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Does Checklist Implementation Improve Quantity of Data Transfer: An Observation in Postanesthesia Care Unit (PACU)

Open Journal of Anesthesiology 2017年第4期7卷 69-82页

作者： Lauren S. Park Gloria Yang kay see tan Charlotte H. Wong Sabine Oskar Ruth A. Borchardt Luis E. Tollinche The Warren Alpert Medical School of Brown University Providence RI USA Department of Anesthesiology and Critical Care Medicine Memorial Sloan Kettering Cancer Center New York City NY USA Department of Epidemiology and Biostatistics Memorial Sloan Kettering Cancer Center New York City NY USA Cornell University Ithaca NY USA

Background: Omission of patient information in perioperative communication is closely linked to adverse events. Use of checklists to standardize the handoff in the post anesthesia care unit (PACU) has been shown to effectively reduce medical errors. Objective: Our study investigates the use of a checklist to improve quantity of data transfer during handoffs in the PACU. Design: A cross-sectional observational study. Setting: PACU at Memorial Sloan Kettering Cancer Center (MSKCC);June 13, 2016 through July 15, 2016. Patients, other participants: We observed the handoff reports between the nurses, PACU midlevel providers, anesthesia staff, and surgical staff. Intervention: A physical checklist was provided to all anesthesia staff and recommended to adhere to the list at all observed PACU handoffs. Main outcome measure: Quantity of reported handoff items during 60 pre- and 60 post-implementation of a checklist. Results: Composite value from both surgical and anesthesia reports showed an increase in the mean report of 8.7 items from pre-implementation period to 10.9 post-implementation. Given that surgical staff reported the mean of 5.9 items pre-implementation and 5.5 items post-implementation without intervention, improvements in anesthesia staff report with intervention improved the overall handoff data transfer. Conclusions: Using a physical 12-item checklist for PACU handoff increased overall data transfer.

关键词： Checklist PACU Recovery Room Data Transfer Handoff

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Metformin-associated lactic acidosis:A mini review of pathophysiology,diagnosis and management in critically ill patients

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World Journal of Diabetes 2024年第6期15卷 1178-1186页

作者： kay Choong see Department of Medicine National University HospitalSingapore 119228Singapore

Metformin is a common diabetes drug that may reduce lactate clearance by inhibiting mitochondrial oxidative phosphorylation,leading to metforminassociated lactic acidosis(MALA).As diabetes mellitus is a common chronic metabolic condition found in critically ill patients,pre-existing metformin use can often be found in critically ill patients admitted to the intensive care unit or the high dependency *** aim of this narrative mini review is therefore to update clinicians about MALA,and to provide a practical approach to its diagnosis and *** in critically ill patients may be suspected in a patient who has received metformin and who has a high anion gap metabolic acidosis,and confirmed when lactate exceeds 5 mmol/*** factors include those that reduce renal elimination of metformin(renal impairment from any cause,histamine-2 receptor antagonists,ribociclib)and excessive alcohol consumption(as ethanol oxidation consumes nicotinamide adenine dinucleotides that are also required for lactate metabolism).Treatment of MALA involves immediate cessation of metformin,supportive management,treating other concurrent causes of lactic acidosis like sepsis,and treating any coexisting diabetic *** MALA requires extracorporeal removal of metformin with either intermittent hemodialysis or continuous kidney replacement *** optimal time to restart metformin has not been *** is nonetheless reasonable to first ensure that lactic acidosis has resolved,and then recheck the kidney function post-recovery from critical illness,ensuring that the estimated glomerular filtration rate is 30 mL/min/1.73 m^(2) or better before restarting metformin.

关键词： Acid-base equilibrium Biguanides Oxidative phosphorylation Pyruvic acid Renal replacement therapy

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Glycemic targets in critically ill adults: A mini-review

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World Journal of Diabetes 2021年第10期12卷 1719-1730页

作者： kay Choong see Division of Respiratory and Critical Care Medicine Department of MedicineNational University HospitalSingapore 119228Singapore

Illness-induced hyperglycemia impairs neutrophil function,increases pro-inflammatory cytokines,inhibits fibrinolysis,and promotes cellular *** turn,these mechanisms lead to pneumonia and surgical site infections,prolonged mechanical ventilation,prolonged hospitalization,and increased *** optimal glucose control,blood glucose measurements need to be done accurately,frequently,and *** choosing glycemic targets,one should keep the glycemic variability<4 mmol/L and avoid targeting a lower limit of blood glucose<4.4 mmol/*** upper limit of blood glucose should be set according to casemix and the quality of glucose control.A lower glycemic target range(i.e.,blood glucose 4.5-7.8 mmol/L)would be favored for patients without diabetes mellitus,with traumatic brain injury,or who are at risk of surgical site *** avoid harm from hypoglycemia,strict adherence to glycemic control protocols and timely glucose measurements are *** contrast,a higher glycemic target range(i.e.,blood glucose 7.8-10 mmol/L)would be favored as a default choice for medical-surgical patients and patients with diabetes *** targets may be modified if technical advances for blood glucose measurement and control can be achieved.

关键词： Brain injuries Traumatic Critical care Diabetes mellitus Glycemic control Insulin infusion systems Sepsis

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Impact of inhaled and intranasal corticosteroids on glucose metabolism and diabetes mellitus:A mini review

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World Journal of Diabetes 2023年第8期14卷 1202-1211页

作者： kay Choong see Department of Medicine National University HospitalSingapore 119228Singapore

Inhaled corticosteroids(ICS)and intranasal corticosteroids(INS)are the mainstays of treatment for chronic respiratory diseases like asthma,chronic obstructive pulmonary disease,and allergic *** addition,these localized forms of steroid therapy are generally considered to have fewer systemic side effects compared to long-term oral ***,concern and controversy remain over the impact of ICS and INS on the incidence and control of diabetes mellitus(DM).Given the widespread use of ICS and INS,even small individual effects on DM could lead to large consequences for the global *** large observational studies suggest that high dose ICS is associated with increased incident DM and worsened DM control,though the contribution of other risk factors is less *** addition,only two studies were done to investigate the association of INS and DM,with both studies demonstrating a short-term association of INS use with *** more research evaluating the risk of ICS/INS for DM-related adverse events is needed,high doses of ICS/INS should be avoided when *** following strategies for ICS/INS dose minimization can be considered:Use of non-pharmacological measures(trigger avoidance,smoking cessation,vaccination to avoid infection),control of comorbid conditions,use of non-ICS-containing medications,intermittent rather than regular ICS dosing,and appropriate de-escalation of high ICS doses.

关键词： Beclomethasone Budesonide Fluticasone Glucocorticoids Glucose Hyperglycemia

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Diagnosis and management of severe pulmonary and extrapulmonary tuberculosis in critically ill patients:A mini review for clinicians

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World Journal of Critical Care Medicine 2024年第2期13卷 106-115页

作者： Dominic Ti Ming tan kay Choong see Department of Medicine National University HospitalSingapore 119228Singapore

Among critically ill patients,severe pulmonary and extrapulmonary tuberculosis has high morbidity and ***,it is a diagnostic challenge given its nonspecific clinical symptoms and signs in early stages of the *** addition,management of severe pulmonary and extrapulmonary tuberculosis is complicated given the high risk of drug-drug interactions,drug-disease interactions,and adverse drug *** help clinicians acquire an up-to-date approach to severe tuberculosis,this paper will provide a narrative review of contemporary diagnosis and management of severe pulmonary and extrapulmonary tuberculosis in critically ill patients.

关键词： Tuberculosis Severe tuberculosis Mycobaterium tuberculosis Critical care Intensive care Diagnosis of tuberculosis Management of tuberculosis

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Integrating Conjugate Gradients Into Evolutionary Algorithms for Large-Scale Continuous Multi-Objective Optimization

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IEEE/CAA Journal of Automatica Sinica 2022年第10期9卷 1801-1817页

作者： Ye Tian Haowen Chen Haiping Ma Xingyi Zhang kay Chen tan Yaochu Jin the Information Materials and Intelligent Sensing Laboratory of Anhui Province Institutes of Physical Science and Information TechnologyAnhui UniversityHefei 230601China the Institute of Artificial Intelligence Hefei Comprehensive National Science CenterHefei 230601China IEEE the Key Laboratory of Intelligent Computing and Signal Processing of Ministry of Education School of Artificial IntelligenceAnhui UniversityHefei 230601China the Department of Computing The Hong Kong Polytechnic UniversityHong Kong SARChina the Faculty of Technology Bielefeld UniversityBielefeld 33619Germany

Large-scale multi-objective optimization problems(LSMOPs)pose challenges to existing optimizers since a set of well-converged and diverse solutions should be found in huge search *** evolutionary algorithms are good at solving small-scale multi-objective optimization problems,they are criticized for low efficiency in converging to the optimums of *** contrast,mathematical programming methods offer fast convergence speed on large-scale single-objective optimization problems,but they have difficulties in finding diverse solutions for ***,how to integrate evolutionary algorithms with mathematical programming methods to solve LSMOPs remains *** this paper,a hybrid algorithm is tailored for LSMOPs by coupling differential evolution and a conjugate gradient *** the one hand,conjugate gradients and differential evolution are used to update different decision variables of a set of solutions,where the former drives the solutions to quickly converge towards the Pareto front and the latter promotes the diversity of the solutions to cover the whole Pareto *** the other hand,objective decomposition strategy of evolutionary multi-objective optimization is used to differentiate the conjugate gradients of solutions,and the line search strategy of mathematical programming is used to ensure the higher quality of each offspring than its *** comparison with state-of-the-art evolutionary algorithms,mathematical programming methods,and hybrid algorithms,the proposed algorithm exhibits better convergence and diversity performance on a variety of benchmark and real-world LSMOPs.

关键词： Conjugate gradient differential evolution evolutionary computation large-scale multi-objective optimization mathematical programming

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Acute cor pulmonale in patients with acute respiratory distress syndrome:A comprehensive review

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World Journal of Critical Care Medicine 2021年第2期10卷 35-42页

作者： kay Choong see Department of Medicine National University HospitalSingapore 119228Singapore

Acute respiratory distress syndrome(ARDS)-related acute cor pulmonale(ACP)is found in 8%-50%of all patients with ARDS,and is associated with adverse hemodynamic and survival ***-related ACP is an echocardiographic diagnosis marked by combined right ventricular dilatation and septal dyskinesia,which connote simultaneous diastolic(volume)and systolic(pressure)overload *** factors include pneumonia,hypercapnia,hypoxemia,high airway pressures and concomitant pulmonary *** evidence suggests that ARDS-related ACP is amenable to multimodal treatments including ventilator adjustment(aiming for arterial partial pressure of carbon dioxide<60 mmHg,plateau pressure<27 cmH2O,driving pressure<17 cmH2O),prone positioning,fluid balance optimization and *** research is required to elucidate the optimal frequency and duration of routine bedside echocardiography screening for ARDS-related ACP,to more clearly delineate the diagnostic role of transthoracic echocardiography relative to transesophageal echocardiography,and to validate current and novel therapies.

关键词： Coronavirus Critical care Echocardiography Hypertension Pulmonary Respiratory distress syndrome Adult Ventricular dysfunction Right

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Improving environmental sustainability of intensive care units: A mini-review

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World Journal of Critical Care Medicine 2023年第4期12卷 217-225页

作者： kay Choong see Department of Medicine National University HospitalSingapore 119228Singapore

The carbon footprint of healthcare is significantly impacted by intensive care units,which has implications for climate change and planetary *** this,it is crucial to implement widespread efforts to promote environmental sustainability in these units.A literature search for publications relevant to environmental sustainability of intensive care units was done using *** mini-review seeks to equip intensive care unit practitioners and managers with the knowledge necessary to measure and mitigate the carbon cost of healthcare for critically ill *** will also provide an overview of the current progress in this field and its future direction.

关键词： Carbon footprint Critical care Global warming Greenhouse effect Greenhouse gases Plastics

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Principled Design of Translation, Scale, and Rotation Invariant Variation Operators for Metaheuristics

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Chinese Journal of Electronics 2023年第1期32卷 111-129页

作者： TIAN Ye ZHANG Xingyi HE Cheng tan kay Chen JIN Yaochu Key Laboratory of Intelligent Computing and Signal Processing of Ministry of Education Institutes of Physical Science and Information Technology Anhui University School of Artificial Intelligence Anhui University School of Electrical and Electronic Engineering Huazhong University of Science and Technology Department of Computing The Hong Kong Polytechnic University Faculty of Technology Bielefeld University

A large number of metaheuristics have been proposed and shown high performance in solving complex optimization problems. While most variation operators in existing metaheuristics are empirically designed,new operators are automatically designed in this work,which are expected to be search space independent and thus exhibit robust performance on different *** work first investigates the influence of translation invariance, scale invariance, and rotation invariance on the search behavior and performance of some representative operators. This work then deduces the generic form of translation, scale, and rotation invariant operators, and proposes a principled approach for the automated design of operators, which searches for high-performance operators based on the deduced generic form. The experimental results demonstrate that the operators generated by the proposed approach outperform state-of-the-art ones on a variety of problems with complex landscapes and up to 1000decision variables.

关键词： Deep learning Metaheuristics Reinforcement learning Benchmark testing Search problems Robustness Behavioral sciences

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Point-of-care ultrasound for critically-ill patients: A mini-review of key diagnostic features and protocols

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World Journal of Critical Care Medicine 2022年第2期11卷 70-84页

作者： Yie Hui Lau kay Choong see Department of Anaesthesiology Intensive Care and Pain MedicineTan Tock Seng HospitalSingapore 308433Singapore Division of Respiratory&Critical Care Medicine National University HospitalSingapore 119074Singapore

Point-of-care ultrasonography(POCUS)for managing critically ill patients is increasingly performed by intensivists or emergency *** of needs surveys among intensivists reveal emphasis on basic cardiac,lung and abdominal ultrasound,which are the commonest POCUS modalities in the intensive care *** therefore aim to describe the key diagnostic features of basic cardiac,lung and abdominal ultrasound as practised by intensivists or emergency physicians in terms of accuracy(sensitivity,specificity),clinical utility and *** also aim to explore POCUS protocols that integrate basic cardiac,lung and abdominal ultrasound,and highlight areas for future research.

关键词： Critical care Echocardiography Point-of-care testing Sensitivity and specificity Ultrasonography

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