828 resultados para roles and actions
Resumo:
Background
Recently, clinical and research attention has been focused on refining weaning processes to improve outcomes for critically ill patients who require mechanical ventilation. One such process, use of a weaning protocol, has yielded conflicting results, arguably because of the influence of existing context and processes.
Objective
To compare international data to assess differences in context and processes in intensive care units that could influence weaning.
Methods
Review of existing national data on provision of care for critically ill patients, including structure, staffing, skill mix, education, roles, and responsibilities for weaning in intensive care units of selected countries.
Results
Australia, New Zealand, Denmark, Norway, Sweden, and the United Kingdom showed similarities in critical care provision, structure, skill mix, and staffing ratios in intensive care units. Weaning in these countries is generally a collaborative process between nurses and physicians. Notable differences in intensive care units in the United States were the frequent use of an open structure and inclusion of respiratory therapists on the intensive care unit’s health care team. Nurses may be excluded from direct management of ventilator weaning in some institutions, as this role is primarily assumed by respiratory therapists guided by medical directives. Availability of critical care beds was highest in the United States and lowest in the United Kingdom.
Conclusion
Context and processes of care that could influence ventilator weaning outcomes varied considerably across countries. Further quantification of these contextual influences should be considered when translating research findings into local clinical practice and when designing randomized, controlled trials.
Resumo:
The present study provides evidence for a number of calcium pools important in histamine secretion from the mast cell. Firstly, calcium loosely bound to the cell membrane, and in rapid equilibrium with the extracellular environment, may be utilized for histamine release induced by most secretagogues. Secondly, all inducers are able to mobilize deeply buried or internal stores of calcium to initiate exocytosis. Finally, calcium bound to regulatory sites in the membrane may modulate the secretory process, Removal of calcium from the latter sites by brief treatment with chelating agents markedly enhances the secretory response in the absence of extracellular calcium, probably by facilitating the mobilization of bound stores of the ion, Saturation of these sites in the presence of excess calcium inhibits the release process and may restrict influx of the cation.
Resumo:
Revealing the consequences of species extinctions for ecosystem function has been a chief research goal(1-7) and has been accompanied by enthusiastic debate(8-11). Studies carried out predominantly in terrestrial grassland and soil ecosystems have demonstrated that as the number of species in assembled communities increases, so too do certain ecosystem processes, such as productivity, whereas others such as decomposition can remain unaffected(12). Diversity can influence aspects of ecosystem function, but questions remain as to how generic the patterns observed are, and whether they are the product of diversity, as such, or of the functional roles and traits that characterize species in ecological systems. Here we demonstrate variable diversity effects for species representative of marine coastal systems at both global and regional scales. We provide evidence for an increase in complementary resource use as diversity increases and show strong evidence for diversity effects in naturally assembled com-munities at a regional scale. The variability among individual species responses is consistent with a positive but idiosyncratic pattern of ecosystem function with increased diversity.
