Articles: critical-care.
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Clin Intensive Care · Jan 1992
Rationing and regionalisation of health care services: a critical care physician's opinion.
It is becoming apparent that we have created a demand for medical goods and services that threatens to overwhelm our health care system. Present fiscal policies for financing health care such as excluding a large portion of the population are clearly unacceptable to the public. Current reimbursement policies for health care providers are so murky and, in some cases, so conflicting that they could have been designed only as a method of rationing by inconvenience. ⋯ Regionalisation of medical services has proven to be cost-effective in the specialties of trauma and neonatology. There is accumulating evidence that this same concept, using severity of illness scoring as an objective marker of potential benefit, may maximise cost/benefit for medical and surgical critical care patients. However, multifaceted deterrents to the concept of regionalisation must be addressed, including reimbursement problems, logistics of bed occupancy and physician incentives to participate.
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The pathophysiology and clinical management of acute brain injury in infancy and childhood are presented using acute traumatic brain injury as a model. The principles of stabilization, transport, and intensive care management are critically reviewed.
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Int J Technol Assess Health Care · Jan 1992
ReviewProblems in assessing the technology of critical care medicine.
Technology assessment is becoming increasingly important in the area of critical care due both to the explosion of technology associated with this discipline and to the realization that future demand for these health care resources will undoubtedly exceed the ability to pay. Technology assessment remains both confusing and controversial to many physicians. ⋯ From there, problems and prospects for the evaluation of critical care as a program are presented, followed by the assessment of components within the area of critical care. Finally, recommendations are made on how technology assessment could proceed in the future to best achieve the efficient provision of this service.
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NAACOGS Clin Issu Perinat Womens Health Nurs · Jan 1992
Cardiopulmonary resuscitation during pregnancy.
Cardiopulmonary arrest during pregnancy, although relatively rare, poses a unique challenge to the obstetric nurse. Resuscitation measures attempt to restore maternal hemodynamic stability and promote fetal well-being. ⋯ This chapter reviews significant physiologic alterations in pregnancy that have an impact on resuscitation and cardiopulmonary resuscitation (CPR) algorithms for selected pulseless rhythms. As critical care capabilities continue to develop within obstetric units, it is reasonable to predict that obstetric nurses will face this challenge with increasing frequency.
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NAACOGS Clin Issu Perinat Womens Health Nurs · Jan 1992
Case ReportsPrinciples in hemodynamic assessment.
Use of invasive hemodynamic monitoring provides more thorough assessment of hemodynamic function and may reveal abnormal data before the development of adverse clinical signs and symptoms. The obstetric nurse caring for critically ill patients is responsible for understanding the principles associated with hemodynamic monitoring and interpretation of data to better plan and implement nursing care.