腹膜透析应关注的临床问题

随着腹膜透析（PD）技术的不断改进以及透析患者生存质量及存活率的显著增高,临床对PD的认识较以往发生了很大的变化。突出体现在PD不再是终未期肾衰竭（ESRD）患者肾脏替代治疗的附属选择,而是肾脏替代一体化治疗措施中最核心的环节之一。     

Why clinical ethics consultants might not want to be educators

...Perhaps we should make explicit that clinical ethics consultants' work is to encourage and to assist others to think about the nature of their profession and reflect on their own behaviors, rather than to change behavior directly. Clinical ethics consultants' work is thus made more difficult, but it should be difficult. They should be continually challenged in their work (as teaching in that setting will do) because it will keep them from succumbing to their titles, from believing that they do know what is best, that they are ethics experts. Furthermore, clinical ethics consultants should be doing something very different from what other people in the healthcare environment are doing; they should acknowledge themselves as outsiders and should cherish that status because only then will they be able to ask the difficult questions that psychological proximity to and practical involvement in healthcare obscure. True education, of course, is the most dangerous activity, but the danger posed by such education is considerably more appealing than the danger posed by clinical ethics consultants who pursue and exert power in healthcare under cover of implicit claims and false beliefs about their expertise.     

Here are trends you must be ready for

Trends that are predicted to continue in the ED include high diversion rates, overcrowding, and a shortage of nurses and consultants. To reduce diversion rates, involve EMS agencies and county authorities. Use patient tracking systems to improve ED capacity and bed tracking systems to improve hospital inpatient capacity. Recruit and retain nursing staff by cross-training staff from telemetry or the intensive care unit, starting nurse internship programs, and offering flexible schedules.