Current opinion in critical care
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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
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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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
ReviewStructure and function: planning a new ICU to optimize patient care.
To survey the recent medical literature reporting effects of ICU design on patients' and family members' well being, safety and functionality. ⋯ An organization structured on the needs of the patient and their family is mandatory in designing a new ICU. The main aims in the design of a new department should be patient-centered care, safety, functionality, innovation and a future-proof concept.
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There is still an ongoing debate whether damage control orthopedics (DCO) or other treatment strategies should be favored in the treatment of multiply injured patients. This review gives an overview of the current literature concerning this important question in the treatment of severely injured patients. ⋯ In severely injured patients, DCO should be considered. On the other hand, there is still a lack of randomized studies for a more precise characterization of the patients who benefit from DCO treatment.