Articles: patients.
-
Journal of anesthesia · Mar 1989
A new closed-system using partially frozen injectate for thermodilution cardiac output determinations.
The FI (partially frozen injectate) system, a new closed-system devised by the authors for thermodilution cardiac output determinations, has two major features: 1) it needs no ice-filled receptacle to keep injectate cold because it uses partially frozen injectate, and 2) it can go without monitoring the injectate temperatures during the whole process of cardiac output determinations. The author evaluated the accuracy and reproducibility of cardiac output determinations with the FI system in 10 critically ill patients, as compared with another closed-system (which is commercially available) and the standard open method. ⋯ Even when no monitoring of injectate temperatures was made, the predicated error in the calculated cardiac output resulted as low as 2% with the FI system. The mean cardiac output values were not statistically different between the FI system and the other two systems.
-
A prospective study among unselected patients hospitalized in an internal medicine ward showed that 46 patients, 6.9% of total admissions, had serum concentrations of sodium less than 132 mEq/l. In 28.3% of hyponatremic patients (n = 13), the cause was the syndrome of inappropriate antidiuretic hormone secretion; 21.7% of the cases (n = 10) developed hyponatremia during hospitalization, mainly because of hypotonic solution administration. ⋯ In our opinion, the high mortality reflects the severity of the underlying diseases, although 82.5% of the patients were asymptomatic or had mild neurological signs. There was no significant correlation between the degree of hyponatremia and neurological signs, or mortality.
-
The purpose of this study was to describe interactional styles used by nurse practitioners and physicians in their attempts to influence patients' decision making. The ethical concepts of paternalism, maternalism, and shared decision making (operationalized as command, consequence, and concordance, respectively) formed the conceptual framework for the analysis of the interactions. ⋯ Tests of a priori hypotheses using hierarchical log-linear modeling yielded the following significant results: Males and physicians in solo practice used more command statements and fewer consequence statements than females and nurse practitioners in solo practice, who used fewer command statements and more consequence statements. All groups used more command/consequence statements than concordance statements.
-
DEVELOPING AN EFFECTIVE MANAGEMENT PLAN REQUIRES PHYSICIANS AND PATIENTS TO REACH AGREEMENT IN THREE KEY AREAS: the nature of the problems, the goals and priorities of treatment, and the roles of the doctor and patient. Often doctors and patients have widely divergent views in each of these areas. The process of finding a satisfactory resolution is not so much one of bargaining or negotiating but rather of moving towards a meeting of minds or finding common ground. This framework reminds physicians to incorporate patients' ideas, feelings, and expectations into treatment planning.