This pilot study demonstrated a trend towards decreased vasopressor dose, and decreased benzodiazepine and opiate use when ketamine is used as the sole sedative. The limitations to our study include a small sample size and those inherent in using a retrospective control group. Our findings should be further explored in a large, randomized prospective study.
BACKGROUND
Initiation of enteral feeding is an important part of the best practice model for critically ill patients. Although nasogastric feeding is appropriate for the majority of patients requiring short‐term nutrition support, certain patients benefit greatly from postpyloric feeding.
OBJECTIVE
To determine which of 2 specialized enteral tube systems achieved postpyloric placement on initial insertion attempt most efficiently.
DESIGN
Retrospective study comparing the Tiger 2 tube (T2T) and Cortrak Enteral Access System (C‐EAS).
SETTING
Academic medical center, mixed intensive care unit (ICU).
PATIENTS
All patients admitted to the ICU between 2009 and 2013 who had either a C‐EAS or T2T placed.
MEASUREMENTS
Success rate for postpyloric placement, congruency of real‐time tube placement with x‐ray confirmation for C‐EAS, and complication rates.
RESULTS
Seventy‐one T2T and 74 C‐EAS patients were included. The T2T was postpyloric 62% (44/71) of attempted placements. C‐EAS was postpyloric 43% (32/74) of attempted placements (P = 0.03). C‐EAS tracings accurately reflected chest x‐ray findings 83% and 82% for postpyloric and non‐postpyloric insertion, respectively. During the entire study period, no adverse events were recorded.
CONCLUSION
Our institution evaluated 2 different systems designed to ensure postpyloric placement of a small bore feeding tube. No literature exists directly comparing the 2 systems. Our retrospective review, although limited, showed that the T2T was more effective at postpyloric placement on first attempt. Although 1 benefit of the C‐EAS system may be real‐time visualization, our practice showed this system to be user dependent, which likely led to less success with postpyloric placement. Journal of Hospital Medicine 2014;9:23–28. Published 2013 Society of Hospital Medicine
Background
Comprehensive evaluations of clinical competency consume a large amount of time and resources. An oral examination is a unique evaluation tool that can augment a global performance assessment by the Clinical Competency Committee (CCC).
Objective
We developed an oral examination to aid our CCC in evaluating resident performance.
Methods
We reviewed tools used in our internal medicine residency program and other training programs in our institution. A literature search failed to identify reports of a similar evaluation tool used in internal medicine programs. We developed and administered an internal medicine oral examination (IMOE) to our postgraduate year–1 and postgraduate year–2 internal medicine residents annually over a 3-year period. The results were used to enhance our CCC's discussion of overall resident performance. We estimated the costs in terms of faculty time away from patient care activities.
Results
Of the 54 residents, 46 (86%) passed the IMOE on their first attempt. Of the 8 (14%) residents who failed, all but 1 successfully passed after a mentored study period and retest. Less than 0.1 annual full-time equivalent per faculty member was committed by most faculty involved, and the time spent on the IMOE replaced regular resident daily conference activities.
Conclusions
The results of the IMOE were added to other assessment tools and used by the CCC for a global assessment of resident performance. An oral examination is feasible in terms of cost and can be easily modified to fit the needs of various competency committees.
A series of evidence-based interventions beginning with an intensive care unit diary and a patient/family educational pamphlet were implemented to address the long-term consequences of critical illness after discharge from the intensive care unit, bundled as post-intensive care syndrome and post-intensive care syndrome-family. An extensive literature review and nursing observations of the phenomenon highlighted the potential for this project to have a favorable impact on patients, their families, and the health care team. The goal of this article is to explain the education of all stakeholders; the introduction of the diary, video, and educational pamphlet; and the evaluation of the acceptance of these interventions. This process began with an informal evaluation of the educational products and overall perception of the usefulness of the diary by patients, family members, and staff. The efforts described contribute to the evidence base supporting diaries as an adjunct to intensive care.
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