Current opinion in critical care
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Acute kidney injury (AKI) is a major clinical problem in hospitalized patients. Effective treatment and early diagnosis of this syndrome are not currently available. This review focuses on recent studies examining the biological characteristics and the diagnostic and prognostic value of a novel biomarker--neutrophil gelatinase-associated lipocalin (NGAL)--in the two major patient populations at risk for AKI. ⋯ NGAL appears to fulfill many characteristics of an appropriate 'real-time' biomarker for AKI detection.
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Curr Opin Crit Care · Dec 2010
ReviewCritical incident monitoring in paediatric and adult critical care: from reporting to improved patient outcomes?
Critical incident reporting alone does not necessarily improve patient safety or even patient outcomes. Substantial improvement has been made by focusing on the further two steps of critical incident monitoring, that is, the analysis of critical incidents and implementation of system changes. The system approach to patient safety had an impact on the view about the patient's role in safety. This review aims to analyse recent advances in the technique of reporting, the analysis of reported incidents, and the implementation of actual system improvements. It also explores how families should be approached about safety issues. ⋯ A persisting high number of reported incidents is anticipated and regarded as continuing good safety culture. However, only the implementation of system changes, based on incident reports, and also involving the expertise of patients and their families, has the potential to improve patient outcome. Hard outcome criteria, such as standardized mortality ratio, have not yet been shown to improve as a result of critical incident monitoring.
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To review the new findings about the physiological roles of kidney injury molecule-1 (KIM-1) and the rapidly expanding evidence for this molecule as a promising biomarker in preclinical kidney toxicity evaluation and various human kidney diseases. ⋯ KIM-1 mediates epithelial phagocytosis in the injured kidney converting the proximal epithelial cell into a phagocyte, with potentially important pathophysiological implications for modulation of the immune response and repair process after injury. KIM-1 serves as a highly sensitive and specific urinary biomarker for kidney injury and may also be a therapeutic target for various kidney diseases.
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Curr Opin Crit Care · Dec 2010
ReviewLearning through observation: the role of ethnography in improving critical care.
To determine the conditions under which ethnographic research is a useful tool for reflexive self-learning and enhanced performance in critical care units. ⋯ Qualitative researchers have long been involved in the study of critical care. There is a new emphasis on using ethnographic methods as a tool for behavioural change through the process of iterative feedback.
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To summarize the history and current findings for creatinine as a renal biomarker and try to predict its future, looking at new biomarkers for kidneys (neutrophil gelatinase-associated lipocalin and cystatin C) and comparing current development to other diseases (troponins and procalcitonin). ⋯ Unless enough evidence accumulates, considering the history, familiarity, and recent findings related to outcome, creatinine will continue to be used and dominate in clinical practice.