Major Publications in the Critical Care Pharmacotherapy Literature: 2023.

OBJECTIVES: We aimed to summarize the most significant and impactful publications describing the pharmacotherapeutic care of critically ill patients in 2023. DATA SOURCES: PubMed/MEDLINE and the Clinical Pharmacy and Pharmacology Pharmacotherapy Literature Update. STUDY SELECTION: Randomized controlled trials and prospective studies of adult critically ill patients assessing a pharmacotherapeutic intervention and reporting clinical endpoints published between January 1, 2023, and December 31, 2023, were eligible for inclusion in this article. DATA EXTRACTION: Articles from a systematic search and the Clinical Pharmacy and Pharmacology Pharmacotherapy Literature Update were included. An a priori defined three-round modified Delphi process was employed to achieve consensus on the most impactful publications based on the following considerations: 1) overall contribution to scientific knowledge and 2) novelty to the literature. DATA SYNTHESIS: The systematic search and Clinical Pharmacy and Pharmacology Pharmacotherapy Literature Update returned a total of 1202 articles, of which 1164 were excluded. The remaining 38 articles underwent a three-round modified Delphi process. In each round, articles were independently scored based on overall contribution to scientific knowledge and novelty to the literature. Included articles are summarized and their impact discussed. Article topics included hydrocortisone for severe community-acquired pneumonia, inhaled amikacin for prevention of ventilator-associated pneumonia, methylene blue for septic shock, restrictive vs. liberal fluid management for sepsis-induced hypotension, andexanet alfa for major bleeding associated with factor Xa inhibitors, and early administration of four-factor prothrombin complex concentrate in patients with trauma at risk for massive transfusion. CONCLUSIONS: This review provides a summary and perspective on the potential impact of the most relevant articles in 2023 describing advances in the pharmacotherapeutic care of critically ill patients.

European citizens' use of E-health services: a study of seven countries.

BACKGROUND: European citizens are increasingly being offered Internet health services. This study investigated patterns of health-related Internet use, its consequences, and citizens' expectations about their doctors' provision of e-health services. METHODS: Representative samples were obtained from the general populations in Norway, Denmark, Germany, Greece, Poland, Portugal and Latvia. The total sample consisted of 7934 respondents. Interviews were conducted by telephone. RESULTS: 44 % of the total sample, 71 % of the Internet users, had used the Internet for health purposes. Factors that positively affected the use of Internet for health purposes were youth, higher education, white-collar or no paid job, visits to the GP during the past year, long-term illness or disabilities, and a subjective assessment of one's own health as good. Women were the most active health users among those who were online. One in four of the respondents used the Internet to prepare for or follow up doctors' appointments. Feeling reassured after using the Internet for health purposes was twice as common as experiencing anxieties. When choosing a new doctor, more than a third of the sample rated the provision of e-health services as important. CONCLUSION: The users of Internet health services differ from the general population when it comes to health and demographic variables. The most common way to use the Internet in health matters is to read information, second comes using the net to decide whether to see a doctor and to prepare for and follow up on doctors' appointments. Hence, health-related use of the Internet does affect patients' use of other health services, but it would appear to supplement rather than to replace other health services.

Preventing hospital-acquired venous thromboembolism: Improving patient safety with interdisciplinary teamwork, quality improvement analytics, and data transparency.

BACKGROUND: Hospital-acquired venous thromboembolism (HA-VTE) is a potentially preventable cause of morbidity and mortality. Despite high rates of venous thromboembolism (VTE) prophylaxis in accordance with an institutional guideline, VTE remains the most common hospital-acquired condition in our institution. OBJECTIVE: To improve the safety of all hospitalized patients, examine current VTE prevention practices, identify opportunities for improvement, and decrease rates of HA-VTE. DESIGN: Pre/post assessment. SETTING/PATIENTS: Urban academic tertiary referral center, level 1 trauma center, safety net hospital; all patients. INTERVENTION: We formed a multidisciplinary VTE task force to review all HA-VTE events, assess prevention practices relative to evidence-based institutional guidelines, and identify improvement opportunities. The task force developed an electronic tool to facilitate efficient VTE event review and designed decision-support and reporting tools, now integrated into the electronic health record, to bring optimal VTE prevention practices to the point of care. Performance is shared transparently across the institution. MEASUREMENTS: Harborview benchmarks process and outcome performance, including patient safety indicators and core measures, against hospitals nationally using Hospital Compare and Vizient data. RESULTS: Our program has resulted in >90% guideline-adherent VTE prevention and zero preventable HA-VTEs. Initiatives have resulted in a 15% decrease in HA-VTE and a 21% reduction in postoperative VTE. CONCLUSIONS: Keys to success include the multidisciplinary approach, clinical roles of task force members, senior leadership support, and use of quality improvement analytics for retrospective review, prospective reporting, and performance transparency. Ongoing task force collaboration with frontline providers is critical to sustained improvements. Journal of Hospital Medicine 2016;11:S38-S43. © 2016 Society of Hospital Medicine.

Use and perception of internet for health related purposes in Germany: results of a national survey.

OBJECTIVES: Patient empowerment through the Internet is seen as a chance to improve patient-physician communication. Studies on the prevalence of Internet use for health related purposes and on how patients perceive those technologies are still rare. We therefore studied perception of and trends in health related Internet use. METHODS: As part of a European survey 1.000 German individuals were interviewed using a computer-based telephone interview (CATI: Gabler-Hider-Design, random-digit-dialing, last birthday method) in October 2005. Descriptive statistics and logistic regression models were applied for elaborating characteristics of the health Internet users. RESULTS: Internet use in general (72.3%) and for health related purposes (53.1%) is already quite high. Its importance, relative to other sources of health related information, was rated rather low. Younger citizens and people with paid work used the Internet more often for health related purposes, nevertheless, assessing it as less important for health related purposes than their counterparts. CONCLUSION: Despite booming of Internet use in Germany, consumers still value and use more the traditional sources of health information/communication with their doctors. Followup studies with a subsequent survey in 2007 will be pursued.

German healthcare consumer's perception of the Internet as a source of health related information.

OBJECTIVE: To determine the extent to which German health-care consumers seek health related information on line and their perceived importance of the internet, as compared to other sources of health information. RESEARCH DESIGN: Computer-assisted telephone interviews through which surveys were conducted concomitantly in seven European countries, including Germany. The instrument of the survey was a questionnaire designed in English and subsequently translated in German using a dual focus approach. SUBJECTS: A household sample generated by random digit dialling, including 934 individuals (age 15-80. OUTCOME: Internet was used by 675 (72.1%) respondents, 73.5% of whom (53.2% of the total sample) looked for health related information. The importance of internet was rated rather low in comparison with other sources of health related information, while direct contact with healthcare professionals was deemed the most important source of health information by all socio-demographic groups considered, regardless of whether they used the internet or not.