Neonatal intensive care and radiation

Radiography plays an important role in a neonatal intensive care nursery. Diagnostic radiation was measured in 96 newborns. Mean exposure per neonate was 68.1 milliroentgens (mR) (SD = 132.7) with a median exposure per neonate of 28 mR. Radiation received by neonates was low, but further studies are needed to show the safety of radiation or its delayed effects. The measurement of radiation is simple, and routine radiation recording can prove useful in future evaluations of this high-risk population.     

Mobile intensive care units. An evaluation of effectiveness.

Implementation of mobile intensive care units in four suburban communities permitted a retrospective evaluation of their impact on patient outcome. Data on 1,796 cases of myocardial infarction were obtained from medical reords and death certificates of patients arriving at four hospitals during a 65-month period. There were statistically significant reductions in mortality rates in two communities (41.1% to 23.9% and 37.6% to 27.0%) after the service began. A reduction in one community (34.5% to 22.0%) was not statistically significant, and the fourth community showed an increase in the mortality rate (31.1% to 44.0%). Analysis of plausible rival hypotheses permitted most of these to be ruled out as causes for the observed reduction in mortality.     

新生儿重症监护室护士职业危害与防护

分析新生儿重症监护室的护士存在的职业危害因素,并提出相应的防护措施,以减少职业伤害的发生,对护士进行职业防护教育,健全职业防护管理体系,增强护士防范意识,提高职业防护能力,配备适当的防护用品,加强职业暴露后的处理,使护士在确保惠儿安全的同时,要注意自身的职业安全,把职业危害降到最低。     

The cost of intensive and special care of the newborn

The cost of providing intensive (level-3) and special (level-2) care for newborn infants in a tertiary perinatal service was determined prospectively and was expressed in 1984 Australian dollars. Direct costs that were expressed per occupied bed-day were $690 for level-3, high-dependency care; $421 for level-3, low-dependency care; $544 for over-all level-3 care; $242 for level-2, high-dependency care; $170 for level-2, low-dependency care; and $201 for over-all level-2 care. Each level of care generated additional costs of $42 per occupied bed-day. Taking these additional costs into account, the over-all occupied bed-day cost of level-3 and level-2 neonatal care was $339. The major components of this over-all cost were: nursing staff members, 50%; medical staff members, 11%; consumable and recyclable items, 12%; and diagnostic services, 8%.     

Ethical issues of cost effectiveness analysis and guideline setting in mental health care

This article discusses ethical issues which are raised as a result of the introduction of economic evidence in mental health care in order to rationalise clinical practice. Cost effectiveness studies and guidelines based on such studies are often seen as impartial, neutral instruments which try to reduce the influence of non-scientific factors. However, such rationalising instruments often hide normative assumptions about the goals of treatment, the selection of treatments, the role of the patient, and the just distribution of scarce resources. These issues are dealt with in the context of increased control over clinical practice by third parties. In particular, health insurers have a great interest in economic evidence in clinical care settings in order to control access to and quality of (mental) health care. The authors conclude that guideline setting and cost effectiveness analysis may be seen as important instruments for making choices in health care, including mental health care, but that such an approach should always go hand in hand with a social and political debate about the goals of medicine and (mental) health care. This article is partly based on the results of a research project on the normative aspects of guideline setting in psychiatry and cardiology which was conducted under the guidance of the Royal Dutch Medical Association.     

Evidence-based medicine in intensive care.

The life-threatening nature of critical illness, requiring simultaneous, multiple interventions, makes it difficult, if not impossible, to study the effects of any one treatment. It is often not possible to conduct trials in critically ill patients, as they can not give informed consent. Some high quality, prospective studies have influenced clinical practice in intensive care, but others with lower grades of evidence have led to some controversy. In intensive care, clinical practice is still influenced by a combination of theory, experience and evidence.     

Efficiency of intensive care. A comparative analysis of eight pediatric intensive care units

To calculate overall pediatric intensive care unit (PICU) efficiency rates, 1668 patients representing 6962 patient-days were studied in eight PICUs. The contributions to inefficiency by two patient groups--low-risk monitored patients and potential early-discharge patients--were quantified using measures of daily mortality risk and therapeutic assessments. Low-risk monitored patients never received a unique PICU therapy and had daily mortality risks less than 1%. Potential early-discharge patients were similar to the low-risk monitored patients except that their unnecessary PICU use came only on their last consecutive day(s) of PICU stay. Efficiency ratings ranged from 0.894 to 0.547 in the eight PICUs. Low-risk monitored patients constituted from 16% to 58% of the PICU patient populations and used from 5.4% to 34.5% of the total days of care. Potential early-discharge patients constituted from 12% to 29% of the populations and the potential early-discharge days of care ranged from 5.1% to 17.2% of the total days of care. These results indicate that large disparity exists in efficiency among PICUs. Efficiency rates of greater than 0.80 seem to be a reasonable goal.     

重症监护治疗学（12）：——重症监护的组织构成

重症监护始于 1 952年 ,由于当时脊髓灰质炎在哥本哈根流行 ,接受胸甲通气治疗的患者死亡率高达 90 %,而通过气管切开实施手动正压通气治疗 ,并联合将患者集中到一个特定病区进行特殊监护的方法 ,可使死亡率降至 40 %。这种病床旁的持续监护虽然提高了监护质量 ,但却增加了医疗费用 ,而对于某些患者 ,只是推迟了死亡时间。这些成果对现代重症监护仍有影响。重症监护技术发展非常迅速 ,目前几乎每个医院都拥有不同形式的重症监护病房。关于重症监护的质量和费用、重症监护病房的大小和位置、医疗护理人员和重症监护床位的数目 ,以及如何利用…     

新生儿窒息复苏后护理

目的:探讨新生儿窒息复苏后的护理工作。方法:对窒息新生儿复苏后的常见观察和护理方法和措施进行总结归纳。结果:经过全面系统的护理,急救新生儿治愈成功率达96.67%,治疗新生儿窒息效果明显。结论:通过对新生儿窒息复苏后实施及时准确的护理,不仅能降低新生儿的病死率,同时也对提高新生儿的生活质量起到一定的指导意义。     

On the delivery of intensive care.

A 12-bed medical-surgical intensive care unit in a provincial, university-affiliated teaching hospital had 810 admissions during an 18-month period. Most patients were admitted under the care of a family physician. Quality care in the ICU was maintained by the efforts of dedicated unit managers, specialists and house staff. The overall mortality in the ICU of 8.1%, when added to the post-ICU mortality of 2.7% (giving a total hospital mortality of 10.8%), compares favourably with the best reported figures. Strong emphasis on selection of patients with potentially reversible disease, prompted in part by the limited facilities, may have played a role in yielding such favourable statistics. It is possible to retain participation of all members of the health care team during the brief phase of severe illness requiring intensive care.     

Industrial hypertension program in a rural state. Efficacy and cost effectiveness.

A program was designed to evaluate the efficacy and cost of detecting and treating hypertension in an industrial population of a rural state. Original screening and evaluation was initiated by a trained blood-pressure technician team, but initiation of therapy was the responsibility of the private physician. Follow-up data were obtained at one year by rescreening in 83% and by telephone contact in 91% of the original hypertensive patients. Eighty-three percent of those patients with moderate or severe hypertension complied with physician visits. The condition of 60% of the treated patients was controlled, and the condition of 74% was improved. The total cost per patient treated for one year was 250 dollars; per patient with controlled hypertension, 446 dollars; and per patient with controlled or improved hypertension, $362.