Articles: intensive-care-units.
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Critical care medicine · Aug 1998
Multicenter Study Comparative StudyEvaluation of acute physiology and chronic health evaluation III predictions of hospital mortality in an independent database.
To assess the accuracy and validity of Acute Physiology and Chronic Health Evaluation (APACHE) III hospital mortality predictions in an independent sample of U.S. intensive care unit (ICU) admissions. ⋯ APACHE III accurately predicted aggregate hospital mortality in an independent sample of U.S. ICU admissions. Further improvements in calibration can be achieved by more precise disease labeling, improved acquisition and weighting of neurologic abnormalities, adjustments that reflect changes in treatment outcomes over time, and a larger national database.
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Am. J. Respir. Crit. Care Med. · Aug 1998
Randomized Controlled Trial Clinical TrialOutreach education to improve quality of rural ICU care. Results of a randomized trial.
This study tests whether an outreach educational program tailored to institutional specific patient care practices would improve the quality of care delivered to mechanically ventilated intensive care unit (ICU) patients in rural hospitals. The study was conducted as a randomized control trial using 20 rural Iowa hospitals as the unit of analysis. Twelve randomly selected hospitals received an outreach educational program. ⋯ Unfortunately, the program had no detectable effects on the clinical outcomes of mortality or nosocomial events. We conclude that an outreach program of this type can effectively improve processes of care in rural ICUs. However, improving processes of care may not always translate into improvement of specific outcomes.
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Critical care medicine · Aug 1998
Multicenter Study Comparative StudyOutcome of intensive care patients in a group of British intensive care units.
To identify priorities for intensive care unit (ICU) intervention and research. ⋯ Early identification of patients at risk, both before admission and after discharge from the ICU, may allow treatment to decrease mortality. Research and resources may be best directed at patients who die, despite a relatively low predicted mortality. Although these patients are a small percentage of the low-risk admissions, they constitute a large number of ICU deaths. Many patients die after discharge from ICU and this mortality may be decreased by minimizing inappropriate early discharge to the ward, by the provision of high-dependency and step-down units, and by continuing advice and follow-up by the ICU team after the patient has been discharged. Intervention before ICU admission and support of patients after discharge from the ICU should be part of the effort to decrease mortality for ICU patients. Inadequate provision of resources for critically ill patients may result in excess intensive care mortality that is not detected with ICU outcome prediction methods.
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Critical care medicine · Aug 1998
Comparative StudyNo difference exists in the alteration of circadian rhythm between patients with and without intensive care unit psychosis.
To determine if a difference exists in the circadian rhythm entrainment between patients with and without intensive care unit (ICU) psychosis. ⋯ Either patients who develop ICU psychosis have an increased sensitivity to an alteration of their circadian rhythm, or ICU psychosis develops independent of circadian rhythm abnormalities.
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Noise levels in the hospital setting are exceedingly high, especially in the ICU environment. We set out to determine what caused the noises producing sound peaks > or = 80 A-weighted decibels (dBA) in our ICU settings, and attempted to reduce the number of sound peaks > or = 80 dBA through a behavior modification program. ⋯ We conclude that many of the noises causing sound peaks > or =80 dBA are amenable to behavior modification and that it is possible to reduce the noise levels in an ICU setting significantly through a program of behavior modification.