Current opinion in critical care
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The ageing population, changing societal expectations and medical workforce shortages have created an unprecedented demand for intensive care services. This review describes the challenges to supporting rural-based critical care and discusses potential solutions for ensuring not only that rural patients receive a comparable level of care to their metropolitan counterparts, but also that patient outcomes are equivalent. ⋯ A number of solutions for supporting critical care in rural communities exist. None of these strategies are stand-alone solutions, nor are they universally applicable. Individual healthcare regions need to implement different strategies depending on local requirements and resources. Ultimately, lobbying for productive changes to healthcare policy will ensure the long-term viability of rural critical care.
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Curr Opin Crit Care · Dec 2007
ReviewEducation and simulation techniques for improving reliability of care.
Multiple factors influence the dependability of intensive care provision. The management of a group of unstable, critically ill patients requires focused attention from the clinical team. Medical simulation is an important tool to improve safety and team work within the ICU. ⋯ This review summarises the evidence and opinion about how simulation tools can be optimally used. In addition, we propose an educational strategy to optimise the impact on clinical practice by embedding simulation training in a multidisciplinary teaching programme based upon a specifically developed curriculum focusing on the teaching of crisis resource management and patient safety.
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Curr Opin Crit Care · Dec 2007
ReviewHow safe is my intensive care unit? An overview of error causation and prevention.
To link generic research on patient safety and the reliability of care to the specific context of the critically ill patient and the environment of the intensive care unit. ⋯ Patient safety initiatives, clinical care and medical education need to be better integrated to follow the continuum of the acutely ill patient's journey through the hospital system. Key elements include improving the reliability and standardization of processes of care, reducing unnecessary variation and complexity, and encouraging teamworking.
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The early detection of acute kidney injury may allow for timely preventive or therapeutic measures. This review discusses the role of traditional and novel biomarkers in early acute kidney injury diagnosis. ⋯ The early detection of acute kidney injury is a clinical and research priority. Traditional measures may contribute to delayed acute kidney injury diagnosis. Recent biomarkers have promise for earlier detection and for research into novel interventions.