Articles: intensive-care-units.
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Paediatric intensive care has developed into a highly specialized and labour-intensive clinical activity. The provision of adequate numbers of properly staffed children's intensive care beds within the UK, and the lack of national planning and coordination are both problematic. This article examines these problems and discusses current thinking on the provision of paediatric intensive care services.
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Modern surgical care must meet high standards of quality but must also be cost-effective. Critical care uses huge amounts of resources, and strategies for effective use of scarce, expensive intensive care unit beds must be implemented. Previously, we demonstrated that ancillary expenditures can be decreased without compromising care. The present study was performed to determine whether our cost-containment strategies were durable and could be extended to areas, such as chest roentgenography, where savings previously proved elusive. ⋯ Durable reductions in physician-ordered ancillary expenditures are possible without compromising the standard of care of critically ill patients, but active management and daily reinforcement are necessary to the process. Shorter length of stay and lower costs benefit the patient, the surgeon, the intensivist, and the institution.
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This article discusses the care of Pediatric Intensive Care Unit (PICU) families who are present during the death of a child other than their own. "Other" families witness bereavement and experience grief, and there is no literature available to evaluate and describe their needs. Many PICU families are exposed to the death of a child. Nursing interventions to ameliorate self-awareness skills, validate the significance of the event, eliminate unnecessary fears, and cultivate effective coping strategies are necessary to decrease the stress of the experience. Research is needed to specify the needs of "other" families and to improve care for everyone present during the death of a child.
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Management of the critically ill patient forms a significant proportion of obstetric and gynaecological (O & G) practice. There have however, been very few reports on the management of such patients in intensive care units (ICU). We review all O & G patients admitted to the surgical ICU at King Edward VIII Hospital, Durban, South Africa, and make recommendations regarding management of such patients. ⋯ O & G patients form a major workload of surgical ICUs and the majority of these patients are women with eclampsia. Management of such patients requires an understanding of the physiological changes of normal and abnormal pregnancies. Therefore, all large obstetrical units in developing countries should establish their own ICU in order that patient care, health personnel training and continuing health care education may be improved.