Objective. To identify the perceptions and benefits of participation in a web-based journal club by the critical care pharmacy residents who presented and their mentors. Methods. Former and current resident presenters and their mentors were invited to complete one of three electronic surveys created to assess their perceptions of their experiences with a web-based journal club sponsored by the Clinical Pharmacy and Pharmacology (CPP) Section of the Society of Critical Care Medicine (SCCM). Descriptive statistics were used to analyze the data gathered. Results. Thirty-eight (41%) former residents, 23 (72%) recent or current residents, and 32 (58%) presentation mentors responded to the survey. Residents in both groups indicated that participation was a beneficial educational and professional experience. Residents who more recently presented an online journal club reported improved confidence in critically evaluating research, determining clinical applications of published literature, developing evidence-based recommendations, and educating trainees on evidence-based medicine. Mentors believed their residents' journal club participation influenced their future involvement in both the SCCM and the CPP Section and were extremely likely to recommend their future residents participate in the web-based journal club. Conclusion. Participation in a web-based journal club provided professional benefits to participants and their mentors that extended beyond the presentation itself. Interaction with the organization through this experience may have encouraged these individuals to maintain their professional involvement in the organization after the web-based journal club experience was completed. Other professional organizations may benefit from implementation of a similar web-based journal club.
Providing adequate analgesia during burn wound care is essential to patient-centered care. Both oral and intravenous (IV) ketamine are often used for analgesia and sedation. Ketamine may improve analgesia and decrease opioid requirements for burn wound care. Oral ketamine wafers and tablets have been used as a safe alternative internationally but are unavailable in the United States. The purpose of this study was to compare opioid usage and patient satisfaction scores in patients with and without the use of oral injectable ketamine for burn wound care, with each patient serving as their own control. Ketamine, opioid, and benzodiazepine dosages recorded during dressing changes were compared to dressing changes without ketamine use that occurred before and after ketamine-associated sessions in each patient. Fourteen patients received oral ketamine at a median (interquartile range [IQR]) dose of 2.5 (2.2-2.7) mg/kg. Ketamine use significantly decreased opioid requirements when compared to wound care sessions that did not use ketamine both before (50 [IQR: 30-75] mg vs 75 [IQR: 46–91] mg median IV morphine equivalents, P = .0097) and after (50 [IQR: 30-75] mg vs 63 [IQR: 50-96] mg median IV morphine equivalents, P = .0042) the ketamine-associated sessions. One patient experienced hallucinations, and no adverse events were observed. Hence, oral administration of injectable ketamine was associated with a decrease in opioid requirements during dressing changes. Additionally, ketamine use improved patient satisfaction ( P = .0034). Preliminary data suggest this promising analgesia method is safe and effective for burn wound care.
Background Delirium occurs frequently in critically ill and injured patients and is associated with significant morbidity and mortality. Limited data exists on the risk factors for developing delirium in critically ill trauma patients and the effect of antipsychotic (AP) medications on delirium progression. Objective The objective of this study is to determine the incidence of delirium in critically ill trauma versus non-trauma surgical patients and determine if the presence of trauma was associated with intensive care unit (ICU) delirium. Secondary outcomes included identifying risk factors for delirium and determining the impact of AP medication use on delirium progression in critically ill trauma patients. Methods This retrospective review studies adult trauma/surgical ICU patients admitted between May 2017-July 2018 to a level I trauma and tertiary referral center. Regression modeling was used to determine the impact of AP use on delirium-free days. Results Delirium was more common in critically ill trauma patients versus non-trauma surgical ICU patients [54/157 (34.4%) vs 42/270 (15.6%), P < .001]. Of the 54 trauma patients with delirium, 28 (52%) received an AP medication for delirium treatment and in the multiple linear regression analysis, AP use was significantly associated with fewer delirium-free days ( P = .02). Discussion Higher admission sequential organ failure assessment scores and increased length of stay were significantly associated with delirium onset in critically ill trauma patients. Use of AP medications for delirium treatment in this population had a negative impact on delirium-free days.
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