Current opinion in critical care
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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.
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Curr Opin Crit Care · Dec 2012
Review Comparative StudyInternational comparisons of intensive care: informing outcomes and improving standards.
Interest in international comparisons of critical illness is growing, but the utility of these studies is questionable. This review examines the challenges of international comparisons and highlights areas in which international data provide information relevant to clinical practice and resource allocation. ⋯ Differences in provision of critical care can be leveraged to inform decisions on allocation of ICU beds, improve interpretation of clinical outcomes, and assess ways to decrease costs of care. International definitions of key components of critical care are needed to facilitate research and ensure rigorous comparisons.
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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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Acute kidney injury (AKI) is a clinical syndrome with many different causes. The Kidney Disease: Improving Global Outcomes consensus AKI definition has harmonized the study of AKI, yet effective clinical therapeutics are not available to treat most cases of AKI. In order to develop therapeutic interventions, an approach to AKI that subdivides the various causes of AKI into well codified subclasses of AKI may allow a process of 'disentanglement'. ⋯ Disentangling the AKI syndrome requires an approach of rigorous taxonomy, molecular diagnostics, and intense collaboration. This approach may be applied to other complex and heterogeneous syndromes like sepsis and acute respiratory distress syndrome as well, but this article only outlines this approach to AKI.
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Acute kidney injury (AKI) in the ICU is associated with adverse outcomes. We review the long-term consequences of AKI in ICU patients. ⋯ Further research is necessary to delineate the mechanisms by which AKI may lead to CKD, and to understand how CKD enhances the risk for developing AKI. Whereas restrospective observational studies of this population exist, prospective clinical studies and trials evaluating the long-term clinical outcomes of AKI specifically in ICU patients are needed.