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OBJECTIVE: To determine if fourth-year medical students can learn the high-level cognitive skills needed to manage critically ill patients during a critical care medicine elective designed in accordance with established educational principles. DESIGN: Students were randomly assigned to take one of two examinations with ten short essay questions to complete on the initial day. After the elective, students completed the other examination in a crossover design. SETTING: Five surgical intensive care units (ICUs) in a tertiary care university teaching hospital. PARTICIPANTS: Fourth-year medical students enrolled in the critical care medicine elective. INTERVENTIONS: All students were enrolled in a critical care medicine elective consisting of an orientation, interactive conferences, technical skills laboratories, daily rounds, and patient-care experience. These components were designed to encourage problem-solving, improve analytical skills, and minimize the deterrents to education in the ICU. MEASUREMENTS: The primary outcome measure was the difference in examination scores before and after the rotation. Examinations were designed to test the student's skills in application, analysis, synthesis and evaluation. Specific questions concerning hemodynamic assessment were compared. MAIN RESULTS: The students' mean pre-elective scores were 58.8 +/- 10.8%, compared with 85.5 +/- 9.4% after the elective (p < .0001). CONCLUSION: Students can learn cognitive components of patient management skills using a format that encourages judgment, decision-making, and analytical skills, despite the liabilities inherent to education in an ICU.

Assuntos

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When successful solid organ transplantation was initiated almost 40 years ago, its current success rate was not anticipated. But continuous efforts were undertaken to overcome the two major obstacles to success: injury caused by interrupting nutrient supply to the organ and rejection of the implanted organ by normal host defense mechanisms. Solutions have resulted from technologic medical advances, but also from using organs from different sources. Each potential solution has raised ethical concerns and has variably resulted in societal acclaim, censure, and apathy. Transplant surgery is now well accepted, and the list of transplant candidates has grown far quicker than the availability of organs. More than 30,000 patients were awaiting organs for transplantation at the end of March 1993. While most organs came from donors declared dead by brain criteria, the increasing shortage of donated organs has prompted a reexamination of prior restrictions of donor groups. Recently, organ procurement from donors with cardiac death has been reintroduced in the United States. This practice has been mostly abandoned by the U.S. and some, though not all, other countries. Transplantation has been more successful using organs procured from heart-beating, "brain dead" cadavers than organs from non-heart-beating cadavers. However, recent advances have led to success rates with organs from non-heart-beating donors that may portend large increases in organ donation and procurement from this source.

Assuntos

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Critical care, as a specialty in both nursing and medicine, is well recognized and the number of people requiring hospitalization for critical illnesses continues to increase. The purpose of this paper is to examine the future and the changes that lie ahead in critical care. New and expanding roles for nurses are projected along with a continued refinement and expansion of the critical care medicine subspecialty for physicians. A variety of changes in critical care are anticipated that reflect our increasing abilities in biotechnology, basic and clinical research, and data management. These changes are viewed for their obvious impact on cost, ethical controversies, and patient care and outcome.

Assuntos

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In recent years, transplantation has assumed an important role in the treatment of patients with end-stage diseases of most major organ systems. However, the greatest limitation in organ transplantation today is organ supply. Among factors that can affect the organ supply favorably, donor management has received the least attention. This review addresses management of the multi-organ donor within the intensive care unit. With an increased awareness of donor management issues and the application of a rational physiological approach, the supply of functional organs for transplantation can be increased.

KIE: Clinical management of the brain dead, potential multi-organ donor within the intensive care unit is reviewed. The emphasis is on physiological maintenance until organ procurement. Among the topics discussed are donor recognition and evaluation, declaration of brain death, medical management, and organ procurement and coordination.

Assuntos

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Since the first successful organ transplantation in 1953, we have seen an explosive development in transplantation surgery, particularly during the 1980s. With it followed an abundance of legal controversies and ethical dilemmas. Optimal use of viable organs necessitated precise definition of brain death in heart-beating cadavers with artificially maintained ventilation and circulation. Viable organs must remain well perfused to be suitable for procurement and transplantation into carefully selected recipients on an equal-opportunity basis. Due consideration must be given to both medical and social indications. At present, homografts dominate the field of organ transplantation; however, because of the shortage of human organs, both artificial organs (especially hearts) and xenografts are expected to become increasingly common in the near future. No doubt, the use of such modern technology will introduce additional ethical problems.

Assuntos