Current opinion in critical care
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Critical care medicine (CCM) is expensive. CCM costs have continued to rise since they were first calculated in the 1970s. By 2005, CCM costs in the US were estimated to be $81.7 billion accounting for 13.4% of hospital costs, 4.1% of the national health expenditures and 0.66% of the gross domestic product. ⋯ Cost containment is difficult to attain in critical care as the programs proposed to achieve cost control may be so pricey, that potential cost savings are offset. Some CCM cost saving methodologies may benefit patient care, whereas others may be detrimental to society. CCM cost containment may prove as illusory in the future as it has been in the past.
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Alterations of the renal microcirculation can promote the development of acute kidney injury through the interlinked occurrence of renal hypoxia and activation of inflammatory pathways. This review focuses on the recent advances in this area, and discusses the possible therapeutic interventions that might be derived from these insights. ⋯ Knowledge of the pathophysiological mechanisms of acute kidney injury emphasizes the importance of the role of the microcirculation in its development. Preventive and therapeutic approach should be based on restoring the homeostasis between nitric oxide, reactive oxygen species and renal oxygenation.
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Curr Opin Crit Care · Dec 2009
ReviewFinancial and intellectual conflicts of interest: confusion and clarity.
To examine the literature on competing interests for individuals and organizations involved in healthcare and to determine the nature and extent of the problem, and the most effective methods of management. ⋯ Transparency is a necessary, but not a sufficient component in managing bias. Organizations should develop integrated systems for declaring, monitoring and managing financial interests; insight into other forms of bias could be improved through educational programmes. Marketing masquerading as education should be prohibited for undergraduates and trainees, and by professional organizations. Universities and journals should separate their conflicted roles as regulators and beneficiaries in commercial relationships.
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To bring together in one review article, the most current and relevant evidence relating to military trauma resuscitation. ⋯ The review aims to educate the readership in recent advances in trauma practice, culminating in a novel empiric massive transfusion algorithm seamlessly guiding the clinician through the initial resuscitation stage resulting in reduced mortality, morbidity, coagulopathy and decreased overall blood product usage.
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To review recent advances in understanding of the occurrence, pathophysiology, prophylaxis and treatment of cardiac surgery-associated acute kidney injury (AKI). ⋯ The vexing problem of AKI following cardiac surgery is common and unsolved. Clinical strategies that stress avoidance rather than treatment remain the mainstay of effective management of patients at high renal risk.