The R package mice imputes incomplete multivariate data by chained equations. The software mice 1.0 appeared in the year 2000 as an S-PLUS library, and in 2001 as an R package. mice 1.0 introduced predictor selection, passive imputation and automatic pooling. This article documents mice, which extends the functionality of mice 1.0 in several ways. In mice, the analysis of imputed data is made completely general, whereas the range of models under which pooling works is substantially extended. mice adds new functionality for imputing multilevel data, automatic predictor selection, data handling, post-processing imputed values, specialized pooling routines, model selection tools, and diagnostic graphs. Imputation of categorical data is improved in order to bypass problems caused by perfect prediction. Special attention is paid to transformations, sum scores, indices and interactions using passive imputation, and to the proper setup of the predictor matrix. mice can be downloaded from the Comprehensive R Archive Network. This article provides a hands-on, stepwise approach to solve applied incomplete data problems.

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mice: Multivariate Imputation by Chained Equations in R

Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

Medscape

Werner, Sabine, and Richard Grose. Regulation of Wound Healing by Growth Factors and Cytokines. Physiol Rev 83: 835–870, 2003; 10.1152/physrev.00032.2002.—Cutaneous wound healing is a complex proce...

/pdf/regulation-of-wound-healing-by-growth-factors-and-cytokines-2zk7orhjdk.pdf

Regulation of Wound Healing by Growth Factors and Cytokines

This document represents the first collaboration between 2 organizations-the American Society for Parenteral and Enteral Nutrition and the Society of Critical Care Medicine-to describe best practices in nutrition therapy in critically ill children. The target of these guidelines is intended to be the pediatric critically ill patient (>1 month and 2-3 days in a PICU admitting medical, surgical, and cardiac patients. In total, 2032 citations were scanned for relevance. The PubMed/MEDLINE search resulted in 960 citations for clinical trials and 925 citations for cohort studies. The EMBASE search for clinical trials culled 1661 citations. In total, the search for clinical trials yielded 1107 citations, whereas the cohort search yielded 925. After careful review, 16 randomized controlled trials and 37 cohort studies appeared to answer 1 of the 8 preidentified question groups for this guideline. We used the GRADE criteria (Grading of Recommendations, Assessment, Development, and Evaluation) to adjust the evidence grade based on assessment of the quality of study design and execution. These guidelines are not intended for neonates or adult patients. The guidelines reiterate the importance of nutrition assessment-particularly, the detection of malnourished patients who are most vulnerable and therefore may benefit from timely intervention. There is a need for renewed focus on accurate estimation of energy needs and attention to optimizing protein intake. Indirect calorimetry, where feasible, and cautious use of estimating equations and increased surveillance for unintended caloric underfeeding and overfeeding are recommended. Optimal protein intake and its correlation with clinical outcomes are areas of great interest. The optimal route and timing of nutrient delivery are areas of intense debate and investigations. Enteral nutrition remains the preferred route for nutrient delivery. Several strategies to optimize enteral nutrition during critical illness have emerged. The role of supplemental parenteral nutrition has been highlighted, and a delayed approach appears to be beneficial. Immunonutrition cannot be currently recommended. Overall, the pediatric critical care population is heterogeneous, and a nuanced approach to individualizing nutrition support with the aim of improving clinical outcomes is necessary.

Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.)

Morbidity and mortality from sepsis remains unacceptably high. Large variability in clinical practice, plus the increasing awareness that certain processes of care associated with improved critical...

/pdf/severe-sepsis-and-septic-shock-4qc6kawnx8.pdf

Severe sepsis and septic shock

Mortality prognostication scores do not predict long-term, health-related quality of life after burn: A burn model system national database study.

278 A Comprehensive Legislative Framework to Address Chemical Assault

Little is understood about the inpatient experience from the burn patients' perspectives. Rather, hospitals emphasize quantitative feedback as part of the ongoing process improvement. Comments returned with the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) administrative survey may provide important patient perspectives. They analyzed quantitative and qualitative HCAHPS data to identify areas for care improvement. They reviewed our burn center HCAHPS results over 2 years. They analyzed "top-box" result in each defined HCAHPS category, which is the most frequently reported best result in each composite, including survey scores ≥9 (out of 10). They performed qualitative content analysis of open-text responses via a HIPAA-compliant analysis software. They developed a hierarchy of major expressed themes and organized them using HCAHPS-validated satisfaction domains. A total of 610 inpatient HCAHPS surveys (21% response rate) were returned. Seventy-five percent of respondents ranked their burn center as ≥9 (out of 10) in care scores. Content analysis identified three main components of the inpatient experience: 1) provider/nurse communication, 2) hospital environment, and 3) the discharge experience. Caring, respect, handoff coordination, explanations, listening, and confidence in provider constituted the six key communication themes. Patients generally reported that burn providers listened to their concerns, but others requested clearer explanations of their condition and care. Responses about hospital environment highlighted excessive noise and disrupted sleep, and variable responses related to cleanliness. Challenges in the discharge experience included difficulties procuring wound care supplies and discharge medications. Qualitative data from HCAHPS helped identify major target areas for burn center performance improvement. Analysis of HCAHPS direct patient feedback is useful in process improvement, whereas numerical data alone do not provide sufficient actionable information.

Burn Patients' Perceptions of Their Care: What Can We Learn From Postdischarge Satisfaction Surveys?

http://academic.oup.com/jbcr/article-pdf/39/suppl_1/S97/24770172/iry006.181.pdf

259 Outpatient Opioid Use in Burn Patients: A Retrospective Review

la supervivencia y la mejoria de los resultados funcionales de los pacientes quemados, a lo largo de los ultimos 30 anos. El tratamiento optimo de las quemaduras en el siglo XXI se basa en un esquema de tratamiento especializado que incorpora el cierre precoz de la herida quirurgica, la asistencia en unidades de criticos y los esfuerzos de rehabilitacion. El exito del tratamiento de las quemaduras de acuerdo con un modelo multidisciplinario ha promovido la organizacion de centros de quemados como recursos regionales para los pacientes con lesiones graves, incluyendo aquellos con heridas abiertas grandes. La revision ofrecida en este articulo y las Burn Care Guidelines publicadas por la American Burn Association ilustran la necesidad de ensayos en fase I para fundamentar las pautas de tratamiento de quemados [1]. En muchos casos, nuestras practicas se basan en anos de ensayos en fase II procedentes de ensayos clinicos pequenos. Las colaboraciones para la investigacion multicentrica, como el proyecto de genomica subvencionado por los National Institutes of Health, «Inflammation and the Host Response» (http://www.gluegrant.org), han comenzado a codificar las pautas de tratamiento que deben preparar el camino para futuros ensayos clinicos multicentricos [2,3].

Nicole S. Gibran

Papers

Mortality prognostication scores do not predict long-term, health-related quality of life after burn: A burn model system national database study.

278 A Comprehensive Legislative Framework to Address Chemical Assault

Burn Patients' Perceptions of Their Care: What Can We Learn From Postdischarge Satisfaction Surveys?

259 Outpatient Opioid Use in Burn Patients: A Retrospective Review

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