Background The Finnish Intensive Care Consortium coordinates selleck a national intensive care benchmarking programme. Clinical information systems selleck inhibitor (CISs) that collect data automatically are widely used. The aim of this study was to explore whether the severity of illness-adjusted hospital Inhibitors,Modulators,Libraries mortality of Finnish intensive care unit (ICU) patients has changed in recent years and whether the changes reflect genuine improvements in the quality of care or are explained by changes in measuring severity of illness. Methods We retrospectively analysed data collected prospectively to the database of the Consortium. During the years 20012008, there were 116,065 admissions to the participating ICUs. We excluded readmissions, cardiac surgery patients, patients under 18 years of age and those discharged from an ICU to another hospital’s ICU.
The study population comprised 85,547 patients. The Simplified Acute Physiology Score II (SAPS II) was used to measure severity of illness and to calculate standardised mortality ratios Inhibitors,Modulators,Libraries (SMRs, the number of observed deaths divided Inhibitors,Modulators,Libraries by the number of expected deaths). Results The overall hospital mortality rate was 18.4%. The SAPS II-based SMRs were 0.74 in 20012004 and 0.64 in 20052008. Inhibitors,Modulators,Libraries The severity of illness-adjusted odds of death were 24% lower in 20052008 than in 20012004. One fifth of this computational difference could be explained by differences in data completeness and the automation of data collection with a CIS.
Conclusion The use of a CIS and improving Inhibitors,Modulators,Libraries data completeness do decrease severity-adjusted mortality Inhibitors,Modulators,Libraries rates.
However, this explains only one fifth of the improvement in measured outcomes of intensive care in Finland.
Background Widespread use of patient-controlled sedation (PCS) demands simplicity and a predictable outcome. We evaluated Inhibitors,Modulators,Libraries patients safety and ease of use Inhibitors,Modulators,Libraries of PCS for gynaecological outpatient procedures. Methods In a prospective double-blind study, 165 patients were randomized to use propofol or propofol with alfentanil as PCS combined with local anaesthetic for pain control. Data on cardiopulmonary function, consciousness, and need for interventions were collected at baseline and every fifth minute. The surgeons evaluation of the ease and the duration of the procedure were recorded.
Results One hundred and fifty-five patients used PCS for the entire procedure, 76 patients propofol, Inhibitors,Modulators,Libraries and 79 patients propofol/alfentanil.
Fifteen procedures in the propofol group were limited or could not be done, compared with four in the propofol/alfentanil Inhibitors,Modulators,Libraries selleckchem group (P?=?0.02). The duration of surgery was not affected. The addition of alfentanil affected respiratory function compared with the propofol group: five patients compared original site with none were manually ventilated (P?=?0.03), and two thirds, compared with a quarter, were given supplementary oxygen as their saturation decreased below 90% (P?<?0.001). Overall cardiovascular stability was maintained.
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