ライフサイエンスコーパス: intensivist

1 one medical education expert, zero community intensivists).

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

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

4 o address topics important to the practicing intensivist.

5 articularly challenging and rewarding to the intensivist.

6 ome more profound and more prominent for the intensivist.

7 stic and monitoring imaging modality for the intensivist.

8 s on those areas of greatest interest to the intensivist.

9 the required level of echo expertise of the intensivist.

10 elated factors and was highly variable among intensivists.

11 ) and present a major treatment challenge to intensivists.

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

13 mergency physicians, 37 hospitalists, and 37 intensivists.

14 ical care societies in the challenges facing intensivists.

15 enging with staff shortages for surgeons and intensivists.

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

17 and medical decision making among pediatric intensivists.

18 favorable outcome might be underestimated by intensivists.

19 64 junior investigators supervised by senior intensivists.

20 erests are neutral, at best, to the needs of intensivists.

21 emergency physicians, 13 hospitalists, and 8 intensivists.

22 rriculum and necessary training elements for intensivists.

23 n the United States are staffed by dedicated intensivists.

24 +/- 2.8 vs 3.9 +/- 2.8; p < 0.001) than home intensivists.

25 ; 95% CI, 0.89-2.46; p = 0.13) compared with intensivists.

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

27 rolled 11 palliative care specialists and 25 intensivists.

28 fe treatment decisions in ICUs compared with intensivists.

29 aging conflict with surrogates compared with intensivists.

30 Palliative care specialists and intensivists.

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

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

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

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

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

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

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

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

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

42 This article will enlighten the intensivist and others of their potential and contrast e

43 practitioners in supporting the goal of the intensivist and the critical care team is similarly expl

44 with an emphasis on issues pertinent to the intensivist and to define the newly recognized "Delayed

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

46 Intensivists and emergency physicians (p = 0.048) were m

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

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

49 was distributed electronically to pediatric intensivists and neurologists.

50 There is a general consensus by intensivists and nonsurgical providers that surgeons hes

51 This review is intended to provide intensivists and other interested clinicians with an und

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

53 Attending intensivists and postgraduate surgical trainees with SIC

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

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

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

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

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

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

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

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

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

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 General recommendations for intensivists are made for assessing cooling technology w

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

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

71 ncially reward hospitals that have dedicated intensivists around the clock.

72 a potentially expanded role for nonsurgical intensivists as the critical care time available for tra

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

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

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

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

77 stems, particularly for systems with limited intensivist availability.

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

79 Attending intensivists blinded to the clinical scenario reviewed t

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

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

82 The problem, however, is that the supply of intensivists by training is not projected to increase, w

83 n thinking and strong leadership skills, the intensivist can marshal support from staff and administr

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

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

86 linary participation of various specialties (intensivists, cardiologists, surgeons) in AKI clinical s

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

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

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

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

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

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

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

94 Sixty-nine intensivists completed the survey.

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

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

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

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

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

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

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

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

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

104 Transition to an intensivist-directed ICU in an Army Combat Support Hospi

105 Intensivist-directed intensive care units (ICUs) have be

106 e ICU was converted from an open model to an intensivist-directed model.

107 This intensivist-directed team model provides sophisticated c

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

109 Intensivists doing shift work experienced less burnout (

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

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

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

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

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

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

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

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

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

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

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

121 The intensivist group consisted of 11 attending physicians,

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

123 technologies, including cooling technology, intensivists have little guidance or training on tactics

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

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

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

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

128 Intensivist identity explained the greatest proportion o

129 rgery include the role of the traumatologist/intensivist in the intensive care unit, as opposed to th

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

131 Influenza is a major concern for intensivists in all communities in the U.S.

132 Only 25% (three of 12) of intensivists in ICUs meeting the standard had authority

133 percentage of patients visited on rounds by intensivists in ICUs who met (80 +/- 14.58) vs. did not

134 Visitor intensivists in some ICUs were associated with higher mo

135 ight of the primacy of appropriately trained intensivists in the critical care unit.

136 likely to remain a significant challenge for intensivists in the future because the patient populatio

137 g residency if there is to be an increase in intensivists in the hospital workforce.

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

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

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

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

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

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

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

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

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

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

148 Medical intensivists leading patient care rounds.

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

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

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

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

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

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

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

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

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

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

159 A given intensivist made more decisions per patient during days

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

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

162 Intensivists made over 100 daily critical care decisions

163 Female intensivists made significantly more decisions than male

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

165 1, 2013, to December 31, 2014 (24/7 in-house intensivist model).

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

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

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

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

170 The cardiac intensivist must have a comprehensive understanding of c

171 agnitude of these alterations indicates that intensivists must be aware of these alterations in order

172 Intensivists must understand the hospital acquisition pr

173 Intensivists need to recognize the importance of seasona

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

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

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

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

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

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

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

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

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

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

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

185 e unit, one may logically reason that as the intensivist/patient ratio decreases, morbidity or mortal

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

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

188 little has been published regarding optimal intensivist/patient ratios.

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

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

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

192 We sought to determine intensivist physician attitudes and potential barriers t

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

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

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

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

197 Daytime intensivist physician staffing is associated with improv

198 Intensivist physician staffing is associated with lower

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

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

201 Intensivist physicians have mixed opinions about regiona

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

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

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

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

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

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

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

209 Most intensivists receive training in pulmonary medicine and

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

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

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

213 te that varied significantly among attending intensivists responsible for decision making for this pr

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

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

216 noses that will often dramatically alter the intensivist's current therapy.

217 diography is becoming an integral part of an intensivist's diagnostic and monitoring armamentarium.

218 f the large pile of requisition requests, an intensivist's proposal must be well conceived and aligne

219 Intensivist scheduling should account for the significan

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

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

222 infectious diarrhea successfully in the ICU, intensivists should be aware that epidemiology, risks, a

223 Intensivists should be familiar with techniques to induc

224 Intensivists should be familiar with the diagnosis and t

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

226 Intensivists spend much of their time managing problems

227 Intensivists staffed ICUs in 100% of hospitals meeting t

228 be the organization of physician services in intensivist-staffed intensive care units (ICU) reporting

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

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

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

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

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

234 Nighttime intensivist staffing does not improve patient outcomes i

235 Studies of nighttime intensivist staffing have yielded mixed results.

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

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

238 d purported benefit derived from a dedicated intensivist staffing model, little has been published re

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

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

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

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

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

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

245 he evidence continues to mount in support of intensivist staffing to improve both patient outcomes an

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

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

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

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

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

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

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

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

254 mand without an unnecessary expansion of the intensivist supply.

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

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

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

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

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

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

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

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

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

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

265 Telemedicine technology, which can enable intensivists to simultaneously monitor several intensive

266 is in mind, there becomes a growing need for intensivist-trained cardiologists and a push for the dev

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

268 Intensivists use neuromuscular blocking agents for a var

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

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

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

272 the critical care time available for trauma/intensivists wanes due to increased surgical and non-cri

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

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

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

276 Intensivists were present at least 8 hrs/day in 83% (ten

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

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

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

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

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

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

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

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

285 Pediatric intensivists who had a lower Personal Preference Score (

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

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

288 f influenza with emphasis on the issues that intensivist will encounter.

289 structure changes, the worsening shortage of intensivists will precipitate a crisis, resulting in the

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

291 nt, and the proposed curriculum will provide intensivists with a detailed roadmap for training.

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

293 The purpose of this article is to provide intensivists with information and examples regarding coo

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

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

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

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

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