scholarly journals Does Gender Impact Intensity of Care Provided to Older Medical Intensive Care Unit Patients?

2010 ◽  
Vol 2010 ◽  
pp. 1-8
Author(s):  
Kathleen M. Akgün ◽  
Terrence E. Murphy ◽  
Katy L. B. Araujo ◽  
Peter H. Van Ness ◽  
Margaret Pisani
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Medical Intensive Care Unit ◽  
Demographic Data ◽  
University Teaching ◽  
Explanatory Variables ◽  
Health Differences ◽  
Medical Intensive Care ◽  
Gender Based

Introduction. Women receive less aggressive critical care than men based on prior studies. No documented studies evaluate whether men and women are treated equally in the medical intensive care unit (MICU). The Therapeutic Intervention Scoring System-28 (TISS-28) has been used to examine gender differences in mixed ICU studies. However, it has not been used to evaluate equivalence of care in older MICU patients. We hypothesize that given nonsignificant, baseline health differences between genders at MICU admission, the level of care provided would be equivalent.Methods. Prospective cohort of 309 patients≥60 years old in the MICU of an urban university teaching hospital. Explanatory variables were demographic data and baseline measures. Primary outcomes were TISS-28 scores and MICU interventions. We compare TISS-28 scores by gender using a statistical test of equivalence.Results. Women were older and had more chronic respiratory failure at MICU admission. Using equivalence limits of±15% on gender-based scores of TISS-28, MICU interventions were equivalent. Supplementary analysis showed no statistically significant association between gender and mortality.Conclusions. In contrast with other reports from the cardiac critical care literature, as measured by the TISS-28, gender-based care delivered to older MICU patients in this cohort was equivalent.

Moral Distress of Staff Nurses in a Medical Intensive Care Unit

2005 ◽  
Vol 14 (6) ◽  
pp. 523-530 ◽  
Author(s):  
Ellen H. Elpern ◽  
Barbara Covert ◽  
Ruth Kleinpell
Keyword(s):  
Job Satisfaction ◽  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Moral Distress ◽  
Medical Intensive Care Unit ◽  
Well Being ◽  
Individual Characteristics ◽  
Medical Intensive Care ◽  
Distress Scale

• Background Moral distress is caused by situations in which the ethically appropriate course of action is known but cannot be taken. Moral distress is thought to be a serious problem among nurses, particularly those who practice in critical care. It has been associated with job dissatisfaction and loss of nurses from the workplace and the profession.• Objectives To assess the level of moral distress of nurses in a medical intensive care unit, identify situations that result in high levels of moral distress, explore implications of moral distress, and evaluate associations among moral distress and individual characteristics of nurses.• Methods A descriptive, questionnaire study was used. A total of 28 nurses working in a medical intensive care unit anonymously completed a 38-item moral distress scale and described implications of experiences of moral distress.• Results Nurses reported a moderate level of moral distress overall. Highest levels of distress were associated with the provision of aggressive care to patients not expected to benefit from that care. Moral distress was significantly correlated with years of nursing experience. Nurses reported that moral distress adversely affected job satisfaction, retention, psychological and physical well-being, self-image, and spirituality. Experience of moral distress also influenced attitudes toward advance directives and participation in blood donation and organ donation.• Conclusions Critical care nurses commonly encounter situations that are associated with high levels of moral distress. Experiences of moral distress have implications that extend well beyond job satisfaction and retention. Strategies to mitigate moral distress should be developed and tested.

Noncardiovascular Disease and Critical Care Delivery in a Contemporary Cardiac and Medical Intensive Care Unit

2017 ◽  
Vol 34 (7) ◽  
pp. 537-543 ◽  
Author(s):  
Michael Goldfarb ◽  
Sean van Diepen ◽  
Mark Liszkowski ◽  
Jacob C. Jentzer ◽  
Isabel Pedraza ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Medical Intensive Care Unit ◽  
Care Delivery ◽  
Medical Intensive Care

Evaluation and revision of a vasopressin/nitroglycerin protocol for use in variceal bleeding

1993 ◽  
Vol 2 (3) ◽  
pp. 202-207 ◽  
Author(s):  
SM Burns ◽  
M Martin ◽  
P Merrill ◽  
J Luer ◽  
DD Stone
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Esophageal Varices ◽  
Variceal Bleeding ◽  
Medical Intensive Care Unit ◽  
Portal Pressure ◽  
Cardiovascular Effects ◽  
University Teaching ◽  
Beneficial Effects ◽  
Medical Intensive Care

BACKGROUND: Continuous infusion of IV vasopressin have been widely used to lower portal pressure and reduce bleeding from esophageal varices. Recently, the combination of vasopressin and nitroglycerin has been noted to be superior to vasopressin alone. This is due to the ability of nitroglycerin to reduce the detrimental effects of vasopressin while preserving its beneficial effects. In September 1989 the authors initiated a protocol in the medical intensive care unit of a large university teaching center that directed caregivers in the simultaneous use of vasopressin and nitroglycerin for use in variceal bleeding. OBJECTIVE: To determine whether the protocol was being used correctly and whether the addition of nitroglycerin produced the desired cardiovascular effects. METHOD: Nineteen patients (25 separate episodes) assigned to the vasopressin/nitroglycerin protocol were monitored retrospectively over a 20-month period for a total of 1068 hours of vasopressin/nitroglycerin infusion. Twenty-four patients received nitroglycerin at 10 to 50 micrograms per minute, 13 at 50 to 100 micrograms per minute and 6 at 100 to 400 micrograms per minute. RESULTS: Nitroglycerin dosage was not advanced appropriately in 78% of episodes despite evidence of bradycardia, hypertension and peripheral vasoconstriction. CONCLUSIONS: Revision of the protocol, giving additional guidance to clinicians on assessment and nitroglycerin advancement, was necessary and was accomplished.

Liaison Psychiatry: A Role on the Medical Intensive Care Unit

1982 ◽  
Vol 11 (4) ◽  
pp. 379-386 ◽  
Author(s):  
Nathan Billig
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Care Setting ◽  
Medical Intensive Care Unit ◽  
Holistic Approach ◽  
Separate Entity ◽  
Liaison Psychiatry ◽  
Case Conferences ◽  
Medical Intensive Care

A psychiatric liaison program on a medical intensive care unit is described. The principle elements of the program include the psychiatrist becoming a member of the MICU “team” via: 1) attendance at morning medical rounds; 2) conducting case conferences; 3) availability to the nursing staff as a separate entity; 4) consulting with the unit directors; and 5) supervising a resident in psychiatry in his consultative work on the unit. The liaison psychiatrist's presence on the team facilitates an holistic approach to the patient and deals with intra-staff and patient-staff reactions in the critical care setting.

scholarly journals Study of resistance pattern of isolated micro-organisms towards commonly used anti-microbial agents in medical intensive care unit of a tertiary care teaching hospital

2019 ◽  
Vol 9 (1) ◽  
pp. 158
Author(s):  
Mansij Biswas ◽  
Nirmala N. Rege ◽  
Niteen D. Karnik ◽  
Gita Nataraj
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Medical Intensive Care Unit ◽  
Demographic Data ◽  
Tertiary Care ◽  
Polymyxin B ◽  
Resistance Pattern ◽  
Different Types ◽  
Medical Intensive Care ◽  
Microbial Agents

Background: The objective of the study was to find out different types of biological samples from admitted patients tested for culture and sensitivity (C&S), prevalence of different types of organisms isolated from those samples, and to analyze the resistance pattern of those isolated organisms against commonly used or tested anti-microbial agents (AMAs).Methods: Following institutional ethics committee approval and written informed consent, adult patients of both genders, receiving AMAs were enrolled from June 2014 to July 2015 and followed up daily till they were in medical intensive care unit (MICU). Demographic data, diagnosis, culture-sensitivity (antibiogram) and other investigation reports and treatment details were recorded. Descriptive statistical analysis of collected data was done.Results: Of the 514 samples (from 600 patients enrolled) sent for C&S testing, 143 were reported as sterile while from the rest 371 samples, 504 organisms were isolated; commonly isolated organisms were Pseudomonas aeruginosa (30%), Acinetobacter baumannii (23%), Klebsiella pneumoniae (16%), Providencia sp. (7.1%), Escherichia coli (5.7%), and Enterobacter sp. (4.2%). Samples were sent in 63% of enrolled patients, the commonest being broncho-alveolar lavage (48% of total). Microbial resistance was high for cephalosporins (ceftriaxone, cefepime, ceftazidime), carbapenems (meropenem, imipenem), penicillins (piperacillin), quinolones (ciprofloxacin, levofloxacin), aminoglycosides (gentamicin, netilmicin, amikacin) and cotrimoxazole. Most organisms were sensitive to colistin (100%), polymyxin B (92%) and tigecycline (69%).Conclusions: The information regarding commonly isolated organisms and their resistant pattern would aid in rational selection of AMAs and thus the present study is useful to clinicians managing MICU and the hospital infection committee to plan future policies regarding AMA use in MICU.

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