The Beginning of the End?

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Dr Gary Masterson, President of the Society, reflects on how changes in the way critical care is commissioned may impact on critical care bed provision.

There have always been (and always will be) bed pressures in critical care. I don’t know about you, but I find this the most stressful aspect of my job. However, over the last 20 years of my working life as a consultant, when I have had the misfortune of stumping around my hospital’s general wards, I am always extremely glad to return home to my critical care unit. The general wards struggle: they’re jam-packed with elderly and frail patients with nowhere else to go, grossly understaffed, chaotic and little in the way of continuity of care. You know what I mean. In critical care, we don’t suffer these problems to the same extent and, since the advent of critical care networks and a more regional approach to managing critical care beds, we can usually cope when bed are short.

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The press, medical information, ethics and money

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Jeremy Groves reflects on some of the wider issues arising from the tragic case of Charlie Gard.

I have already written about something the adult critical care community can take away from the tragic case of Charlie Gard; however, I think there are several other issues that we can mull over.  Charlie and his parents’ plight captured the public’s attention and everyone had a view, as I discussed before, informed or otherwise.  To me it was striking how much of the discussion, and presentation of clinical information, took place in the press.

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Life support for critical care staff

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Dr Linda Jayne Mottram, Intensive Care Consultant at Belfast HSC Hospital discusses the crucial importance of maintaining clinicians mental wellbeing in the current medical culture.

Basic life support algorithms start with the premise that clinicians check for danger before approaching the patient.  The rationale being that if you are injured by something in the environment, you will be of little practical use to a patient in extremis.   The same logic applies to scene safety in prehospital medicine. No one questions your commitment to the patient by protecting yourself first, because it makes common sense to do so.  You have to be free from injury in order to provide any meaningful assistance.

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Rehabilitation after critical illness in adults

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Gillian Sharpe, Lead Critical Care Physiotherapist, Chesterfield Royal Hospital, welcomes the update on NICE Quality Standard CG83 and the increased focus on rehabilitation of the critically ill it will bring.

Historically, mortality rates have been the main indicator of success following critical illness. Healthcare professionals working with the critically ill however, have long recognized that many of those who survive are left with significant physical and non-physical morbidity and often face a lengthy convalescence.

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A lesson from little Charlie

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Dr Jeremy Groves reflects on one implication that the case of Charlie Gard has in adult critical care.

The Charlie Gard case has been the dominant medical story over the last few months.  One cannot but have extreme sympathy for Charlie’s parents who fought valiantly to give their son a chance in life. It was a personal tragedy, played out on social media and in the press, where the pope, presidents, politicians and pundits all had a view and expressed it, informed or otherwise.

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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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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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