1. A JC is an academic session where we go through a scientific article for 1 hour.
2. It takes place every Friday.
3. Its purpose is to understand and discuss relevant elements about the content taking interactive and pedagogic notes (highlighting, underlining and using other learning resources) about the content.
4. We generate further appraisal, identify the opportunities of learning and formulate some potential research questions.
5. We write down the key-points of every session and publish them on our website
6. The article for the next session is posted one week in advance the must-read JC channel of our DISCORD server.
Friday, January 26, 2024, at 18h BO
VFP, HIBN, AAQC
1. The point to understand vulnerability without risking excellence
2. Tension between once-acceptable workplace demands and well-being is hardly unique to medicine.
3. Discomfort is part of the human condition and a prerequisite for learning (Mitchell)
4. The ability to discern (oppression 🆚 violence) the difference is a form of EMOTIONAL MATURITY we should encourage
5. While most trainees were striving for excellence, a vocal minority could set the tone — and shape perceptions — for the majority.
6. Daily racism is different from being asked if you’re old enough to be a doctor OR burn-out 🆚 depression
7. Doctor posts a twitter about success and is interpreted as offense (those who work hard, are burned out).
8. Resident telling a female attendant about how difficult is to be a woman in medicine (asking her to “smile more”)
9. Does the pursuit of excellence conflict with the pursuit of wellbeing?
10. The heightened sensitivity regarding expectations of excellence impedes our ability to give candid constructive feedback.
11. “How far we’ve fallen”
12. Pretending to be someone example ➩ changing her hair… her voice… being naive… “playing a performance”
13. Invocations of harm thus often force a moral choice: Are you with the victim or the victimizer?
⏳ TIME MANAGEMENT.
Round: 9 21:29:46 Wrap-up
Round: 8 05:57:01 Questioning the narrative
Round: 7 02:30:75 Playing the game
Round: 6 11:54:78 Playing the game
Round: 5 07:38:08 Constructive criticism
Round: 4 13:46:67 Excellence as offense
Round: 3 23:38:95 New hierarchy
Round: 2 15:32:11 Intro
Round: 1 06:15:19 Selecting ART
Friday, April 19, 2024 at 17:15 BE
HIBN, GIP, AAQC
ICU LOS = ICU length of stay, MV = mechanical ventilation, H+_MM = hospital mortality, ITW = interviews, Hospital Anxiety and Depression Scale = HADS
1. Y, J, C ➖ T ➕ N ➕ t ➖ PICO:
2. 2024, ICM, FR ➖ RCT ➕ 385 pxs ➕ 2020-2023 ➖ PICO:
- P: ICU pxs families
- I: nurse facilitators communication & support
- C: standard communication by ICU clinicians
- O: pOC = family symptoms of depression ➕ sOC = HADS-anxiety, event scale-6, QUAL-E
3. Importance:
- Psychological burden = anxiety, depression & post traumatic stress
- Communication = skills, goals of care, confidence & biliefs
- Family satisfaction = influenced by hospital culture
- Previous interventions (px navigation, discharge planning, care coordination) = ↘️ re-hospitalizations
4. Methods:
- Co-designed with J. Randall Curtis
- 5 university H+
- Table 1 explored: MV same % in I + C ➕ ICU LOS = same % in I + C
- IN pxs: adults + expected LOS ≥2d + chronic life-timing illness (SS >2y + SOFA H+_MM >15%), FR speaking, visiting relatives, informed OR deferred consent
- IN families: adults + FR speaking + legal surrogates + w_informed consent
5. Procedures:
- 2-day training session for training facilitators by EXTERNAL CONSULTANTS (EC)
- EC w_expertise in clinical communication skills, use of attachment theory, and mediation.
6. The facilitators’ role = help families prepare for ITW w_docto, considering:
- what information did they want to share
- what questions did they want to ask
- what difficulties were they experiencing
- what were their specific needs
- once these were identified, the facilitator would strive to help families express these questions/difficulties/needs.
7. The control:
- open visitation policies
- multidisciplinary D3 meeting to review (DX, TTO, PROG)
- Meetings when deemed necessary - The possibility to meet with a psychologist ± a social worker.
8. Results: - pOC ➩ HADS at 6m - sOC ➩ anxiety, PTS, goal-concordant care, QOL9. Limitations: … to continue…
Friday, May 10, 2024 at 17h15 at BE
HIBN, AAQC
2024 ICM - Systemic inflammation and delirium during critical illness (brummel) [R].pdf
Glossary: oDYS = dysfunction; CI = cognitive impairment
1. 2024, ICM, USA ➖ prospective cohort ➕ 991 (5 centers)➕ 3y (Jan 2007 - Dec 2010) ➖ PICO:
- P: BRAIN-ICU + MIND-ICU. 🫁 failure + SHOCK (>18y)
- I: samples (CRP, IFN-∂, IL-1ß, MMP-9, TNF-alfa, TNFR1, prot C) + mental status (RASS, CAM-ICU) ➩ association delirium ⌄ coma
- C: normal mental status (next day)
- O: “association”
2. Importance + background:
- Delirium affects 1/2 pxs w_Critical Illness.
- Duration predicts: ↗️ MM + in survivors “CI + daily activity disability”
- Acute inflammation + ↓ endogenous anticoagulant activity = oDYS
3. Justification:
- Small sample size previous studies
- Limited number of markers
- Inconsistent associations
4. Methods
- IN. ✔︎
- EX. Acute oDYS for>72 h ➕ a recent ICU stay>5 d ➕ s_preexisting CI ➕ inability to communicate in English.
- Taken from PARENT STUDIES
5. Results. The following day: - Delirium = ↑ concentrations of IL-6 (OR 1.8), IL-8 (1.3), IL-10 (1.5), TNF-α (1.2), and TNFR1 (1.3) and lower concentrations of protein C (0.7)
- Coma = ↑ concentrations of CRP (1.4), IFN-γ (1.3), IL-6 (2.3 ), IL-8 (1.8), and IL-10 (1.5) and lower concentrations of protein C (0.6) - IL-1β, IL-12, MMP-9 ➩ NOT associated w_mental status.
