Articles: intensive-care-units.
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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.
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Conventional haemodialysis is not available on all intensive care units (ICUs) and there are relatively few renally trained nurses able to run haemodialysis machines. Continuous arteriovenous haemodialysis provides effective renal replacement therapy for critically ill patients in the ICU. Unlike continuous arteriovenous haemofiltration it provides sufficient control over electrolyte, solute and water balance to obviate the need for additional treatment with intermittent conventional haemodialysis.
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J Burn Care Rehabil · May 1990
Post-traumatic stress disorder in hospitalized patients with burn injuries.
The degree to which patients hospitalized for a major burn displayed symptoms of post-traumatic stress disorder or met the full criteria for this disorder was assessed during the course of hospitalization. Fifty-four consecutive patients were screened weekly for symptoms of post-traumatic stress disorder. ⋯ Post-traumatic stress disorder was found to be related to patients' total body surface area burn, length of hospital stay, sex (female patients), and lack of responsibility for the injury. The results suggest that although post-traumatic stress disorder in patients with burn injuries generally resolves without interventions other than standard hospital care, it might be preventable if patients who are at risk for developing it receive appropriate psychologic treatment soon after the injury.
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Critical care medicine · May 1990
Age, chronic disease, sepsis, organ system failure, and mortality in a medical intensive care unit.
We retrospectively studied relations between age, pre-existing chronic disease, sepsis, organ system failure, and mortality in 487 patients from a medical ICU. Single organ system failure (SOSF) occurred in 136 (28%) and multiple (greater than or equal to 2) organ system failure (MOSF) in 187 (38%) patients. Cardiovascular and pulmonary failure predominated. ⋯ Advancing age and prior chronic disease may diminish physiologic reserve and predispose to sepsis and MOSF. Although sepsis is a major risk factor for MOSF, a nonspecific host response to critical illness may contribute to the syndrome in 35% of patients. Advancing age, chronic disease, and the number of failing organs, particularly failure of cardiovascular, pulmonary, renal, and neurologic systems, are major determinants of overall mortality, but sepsis is not an independent contributor.