PubMed Health⌕ Search

Biomedical subjects

M M Pollack

Publications and source records attributed to M M Pollack.

At least 55 records · Page 3Linked to original sources
PubMed1994

Erythropoietin response to critical illness.

OBJECTIVE: To examine the endogenous erythropoietin response in critically ill children with acute anemia or acute hypoxemia. DESIGN: A prospective case study of critically ill acutely anemic, and acutely hypoxemic pediatric patients compared with control groups of critically ill nonanemic and nonhypoxemic patients and with a hemoglobin and age-matched, chronically anemic patient group. SETTING: Multidisciplinary, tertiary, pediatric intensive care unit (ICU). PATIENTS: Critically ill patients admitted to the pediatric ICU during an 11-month period between February 1992 and March 1993 with acute anemia (n = 21), acute hypoxemia (n = 18), or neither anemia nor hypoxemia (n = 10). Outpatients with chronic anemia (n = 21) and no acute illness were also studied as a comparison group. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Ages were equivalent among the groups and averaged 57.4 +/- 47.2 months (range 1 to 144). Acutely hypoxemic and critically ill control patients had normal hemoglobin levels. Acutely anemic patients had a hemoglobin level equivalent to chronically anemic outpatients, but lower (p < .001) hemoglobin levels than acutely hypoxemic and critically ill control patients. The serum erythropoietin concentrations in the acutely anemic group were significantly lower than erythropoietin values in the chronically anemic group (39.3 +/- 62.2 vs. 861 +/- 758 mU/mL, p < .001) and similar to erythropoietin concentrations in the critically ill control (13.5 +/- 10.5 mU/mL) and acutely hypoxemic (5.2 +/- 3.3 mU/mL) patient groups. Only ten of 49 critically ill patients had an erythropoietin concentration above normal, compared with 20 of 21 chronically anemic patients, whose erythropoietin concentrations were above normal. CONCLUSIONS: The erythropoietin response to known physiologic stimuli is blunted in critically ill children. This blunted erythropoietin response may result in increased transfusion requirements.

Acute Disease↗
PubMed1994

Regionalization of critical care medicine: task force report of the American College of Critical Care Medicine.

OBJECTIVES: To review the existing literature and task force opinions on regionalization of critical care services, and to synthesize a judgement on possible costs, benefits, disadvantages, and strategies. DATA SOURCES: Pertinent literature in the English language. STUDY SELECTION: One hundred forty-six English language papers were studied to determine possible ramifications of regionalization of critical care or other similar services. DATA EXTRACTION: Information on possible influence on the care of the critically ill was sought and integrated with the opinions of task force members. Possible costs, benefits, as well as disadvantages to the patient, transferring and receiving institutions, and region as a whole were sought. DATA SYNTHESIS: Regionalization of critical care services was thought to be advantageous to the patient. The larger academic institutions tend to have more resources, better subspecialty availability, and expertise in the care of the critically ill. Efficiency and safety during transport need to be in place. Disadvantages of overutilization, possible costliness to both the referring institution as well as to the receiving institution were outlined. It was agreed that pediatric critical care medicine was a separate issue. CONCLUSIONS: Regionalization of critical care medicine probably is beneficial and the concept should be explored.

Adult↗
PubMed1994

Cost containment: the pediatric perspective.

Pediatric critical care resource use in the United States is rapidly expanding despite low occupancy rates and organizational and leadership characteristics that suggest inefficient resource use in pediatric ICUs (PICUs). Studies confirm widespread inefficiencies. Use of PICU resources relates directly to severity of illness, and as a result mortality rates are directly related to efficiency rates. In addition, medical and social costs after PICU discharge are extensive, especially for long-term care of children left disabled by critical illness. Patients with acute illnesses requiring PICU care may account for > 20% of all profoundly retarded individuals. Neonatal ICU costs are driven up by the number of premature, low-birth-weight infants and treatment successes and failures, as well as the long-term functional status of patients. There are two strategies used in assessing the appropriate use of ICU resources: severity-adjusted length of stay and efficiency. Pediatric studies have focused more on efficiency evaluated on each day of ICU stay according to therapies used and severity of illness. If institutions are functioning in a very inefficient manner, a re-evaluation of admission and discharge criteria, as well as other hospital services, may be required to develop more efficient use of the PICU. The solution generally involves reducing the number of patients who are "too healthy to benefit." One intervention that has been successful in reducing resource use by these patients is a risk assessment program that contributes actual mortality risk information.(ABSTRACT TRUNCATED AT 250 WORDS)

Bed Occupancy↗
PubMed1993

A time-series approach to predict outcome from pediatric intensive care.

Daily assessment of the physiologic status of intensive care unit (ICU) patients by a validated score is used to predict their discharge as either alive or dead. Daily scores were decorrelated by time-series analysis techniques to establish a predictor of the next day's score. Data from 3299 patients (290 deaths) in nine different pediatric ICUs were used to derive the predictor model. Using the highest predicted score observed in any survivor from this data base as a threshold value, this predictor correctly identified 21.9% (sensitivity) of the nonsurvivors with no errors in predicting a fatal outcome (100% specificity). This performance is significantly (P < 0.001) better than that with a static predictor based on the first- or second-day scores only (6.6 or 7.4% sensitivity, respectively), or a known empirical dynamic model using the scores of the 2 most recent days (10.3% sensitivity, P < 0.002).

Age Factors↗
PubMed1993

Pediatric intensive care units: results of a national survey.

OBJECTIVE: To describe the structure and organization of pediatric intensive care units (ICUs) in the United States. SURVEY METHODS: We directed a mail survey to pediatric ICU medical and nursing directors and hospital quality assurance officers. A total of 201 of 301 hospitals with pediatric ICUs initially responded. Telephone confirmation of the mail survey (n = 193) and telephone data collection for mail survey nonresponders (n = 42) were also undertaken. SURVEY RESULTS: The largest proportion (40.0%) of pediatric ICUs had four to six beds per unit, while only 6.0% had > 18 beds per unit. The admissions per year averaged 528 +/- 24, and the mortality rates averaged 5.5 +/- 0.2%. Only 79.6% of the pediatric ICUs had full-time medical directors. A pediatric intensivist was available to 73.2% of the units. Physician coverage for 24 hrs/day dedicated only to the pediatric ICU was present in 48.5% of hospitals. As ICU size increased, the estimated mortality rates increased, as did the percentages with full-time directors, pediatric intensivists, and 24 hrs/day dedicated coverage. Medical school affiliation existed for 79.6% of pediatric ICU hospitals, and 81.1% of these hospitals were the primary teaching program sites for pediatrics. Other ICUs caring for children were present in 30.2% of the hospitals. SURVEY APPLICATION: The mail survey respondents were stratified using four factors: size, teaching status, intensivist status, and coordination of care status. A total of 16 respondents were randomly selected for an ongoing outcomes study of the importance of these factors. CONCLUSIONS: Substantial diversity exists in pediatric ICU structure and organization. Determining factors associated with quality of care is important for improving outcomes.

Hospital Bed Capacity↗
PubMed1993

Outcomes of children in a persistent vegetative state.

OBJECTIVE: To determine the long-term outcomes and resource utilization of children discharged home in a vegetative state following neurologic injury. DESIGN: A case series. SETTING: Patients' homes. PATIENTS: Twenty children discharged from acute and chronic care hospitals with a diagnosis and discharge examination consistent with the vegetative state. INTERVENTIONS: Home care delivered, in part, by registered nurses. MEASUREMENTS: Assessed outcomes included survival/death, mental status, functional status, costs, and personnel requirements and technologies used for home care. A mailed questionnaire and telephone follow-up were used to assess patients awareness and caretaker satisfaction with home care. RESULTS: Children were followed in the vegetative state for 4.5 +/- 2.9 yrs. Six children died at home and two children died after rehospitalization. Twelve children survived at home, all for > 1 yr; eight children survived for > 3 yrs. Most patients were stable after the first year of home care. Twelve of 13 caretakers felt their child had some minimal awareness (e.g., voice recognition), although all children remained totally dependent. Costs of care averaged > $90,000/yr per patient. Care included 10 to 12 hrs/day of professional nursing care, and extensive time investments by other personnel, including public school personnel. CONCLUSIONS: The long-term outcome for children discharged from the hospital in a persistent vegetative state was poor. Forty percent of the patients died and, at best, children showed only minimal awareness after an average of 4.5 yrs. Care costs were > $90,000/yr per patient.

Activities of Daily Living↗
PubMed1992

Quantitative quality assurance in a community hospital pediatric intensive care unit.

Unbiased, objective evaluations of quality of care are preferred over subjective evaluations. We observed 681 admissions to a pediatric intensive care unit of a community hospital from 1989 through 1990 for outcomes and physiologic profiles of the patients on the admission day using the Pediatric Risk of Mortality score to assess severity of illness. Mortality adjusted for severity of illness was compared with that predicted from a pediatric intensive care unit of a tertiary medical center: 32.6 deaths were predicted based on the physiologic profiles, and 23 occurred. The number of outcomes and their distribution according to mortality risk indicated close agreement between observed and predicted results. Thus, a quality-assurance technique developed in tertiary care centers can be used to indicate a comparable level of care in a community hospital.

Child↗
PubMed1991

Outcome of home care for technology-dependent children: success of an independent, community-based case management model.

Case management is important for successful home care of technology-dependent, respiratory-disabled children. Traditionally, the medical model of hospital-based home care and case management has been used for these children. The outcome may be different from when using independent, community-based home care and case management. We evaluated the results of 28 technology-dependent children [23 receiving mechanical ventilation and 5 receiving continuous positive airway pressure (CPAP)] from 8 hospitals, who utilized an independent, community-based, case management group to coordinate home care. After 26.3 +/- 20.6 months of follow-up, 13 children (46%) remained technology-dependent, 10 (36%) were technology-independent, and 5 (18%), all with neurologic dysfunction, had died. Only one death was caused by a complication of technology. All children with congenital anomalies (n = 4), primary pulmonary disease (n = 8), and neuromuscular disease (n = 4) survived, and 9 (56%) were weaned from technological support. Children with chronic respiratory failure secondary to central neurologic dysfunction (n = 12) did poorly: 5 died, 6 remained technology-dependent, and only 1 became independent of technology. Children with neuromuscular diseases tended to use less home care nursing at a lower home care cost. Parent satisfaction was high among those who responded (82%), indicating that the child, siblings, and family were better off with the child at home. These outcomes suggest that community-based home care and case management is a reasonable alternative to the hospital-based model.

Abnormalities, Multiple↗
PubMed1991

An objective method to evaluate rationing of pediatric intensive care beds.

Rationing of pediatric intensive care beds occurs when the severity of illness of patients admitted to and discharged from the PICU is inversely proportional to the number of available PICU beds. Bed rationing may also increase the proportion of patients using unique PICU therapies, thereby increasing efficiency. Consecutive PICU admissions (n = 283) were evaluated for three months for descriptive data, daily severity of illness, and daily care modalities. PICU and hospital censuses were also recorded. The mean PICU occupancy was 75% (range 37.5%-100%), the hospital occupancy was 79% (range 60%-96%) and the daily PICU efficiency was 78% (range 50%-100%). The PICU census was greater than 90% on 13% of the study days. Neither PICU nor hospital census was associated with the severity of illness of patients admitted to or discharged from the PICU. Severity of illness for patients admitted when only one bed was available or discharged when there were no available beds was not higher than at other times. Therefore, we did not find evidence of rationing of pediatric intensive care by using quantitative methods. As health care funding becomes more limited, quantitative analyses such as this study differentiating the need for more PICU beds from the need for better PICU bed utilization will be beneficial.

Bed Occupancy↗
PubMed1991

Pediatric critical care cost containment: combined actuarial and clinical program.

OBJECTIVE: To determine if providing patients' daily survival probabilities to physicians and nurses along with a short videotape on the measurement of survival probabilities and costs of pediatric intensive care would reduce resource use. DESIGN: Prospective, randomized, controlled trial. SETTING: Pediatric ICU. PATIENTS: Medical patients in a prospective control period (n = 113), an intervention period (n = 226), and a follow-up control period (n = 97). INTERVENTIONS: The survival probabilities of 50% of the patients in the intervention period were displayed at the bedside and the staff viewed a short videotape on the measurement of survival probabilities and costs of pediatric intensive care. MEASUREMENTS AND MAIN RESULTS: Daily survival probabilities and resource use were evaluated each day. Resource use, adjusted for severity of illness, was evaluated using analysis of covariance. Compared with the prospective control group, reductions in the daily use of blood gases (p less than .01), hematology tests (p less than .001), hourly vital signs (p less than .001), and hourly neurologic vital signs (p less than .001) resulting in a composite reduction in daily laboratory and imaging charges from $759 +/- $22 to $622 +/- $18 (p less than .01) were observed in the patient group receiving the survival probabilities and whose physicians also viewed the videotape. Equivalent reductions in resource use also occurred in a simultaneous control group (patients did not receive survival probabilities but healthcare workers did view the videotape) and in a follow-up control group. CONCLUSION: Reduction in pediatric intensive care resource use can occur from the combined effects of actuarial and clinical interventions.

Actuarial Analysis↗