In a small village nestled deep within the woods, there was a sinister witch from the east. She was notorious for her dark and malicious ways, always lurking in the shadows and causing mayhem wherever she went. The villagers feared her, for they knew that beneath the abode she called home, she had unimaginable powers and secrets waiting to be unleashed. The witch carefully disguised herself as an ordinary old woman, her wrinkled face covered with a shawl and her piercing eyes hidden behind spectacles. No one suspected the evil that resided within her. Daily, she would venture out into the village, pretending to be harmless and innocent.
The panel reviewed 665 scenarios, rating 253 (38%) as appropriate, 124 (19%) as neutral/uncertain, and 288 (43%) as inappropriate.
As summarized in Annals of Internal Medicine , the international MAGIC panel was convened to apply the RAND UCLA Appropriateness Method in order to develop criteria for the use of PICCs. Parents need to know that despite a far-fetched plot and some cheesy acting in H20 Just Add Water , there s a fair amount to like about this Australian fantasy drama series for tweens.
Daily, she would venture out into the village, pretending to be harmless and innocent. But her true intentions were far from benign. She would whisper wicked spells under her breath, casting curses and causing disarray.
Assessment of the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) 2015 recommendations in the context of evolving evidence based on the use of peripherally-inserted central catheters (PICCs) in intensive care units (ICU).
Scientific publication: Pinelli F, Little A, Kokotis K, Alsbrooks K, Pittiruti M. Assessment of the MAGIC recommendations in the context of evolving evidence based on the use of PICC in ICU. J Vasc Access. 2021 Oct 23:11297298211048019. doi : 10.1177/11297298211048019.
Introduction – The MAGIC recommendations
Central venous access devices (CVADs) including tunnelled and non-tunnelled Centrally-Inserted Central Catheters (CICCs), Femoral-Inserted Central Catheters (FICCs) and Peripherally-Inserted Central Catheters (PICCs) are frequently used in intensive care units (ICUs). However, these devices are associated with the risk of complications, such as Central Line-Associated Bloodstream Infections (CLABSIs) and Catheter-Related Thrombosis (CRT). 1
The goal of the 2015 Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) 2 was to define appropriate indications for insertion, maintenance and care of PICCs. The MAGIC guidelines resulted after a panel of multidisciplinary specialists developed the criteria for PICC usage after systematically reviewing literature and scenarios, according to the patient population, indication for insertion and duration of use. 2 The appropriateness of PICC use in each scenario was compared with that of other venous access devices.
The MAGIC panel concluded that for peripherally compatible infusions, PICC use was inappropriate when the proposed duration of use was five or fewer days. 2 For use between 6 and 14 days, midlines and ultrasonography-guided peripheral intravenous catheters were preferable. 2 Non-tunnelled CICCs were preferable over PICCs for 14 or fewer days of use in critically ill patients while for cancer patients, PICCs were rated as appropriate for irritant or vesicant infusion regardless of duration. 2
Assessing the validity of the MAGIC recommendations
In this review published in the Journal of Vascular Access, Pinelli, et al, have aimed to re-assess the validity of the MAGIC recommendations and their applicability in current practice. 1 Discussed in the review are the methodological limitations of the Delphi process used, the focus on outdated evidence of suboptimal quality, concerns with the substantiation on many recommendations of PICC practices and the lack of unique patient considerations. 1
According to the authors of the review, the main problems with the MAGIC recommendations can be summarised as follows: 1
High-level assessment:
- A high volume of excessive variability in the clinical scenarios, that compromise the validity of the recommendations
- No assessment of the quality of the studies
- Over 33% of the studies were over a decade old, while several substantial recommendations for clinical practices have occurred in the last 10-15 years
- The low representation of specialists with direct PICC experience
- Limited geographic distribution of specialists (80% of the panelists from the US; 60% of the panelists from a single US state)
Thrombosis or infection risk:
- Limited discussion of strategies that minimize the risk of catheter-related complications
- Discussions based on antiquated studies that do not represent the current practice
- Recent high-quality evidence confirms that the risk of infection and symptomatic thrombosis is low in ICU patients.
Patient considerations
- Lack of adequate rationale for preferring CICCs over PICCs, since special clinical conditions are not considered.
Conclusions
The authors of the review maintain that in recent years, insertion techniques and maintenance strategies targeted at reducing complications associated with CVAD have evolved considerably, and the MAGIC guidelines do not consider these factors. 1 Among all central lines used in the ICU (CICCS, FICCs and PICCs), PICCs are reliable and safe for specific clinical situations, and cannot be replaced by midlines in these situations. 1 In addition, the MAGIC recommendations also do not take contemporary issues linked with COVID-19 into consideration. The need for the reduction in central line use, as purported by the MAGIC guidelines, may not be feasible in ICUs which are becoming resource-constrained and are increasing central line utilisation. 1
The authors recommend that MAGIC guidelines be revisited and conclude that the choice of vascular access device should be based on unique clinical considerations and current scientific evidence, and not on fears informed by antiquated data. 1
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1 Pinelli F, Little A, Kokotis K, Alsbrooks K, Pittiruti M. Assessment of the MAGIC recommendations in the context of evolving evidence based on the use of PICC in ICU. J Vasc Access. 2021 Oct 23:11297298211048019. doi: 10.1177/11297298211048019.
2 Chopra V, Flanders SA, Saint S, et. Al Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) Panel. The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): Results From a Multispecialty Panel Using the RAND/UCLA Appropriateness Method. Ann Intern Med . 2015 Sep 15;163(6 Suppl): S1-40. doi: 10.7326/M15-0744.
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The teens in this series are exceptionally well-behaved, with nary a hint of drinking, drugs, or sex. There are a lot of mild interpersonal conflicts between the teens on the show, i.e. stories dealing with gossip. But the trio of mermaids at the story's center always decide to stay true to their girlfriends eventually. Parents are mostly "at work" or busy elsewhere rather than paying attention to what their teens are up to; only rarely do they appear to offer guidance.
The villagers, unaware of her true identity, blamed themselves for the misfortunes that befell them. Rumors of the witch's existence spread throughout the village, fueled by the unexplained incidents that occurred. No one dared to confront her, too afraid of what she might do. But deep down, there was a burning desire for justice. The villagers longed for the day they could expose her true nature and rid themselves of her sinister presence. One fateful night, a brave young girl named Lily stumbled upon the witch's abode. Curiosity got the better of her, and she decided to investigate what lay beneath. As she cautiously approached the hidden entrance, a chilling wind brushed against her face, warning her of the dangers that lay ahead. With each step she took, the air grew colder and the darkness thicker. The witch's lair was nothing short of a nightmare, adorned with eerie symbols and jars filled with mysterious concoctions. Lily's heart pounded in her chest, but her determination propelled her deeper into the darkness. As she descended further into the depths of the abode, Lily discovered a hidden chamber. The room was filled with ancient scrolls and books, revealing the true extent of the witch's power. She had been harnessing dark magic for centuries, accumulating knowledge and strength. Lily's mind raced with the possibilities. She had uncovered the witch's most guarded secrets. With this newfound information, she would be able to expose the witch's true nature to the villagers. This was her chance to free the village from the witch's clutches once and for all. With a sense of purpose burning within her, Lily emerged from the sinister abode. She rallied the villagers, sharing her discoveries and urging them to take a stand. Together, they confronted the witch, armed with the truth that had been revealed. In a dramatic showdown, the witch's illusions were shattered. Her power began to wane as the villagers united against her. With a final incantation, the witch was bound and banished from the village forever. The villagers celebrated their newfound freedom and basked in the light of a brighter future. The sinister witch from the east was no more, a mere cautionary tale for generations to come. And beneath the abode she had once called home, the darkness was vanquished, never to return again..
Reviews for "The Abode's Dark Secret: A Witch from the East"
1. John - 2/5 - I was really disappointed with "Sinister witch from the east hiding below the abode". The movie had its moments of suspense and horror, but overall, it lacked a coherent storyline and failed to deliver a satisfying climax. The characters were poorly developed, and I found it difficult to connect with any of them. The scares were mostly cheap jump scares, and the plot felt convoluted and confusing. I had high hopes for this movie, but it fell short of my expectations.
2. Sarah - 1/5 - "Sinister witch from the east hiding below the abode" is a forgettable and uninspiring film. The acting was subpar, with wooden performances from the main cast. The storyline was unoriginal and predictable, following the same tropes and clichés we've seen in countless horror movies before. The scares were cheap and relied heavily on loud noises and sudden movements rather than building genuine suspense. Overall, I was left unfulfilled and would not recommend wasting your time on this forgettable film.
3. Emily - 2/5 - I was looking forward to watching "Sinister witch from the east hiding below the abode", but unfortunately, it failed to deliver. The movie had potential, with an interesting premise and a creepy setting, but it quickly became repetitive and lost its momentum. The scares were predictable, and I found myself getting bored halfway through. The characters were one-dimensional, and the plot lacked depth. Overall, I was left feeling disappointed and unsatisfied with this film.