Severity of illness

An ongoing assessment is one that is made at the time of each patient contact and may include the collection of objective data, subjective data, or both. The scope of an ongoing assessment depends on many factors, such as the patient s diagnosis, the severity of illness, the response to treatment, and the prescribed medical or surgical treatment. 

In the clinical setting, zanamivir 12 and oseltamivir 19 are effective in both the prevention and treatment of influenza A and B infection. Benefit in treatment is restricted to patients treated within 48 h of symptom onset (Fleming 2003). Importantly, the effects of drug treatment are a rednction in the severity of illness, and in the incidence of secondary complications. The term of illness is generally rednced between 1 and 2.5 days. The evalnation of zanamivir (Calfee and Hayden 1998 Oxford 2000 Fleming 2003), oseltamivir (Doncette and Aoki 2001 Oxford 2005) and peramivir (Sidwell and Smee 2002) for the treatment, and prophylaxis, of inflnenza virus infection has been reviewed. The reader is directed to these reviews for further details of drug pharmacodynamics and clinical trial data. 

Brain-injured patients commonly experience fever, and hyperthermia may correlate with poor outcome in these patients, although a direct causative link has yet to be established. The impact of fever on patients in a neurocritical care unit has been evaluated, and after controlling for severity of illness, diagnosis, age, and complications, increased body temperature was found to strongly associate with an increased length of ICU and hospital stay, as well as higher mortality and... 

Upon stabilization, placement of a pulmonary artery (PA) catheter may be indicated based on the need for more extensive cardiovascular monitoring than is available from non-invasive measurements such as vital signs, cardiac rhythm, and urine output.9,10 Key measured parameters that can be obtained from a PA catheter are the pulmonary artery occlusion pressure, which is a measure of preload, and CO. From these values and simultaneous measurement of HR and blood pressure (BP), one can calculate the left ventricular SV and SVR.10 Placement of a PA catheter should be reserved for patients at high risk of death due to the severity of shock or preexisting medical conditions such as heart failure.11 Use of PA catheters in broad populations of critically ill patients is somewhat controversial because clinical trials have not shown consistent benefits with their use.12-14 However, critically ill patients with a high severity of illness may have improved outcomes from PA catheter placement. It is not clear why this was... 

The success of therapy is measured by the degree to which the care plan decreases the pretreatment deterioration rate, preserves the patients functioning, and treats psychiatric and behavioral symptoms. The primary outcome measure is thus subjective information from the patient and the caregiver, although the MMSE can be a helpful tool for monitoring changes in the severity of illness. There are no physical examination or laboratory parameters that are used to evaluate the success of therapy. 

Select empirical antimicrobial therapy based on spectrum-of-activity considerations that provide a measured response proportional to the severity of illness. Provide a rationale for why a measured response in antimicrobial selection is appropriate. 

Clinical manifestations and severity of illness (to assess the need for IV versus oral therapy)... 

EN should not be used or should be used with extreme caution in certain conditions (Table 98-3). It is possible to use EN in some patients with these conditions depending on severity of illness, location of the abnormality and experience of the practitioners delivering care. Controversy surrounds some of these contraindications and precautions. For example, whereas some clinicians will deliberately avoid enteral feedings in the hemo-dynamically unstable patient for fear of worsening intestinal... 

There are various severity of illness scoring systems for sepsis and trauma (R11). Severity scoring can be used, in conjunction with other risk factors, to anticipate and evaluate outcomes, such as hospital mortality rate. The most widely used system is the Acute Physiology, Age, Chronic Health Evaluation II (APACHE II) classification system (K12). The APACHE III was developed to more accurately predict hospital mortality for critically ill hospitalized adults (K13). It provides objective probability estimates for critically ill hospitalized patients treated in intensive care units (ICUs). For critically ill posttrauma patients with sepsis or SIRS, another system for physiologic quantitative classification and severity stratification of the host defense response was described recently (R11). However, this Physiologic State Severity Classification (PSSC) has yet not been applied routinely in ICU setting. 

L7. Leithauser, B., Matthias, F. R Nicolai, U., and Voss, R., Hemostatic abnormalities and the severity of illness in patients at the onset of clinically defined sepsis. Intensive Care Med. 22, 631-636(1996). 

P12. Pittet, J.-F., Morel, D. R., Hemsen, A., Gunning, K., Lacroix, J.-S., Suter, P. M., and Lundberg, J. M., Elevated plasma endothelin-1 concentrations are associated with the severity of illness in patients with sepsis. Ann. Surg. 213,261-264 (1991). 

Complicated coli Proteus mirabiiis Klebisella pneumoniae Pseudomonas aeruginosa Enterococcus faecalis 1. Quinolone x 14 days (B, III)0 2. Extended-spectrum penicillin plus aminoglycoside (B, III)0 Severity of illness will determine duration of IV therapy culture results should direct therapy Oral therapy may complete 14 days of therapy... 

Renal replacement therapy (RRT), such as hemodialysis and peritoneal dialysis, maintains fluid and electrolyte balance while removing waste products. See Table 75-4 for indications for RRT in ARF. Intermittent and continuous options have different advantages (and disadvantages) but, after correcting for severity of illness, have similar outcomes. Consequently, hybrid approaches (e.g., sustained low-efficiency dialysis and extended daily dialysis) are being developed to provide the advantages of both. 

If the vaccine is given within 4 days after exposure to smallpox, it can lessen the severity of illness or even prevent it. 

Severity of illness. Considering your total clinical experience with this particular population, how mentally ill [the investigator may substitute a more appropriate term if this is not apphcable] is the patient at this time ... 

Severity of illness is the only one of these three rated pretreatment. All three questions may be rated posttreatment, and additional ratings are possible during a clinical trial. The CGI measure, which is widely used in all types of medicine trials, is generally well accepted. 

Conners Teacher Questionnaire. The TQ form was designed to obtain teacher evaluations of children up to age 15 in terms of their interactions with peers and their ability to cope with the school environment and requirements. There are 41 items, and the first 39 have a four-point scale. Question 40 deals with the teacher s evaluation of the child s severity of illness, and question 41 deals with global improvement in four different areas. This test is used once at pretreatment and as needed afterwards. It takes about 15 minutes to complete and covers either the present or any interval period up to one month. A shorter 11-item PTQ is often used after the initial use of the 41-item TQ. The five subscales included are conduct, inattentive-passive, tension-anxiety, hyperactivity, and social ability. 

Severity of Illness. J. M. Roberts (1959] originally reported that higher symptom scores at baseline predicted better ECT response. In contrast, Andrade et al. (1988] and Sackeim et al. (1987a] found no differences between responders and nonresponders in initial severity, while others reported that ECT nonresponders had greater initial severity of depression (Kindler et al. 1991 Pande et al. 1988]. Thus, there is no consensus on how symptom severity, independent of the presence of psychosis or melancholia, is predictive of ECT response. 

The illness variables that were predictive of poor outcome all reflected severity of illness. They included more severe panic and agoraphobic symptoms, psychiatric hospitalization, and longer duration of illness. The best prognostic indicators were the severity of the illness and its duration at the time of first assessment. Comorbid depression was also associated with poorer outcome. A number of environmental variables were also predictive of poor outcome separation from a parent by death or divorce, high interpersonal sensitivity, low social class, and unmarried marital status. 

B. Indications and use Xigrix is indicated for the reduction of mortahty in adult patients with severe sepsis (sepsis associated with acute organ dysfunction) who have a high risk of death [as determined by the acute physiology and chronic health evaluation (APACHE) score, the most widely used method of assessing the severity of illness in acutely ill patients in intensive care units]. 

FIG. 5-4. Severity of illness over time in patients treated with phenothiazines. (From Cole JO, Davis JM. Antipsychotic drugs. In Beliak L, Loeb L, eds. schizophrenic syndrome. New York Grune Stratton, 1969 478-568, with permission.)... 

Using meta-analytic techniques based on the means and the standard errors presented graphically in the poster, we estimated pooled data of the four effective dosages of quetiapine both for the BPRS and the CGI severity of illness change scores from baseline to endpoint. Quetiapine produced an improvement of 0.43 effect-size units in comparison with placebo, a difference that was highly statistically significant and about the same improvement as haloperidol. Thus, based on the BPRS or PANSS, quetiapine was similar to neuroleptics in efficacy (i.e., differences were nonsignificant). Based on our meta-analysis, quetiapine is clearly superior to... 

Informed consent must be obtained before the administration of ECT. Often, the same severity of illness that necessitates the use of ECT also impairs a patient s capacity to consent. When the patient is unable to give adequate informed consent, the clinician and the patient s family can attempt to obtain partial conservatorship from the court allowing a family member to give substituted permission (see also Chapter 2, Informed Consent ). 

It is important to minimize or control for the impact of confounding variables in any study. In order to do so, it is imperative that all possible variables that may have an effect on the primary outcome be identified. These usually include demographic variables such as age, sex, income level, education level, and ethnicity. Health-related variables such as comorbidities and severity of illness should also be recorded. Variables also may be identified that cannot be measured. These may include outside education, changes in family structure or support system, and drastic changes in health status not related to the pertinent disease state. 

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