Current opinion in critical care
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Curr Opin Crit Care · Dec 2022
ReviewCoronavirus disease 2019 aftermath: psychological trauma in ICU healthcare workers.
We aim to describe the extent of psychological trauma and moral distress in healthcare workers (HCW) working in the intensive care unit (ICU) during the coronavirus disease 2019 (COVID-19) pandemic. Specifically, we review reports on prevalence of mental health symptoms, highlight vulnerable populations and summarize modifiable risk factors associated with mental health symptoms in ICU HCW. ⋯ The COVID-19 pandemic has severely impacted ICU HCW worldwide. The psychological trauma, manifesting as posttraumatic stress disorder, burnout, anxiety, and depression, is substantial and concerning. Urgent action by lawmakers and healthcare administrators is required to protect ICU HCW and sustain a healthy workforce.
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Curr Opin Crit Care · Dec 2022
ReviewOpportunities in digital health and electronic health records for acute kidney injury care.
The field of digital health is evolving rapidly with applications relevant to the prediction, detection and management of acute kidney injury (AKI). This review will summarize recent publications in these areas. ⋯ Further research is required to overcome barriers to the validation and implementation of ML models for AKI care. Simpler electronic systems within the electronic medical record can lead to improved care in some but not all settings, and careful consideration of local context and implementation strategy is recommended.
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Curr Opin Crit Care · Dec 2022
ReviewPragmatic platform trials to improve the outcome of patients with acute kidney injury.
There is an important need for improved diagnostic strategies and treatment among patients with acute kidney injury (AKI). Classical randomized clinical trials have generated relevant results in AKI but are associated with shortcomings, such as high costs and sometimes lack of generalizability. In this minireview, we discuss the value and limits of pragmatic trials and platform trials for AKI research. ⋯ Pragmatic and platform trials can provide clinical answers in 'real-life' settings, facilitate a significant sample size enrollment at a limited cost, and provide results that can have a faster implementation in clinical practice.
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Curr Opin Crit Care · Dec 2022
ReviewFundamental drivers of nurses' experiences of ICU surging during the coronavirus disease 2019 (COVID-19) pandemic.
Nurses working in intensive care units have been heavily impacted by the coronavirus disease 2019 (COVID-19) pandemic. This review summarizes the current state of the evidence regarding intensive care nurses experience of the pandemic. ⋯ Many of the adverse impacts of the pandemic are interdependent; for example, reducing nurses' workload is likely to have benefits for mental health indicators.Adverse mental health outcomes are likely to have an impact on future recruitment and retention for intensive care nursing.More studies are needed to understand the longer term impact of the pandemic on intensive care nurses.
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Acute surge events result in health capacity strain, which can result in deviations from normal care, activation of contingencies and decisions related to resource allocation. This review discusses the impact of health capacity strain on patient centered outcomes. ⋯ An understanding of ICU strain is fundamental to the appropriate clinical care for critically ill patients. Accounting for stain on outcomes in critically ill patients allows for minimization of variation in care and an ability of a given healthcare system to provide equitable, and quality care even in surge scenarios.