ICUs worldwide: An overview of critical care medicine in South Africa

South Africa has undergone rapid changes in the political and social arenas since 1994. With new policy-makers in the Department of Health, the distribution of health care resources are being rationalised and redirected to benefit the majority of the previously disadvantaged population of the country. The role and rationalisation of intensive care medicine has to be re-evaluated to ascertain that it is at a level appropriate for a developing country. Despite progress made, the subspecialty of intensive care medicine faces challenges from changing disease patterns and from lack of human and financial resources as these are redirected to primary health care and other priorities facing the country.     

ICUs worldwide: critical care in India

Critical care practices in India have evolved significantly over the past decade. Critical care initially began as a service in major hospitals, but with the formation of the Indian Society of Critical Care Medicine the development of this speciality has been very rapid. Regular conferences, updates, continuing medical education programmes and workshops have emerged, and postdoctoral training programmes have been developed. Scientific publications have begun to appear and in spite of the diverse problems and standards, meaningful speciality-related activities have begun. Future challenges include the development of guidelines, the consolidation of training activities and research on the outcome of critical tropical problems.     

Computer assisted management of information in an intensive care unit

Summary In order to use the capability of computers for handling large amounts of information, we developed a program for the acquisition, handling, storage and retrieval of administrative and clinical information generated in the 20 bedded multidisciplinary critical care unit of a University Hospital. At an initial phase a personal computer (PC) was used to collect information from 4362 patients, that included registration data, coded admission problems, techniques and special treatments, and final diagnosis. This information combined with free text provided a discharge report. Complementary programs allowed calculation and storage of hemodynamic and gas exchange parameters. This experience led to a second phase in which a computer with microprocessor Intel 80386 at 25MHz, 8MB RAM, 310 MB hard, disk and a streamer for 150MB cartridge tape back up, using UNIX operating system, permitted multiple users working simultaneously through 1 central console and 7 ASCII terminals. Data input included demographic data, previous and admission problems in coded form, present history and physical examination in free text, list of present problems in coded form, comments on evolution, record of special techniques and treatments, laboratory data, treatment, final diagnosis and facility for using all the information to elaborate the final report. Side modules provide help for drugs dosing, protocols for specific conditions and clerical routines. The system is open for connection to other areas of the Hospital. Data from more than 2000 patients have been included so far. The program is used by medical, nursing and clerical staff with high degree of acceptance. All patients have their clinical information filed and 100% of the final reports are elaborated with the program.We conclude that a PC supported application is not adequate for implementing a historical database. On the contrary the integration of a relational database management system with a text editor in a more potent multiuser set up, provides a highly efficient tool to handle all the data generated during the patients' admission.     

Multidisciplinary team perception of games-based therapy in critical care: A service evaluation

Background

As survivorship following critical illness improves, there is greater focus on maximizing recovery. As well as physical effects, critical illness often results in cognitive impairments such as delirium, anxiety, or disorientation. In other populations, such as delirium, non-pharmacological approaches to manage these conditions are preferred, including re-orientation and ensuring personal care needs are met. Cognitive rehabilitation is also well documented for patients with neuropsychological deficits. Treatments include memory aids, compensation strategies, and functional execution. In other hospital populations, games and activities have been utilized to optimize patient engagement, stimulation, and aid recovery, but it is considered an emerging therapy in intensive care.

Aims

This service evaluation aimed to gather multidisciplinary team members' perceptions of the use of games based therapy (GBT) in critical care, including patient engagement and acceptability in clinical practice.

Study design

A UK-based single-centre qualitative service evaluation. Purposive sampling was used to identify interviewees within an adult intensive care who had experience of using a recently implemented GBT intervention. Qualitative data were collected through semi-structured interviews, which were recorded and transcribed verbatim. Data were analysed using thematic analysis.

Results

Eight staff members across the multidisciplinary team were interviewed. One overarching theme of humanizing health care was identified, with three sub-themes of enhancing recovery, non-physical components of care, and bespoke tailoring. In addition, further recommendations for development of the service were summarized.

Conclusion

GBT was well received by staff in clinical practice. It was described as a supportive adjunct to traditional care and rehabilitation, enhancing staff-patient relationships. While it was recognized it may not suit all patients, GBT has the potential to enhance cognitive and physical recovery.     

ICU护士评判性思维的现状及影响因素分析

目的 调查ICU护士评判性思维的现状,并探讨其相关影响因素.方法 采用一般资料调查表及评判性思维能力量表对长沙市7所三级甲等医院ICU的324名护士进行横断面调查.结果 ICU护士的评判性思维能力总分为（284.22±23.62）分;职称、第一学历、从事ICU工作年限、参加活动频率和学习频率是ICU护士评判性思维能力的影响因素.结论 ICU护士的评判性思维能力总体表现为正性,但离评判性思维能力强的标准还有很大的差距,还有待进一步培养和强化.     

远程多中心重症监护网络的临床应用

目的 评价应用远程多中心重症监护网络是否能提高入网医院重症监护病房(ICU)危重患者的抢救效率和经济效益.方法 建立医院重症监护专业医师和多科专家组成的会诊中心,通过会诊中心和远程ICU均配备相应的软件平台来实现电子数据的传输、显示和影音交流,对危重病患者进行远程会诊指导.在项目实行后,对入网满1年的医院进行医疗和经济效益评价,并与入网前1年的结果进行比较.结果 至2009年7月止,浙江省共有63家医院加入远程多中心重症监护网络,有1 617例重症监护患者接受了远程会诊,同时进行了173次远程教学查房和72次远程授课.对其中23家入网时间满1年的医院进行了前后数据的比较,结果显示,ICU的平均病死率下降了11.6%(12.9%比14.6%),危重患者转院率下降了38.3%(2.9%比4.7%),ICU床位利用率提高了6.1%(83.4%比78.6%).结论 远程重症监护项目的 实施可以改善患者的临床预后,提高医院经济效益.     

Correlation between the TISS‐28 and NEMS indicators in an intensive care unit

Cross‐sectional study aimed at to analyse and compare the correlation between the Therapeutic Intervention Scoring System (TISS)‐28 and Nine Equivalents of Nursing Manpower Use (NEMS) indicators with a sample of 725 patients, for which data was collected from the computerized system of a university hospital. The findings of the present study well demonstrated a strong correlation between the TISS‐28 and NEMS, both at the time of patient admission and discharge (0.888 and 0.885; P < 0.001), although there is a dispersion of 21% in the data and established cut‐off points to discriminate with greater power the death and no death scenarios. Further research is still necessary to confirm the possibility of replacing the TISS‐28 scoring instrument with NEMS.     

A decision class analysis of critical care life-support decision-making

Decision analysis is a powerful methodology that can help clinicians make good decisions. Because it is not practical to place a decision analyst at the bedside in critical care units, the application of this methodology will require leveraging the analyst through computer-based systems. A decision class analysis is a collective analysis of a group of decisions that provides the high-level specification for such a computer system. This paper presents a decision class analysis of critical care life-support decisions. Key elements of this analysis are: the simplification of an otherwise extremely complex multistage sequential decision problem by using a sequence of two-stage models, and the use of six generic knowledge maps that capture the extremely complex relevant medical knowledge.