Ann Acad Med Singap
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Ann Acad Med Singap · Sep 2001
The need for collaboration between clinicians and statisticians: some experience and examples.
Very often we see poor communication and collaboration between clinicians and statisticians. Both sides may fail to realise the importance of a truly collaborative effort. In this paper we give examples to illustrate some problems clinicians and statisticians may encounter when they do not have the full support of each other. The aim is to convince both parties the importance of a truly collaborative effort. ⋯ On the one hand, robust statistical practice is vital in many medical research projects. On the other hand, medical thinking is important in the formulation and application of statistical strategies. Statistical inputs should be integrated into medical research projects throughout the whole research process. Sporadic contacts between clinicians and statisticians are not enough. Both parties must learn to communicate more effectively and to be willing to collaborate with each other.
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Ann Acad Med Singap · May 2001
Randomized Controlled Trial Clinical TrialEffect of different endotracheal suctioning systems on cardiorespiratory parameters of ventilated patients.
We conducted this prospective randomised cross-over study to evaluate the effect of closed system (CS) versus open system (OS) endotracheal suctioning on heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), oxygen saturation (SpO2) and electrocardiogram (ECG) rhythm of patients on mechanical ventilation. ⋯ Our study shows that OS suctioning results in more adverse changes in cardiorespiratory parameters compared to CS suctioning.
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To highlight recent advances in neurological and neurosurgical intensive care. ⋯ Specialised neurointensive care units provide the best environment for the patient with acute brain injury. Outcome is frequently enhanced the clinicians skilled towards dealing with the whole spectrum of neurologic insults.
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Ann Acad Med Singap · May 2001
ReviewLimitation of life support in the critically ill: the Hong Kong perspective.
Patients admitted to the intensive care unit (ICU) may not benefit from the life support provided and it may result in prolonged and unnecessary suffering. Limiting life-support therapy in this situation is an ethically acceptable practice in Western countries. Statements produced by professional bodies have been generally made from a Western perspective. Cultural influences, aspects of management and resource limitations may create differences, yet there is little information available on the ethical decision making processes involved in limitation of life support in Asian countries. This article reviews the processes involved in the limitation of life support in critically ill intensive care patients in the predominantly Chinese population of Hong Kong. ⋯ Limitation of therapy in dying Chinese patients occurs in ICUs and, patients and relatives concur in 95% of cases with medical decisions to limit therapy in these patients. The importance of communication as well as a desire to participate in the decision-making process regarding limitation of therapy suggest similarities between Western and Asian expectations. More comprehensive data are required regarding end-of-life issues in the Asian context, especially in relation to the general population's perception as to the processes involved.
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The optimal haematocrit for the critically ill patient is undetermined. ⋯ Oxygen consumption requires oxygen delivery. Haematocrit delivers oxygen. However, if oxygen delivery is not limited by haematocrit or is achieved by other means, then the concept of the optimal haematocrit is irrelevant. There are currently no guidelines for the management of anaemia in the critically ill.