Articles: intensive-care-units.
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In recent years, several factors have led to increasing focus on the meaning of appropriateness of care and clinical performance in the intensive care unit (ICU). The emergence of new and expensive treatment modalities, a deeper reflection on what constitutes a desirable outcome, increasing financial pressure from cost containment efforts, and new attitudes regarding end-of-life decisions are reshaping the delivery of intensive care worldwide. ⋯ Their application has broadened to include ICU performance assessment, individual patient decision-making, and pre- and post-hoc risk stratification in randomised trials. In this paper, we review the popular scoring systems currently in use; design issues in the development and evaluation of new scoring systems; current applications of scoring systems; and future directions.
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The development of the specialty of critical care and the intensivist is outlined and the data that favours critically ill patients being cared for by intensivists are reviewed. The future challenges for intensive and critical care are dealing with the new ethical dilemmas raised by intensive care, providing appropriate intensive care in both developed and developing countries and applying the principles of evidence-based medicine to intensive therapy.
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Critical care medicine · May 1998
Comparative StudyPredictive value of severity scoring systems: comparison of four models in Tunisian adult intensive care units.
To compare the performance of four severity scoring systems: the Acute Physiology and Chronic Health Evaluation (APACHE) II, the new versions of the Mortality Prediction Model (MPM0 and MPM24), and the Simplified Acute Physiology Score (SAPS) II. ⋯ Despite an overall good discrimination, APACHE II, MPM0, MPM24, and SAPS II showed a less satisfactory calibration in our Tunisian sample of ICU patients. Part of the models inaccuracy could be related to quality of care problems in our ICUs, but this issue needs further analysis.
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The Western Pacific region has seen rapid recent economic development but variation in the provision and organisation of intensive care units (ICUs) between different countries remains. While Japan, Australia, New Zealand, Singapore, Taiwan, Korea and Hong Kong have well developed intensive care facilities, in other countries the more limited funding for healthcare can be reflected by differential availability of modern medical technology between the public and private sectors. Other factors important to intensive care include physician training, availability of other staff and whether intensive care is delivered in "open" or "closed" units. ⋯ Future development of intensive care in the region will parallel economic development. In most countries increasing patient expectations, ageing populations and "Western" diseases will increase demand for intensive care services. Only a few countries currently have recognised programmes of training and certification in intensive care but as more adopt this process it should lead to a clearer recognition and acceptance of the role of the intensivist.
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Ann Acad Med Singap · May 1998
Audit of 2431 admissions to the Surgical Intensive Care Unit, Singapore General Hospital.
A prospective analysis of 2431 patients admitted to the Surgical Intensive Care Unit (SICU) of Singapore General Hospital was conducted between January 1994 and June 1997. All patients were followed up until hospital discharge. This ongoing project serves as both audit and quality assurance in the SICU. ⋯ Thirty (29%) died before the SICU discharge. SICU mortality was 9.46%, hospital mortality was 10.86% and standardised mortality ratio was 1.95. Computerised tools that analyse ICU utilisation patterns and outcomes have the potential to better target resources and so lower hospital costs, reducing futile medical care by selecting patients for appropriate expensive ICU care.