ABSTRACT
Stretching scarce resources is more than a managerial issue. Should an understaffed ICU accept the patient or divert him to another facility? The intense "medical utility" controversy focuses on a situation that critical care nurses now face every day.
Subject(s)
Critical Care/organization & administration , Ethics, Nursing , Health Care Rationing/organization & administration , Intensive Care Units , Humans , Medical Futility , Needs Assessment , Patient Admission , Patient AdvocacySubject(s)
Chaplaincy Service, Hospital/organization & administration , Critical Care/psychology , Intensive Care Units/organization & administration , Interdepartmental Relations , Pastoral Care/methods , Cooperative Behavior , Humans , Interprofessional Relations , Job Description , Nursing Staff, Hospital/organization & administration , Nursing Staff, Hospital/psychologyABSTRACT
Stretching scarce resources is more than a managerial issue. Should you accept the patient to an understaffed ICU or divert him to another facility? The intense "medical utility" controversy focuses on a situation that critical care nurses now face every day.
Subject(s)
Critical Care/organization & administration , Ethics, Nursing , Health Care Rationing/organization & administration , Medical Futility , Patient Admission , Patient Advocacy , Humans , Needs AssessmentABSTRACT
The organization of the collagen fibrils in the human umbilical cord at term is directly visualized by means of a scanning electron microscopy cell maceration method. This technique clearly reveals that there is a much more extensive collagen fibrillar architecture within the umbilical cord than that reported in the classical histological descriptions. The Wharton's jelly, in fact, appears as a spongy network of interlacing collagen fibres and small woven bundles apparently arranged at random and forming a continuous soft skeleton that encases the umbilical vessels. The collagen fibrillar network shows the presence of a wide system of interconnected cavities consisting of canalicular-like structures as well as cavernous and perivascular spaces. This system of cavities might play a mechanical role allowing the storing of the ground substance of the jelly and its diffusion during twisting or compression. Furthermore, it may have an important role facilitating the diffusion throughout the jelly of diffused materials (i.e. water and trophic metabolites) either from or to the umbilical vessels and the amniotic cavity, thus overcoming the lace of a proper vasculature with the jelly.