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1
Translational research and clinical practice: Basic tools for medical decision making and self-learning. New York: Oxford University Press, 2011.
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Evans, Charlotte, Anne Creaton, Marcus Kennedy, and Terry Martin, eds. Respiratory support. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198722168.003.0008.
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The aim of the respiratory support chapter is to provide the retrievalist with an armamentarium of information regarding advanced airway management. The chapter details the approach to the difficult airway with assessment tools and clinical features. Airway devices are discussed and intubation methods outlined. Practical guidance is provided on how to set up your non-invasive and invasive modes of ventilation with sections on mechanical ventilation of the healthy lung.
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Bhugra, Dinesh, Antonio Ventriglio, and Kamaldeep S. Bhui. Assessment tools and cultural formulation. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198723196.003.0005.
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Assessment tools can support clinical assessments but cannot replace them. They can be used for a number of purposes. They are standardized tools but may require some adjustments if they are being used in cultures other than those in which they were developed. If they have been translated into other languages, it is essential that translation be carried out with proper conceptual equivalence rather than simple literal translation. The experiences of migration and acculturation need to be assessed carefully. Furthermore, for the first time DSM-5 includes concepts of cultural formulation; the key features include cultural identity of individuals, cultural explanations of their illnesses, cultural factors related to their environment and levels of functioning, various cultural elements of relationship between the clinician and the individual, and overall cultural assessment. At the heart of cultural formulation lie the principles of cultural sensitivity.
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Coyne, Imelda, Freda Neill, and Fiona Timmins, eds. Clinical Skills in Children's Nursing. Oxford University Press, 2010. http://dx.doi.org/10.1093/oso/9780199559039.001.0001.
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Children's Nurses require excellent clinical skills to provide high quality care to children and young people across a range of different ages. After the first year of their training, children's nursing students must master skills of increasing complexity whilst developing clinical judgement and confidence. Therefore, it is vital that links are made to children's biology and development, family needs, legal issues and problem solving but until now, it has been hard to find all this in one place. Clinical Skills for Children's Nursing is designed for children's and general nursing students in second year onwards to facilitate the transition from closely supervised beginners, to qualified professionals. By clearly explaining essential principles, evidence and special considerations, this text helps students to build up their confidence, not just in performing skills, but also in decision-making in readiness for registration and beyond. Step-by-step guides to performing core and advanced procedures are presented in tables for easy comprehension and revision, illustrated by photographs and drawings. Each skill draws on the available evidence base, which is updated regularly on the accompanying Online Resource Centre. Uniquely, this text develops students' critical thinking skills and ability to deliver child centred care by providing clear links to anatomical, physiological and child development milestones as well as regular nursing alerts which help prevent readers from making common mistakes. Clearly reflecting the Nursing and Midwifery Council's Essential Skills Clusters for registration and beyond, Clinical Skills for Children's Nursing is designed to support student nurses develop into competent practitioners. Supported by a dedicated Online Resource Centre with up-to-date evidence, realistic scenarios, and a wealth of other tools. On the Online Resource Centre: For registered lecturers and mentors: - Figures from the book, ready to download and use in teaching material For students: - Evidence, guidelines and protocols, reviewed and updated every 6 months - Over 40 interactive scenarios - Active web links provide a gateway to the articles cited in the book - Flashcard glossary to help learn key terms
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Fye, W. Bruce. The Reinvention of the American Heart Association and the Invention of Cardiac Catheterization. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199982356.003.0008.
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President Harry Truman signed the National Heart Act in 1948, which resulted in the creation of the National Heart Institute and started federal funds flowing to academic centers to support cardiovascular research. Mayo cardiologist Arlie Barnes’s term as president of the American Heart Association coincided with its transformation from a low-budget professional society into a large voluntary health organization that raised funds from the public to support its programs. World War II research into shock contributed to the development of cardiac catheterization as a clinical diagnostic tool. Mayo’s wartime research program that focused on ways to protect fighter pilots from blackouts due to high gravitational forces led to the invention of technologies to measure blood pressure and blood oxygen content. Physiologist Earl Wood used these tools in Mayo’s cardiac catheterization laboratory, which was established at the institution in 1947. The clinic helped pioneer the emerging field of cardiac catheterization.
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Feinstein, Robert E. Violence and Suicide. Edited by Robert E. Feinstein, Joseph V. Connelly, and Marilyn S. Feinstein. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190276201.003.0018.
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Patients exhibiting violent or suicidal behavior have psychiatric symptoms varying along a spectrum of risk, from minimal to fatal. Evidence supports screening patients for intimate partner violence and suicide risk. Clinical care focuses on establishing a team and a working alliance, determining the “Why now?” of dangerousness, and using clinical judgments, risk assessment tools, a critical pathway, and a risk registry. Clinical care includes assessment of (1) violent or suicidal ideation, (2) recent dangerous behaviors, (3) past history of risky behaviors, (4) support system, (5) substance use, (6) cooperation with treatment, and (7) clinician reactions (8) diagnosis of medical and neurologic comorbidities. A multidisciplinary team can optimally manage these patients by deciding on the level of care needed for each problem or episode. Care can be delivered by using a practice registry and a critical pathway and focusing care on psychotherapy, with medications as needed. Steps are outlined for managing intimate partner violence.
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Feuerstein, Seth. The Integration of New Technological Approaches in OCD Care. Edited by Christopher Pittenger. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190228163.003.0065.
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This chapter explores topics related to how technology is impacting care for patients with obsessive compulsive disorder (OCD) and providing new resources for their caregivers. It explores what has occurred and is occurring today in clinical environments with the introduction of new technologies. It goes on to describe current research into how to leverage newer technologies, and discusses what we might expect in a few years. Technology can mean many things, including new medications, novel pharmaceutical approaches such as immunotherapeutics, genetic testing to support treatment selection, and potential new diagnostic tools such as fMRI. The emphasis here is on software technology; other areas of clinically relevant technological advances are covered elsewhere in this text.
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Katritsis, Demosthenes G., Bernard J. Gersh, and A. John Camm. Clinical Cardiology. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199685288.001.0001.
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The purpose of this book is to provide a useful, easily accessible, and user-friendly clinical tool that can be used in the every day clinical practice. Definition, epidemiology, aetiology, and pathophysiology and genetics of cardiac diseases are summarized according to recent evidence. Presentation of diseases, physical findings and investigations for a contemporary, evidence- based approach are organized in a clear and instructive manner. The management of the patient is presented according to most recent randomized control trials and recommendations of guidelines by the ACC/AHA and the ESC. Most recent guidelines and updates have been collected for each topic, and current recommendations have been extracted and presented in abbreviated tables. The reference list is aimed at presenting seminal studies that support statements in the book, randomized control trials that are dictating modern management, and scholarly, instructive reviews that have appeared in the major cardiology journals. Recent only articles are presented in order to guide potential further reading. The on-line editions of the book are updated on a regular basis.
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Randhawa, Gurvaneet S., and Edwin A. Lomotan. Harnessing Big Data-Based Technologies to Improve Cancer Care. Edited by David A. Chambers, Wynne E. Norton, and Cynthia A. Vinson. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190647421.003.0034.
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Big data promises to harness the power of advanced computing to transform health and health care, including cancer research and care delivery. In health care, big data can be generated by administrative and clinical processes, by patients and families, and by machines. Ultimately, the goal of big data is to transform data into actionable knowledge with attention to four dimensions: person-level data collection; data access, exchange, and aggregation; population-level analytics; and provider, researcher, or patient-facing clinical decision support. A fabric of trust forms the basis for policies for governance, privacy and security, and confidentiality. This chapter offers several examples of the application of big data along the cancer care continuum, ranging from primary prevention through diagnosis, survivorship, and end-of-life care. Challenges to the effective collection and use of big data include its integration with health care delivery; interoperability; and the need for validated, well-designed informatics tools.
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Brown, Jacqueline A., and Shane R. Jimerson, eds. Supporting Bereaved Students at School. Oxford University Press, 2017. http://dx.doi.org/10.1093/med:psych/9780190606893.001.0001.
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Given that most children will experience the death of at least one close or special person prior to high school graduation, and because the vast majority of children attend school on a regular basis, school-based mental health professionals must be prepared to effectively support bereaved students. Supporting Bereaved Students at School is a contemporary guide that provides school-based mental health professionals with the information they need to support bereaved students, with a particular emphasis on practitioners in the fields of school psychology, school counseling, school social work, and clinical child psychology. The book covers how these professionals can help children and adolescents cope with their emotional, physical, and social reactions during the period of grief, lasting months or years, following a significant death in their lives. The book is divided into two sections, the first focusing on foundational knowledge and the second offering a range of evidence-based intervention strategies. This book provides school-based professionals and graduate students with tools that can be easily integrated into their daily practice.
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Tieman, Jennifer J., and David C. Currow. Informatics and Literature Search. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199656097.003.0073.
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Health information technology is changing how health professionals engage with and use knowledge and how health systems organize care. Tools and resources can facilitate access to evidence and enable its application in practice improving outcomes for the individual patient and for the health-care system. However, the quality of these applications relies on the quality and currency of the domain knowledge that is embedded within them and distributed through them. Therefore being able to identify and retrieve palliative care’s evidence base is more critical than ever. Given the complexity of timely, efficient, and effective retrieval of needed knowledge, new approaches are needed to manage the expanding and diffuse knowledge base for palliative care. Such strategies include developing online repositories of clinical knowledge to ensure immediate access and creating search solutions that shortcut access to literature and evidence to support practice, research, and education.
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Elbogen, Eric B., and Robert Graziano. Assessing Acute Risk of Violence in Military Veterans. Edited by Phillip M. Kleespies. Oxford University Press, 2015. http://dx.doi.org/10.1093/oxfordhb/9780199352722.013.15.
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Research has shown aggression toward others is a problem in a subset of military veterans. Predicting this kind of aggression would be immensily helpful in clinical settings. To our knowledge, there currently are no risk assessment tools or screens that have been validated to specifically evaluate acute violence among veterans. This chapter reviews what we do and do not know about violence in veterans so that clinicians who are making decisions about acute violence can be informed by the existing scientific knowledge base. Examining these empirically supported risk and protective factors using a systematic approach may optimize clinical decision making when assessing acute violence in veterans.
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Williams, Monnica T. Managing Microaggressions. Oxford University Press, 2020. http://dx.doi.org/10.1093/med-psych/9780190875237.001.0001.
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Abstract: This book is intended to provide clinicians and trainees with a better understanding of racial microaggressions as they relate to therapy. This book provides thorough information on the research surrounding microaggressions as well as practical skills to use in session with clients. Microaggressions can be hard to spot and hard to understand. This book provides needed tools to identify microagressive behavior. It also outlines the research on how microaggressions can be damaging to people of color, causes of microaggressions, how to prevent them from happening, and how to help clients suffering as a result of experiencing them. Furthermore, it provides support for therapists of color on how to navigate microaggressions within their professional sphere. The book also describes validated measures and clinical interviews that may be used to better understand microaggressions and other cultural concepts relevant to clients. This book is a road map readers can use to begin their journey toward culturally competence to avoid microaggressive behavior in their profession and in their life in general. Case examples, therapeutic interactions, and discussion scenarios supplement the information provided. Finally, it outlines controversies regarding microaggressions and future directions related to this concept.
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Weil, Andrew. Integrative Sexual Health. Edited by Barbara Bartlik, Geovanni Espinosa, and Janet Mindes. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190225889.001.0001.
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Integrative Sexual Health explores beyond the standard topics in men’s and women’s health, drawing on a very rich and diverse research literature. Books on sexuality typically are for the clinical specialist and cite only focally relevant research, or are geared to lay knowledge and cite almost no research. Integrative Sexual Health provides an overview of sexual biology and sexual dysfunction, diverse lifespan, lifestyle, and environmental impacts on sexual function, applies complementary and integrative medicine solutions to sexual problems, and offers traditional Eastern and Western treatment approaches to resolving sexual difficulties. Written by diverse integratively trained experts in sexuality, psychology, psychiatry, and other medical specialties. Integrative Sexual Health includes clinical vignettes, detailed treatment strategies for mitigating the side effects of medications, and sexual dysfunction associated with medical illness and poor lifestyle habits, as well as citing extensive research and further resources. Integrative treatment modalities not typically consulted in mainstream sexual medicine, such as traditional Chinese medicine, Ayurvedic medicine, aromatherapy, and botanical medicine are presented with the best available evidence, in a clinically relevant manner. This volume in the Weil Integrative Medicine Library will be valuable to the specialist and non-specialist alike, who seek to understand and treat sexual problems using an integrative medicine approach, and acquire tools to help patients maintain lifetime optimal general health and vitality that supports healthy sexuality.
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Fine, Perry G. The Hospice Companion. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190456900.001.0001.
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The Hospice Companionis a guide to best practices in end-of-life care, informed by the most current evidence-based literature in the field. It is intended to be used “at the bedside” and during interdisciplinary team meetings to efficiently and effectively improve patient care and provide useful family and caregiver support. It should be thought of as a “decision support tool” to be used by all members of the hospice interdisciplinary team, including nurses, physicians, counselors, and social workers. This is the third edition of this clinical guide and it includes forty chapters allotted into three sections (General Processes; Personal, Social, and Environmental Processes; Clinical Processes and Symptom Management) plus five appendices. The symptom management chapters are arranged alphabetically, covering the gamut of common and highly burdensome problems encountered in caring for patients with far-advanced illness, from agitation and anxiety to xerostomia. Chapters are concise, averaging 1,000 to 1,500 words (the exception is the chapter on pain, in view of its complexity). Each is organized around the specific clinical issue of concern by defining the problem and its usual causes, findings, and differential diagnosis. This is followed by outlining salient features of assessment and management according to practical, psychosocial, biomedical, and spiritual categories. Each chapter concludes with a list of goals that should be defined in establishing a plan of care and what should be documented in the clinical record as well as a list of recommended readings from the contemporary literature.
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Roth, Andrew, and Chris Nelson. Psychopharmacology in Cancer Care. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780197517413.001.0001.
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Clinicians who care for adult cancer patients have many tools to manage symptoms of depression, anxiety, cognitive changes, insomnia, and fatigue. Non-prescribing clinicians, such as psychologists, nurses, social workers, and occupational and physical therapists, provide frontline psychosocial interventions and physical support for cancer patients. Psychotropic treatments are sometimes required to resolve complex syndromes that mingle both medical and psychiatric features. Psychiatric medications are most frequently prescribed to cancer patients by oncologists, general medical practitioners, general psychiatrists, and psychiatric advanced practice providers such as nurse practitioners and physician assistants, as few oncology practices have dedicated psycho-oncologists. Non-prescribing practitioners who care for people with cancer are often the first to identify a psychiatric syndrome that requires a referral for psychopharmacologic intervention. They can also play an important role in educating patients about how psychopharmacologic agents can augment their cancer care. After psychotropic medications are started, non-prescribers can observe for improvement and detect problematic side effects if they arise, thus improving adherence with medication regimens. Practitioners who read this book will benefit from the highlighted clinical pearls to follow, and the potholes to avoid, regarding the tricky diagnostics and pharmacologic treatment of psychiatric syndromes. All clinicians will learn communication strategies that bridge distances of professional specialty and geography so that treatment by multiple providers may be more seamless, which it is hoped will enrich outcomes, both medical and emotional.
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Schultz, Jaime. Rules, Rulers, and the “Right Kind” of Competition. University of Illinois Press, 2017. http://dx.doi.org/10.5406/illinois/9780252038167.003.0004.
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This chapter discusses how women physical educators began to reevaluate their collective position against intercollegiate, commercial, and hypercompetitive sports for their students. Particular attention is given to a series of National Institutes on Girls' Sports, jointly sponsored by the Division for Girls and Women's Sports (DGWS) and the United States Olympic Committee (USOC) that took place during the 1960s. At these clinics, educators, recreation leaders, and other interested parties learned the necessary tools to teach sport skills to their respective charges and to encourage them to engage in “the right kind of competition.” The emergent groundswell of support was an important antecedent to the subsequent developments in women's sport.
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Le Melle, Stephanie. Navigating Systems. Edited by Hunter L. McQuistion. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190610999.003.0006.
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People who have complex behavioral health needs must navigate many different systems of care. To do this, they may require the support of providers who are knowledgeable about these systems of care and understand their roles from a systems perspective. The four factor model of systems-based practice gives providers a recovery-oriented conceptual framework for providing optimal care. The model is conceptualized as four roles—patient care advocate, team member, information integrator, and resource manager—that are performed by providers/psychiatrists to meet the comprehensive needs of the individual patient within and beyond the health care system and the traditional provider role. This model can also be used as a tool for helping providers think through complex clinical problems that are not easily addressed using the standard medical model of care.
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Burns, Tom, and Mike Firn. Research and development. Edited by Tom Burns and Mike Firn. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198754237.003.0029.
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This chapter covers the spectrum of routine monitoring, audit, service evaluation, and formal research. Routine monitoring is an essential task for all mental health professionals, and techniques to make it more palatable are explored, including using routine data for clinical supervision and monitoring team targets. Regular audit is described as an essential tool for logical service development and quality improvement. In the discussion of research, the importance of choosing the correct methodology and of paying attention to detail are stressed. In community psychiatry, sampling bias, regression to the mean, and the Hawthorne effect pose important risks. The hierarchy of research methods is outlined with randomized controlled trials (RCTs) at the top, preferably with either single- or double-blinding. Careful statistics and systematic reviews support evidence-based practice. In addition to experimental quantitative trials, there is a place for cohort and case control trials, as well as for qualitative trials to generate hypotheses.
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Tong, Cheuk Yan William, Caryn Rosmarin, and Armine Sefton, eds. Tutorial Topics in Infection for the Combined Infection Training Programme. Oxford University Press, 2019. http://dx.doi.org/10.1093/oso/9780198801740.001.0001.
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Microbiology and virology laboratories provide a diagnostic service that supports the management of patients under the care of front-line clinicians. Despite the significant overlap, laboratory expertise and clinical patient management are traditionally viewed as independent entities. Trainees in the infection disciplines of microbiology, virology, infectious diseases, and tropical medicine have until recently received separate, and as a result, limited training. To address this problem, the UK replaced the FRCPath Part 1 examination for infectious disease trainees with a combined infection training (CIT) curriculum in 2015. Based on the idea of integration and collaboration within the field, CIT links laboratory expertise to clinical patient management. Tutorial Topics in Infection for the Combined Infection Training Programme is the first book covering the complete CIT curriculum. Following the format of the CIT certificate examination, each chapter ends with three single best answer multiple choice questions accompanied by in-depth discussions. This extensive content helps students appreciate the breadth of knowledge required, emphasises how the different aspects of the field are related, and is an essential tool for those preparing for the CIT certificate examination. Written by a multi-disciplinary team of medical microbiologists, virologists, infectious disease physicians, clinical scientists, biomedical scientists, public health specialists, HIV clinicians, and infection control nurses, this well-illustrated and easy to use book offers a unique insight into infectious diseases. It is the perfect primer for further study, a starting point for medical students and professionals wishing to learn more about the different topics within the infection specialty, and ideal for biomedical scientists looking to broaden their clinical understanding of the field beyond the diagnostic test.
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Craven, Rachael, Hilary Edgcombe, and Ben Gupta, eds. Global Anaesthesia. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780198809821.001.0001.
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The Oxford Specialist Handbook of Global Anaesthesia is an authoritative and comprehensive reference tool for anaesthetists practising in low-resource settings. It provides essential information to trained anaesthetists on delivering care without the equipment, drugs, and colleague support they might be used to in high-resource settings. Written by international experts in the field it will be useful to anaesthetists planning to work in remote and rural areas or countries with poor healthcare resources. It will also be useful to those working as part of disaster and emergency response medical teams. The technical and organizational aspects of delivering anaesthesia in austere environments are addressed, as are drugs and equipment that might be unfamiliar to anaesthetists practising in high-resource settings, e.g. ketamine and draw-over anaesthesia. The sub-specialties of obstetrics, paediatrics, burns, pain, trauma, and critical care are all covered in the clinical section. Useful reference tables, including a drug formulary, ensure that this book is the essential ‘survival guide’ for any trained anaesthetic practitioner planning to work or teach in a remote or resource-poor environment.
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Piel, Jennifer L., and Ronald Schouten. Violence Risk Assessment. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199387106.003.0003.
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The problem of violence in our society has received increasing attention from the public and mental health professions in recent years, and assessing the risk of violence has become a core skill for mental health clinicians and forensic specialists alike. In fact, mental health practitioners in all clinical settings are tasked with assessing and managing their patients’ risk of violence. Although research on the nature of violence and factors that increase the likelihood that a person will commit violent acts has grown in the past several decades, there is no single standard protocol or tool for assessing the risk of violence. This chapter reviews the key risk factors for violence that are supported by research, examines the relationship between mental disorders and violence, and describes approaches that mental health professionals can use to assess the risk of violence.
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Hain, Richard, and Satbir Jassal. Paediatric Palliative Medicine. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198745457.001.0001.
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Looking after children with life-limiting conditions can be very difficult for both parents and health-care professionals. This second edition of Paediatric Palliative Medicine is full of easily accessible, detailed information on medical conditions and symptoms, and includes specific management plans in order to guide the practising clinician through treatment of children requiring palliative care. Using the bestselling Oxford Specialist Handbook format to deliver practical and concise information, this handbook facilitates bedside delivery of effective palliative medicine. It includes detailed information on symptom control and the philosophy and models that support delivery of palliative medicine to children, while also covering practical delivery of palliative medicine relating to other professionals and families, and the learning and coping skills required in palliative care. It also contains a quick-reference drug formulary. Fully updated with an expanded formulary and a new chapter on the intensive care unit, this new edition continues to be the authoritative reference tool in paediatric palliative care.
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Mizock, Lauren, and Zlatka Russinova. Acceptance of Mental Illness. Oxford University Press, 2016. http://dx.doi.org/10.1093/med:psych/9780190204273.001.0001.
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The book covers a topic that is often overlooked in the literature: How people with serious mental illnesses (i.e., schizophrenia, bipolar disorder, severe depression) come to recognize and deal with the symptoms of a mental illness in order to promote recovery. Per the recovery movement in mental health, recovery is understood as not simply symptom elimination, but the process of living a meaningful and satisfying life in the face of mental illness. Acceptance of Mental Illness draws from research to provide educators, clinicians, researchers, and consumers with an understanding of the multidimensional process of acceptance of mental illness in order to support people across culturally diverse groups to experience empowerment, mental wellness, and growth. Chapters focus on providing a historical overview of the treatment of people with mental illness, examining the acceptance process, and exploring the experience of acceptance among women, men, racial–ethnic minorities, and LGBT individuals with serious mental illnesses. The book is a useful tool for mental health educators and providers, with each chapter containing case studies, clinical strategies lists, discussion questions, experiential activities, diagrams, and worksheets that can be completed with clients, students, and peers.
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Bloos, Frank, and Konrad Reinhart. Mixed and central venous oxygen saturation monitoring in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0134.
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Haemodynamic resuscitation should target goals that reflect the tissue oxygen needs of an individual patient. Venous oximetry may be such a tool. Oxygen saturation of blood in the pulmonary artery contains venous blood from the whole body and is referred to as mixed oxygen saturation (SvO2). Measurement of oxygen saturation in blood obtained from a central venous catheter is referred to as central venous oxygen saturation (ScvO2). Both values are not identical since a catheter placed into the superior vena cava only represents venous blood draining the upper body. While it is not possible, in the clinical setting, to predict SvO2 from ScvO2, changes in SvO2 are adequately mirrored by changes in ScvO2. Post-operative patients and patients admitted to intensive care with a low ScvO2 show a higher morbidity and mortality. Early goal-directed therapy (EGDT) combines several haemodynamic goals into a treatment algorithm, including a ScvO2 target. However, recent studies do not support the systematic use of this protocolized approach. A normal value of SvO2 or ScvO2 saturation does not always exclude tissue hypoxia, since it is not possible to identify an inadequate oxygen supply in single organs. A further limitation of this technique is that organ dysfunction can progress, or serum lactate increases, despite normal or even increased venous oximetry values.