American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Sepsis is a complex syndrome that can lead to multiple organ failure and death. Severe sepsis has been associated with mortality rates ranging from 28% to 50% and is the most common cause of death in the noncardiac intensive care unit. Despite advances in both antibiotic therapy and supportive care, the mortality rate due to severe sepsis has remained fundamentally unchanged in the past several decades. ⋯ The epidemiology, pathophysiology, and treatment of severe sepsis are reviewed. Also discussed are the recently published results from a multicenter, randomized, placebo-controlled phase 3 clinical trial of drotrecogin alfa (activated), a recombinant form of human activated protein C, in patients with severe sepsis. The nursing implications of this new approved therapy are discussed.
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Links between teamwork and outcomes have been established in a number of fields. Investigations into this link in healthcare have yielded equivocal results. ⋯ The results of this study and other establish a link between teamwork and patients' outcomes in intensive care units. The evidence is sufficient to warrant the implementation of strategies designed to improve the level of teamwork and collaboration among staff members in intensive care units.
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Critically ill adults admitted for noncardiac conditions are at risk for acute myocardial ischemia. ⋯ Transient myocardial ischemia and advanced age are predictors of cardiac events and may indicate patients at risk for cardiac events.
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Skillful communication between and among clinicians and patients' families at the patients' end of life is essential for decision making. Yet communication can be particularly difficult during stressful situations such as when a family member is critically ill. This is especially the case when families are faced with choices about forgoing life-sustaining treatment. ⋯ Although family members who experienced conflict were in the minority of the larger study sample, their concerns and needs are important for clinicians to examine. Paying careful attention to these communication needs could reduce the occurrence of conflict between clinicians and patients' families in caring for dying patients and reduce stress for all involved.
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Comparative Study
Management of patients in the intensive care unit: comparison via work sampling analysis of an acute care nurse practitioner and physicians in training.
Little is known about aspects of practice that differ between acute care nurse practitioners and physicians that might affect patients' outcomes. ⋯ The nurse practitioner and the physicians in training spent a similar proportion of time performing required tasks. Because of training requirements, physicians spent more time than the nurse practitioner in nonunit activities. Conversely, the nurse practitioner spent more time interacting with patients and patients' families and collaborating with health team members.