Articles: intensive-care-units.
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Recent reports suggest adrenal insufficiency in critically ill patients is common. We found only one case of de novo adrenal insufficiency using admission ACTH injection in 70 selected intensive care unit (ICU) patients. ⋯ Based on our results, routine screening for adrenal insufficiency in ICU patients is not warranted. If it is suspected, the cosyntropin test should be performed since low random cortisol levels (even to 5 micrograms/dl) are not diagnostic of adrenal insufficiency.
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A prospective survey was conducted of all patients requiring admission to the Regional Burns Centre for South East Scotland at Bangour Hospital and the Royal Hospital for Sick Children in Edinburgh. All patients admitted between May 1983 and April 1984 were studied. ⋯ A total of 276 patients were studied, of whom 152 were transferred. Early management by referring hospitals was often far from ideal, with errors in initial care that should have been avoided.
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Comparative Study
Automatic extraction of intensity-intervention scores from a computerized surgical intensive care unit flowsheet.
Systems that objectively score severity of illness and intensity of patient care interventions have been used to guide the appropriate use of intensive care facilities, provide information on nurse staffing ratios, validate subjective classifications of patient illness, and normalize scientific and financial studies for severity of illness. Existing scoring systems require a well-trained observer to perform a thorough chart review to complete manual scoring forms. ⋯ In prospective studies, these computerized scores correlated well with manual TISS scores, intensive care unit mortality, intensive care unit length of stay, hospital length of stay, and a subjective classification of patients to graded levels of hospital care. Such automated scores may be used for real-time allocation of health care resources and normalization of prospective studies for severity of illness.
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The staff of a burn unit was surveyed concerning attitudes about their patients and the treatment procedure. Previous research indicates that in such medical settings paradoxical interactions (double binds) may occur among staff, patient, and family. We hypothesized that the paradoxical environment of burn care units facilitates individuals who can change their perspective (or reframe these situations) and that this ability is related to attitudes and feelings about burn patients and their treatment. ⋯ Staff members are quite positive about burn treatment and agree that the staff instills hope. The staff's endorsement of providing accurate information, while behaving optimistically even if pessimistic about the patient's condition, does represent possible double-binding communication patterns. Nursing managers with high reframing ability may facilitate staff coping with these issues.