Critical Care Is a Rising Med School Specialty

Stephen Weston finds everything about the intensive care unit exciting: the life-and-death decisions, the teamwork between specialists, and the head-scratching that goes into treating complex cases. A second-year medical student at the University of California-San Diego, he was introduced to hospital work when he had a job as a respiratory therapist. Now he's found a specialty that will put him squarely in the ICU: critical care medicine.

Physicians with specialized training in critical care, known as intensivists, treat some of the most seriously ill patients in the hospital those on ventilators or dialysis and those with multiple organ failure. After med school, Weston plans to do a residency in anesthesiology followed by a yearlong fellowship in critical care medicine.

Ever since critical care was recognized as a specialty in the 1980s, hospitals, physicians, and patients have been reaping its benefits. Studies have shown that full-time intensivists, devoted solely to critically ill ICU patients, can trim the length of hospital stays, reduce medical errors, and improve mortality. According to Robb Glenny, a pulmonary critical care specialist at the University of Washington: That's a win-win situation all around reducing costs for hospitals and benefiting the patients' survival.

Indeed, the insurance industry has taken notice. The Leapfrog Group, a consortium of large businesses and organizations that includes GE and IBM and promotes healthcare quality and safety, supports the widespread adoption of intensivist-led ICUs. The intensivist brings an expertise not only to the medical management of acutely ill patients but also to the integration of and coordination with other physicians and surgeons, says Peter Pronovost, a professor of anesthesia critical care at Johns Hopkins Medical School and a medical adviser to the Leapfrog Group. The result? A previously unheard of 30 percent reduction in mortality, he says.

Single focus. Intensivists have been able to accomplish this by pioneering new standards and protocols in ICU treatment. Specialists point to the dramatic improvement of acute lung illness and injury with advancements in ventilation and lung volume control strategies developed by critical care specialists. Intensivists have more time to devote to ICU patients without the added stress of seeing patients on other floors or off site. This has helped patients with diseases ranging from pulmonary embolism a blockage of the artery leading from the heart to the lungs to liver failure and even pneumonia.

With aging baby boomers as its driving force, demand will remain high for more than a decade as hospitals make the switch to intensivist-managed ICUs and as more and more payers insist they have full-time critical care physicians on staff. Even if we doubled the number of fellowships over the next 10 years, there still wouldn't be enough intensivists to meet the job market's needs, says Gerald Maccioli, president of the American Society of Critical Care Anesthesiologists. If current trends continue, there could be a shortage of intensivists by 2020.

From a lifestyle point of view, part of critical care's appeal, says Derek Angus, chairman of the department of critical care medicine at the University of Pittsburgh, is its reinvention as a shift specialty, much like emergency medicine or trauma surgery, with concrete hours when you're done, you're done. And with a competitive starting salary of around $187,000 and $215,000 for critical care plus pulmonology the field is likely to attract even more interest.

Critical care medicine is attractive to physicians from a range of medical backgrounds, a feature many experts believe makes for superior patient care and, ultimately, better outcomes in the ICU. While more than 80 percent of intensivists come from internal medicine, those with residency training in general surgery, anesthesiology, pediatrics, and obstetrics and gynecology, can obtain a fellowship or certification in critical care medicine.

Taking charge. Although the ICU is hardly the boardroom, critical care training programs focus increasingly on developing managerial skills. Intensivists need to be leaders during medical crises, managing a whole cadre of nurses, pharmacists, and respiratory therapists, says Angus. Beyond the medical staff, the intensivist must coordinate with social workers and case managers to help patients' families. When patients are that sick, it's not only a crisis of the body but a crisis of the family. And intensivists are able to develop deep bonds with them in a relatively short period of time, notes Stephen Frankel, section head of critical care and hospital medicine at National Jewish Medical and Research Center in Denver. 1 2

Who eat fruits physical well known, but what kind of the most nutritious fruit, and the health of our most useful may not be known. Perhaps we can find the proverbial Western one answer: Apple a day after a doctor away from me. (An apple a day, keep the doctor away). Apple really so wonderful effect?

Compared with other fruits, apples contain a valuable element of pectin, it is kind of soluble fibre, a medium-size apple contains five grams on these fibers, larger part of oil should be more than cholesterol and with it, will help cholesterol excreted from the human body to achieve the purpose of lowering cholesterol deposition. In addition, the timing of today no fresh peak owners, because the lack of gallbladder stimulate consumption and less from the bile, bile constantly under concentrated, it is easy to form gallstones. Apple pectin in the will and cholesterol in the gallbladder from the combination, can be diluted bile, the effect of prevention of gallstones.

Keen to maintain body weight loss of men and women not know that Apple pectin in the water after expansion, so drink plenty of water before eating apple, will be very easy Baodu if daily breakfast and lunch Xianqi an apple before eating, drinking a cup of water, so they will not eat Taibao. Can be said to be both easy and economical method of slimming thin.

However, we should pay attention to the existence of Apple Pectin only meat, it s best to eat the whole apple; even if Apple juice, and do not remove the flesh, or nutritional effects will be greatly reduced, so the market sold on the generally clear apple juice the relative lack of pectin components.

Pengguanpi help cancer

Apple also the effectiveness of a more alarming, according to the National Cancer Institute in 2001 released a report that food containing flavonoids, may reduce the risk of cancer half, and the density of Apple containing flavonoids all fruit 1974. In addition, published in the 2000 Nature in June, from Cornell University confirmed by the experiments, Pengguanpi contain antioxidant substances can inhibit the proliferation of cancer cells by 43

Researchers are not yet aware that Apple is a major element of what cancer. But research has proved tied to Apple cancer prevention effects.

Five big benefits tied to Apple

1. Containing a large number of pectin can reduce the accumulation of cholesterol.

2. Rich in calcium, phosphorus, iron, zinc and vitamins A, B and C.

3. Containing antioxidants promote lung health, the prevention of lung disease.

4. Lot of fiber, can promote digestion and help weight loss.

5. Containing flavonoids and boron, can help prevent heart disease, stroke and strengthen bone health.

4 thin nutrition Apple recipes

Apple asparagus salad

Ingredients: Apple a jade green asparagus 4 (250 grams).

Sauces: salad dressings (Kuril sauce) 2 tablespoons.

Practices:

1. Apple to Percutaneous tablets bubble in brine and then cold water rinse.

2. Green asparagus into a hot wash water soak ice water, drained and cut into strips after.

3. Apple and the Green asparagus home intraday, Linshang salad dressings can be eaten.

Apple Pickles

Ingredients: 1 apple, cucumber, red and white radishes the 150 grams, 100 grams of garlic.

Sauces: white pepper 1 / 2 teaspoon sugar 2 teaspoons of salt a little.

Practices:

1. Apple, cucumber, red and white radishes, garlic cleaned pelletizing.

2. Materials slightly pickled in salt for 10 minutes, wash with cold water and drained.

3. White pepper, sugar after cooling boil, add all the materials can be soaked on the 1st.

Apple Tremella soup

Ingredients: Apple one, two Tremella 4, 4 cups of water.

Sauces: Bingtangshui 1 / 2 cup.

Practices:

1. Addition Beattie after Apple cut off about 1 / 5 of the superstructure.

2. Second half of removing the flesh into cup pulp pelletizing.

3. Tremella soft foam, and rock sugar, pulp, water steamed into the rotten apple cup after Shing it will.

Apple sushi

Ingredients: rice 3 / 4 bowls, 40 grams of ham, cucumber 1 / 4, Apple 1 / 3

Seasoning: 1 tablespoon of sushi vinegar, seaweed half.

Practices:

1. Apple, cucumber washed after cutting, to soak in brine after Drain.

2. Ham cut into strips.

3. Meat sushi rice vinegar, after the overlay layer placed apples, cucumber and ham, rolled into tube-shaped, sliced can be.

Shin Min Daily News

(Editor: Su-ya)

Additional information :

From www.usnews.com:
Faith Regional Pulmonology Services specializes in the treament and diagnosis of. Pulmonology Services Clinic Faith Regional Medical.
Pulmonologists specialize in treatment of diseases of the lungs and respiratory tract. Primarily, this includes asthma, pneumonia, cystic.
Offers peer reviewed medical articles focusing on pulmonary disorders including asthma, lung cancer, disorders of pulmonary circulation, sleep disorders.
Pulmonary specialists find disease and prescription drug information including condition guides, clinical treatment guidelines and patient.
The mission of the Division of Pediatric Pulmonology is to improve the respiratory health of children through outstanding clinical care, research.
Providing Houston Pulmonary medical services including Pulmonology, sleep disorders, lung problems, bronchitis, Emphysema and asbestos related.
A group practice specializing in Pulmonology, the diagnosis and treatment of lung diseases. Find physician qualifications, a description.
Our pediatric pulmonologists work together with nurse practitioners, nurses and respiratory therapists to offer a multidisciplinary approach.