Critical care medicine
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Critical care medicine · Jan 2011
ReviewPartial do-not-resuscitate orders: A hazard to patient safety and clinical outcomes?
Patients and families commonly discuss end-of-life decisions with clinicians to create a treatment plan based on patient wishes. In some instances, respect for patient autonomy in making choices may create the potential for patient harm. Medical treatments are often performed in groupings in order to work effectively. When such combinations are separated as a result of patient or surrogate choices, critical elements of life- saving care may be omitted, and the patient may receive nonbeneficial or harmful treatment. A partial do-not-resuscitate order may serve as an example. ⋯ Discouraging partial do-not-resuscitate(s) order may help promote more accurate and comprehensive advance care planning.
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Critical care medicine · Jan 2011
ReviewSeverity of illness scoring systems in the intensive care unit.
Adult intensive care unit prognostic models have been used for predicting patient outcome for three decades. The goal of this review is to describe the different versions of the main adult intensive care unit prognostic models and discuss their potential roles. ⋯ The fourth-generation Acute Physiology and Chronic Health Evaluation, Simplified Acute Physiology Score 3, Acute Physiology and Chronic Health Evaluation IV, and Mortality Probability Model0 III adult prognostic models, perform well in predicting mortality. Future studies are needed to determine their roles for benchmarking, performance improvement, resource use, and clinical decision support.
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Critical care medicine · Jan 2011
Review Comparative StudyUsing evidence-based medicine to protect healthcare workers from pandemic influenza: Is it possible?
To use evidence-based principles to develop infection control algorithms to ensure the protection of healthcare workers and the continuity of health service provision during a pandemic. ⋯ Conventional evidence-based principles could not be applied to formulate recommendations due to the lack of pandemic-specific efficacy data of protection tools and the inherent unpredictability of pandemics. As an alternative, evidence-based principles have been used to formulate recommendations while giving priority to the needs and values of healthcare workers over the research evidence.