ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

In this review, topics in connection with recent developments in clinical applications of severity of illness scoring systems are addressed. New, recently introduced scoring systems that might have additional value are discussed. Recent studies of applications that involve assessing day-to-day changes in mortality risk, the merits of generic versus disease-specific scoring systems, prognostication of functional outcome, prognostication in individual patients, and application for assessment of cost-effectiveness are also reviewed.

ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

In recent years, professional groups have accepted the legitimacy of physicians limiting the provision of futile life-prolonging therapies, even if patients or surrogates request that they be provided. One of the crucial difficulties with this proposal is defining medical futility and determining when particular interventions meet that definition. It might be suggested that severity of illness scores could be used to help make that determination. This suggestion does not work. More generally, the whole definitional approach to medical futility needs to be replaced with a procedural approach. Such a procedural approach has been developed recently and is now recommended by the American Medical Association.

ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The field of medical informatics offers the possibility of making the severity scoring in intensive care units more useful. Improved accuracy of data entry, facilitated data retrieval, automated score calculation, and improved delivery of severity scores to the clinician can all be achieved. In addition, the scores themselves may be enhanced by further computer processing, or supplemented by additional markers of severity of illness. This review summarizes the ways in which these gains might be seen, and discusses applicable recent publications.

ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Exponential changes occurring within health care continue to have a dramatic impact on the practice of critical care nursing. Although many systems have “reengineered” their care delivery models, little objective research exists articulating the relationships between restructuring, nurse staffing, and quality. Similar to other disciplines, the practice of critical care nursing and the resultant quality of care do vary among nurses and intensive care units. When comparing quality outcomes, an adjustment for differences in patient risk must be made. Critically important is the development of improved prediction models that match patient needs with the level and type of nurse staffing. This paper selectively reviews the most recent literature published on this topic.

ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Health care systems are in a period of transition. As health care systems become more attuned to market forces, intensive care units are likely to be targets of reengineering and reorganization efforts. Patient outcomes in the intensive care unit are affected by clinical and nonclinical factors. It is important for health care leaders and managers to be familiar with management experiences from the non-health care sector. There are several management theories that can be adopted in the intensive care unit to optimize quality of care and also patient and management outcomes that would provide health care entities a significant competitive advantage while competing in the changing health care market.

ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Postresuscitation myocardial dysfunction recently has been recognized as a leading cause of the high postresuscitation mortality rate. Although the initial success of cardiopulmonary resuscitation (CPR) is approximately 40%, a majority of these victims die within 72 hours, primarily due to heart failure or recurrent ventricular fibrillation. CPR itself therefore yields a functional survival rate of only 1.4% to 5%. The current, very disappointing postresuscitation survival rate raises a critical but as yet largely unexplored issue: myocardial preservation during cardiac arrest and CPR. In this review, the mechanisms of “ischemic preconditioning,” the potential role of myocardial preservation by pharmacologic means, and the direction of future research are discussed.

ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Drug therapy during advanced cardiac life support for cardiac resuscitation continues to evolve, with new experimental and clinical data appearing each year. During the last year, important work has come forth in the following areas: optimal vaso-constrictive agents for improving coronary perfusion pressure during cardiopulmonary resuscitation; antiarrhythmic drug use for refractory ventricular fibrillation during ongoing cardiopulmonary resuscitation; and treatment of postresuscitation myocardial dysfunction. Much of the previous practice of drug therapy during cardiopulmonary resuscitation was based on anecdotal or consensus opinion. Careful prospective evaluation of drug therapy in both experimental and clinical settings is sorely needed. Such data have appeared recently for the use of vasopressin, amiodarone, and dobutamine during and after resuscitation.

ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The importance of early monitoring and intervention in the presenting critically ill patient drives a significant segment of critical care research. Recent progress includes increasingly detailed descriptions of the natural history of circulatory dysfunction, new approaches to resuscitation, new methods of noninvasive monitoring, the effectiveness of physiologically supranormal therapeutic goals, and the use of currently “standard” invasive monitoring modalities. Descriptive research continues to clarify the role of the inflammatory cytokine cascade in the pathophysiology of critical illness, and pharma-cologic interventions based on current knowledge have suggested new therapeutic approaches to critical illness. However, these new approaches have not proven effective. Future trends in managing critical illness will address prevention of sequelae by early, individualized interventions involving easily established, emergency department hemodynamic monitoring with protocols aimed at achieving and maintaining a hemodynamic status consistent with improved outcome. The initiation of individualized care at the earliest possible moment is paramount to reducing the morbidity and mortality associated with critical illness.

ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID