ライフサイエンスコーパス: intensivist

1 one medical education expert, zero community intensivists).

2 the required level of echo expertise of the intensivist.

3 ram and did not depend on the presence of an intensivist.

4 Each was staffed by a board certified intensivist.

5 closed units, and 41% had a 24-hour in-house intensivist.

6 ital residents with an in-hospital nighttime intensivist.

7 ; 95% CI, 0.89-2.46; p = 0.13) compared with intensivists.

8 n from a database of 1,712 eligible academic intensivists.

9 rolled 11 palliative care specialists and 25 intensivists.

10 fe treatment decisions in ICUs compared with intensivists.

11 aging conflict with surrogates compared with intensivists.

12 Palliative care specialists and intensivists.

13 was a combination of full-time and part-time intensivists.

14 U), yet many ICUs are not staffed by trained intensivists.

15 , or presence of in-hospital attending-level intensivists.

16 elated factors and was highly variable among intensivists.

17 ) and present a major treatment challenge to intensivists.

18 n from a database of 1,850 eligible academic intensivists.

19 mergency physicians, 37 hospitalists, and 37 intensivists.

20 highlight potential areas of improvement for intensivists.

21 ical care societies in the challenges facing intensivists.

22 enging with staff shortages for surgeons and intensivists.

23 and medical decision making among pediatric intensivists.

24 favorable outcome might be underestimated by intensivists.

25 64 junior investigators supervised by senior intensivists.

26 52%) had intensivists and 1,345 (48%) had no intensivists.

27 (2 vs 1; p < 0.0001) than hospitals without intensivists.

28 levels of burnout syndrome are common among intensivists.

29 ent intensivists in the 1,469 hospitals with intensivists.

30 ding ICUs; eight of 43 (18.6%) had nighttime intensivists.

31 +/- 2.8 vs 3.9 +/- 2.8; p < 0.001) than home intensivists.

32 stributed in the entire cohort; 77% had 24/7 intensivists; 46% had a physician-to-patient ratio betwe

33 es of conflict than older surgeons with both intensivists (57% vs 32%; P = .001) and nurses (48% vs 3

34 Twenty-seven out of 36 intensivists (75%) completed the survey.

35 ) and a higher proportion of board-certified intensivists (88% vs 60%, P < 0.001) when compared to hi

36 The odds of reporting conflict with intensivists about goals of postoperative care were 40%

37 Visitor intensivists admitted patients with similar age and gend

38 al membrane oxygenation support demands that intensivists adopt a physiologically-based approach to m

39 l ICU mortality rates were higher in visitor intensivists, albeit not significantly so (11.5% vs 10.2

40 the wide array of shock states dealt with by intensivists, an integrated approach that takes into acc

41 intensive care unit program with remote 24/7 intensivist and critical care nurse electronic monitorin

42 ist with ID expertise (44%) or as equally an intensivist and ID physician (38%).

43 cute care hospitals studied, 1,469 (52%) had intensivists and 1,345 (48%) had no intensivists.

44 sense of professional dissatisfaction among intensivists and a lack of public awareness that critica

45 assess and avoid the burnout syndrome among intensivists and advanced practice providers are needed.

46 e workforce, workload, and burnout among the intensivists and advanced practice providers of establis

47 g primary care doctors, hospital internists, intensivists and gastroenterologists due to its peculiar

48 d environment with close collaboration among intensivists and infectious disease specialists, de-esca

49 Shiftwork staffing was better for intensivists and most were receptive once they had exper

50 was distributed electronically to pediatric intensivists and neurologists.

51 tarian settings provides crucial guidance to intensivists and nonintensivists alike.

52 e, and prevention committees, but fewer 24/7 intensivists and poorer nurse-to-patient ratio.

53 sought to characterize communication between intensivists and surgeons and to assess enablers and bar

54 In this concise review, targeted at intensivists and surgeons, we discuss the routine manage

55 Close collaboration with surgeons and intensivists and the use of recently developed systems f

56 PATIENTS/SUBJECTS: Eight attending pediatric intensivists and their physician rounding teams.

57 flict about postoperative goals of care with intensivists, and 43% reported conflict with nurses.

58 Three hundred three nurses, intensivists, and advanced practice providers.

59 and has important implications for surgeons, intensivists, and patients.

60 l surgeons, gastroenterologists, internists, intensivists, and radiologists who are currently active

61 ist-level palliative care among oncologists, intensivists, and specialists caring for patients with a

62 Multidisciplinary care teams led by intensivists are an essential component of critical care

63 However, the degree to which nighttime intensivists are associated with improvements in the qua

64 e physician workforce, raising concerns that intensivists are becoming overburdened by workload.

65 n of the role of telemedicine in areas where intensivists are inaccessible are potential strategies t

66 Intensivists are increasingly likely to encounter patien

67 Intensivists are increasingly needed to care for the cri

68 supply, without clear justification for why intensivists are more important.

69 performed by a multidisciplinary team, which intensivists are positioned to engage and lead.

70 icine and only 1% of current board-certified intensivists are trained in ID.

71 ng of the current supply and distribution of intensivists as well as future research into the intensi

72 ed by observers with input from the rounding intensivists at a 24-bed open SICU at an urban, academic

73 he experience of percutaneous cannulation by intensivists at a single institution.

74 Surgeons (attendings and residents), intensivists (attendings and residents), and ICU nurses

75 mal ICU administration, patient coverage and intensivist availability and a lack of national data on

76 stems, particularly for systems with limited intensivist availability.

77 This review will also help the intensivist better understand published studies on admin

78 Attending intensivists blinded to the clinical scenario reviewed t

79 may be useful to alleviate overburdening the intensivist, but should be evaluated using rigorous meth

80 may be useful to alleviate overburdening the intensivist, but should be evaluated using rigorous meth

81 n for extracorporeal membrane oxygenation by intensivists can be performed with a high rate of succes

82 ous cannulation is increasingly performed by intensivists, cardiologists, interventional radiologists

83 A transition to a 24/7 in-house intensivist care model was associated with a reduction i

84 Most intensivists chose fentanyl as their first-line opioid (

85 Self-described prescribing patterns from intensivists closely matched their actual behavior, sugg

86 ls (to improve ICU quality in the absence of intensivists) combined with limitations on the future gr

87 n of a common "product specification" for an intensivist, combined with persisting variation in the e

88 ist-led team or mandatory consultation of an intensivist), compared to low-intensity staffing, was as

89 Six hundred sixty-one intensivists completed the survey (completion rate, 38.6

90 Sixty-nine intensivists completed the survey.

91 of the wide array of shock states with which intensivists contend, an approach that takes into accoun

92 to ICUs that use a "closed" model where the intensivists control triage and patient care.

93 In contrast, 24-hour intensivist coverage (p = 0.89) and closed ICU status (p

94 a high-intensity model, 24-hour in-hospital intensivist coverage did not reduce hospital, or ICU, mo

95 association between dedicated in-house 24/7 intensivist coverage on outcomes in specialized cardiac

96 roportion of participating ICUs with 24-hour intensivist coverage was lower in North America than in

97 tensity staffing models, 24-hour in-hospital intensivist coverage, compared to daytime only coverage,

98 Shorter schedules of consecutive intensivist days worked were also associated with trends

99 We sought to describe intensivist decision making and determine how the number

100 mized trial, patient values had no effect on intensivists' decisions to discuss withdrawal of life su

101 Documenting prognosis may help intensivists disclose prognosis to ICU proxies, but in i

102 ted States exhibit marked heterogeneity, and intensivists do not agree about the value of attending h

103 Intensivists doing shift work experienced less burnout (

104 omplications demand increased attention from intensivists due to their frequency and increasing cance

105 te decision, and being cared for by only one intensivist during ICU stay were significantly associate

106 n the rise even among nonechocardiographers (intensivists, emergency care physicians, internists, and

107 s non-operative treatments or the consulting intensivists' endorsement of operative intervention, wer

108 We found that 71% (105 of 149) of intensivists estimated the correct cuff size rather than

109 that ICU and compared with those admitted by intensivists familiar with an ICU elsewhere in the same

110 Consecutive intake forms completed by staff intensivists following each telemedicine encounter were

111 s were given to the use of ultrasound by the intensivist for diagnosis of acalculous cholecystitis, r

112 ays in 43 (39.4%) ICUs; 27 (24.7%) scheduled intensivists for 5 days, 22 (20.1%) for 4 days, seven (6

113 , and daily meetings between oncologists and intensivists for care planning (OR, 0.69; 95% CI, 0.52 t

114 ay provide valuable insights and guidance to intensivists for safer clinical practice.

115 opportunities in surgical critical care for intensivists from all base specialties and for maintaini

116 intensivist model, and the recognition that intensivists from all specialties can provide optimal ca

117 ticle is a methodological review to help the intensivist gain insights into the classic and sometimes

118 The intensivist group consisted of 11 attending physicians,

119 s the blinded reviewers' assessment that the intensivist had presented the option of care focused ent

120 he hospital level, hospitals with privileged intensivists had significantly more hospital beds (media

121 A new paradigm of how intensivists handle the brain is required.

122 r, the number and types of decisions made by intensivists have not been well characterized.

123 high risk)/DOVE (low risk) patient grouping, intensivist/hospitalist comanagement of surgical patient

124 nt cohorting, floor-based team building, and intensivist/hospitalist staffing of progressive care uni

125 being needed in a health system filled with intensivists, hospitalists, and skilled nursing facility

126 Compared with hospitals without intensivists, hospitals with privileged intensivists wer

127 Intensivist identity explained the greatest proportion o

128 The role of the intensivist in the care of patients on extracorporeal me

129 s from size 12 to 31F were performed by four intensivists in 100 subjects.

130 mbers of privileged and full-time equivalent intensivists in acute care hospitals with ICU beds in th

131 Engaging intensivists in antibiotic stewardship program efforts i

132 Visitor intensivists in some ICUs were associated with higher mo

133 8 privileged and 19,996 full-time equivalent intensivists in the 1,469 hospitals with intensivists.

134 emorrhage and in critical care monitoring by intensivists in the ICU.

135 Intensivists in the intervention versus control group we

136 und to be significantly higher than for home intensivists in two of the four ICUs (p = 0.017, 0.006).

137 e was no effect of patient values on whether intensivists intended to discuss withdrawal of life supp

138 ormance of goal-directed echocardiograms and intensivists' interpretations for evaluating right ventr

139 fects of nighttime staffing with in-hospital intensivists (intervention) as compared with nighttime c

140 sfaction with incomes, which has forced many intensivists into multijob schemes.

141 Notwithstanding this, the shortage of intensivists is a problem recognized throughout the worl

142 The demand for intensivists is increasing around the world, not only to

143 The lack of intensivists is multifactorial: the specialty is not tau

144 tional value of the clinical judgment by the intensivist, it is not possible to reliably identify pot

145 Medical intensivists leading patient care rounds.

146 between surgical and ICU teams exist in the intensivist-led ICU environment.

147 nities exist to improve communication in the intensivist-led ICU.

148 tality coincided with the introduction of an intensivist-led model of care, the empiric use of merope

149 The intensivist-led model of ICU care requires surgical cons

150 was to examine the impact of implementing an intensivist-led multidisciplinary extended rapid respons

151 ed on pre-defined criteria and a four-member intensivist-led multidisciplinary rapid response team re

152 tality coincided with the introduction of an intensivist-led service, meropenem, and adjuvant granulo

153 nsity staffing (i.e., transfer of care to an intensivist-led team or mandatory consultation of an int

154 , many studied rapid response teams were not intensivist-led, had limited involvement beyond the init

155 Task Force on Models of Critical Care: 1) An intensivist-led, high-performing, multidisciplinary team

156 A given intensivist made more decisions per patient during days

157 erved patient rounds on 374 unique patients, intensivists made 8,174 critical care decisions (mean, 8

158 Pulmonary Critical Care Medicine Fellows and intensivists made a timely and accurate assessment.

159 Intensivists made over 100 daily critical care decisions

160 Female intensivists made significantly more decisions than male

161 all base specialties and for maintaining the intensivist model within acute care surgery practice.

162 1, 2013, to December 31, 2014 (24/7 in-house intensivist model).

163 to engage in dedicated critical care per the intensivist model, and the recognition that intensivists

164 vs 0.3 per mo; p < 0.01) were lower with the intensivist model.

165 el were matched to 1,509 patients during the intensivist model.

166 surgery continues to expand, and the cardiac intensivist must be familiar with a broad spectrum of pr

167 The cardiac intensivist must have a comprehensive understanding of c

168 obstetricians, nephrologists, hematologists, intensivists, neonatologists, and complement biologists,

169 NTS: We conducted a cross-sectional study of intensivists, neurosurgeons, and neurologists that parti

170 n the level of care was found among Canadian intensivists, neurosurgeons, and neurologists.

171 tive care, whether provided by a generalist (intensivist, nurse, social worker) or palliative care sp

172 e Choosing Wisely Task Force recommends that intensivists offer patients at high risk for death or se

173 of the weekly transition of care among staff intensivists on compliance with three evidence-based pro

174 at nighttime telecommunication linking staff intensivists on home-call with pediatric intensive care

175 intervention days were exposed to nighttime intensivists on more nights than were patients admitted

176 he impact of transitions of care among staff intensivists on the compliance with evidence-based proce

177 aluate the association between 24/7 in-house intensivist-only management of cardiac surgical patients

178 o 2.07) and meetings between oncologists and intensivists (OR, 4.70; 95% CI, 1.15 to 19.22) were also

179 ty and nurse ICU experience, presence of any intensivist, or absence of residents after risk adjustme

180 nd independently performed by a neurologist, intensivists, or trauma surgeon, and a nurse in three mu

181 made significantly more decisions than male intensivists (p < 0.05).

182 ing models that include daily rounding by an intensivist, palliative care integration, and expansion

183 Thereafter, each intensivist participated in a standardized, video-record

184 cademic medical ICUs, there is evidence that intensivist/patient ratios less favorable than 1:14 nega

185 cademic medical ICUs, there is evidence that intensivist/patient ratios less favorable than 1:14 nega

186 taskforce to generate guidelines on maximum intensivists/patient ratios.

187 In addition, some intensivists perceive a link between suboptimal attendin

188 Two intensivists performed secondary reviews of possible err

189 Among pediatric intensivists, personal preferences for life-sustaining t

190 itate clinical communication among pediatric intensivists pertaining to bleeding and serve in the des

191 These findings suggest that 24/7 intensivist physician care models may improve patient ou

192 to reexamine the association between daytime intensivist physician staffing and ICU mortality and det

193 There was no association between daytime intensivist physician staffing and in-hospital mortality

194 Hospitals are increasingly adopting 24-hour intensivist physician staffing as a strategy to improve

195 Daytime intensivist physician staffing is associated with improv

196 Intensivist physician staffing is associated with lower

197 estimated the independent effect of daytime intensivist physician staffing on in-hospital mortality

198 echanical ventilation, the effect of daytime intensivist physician staffing remained nonsignificant (

199 availability and a lack of national data on intensivist practices.

200 The reasons are unknown but could relate to intensivists' practices, unfamiliarity with the patients

201 The clinical judgment of the intensivist predicted death within 60 and 120 mins with

202 are provided in the ICUs staffed with a 24/7 intensivist presence is associated with improved overall

203 d from 0-100 points assessed outcomes for 24 intensivists (primary outcome: burnout); 119 families (s

204 nit physician staffing standard of dedicated intensivists providing 24-hr intensive care unit coverag

205 logists, anesthesiologists and critical care intensivists, radiologists, pathologists, organ procurem

206 s withdrawal of life support (p = 0.81), but intensivists randomized to record functional prognosis w

207 Intensivists randomized to the intervention group answer

208 Among the 63 intensivists randomized to the intervention, 50 (79%) ex

209 hing, and length of stay when the patient to intensivist ratio is greater than or equal to 15.

210 Most intensivists receive training in pulmonary medicine and

211 Six hundred thirty intensivists recruited via e-mail invitation from a data

212 intensivist worked 7 day shifts, while other intensivists remained in the ICU at night.

213 In addition, efforts to train more intensivists require us to prioritize intensive care ove

214 All intensivists reviewed a paper-based medical record for a

215 Two blinded intensivists reviewed deidentified written transcripts o

216 During a period of service reconfiguration, intensivists routinely rostered to work in one ICU worke

217 tality when ICU patients were admitted under intensivists routinely working in that ICU and compared

218 Intensivist scheduling should account for the significan

219 Analyzing the intensivist section of the American Hospital Association

220 the association between days of consecutive intensivist service and patient outcomes; the predicted

221 Nevertheless, the intensivist shortfall is quite real as evidenced by the

222 The magnitude of the intensivist shortfall, however, is difficult to determin

223 Intensivists should be familiar with the diagnosis and t

224 In addition, intensivists should be ready to implement systems change

225 Intensivists should consider the modern literature descr

226 to assess the relationship between nighttime intensivist staffing and in-hospital mortality among ICU

227 We defined high-intensity daytime intensivist staffing as either a mandatory consult or cl

228 4/7 availability have contributed to growing intensivist staffing concerns.

229 h high-intensity daytime staffing, nighttime intensivist staffing conferred no benefit with respect t

230 ICUs) are adopting the practice of nighttime intensivist staffing despite the lack of experimental ev

231 in the United States, nighttime in-hospital intensivist staffing did not improve patient outcomes.

232 Nighttime intensivist staffing does not improve patient outcomes i

233 Studies of nighttime intensivist staffing have yielded mixed results.

234 nation availability, and 24-hour in-hospital intensivist staffing increased with PICU beds per hospit

235 on is needed to clarify how around-the-clock intensivist staffing influences the various stakeholders

236 review and meta-analysis suggests nighttime intensivist staffing is not associated with reduced ICU

237 physician coverage model to a 24/7 in-house intensivist staffing model.

238 This 32-week, crossover pilot trial of two intensivist staffing models, performed in two Canadian I

239 Nonetheless, intensivist staffing on the night of admission did not h

240 Comparative observational studies examining intensivist staffing patterns and reporting hospital or

241 We find that 24-hr intensive care unit intensivist staffing reduces lengths of stay and cost es

242 The addition of nighttime intensivist staffing to a low-intensity daytime staffing

243 th low-intensity daytime staffing, nighttime intensivist staffing was associated with a reduction in

244 e two staffing models, in-hospital nighttime intensivist staffing was associated with small increases

245 d studies with exposure limited to nighttime intensivist staffing with adjusted estimates of effect)

246 for studies comparing in-hospital nighttime intensivist staffing with other nighttime staffing model

247 OALS: To review the association of nighttime intensivist staffing with outcomes of intensive care uni

248 In contrast to 24-hour intensivist staffing, improvement in team communication

249 ng ICU patients, with adjustment for daytime intensivist staffing, severity of illness, and case mix.

250 number of proposals intended to increase the intensivist supply in the United States.

251 ntinuing an unwarranted push to increase the intensivist supply, we suggest alternative workforce pol

252 mand without an unnecessary expansion of the intensivist supply.

253 raining report experiences with telemedicine intensivists that are positive and increased patient saf

254 However, there is a nationwide shortage of intensivists that has occurred despite years of well pub

255 ssionals were interviewed (nine surgeons, 16 intensivists, three nurse practitioners, and two "other"

256 ly ill patients expedites the ability of the intensivist to properly manage them.

257 em in pathophysiologic conditions will allow intensivists to better appreciate the complex circulator

258 nous system in health and disease will allow intensivists to better appreciate the complex circulator

259 hind the present situation, the need for all intensivists to engage in dedicated critical care per th

260 paucity of research on optimal scheduling of intensivists to provide continuous on-site coverage.

261 However, requiring intensivists to record patients' estimated 3-month funct

262 profession and workplace to encourage senior intensivists to remain in the field, proactive marketing

263 We hypothesized that intensivists unfamiliar with an ICU team and the context

264 Intensivists use neuromuscular blocking agents for a var

265 valuate pulmonary critical care fellows' and intensivists' use of goal-directed echocardiography in d

266 ces between palliative care specialists' and intensivists' use of task-focused communication and rela

267 were managed by a defined group of surgical intensivists using established definitions and an eviden

268 Each intensivist was randomized to review 10, online, clinica

269 ur intensive care units, the board-certified intensivists we do have are being stretched ever more th

270 mbers of privileged and full-time equivalent intensivists were 11 (5-24) and 7 (2-17), respectively.

271 nalysis, the odds of reporting conflict with intensivists were 2.5 times higher for surgeons with few

272 Daytime intensivists were present in 21 of 43 (48.8%) responding

273 In these ICUs, intensivists were present in-house 24/7 in 49%; advanced

274 hout intensivists, hospitals with privileged intensivists were primarily located in metropolitan area

275 rs, medical education experts, and community intensivists were recruited to participate MEASUREMENTS

276 Academic intensivists were recruited via e-mail invitation from a

277 ues were identical to the control group, but intensivists were required to record the patient's estim

278 Intensivists were scheduled for seven or more consecutiv

279 "Home" intensivists were those who continued to work in their u

280 tinued to work in their usual ICU; "visitor" intensivists were those who delivered care in an unfamil

281 We tested the a priori hypothesis that intensivists who are prompted to document patient progno

282 he heterogeneity in sedation practices among intensivists who care for critically ill children as wel

283 Pediatric intensivists who had a lower Personal Preference Score (

284 enomenon, and is likely to be encountered by intensivists who regularly employ vasopressin for the tr

285 stics of these systems must be understood by intensivists who use such information to guide their pat

286 compared with nighttime coverage by daytime intensivists who were available for consultation by tele

287 Eighty-three percent identified as either an intensivist with ID expertise (44%) or as equally an int

288 neuromuscular blocking agents, when used by intensivists with a high level of training and experienc

289 om home; and the shift work model, where one intensivist worked 7 day shifts, while other intensivist

290 affing models: the standard model, where one intensivist worked for 7 days, taking night call from ho

291 Full-time intensivists worked a median of 168 days (range 42-192 d

292 ticle offers proposals to increase the adult intensivist workforce through expansion and enhancements

293 nsivists as well as future research into the intensivist workforce.

294 cal care fellows, who represent the emerging intensivist workforce.

295 ted ICU length of stay = 2.85 d), care by an intensivist working 3 or fewer consecutive days was asso

296 Compared with care by intensivists working 7+ consecutive days (adjusted ICU l

297 Care by intensivists working fewer consecutive days is associate

298 In total, 34.5% of patients were admitted by intensivists working in nonfamiliar surroundings.

299 Surprisingly, 83% of surveyed intensivists would choose critical care medicine again,

300 he presence of a workforce gap, training new intensivists would not place them in hospitals where the