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At least 73 records · Page 4Linked to original sources
PubMed1977

The intensive care unit: social work intervention with the families of critically ill patients.

Hospital intensive care units can be a significant practice area for social workers. Nowhere are families in more obvious crises than when faced with the life-threatening illness of a significant other who may be unresponsive and dependent on a frightening array of highly technical equipment. Using the crisis model for their intervention, social workers can significantly lessen the trauma experienced by these families. Additionally, they can develop other supportive hospital resources such as family groups and volunteer services to help meet their needs.

Adaptation, Psychological↗
PubMed1978

Antecedents of child abuse and neglect in premature infants: a prospective study in a newborn intensive care unit.

Families of premature and ill newborns admitted to a regional newborn intensive care unit were studied prospectively to assess the incidence of reported child abuse and neglect. Of the 255 infants discharged to their parents, ten were subsequently reported as victims of maltreatment during the first year of life. The high incidence of maltreatment (3.9%) in these premature and ill newborns supports the findings of retrospective studies that there is an increased risk of maltreatment in these special infants. Thirteen family psychosocial characteristics, assessed by admission interview, showed significant association with later maltreatment. These family characteristics included social isolation, a family history of child abuse and neglect, serious marital problems, inadequate child care arrangements, apathetic and dependent personality styles, and inadequate child spacing. Maltreated infants were less mature at birth and had more congenital defects than their nursery mates. There was also less family-infant contact during the prolonged nursery hospitalization in families in which maltreatment eventually occurred.

Adult↗
PubMed1978

[Centralized system for EEG-diagnosis and EEG-monitoring in a neurologic intensive care unit (author's transl)].

A centralized EEG system installed in a neurologic intensive care unit is described. It is the first step to a computerized EEG monitoring which on the basis of conventional EEG recordings already permits a "brain monitoring" to some extent. It consists of a system for total EEG diagnosis which is connected with a central EEG laboratory via long-distance transmission lines, and of a system for EEG-monitoring which is part of the general beside monitor system. The possibilities of this system are demonstrated in monitoring of patients with epileptic seizures.

Aged↗
PubMed1979

[Severity factors of poisoning in children admitted to intensive care units].

From 1964 to 1976, 854 children were admitted with poisoning to three intensive care units in Paris. The severity of the condition has been assessed in terms of the patients received: 1. observation only (67%). 2. routine intensive care (27%). 3. very seriously ill (6%). At the time of discharge, 92% of children were normal, 3% had minor sequelae, 3% had major sequelae; 2% died. The outcome was closely related to the severity of the illness. The main factors affecting the severity were: 1. The nature of the ingested substance. Poisoning with Amanita phalloides was the most serious with a high mortality. Poisoning with domestic agricultural and industrial products were more often responsible for major sequelae, particularly affecting the oesophagus, than drugs. 2. The type of poisoning. This was related to the age of the child. Iatrogenic poisoning of infants and self poisoning by adolescents were more serious than accidental poisoning in toddlers. 3. The toxicity of the ingested dose. 4. The interval between ingestion and effective treatment. Although all the factors are interrelated, each factor has its own prognostic value.

Adolescent↗
PubMed1978

Intensive care unit radiology. Problems of interpretation.

The radiographic examination of the chest plays an important role in the evaluation of patients in the intensive care unit. The maximum diagnostic value of the radiographs can be achieved only if the films are frequently reviewed, preferably in a daily working conference of the radiologist with the clinicians. Without detailed knowledge of the patient's clinical status, the radiologist will be severely limited in the precision with which the radiographs can be used to evaluate the status of a patient in the intensive care unit.

Adult↗
PubMed2025

Gut Colonization With Vancomycin-Resistant Enterococcus Shapes the Gut Microbiome in the Intensive Care Unit.

BACKGROUND: Gut pathogen colonization with vancomycin-resistant Enterococcus (VRE) is common in the intensive care unit (ICU) and is associated with worse clinical outcomes; however, the timing of VRE colonization and its collateral effects on the gut microbiome are incompletely understood. METHODS: Medical ICU patients admitted with sepsis and receiving broad-spectrum antibiotics were sampled via deep rectal swabs at ICU admission and on ICU day 3, 7, 14, and 30. Rectal swabs were cultured for VRE on selective media and analyzed via 16S ribosomal RNA gene sequencing. RESULTS: Ninety patients were sampled (340 longitudinal swabs). VRE positivity rose from 20% at ICU admission to a peak of 33% by ICU day 14 and then modestly declined to 31% by ICU day 30. Paralleling this, alpha diversity fell while Enterococcus relative abundance rose through ICU day 14 with both returning to baseline by ICU day 30. The median relative abundance of Enterococcus was 38% (interquartile range [IQR], 7.4%-75%) for VRE-positive samples compared to 0.01% (IQR, 0%-19%) for VRE-negative samples (rank-sum P < .01); 38 samples had &#x2265;90% Enterococcus and 8 samples were 100% Enterococcus by sequencing. VRE was associated with lower alpha diversity (median Shannon index 1.90 [IQR, 0.89-2.66] if VRE positive versus 2.64 [IQR, 1.58-3.22] if VRE negative; P < .01). CONCLUSIONS: VRE gut colonization peaked at ICU day 14 followed by a modest decline and was associated with low alpha diversity. Improved understanding of dynamic changes in the gut microbiome may facilitate successful future ICU interventions. CLINICAL TRIALS REGISTRATION: NCT03865706.

Aged↗
PubMedDate not supplied

Arterial blood-gas interpretations in the respiratory intensive-care unit.

The role of the nurse in the respiratory intensive-care unit requires increased sophistication as our knowledge of the patient becomes more complex. This expanded role should include a thorough understanding of disturbances in acid-base balance, the relationship of PaCO2 to ventilation, the difference in acute and chronic respiratory problems, and the causes and treatment of hypoxemia. The ability to analyze and evaluate blood-gas determinations is simply one more important tool the nurse may utilize in the care and treatment of the critically ill patient.

Acid-Base Imbalance↗
PubMed1976

The psychiatrist in the surgical intensive care unit. II. A consideration of staff roles.

The stresses present within the Surgical Intensive Care Unit (SICU) affect both patients and staff. The liaison psychiatrist attached to the unit helps in identifying and neutralizing tension displaced from its source. Death, although commonplace on the unit, often engenders strong feelings in the staff. Pulmonary patients, especially those who must be weaned from the respirator, also increase the psychological strain on the staff beyond the necessary effort involved in physical caretaking. Aside from emotional difficulty presented by working with very sick patients, there exists group pressures resulting from hierachy within the staff. Here, particularly, the psychiatrist can promote understanding and reduce polarization.

Attitude to Death↗
PubMed1977

[Admission and treatment of 592 patients over 70 years in an intensive care unit].

Using an IBM 3741 computer, the authors analysed 592 case records of patients aged over 70 years, admitted to hospital on an intensive care unit, age appears to be an important factor in determining the prognosis of numerous diseases without, however, being a criteria for rejection of admission of these patients to an intensive care unit. The fragility of these patients leads one to consider the following parameters: 1--the degree of resuscitation is assessed by quantification of the therapeutic means. As for other patients, survival varies inversely in relation to the important of the therapeutic means, but in the case of the elderly patient, there is a definite difference in the correlation mortality-therapeutic index towards aggravation, so one may determine a ceiling above which survival is not possible; 2--duration of the intensive care is very important. In most cases, the decisive point is situated on the 3rd or 4th day of care, at which time the decision to continue or stop treatment may be considered in the light of the patient's progress.

Aged↗
PubMed1977

Outbreak of influenza in a neonatal intensive care unit.

An outbreak of influenza A/Victoria/3/75 (H3N2) involving five infants in a neonatal intensive care unit is described. The clinical signs and symptoms were indistinguishable from those seen in bacterial sepsis. There was no evidence of meningoencephalitis. All infants recovered without any sequelae.

Antibodies, Viral↗
PubMed2025

Implementing customized genomic sequencing reports to empower providers in safety-net neonatal intensive care units.

PURPOSE: Through our implementation study providing rapid genomic sequencing (rGS) in safety-net neonatal intensive care units (NICUs), we investigated the feasibility and perceived usefulness of customized "clinical interpretive reports" (CIRs) to help neonatal providers with interpreting, disclosing, and managing care based on rGS results. METHODS: Enrolled infants received rGS through a clinically accredited vendor. We developed 5 CIR types to provide customized interpretation of rGS results and link results to clinical management considerations, research opportunities, and resources. We developed workflows to triage, create, and deliver CIRs within 3 business days. Providers received the vendor reports and CIRs, disclosed results, and completed post-disclosure surveys. We analyzed summary statistics for the first 100 cases. RESULTS: We delivered 97 of 100 CIRs (97%) within our goal time frame (average 1.3 days) and provided clinical management recommendations in 40 of 100 (40%). Neonatal providers completed the post-disclosure surveys for 86 of 100 disclosures (86%). Most reported using the CIR before disclosure (80/86, 93%) and found it helpful at providing useful information beyond the vendor report (79/80, 99%). CONCLUSION: It is feasible and useful to develop customized rGS reports to assist non-genetics providers in safety-net NICU settings. Similar approaches may hold promise for equitably advancing genomic care in non-NICU settings.

Humans↗
PubMed1979

A newly designed flexible fiberoptic bronchoscope for use in intensive care units.

A newly designed flexible fibroptic bronchoscope has been manufactured for use in intensive care units (ICU). It has an inside channel of large caliber, diameter 2.5 mm, through which pulmonary secretions can be aspirated directly via the suction tube. Furthermore, prompt bedside use is possible since handle type batteries can easily be attached to the bronchofibroscope. This new instrument is now employed in our ICU for: 1. The diagnosis and treatment of atelectasis. 2. Suction of retained secretions. 3. Detection of tracheal obstruction. 4. Evaluation of endotracheal and tracheostomy tubes whilst in position. 5. Observation of tracheal and bronchial changes. 6. Help in endotracheal intubation. It was used most frequently for the diagnosis and treatment of atelectasis and suction of retained secretions.

Bronchoscopes↗
PubMed1975

The place of a general intensive care unit in a metropolitan hospital.

The results of a six-year survey are given of the admissions, treatment and prognosis of 3310 patients in the intensive care unit at Middlemore Hospital from 1966-72. The range and extent of the treatment underlines both the need for and the value of a general intensive care unit in the integrated daily routine of a large general hospital.

Heart Arrest↗
PubMed1977

Outbreak of meningitis in a newborn intensive care unit caused by a single Escherichia coli K1 serotype.

Three cases of meningitis that occurred during a nine-day period in a newborn intensive care unit were caused by a single E. coli serotype 07:K1:H-. A single organism outbreak was suspected when the three spinal fluid isolates all possessed the same two unusual bacteriologic and biochemical characteristics: nonmotile and ornithine negative. Culture surveillance identified eight infants colonized with the same strain of E. coli; three of these infants are described. Clusters of cases of E. coli meningitis in newborn intensive care units should be evaluated and managed as potential outbreaks.

Cross Infection↗
PubMed1977

Two outbreaks of Flavobacterium meningosepticum type E in a neonatal intensive care unit.

Two separate outbreaks due to Flavobacterium meningosepticum type E occurred in a neonatal intensive care unit in March-April and July 1975. The first outbreak involved all five infants in the unit. Two infants developed meningitis, one had bacteremia, and two were colonized. During the second outbreak, five of seven infants were colonized but none developed disease. The upper respiratory tract was colonized first in most instances, and the organism persisted at this site for a mean of 17.3 days. Duration of colonization was more prolonged in infants receiving antibiotics than in untreated infants. Extensive environmental surveillance failed to demonstrate a reservoir, however, F. meningosepticum was recovered from three nasoendotracheal tubes and from an aerosol tube before colonization of four infants. The organism was resistant to most antimicrobial colonization of four infants. The organism was resistant to most antimicrobial agents tested and developed resistance to others during the treatment course of one infant. Although F. meningosepticum was not recovered from cultures of transport vehicles, several other gram-negative bacteria were isolated and were also resistant to multiple antibiotics.

Anti-Bacterial Agents↗
PubMed1978

Otitis media in the neonatal intensive care unit.

Thirty-eight of 125 premature infants who were hospitalized in a neonatal intensive care unit (NICU) had abnormal tympanic membrane mobility compatible with otitis media. Twenty-five of these 38 had received antibiotics within one week of otoscopic examination and were considered to have either serous otitis or partially treated bacterial otitis media; tympanocentesis was not performed in them. Tympanocentesis was performed in the remaining 13 infants who had not received antibiotics. Bacterial otitis media was confirmed in ten of the 13. Either staphylococcal (six cases) or Gram-negative enteric organisms (four cases) were isolated in cultures obtained by tympanocentesis in these cases. The four cases of Gram-negative infections occurred in infants within six weeks of birth. Nasotracheal intubation for more than seven days was significantly correlated with impaired tympanic membrane mobility compatible with otitis media. Otitis media occurs frequently among premature infants who are hospitalized in an NICU, and it should be looked for in any infant in whom sepsis is clinically suspected.

Cross Infection↗
PubMed1976

[The patient as a source of bacteria in intensive care units: influence of antibiotics and tracheal intubation (author's transl)].

133 patients in an intensive care unit, who prior to admission had not shown any signs of bacterial infection and had not received antibiotic treatment, were assigned to two groups at random. One group received antibiotic prophylaxis with penicillins or cephalosporins (+Pat.), the other group did not receive antibiotics (-Pat.). Staph. aureus was the most frequent facultative pathogen in tracheal secretions and in the environment of "-Pat.". This organism was significantly more frequent in "-Pat." than in "+Pat." in both the tracheal secretions and the environment. Klebsiella spp. outnumbered all other species in "+Pat.". They were significantly more frequent in tracheal secretions of "+Pat." than of "-Pat.". In the first week of hospitalisation marked changes were seen in bacterial flora of tracheal secretions of "+Pat.". Colonization with grammnegative bacteria rose to nearly 100%, the frequency of Staph. aureus diminishing at the same time. Monitoring by contact cultures revealed that gramnegative rods were significantly more numerous in the environment of "+Pat." than of "-Pat.". Matching bacterial strains cultured from tracheal secretions and from the environment of the patients proved that "+Pat. spread significantly higher numbers of their gramnegative bacteria into the environment. The same is true of "-Pat." for Staph. aureus. Intubation had no noticeable effect on the degree of contamination of the surroundings with Staph. aureus. Gramnegative rods were significantly more frequent in tracheal secretions of patients with intubation than in patients without. The same trend was observed for environmental contamination. As the clinical results of this study have shown, antibiotic prophylaxis does not protect patients from infections to the extent expected. Patients, and particularly intubated patients, receiving antibiotic treatment have to be considered as sources of highly resistant gramnegative organisms.

Anti-Bacterial Agents↗