共查询到20条相似文献,搜索用时 15 毫秒
1.
2.
3.
4.
5.
6.
Objective To evaluate the attitudes of Israeli intensive care physicians regarding intensive care unit (ICU) triage issues.Design An opinion survey using questionnaires similar to those used in a previous study in the United States.Setting and participants Forty-three physicians, members of the Israel Society of Critical Care Medicine (45%).Results Important factors for admission to the last ICU bed were: small likelihood of surviving hospitalization, irreversibility of acute disorder, nature of chronic disorders and the physicians personal attitude. Most respondents would admit a patient with a predicted survival of a few weeks (70%) or a patient whose quality of life would be poor according to the physicians (98%) or patients (77%) definition, to the last ICU bed. The personal attitude of the respondents and their own view of the patients quality of life were considered as important as the quality of life as viewed by the patient. Israeli physicians tended to refuse patient admission into the ICU more than their US counterparts. Most Israeli physicians refused to discharge an ICU patient in order to admit another, despite bed shortage.Conclusions The attitudes of Israeli intensive care physicians towards distribution of ICU resources differ from those of their United States counterparts; they are more paternalistic and comply less with requests for admission. Such attitudes are comparable to those expressed by some European intensive care physicians, highlighting the existence of diversity in the factors important to physicians decision-making. 相似文献
7.
M Lindsay 《Journal of PeriAnesthesia Nursing》1999,14(2):73-77
The increasing number of critically ill patients requiring prolonged lengths of stay in the surgical intensive care unit has led hospitals to examine ways of using the PACU as a short-term area for critically ill patients. This article identifies common problems associated with this situation, and offers suggestions/guidelines to facilitate a smooth transition and ensure competent care of these patients. This article will not focus on financial issues related to patient charges. The criteria established in this article are based on personal experience. 相似文献
8.
9.
10.
11.
12.
OBJECTIVE: Intensive care units (ICUs) use severity-adjusted mortality measures such as the standardized mortality ratio to benchmark their performance. Prognostic scoring systems such as Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score II, and Mortality Probability Model II0 permit performance-based comparisons of ICUs by adjusting for severity of disease and case mix. Whether different risk-adjustment methods agree on the identity of ICU quality outliers within a single database has not been previously investigated. The objective of this study was to determine whether the identity of ICU quality outliers depends on the ICU scoring system used to calculate the standardized mortality ratio. DESIGN, SETTING, PATIENTS: Retrospective cohort study of 16,604 patients from 32 hospitals based on the outcomes database (Project IMPACT) created by the Society of Critical Care Medicine. The ICUs were a mixture of medical, surgical, and mixed medical-surgical ICUs in urban and nonurban settings. Standardized mortality ratios for each ICU were calculated using APACHE II, Simplified Acute Physiology Score II, and Mortality Probability Model II. ICU quality outliers were defined as ICUs whose standardized mortality ratio was statistically different from 1. Kappa analysis was used to determine the extent of agreement between the scoring systems on the identity of hospital quality outliers. The intraclass correlation coefficient was calculated to estimate the reliability of standardized mortality ratios obtained using the three risk-adjustment methods. MEASUREMENTS AND MAIN RESULTS: Kappa analysis showed fair to moderate agreement among the three scoring systems in identifying ICU quality outliers; the intraclass correlation coefficient suggested moderate to substantial agreement between the scoring systems. The majority of ICUs were classified as high-performance ICUs by all three scoring systems. All three scoring systems exhibited good discrimination and poor calibration in this data set. CONCLUSION: APACHE II, Simplified Acute Physiology Score II, and Mortality Probability Model II0 exhibit fair to moderate agreement in identifying quality outliers. However, the finding that most ICUs in this database were judged to be high-performing units limits the usefulness of these models in their present form for benchmarking. 相似文献
13.
《Australian critical care》2023,36(5):863-871
BackgroundEvidence suggests that intensive care unit (ICU) survivors often suffer long-term complications such as post–intensive care syndrome (PICS) and post-traumatic stress disorder (PTSD) from critical illness and ICU stay. PICS and PTSD affect both ICU survivors and their families, which overburdens the healthcare systems. Lack of evidence on the comparative psychometric properties of assessment tools is a major barrier in evidence-based screening for post-ICU symptomatology and health-related quality of life.ObjectivesWe aimed to identify existing tools for screening PTSD and PICS in ICU survivors and their families and to examine evidence on the validity, reliability, sensitivity, and specificity of existing tools, as reflected in published peer-reviewed studies.MethodA scoping review based on literature searches (CINAHL, MEDLINE, EMBASE, PsycINFO, Scopus, Health and Psychosocial Instruments, Dissertations and Theses Global, and Google Scholar) and predefined eligibility criteria was conducted according to current scoping review guidelines.FindingsWe identified 44 studies reporting on the development and assessment of psychometric properties of PICS/PTSD in ICU survivors or families globally. We identified five tools addressing all three aspects of PICS manifestations, one tool for both physical and mental aspects of PICS, and fivefive tools for quality-of-life assessment in ICU survivors. Altogether, 25 tools assess only one aspect of PICS: five for cognitive impairment, seven for physical impairment, and 13 for mental health impairment and PTSD in ICU survivors. However, only two tools were found for PICS-family assessment. Other findings include (i) unclear validity and often limited feasibility of tools, (ii) low diagnostic accuracy of cognitive assessment tools, and (iii) evidence of appropriate psychometric properties and feasibility of psychological health assessment tools.ConclusionThese results have implications for the selection and implementation of the assessment methods as a means for promoting meaningful patient-centred clinical outcomes to minimise long-term sequelae, reduce the rate of rehospitalisation, and optimise recovery after ICU discharge. 相似文献
14.
Bambi S 《Assistenza infermieristica e ricerca : AIR》2004,23(1):36-47
Unplanned extubations are defined as unwelcome extubations. The phenomenon is classified in "accidental extubation", if occurring during procedures performed by healthcare workers, or in "self extubation", if the patient removes the endotracheal tube. Unplanned extubations are increasingly being considered an indicator of healthcare quality in ICU. Their rate varies from 3% to 14% of the intensive care units patients, the highest percentages being in burn units (27%). Re-intubations rate varies from 31% to 74%, determining increased length of hospitalisations without affecting mortality rates. Analysis of the local setting is required to improve the safety and quality of care, in order to plan appropriate measures, such as staff education. Preventive strategies include: increasing safety during nursing interventions, research for risk indicators of self-extubation, patient's comfort and sedation protocols, and finally alternative methods to physical and pharmacological restraints. The relationship between unplanned extubations and nursing workload can be used as indicator for the optimization of staff resources in intensive care unit. 相似文献
15.
16.
Armstrong F 《Australian nursing journal (July 1993)》2005,13(2):18-9, 21
17.
18.
Griffiths RD 《Critical care medicine》2008,36(10):2945-2946
19.
《Expert review of anti-infective therapy》2013,11(5):581-595
Stewardship of all antimicrobials, including β-lactam antibiotics, has gained in prominence over the last decade. Appropriate use of these agents has become vitally important; especially in the treatment and management of the critically ill. Opportunities therefore exist to develop innovations to optimise the use of antimicrobials in places like the intensive care unit. The next few years represent an important window in which routine antimicrobial stewardship principles such as surveillance of local ecology, minimising overlap of spectrum of activity and prompt de-escalation upon review of cultures can be integrated with new technologies including improved diagnostic techniques, individualised dosing strategies and computerised decision support. It is important though, that these measures to improve stewardship in the intensive care unit continue to be critically evaluated in the literature. 相似文献
20.