Articles: patients.
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Hemodynamic monitoring gives early warning of changes in a critically ill patient's condition. Accuracy is essential; for example, a blood pressure cuff is inaccurate at low pressures. Hospitalized adults will usually have a higher central venous pressure, so a CVP less than 4 cm H(2)O may indicate hypovolemia. ⋯ Measurement of cardiac output eliminates the need for arterial and mixed venous blood samples, and can be valuable in decision-making. Calculation of vascular resistance can also be very important in management of the critically ill. With today's facilities, routine clinical assessment is no longer adequate care for these patients.
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Clinical pediatrics · Sep 1982
Interaction of health-care professionals with critically ill children and their parents.
The stress imposed on the emotional equilibrium of a team of health-care professionals by the serious illness of a child can disrupt communication among the team, the child, and the parents. Such stresses may be so severe as to interfere with the ability to the adults to meet the child's needs. Although the feelings and attitudes of critically ill children and their parents are well described in the medical literature, very little has been written about the psychosocial interaction among those responsible for the patient's care. ⋯ The purpose of this article is to review available information, as well as experience at St. Jude Children's Research Hospital, on the psychosocial interaction of the health-care team with critically ill children and their parents. An awareness of the difficulties of caring for such patients is essential in overcoming communication barriers, in reducing any interprofessional tensions that might arise during treatment, and in ensuring high-quality medical care.
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The patients of a community health centre who visited a hospital emergency department were compared with a random sample of the patients who visited the health centre during the same four months. Visiting rate to the emergency department was higher for teenagers and patients over 60. Emergency department visitors were more frequent users of health care, both at the health centre and in the emergency department. No differences were found between the two groups concerning sex, length of time as a patient, continuity of care, and distance of home from hospital or health centre.
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The question of suffering and its relation to organic illness has rarely been addressed in the medical literature. This article offers a description of the nature and causes of suffering in patients undergoing medical treatment. A distinction based on clinical observations is made between suffering and physical distress. ⋯ Suffering can include physical pain but is by no means limited to it. The relief of suffering and the cure of disease must be seen as twin obligations of a medical profession that is truly dedicated to the care of the sick. Physicians' failure to understand the nature of suffering can result in medical intervention that (though technically adequate) not only fails to relieve suffering but becomes a source of suffering itself.
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A study was conducted under the sponsorship of the Emergency Medical Services (EMS) Committee of the American College of Emergency Physicians (ACEP) that was intended to examine prospectively patients' and physicians' perceptions of the urgency of need for medical attention. Patients presenting to the emergency departments of 24 hospitals between February 25, 1980 and March 3, 1980, were surveyed. The hospitals represented a range of geographic areas and bed capacities. ⋯ Physicians concurred that 70% of these patients needed care within 13 hr. Twelve percent of patients rated the urgency of their condition lower than did the physicians, and 25% of patients that the physicians rated as needing immediate attention did not recognize the need for urgent care and thought they could wait from 1 hr to days. This study indicates that patients presenting to the emergency department need care more urgently than was previously supposed.