Crit Care Resusc
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Despite government encouragement for patients to make advance plans for medical treatment, and the increasing numbers of patients who have done this, there is little research that examines how doctors regard these plans. ⋯ Many intensive care doctors believe end-oflife decisions remain medical decisions, and MEPAs and ACPs need only be respected when they accord with the doctor's treatment decision. This study suggests a need for further education of doctors, particularly those working in intensive care, who are responsible for initiating and maintaining life support treatment.
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The Fellowship Examination for Intensive Care Medicine in Australian and New Zealand, first held in 1979, has undergone four distinct periods of development and change: * 1979-1996. Initiation and establishment of the exam as a relevant and comprehensive assessment process for a new specialty. * 1997-2001. (*) Revision to increase breadth of coverage and reliability for a growing number of candidates, and to ensure that each candidate received the same exam. (*) Expansion to incorporate assessment of CanMEDS skills, including communication, procedures and professional qualities. (*) Lengthening to increase the number of exposures, to ensure reliability. (*) Quarantining of candidates to allow the provision of a similar exam for each candidate. * 2002-2006. Increasing emphasis on examiner training and standard setting, increasing feedback to candidates to improve the educational experience and guide exam preparation, and blueprinting of questions to maintain validity. * 2007 onwards. ⋯ The exam has been regarded as a "tough but fair" assessment in its 30 years of existence, and the committee overseeing its development has aimed to continually review the process to maintain those qualities, as well as reliability, validity and feasibility. The increasing number of candidates has allowed usable statistics to be accumulated but has tested the feasibility of running such a labour-intensive exam. To date, there have been 800 presentations to the exam, with 498 successful candidates.
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Osmotically active solutions, particularly mannitol, havebeen used for more than 30 years in the treatment ofintracranial hypertension. Recently hypertonic saline hasemerged as an alternative to mannitol. ⋯ Here, we compare the systemic andcerebral effects of mannitol and hypertonic saline, as well astheir side effects and complications. Finally, we makerecommendations about their clinical use.
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Editorial Comment
Treating intracranial hypertension: time to abandon mannitol?