Journal of critical care
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Journal of critical care · Mar 2003
ReviewProcalcitonin as a diagnostic test for sepsis: health technology assessment in the ICU.
Elevation in the serum concentration of procalcitonin (PCT) is associated with systemic infection. This association has led to the proposed use of PCT as a novel biomarker of bacterial sepsis. The advantages and limitations of the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) definitions of sepsis are an important consideration that affects the impact of any diagnostic test for sepsis and these issues are discussed. ⋯ The published evidence does not support a general claim that PCT is a useful decision support tool for diagnosing sepsis in patients who have SIRS. Procalcitonin has a slightly better ability to exclude the diagnosis of sepsis. The role for using PCT testing in the ICU will continue to evolve along with our understanding and definition of sepsis.
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Journal of critical care · Mar 2003
ReviewMedical informatics in the intensive care unit: overview of technology assessment.
Effective patient care in the intensive care unit (ICU) depends on the ability of clinicians to process large amounts of clinical and laboratory data. Recently, medical informatics applications have been developed to store and display patient information and assist clinical decision making. Despite the proliferation of these systems and their potential to improve patient care, there are no comprehensive health technology assessments incorporating considerations of safety, functionality, technical performance, clinical effectiveness, economics, and organizational implications. ⋯ Qualitative and quantitative nonrandomized evaluations of comprehensive information management systems like electronic medical records and picture archiving and communications systems should concentrate on technical and functional issues. Specific applications like clinical decision support systems and computerized patient care systems are designed to improve patient outcomes and clinical performance; randomized controlled trials (RCTs) to assess clinical effectiveness are important in their assessment. Although studies of these applications in the ICU setting are increasing, there are currently very few published randomized trials.
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Journal of critical care · Mar 2003
Review Comparative StudyAcute renal failure in the ICU: assessing the utility of continuous renal replacement.
Acute renal failure (ARF) in the ICU patient still remains a common problem and is associated with increased morbidity, mortality, and cost. Potential advantages of continuous renal replacement (CRRT), compared with intermittent hemodialysis (IHD) include enhanced hemodynamic stability, increased solute removal, and greater ultrafiltration. ⋯ The difficulties associated with designing such prospective studies are the complex status of the medical patients and the ethical dilemma of randomizing patients to a certain dialysis modality. At this time, there is no evidence to support the assertion that CRRT improves clinical outcomes compared with IHD.
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Journal of critical care · Sep 2002
ReviewA review of costing methodologies in critical care studies.
Clinical decision making in critical care has traditionally been based on clinical outcome measures such as mortality and morbidity. Over the past few decades, however, increasing competition in the health care marketplace has made it necessary to consider costs when making clinical and managerial decisions in critical care. Sophisticated costing methodologies have been developed to aid this decision-making process. ⋯ Of the 43 articles that actually counted costs, 37.2% (16 of 43) counted physician costs, 27.9% (12 of 43) counted facility costs, 34.9% (15 of 43) counted nursing costs, 9.3% (4 of 43) counted societal costs, and 90.7% (39 of 43) counted laboratory, equipment, and pharmacy costs. Our conclusion is that despite considerable progress in costing methodologies, critical care studies have not adequately implemented these techniques. Given the importance of financial implications in medicine, it would be prudent for critical care studies to use these more advanced techniques.
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Journal of critical care · Jun 2002
ReviewChanging physician behavior: a review of patient safety in critical care medicine.
The publication of the Agency for Healthcare Research and Quality (AHRQ) report in July 2001 entitled "Making Health Care Safer: A Critical Analysis of Patient Safety Practices," represents a significant perceptual change in health care ideology. It can be argued that this compilation recognizes not only that medical errors occur in the health care system, but also that there are significant learning opportunities that may arise in the identification of these errors that are otherwise known as medical misadventures. The report concluded and outlined a series of 11 highly rated practices whose usage are associated with increased safety. ⋯ In other words, after the identification of the 11 priority safety practices, it is thus important to determine the most effective methods to change physician behavior toward these practices that will intuitively result in increased safety performance. Five different educational-based strategies have been identified as techniques to change physician behavior: (1) Academic Detailing, (2) Audit and Feedback, (3) Local Opinion Leaders, (4) Reminder Systems, and (5) Printed Material. This article reviews these strategies in the context of critical care medicine and offers some opinions regarding setting the future research agenda in this investigative field.