Articles: intensive-care-units.
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Quantify possible increases in cadaveric organ donation from intensive care units; identify major sources of regional variation. ⋯ A 20% increase in number of cadaveric kidney donors from intensive care could be achieved by prompt testing for brain stem death and a quarter reduction in relatives' refusals.
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Randomized Controlled Trial Clinical Trial
Effects of personal control over hospital noise on sleep.
Critical Care Unit (CCU) sound levels, subjective stress due to noise, and sleep were studied in 105 female volunteers in a simulated hospital environment. Subjects were randomly assigned to instruction in personal control over noise via the availability of a sound conditioner, no instruction in personal control over noise, or quiet conditions. Subjects in the two noise conditions heard audiotape-recorded CCU nighttime sounds while attempting to sleep overnight in the laboratory. ⋯ As predicted, scores for subjective stress due to CCU sounds yielded significant relationships with 9 of 16 measures of sleep (all ps less than .01). Hierarchical multiple regressions showed that 13% (p less than .001) and close to 6% (p less than .05) of the variance in sleep efficiency was accounted for by CCU sound levels and noise-induced subjective stress, respectively. Thirty-eight percent (p less than .001) of the variance in Rapid Eye Movement sleep was accounted for by CCU sound levels.
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The introduction of the intensive care unit (ICU) in the 1960s with its demands for management of large volumes of patient data drove the initial introduction of computers into the ICU. Since the mid-1960s computer systems for the ICU have evolved into the highly sophisticated bedside workstations commercially available today. Despite all of the technologic advances in computers, their application in ICUs in the United States continues to spread very slowly. ⋯ Research systems have demonstrated that if one extends these systems to incorporate a fully integrated database, decision-support tools, automation of data acquisition, and more sophisticated display and user-interface technology, then these ICU computer systems can have a significant impact on improving the quality and reducing the costs of patient care. For computers to be embraced in the ICU environment, commercial systems of the future must move beyond merely gathering and displaying information. They must help the clinician at the bedside assimilate the vast array of ICU data and help him to make more effective decisions.
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A completed questionnaire was returned by 246 (85%) intensive care units participating in a national survey of infection control practice in intensive care. Thirty-three units had no provision for isolating patients in single side wards. Sixty percent of responding ICU had fewer than one washbasin per bedspace. ⋯ K. were using a selective decontamination regimen, and nine of these (50%) had no full time consultant microbiologist available to supervise the recommended microbiological management. The majority of ICU received a regular visit (greater than or equal to one per week) from a microbiologist. Proposals are made on the development of a specialized infection control service in order to reduce the risk of nosocomial infection in intensive care, and to improve on existing resource management.
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Mayo Clinic proceedings · Feb 1992
Outcomes of patients admitted to a chronic ventilator-dependent unit in an acute-care hospital.
The outcomes in 61 patients admitted to a chronic ventilator-dependent unit (CVDU) at Saint Marys Hospital in Rochester, Minnesota, during an 18-month period are summarized. This unit was designed for patients who could not be weaned from mechanical ventilators after repeated attempts. Most patients had been ventilator dependent for more than 21 days, but some patients were admitted to the CVDU after briefer periods if special circumstances suggested that weaning from mechanical ventilation would be difficult. ⋯ One patient remains in the CVDU. Thus, the CVDU has successfully liberated patients from ventilator dependence. In addition, because of a decreased need for nursing care, the unit has been cost-effective.