Articles: critical-care.
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Acute pain is a significant problem in critical care patients. Although many barriers to successful assessment and management of pain in critical care patients have been noted, little is known about how critical care nurses make clinical judgments when assessing and managing patients' pain. ⋯ Many nurses' reports showed that they accurately assessed their patients' needs for analgesics. Through testing of and learning from their patients' responses, nurses were able to give amounts of analgesics that diminished patients' postoperative pain. Additionally, nurses had to balance analgesic administration against the patients' hemodynamic and respiratory conditions, medical plan and prescriptions, and the desires of the patients and the patients' families.
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Intensive care medicine · Nov 1996
International participation in major intensive care journals. "The smaller the better".
This study seeks to assess the scientific contributions in the field of intensive care medicine from each of the major countries (per million inhabitants) and discusses the possible factors which may contribute to any differences. ⋯ The present study reveals that the smaller European nations have a greater participation than the larger European nations in the major intensive care journals. This phenomenon could be due to different submission practices in these countries compared with the larger European countries, where a considerable number of papers are submitted to local renowned journals. There was no absolute correlation between a nation's gross national product and the total number of publications.
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Neuromuscular blockade is a frequently used therapy in the ICU. However, recent reports of prolonged paralysis and general muscular weakness in patients treated with this procedure have raised concerns about its use in intensive care. ⋯ Among the respondents, variations existed in monitoring practices and in the use of peripheral nerve stimulators, including the frequency of monitoring and use of the baseline milliamperage. Appropriate monitoring and titration of neuromuscular blocking agents by ICU nurses may aid in preventing adverse effects, including the potential for prolonged neuromuscular blockade. The existing variations in practice may affect patients' outcomes.
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Intensive care medicine · Nov 1996
Evaluation by polymerase chain reaction of cytomegalovirus reactivation in intensive care patients under mechanical ventilation.
The study was undertaken to determine if critically ill patients under mechanical ventilation could reactivate latent cytomegalovirus (CMV) in either lung or blood. ⋯ In a series of 23 critically ill patients under mechanical ventilation who were seropositive for CMV, no reactivation of CMV in blood or lung was demonstrated.
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To formulate a theory of shared decision making in critical care that accounts for both the legal and ethical warrants for informed consent, and the roles of nurses and patients' family members in shaping decision making. ⋯ Informed consent occurs when the patient understands the facts; understanding adheres to meaning, and meaning is achieved through narrative. Thus, a theory of shared decision making that uses narrative resolves the problems of informed consent and substantiates the important roles of nurses and patients' families in critical care.