4.6 'Designerly' way of doing
6.3 Developing the methods of the research
6.4.2 Pilot Study B Interview with musicians on their personalizing tools
119
LIMITATIONS OF THE STUDY
1. Intermittent heamodialysis is the only accessible form of dialysis in our
120
RECOMMENDATIONS AND PREVENTIVE STRATEGIES
A. In order to reduce the burden of AKI, there is need to propose a comprehensive approach for the education and training of health care personnel, general public and policy makers through;
1. Identifying high-risk individuals: Timely identification of patients who are at increased risk of developing AKI is crucial for preventive strategies. Several risk factors such as modifiable risk factors (dehydration, hypotension, anaemia, hypoxia use of nephrotoxic agents).
non modifiable risk factors (Cancer, chronic lung disease, CKD, older age) and exposures that contribute to AKI in different setting (sepsis trauma, burns, nephrotoxins, circulatory shock e.t.c). Individuals exposed to these insults should be assessed carefully for AKI risk.
2. Prompt diagnosis: The timely diagnosis of AKI is essential to allow the health team to intervene to minimize further renal injury .In the developing world like ours, there is need to provide adequate socio-economic infrastructure and point-of-care tests by physicians or by other health-care professionals in order to identify AKI early.
3. Interventions for incipient and established AKI: There is an important need to monitor and optimize patients’ heamodynamics especially the fluid balance, correction of anaemia, acidosis, hyperkaleamia and early nephrology referral.
4. Renal support (RRT): There is a compelling need to start immediate dialysis as soon as indicated with the choice of therapy (the mode, dialyzer, measured delivered dose and time) should be based on
co-121
morbid illness. Dialysis facilities should be made available and its cost should be subsidized in all ICU (including continuous renal transplant therapy (CRRT) facilities) and there is need to co-opt renal physicians into the critical managing team.
5. Post - discharge care of patients with AKI: Patients who survive episode of AKI should be monitored for more than 3months after discharge and have their serum creatinine concentration routinely measured to assess for recovery of renal function and possible progression of renal injury.
B. APACHE IV scoring system should be used in our ICU in Nigeria because it
is simple, cheaper and effective in predicting outcome of critically ill patients.
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