Articles: intensive-care-units.
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Improving survival of burned patients has been reported by the majority of burn units over the past decade. Although many sophisticated studies have attempted to delineate the major factors responsible for this improvement, no single factor has emerged as being clearly dominant. On the MUSC burn service, increased survival has been particularly apparent in patients with burns involving 50-90% of the BSA. ⋯ Attributing the increased survival of burned patients to any one of these factors alone currently does not seem to be clearly supported by data reported in the literature nor by our own experience. It is to be hoped that as the quality of skin substitutes and techniques of culturing skin improve, inroads into the extremely high mortality of burns involving more than 90% of the BSA can be made. The MUSC burn service is currently investigating the place of aggressive early burn wound excision and grafting with cultured epithelial autografts in achieving this goal.
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Bedside testing offers a unique opportunity for earlier and more specific diagnosis, faster and more frequent monitoring, and the opportunity to improve patient care and reduce hospital costs. However, if abused it may not improve patient care and may increase hospital costs. In the future, more clinical studies will need to be performed to determine which tests are cost-effective.
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J Burn Care Rehabil · May 1990
A knowledge-based information system for advice in the crisis management of the patient with burns.
A knowledge-based information system that has been designed to be used as an electronic advisor to guide in fluid resuscitation and in the management of the most frequently occurring complications during the first 48 hours after burn injury is described. The system was also developed for training physicians and nurses and may eventually be used for peer review of the management of patients in the burn unit. Ten data screens are used for entry of the administrative data, the clinical background, and the monitored data. ⋯ The system's conclusions, the fluid and ventilation prescription, and other required patient management measures are then displayed as a report. The underlying reasoning for each case may be explored by means of the system's explanation facility. The system has been successfully validated by 125 hypothetic cases that represent typical situations of patients with severe burns.
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Quality assessment and assurance in the intensive care unit require systematic monitoring and evaluation of patient care and its outcome. For analysis of these activities, data must be organized to reflect changes in such factors as patient types, ages, and lengths of stay. A model was developed to group data from the Cleveland Clinic Hospital medical intensive care unit into structural, process, and outcome categories. Development and application of the model are described.