Dr. Needham is Professor of Pulmonary and Critical Care Medicine, and of Physical Medicine and Rehabilitation at the Johns Hopkins University in Baltimore, USA. He is Director of the “Outcomes After Critical Illness and Surgery” (OACIS) Research Group and core faculty with the Armstrong Institute for Patient Safety and Quality, both at Johns Hopkins. From a clinical perspective, he is an attending physician in the medical intensive care unit at Johns Hopkins Hospital and Medical Director of the Johns Hopkins Critical Care Physical Medicine and Rehabilitation program.
Dr. Needham received his MD degree from McMaster University in Hamilton, Canada, and completed both his residency in internal medicine and his fellowship in critical care medicine at the University of Toronto. He obtained his PhD in Clinical Investigation from the Bloomberg School of Public Health at Johns Hopkins University. Notably, prior to his medical training, he completed Bachelor and Master degrees in Accounting and practiced in a large international accounting firm, with a focus in the health care field.
Dr. Needham is Principal Investigator on a number of NIH research grants and has authored more than 250 publications. His research interests include evaluating and improving ICU patients’ long-term physical, cognitive and mental health outcomes, including research in the areas of sedation, delirium, early physical rehabilitation, and knowledge translation and quality improvement.
A – Assess, Prevent and Manage Pain
B – Both SATs and SBTs
C – Choice of Sedation
D – Delirium: Assess, Prevent and Manage
E – Early Mobility and Exercise
F – Family Engagement and Empowerment
*www.iculiberation.org
A – Assess, Prevent and Manage Pain
B – Both SATs and SBTs
C – Choice of Sedation
D – Delirium: Assess, Prevent and Manage
E – Early Mobility and Exercise
F – Family Engagement and Empowerment
*www.iculiberation.org
The term inotropic state is most commonly used in reference to various drugs that affect the strength of contraction of heart muscle (myocardial contractility). However, it can also refer to pathological conditions. For example, enlarged heart muscle (ventricular hypertrophy) can increase inotropic state, whereas dead heart muscle (myocardial infarction) can decrease it.
Antibiotics in the ICU - when, what and how?scanFOAM
A presentation by Fredrik Sjövall at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
The term inotropic state is most commonly used in reference to various drugs that affect the strength of contraction of heart muscle (myocardial contractility). However, it can also refer to pathological conditions. For example, enlarged heart muscle (ventricular hypertrophy) can increase inotropic state, whereas dead heart muscle (myocardial infarction) can decrease it.
Antibiotics in the ICU - when, what and how?scanFOAM
A presentation by Fredrik Sjövall at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
Lessons from the TTM trial and planning for the nexstscanFOAM
A presentation by Niklas Nielsen, Tobias Cronberg and Gisela Lilja at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
The good news in resuscitation is that there have not been any new advances that mandate a change in practice since the 2016 ANZCOR Guidelines. The bad news is that despite our best intent, the ever-increasing research appears unable to demonstrate improved outcomes with any particular approach. Two of the most exciting areas (eCPR and post-resuscitation care) are being covered in detail at separate talks at this meeting. This presentation will focus on updating the audience on the more continuous approach to evidence evaluation, and the key recent publications that have made us at least re-evaluate our practices in BLS (including ventilation), ALS (including anti-arrhythmics) and peri-resuscitation care.
University of Utah Health Orthopaedics Patient Education Reduces Discharge to...University of Utah
The joint replacement team—Drs. Pelt, Gililland, Peters, PA Jill Erickson, and clinic manager Piper Ferrell—explain why going home after a joint replacement is better than going to a post-acute care facility. Their data shows that going home means better value for the patient: a healthier recovery at a lower cost.
University of Utah Health Orthopaedic Center Patient Education PresentationUniversity of Utah
The joint replacement team—Drs. Pelt, Gililland, Peters, PA Jill Erickson, and clinic manager Piper Ferrell—explain why going home after a joint replacement is better than going to a post-acute care facility. Their data shows that going home means better value for the patient: a healthier recovery at a lower cost. This presentation, "Patient Education Reduces Both Discharge to Post-Acute Care Facilities and Postoperative Complications," outlines the process.
PARAMEDIC-2: A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arr...Intensive Care Society
Gavin Perkins is Professor of Critical Care Medicine at the University of Warwick. He leads the emergency and critical care group within Warwick Clinical Trials Unit. He served as Chief Investigator for the BALTI, BALTI-prevention and PARAMEDIC-1 (LUCAS) trial and is currently Chief Investigator for the PARAMEDIC-2 (Adrenaline) and Breathe Trials. Clinically he holds appointments as a Consultant Physician in Critical Care Medicine at Heart of England NHS Foundation Trust and MERIT Team Consultant with West Midlands Ambulance Service. Prof Perkins is a Director of Research for the Intensive Care Foundation and Clinical Speciality Lead for Critical Care (West Midlands CRN), Division 6 Clinical Research Lead (West Midlands CRN). He has been a member (2000-10) and then chairman (2010-present) of the ALS Sub-committee during which time he developed, evaluated and implemented the e-ALS course. He has served as ILCOR and ERC Co-chair for BLS/AED since 2010. In these roles he has developed collaborative networks with international partners and co-ordinated the revision to the 2015 Utstein cardiac arrest template. He was elected as ILCOR Co-chair in 2015.
Brian Cuthbertson is Chief of the Department of Critical Care Medicine at Sunnybrook Health Sciences Centre and Professor in the Interdepartmental Division of Critical Care Medicine at the University of Toronto. He is also an Honorary Professor of Critical Care Medicine at the University of Aberdeen and an Honorary Professorial Fellow at the George Institute of Global Health in Sydney. His research interests include improving outcomes from critical illness and major surgery. He has over 100 peer-reviewed publications and $10million of research grants as well as playing a leading role in a number of key clinical guidelines.
Obstetric Early Warning scores – the 4 P’s study - Peter WatkinsonIntensive Care Society
Dr Peter Watkinson, Associate Professor of Intensive Care Medicine, is joint clinical lead for the Critical Care Research Group based at the Kadoorie Centre for Critical Care Research & Education at the John Radcliffe Hospital, Oxford.
He is an NHS consultant in intensive care and acute medicine and is part of the senior clinical team at the Oxford University Hospitals NHS Foundation Trust. His research interests focus on the identification of the deteriorating patient in hospital and he has designed and run a number of studies in the field of wearable monitoring devices. The research group is now exploring the opportunities offered through non-contact monitoring and standard electronically-recorded descriptors of a patient’s condition.
The research group has a strong link with the University of Oxford Institute of Biomedical Engineering. Using data collected from thousands of patients’ vital signs in Oxford and elsewhere the multi-disciplinary team investigates ways to locate patterns which precede and predict clinical deterioration in hospitalised patients.
Other areas of interest for the research group include development of electronic monitoring systems, use of human factors techniques to introduce new technology into the healthcare environment, and assessing the longer-term effects of critical illnesses on patients’ quality of life.
Enhanced Maternal Care – The Yorkshire & Humber experience - Sarah WinfieldIntensive Care Society
I work as a Consultant Obstetrician and am based at Leeds General Infirmary. I have a special interest in maternal medicine and high risk obstetrics and I run the Obstetric Cardiac and Renal Service in this tertiary referral centre. I also work with the Diabetes team and am part of the twice weekly Diabetic Antenatal Clinic at St. James’s University Hospital. I see women with pre-existing medical conditions for pre-pregnancy counselling and I participate in the consultant on-call rota at LTHT.
I am the Yorkshire and Humber Clinical Network Clinical lead for maternity services and try to link this with my clinical role to optimise what can be achieved to improve maternity services for women and their families in Yorkshire and Humber.
Mothers in Critical Care: learning from patients’ experiences & challenges to...Intensive Care Society
Dr Lisa Hinton is a medical sociologist, and leads applied research in the Health Experiences Research Group (HERG). Improving patient experience is a global priority for health policy makers and care providers. How research on patient and staff experiences can make a difference in these areas is at the core of her research interests.
Lisa has a portfolio of applied, mixed methods, social science research specialising primarily in women's health, in particular experiences of infertility, pregnancy, childbirth and neonatal care. She is also involved in several studies seeking to improve patient experiences in critical care.The role of digital technology in patient self-management and healthcare is another area of interest.
Lisa leads qualitative work developing and evaluating complex interventions and is currently working on two clinical trials of self-monitoring of blood pressure. One is studying the impact of SMBP during pregnancy and a second the impact of SMBP after a stroke or TIA (see Hypertension). She also leads a programme of work as part of the Oxford BRC's Partnerships for Health Wealth and Innovation theme exploring research participation and patient and public involvement.
Defence of physiological function during high risk airway management - Paul ...Intensive Care Society
Dr. Paul H. Mayo MD graduated from Cornell University Medical College and completed his postgraduate training at Roosevelt Hospital and Bellevue Hospital in New York City. He is presently a frontline intensivist in the Northwell System in the New York City area where he is academic director of critical care medicine and professor of clinical medicine at the Zucker School of Medicine at Hofstra/Northwell. He has strong interest in critical care ultrasonography and combined team training for critical care airway management. He has longstanding responsibility for the design and implementation of the national level courses on critical care ultrasonography sponsored by American Society of Chest Physicians.
INTEREST: Efficacy and Safety of FP-1201-lyo (Interferon Beta-1a) in Patients...Intensive Care Society
Geoff is a consultant in intensive care medicine (UCLH) and Reader in Intensive Care at UCL. He is the Hon secretary of the European Society of Intensive Care Medicine (ESICM) and is a member of the Critical Care Committee for the Royal College of Physicians and the research committee for the Intensive Care Society (ICS).
Geoff’s research interests are ARDS infection and the resolution of inflammation, having studied macrophage clearance then fibrosis in ARDS for his PhD and MRC clinician scientist fellowships respectively. Geoff has published widely on pathophysiology and clinical trials in acute lung injury and on MRSA. He is currently leading on the FP7 trial.
POPPI: Provision Of Psychological support to People in Intensive care - Kathy...Intensive Care Society
Kathy is founder and Director of ICNARC and works within a team of audit, research, IT and administrative staff. ICNARC’s aim is to facilitate improvements in the organisation and practise of critical care through a broad programme of audit and research.
In 2004, Kathy was awarded the Humphry Davy Medal by the Royal College of Anaesthetists as a mark of distinction for her significant contribution to critical care. More recently, Kathy completed a Harkness Fellowship in Health Care Policy in the USA (Nov 2004 to Oct 2005).
Kathy is an Honorary Professor in the Department of Public Health and Policy at the London School of Hygiene and Tropical Medicine.
Dr Gardiner is a Consultant in Adult Intensive Care Medicine at Nottingham University Hospitals NHS Trust, UK.
Through an interest in ethics, the diagnosis of death and deceased organ donation he has been a Clinical Lead for Organ Donation since 2009. In June 2018 he was appointed national Clinical Lead for NHS Blood and Transplant.
Dr Gardiner is chair of Nottingham’s Ethics of Clinical Practice Committee and co-chair in a European deceased donation ethics working group (ELPAT). He served for four years as a member of the UK Donation Ethics Committee until its closure in 2016
Alex is an Intensive Care specialist working in Wellington, having trained in London, Melbourne and New Zealand. He has been involved in the design and implementation of Rapid Response Systems in several different hospitals. Because of this, he is clinical lead for the New Zealand Health Quality & Safety Commission’s national ‘Deteriorating Patient’ programme. In his spare time, when not walking his dog or his children, he builds websites & designs logos for Wellington ICU’s prodigious research department. He has nearly written a lot more research papers & as such needs to spend less time on Twitter. He also once ventilated a chimpanzee but it didn’t end well (for the chimp).
AIRWAYS-2: Effect of a Strategy of a Supraglottic Airway Device vs Tracheal I...Intensive Care Society
Jerry is a consultant in anaesthesia and intensive care medicine at the Royal United Hospital, Bath and Honorary Professor of Resuscitation Medicine at the University of Bristol. He trained at Bristol Medical School (MB ChB 1983) and undertook anaesthesia and critical care training in Plymouth, Bristol, Bath and Southampton, and at the Shock Trauma Center, Baltimore in the United States. Jerry is Chair of the European Resuscitation Council (ERC), past Chair of the Resuscitation Council (UK), and the immediate past Co-Chair of the International Liaison Committee on Resuscitation (ILCOR). He received a Lifetime Achievement Award in Cardiac Resuscitation Science from the American Heart Association in 2016. Jerry is Editor-in-Chief of the journal Resuscitation. Jerry’s research interests are in cardiopulmonary resuscitation, airway management, and post-cardiac arrest treatment – he has authored over 300 original papers, reviews and editorials on these topics.
Cardiogenic shock, the poor relation of septic shock – are we missing a trick...Intensive Care Society
Dr Susanna Price trained in both cardiology and intensive care medicine in the UK, and completed a fellowship at the Thorax center with Jos Roelandt. She was awarded a PhD from Imperial College London, and following completion of her training was awarded the two-year BHF Jill Dando GUCH Fellowship in order to train further in critical care and imaging in congenital heart disease. She is a
consultant at the Royal Brompton Hospital where she is Clinical Lead for Critical Care, Honorary Senior Lecturer at National Heart & Lung Institute, Imperial College London.
Dr Price is President-elect of the European Society of Cardiology (ESC) Acute Cardiovascular Care Association, and sits on numerous committees including the ESC Education Committee, ESC Press & Media Committee, ALS subcommittee of the RCUK and SCCM US guideline committee. She is an Associate Editor of the European Heart Journal of Acute Cardiovascular Care, and an invited reviewer
for a number of other journals. She has been a member of a number of Task Forces relating to international guidelines including VA-ECMO, acute cardiovascular care, the management of cardiovascular diseases including valvular disease, endocarditis, non-cardiac surgery, pulmonary hypertension, pericardial disease, cardiovascular disease in pregnancy and grown-up congenital heart disease. Dr Price has authored numerous papers and book chapters on cardiology, echocardiography and intensive care, and lectures regularly globally
Marie Scully was appointed as a consultant at UCLH in 2007, with an interest in haemostasis and thrombosis. I am clinical lead for haematopathology and blood transfusion at UCLH. I am also the lead for TTP and associated TMAs, including aHUS. We are a specialist centre for TTP
Jim Down has been a consultant anaesthetist and Intensivist at University College Hospital London since 2005. He graduated from the NHS staff college leadership programme and was clinical lead for Critical care for 2 years, Divisional Clinical Director for 3 years and is currently Chair of the UCH Critical Care consultants
Rachael graduated from the University of Hertfordshire and after spending some time working for the British Army and London Hospitals settled at the Newcastle Upon Tyne NHS Foundation Trust in 2001. Rachael specialised in respiratory physiotherapy initially within cardiothoracic transplantation before moving into a rotational ICU Band 7 post. She developed a specialist interest in neuro-trauma and this role evolved to become the senior physiotherapy link within the North East long term ventilation team.
More recently Rachael was Respiratory Lead at St Georges Hospital, London managing a diverse team and specialities to now working in a new Consultant Physiotherapy post at Royal Preston Hospital. Rachael’s area of expertise include complex ventilation and weaning and advanced airway clearance techniques for which she lectures and presents both in the UK and internationally and at pre and post graduate level.
Rachael currently sits on BTS Council and the Critical Care Specialist Advisory Group representing AHPs, is an expert member of NHSE Patient Safety Group, AHP representative on the NIV NCEPOD study, Co-chair HMV-UK, Chair Respiratory Leaders in Physiotherapy UK, Board Member and Trustee St Catherines Hospice and most recently elected onto Physiotherapy Council.
Simon Carley is Professor of Emergency Medicine in Manchester, England. He is an active clinician at Manchester Royal Infirmary and the Royal Manchester Children’s Hospital. He has published over 100 papers in clinical journals with research interests in disaster medicine, diagnostics, evidence base medicine and medical education.
He has additional roles as associate editor of the Emergency Medicine Journal. As a co-founder and developer of the BestBets and St.Emlyn’s websites he has integrated web based learning into all levels of EM education.
He developed the StEmlyns Blog to share learning across the globe in the true spirit of #FOAM.
Alex is an Intensive Care specialist working in Wellington, having trained in London, Melbourne and New Zealand. He has been involved in the design and implementation of Rapid Response Systems in several different hospitals. Because of this, he is clinical lead for the New Zealand Health Quality & Safety Commission’s national ‘Deteriorating Patient’ programme. In his spare time, when not walking his dog or his children, he builds websites & designs logos for Wellington ICU’s prodigious research department. He has nearly written a lot more research papers & as such needs to spend less time on Twitter. He also once ventilated a chimpanzee but it didn’t end well (for the chimp).
Alastair Proudfoot is a general and cardiac intensivist at Barts Heart Centre. He has a clinical and research interest in the management of cardiogenic shock and both short term and durable mechanical circulatory support.
Emma Ridley, ANZIC-RC, Monash University and Alfred Health
Emma leads the ICU Nutrition Research Program at the Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia and has 13 years of clinical dietetic experience, including as a senior dietitian in the ICU at The Alfred Hospital, Melbourne. Emma’s research interests include the clinical application of indirect calorimetry, as well as the effect of optimal nutrition delivery on short and long-term outcomes in ICU patients. Emma was awarded a prestigious Churchill Fellowship in 2011 to investigate the role of indirect calorimetry internationally and regularly delivers invited national and international presentations. Emma is on the management committee for the TARGET trial (the largest blinded enteral nutrition trial conducted in critical care) and has been a named investigator on $6.2 million dollars of research funding, including a project based on findings from her PhD of $2.3 million dollars (NCT03292237).
Dr Murray is a Chartered and Registered Health Psychologist with an interest in social inequalities in health, wellbeing in medical students and doctors, and doctor patient communication. She has a long-standing interest in the wellbeing of healthcare professionals and since starting work at Barts and the London she has been developing her research in the area of moral injury. As well us undertaking research on this issue, she works with NHS staff to develop workshops and seminars which focus on psychological wellbeing and moral injury. Her early research was in chronic pain and its effect on doctor-patient communication and she has a background in psychological intervention in cardiac care and training NHS staff in communication skills. She Health Psychology to MBBS students and Physician Associates at Barts and she is course leader for the iBSc in Medical Education.
On the horizon: Critical Care and the Microbiome - Hallie PrescottIntensive Care Society
This is Hallie Prescott's presentation from the opening plenary session at the Intensive Care Society State of the Art Meeting 2018
Dr. Hallie Prescott is an Assistant Professor in Pulmonary & Critical Care Medicine at the University of Michigan and staff physician at the Ann Arbor Veterans Affairs Hospital. She leads grants on post sepsis morbidity and hospital performance measurement from the US National Institutes of Health and the US Department of Veteran’s Affairs. She is an expert in long-term outcomes and recovery after sepsis, with a focus on preventable hospital readmissions. She is co-chair of the Surviving Sepsis Campaign guidelines, inaugural Lowry-Fink fellow of the International Sepsis Forum (2017-2019), a former ANZICS Intensive Care Global Rising Star fellow (2015), and winner of the Early Career Achievement award from the American Thoracic Society’s Critical Care Assembly (2018).
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
The New 2018 SCCM PADIS Guidelines: Quick Hits of Recommendations for Sedation, Delirium and Mobility - Dale Needham
1. 1
The New 2018 SCCM PADIS Guidelines:
Quick Hits of Recommendations for
Sedation, Delirium and Mobility
Dale Needham, MD, PhD
Professor, Pulmonary & Critical Care, and Physical Medicine & Rehab
dale.needham@jhmi.edu
Twitter: @DrDaleNeedham @icurehab #icurehab
www.hopkinsmedicine.org/OACIS
2. Financial Disclosure/Conflict of Interest
• Reck Medical Devices & Baxter Healthcare agreed to lend
bedside cycle ergometers and provide amino acid
product/grant funding, respectively, for a NIH-funded RCT
of early exercise & nutrition in the ICU
• I was a member of SCCM PADIS Guideline committee, and
Chair of the Mobility/Rehab section of PADIS
Disclosure
3. Introduction
4
2018 Pain, Agitation/sedation, Delirium, Immobility, and
Sleep disruption (PADIS) guideline
• Updating 2013 PAD guidelines by:
– Adding 2 new topics: rehab/mobilization & sleep disruption
– Including patients as collaborators and co-authors
– Adding experts from Europe & Australia
• 37 recommendations & 2 ungraded good practice statements
• 2 of 37 recommendations, rated as “strong”
• 32 ungraded statements (non-actionable descriptive questions)
9. Choice of Sedative:
Medical & Surgical pts (Non cardiac surgery)
47
Question: For sedation in critically ill, mech ventilated adults…
Should Propofol, as compared to a Benzodiazepine, be used?
Should Dexmed, as compared to a Benzodiazepine, be used?
Should Dexmed, as compared to Propofol, be used?
10. Choice of Sedative:
Medical & Surgical pts (Non cardiac surgery)
49
Propofol vs. Benzodiazepine:
• Time to extubation (10 RCTs, 423 pts)
– Reduced by 11.6 hr (95% CI, -15.6 to -7.6; low quality)
• Time to light sedation (10 RCTs, 357 pts)
– Reduced by 7.2 hr (95% CI, -8.9 to -5.5; low quality)
Dexmed vs. Benzodiazepine (BZD):
• No significant benefit* of Dexmed over BZD infusion for:
– Duration of mechanical ventilation (5 RCT, 1052 pts)
– ICU length of stay (3 RCTs, 969 pts)
– Risk of delirium (4 RCTs, 1007 pts)
* SEDCOM RCT had lowest ROB & significant decrease extubation time (1.9 d)
and delirium (RR 0.71) – influenced grading of recommendation
Dexmed vs. Propofol:
• No significant difference in time to extubation (3 RCTs, 850 pts)
11. Recommendation …
51
Recommendation:
We suggest using either propofol or dexmedetomidine over
benzodiazepine for sedation in critically ill, mechanically
ventilated adults (conditional recommendation, low quality of
evidence).
NOTE in the existing studies for this recommendation:
− Benzodiazepines mostly given as infusion rather than bolus
13. Delirium pharmacological Prevention
68
Question:
Should a pharmacologic agent (versus no use of this agent) be
used to prevent delirium in critically ill adults?
Rationale: 3 RCTs, 1283 pts
Significant reduction in delirium incidence favoring the pharmacologic agent:
• Haloperidol* (457 pts), RR 0.66; 95% CI, 0.45 to 0.97; low quality
− *Update: REDUCE RCT (1789 pts): No effect on delirium or survival
• Risperidone (126 pts), RR 0.35; 95% CI, 0.16 to 0.77; low quality
• Dexmed** (700 pts), OR 0.35; 95% CI, 0.22 to 0.54; low quality
**Su et al Dexmed for prevention of delirium in elderly patients after non-cardiac surgery. Lancet 2016
low severity of illness; only surgical pts, assessing short-term outcomes; cost & side effects
14. Delirium pharmacological Prevention
69
Recommendation:
We suggest NOT using haloperidol, an atypical
antipsychotic, dexmedetomidine, statin, or ketamine to
prevent delirium in all critically ill adults (Conditional
recommendation, very low to low quality of evidence)
15. Haloperidol vs. No Medication (Treatment)
71
• Duration of Delirium (3 RCTs, 265 pts)
– NOT significant, Increased by 0.29 days (95% CI, -1.49 to 2.07)
• Duration of Mechanical Ventilation (2 RCT, 124 pts)
– Not significant, Reduced by 1.12 days (95% CI, -4.85 to 2.61)
• ICU Mortality (3 RCTs, 265 pts)
– NOT significant, RR 1.00 (95% CI, 0.62 to 1.61)
16. Atypical Antipsychotic vs. None (Treatment)
72
• Duration of Delirium (2 RCTs, 102 pts)
– NOT significant, Reduced by 0.87 days (95% CI, -6.70 to 4.97)
• Duration of Mechanical Ventilation (2 RCTs, 95 pts)
– NOT significant, Reduced by 0.34 days (95% CI, -6.54 to 5.86)
• Length of ICU Stay (2 RCTs, 102 pts)
– NOT significant, Increased by 1.93 days (95% CI, -1.17 to 5.68)
• ICU Mortality (2 RCT, 102 pts)
– NOT significant, RR 0.75 (95% CI, 0.29 to 1.96)
17. 73
Rationale, includes:
• Unnecessary continuation causes significant morbidity & cost
Recommendation:
We suggest NOT routinely using haloperidol and atypical
antipsychotic to treat delirium (conditional recommendation, low quality
of evidence).
Antipsychotic/statin vs. None (Treatment)
18. 75
Rationale: 1 RCT (71 pts)
• Significant increase in ventilator-free hours
– Mean Difference 17 hrs (95% CI, 4 to 33 hrs); very low quality
• NO effect on ICU/Hosp LOS or hospital discharge location
Recommendation:
We suggest using dexmedetomidine for delirium in mechanically
ventilated adults where agitation is precluding weaning/extubation
(conditional recommendation, low quality of evidence).
Dexmedetomidine vs. Placebo (Treatment)
19. 82
Rationale: 5 studies (1 RCT*, 4 Before-after), 1318 pts
• Use of these strategies was associated with:
– Reduced delirium significantly, OR=0.59 (95% CI, 0.39 to 0.88)
– Decreased ICU duration of delirium, ICU LOS & Hospital mortality
Recommendation:
We suggest using a multicomponent, non-pharmacologic
intervention that is focused on (but not limited to) reducing
modifiable risk factors for delirium, improving cognition, and
optimizing sleep, mobility, hearing, and vision in critically ill adults
(conditional recommendation, low quality of evidence)
Non-Pharmacological Treatment
Multi-component
*Int J Nurs Stud 2015; 52:1423–1432 (N=123 patients in Korea – no effect on delirium & LOS
20. Why add “Immobility” to PAD
(Rehabilitation/Mobilization)
84
• ICU-Acquired muscle Weakness (ICUAW)
– Present in 25-50% of critically ill patients
– Associated w/ long-term survival, physical function & quality of life
– Immobility/bed rest is an important risk factor
• Mobility/rehab also may be beneficial for delirium
• Assoc. of pain & sedation status/practices w/ ICU Rehab
• 1 actionable (PICO) question + 3 descriptive questions
21. Efficacy and Benefit
96
1. Muscle strength at ICU discharge (6 RCTs, 304 pt)
– Improved by 6.2 points (95% CI, 1.7 to 10.8; scale is 0 to 60)
– low quality (statistical heterogeneity, CI includes MCID)
2. Duration of mech. ventilation (11 RCTs, 1128 pt)
– Reduced by 1.3 days (95% CI, 2.4 to 0.2 days)
– low quality (2 large RCT high ROB, competing risk, heterogeneity)
3. Quality of life (SF-36 Physical function) w/ in 2 mo. (4 RCTs, 303 pt)
– Improved by SMD of 0.64 (95% CI, -0.05 to 1.34 – not significant)
4. Hospital mortality (13 RCTs, 1421 pt)
– No effect, RR=0.93 (95% CI, 0.74 to 1.18) – moderate quality (CI includes harm)
5. Physical func: small N d/t heterogeneity in measures; NOT significant
– Timed Up & Go test, mean dif 2.22 (95% CI, -4.99 to 9.43; 3 RCT, 172 pt)
– Phys Func. in ICU (PFIT) test, mean dif -0.19 (95% CI, -0.69 to 0.31; 3 RCT, 209 pt)
22. Recommendation …
99
Formal Recommendation:
We suggest performing rehabilitation or mobilization in critically
ill adults (conditional recommendation, low quality evidence).
• Implementation influenced by feasibility, staffing &
resources across ICUs
23. Safety and Risk
102
Question:
… is receiving rehab/mobilization (performed either in-bed or out-of-bed)
commonly associated with patient-related safety events or harm?
Ungraded Statement:
Serious safety events or harms do not occur commonly during
physical rehabilitation or mobilization.
• Rationale: 10 observational & 9 RCTs
– Serious safety events/harms were rare (15 during >12,200 sessions)
– Majority were respiratory-related (4 desaturation & 3 unplanned extubation)
24. Table 1. Safety criteria for start/stop rehab/mobilization (in-bed or out-of-bed)
105
Safety criteria Starting a Rehab/Mobility session Stopping a Rehab/Mobility session
System Start when ALL of the following are present: Stop when ANY of the following are present:
Cardiovascular ● Heart rate between 60 - 130 bpm
● Systolic B/P between 90 - 180 mmHg, or
● Mean arterial pressure between 60-100
● Heart rate decreases <60 or increases >130
● Systolic decreases <90 or increases >180
● MAP decreases <60 or increases >100
Respiratory ● Respiratory rate between 5 - 40 bpm
● SpO2 >=88%
● FiO2 <0.6 & PEEP <10 cmH2O
● Airway (ETT or trach) adequately secured
● Resp. rate decreases <5 or increases >40
● SpO2 decreases <88%
● Concerns re: securement of ETT or trach
Neurologic ● Able to open eyes to voice ● Change in LOC
Other The following should be absent:
● New or symptomatic arrhythmia
● Chest pain with concern for ischemia
● Unstable spinal injury or lesion
● Unstable fracture
● Active or uncontrolled GI bleed
Mobility may be performed with
● Femoral VAD, except sheath, in which hip
mobilization is generally avoided
● Continuous renal replacement therapy
● Vasoactive medication infusion
If following develop & clinically relevant:
● New/symptomatic arrhythmia
● Chest pain with concern for ischemia
● Ventilator asynchrony
● Fall
● Bleeding
● Medical device removal or malfunction
● Distress reported by patient or clinician
“… not be a substitute for clinical judgment”
“All thresholds should be interpreted or modified,
as needed, in the context of individual patients’
clinical symptoms, expected values, recent trends, and
any clinician-prescribed goals or targets.”
25. Publications related to the 2018 SCCM PADIS guidelines:
• PADIS Guidelines
• Executive Summary
• Interpreting & Implementing 2018 PADIS Guideline
• Methodologic Innovation in 2018 PADIS Guideline
Free access to publications & PADIS presentation:
http://www.sccm.org/ICULiberation/Guidelines
2018 SCCM