Characteristics, ICU Interventions, and Clinical Outcomes of Patients With Palliative Care Triggers in a Mixed Community-Based Intensive Care Unit.

Objective: Integration of palliative care initiatives in the intensive care unit (ICU) benefit patients and improve outcomes. Palliative care triggers (PCTs) is a screening tool that aides in stratifying patients who would benefit most from an early palliative care approach. There is no consensus on PCT selection or best timing for implementation. We evaluated the clinical characteristics, ICU and palliative care interventions, and clinical outcomes of critically ill patients with PCT in a community-based mixed ICU. Methods: This retrospective study was conducted in a 44-bed adult, mixed ICU in a 407-bed community-based teaching hospital in Florida. Eleven PCTs were used as a screening tool during multidisciplinary rounds (MDRs). Patients were analyzed based on presence or absence of PCT as well as having met high (>2) versus low (<2) PCT. Data collected included patient demographics, ICU resource utilization and clinical outcomes. We considered a two-sided P value of less than .05 to indicate statistical significance with a 95% confidence interval. Results: Of 388 ICU patients, 189 (48.7%) met at least 1 PCT and 199 (51.3%) did not. The trigger group had higher Acute Physiology and Chronic Evaluation (APACHE) and Sequential Organ Failure Assessment (SOFA) scores within 24 h of ICU admission. The most common PCTs identified were ICU length of stay greater than 7 days or readmission to ICU, terminal prognosis and assisting family in transitioning goals of care. There were statistically significant differences in ICU resource utilization, palliative care interventions, and overall worse clinical outcomes in the trigger-detected group. Similar findings were seen in the cohort with high PCT (>2). Conclusions: Our study supports the implementation of a tailored 11-item palliative care screening tool to effectively identify ICU patients with high ICU and palliative care interventions and worse clinical outcomes.

Persistence and Dropout in Higher Online Education: Review and Categorization of Factors.

Online learning is becoming more popular with the maturity of social and educational technologies. In the COVID-19 era, it has become one of the most utilized ways to continue academic pursuits. Despite the ease and benefits offered by online classes, their completion rates are surprisingly low. Although several past studies focused on online dropout rates, institutions and course providers are still searching for a solution to this alarming problem. It is mainly because the previous studies have used divergent frameworks and approaches. Based on empirical research since 2001, this study presents a comprehensive review of factors by synthesizing them into a logically cohesive and integrative framework. Using different combinations of terms related to persistence and dropout, the authors explored various databases to form a pool of past research on the subject. This collection was also enhanced using the snowball approach. The authors only selected empirical, peer-reviewed, and contextually relevant studies, shortlisting them by reading through the abstracts. The Constant Comparative Method (CCM) seems ideal for this research. The authors employed axial coding to explore the relationships among factors, and selective coding helped identify the core categories. The categorical arrangement of factors will give researchers valuable insights into the combined effects of factors that impact persistence and dropout decisions. It will also direct future research to critically examine the relationships among factors and suggest improvements by validating them empirically. We anticipate that this research will enable future researchers to apply the results in different scenarios and contexts related to online learning.

Physicians' Emotional Intelligence: Improving Performance While Reducing Burnout.

Description Today's physicians are being confronted with an increasing number of challenges and opportunities as our evolving healthcare system progresses into the future. The expectation is not only to provide the best clinical care, but also to satisfy metrics, fulfill budgets, achieve high patient satisfaction levels and accomplish institutional requirements in order to be considered good providers. All these additional demands seem to be affecting not only the clinical performance of physicians but also their wellness, increasing the risk of burnout, depression and suicide.

Inappropriate Shock from Subcutaneous Implantable Cardioverter-Defibrillator Caused by Electrical Remodeling After Wolff-Parkinson-White Ablation.

Hypertrophic cardiomyopathy (HCM) and Wolff-Parkinson-White syndrome have been associated with sudden cardiac death. A subcutaneous implantable cardioverter-defibrillator (S-ICD) is an effective device used to reduce the risk of sudden cardiac death in these patients. The most common cause of inappropriate shocks with S-ICD is T-wave oversensing. We present the case of a 19-year-old man with repeated shocks from his S-ICD. This case highlights some of the sensing issues related to the S-ICD that can result in inappropriate shocks. A vector change may have occurred after T-wave remodeling, post accessory pathway ablation, and loss of R-waves due to HCM scar progression, leading to this consequence.