Assessing data elements in a severity scoring system.

Living wills are often considered by physicians who are faced with a dying patient. Although popular with the general public, they remain problems of authenticity and authority. It is difficult for the examining physician to know whether the patient understood the terms of the advance directive when they signed it, and whether they still consider it authoritative at the time that it is produced. Also, there is little consensus on what spectrum of instruments constitutes a binding advance directive in real life. Does a 'suicide note' constitute an authentic and authoritative 'living will'? Our panel of authorities considers this problem in a round-table discussion.

Critical Care↗

PubMed2001

Critical care medicine in the 21st century: from CPR to PCR.

As in other areas of medicine, the specialty of critical care medicine, which has made important contributions in the pathophysiology of critical illness, is facing challenges that must be recognized and addressed in the current century. In this review, we argue that the skill set required to adequately treat critically ill patients will also require knowledge of molecular biology for better diagnosis and treatment. The foundations of molecular biology and genetics are essential for the understanding of the mechanisms of disease. Incorporating molecular biology techniques in the research arsenal of the intensivist will provide the opportunity to dissect out and define the reversible and irreversible intracellular processes giving rise to the major causes of mortality in intensive care units. Two historical paradigms, the cardiopulmonary resuscitation and polymerase chain reaction, summarize how critical care medicine began, and how it could mature in the years to come.

Critical Care↗

PubMed2001

Twenty-four hour presence of physicians in the ICU.

Intensive-care units (ICUs) must be utilised in the most efficient way. Greater input of intensivists leads to better outcomes and more efficient use of resources. 'Closed' ICUs operate as functional units with a competent on-site team and their own management under the supervision of a full-time intensivist directly responsible for the treatment. Twenty-four-hour coverage by on-site physicians is mandatory to maintain the service. At night, the on-site physicians need not necessarily be specialists as long as an experienced intensivist is on call. Because of the shortage of intensivists, such standards will be difficult to maintain everywhere, but they should, at least, be mandatory for larger hospitals serving as regional centres.

Critical Care↗