Critical care telemedicine: evolution and state of the art.

Objectives: To review the growth and current penetration of ICU telemedicine programs, association with outcomes, studies of their impact on medical education, associations with medicolegal risks, identify program revenue sources and costs, regulatory aspects, and the ICU telemedicine research agenda.

Data Sources: Review of the published medical literature, governmental documents, and opinions of experts from the Society of Critical Care Medicine ICU Telemedicine Committee.

Data Synthesis: Formal ICU telemedicine programs now support 11% of nonfederal hospital critically ill adult patients.

Salivary and free serum cortisol evaluation.

Background: Physiologic free serum cortisol may more accurately reflect adrenal function than total cortisol levels. Salivary cortisol estimates free serum cortisol. We researched the clinical viability of salivary cortisol in hospitalized patients.