Current opinion in critical care
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Curr Opin Crit Care · Dec 2012
ReviewClinical Reflection: a vital process for supporting the development of wisdom in doctors.
This review explores in detail the practice of reflection and its importance for doctors. It offers a definition of and a framework for both oral and written Clinical Reflection. It presents a thorough and detailed explanation of Clinical Reflection, its meaning, purpose, and processes and provides an illustrative case example from critical care. ⋯ Clinical Reflection offers doctors a powerful way of supporting their professional development and providing evidence of their practical wisdom as expressed by Aristotle. It is time that an appropriate understanding of what reflection can offer doctors is explored more generally among the profession.
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Curr Opin Crit Care · Dec 2012
ReviewResident full-time specialists in the ICU: a survivable model?
Intensivists have a professional and personal interest in trying to answer whether immediate review of patients by a consultant intensivist improves outcomes. Although some advocate in-hospital around-the-clock consultant intensivist presence, does the available evidence suggest all ICUs should be staffed in such a manner and is such a service sustainable given the shortage of intensivists, potential loss of staff from burnout and cost? ⋯ A unified staffing solution within a country's different ICUs, let alone between countries, is unlikely. The current evidence does not universally support or justify 24 h/7 days consultant intensivist presence. International differences in staffing models and ICU structures make direct comparisons difficult and in some circumstances the balance may favour 24 h/7 days consultant intensivists.
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Curr Opin Crit Care · Dec 2012
ReviewPrioritizing registered donors in organ allocation: an ethical appraisal of the Israeli organ transplant law.
A new organ transplant law in Israel, which gives priority in organ allocation to candidates who in various ways support organ donation, has resulted in a significant increase in organ donation in 2011. We provide an ethical analysis of the new law. ⋯ Athough needing some modifications, the new Israeli law is based on sound ethical approach that seems to begin already to bear fruits.
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Curr Opin Crit Care · Dec 2012
ReviewManagement strategies for acute spinal cord injury: current options and future perspectives.
Spinal cord injury is a devastating acute neurological condition with loss of function and poor long-term prognosis. This review summarizes current management strategies and innovative concepts on the horizon. ⋯ General management strategies for acute spinal cord injury consist of protection of airway, breathing, oxygenation and control of blood loss with maintenance of blood pressure. Unstable spine fractures should be stabilized early to allow unrestricted mobilization of patients with spinal cord injuries and to decrease preventable complications. Steroids are largely considered obsolete and have been abandoned in clinical guidelines. Nogo-A represents a promising new pharmacological target to promote sprouting of injured axons and restore function. Prospective clinical trials of Nogo-A inhibition in patients with spinal cord injuries are currently under way.
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Trauma scoring systems are used by researchers, registries, or individuals to describe injury severity or to estimate the prognosis of trauma patients. Triage scores also may influence the treatment of a trauma case. ⋯ Cross-national comparisons evaluating different scores will further help to identify the optimal scoring system, based on the available information. The inclusion of patients with partially missing data is also an important task for the future.