Articles: mortality.
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To describe the red blood cell transfusion practices of pediatric intensivists. ⋯ This survey documented a significant variation in transfusion practice patterns among pediatric critical care practitioners with respect to the threshold hemoglobin concentration for red blood cell transfusion. The volume of packed red blood cells given was not adjusted to the hemoglobin concentration.
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Semin Respir Crit Care Med · Oct 2002
Strategies for prevention of hospital-acquired pneumonia: oral and selective decontamination of the gastrointestinal tract.
The use of antimicrobial prophylaxis is the most extensively studied, though probably also the most controversial, method to prevent the development of ventilator-associated pneumonia (VAP). Selective decontamination of the digestive tract (SDD) includes the application of topical nonabsorbable antibiotics in the oropharynx, stomach, and intestines in combination with systemic antibiotics during the first days of ventilation. ⋯ Moreover, the significant reductions in incidences of VAP have, so far, not resulted in reductions of duration of ventilation and ICU-stay, and reductions in ICU-mortality were found only in meta-analysis. Selection of resistant bacteria is the most important drawback of antimicrobial prophylaxis, and the demonstrated benefits of antimicrobial prophylaxis should be carefully balanced with this potential risk.
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Historical Article
Twentieth-century social and health-care influences on location of death in Canada.
Providing the right care, in the right place, to dying persons is hampered by a lack of understanding of where death and dying normally take place and ignorance about what influences location of death. This paper reports the findings of a multidisciplinary historical investigation of 20th-century influences on location of death in Canada. It builds on a study that found a hospitalization-of-death trend in Canada over much of the 20th century but a reduction in hospital deaths beginning in 1994. ⋯ A number of developments limited the availability of home care for chronically ill and terminally ill persons, including the increased participation of women in the workforce and the shift in nursing from private home duty to hospitals. Although some health and social support for home care has developed recently, this support clearly does not match that for hospital care. These findings indicate that location of death is an important focal point for studying and planning improvements in end-of-life care.
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This report presents final 2000 data on U.S. deaths and death rates according to demographic and medical characteristics such as age, sex, Hispanic origin, race, marital status, educational attainment, injury at work, State of residence, and cause of death. Trends and patterns in general mortality, life expectancy, and infant and maternal mortality are also described. A previous report presented preliminary mortality data for 2000. ⋯ Generally, mortality continued long-term trends. The slight increase in the age-adjusted death rate that was experienced in 1999 reversed itself in accordance to a longer standing decreasing pattern. Life expectancy increased 0.2 years, and the infant mortality rate decreased statistically to a record low 6.9 deaths per 1,000 live births, thus maintaining the steady decline that has characterized it for the past four decades.