Thomas J. Papadimos

By SV Satyapriya, ML Lyaker, AJ Rozycki and Papadimos

The goal of this chapter is to identify medications frequently utilized for sedation and analgesia in Extracorporeal Membrane Oxygenation (ECMO) patients. In addition to describing basic pharmacologic principles of these medications, we discuss their benefits and disadvantages and explain the effects the ECMO circuitry will have on pharmacokinetics of each drug. We also discuss need for various depths of sedation and the utility of neuromuscular blocking agents. Emerging techniques for achieving appropriate sedation will be identified. An explosion of literature in recent years has led to Intensive Care Unit (ICU) delirium increasingly being recognized as an indicator of poor outcomes in the general ICU population. We discuss strategies to manage this complex and multifactorial issues, and how they can be applied to our particular subpopulation of ECMO patients.

Part of the book: Extracorporeal Membrane Oxygenation

By Thomas Papadimos, Scott Pappada, Michael Lyaker, James Papadimos and Andrew Casabianca

The flight of refugees has been part of the human condition since the beginning of time. Recent events in the Middle East have caused a mass migration of refugees from Syria, Iraq, and Afghanistan. Their primary destination has been Europe, more specifically, the affluent, better industrialized countries of central and northern Europe. However, the European law currently requires that refugees must be processed at the first port of entry to Europe. In most cases, this involves the eastern Aegean Sea islands of Greece. Here the refugee camps have become overcrowded and underfunded, and have little medical care and security. The Greek government has limited resources and the response for support from the more affluent European countries has been underwhelming. Here we summarize the lack of health security from the refugee perspective of those that are awaiting entry to Europe and are encamped in Greece.

Part of the book: Contemporary Developments and Perspectives in International Health Security

By Mariah Janowski, Olivia Dahlgren, Kori-Ann Taylor, Isha Kaza, Ambreen Alam, Thomas J. Papadimos, Anna Ng Pellegrino and Stanislaw P. Stawicki

The nature of provider-patient relationship (PPR) goes far beyond the simplified paradigm of “chief complaints,” “clinical problems” and corresponding “therapeutic solutions.” In order to more comprehensively explore the scope of PPR in the context of leadership-based partnership (LBP), various factors and their contributions were researched in terms of both the success and optimization of health-care interactions. This is especially relevant to graduate medical education (GME) and advanced practice (AP) training programs. There are numerous nuances to PPR, including various communication, behavioral, ethical and leadership considerations. Body language and tone of voice are essential in establishing rapport, beginning with the so-called ‘first impression,’ which serves as a foundation for developing the PPR. Health-care providers (HCPs) with greater ability to empathize with their patients may achieve higher levels of treatment adherence, better clinical outcomes, and ultimately increased patient satisfaction. The inclusion of a patient as a co-leader and an essential member of their health-care team (HCT) should be a natural step and a top priority for GME and AP trainees. Such collaboration requires an open-minded approach by all stakeholders. Finally, recognizing patient well-being in all domains, including physical, emotional and spiritual, is critical to the holistic approach toward maximizing the benefits of an optimal PPR. Same can be said about the HCP. In this chapter, we will explore key aspects of PPR in the context of both the trainee and the patient being co-leaders within the bounds of the LBP framework.

Part of the book: Contemporary Topics in Graduate Medical Education