Acta médica portuguesa
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Acta médica portuguesa · Nov 1997
Review[Rational distribution of resources in intensive medicine. Analysis of admission and discharge criteria at intensive care units].
Cost-containment in health care has become a major issue in today's practice of medicine. With its needs in advanced technologies and skilled personnel, intensive care is among the most expensive of all hospital activities. This fact makes the analysis of indications for intensive care unit admission, as well as early discharge, of paramount importance: patients who are not likely to benefit from intensive care are at the extremes of disease severity, since low-risk patients are not ill enough to need ICU admission and high-risk patients have a very high mortality, irrespective of intensive care treatment. In this paper we discuss, based on published evidence, the formulation of recommendations for admission and early discharge from ICUs, and also present the Society of Critical Care Medicine guidelines, on this subject.
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Acta médica portuguesa · Nov 1997
[Risk stratification and prognosis in critical surgical patients using the Acute Physiology, Age and Chronic Health III System (APACHE III)].
Outcome prediction in critical surgical patients admitted to intensive care units (ICU) has been established using several scoring systems. To evaluate the predictive performance of the Acute Physiology, Age and Chronic Health Evaluation (APACHE III) scoring system in these patients, we studied a population admitted to a surgical ICU in our University Hospital. ⋯ In a population of critical surgical patients admitted to our ICU the APACHE III scoring system demonstrated an excellent prognostic performance as measured by contingency tables and areas under the ROC curve; this system can be a useful tool for outcome prediction in critical surgical patients.
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We begin this article with the distinction between Deontology, Moral and Ethics. We also review the concept and the relevance of Bioethics, as the "science of survival", and as part of Ethics, a section of Philosophy. ⋯ Some ethical problems were also raised related to the beginning and the end of life. Finally the author reflects on the difficulties of defining ethical concepts in the near future.
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The purpose of this study is to analyse the crossmatched blood units for elective surgery and the real amount of transfused blood, the crossmatch:transfusion rate (C:T) which must be less than 2.5. As in other Blood Banks, the differences are more evident in the situations in which the need for blood is very small, the so called "Type and Screen".
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Patients in intensive care units (ICU) are 3 to 4 times more prone to nosocomial infection (NI) than patients in general wards owing to the severity of their pathology and the frequent use of invasive procedures. The aim of this study was to establish the incidence of NI in an ICU and the associated risk factors. ⋯ The incidence of NI is acceptable in our ICU. The most frequent location was the respiratory tract (52.6%). The pathogens most frequently isolated in this ICU were Gram negative rods. The risk of NI increased in more debilitated patients with more severe disease who were administered antibiotic or corticosteroids and submitted to more invasive procedures.