Crit Care Resusc
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Review
Review of the application of risk-adjusted charts to analyse mortality outcomes in critical care.
This review describes the methods for displaying riskadjusted mortality data for critical care units. Two applications are considered. The comparison within a cohort of risk-adjusted mortality performance uses standardised mortality ratios (SMRs), league tables, caterpillar plots and funnel plots. ⋯ The relative merits of different methods are discussed. Risk-adjusted monitoring plays a role in the context of a holistic quality development strategy. The importance of a planned approach to response and intervention is stressed.
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Clinical Trial
Implementation and outcomes of a severe sepsis protocol in an Australian tertiary hospital.
To evaluate the effect of implementation of a sepsis protocol. ⋯ Implementation of a sepsis protocol led to a change in the delivery of care with no reduction in mortality in patients with severe sepsis and septic shock admitted to a Level III ICU in a tertiary hospital.
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There is evidence that intensive glycaemic control decreases morbidity and mortality in surgical intensive care unit patients. In traumatic brain injury, hyperglycaemia is a prognostic indicator. ⋯ The intensive insulin protocol was effective in lowering blood glucose in neurosurgical ICU patients.
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Biography Historical Article
19th century pioneers of intensive therapy in North America. Part 2: Joseph O'Dwyer.
Dr Joseph O'Dwyer's principal distinction lies in his dedication and achievements in battling laryngeal diphtheria among children at the New York Foundling Asylum, where he was a physician from 1872. He was also active at the Presbyterian Hospital of New York and in private practice. ⋯ The first intubated patient recovered, November 1882, only after change to prolonged wearing of a tracheotomy tube, so O'Dwyer did not date his first intubation success until 21 May 1884. * Introduction of his tubes into the Fell method of forced respiration, with the resultant Fell-O'Dwyer apparatus supplying practical instrumentation for intermittent positive pressure ventilation. * Demonstration that this apparatus, primarily used for saving lives after acute opiate poisoning, was also useful with some intracranial disasters, 1894. * Provision of a system, which others then applied, enabling surgeons to overcome the great "pneumothorax problem" of intrathoracic operations, and thereby conduct safe surgery inside the chest, 1898. * Development of an intubating method using successive short-term dilatations for treating chronic laryngeal stenosis, usually syphilitic, in adults, 1885. Throughout his medical lifetime, O'Dwyer was held in the highest regard as an altruistic, compassionate person of "sincere simplicity and frank goodness of character".
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Comparative Study
Missed opportunities? An observational study of vital sign measurements.
To determine the frequency of monitoring of patient vital signs in two wards of a tertiary hospital. ⋯ Blood pressure, heart rate and temperature were the most diligently recorded vital signs, but documentation of respiratory rate was poor. Failure to perform vital sign measurements may underpin the failure to recognise patients in general wards whose condition is deteriorating.