Journal of critical care
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Journal of critical care · Mar 2003
Review Comparative StudyAcute renal failure in the ICU: assessing the utility of continuous renal replacement.
Acute renal failure (ARF) in the ICU patient still remains a common problem and is associated with increased morbidity, mortality, and cost. Potential advantages of continuous renal replacement (CRRT), compared with intermittent hemodialysis (IHD) include enhanced hemodynamic stability, increased solute removal, and greater ultrafiltration. ⋯ The difficulties associated with designing such prospective studies are the complex status of the medical patients and the ethical dilemma of randomizing patients to a certain dialysis modality. At this time, there is no evidence to support the assertion that CRRT improves clinical outcomes compared with IHD.
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Journal of critical care · Mar 2003
ReviewMedical informatics in the intensive care unit: overview of technology assessment.
Effective patient care in the intensive care unit (ICU) depends on the ability of clinicians to process large amounts of clinical and laboratory data. Recently, medical informatics applications have been developed to store and display patient information and assist clinical decision making. Despite the proliferation of these systems and their potential to improve patient care, there are no comprehensive health technology assessments incorporating considerations of safety, functionality, technical performance, clinical effectiveness, economics, and organizational implications. ⋯ Qualitative and quantitative nonrandomized evaluations of comprehensive information management systems like electronic medical records and picture archiving and communications systems should concentrate on technical and functional issues. Specific applications like clinical decision support systems and computerized patient care systems are designed to improve patient outcomes and clinical performance; randomized controlled trials (RCTs) to assess clinical effectiveness are important in their assessment. Although studies of these applications in the ICU setting are increasing, there are currently very few published randomized trials.
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Journal of critical care · Sep 2002
ReviewA review of costing methodologies in critical care studies.
Clinical decision making in critical care has traditionally been based on clinical outcome measures such as mortality and morbidity. Over the past few decades, however, increasing competition in the health care marketplace has made it necessary to consider costs when making clinical and managerial decisions in critical care. Sophisticated costing methodologies have been developed to aid this decision-making process. ⋯ Of the 43 articles that actually counted costs, 37.2% (16 of 43) counted physician costs, 27.9% (12 of 43) counted facility costs, 34.9% (15 of 43) counted nursing costs, 9.3% (4 of 43) counted societal costs, and 90.7% (39 of 43) counted laboratory, equipment, and pharmacy costs. Our conclusion is that despite considerable progress in costing methodologies, critical care studies have not adequately implemented these techniques. Given the importance of financial implications in medicine, it would be prudent for critical care studies to use these more advanced techniques.
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Journal of critical care · Jun 2002
ReviewVenous thromboembolism and its prevention in critical care.
Evidence-based guidelines for the prevention of venous thromboembolism (VTE) are available for most major surgical and medical patient groups. Such guidelines have not been established for critically ill patients. ⋯ Data on the epidemiology of VTE and its prevention in critically ill patients are very limited. Further research is needed to better define patient risk factors for VTE, optimal methods of thromboprophylaxis, and strategies to improve compliance with prophylaxis recommendations. In the meantime, prevention strategies, shown to be effective in other related patient groups, and general principles of individual pharmacotherapy should guide the routine use of prophylaxis during critical illness.
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Journal of critical care · Jun 2002
ReviewVenous thromboembolism and its prevention in critical care.
Evidence-based guidelines for the prevention of venous thromboembolism (VTE) are available for most major surgical and medical patient groups. Such guidelines have not been established for critically ill patients. ⋯ Data on the epidemiology of VTE and its prevention in critically ill patients are very limited. Further research is needed to better define patient risk factors for VTE, optimal methods of thromboprophylaxis, and strategies to improve compliance with prophylaxis recommendations. In the meantime, prevention strategies, shown to be effective in other related patient groups, and general principles of individual pharmacotherapy should guide the routine use of prophylaxis during critical illness.