device in 16% and is never used in 9%. In the remainder of programs, the video laryngoscope is only used for difficult intubations or after failure of direct laryngoscopy (32%) or the primary device is determined by the preference of the operator (32%).CONCLUSIONS: The majority of internal medicine critical care program directors who recently responded to an e-mail survey reported that they have changed their approach to teaching endotracheal intubation, driven largely by the adoption of video laryngoscopy for upper airway visualization. Nevertheless, despite widespread availability, video laryngoscopy is used uncommonly as the primary visualization device for intubation at the programs represented by the respondents to this survey.

News Article | December 21, 2016

There's a long night coming, literally — the winter solstice comes on Wednesday (Dec. 21), making it the shortest day and longest night of the year. But will that extra time of darkness help you sleep better? Experts say that in general, people do tend to sleep a little longer in the wintertime, compared to the summertime. But the few minutes of extra darkness on the winter solstice itself may not be enough to make a noticeable difference to people's sleep habits, compared to how they sleep on the days before and after the solstice. "I would say that, yes, the changing day length [over the year] does influence sleep," said Brant Hasler, a sleep expert and assistant professor of psychiatry at the University of Pittsburgh. "[It's] probably not enough to notice a day-to-day difference with regard to the winter solstice and the days before and after, but certainly in comparison to the summer solstice," Hasler told Live Science. [5 Surprising Sleep Discoveries] Exactly how many hours of daylight and darkness a person experiences throughout the year will depend on where that person lives. In the midlatitudes, which include the United States, people experience about 9 hours of daylight around the winter solstice and 15 hours around the summer solstice. (These numbers vary, though: People living farther south have more hours of daylight, year round, than those who live farther north.) Several previous studies have found that the reduction in daylight hours during wintertime is linked with how long people sleep. For example, in a 2007 study, researchers analyzed sleep data from about 55,000 people living in Europe and found that people reported getting about 20 minutes' more sleep a day, on average, during the winter compared to the summer. "Many people report that they feel tired and want to sleep more during the winter," Hasler told Live Science in a 2015 interview. This change in sleep habits is mainly due to the reduction in daylight hours in the wintertime, which affects people's internal circadian clocks and makes them want to sleep more, he said. Our circadian clock is controlled by a certain area of the brain that responds to daylight and darkness, according to the National Sleep Foundation. For example, daylight tells this part of the brain — called the suprachiasmatic nucleus (SCN) — to send signals that result in the production of hormones and other physiological changes that make us feel alert, the NSF said. In addition, daylight also suppresses the release of melatonin, a hormone that is linked with sleep. Because of later sunrises and earlier sunsets, people may wake up later and go to bed earlier, said Jack Edinger, a professor in the Division of Pulmonary, Critical Care and Sleep Medicine at National Jewish Health hospital in Denver. "The lengthening of the total dark period tends to make people sleep longer, both ends," Edinger said. Still, the length of the day isn't the only thing that affects sleep. Other factors around wintertime, including holiday stress and changes in people's moods, likely influence the amount of sleep we get at this time of year as well, Hasler said. And having a drink or two at holiday celebrations may also affect your shut-eye. Studies have found that drinking alcohol helps people fall asleep, but leads to disrupted sleep later in the night. In addition, because people tend to sleep better in cooler environments compared to warm ones, the generally cooler temperatures in winter may help with sleep, Edinger said. "When the temperature gets too warm, sleep gest more fragmented," Edinger said.

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