• Background Long stays in the intensive care unit are associated with high costs and burdens on patients and patients’ families and in turn affect society at large. Although factors that affect length of stay and outcomes of care in the intensive care unit have been studied extensively, the conclusions reached have not been reviewed to determine whether they reveal an organizational pattern that might be of practical use in reducing length of stay in the unit. • Objective To identify and categorize the factors associated with prolonged stays in the intensive care unit and to describe briefly the nonmedical interventions to date designed to reduce length of stay. • Methods Articles published between January 1990 and March 2005 in English-language journals indexed by MEDLINE were searched for studies on outcomes and costs of care in the intensive care unit and on care at the end of life. • Results The emerging consensus is that length of stay in the intensive care unit is exacerbated by several increasingly discernible medical, social, psychological, and institutional factors. At the same time, several nonmedical, experimental interventions have been designed to reduce length of stay. • Conclusions Interventions involving palliative care, ethics consultations, and other methods to increase communication between healthcare personnel, patients, and patients’ families may be helpful in decreasing length of stay in the intensive care unit. Further studies are needed to provide a strategy for targeting specific risk factors indicated by the literature review.

An 80-year-old white female patient presented with severe intermittent abdominal cramps. She described episodes of pain and nausea that lasted up to 12 hours every 4 to 6 weeks. The pain was unremitting in the periumbilical and lower abdominal area, produced bowel urges, and was unrelieved after bowel movements. She made no reports of having constipation, diarrhea, or bloody stools. The cramps were not associated with vomiting, angina, diaphoresis, dyspnea, or constitutional symptoms.Her past medical history was significant for a 40-pack-year former-smoker history, hypercholesterolemia, angina, gastroesophageal reflux disease, and hypothyroidism. Her surgical history included coronary artery bypass grafting and three pregnancies by Cesarean section. She reported no food allergies or chronic use of nonsteroidal anti-inflammatory drugs.On examination, her abdomen was nondistended with bowel sounds present and mild diffuse tenderness to palpation without rebound or guarding. During one painful episode, a computed tomography (CT) scan of the abdomen showed splenomegaly, ascites, and small bowel thickening in the proximal jejunum and gastric antrum. An esophagogastroduodenoscopy demonstrated no significant findings in the stomach or small bowel to explain the CT scan findings. An upper endoscopic ultrasound visualized normal-appearing stomach wall layers in the gastric antrum and body, notable for the absence of wall thickening, tumors, or adjacent lymphadenopathy.One week later, a follow-up CT scan revealed persistent splenomegaly, but with resolution of both ascites and small bowel thickening. The etiology of the patient's abdominal symptoms was not

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Atypical presentation of IL-12 receptor β1 deficiency with pneumococcal sepsis and disseminated nontuberculous mycobacterial infection in a 19-month-old girl born to nonconsanguineous US residents

Biologic therapies currently represent useful adjunctive treatments for asthma, especially in patients with more severe disease that is not responsive to conventional therapies alone. However, the varied responses now found suggest that specific phenotypes may need to be identified to see optimal effects from specific treatments. Further studies are required to access the efficacy and side effect profiles of these therapies.