Fasting our patients in the critical care unit. How can we get it right?

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Ella Segaran, Advanced dietitian for Critical Care, Imperial College Healthcare NHS Trust and Chair of the NAHP committee of the ICS, considers barriers to achieving nutritional targets in critical care and proposes some solutions.

On average critically ill patients only receive 50-60% of their nutritional target. As a critical care dietitian this causes me considerable frustration. I perform a detailed nutritional assessment, develop a feeding plan only to find the system is working against me. Underfeeding is associated with more infections and longer ICU and hospital stay. We know if we get it right and achieve more than 80% of the target we decrease mortality and ventilator days.

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Using a Winston Churchill Memorial Trust Travelling Fellowship for critical care research – Applications open for 2018

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by Joanne McPeake

In 2011, I was a Staff Nurse in critical care in Glasgow, and a Lecturer Practitioner at the University of Glasgow. I first heard about the Travelling Fellowships through a list of openings advertised by the university. I felt that this could be a fantastic opportunity for me so I decided to apply. I was elated when I found out my application had been successful. I discovered after the interview that about 1,000 people had applied, so I definitely didn’t expect to be chosen!

For my Fellowship, I went to the USA for four weeks. The broad aims of my project were to look at how to improve outcomes for patients recovering from a period of critical illness. I visited several Intensive Care Units (ICUs), exploring the use of various techniques to improve short and long-term outcomes for patients.

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In Search of the Intensive Care “Pessimist”

 

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By Peter Brindley

In spring I wrote in this venerable blog about travelling to India and hoping to see the elusive tiger 1.  In summer I subsequently came to Britain expecting to see nothing but ICU pessimists. I saw lots of Indian tigers; I met very few true British pessimists. Despite a UK summer that could be remembered for bombs, knives, fires and anger, your lovely country has endured, despite being injured.  Like much of the world, you have a political and healthcare system seemingly tailor-made to produce burnout and despondency. However, while many of you are “down”, you are definitely, and defiantly, not “out”. Continue reading “In Search of the Intensive Care “Pessimist””

The ARCP, – “if only i knew what i was supposed to do” – a tirade, and a request to my fellow trainees…

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by Jamie Strachan

The Annual Review of Competency Progression (ARCP) season has just passed for many trainees in Intensive Care Medicine in the UK, and we are at the start of a new academic year.  Those that sail through with an outcome 1 (ready to progress to the next year) breathe a sigh of relief, but those with any other outcome, for example an outcome 5,  need to provide more evidence and may feel despondent – “I didn’t know I had to have that paperwork in that place”…

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The Medical Training Initiative – a personal perspective.

The Medical Training Initiative enables overseas graduates to come to the UK for experience in intensive care. In small and large units with posts and training capacity the scheme can be mutually beneficial. Dr David Odaba, currently working at the Cumberland Infirmary in Carlisle, gives us his view on the application process and the benefit of the experience he gained. – Jeremy Groves

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What is the Medical Training Initiative?

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by Jon Sturman,

Clinical Director of Critical Care, North Cumbria.

MTI stands for Medical Training Initiative and is one way of allowing overseas doctors access to training in the UK. Applicants should have at least 3 years’ postgraduate clinical training and possess a postgraduate medical qualification – see MTI sections in the RCOA and RCP websites for more information on this. Application is facilitated by the Colleges to help with GMC registration and hospital trusts’ sponsorship on a tier 5 (2 year) visa.

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Critical Care Recovery – a new patient support website

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by Dr Pam Ramsay

Post Doctoral Research Fellow, Edinburgh Medical School

Critical Care Recovery is a website to support patients and families in and after Intensive Care. The website can be customised for your own ICU or region. 

What’s the website for? This innovative website is a one-stop shop providing information, advice and support for ICU patients and their families. It’s the outcome of 10 years’ interview-based research with patients, and 5 years’ development, evaluation and quality improvement. It’s ideally placed to address a top research priority of the James Lind Alliance & ICS. To “support to help patients start living at home again”.

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Mediating conflict between health professionals, patients and families: It’s all about the human stuff.

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Sarah Barclay, Founder/Director, The Medical Mediation Foundation.

Conflict between patients, families and health professionals is upsetting for all and can affect decision-making about medical care and treatment. All too often the warning signs are missed.  This can lead to a breakdown of relationships that may end up in court. Although recourse to the courts will lead to a decision, there are inevitably perceived to be winners and losers. Complex, often agonising dilemmas for families, patients and health professionals are portrayed (and felt) as battles.

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Hospital Politics

Reporters: M Beed, G Suntharalingam, P Brindley

As results came in, it became clear that asking hospital staff for their opinion had backfired. Ms May, from the orthopaedic wing of the party, has been accused of fighting a lacklustre campaign, and there are calls for her to resign as Chief Surgeon. Ms May has taken responsibility and has sought support from eight little-known staff Anaesthetists Continue reading “Hospital Politics”