Reductionism vs Numerology: why less is best

Professor John Myburgh

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Lecture overview

The optimal treatment of vulnerable, critically ill patients depends primarily on two factors: the patient's innate response to the insult (host response) and minimising secondary insults (iatrogenesis). The host response is primarily genetically determined, but the adequacy of this response is influenced by associated co-morbidities and environmental factors such as access to effective health care. In this context, the greatest impact on human survival has evolved from advances in preventive medicine, public health initiatives, universal health access, and medical technology.
While Intensive Care Medicine has resulted in major improvements in the care of critically ill patients, many of the fundamental interventions have evolved through physiologically-based paradigms, often predicated on normalising short-term variables, clinical measurements, or surrogate clinical endpoints. When many of these strategies are tested in comparative effectiveness studies, evidence of adverse impacts on patient-centered outcomes has emerged that is often attributed to iatrogenic injury. While some technological advances have delivered substantial benefits, the safety and efficacy of these technologies have not been evaluated by high-quality studies. This technological imperative is associated with inexorable indication creep, overuse, and misapplication of related strategies that are applied with little consideration of adverse down-stream consequences that independently affect patient-centered outcomes. Coupled with non-validated management bundles and clinical practice guidelines, the art and science of medicine is lost, so that effective treatment directed at augmenting the innate host response over the course and trajectory of critical illness becomes obscured.

Learning Objectives:
By the end of this lecture, the attendee will be able to:

  1. Understand key principles of the trajectory of human illness.
  2. Appreciate that physiological-based treatment strategies do not translate to improved patient-centred outcomes.
  3. Re-evaluate the clinical utility and safety of fundamental interventions such as fluid resuscitation and haemodynamic management.
  4. Re-evaluate temporal changes to patient-management and recognise iatrogenesis.

This lecture is equal to 1 CE Contact Hour, 1 CPD Point, and 1 AMA PRA Category 1 Credit



Additional CME Info

Release Date: February 1, 2020, Termination Date: January 31, 2023

Accreditation: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of EB Medicine and Continulus. EB Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation: EB Medicine designates this internet enduring material for a maximum of 1 AMA PRA Category 1 Credit™ per lecture. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

Commercial Support: This activity received no commercial support.

Earning Credit: In order to earn CME credit, the participant must take the pre-test, listen to the lecture, take the CME post-test, and complete the post-test evaluation.

Duration 1 hour(s).

Lecture speaker

Professor John Myburgh

Professor John A Myburgh is Professor of Intensive Care Medicine, UNSW Sydney, Director of the Critical Care Division at the George Institute for Global Health and Senior Intensive Care Physician at the St. George Hospital, Sydney.
He has an internationally recognised reputation as a clinical researcher having conducted over 30 trials in fundamental aspects of Intensive Care Medicine including haemodynamic management, traumatic brain injury, sepsis and acute kidney injury. He established the ANZICS Clinical Trials Group with collaborators in 1994 and leads an internationally 2 recognised Intensive Care Medicine research program at the George Institute with extensive national and international networks. His research program is focussed on improving cost effective patient centred outcomes in critically ill patients through high-quality trials that are internationally generalisable.
He is a Past-President of the College of Intensive Care Medicine of Australia and New Zealand and Past Secretary General of the World Federation of Societies of Intensive and Critical Care Medicine

CME Faculty Disclosure: It is the policy of EB Medicine to ensure objectivity, balance, independence, transparency, and scientific rigor in all CME-sponsored educational activities. All faculty participating in the planning or implementation of a sponsored activity are expected to disclose to the audience any relevant financial relationships and to assist in resolving any conflict of interest that may arise from the relationship. In compliance with all ACCME Essentials, Standards, and Guidelines, all faculty for this CME activity were asked to complete a full disclosure statement. The speaker did not report any relevant financial interest or other relationship with the manufacturer(s) of any commercial product(s) discussed in this educational presentation.