Articles: intensive-care-units.
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The arrival of continuous renal replacement therapy (CRRT) has given the intensivist and the intensive care nurse the opportunity to treat acute renal failure (ARF) independently by giving them the necessary technology and taking CRRT away from absolute nephrological control. This structural shift has created a controversy between those countries where control of CRRT has completely shifted to the intensivist and those countries where nephrological input is still dominant. The argument in favor of intensivist-driven CRRT rests upon several observations, including the fact that therapy is continuous, as is the presence of the intensivist in the intensive care unit (ICU). ⋯ Intensivists are successfully performing more and more procedures that were previously seen as part of other specialties and, last but not least, "closed" models of ICU care appear to work best. Australian intensivists have taken up CRRT from the start and now control it. Patient outcomes under such a system, as reported here, are above average, and confirm the effectiveness of such an approach.
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Continuous renal replacement therapy (CRRT) in the intensive care unit (ICU) requires a dedicated training and educational process that includes both theoretical and practical approaches. Important goals for this process include achieving an acceptable circuit life without patient complications and providing a high percentage of staff with bedside expertise. Lectures or didactic sessions must link into bedside instruction and simulations or mock patient/circuit setup. ⋯ Managers require a system of staff review to ensure expertise levels are maintained. Policy development, quality assurance, and complication monitoring systems provide useful information for managers and educators in this field. Credentialing may be useful to confirm the goals of CRRT, but it requires further development of practice standards before adoption.
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Comparative Study
Predictors of mortality in a medical intensive care unit.
Scoring systems to predict mortality in intensive care units have been developed in western populations. There is a need to identify and validate prognostic variables in the Indian context. We compared two scoring systems to predict the discharge outcome in patients admitted to a medical intensive care unit. ⋯ The modified OSF score was superior to the modified APACHE II score in predicting mortality in patients admitted to the medical intensive care unit.
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Working on an intensive care unit is perceived as stressful. This study investigated occupational stress in staff working on an intensive care unit using the occupational stress indicator. Questionnaires were given to all intensive care staff; the replies were then analysed and compared with normative data. ⋯ Their coping strategies differ but the only significantly different measure of adverse outcome was related to personal relationships at work. The job itself was not found to be a significant source of stress. Nursing staff have different sources of stress from medical staff and individuals with partners or children are relatively protected from stress.