Critical Care Alert – July 1, 2003

July 1, 2003

• Blood Cultures Drawn From Central vs Peripheral Lines: Does it Matter?

  This study of blood culture draw sites in febrile ICU patients found that it is safe and reliable to obtain at least 1 of the blood cultures from a central venous catheter, irrespective of the type of catheter in place.

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• Cardiac Troponins in Pulmonary Embolism

  In patients with pulmonary embolism, elevated plasma levels of cardiac troponins help to identify a subgroup of patients who are at high risk and who may benefit from more aggressive treatment.

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• Special Feature: Adrenal Insufficiency in Critically Ill Patients

  In 1936 Selye noted that rats exposed to stressors had enlarged adrenal glands. In the late 1940s, Kendall and Reichstein isolated cortisone as the active principle of the adrenal glands. In more recent years our understanding of the hypothalamic-pituitary-axis has grown immensely.

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• Critical Care Plus: Bill for as Much Critical Care as You Deliver, Consultant Says

  Many ICU physicians dont get the reimbursement they deserve because they quit billing for critical care too soon, says consultant Frank Lucas, who has performed chart audits based on payer mix and midnight census of 100-150 records to assess potential revenues for more than 35 ICUs.

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• Critical Care Plus: Denver ICU Maintains Sedative Cost Savings

  The initial 80% savings rate that Denvers Centura-St. Anthony Central Hospital realized through standardizing a formulary for ICU sedative drugs has held firm for more than four years, according to medical director Joseph Heit, MD.

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• Critical Care Plus: Survey Tool Measures Quality, Satisfaction with End-of-Life Care

  Developing a research survey instrument is a lengthy and complicated process, says Daniel P. Sulmasy, OFM, MD, PhD, of the John J. Conley Department of Ethics at Saint Vincents Hospital in Manhattan. Sulmasy and several colleagues spent five years developing an instrument that elicits ratings of quality and satisfaction with care from medical inpatients, especially those near the end of life.

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• Critical Briefs in Primary Care Supplement

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• Pharmacology Watch: HRT, Estrogen, and Postmenopausal Women: Year-Old WHI Study Continues to Raise Questions

  The Women's Health Initiatives (WHI) was halted 1 year ago, but fallout from this landmark study continues. The study was designed to identify the risks or benefits of estrogen plus progesterone vs placebo in healthy postmenopausal women.

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