Journal of critical care
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Journal of critical care · Sep 2002
ReviewA review of costing methodologies in critical care studies.
Clinical decision making in critical care has traditionally been based on clinical outcome measures such as mortality and morbidity. Over the past few decades, however, increasing competition in the health care marketplace has made it necessary to consider costs when making clinical and managerial decisions in critical care. Sophisticated costing methodologies have been developed to aid this decision-making process. ⋯ Of the 43 articles that actually counted costs, 37.2% (16 of 43) counted physician costs, 27.9% (12 of 43) counted facility costs, 34.9% (15 of 43) counted nursing costs, 9.3% (4 of 43) counted societal costs, and 90.7% (39 of 43) counted laboratory, equipment, and pharmacy costs. Our conclusion is that despite considerable progress in costing methodologies, critical care studies have not adequately implemented these techniques. Given the importance of financial implications in medicine, it would be prudent for critical care studies to use these more advanced techniques.
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Journal of critical care · Sep 2002
Multicenter StudySystemic candidiasis in intensive care units: a multicenter, matched-cohort study.
To determine the impact of systemic candidiasis on the mortality and length of hospital stay of intensive care unit (ICU) patients and the associated workload. ⋯ Systemic Candida infections increased mortality and morbidity in severely ill patients. Optimizing management of such infections is imperative.
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Journal of critical care · Sep 2002
Multicenter StudyStudying communication about end-of-life care during the ICU family conference: development of a framework.
Family-clinician communication in the intensive care unit (ICU) about withholding and withdrawing life support occurs frequently, yet few data exist to guide clinicians in its conduct. The purpose of this study was to develop an understanding of the way this communication is currently conducted. ⋯ This article describes a qualitative methodology to understand clinician-family communication during the ICU family conference concerning end-of-life care and provides a frame of reference that may help guide clinicians who conduct these conferences. We also identify strategies clinicians use to improve communication and enhance the support provided. Further analyses and studies are needed to identify whether this framework or these strategies can improve family understanding or satisfaction or improve the quality care in the ICU.
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Journal of critical care · Sep 2002
Comparative StudyDo isolation rooms reduce the rate of nosocomial infections in the pediatric intensive care unit?
To determine the effect of isolation rooms on the direct spread of nosocomial infections (NIs) owing to cross-colonization in a pediatric intensive care unit (PICU). ⋯ Our preliminary analysis suggests a possible beneficial effect of single isolation rooms in reducing NI rate in the PICU. Hence, the influence of room isolation on NIs in pediatric intensive care warrants further investigation.
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Journal of critical care · Sep 2002
Multicenter StudyPrevention of ventilator-associated pneumonia: current practice in Canadian intensive care units.
To evaluate the current use of strategies to prevent ventilator-associated pneumonia (VAP) and to identify interventions to target for quality-improvement initiatives. ⋯ Significant opportunities exist to improve VAP prevention practices in Canada. These strategies include decreasing the frequency of ventilator circuit changes, and increasing the use of non-invasive ventilation, subglottic secretion drainage endotracheal tubes, kinetic bed therapy, small bowel feedings, and elevation of the head of the bed.