| 1 | Critical care practice in India:Results of the intensive care unit need assessment survey(ININ2018)显示文摘BACKGROUND A diverse country like India may have variable intensive care units(ICUs)practices at state and city levels.AIM To gain insight into clinical services and processes of care in ICUs in India,this would help plan for potential educational and quality improvement interventions.METHODS The Indian ICU needs assessment research group of diverse-skilled individuals was formed.A pan-India survey'Indian National ICU Needs'assessment(ININ 2018-I)was designed on google forms and deployed from July 23rd-August 25th,2018.The survey was sent to select distribution lists of ICU providers from all 29 states and 7 union territories(UTs).In addition to emails and phone calls,social medial applications-WhatsApp™,Facebook™and LinkedIn™were used to remind and motivate providers.By completing and submitting the survey,providers gave their consent for research purposes.This study was deemed eligible for category-2 Institutional Review Board exempt status.RESULTS There were total 134 adult/adult-pediatrics ICU responses from 24(83%out of 29)states,and two(28%out of 7)UTs in 61 cities.They had median(IQR)16(10-25)beds and most,were mixed medical-surgical,111(83%),with 108(81%)being adult-only ICUs.Representative responders were young,median(IQR),38(32-44)years age and majority,n=108(81%)were males.The consultants were,n=101(75%).A total of 77(57%)reported to have 24 h in-house intensivist.A total of 68(51%)ICUs reported to have either 2:1 or 2≥:1 patient:nurse ratio.More than 80%of the ICUs were open,and mixed type.Protocols followed regularly by the ICUs included sepsis care,ventilator-associated pneumonia(83%each);nutrition(82%),deep vein thrombosis prophylaxis(87%),stress ulcer prophylaxis(88%)and glycemic control(92%).Digital infrastructure was found to be poor,with only 46%of the ICUs reporting high-speed internet availability.CONCLUSION In this large,national,semi-structured,need-assessment survey,the need for improved manpower including;in-house intensivists,and decreasing patient-tonurse ratios was evident.Sepsis was the most common diagnosis and quality and research initiatives to decrease sepsis mortality and ICU length of stay could be prioritized.Additionally,subsequent surveys can focus on digital infrastructure for standardized care and efficient resource utilization and enhancing compliance with existing protocols. | Rahul Kashyap Kirtivardhan Vashistha Chetan Saini Taru Dutt Dileep Raman Vikas Bansal Harpreet Singh Geeta Bhandari Nagarajan Ramakrishnan Harshit Seth Divya Sharma Premkumar Seshadri Mradul Kumar Daga Mohan Gurjar Yash Javeri Salim Surani Joseph Varon 无 | 2020 | World Journal of Critical Care Medicine2020，9，2： | 1 |
| 2 | Esophageal stent fracture:case report and review of the literature显示文摘Endoscopic esophageal stent placement is widely used in the treatment of a variety of benign and malignant esophageal conditions.Self expanding metal stents(SEMS)are associated with significantly reduced stent related mortality and morbidity compared to plastic stents for treatment of esophageal conditions;however they have known complications of stent migration,stent occlusion,tumor ingrowth,stricture formation,reflux,bleeding and perforation amongst others.A rare and infrequently reported complication of SEMS is stent fracture and subsequent migration of the broken pieces.There have only been a handful of published case reports describing this problem.In this report we describe a case of a spontaneously fractured nitinol esophageal SEMS,and review the available literature on the unusual occurrence of SEMS fracture placed for benign or malignant obstruction in the esophagus.SEMS fracture could be a potentially dangerous event and should be considered in a patient having recurrent dysphagia despite successful placement of an esopha-geal SEMS.It usually requires endoscopic therapy and may unfortunately require surgery for retrieval of a distally migrated fragment.Early recognition and prompt management may be able to prevent further problems. | Harshit S Khara David L Diehl Seth A Gross | 2014 | World Journal of Gastroenterology2014，20，10： | 1 |
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