No abstract

Our results indicate a significant inflammatory response to implantation of the left ventricular assist device, a known effect. The magnitude of this response may be effectively and easily monitored over time using the neutrophil-to-lymphocyte ratio. In general, approximately 30 days is required for the neutrophil-to-lymphocyte ratio to return to preoperative levels. After several months, the neutrophil-to-lymphocyte ratio improves to below preoperative levels. It is possible that this reduction reflects the reversal of various heart failure-mediated inflammatory processes following left ventricular assist device implantation.

This prospective quasi-experimental study from the NASAM (National Approach to Standardize and Improve Mechanical Ventilation) collaborative assessed the impact of evidence-based practices including subglottic suctioning, daily assessment for spontaneous awakening trial (SAT), spontaneous breathing trial (SBT), head of bed elevation, and avoidance of neuromuscular blockers unless otherwise indicated. The study outcomes included VAE (primary) and intensive care unit (ICU) mortality. Changes in daily care process measures and outcomes were evaluated using repeated measures mixed modeling. The results were reported as incident rate ratio (IRR) for each additional month with 95% confidence interval (CI). A comprehensive program that included education on evidence-based practices for optimal care of mechanically ventilated patients with real-time benchmarking of daily care process measures to drive improvement in forty-two ICUs from 26 hospitals in Saudi Arabia (>27,000 days of observation). Compliance with subglottic suctioning, SAT and SBT increased monthly during the project by 3.5%, 2.1% and 1.9%, respectively (IRR 1.035, 95%CI 1.007–1.064, p = 0.0148; 1.021, 95% CI 1.010–1.032, p = 0.0003; and 1.019, 95%CI 1.009–1.029, p = 0.0001, respectively). The use of neuromuscular blockers decreased monthly by 2.5% (IRR 0.975, 95%CI 0.953–0.998, p = 0.0341). The compliance with head of bed elevation was high at baseline and did not change over time. Based on data for 83153 ventilator days, VAE rate was 15.2/1000 ventilator day (95%CI 12.6–18.1) at baseline and did not change during the project (IRR 1.019, 95%CI 0.985–1.053, p = 0.2812). Based on data for 8523 patients; the mortality was 30.4% (95%CI 27.4–33.6) at baseline, and decreased monthly during the project by 1.6% (IRR 0.984, 95%CI 0.973–0.996, p = 0.0067). A national quality improvement collaborative was associated with improvements in daily care processes. These changes were associated with a reduction in mortality but not VAEs. Registration The study is registered in clinicaltrials.gov (NCT03790150).

Purpose: Concerns over burnout and other factors may influence whether students pursue hospital medicine as a career. We investigate whether there are certain predictive factors that ultimately play a role in medical students' career interest in hospital medicine. Methods:In January 2011, 960 third-year medical students from 24 U.S. allopathic medical schools were surveyed at baseline, and six to nine months later when they became fourth-years at follow-up. Hospitalist-oriented students were categorized as those students who indicated interest in the specialties of family medicine, internal medicine, or pediatrics, and who indicated that they were "very likely" or "somewhat likely" to become a hospitalist. Respondents were also asked to respond to a list of seven factors that potentially influenced their specialty choice.Results: Adjusted response rate for the fourth-year survey was 50% (n=463/919). Medical students considering hospitalist careers were more likely to report that perceived burnout between various specialties played an important influential role in their specialty decisionmaking (49.7% [42.2-57.2%], vs. non-hospitalists 39.9% [32.8-47.0%], P=0.03).Conclusions: Given that students are reporting burnout as a factor in their decision-making in favor of hospitalist careers, further studies are needed to explore what aspects of a hospitalist career are appealing to students.