Dissertations / Theses on the topic 'ICUC Score'

This note proposes the continuous treatment approach as a valuable alternative to propensity score matching for evaluating economic effects of merger and acquisitions (M&As). This framework allows considering the variation in treatment intensities explicitly, and it does not call for an arbitrary definition of cutoff values in traded ownership shares to construct a binary treatment indicator. We demonstrate the usefulness of this approach using data from European M&As and by relying on the example of post-M&A employment effects. The empirical exercise reveals some heterogeneities over the whole distribution of acquired ownership shares and across different types of M&As and country groups.

Les infections nosocomiales demeurent un véritable défi de santé publique en dépit des progrès techniques considérables enregistrés. Inhérentes à la prise en charge de soins, se sont les services de réanimation qui comptabilisent les plus fort taux de prévalence. En effet, quelle que soit leur orientation (chirurgicale, médicale ou mixte), ces services, ont pour mission la prise en charge des patients dont le processus vital est menacé par la survenue brutale d’une ou de plusieurs défaillances organiques nécessitant un arsenal diagnostic et/ou thérapeutique souvent invasif.Parmi les conséquences induites par ces infections ; i) l’allongement de la durée de séjour, ii) le surcoût, iii) une augmentation de la mortalité, et iv) la résistance bactérienne.Pouvoir anticiper en amont et en aval cette problématique aux motifs complexes et aux conséquences parfois fatales serait un atout majeur au profit des patients et un outil stratégique pour les équipes soignantes.Organisée autour de trois étapes charnières, la présente étude s’est d’abord attelée à la phasede l’identification des facteurs de risque de l’évènement nosocomial et de mortalité au service de réanimation ou s’est passé l’étude –prise en compte du case-mix du service de réanimation CHU la TIMONE-. Réalisée grâce à deux méthodes statistiques différentes à savoir la régression logistique et la méthode des risques compétitifs. L’étape suivante a consisté dans un premier temps à comparer les capacités prédictives des scores APACHE II, LOD, SOFA et SAPS II chez ces patients -hospitalisés en réanimation-ayant développé un épisode nosocomial. Dans un second temps de déterminer si la variation des scores LOD, SOFA, APACHEII et SAPS II est un facteur pronostique du risque nosocomial. Les résultats obtenus révèlent que la meilleure performance prédictive est objectivée au profit du SOFA et que seule la variation de ce même score entre le premier jour d’hospitalisation et celui du diagnostic de l’infection nosocomiale mesurée grâce à l’AUC est prédictive du risque nosocomial.À l’issue de ces étapes et au moyen des résultats obtenus une construction d’un score prédictif est réalisée grâce à la méthode de régression logistique. L’objectif de ce score est d’éclairer voire d’influencer le prescripteur lors de ses prises de décisions ou d’éventuelle démarche d’ajustement de ses conduites thérapeutiques<br>Limiting nosocomial infections is still a health challenge although the technical development has improved. They are inherent in medical care and the health care services have the highest prevalence. Indeed, whatever the service (surgical, medical or both), the patients life-giving process is under attack because of the emergence of one or several organ faillures;This generates a diagnostic and therapeutic arsenal which is often invasive.Among the consequences resulting from these infections we will take into account :i) a longer stay in hospitalii) an extra costiii) a higher mortality rateiv) bacterial resistance .If we could anticipate upstream and downstream this issue with complex origins and sometimes fatal consequences, it would be a major asset for patients and a strategic tool for medical teams.The present study is organized in three parts, and first focusses onto the identification of the nosocomial event and death risk factors in intensive care where the study took place. We took into account the the case-mix of the intensive care unit in the TIMONE University Hospital. The study was made with two different statistic methods that is logistic regression and the competitive risks method.The next step first consisted in comparing the predictive capacities of the APACHE II, LOD, SOFA and SAPS II scores in nosocomial patients hospitalized in intensive care . Then it tried to determine if the variation of the LOD, SOFA, APACHEII and SAPS II scores was a prognostic risk factor.Results showed that the best predictive performance was objectively measured by the SOFA and that only the variation of this score between the first day in hospital and the day of the diagnosis of a nosocomial infection, calculated thanks to the AUC, could be predictive of a nosocomal risk. After these steps, and with the results calculated , the construction of a predictive score could be established thanks to the logistic regression method. The objective of this score is to help, or even influence the prescribing doctors when they take decisions or when they try to adjust their therapeutic practices

Queijo, AF. Tradução para o português e validação de um instrumento de medida de carga de trabalho de enfermagem em unidade de terapia intensiva: NURSING ACTIVITIES SCORE (N. A. S.). [Dissertação]. São Paulo (SP): Escola de Enfermagem da USP; 2002. O presente estudo teve como objetivos traduzir para o português e avaliar as propriedades de medida do Nursing Activities Score (NAS). A finalidade deste instrumento é medir carga de trabalho de enfermagem em UTI. O estudo foi subdividido em duas partes. A primeira composta da tradução do NAS para a língua portuguesa e a segunda, da análise da confiabilidade e validade do instrumento. Após o processo de tradução para a língua portuguesa, foi realizada sua aplicação em uma amostra de 200 pacientes adultos internados em UTIs. A avaliação da confiabilidade do instrumento, feita por meio da repetibilidade entre dois observadores, demonstrou alta concordância (99,8%) e índice Kappa médio de 0,99. Já a análise da consistência interna, verificada pelo coeficiente Alpha de Cronbach revelou que o NAS possui 23 medidas independentes que não comportam consolidação ou redução. O NAS também foi aplicado para as validades de critério (concorrente) e de constructo (convergente). A validade concorrente mostrou correlação estatisticamente significativa entre o TISS-28 e o NAS (r=0,67; p<0,0001), o mesmo ocorrendo quando se utilizou a análise de regressão (R2=94,4%; p<0,0001) Quanto a validade convergente, pela técnica da análise de regressão verificou-se associação estatisticamente significativa entre o NAS e o índice de gravidade SAPS II, quando ao modelo foi inserida a variável idade. (R2=99,8%; p<0,0001). Pelos resultados obtidos, o NAS mostrou-se um instrumento confiável e válido para mensurar carga de trabalho de enfermagem em UTI, na realidade brasileira.<br>Queijo, AF. Translation to portuguese and validation of a instrument to measure work load of nursing in the intensive care unit (ICU): NURSING ACTIVITIES SCORE (N.A.S.). [Dissertação]. São Paulo (SP): Escola de Enfermagem da USP; 2002. The present study aimed to translate into Portuguese and to evaluate the properties of measure of the Nursing Activities Score (NAS). The purpose of this instrument is to measure work load of nursing in the intensive care unit (ICU). The study was subdivided in two parts. The first composed of translation and cross-cultural adaptation; and second, in the analysis of the reliability and the validity of the instrument. After the process of translation into Portuguese language and cross-cultural adaptation, was carried through its application in 200 adult inpatients in ICUs, in order to get the measure of reliability. At once, this was obtained by the repeatable between two observers by the statistical test of Kappa that demonstrated one high concord (99,8%) and average Kappa of 0,99. At once, the analysis of the internal consistency verified for the Cronbach´s alpha coefficient disclosed that it possess 23 independent measures that do not hold consolidation or reduction. The NAS was also applied for the validities of criterion (competing) and constructo (convergent). The competing validity showed statisticaly significant correlatio between the TISS-28 and NAS (r=0,67; p<0,001), the same occurring when the analysis of regression was used (r2=94,4%; p<0,001). About the convergent validity, by the technique of the regression analysis, it was verified signicant association statisticaly between NAS and the index of gravity SAPS II, when was inserted to the model the changeable age (r2=99,8%, p<0,001). For the gotten results, in the Brazilian reality, the NAS revealed a trustworthy and valid instrument to measure work load of nursing in ICU.

Recent advancements in Artificial Intelligence has prompted a shearexplosion of new research initiatives and applications, improving notonly existing technologies, but also opening up opportunities for newand exiting applications. This thesis explores the MIMIC-III intensive care unit database and conducts experiment on an interpretable feature space based on sever-ty scores, defining a patient health state, commonly used to predict mortality in an ICU setting. Patient health state trajectories are clustered and correlated with administered medication and performed procedures to get a better understanding of the potential usefulness in evaluating treatments on their effect on said health state, where commonalities and deviations in treatment can be understood. Furthermore, medication and procedure classification is carried out to explore their predictability using the severity subscore feature space.

Dissertação de Mestrado Integrado em Medicina Veterinária<br>Os cuidados de saúde prestados tanto em Medicina Humana como em Veterinária estão em constante evolução e modernização e, como tal, um bom clínico deve estar em aprendizagem contínua de modo a poder praticar a sua profissão da melhor maneira possível elevando ao máximo a qualidade de serviço prestado ao seu cliente e respectivo proprietário. A Medicina Intensiva, representa uma área dedicada à monitorização constante de pacientes em condições não fisiológicas reversíveis que ameaçam uma ou mais funções vitais e que, por tal, necessitam de acompanhamento médico intensivo. A prestação de cuidados intensivos é geralmente realizada numa área específica dos establecimentos hospitalares denominada Unidade de Cuidados Intensivos (UCI). Estas, deverão estar equipadas com uma vasta gama de equipamentos e materiais que tornem as tarefas de monotorização e intervenções terapêuticas o mais rápidas e eficazes possíveis com o mínimo de manipulação animal. O staff da UCI, tanto médicos veterinários como enfermeiros e auxiliares, deve estar devidamente treinado e qualificado, inclusivé acreditado, para trabalhar nesta secção do hospital. São inúmeras as doenças que beneficiam com uma estadia numa UCI nomeadamente aquelas que afectam os sistemas cardiovascular, respiratório, neurológico, gástrico, renal e hematológico. Um sistema de triagem funcional é essencial no diagnóstico precoce e respectivo internamento nas UCIs. Sistemas de scores humanos adaptados à Medicina Veterinária poderão ser implementados de modo a estimar a evolução terapêutica, tempo de recuperação e prognóstico dos pacientes críticos internados. De referir que as UCIs deverão ser destinadas a pacientes com condições reversíveis e nunca como unidades de tratamento paliativo ou geriátrico. Em Portugal, esta área da Medicina Veterinária surgiu muito recentemente e, apesar de já existirem algumas unidades espalhadas pelo país, muitas delas encontram-se incompletas em termos de equipamentos e materiais e carecem de qualificação do staff que nela trabalha. Os custos fixos e variáveis inerentes à sua implementação inicial e funcionamento regular são elevados mas devem ser encarados como necessários em ambiente hospitalar.<br>ABSTRACT - The importance of implementing an Intensive Care Unit in a hospital ambit - In Veterinary Medicine, just like in Human Medicine, the level of health care is in constant evolution and development which makes it important for the veterinary practitioner to accompany this modernization process in order to maximize the quality of his or her craft regarding the patient and its owner. Intensive Care Medicine is one of the many branches of Veterinary Medicine dedicated to the continuous monitoring and treatment of patients with reversible non physiological conditions that threaten one or more vital parameters and that require round the clock care. The practicing of Intensive Care Medicine is done in a specific area of a hospital called the Intensive Care Unit (ICU). These units should be equipped with a great variety of equipment and materials that allow fast and effective monitoring and therapeutic interventions with minimal animal handling in order to minimize patient stress and prognosis aggravation. The staff working in these ICUs should ideally be board certified physicians or at least have some proper training and experience in the field. A great number of medical conditions benefit greatly from a short term admission and stay in the ICU, especially those involving the cardiovascular, respiratory, gastrointestinal, renal, neurological and hematological systems. An effective triage system is a key factor in the early diagnoses and treatment process of critically ill patients. Human scoring systems, adapted to Veterinary Medicine, can be implemented in order to predict therapeutic evolution, recovery time and prognosis of critical patients. ICUs should not be used for terminal, palliative or geriatric care. In Portugal, this branch of Veterinary Medicine is only now, very recently, been tapped in to. A few hospital units have begun to offer this type of service, however, their facilities lack in equipment and staff qualification and knowledge. The costs involving the initial equipping of the ICUs are high as well as the monthly expenses concerning the staffing of the unit itself and materials consumed but should be looked upon as an important mean to optimize patient care.

Includes bibliographical references.<br>The United Nations was established to promote international peace and security and has become the world's most important peacekeeper and safeguard of human rights.1 Due to the increasing number of attacks against those who keep the peace in practice, the international community felt the urgent need for a better protection for its peacekeeping personnel.2 Therefore, attacks against peacekeepers have been incorporated in Article 8(2)(b)(iii) and (e)(iii) of the Statute of the International Criminal Court (ICC-Statute) as well as later in Article 4(b) of the Statute of the Special Court for Sierra Leone (SCSL-Statute). The incorporation of attacks against peacekeepers in the ICC-Statute was not the only novelty. It is the first international criminal code that provides a general part which explicitly includes the principle of legality (Articles 22- 24 ICC-Statute) and its component of specificity (nullum crime sine lege scripta) (Article 22(2) ICC-Statute). It is the aim of this paper to examine whether the war crimes of intentionally directed attacks against peacekeepers, in its current version, meets the requirement of specificity. This paper will argue that the notion of the principle of legality (nullum crime sine lege) in the ICC-Statute witnesses a development from a loose to a strict application of this principle, and its components. Due to the limitation of this paper, the discussion will focus on the most controversial elements of crime, namely "attack", "peacekeeping mission in accordance with the U.N. Charter" and "as long as they are entitled to the protection afforded to civilians under IHL." I will argue that the elements "attack" and "as long as they are entitled to the protection afforded to civilians under IHL" cannot be clearly defined and that their scope is controversy, which makes it impossible for the subject of law to determine whether certain behaviour has a criminal conduct. This paper will conclude that the current versions of Article 8(2)(b)(iii), (e)(iii) and Article 4(b) SCSL-Statute are consequently violating the principle of specificity, which makes them void. The conclusion will offer a possible lawful version.

碩士<br>國立清華大學<br>高階經營管理碩士在職專班<br>102<br>ABSTRACT APACHE Ⅱ score has been used as a tool for evaluation of severity of illness for ICU patients for three decades. It is also used for predicting the mortality rate for ICU patients. Different scoring system were developed over the years, however APACHE Ⅱwas the most popular one been used among all. APACHE Ⅱ was developed by Knaus et al in 1985. The scoring system is primarily based on acute physiology score, age and chronic health evaluation, which can be added up and using the total score to predict mortality rate. However, whether the scoring system can be used in all levels of medical facilities in Taiwan still need to be evaluated. There may be a possibility that predicting mortality can be achieved by fewer items. We have collected 323 patients who were admitted to medical ICU from Jan, 1st.2013 to Dec, 31st. 2013 at a regional teaching hospital in northern Taiwan to evaluate their Apache score in 24 hours and their end results of this admission. The end results of this study revealed: 1.The higher Apache score is, the lower the survival rate. One point higher in Apache score decreases the survival by 0.013 with the accuracy rate of 0.839. 2. The survival rate decreases as every one point the APS increases by 0.013 with the accuracy rate of 0.842. 3. There are four single items , mean arterial pressure, respiratory rate, GCS coma scale, and arterial oxygenation are significant correlated with survival rate, the higher the score the lower the survival rate, with different marginal effects. Keyword ：Apache score、mortality、survival rate

碩士<br>國立臺北護理健康大學<br>護理研究所<br>104<br>The job stress of nurses not only causes the exhaustion of physical and mental health, but also directly influences the quality of patient care. However, due to the severity of patient illness, working at the intensive care unit is definitely stressful than those who work at the general wards. This study was designed to investigate the correlation between the severity of ICU patients and job stress of nurse and identify the factors of job stress. This study adopted cross - sectional study design and utilized structured questionnaire as a research tool. Purposive sampling was applied to select ICU nurses of teaching hospitals in east area. The data of 81 samples were collected by the investigator personally. The data collection tools were mainly structured questionnaire, including personal information of ICU nurses, APACHE II scale, and nurse stress scale. Knaus et al.'s APACHE II scale, published in 1982, was used as assessment tool of the severity of ICU patients. Nurses stress scale, published in 1996, was used to assess job stress of ICU nurses. The correlation analysis of disease severity and job stress was not significant (p > .05). This result might reflect the gap between urban and rural areas, the severity of patients were different. However, the analysis of a regression model found that patient severity played a moderation effect between characteristics of nurses and the four factors of job stress (personal response, work concerns, competence, and pressure of being not able to complete personal affairs).

碩士<br>中山醫學大學<br>醫學研究所<br>96<br>Background: Some scoring system have been used to predict the treatment outcome or mortality rate for the critically ill patients in the intensive care unit (ICU), such as acute physiology and chronic health evaluation II (APACHE II) score；sepsis-related organ failure assessment (SOFA) score；multiple organ dysfunction system (MODS) score、logistic organ dysfunction system (LODS) score. Other methods which are used to evaluate the severity of acute illness are also useful to predict the treatment outcome or disease-associated mortality, such as pneumonia severity index (PSI) for the community-acquired pneumonia；clinical pulmonary infection score (CPIS) for the nosocomial pneumonia/ ventilator- associated pneumonia, Ranson criteria for the acute pancreatitis。 However, these methods are usually complicated and need to monitor many factors. Nowadays, there was no study to evaluate clinically practical value when use a single factor to predict the treatment outcome or mortality for ICU patients. Study objectives: In this study we wish to examine the practical value when serum level of lactate dehydrogenase (LDH) was used as a single factor to predict the treatment outcome or mortality for critically ill patients who were admitted to medical ICU. Design and setting: We retrospectively reviewed medical records of 273 patients who were admitted to medical ICU in Chung-Shan University Hospital from the beginning to the end of 2007. The serum levels of LDH and C-reacting protein (CRP) as well as APACHE II score were reviewed and were used to examine the treatment outcome and mortality for these critically ill patients. Results: By the difference of patient source, those patients who were transferred from ordinary ward had significantly higher serum levels of LDH and CRP than those from emergency room, p=0.006, p=0.03 respectively, but there was no statistic difference in APACHE II score, p=0.057. By the results of mortality, serum LDH level and APACHE II score were significantly higher in the mortality group than in the survival group (p&amp;lt;0.001, p&amp;lt;0.001), but there was no difference between these two groups in CRP (p=0.499). To the survivals, only APACHE II score were significantly higher in patients who were transferred to respiratory care center (RCC) than in patients who were referred to ordinary ward (p=0.008). There was no statistic difference in serum level of LDH and CRP (p=0.737, p=0.815). By the results of the Pearson correlation analysis for mortality, APACHE II score has the most strong correlation (r=0.359), and followed by LDH (r=0.218), but no correlation with CRP (r=0.026). The same results were also acquired from the Logistic regression analysis. Conclusion: Both serum levels of LDH and APACHE II score were significantly higher in patients of ICU mortality than in survivals. Although APACHE II score had higher correlation with mortality than LDH, when used LDH as a singer predictor for mortality, the results were acceptable. These findings suggest that it is a simple and useful way in monitoring the outcome of ICU patients by regular follow-up of serum level of LDH.