Journal of Critical Care 28 (2013) 887–889
Contents lists available at ScienceDirect
Journal of Critical Care journal homepage: www.jccjournal.org
Editorial
The Durban declaration
During the 11th Quadrennial World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM) Meeting in Durban and at its invitation, a proposal was made to create a statement aligning the opinion of leading international critical care organizations regarding basic principles for the delivery of care to the critically ill. The document is reproduced in its entirety and represents the aligned opinion of the following organizations: World Federation of Societies of Intensive and Critical Care Medicine convener World Federation of Critical Care Nurses World Federation of Pediatric Intensive and Critical Care Societies Critical Care Society of Southern Africa Global Sepsis Alliance International Forum on Acute Care Trials Introduction A person is critically ill when one or more organs/systems are not functioning, and this poses a threat to life. Critical care is the specialty that can save lives and help these persons to return to their preceding quality of life. The process of care extends from initial emergency care through to rehabilitation. Effective critical care demands that attention be given to all aspects of illness. Critical care is an important component of health care cost, and services provided should be appropriate to the needs and challenges unique to each area of the world. This declaration emphasizes the promotion of inclusive health policies that consider all facets of critical care within the context of regional realities to ensure critical care for all. The key tenets 1. It is a basic human right for all people to have access to nationally available critical care services. 2. Critical care must be an established specialty throughout the world. 3. Patients, their families, and their communities must be empowered to make informed critical care choices. 4. The critical care needs of the most vulnerable populations must be properly identified. 5. All ethical principles must be considered to ensure rational decision making in critical care. 6. Appropriately trained and supported health care personnel are fundamental to effective critical care practice. 7. Adequate infrastructure must be provided to ensure safe and effective critical care services within the broader health care system. 0883-9441/$ – see front matter © 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jcrc.2013.10.001
8. A culture of learning must be fostered within the critical care domain. 9. All stakeholders must be committed to the development of strategies necessary to implement critical care services appropriate to the needs of each community. 10. Effective, clinically relevant, collaborative critical care research programs need to be developed and existing programs expanded. The 10-point plan 1. It is a basic human right for all people to have access to nationally available critical care services. Access to critical care is a basic human right. Consequently, all countries must provide critical care services. Access to critical care services must be facilitated for all people within a country. Although it is clear that low-income countries may not have the ability to invest the same resources as high-income countries, the quality of care provided in both should always be equivalent. 2. Critical care must be an established specialty throughout the world. For the delivery of effective services, critical care must be an established specialty. The coordination of the discipline into a specialty requires the definition of the scope of practice of a multidisciplinary team. 3. Patients, their families, and their communities must be empowered to make informed critical care choices. A key goal must be to empower patients, their families, and communities preemptively such that they are adequately informed to make choices and to be advocates for the wellbeing of the individual, at the same time serving the interests of the broader communities from which they come. 4. The critical care needs of the most vulnerable populations must be properly identified. At-risk populations, such as people at extremes of age and those lacking mental capacity, represent a group that require particular attention by virtue of their vulnerability. 5. All basic ethical principles must be applied to ensure rational decision making in critical care. Ensuring respect for patient autonomy is fundamental to ethical critical care practice. Beneficence and nonmaleficence further drive caregivers to ensure care is appropriate and without harm. Because critical care is a limited resource, the social justice principle as a competing interest must be recognized. 6. Appropriately trained and supported health care personnel are fundamental to effective critical care practice. Recruiting, training, and retaining skilled personnel must occur in the context of creating effective critical care by a cohesive team. It
888
Editorial / Journal of Critical Care 28 (2013) 887–889
7.
8.
9.
10.
is crucial to provide adequate support and care for health care workers involved in critical care, as it is a very high-risk environment for the personnel. Adequate infrastructure must be provided to ensure safe and effective critical care services within the broader health care system. Although economic resources of countries vary, the health care system must provide vital infrastructure that is well defined and ensure the availability of essential equipment, drugs, and disposables for the provision of critical care specific to each environment. A culture of learning must be fostered within the critical care domain. Continuing medical education is essential for existing personnel. Training programs must aim to develop all health care providers in a nurturing environment that will foster a culture of learning. All stakeholders must be committed to the development of strategies necessary to implement Critical care services appropriate to the needs of each community. Patients and families, health care providers, policy makers, and funders as major stakeholders must share the commitment and implementation strategies to develop critical care services appropriate to the needs of each community. Key opinion leaders have the responsibility of leading all facets of the critical care agenda in achieving the goal of providing critical care for all. Effective, clinically relevant, collaborative critical care research programs need to be developed and existing programs expanded. The vast global differences in disease patterns, human capacity, and infrastructure demand that effective and innovative research programs be created that will direct caregivers to provide the best possible care based on evidence derived from suitably designed clinical research projects.
Although it is impossible to ascribe authorship to a joint declaration, the sponsoring societies wish to thank the Congress CoChairs Drs Satish Bhagwanjee and Pragasan (Dean) Gopalan for organizing the workgroup and Drs Edgar Jimenez, John Marshall, Konrad Reinhart, and Jean-Louis Vincent for their invaluable contributions to the final document. Leadership transitions The December issue of the Journal recognizes the leadership transitions in both its sponsor societies. The Society for Complex Acute Illness (SCAI) held its 12th International Congress August 8 to 11 in Budapest during which the Society elected new officers and board members. The new officers are: President: Andriy Batchinsky, MD, US Army Institute of Surgical Research Vice President: Randall Moorman, MD, University of Virginia, Charlottesville Secretary: Leopold C Cancio, MD, US Army Institute of Surgical Research Treasurer: Judy Day, PhD, University of Tennessee, Knoxville Board members: Yoram Vodovotz, PhD, University of Pittsburgh Medical Center (Past President) Timothy Buchman, MD, PhD, Emory University School of Medicine (Past President) Edmund Neugebauer, MD, PhD, Medicine Witten/Herdecke University, Cologne, Germany (Past President) Giles Clermont, MD, PhD, University of Pittsburgh Medical Center Gary An, MD, University of Chicago Andrew Seely, MD, University of Ottawa
Sven Zenker, MD, PhD, Rheinische Friedrich-Wilhelms-Universität Bonn, Germany Steve Chang, PhD, Immunetrics, Pittsburgh Brahm Goldstein, MD, Ikaria Mitchell Cohen, MD, University of California San Francisco Marie Csete, MD, PhD, Pasadena, California Jose Salinas, PhD, US Army Institute of Surgical Research The WFSICCM held its 11th Quadrennial World Congress August 28 to September 1 in Durban, South Africa, during which 17 new societies were admitted creating a world federation of 73 member societies representing approximately 72 000 critical care physicians, nurses, and allied health care professionals. New council members elected at the annual general meeting are: President: Jean-Louis Vincent, MD, PhD, Belgium Secretary-General: John Marshall, MD, PhD, Canada Treasurer: Janice Zimmerman, MD, USA Immediate Past President: Edgar Jimenez, MD, USA New council members joining the continuing members are: John Myburgh, MD, ANZICS Alvaro Rea-Neto, MD, Brazil Djillane Annane, MD, France Masaji Nishimura, MD, PhD, Japan Lluis Blanch, MD, PhD, Spain Arzu Topeli, MD, Turkey Janice Zimmerman, MD, USA The returning council members are: Sebastian Ugarte, MD, Chile Bin Du, MD, China Guillermo Castorena, MD, Mexico Pravin Amin, MD, India Raffaele de Gaudio, MD, Italy Younsuck Koh, MD, South Korea The World Federation Council thanked the following individuals for their dedicated service to the WFSICCM during their 8-year term: Flavio Monteiro de Barros Maciel, MD, Brazil Edgar Celis-Rodriguez, MD, Colombia (Treasurer) Georges Offenstadt, MD, France Ana-Maria Montanez-Mendoza, MD, Peru Mercedes Palomar Martinez, MD, Spain Francisco Javier Hurtado, MD, Uruguay Konrad Reinhart, MD, PhD, Germany The leadership transitions occurred during major international gatherings, and society activity did not stop with elections. From both meetings, the Journal is proud to continue its sponsorship of excellent abstracts from the SCAI (Budapest) and the WFSICCM (Durban) meetings. The accepted abstracts appear in this issue of the Journal and are worthy of your attention as they not only define the interests of the sponsoring organizations but also provide innovative new and established scientists an opportunity to present and publish their new work. The Journal is indebted to the international judging panel convened and chaired by Drs Fathima Paruk and Kerry Firmani who reviewed the abstracts and helped select those appearing in this issue. December issue I am excited by the increasing interest in the Journal as evidenced by the number of submitted abstracts and Elsevier's support of an increased page count and print presence. In addition, this issue
Editorial / Journal of Critical Care 28 (2013) 887–889
features the first accepted open access articles, and I look forward to tracking the progress of this publishing option. In February, I look forward to providing the statistics for this year's performance and to recognizing the volunteer reviewers without whose support the integrity of the peer-review process would be impossible. This issue continues the selection of clinically relevant manuscripts across multiple disciplines, and the open access article features experiences from the Boston Marathon that link the SCAI to mainstream critical care monitoring through the means of “Real-Time Sample Entropy Predicts Life Saving Interventions after the Boston Marathon Bombing”; an additional open access article in this issue that discusses “Decreased Heart-Rate Complexity in Combat Casualties Undergoing Lifesaving Interventions” further amplifies the importance of the SCAI's involvement in the Journal and its focus on the use of “in-silica”
889
experimentation to refine the manner in which we monitor and evaluate patients on the “episode of illness” continuum. Additional interest is generated by a robust series of editorial/ letter discussions between interested/supportive/illuminating/critical readers and corresponding authors. I encourage all interested parties to indulge in editorial correspondence; it is important to understand your focus and priorities regarding the manuscripts published and the manner in which clinical relevance is brought to practices worldwide. I welcome your comments and look forward to your continued engagement with the Journal of Critical Care in the upcoming year. Philip Lumb MB, BS, MCCM Los Angeles, CA, USA E-mail address: [email protected]
Contents lists available at ScienceDirect
Journal of Critical Care journal homepage: www.jccjournal.org
Editorial
The Durban declaration
During the 11th Quadrennial World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM) Meeting in Durban and at its invitation, a proposal was made to create a statement aligning the opinion of leading international critical care organizations regarding basic principles for the delivery of care to the critically ill. The document is reproduced in its entirety and represents the aligned opinion of the following organizations: World Federation of Societies of Intensive and Critical Care Medicine convener World Federation of Critical Care Nurses World Federation of Pediatric Intensive and Critical Care Societies Critical Care Society of Southern Africa Global Sepsis Alliance International Forum on Acute Care Trials Introduction A person is critically ill when one or more organs/systems are not functioning, and this poses a threat to life. Critical care is the specialty that can save lives and help these persons to return to their preceding quality of life. The process of care extends from initial emergency care through to rehabilitation. Effective critical care demands that attention be given to all aspects of illness. Critical care is an important component of health care cost, and services provided should be appropriate to the needs and challenges unique to each area of the world. This declaration emphasizes the promotion of inclusive health policies that consider all facets of critical care within the context of regional realities to ensure critical care for all. The key tenets 1. It is a basic human right for all people to have access to nationally available critical care services. 2. Critical care must be an established specialty throughout the world. 3. Patients, their families, and their communities must be empowered to make informed critical care choices. 4. The critical care needs of the most vulnerable populations must be properly identified. 5. All ethical principles must be considered to ensure rational decision making in critical care. 6. Appropriately trained and supported health care personnel are fundamental to effective critical care practice. 7. Adequate infrastructure must be provided to ensure safe and effective critical care services within the broader health care system. 0883-9441/$ – see front matter © 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jcrc.2013.10.001
8. A culture of learning must be fostered within the critical care domain. 9. All stakeholders must be committed to the development of strategies necessary to implement critical care services appropriate to the needs of each community. 10. Effective, clinically relevant, collaborative critical care research programs need to be developed and existing programs expanded. The 10-point plan 1. It is a basic human right for all people to have access to nationally available critical care services. Access to critical care is a basic human right. Consequently, all countries must provide critical care services. Access to critical care services must be facilitated for all people within a country. Although it is clear that low-income countries may not have the ability to invest the same resources as high-income countries, the quality of care provided in both should always be equivalent. 2. Critical care must be an established specialty throughout the world. For the delivery of effective services, critical care must be an established specialty. The coordination of the discipline into a specialty requires the definition of the scope of practice of a multidisciplinary team. 3. Patients, their families, and their communities must be empowered to make informed critical care choices. A key goal must be to empower patients, their families, and communities preemptively such that they are adequately informed to make choices and to be advocates for the wellbeing of the individual, at the same time serving the interests of the broader communities from which they come. 4. The critical care needs of the most vulnerable populations must be properly identified. At-risk populations, such as people at extremes of age and those lacking mental capacity, represent a group that require particular attention by virtue of their vulnerability. 5. All basic ethical principles must be applied to ensure rational decision making in critical care. Ensuring respect for patient autonomy is fundamental to ethical critical care practice. Beneficence and nonmaleficence further drive caregivers to ensure care is appropriate and without harm. Because critical care is a limited resource, the social justice principle as a competing interest must be recognized. 6. Appropriately trained and supported health care personnel are fundamental to effective critical care practice. Recruiting, training, and retaining skilled personnel must occur in the context of creating effective critical care by a cohesive team. It
888
Editorial / Journal of Critical Care 28 (2013) 887–889
7.
8.
9.
10.
is crucial to provide adequate support and care for health care workers involved in critical care, as it is a very high-risk environment for the personnel. Adequate infrastructure must be provided to ensure safe and effective critical care services within the broader health care system. Although economic resources of countries vary, the health care system must provide vital infrastructure that is well defined and ensure the availability of essential equipment, drugs, and disposables for the provision of critical care specific to each environment. A culture of learning must be fostered within the critical care domain. Continuing medical education is essential for existing personnel. Training programs must aim to develop all health care providers in a nurturing environment that will foster a culture of learning. All stakeholders must be committed to the development of strategies necessary to implement Critical care services appropriate to the needs of each community. Patients and families, health care providers, policy makers, and funders as major stakeholders must share the commitment and implementation strategies to develop critical care services appropriate to the needs of each community. Key opinion leaders have the responsibility of leading all facets of the critical care agenda in achieving the goal of providing critical care for all. Effective, clinically relevant, collaborative critical care research programs need to be developed and existing programs expanded. The vast global differences in disease patterns, human capacity, and infrastructure demand that effective and innovative research programs be created that will direct caregivers to provide the best possible care based on evidence derived from suitably designed clinical research projects.
Although it is impossible to ascribe authorship to a joint declaration, the sponsoring societies wish to thank the Congress CoChairs Drs Satish Bhagwanjee and Pragasan (Dean) Gopalan for organizing the workgroup and Drs Edgar Jimenez, John Marshall, Konrad Reinhart, and Jean-Louis Vincent for their invaluable contributions to the final document. Leadership transitions The December issue of the Journal recognizes the leadership transitions in both its sponsor societies. The Society for Complex Acute Illness (SCAI) held its 12th International Congress August 8 to 11 in Budapest during which the Society elected new officers and board members. The new officers are: President: Andriy Batchinsky, MD, US Army Institute of Surgical Research Vice President: Randall Moorman, MD, University of Virginia, Charlottesville Secretary: Leopold C Cancio, MD, US Army Institute of Surgical Research Treasurer: Judy Day, PhD, University of Tennessee, Knoxville Board members: Yoram Vodovotz, PhD, University of Pittsburgh Medical Center (Past President) Timothy Buchman, MD, PhD, Emory University School of Medicine (Past President) Edmund Neugebauer, MD, PhD, Medicine Witten/Herdecke University, Cologne, Germany (Past President) Giles Clermont, MD, PhD, University of Pittsburgh Medical Center Gary An, MD, University of Chicago Andrew Seely, MD, University of Ottawa
Sven Zenker, MD, PhD, Rheinische Friedrich-Wilhelms-Universität Bonn, Germany Steve Chang, PhD, Immunetrics, Pittsburgh Brahm Goldstein, MD, Ikaria Mitchell Cohen, MD, University of California San Francisco Marie Csete, MD, PhD, Pasadena, California Jose Salinas, PhD, US Army Institute of Surgical Research The WFSICCM held its 11th Quadrennial World Congress August 28 to September 1 in Durban, South Africa, during which 17 new societies were admitted creating a world federation of 73 member societies representing approximately 72 000 critical care physicians, nurses, and allied health care professionals. New council members elected at the annual general meeting are: President: Jean-Louis Vincent, MD, PhD, Belgium Secretary-General: John Marshall, MD, PhD, Canada Treasurer: Janice Zimmerman, MD, USA Immediate Past President: Edgar Jimenez, MD, USA New council members joining the continuing members are: John Myburgh, MD, ANZICS Alvaro Rea-Neto, MD, Brazil Djillane Annane, MD, France Masaji Nishimura, MD, PhD, Japan Lluis Blanch, MD, PhD, Spain Arzu Topeli, MD, Turkey Janice Zimmerman, MD, USA The returning council members are: Sebastian Ugarte, MD, Chile Bin Du, MD, China Guillermo Castorena, MD, Mexico Pravin Amin, MD, India Raffaele de Gaudio, MD, Italy Younsuck Koh, MD, South Korea The World Federation Council thanked the following individuals for their dedicated service to the WFSICCM during their 8-year term: Flavio Monteiro de Barros Maciel, MD, Brazil Edgar Celis-Rodriguez, MD, Colombia (Treasurer) Georges Offenstadt, MD, France Ana-Maria Montanez-Mendoza, MD, Peru Mercedes Palomar Martinez, MD, Spain Francisco Javier Hurtado, MD, Uruguay Konrad Reinhart, MD, PhD, Germany The leadership transitions occurred during major international gatherings, and society activity did not stop with elections. From both meetings, the Journal is proud to continue its sponsorship of excellent abstracts from the SCAI (Budapest) and the WFSICCM (Durban) meetings. The accepted abstracts appear in this issue of the Journal and are worthy of your attention as they not only define the interests of the sponsoring organizations but also provide innovative new and established scientists an opportunity to present and publish their new work. The Journal is indebted to the international judging panel convened and chaired by Drs Fathima Paruk and Kerry Firmani who reviewed the abstracts and helped select those appearing in this issue. December issue I am excited by the increasing interest in the Journal as evidenced by the number of submitted abstracts and Elsevier's support of an increased page count and print presence. In addition, this issue
Editorial / Journal of Critical Care 28 (2013) 887–889
features the first accepted open access articles, and I look forward to tracking the progress of this publishing option. In February, I look forward to providing the statistics for this year's performance and to recognizing the volunteer reviewers without whose support the integrity of the peer-review process would be impossible. This issue continues the selection of clinically relevant manuscripts across multiple disciplines, and the open access article features experiences from the Boston Marathon that link the SCAI to mainstream critical care monitoring through the means of “Real-Time Sample Entropy Predicts Life Saving Interventions after the Boston Marathon Bombing”; an additional open access article in this issue that discusses “Decreased Heart-Rate Complexity in Combat Casualties Undergoing Lifesaving Interventions” further amplifies the importance of the SCAI's involvement in the Journal and its focus on the use of “in-silica”
889
experimentation to refine the manner in which we monitor and evaluate patients on the “episode of illness” continuum. Additional interest is generated by a robust series of editorial/ letter discussions between interested/supportive/illuminating/critical readers and corresponding authors. I encourage all interested parties to indulge in editorial correspondence; it is important to understand your focus and priorities regarding the manuscripts published and the manner in which clinical relevance is brought to practices worldwide. I welcome your comments and look forward to your continued engagement with the Journal of Critical Care in the upcoming year. Philip Lumb MB, BS, MCCM Los Angeles, CA, USA E-mail address: [email protected]
