Development of a web-based, specialty specific portfolio.

BACKGROUND: This article illustrates the creation of a specialty specific portfolio that can be used by several different residency programs to document resident competence during a given rotation. METHODS: Three different disciplines (anesthesiology, surgery and medicine) worked together to create a critical care medicine portfolio. We began by reviewing the curriculum requirements for critical care medicine and organized these requirements into the six ACGME core competencies. We then developed learner led exercises in each core competency that were specific to critical care. Each exercise includes assessment of resident knowledge and application, an evaluation of the exercise, a learner self-assessment of skill, and a review of performance by a faculty member. Portfolio entries are highlighted in a multi-disciplinary weekly conference and posted on a critical care web site at our University. CONCLUSIONS: Creation of specialty specific portfolio reduces redundancy between disciplines, allows for increased time to be spent on the development of exercises specific to rotation objectives, and aids program directors in the collection of portfolio entries for each resident over the course of a residency.

Mitochondrial disease: a pulmonary and critical-care medicine perspective.

The clinical spectrum of mitochondrial diseases has expanded dramatically in the last decade. Abnormalities of mitochondrial function are now thought to participate in a number of common adult diseases, ranging from exercise intolerance to aging. This review outlines the common presentations of mitochondrial disease in ICUs and in the outpatient setting and discusses current diagnostic and therapeutic options as they pertain to the pulmonary and critical-care physician.

Management of myxedematous respiratory failure: review of ventilation and weaning principles.

Respiratory failure in myxedema is a complex medical emergency and may require prolonged ventilatory assistance. Appropriate management of this medical problem requires an understanding of its effects on the central nervous system and peripheral neuromusculoskeletal system. Weaning of these patients can be very protracted and requires a diligent multidisciplinary approach. Because of its infrequency, ventilatory management of severe hypothyroidism has not been studied in a controlled fashion. The first part of this review discusses the mechanisms of respiratory failure in myxedema. The second part explores strategies in mechanical ventilation and weaning of myxedematous patients.