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Cho NR, Jung WS, Park HY, Kang JM, Ko DS, Choi ST. Discrepancy between the Demand and Supply of Intensive Care Unit Beds in South Korea from 2011 to 2019: A Cross-Sectional Analysis. Yonsei Med J 2021; 62:1098-1106. [PMID: 34816640 PMCID: PMC8612860 DOI: 10.3349/ymj.2021.62.12.1098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/18/2021] [Accepted: 09/27/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Intensive care unit (ICU) bed availability is key to critical patient care. In many countries, older patients generally account for a significant proportion of hospitalizations and ICU admissions. Therefore, considering the rapidly increasing aging population in South Korea, it is important to establish whether the demand for critical care is currently met by available ICU beds. MATERIALS AND METHODS We evaluated a 9-year trend in ICU bed supply and ICU length of stay in South Korea between 2011 and 2019 in a population-based cross-sectional analysis, using data from the Korean Health Insurance Review & Assessment Service and Statistics database. We described the changes in ICU bed rates in adult (≥20 years) and older adult (≥65 years) populations. ICU length of stay was categorized similarly and was used to predict future ICU bed demands. RESULTS The ICU bed rate per 100000 adults increased from 18.5 in 2011 to 19.5 in 2019. In contrast, the ICU bed rate per 100000 older adults decreased from 127.6 in 2011 to 104.0 in 2019. ICU length of stay increased by 43.8% for adults and 55.6% for older adults. In 2019, the regional differences in the ICU bed rate nearly doubled, and the ICU length of stay increased six-fold. The ICU bed occupancy rate in South Korea is expected to rise to 102.7% in 2030. CONCLUSION The discrepancy between the demand and supply of ICU beds in South Korea requires urgent action to anticipate future ICU demands.
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Affiliation(s)
- Noo Ree Cho
- Department of Anaesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Wol Seon Jung
- Department of Anaesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Hee Yeon Park
- Department of Anaesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Jin Mo Kang
- Division of Vascular Surgery, Department of Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Dai Sik Ko
- Division of Vascular Surgery, Department of Surgery, Gachon University Gil Medical Center, Incheon, Korea.
| | - Sang Tae Choi
- Division of Vascular Surgery, Department of Surgery, Gachon University Gil Medical Center, Incheon, Korea.
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Castellanos-Ortega A, Broch M, Barrios M, Fuentes-Dura M, Sancerni-Beitia M, Vicent C, Gimeno R, Ramírez P, Pérez F, García-Ros R. Análisis de la aceptación y validez de los métodos utilizados para la implementación de un programa de formación basado en competencias en un servicio de Medicina Intensiva de un hospital universitario de referencia. Med Intensiva 2021. [DOI: 10.1016/j.medin.2019.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Castellanos-Ortega A, Broch MJ, Barrios M, Fuentes-Dura MC, Sancerni-Beitia MD, Vicent C, Gimeno R, Ramírez P, Pérez F, García-Ros R. Acceptance and validity of the methods used to implement a competency based medical education programme in an Intensive Care Department of a teaching referral center. Med Intensiva 2021; 45:411-420. [PMID: 34563341 DOI: 10.1016/j.medine.2019.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 12/02/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES 1. To determine the satisfaction of tutors and residents with a specific methodology used to implement CoBaTrICE. 2. To determine the reliability and validity of the global rating scales designed ad hoc to assess the performance of the residents for training purposes. DESIGN Prospective cohort study. PARTICIPANTS All the residents and tutors of the ICU Department of the Hospital Universitario y Politécnico la Fe de Valencia. INTERVENTION CoBaTrICE implementation started in March 2016, it was based on: (1) Training the tutors in feedback techniques; (2) Performing multiple objective and structured work based assessments to achieve the competences of the program; and (3) The use of an electronic portfolio to promote learning reflection and to collect the evidence that learning was taking place. METHODS The acceptance of CoBaTrICE was explored through a satisfaction survey conducted after 9 months of implementation of the training program. The 15 residents and 5 tutors of the ICU Department were asked about the methodology of the formative assessments, the quality of the feedback, self-learning regulation and the electronic portfolio usefulness. The validity of the global rating scales was assessed through the tests alfa de Cronbach, reliability and generalizability indexes, and intraclass correlation coefficient. RESULTS The implementation of CoBaTrICE was satisfactory in all the dimensions studied. The global rating scales used for formative purposes showed reliability and validity. CONCLUSIONS The methodology used to implement CoBaTrICE was highly valued by tutors and residents. The global rating scales used for formative purposes showed reliability and validity.
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Affiliation(s)
- A Castellanos-Ortega
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - M J Broch
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - M Barrios
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - M C Fuentes-Dura
- Departamento de Metodología de Ciencias del Comportamiento, Universidad de Valencia, Valencia, Spain
| | - M D Sancerni-Beitia
- Departamento de Metodología de Ciencias del Comportamiento, Universidad de Valencia, Valencia, Spain
| | - C Vicent
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - R Gimeno
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - P Ramírez
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - F Pérez
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - R García-Ros
- Departamento de Psicología Evolutiva y de la Educación, Universidad de Valencia, Valencia, Spain.
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Kobbe P, Bläsius FM, Lichte P, Oberbeck R, Hildebrand F. Neuroendocrine Modulation of the Immune Response after Trauma and Sepsis: Does It Influence Outcome? J Clin Med 2020; 9:jcm9072287. [PMID: 32708472 PMCID: PMC7408630 DOI: 10.3390/jcm9072287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/13/2020] [Accepted: 07/16/2020] [Indexed: 12/29/2022] Open
Abstract
Although the treatment of multiple-injured patients has been improved during the last decades, sepsis and multiple organ failure (MOF) still remain the major cause of death. Following trauma, profound alterations of a large number of physiological systems can be observed that may potentially contribute to the development of sepsis and MOF. This includes alterations of the neuroendocrine and the immune system. A large number of studies focused on posttraumatic changes of the immune system, but the cause of posttraumatic immune disturbance remains to be established. However, an increasing number of data indicate that the bidirectional interaction between the neuroendocrine and the immune system may be an important mechanism involved in the development of sepsis and MOF. The aim of this article is to highlight the current knowledge of the neuroendocrine modulation of the immune system during trauma and sepsis.
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Affiliation(s)
- Philipp Kobbe
- Deparment of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, D-52074 Aachen, Germany; (P.K.); (F.M.B.); (P.L.)
| | - Felix M. Bläsius
- Deparment of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, D-52074 Aachen, Germany; (P.K.); (F.M.B.); (P.L.)
| | - Philipp Lichte
- Deparment of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, D-52074 Aachen, Germany; (P.K.); (F.M.B.); (P.L.)
| | - Reiner Oberbeck
- Deparment of Trauma and Hand Surgery, Wald-Klinikum, 07548 Gera, Germany;
| | - Frank Hildebrand
- Deparment of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, D-52074 Aachen, Germany; (P.K.); (F.M.B.); (P.L.)
- Correspondence: ; Tel.: +49-241-89350
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Edwards Z, Lucas DN, Gauntlett R. Is training in obstetric critical care adequate? An international comparison. Int J Obstet Anesth 2018; 37:96-105. [PMID: 30482716 DOI: 10.1016/j.ijoa.2018.08.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 07/17/2018] [Accepted: 08/29/2018] [Indexed: 01/18/2023]
Abstract
Obstetric critical care is an emerging discipline which cuts across speciality boundaries. We have analysed the training curricula in the three major specialities (obstetrics, anaesthesia and intensive care medicine) likely to be involved in the care of the critically-ill obstetric patient, to assess whether it is adequate to ensure effective training on this subject.
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Affiliation(s)
- Z Edwards
- Department of Anaesthetics, Northwick Park Hospital, Harrow, United Kingdom.
| | - D N Lucas
- Department of Anaesthetics, Northwick Park Hospital, Harrow, United Kingdom
| | - R Gauntlett
- Department of Anaesthetics, Royal Victoria Infirmary, Newcastle, United Kingdom
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Critical Care Resources in Guangdong Province of China: Three Surveys from 2005 to 2015. Crit Care Med 2017; 45:e1218-e1225. [PMID: 28902121 DOI: 10.1097/ccm.0000000000002700] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Data about the critical care resources in China remain scarce. The purpose of this study was to investigate the variation and distribution of critical care resources in Guangdong province from 2005 to 2015. DESIGN Data in regard to critical care resources were collected through questionnaires and visits every 5 years from 2005. SETTING All hospitals in Guangdong province were screened and hospitals that provide critical care services were enrolled. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS One hundred eleven, 158, and 284 hospitals that provide critical care services were enrolled in the three consecutive surveys respectively. The number of ICUs, ICU beds, intensivists, and nurses increased to 324, 3,956, 2,470, and 7,695, respectively, by 2015. Adjusted by population, the number of ICU beds per 100,000 (100,000) population increased by 147.7% from 2005 to 2015, and the number of intensivists and nurses per 100,000 population increased by 35.3% and 55.1% from 2011 to 2015. However, the numbers in the Pearl River Delta, a richer area, were higher than those in the non-Pearl River Delta area (ICU beds: 4.64 vs 2.58; intensivists: 2.90 vs 1.61; nurses: 9.30 vs 4.71 in 2015). In terms of staff training, only 17.85% of intensivists and 14.29% of nurses have completed a formal accredited critical care training program by 2015. CONCLUSIONS Our study was the first one to investigate the trend and distribution of critical care resources in China. The quantity of ICU beds and staff has been increasing rapidly, but professional training for staff was inadequate. The distribution of critical care resources was unbalanced. Our study can be beneficial for healthcare policymaking and the allocation of critical care resources in Guangdong province and other provinces in China.
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Castellanos-Ortega A, Rothen HU, Franco N, Rayo LA, Martín-Loeches I, Ramírez P, Cuñat de la Hoz J. Training in intensive care medicine. A challenge within reach. Med Intensiva 2014; 38:305-10. [PMID: 24589154 DOI: 10.1016/j.medin.2013.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 12/30/2013] [Indexed: 11/30/2022]
Abstract
The medical training model is currently immersed in a process of change. The new paradigm is intended to be more effective, more integrated within the healthcare system, and strongly oriented towards the direct application of knowledge to clinical practice. Compared with the established training system based on certification of the completion of a series or rotations and stays in certain healthcare units, the new model proposes a more structured training process based on the gradual acquisition of specific competences, in which residents must play an active role in designing their own training program. Training based on competences guarantees more transparent, updated and homogeneous learning of objective quality, and which can be homologated internationally. The tutors play a key role as the main directors of the process, and institutional commitment to their work is crucial. In this context, tutors should receive time and specific formation to allow the evaluation of training as the cornerstone of the new model. New forms of objective summative and training evaluation should be introduced to guarantee that the predefined competences and skills are effectively acquired. The free movement of specialists within Europe is very desirable and implies that training quality must be high and amenable to homologation among the different countries. The Competency Based training in Intensive Care Medicine in Europe program is our main reference for achieving this goal. Scientific societies in turn must impulse and facilitate all those initiatives destined to improve healthcare quality and therefore specialist training. They have the mission of designing strategies and processes that favor training, accreditation and advisory activities with the government authorities.
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Affiliation(s)
- A Castellanos-Ortega
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España.
| | - H U Rothen
- Department of Intensive Care Medicine, University Hospital of Bern, Berna, Suiza
| | - N Franco
- Servicio de Medicina Intensiva, Hospital Universitario de Móstoles, Móstoles, Madrid, España
| | - L A Rayo
- Servicio de Medicina Intensiva, Hospital Son Espases, Palma de Mallorca, España
| | - I Martín-Loeches
- Servicio de Medicina Intensiva, Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, España
| | - P Ramírez
- Servicio de Medicina Intensiva, Hospital La Fe, Valencia, España
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Blanch L, Annane D, Antonelli M, Chiche JD, Cuñat J, Girard TD, Jiménez EJ, Quintel M, Ugarte S, Mancebo J. The future of intensive care medicine. Med Intensiva 2013; 37:91-8. [PMID: 23398846 DOI: 10.1016/j.medin.2012.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 12/19/2012] [Indexed: 02/04/2023]
Abstract
Intensive care medical training, whether as a primary specialty or as secondary add-on training, should include key competences to ensure a uniform standard of care, and the number of intensive care physicians needs to increase to keep pace with the growing and anticipated need. The organisation of intensive care in multiple specialty or central units is heterogeneous and evolving, but appropriate early treatment and access to a trained intensivist should be assured at all times, and intensivists should play a pivotal role in ensuring communication and high-quality care across hospital departments. Structures now exist to support clinical research in intensive care medicine, which should become part of routine patient management. However, more translational research is urgently needed to identify areas that show clinical promise and to apply research principles to the real-life clinical setting. Likewise, electronic networks can be used to share expertise and support research. Individuals, physicians and policy makers need to allow for individual choices and priorities in the management of critically ill patients while remaining within the limits of economic reality. Professional scientific societies play a pivotal role in supporting the establishment of a defined minimum level of intensive health care and in ensuring standardised levels of training and patient care by promoting interaction between physicians and policy makers. The perception of intensive care medicine among the general public could be improved by concerted efforts to increase awareness of the services provided and of the successes achieved.
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Affiliation(s)
- L Blanch
- Critical Care Center, Hospital de Sabadell, Corporacio Sanitaria Universitària Parc Taulí, Sabadell, Spain.
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The variability of critical care bed numbers in Europe. Intensive Care Med 2012; 38:1647-53. [DOI: 10.1007/s00134-012-2627-8] [Citation(s) in RCA: 331] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 06/14/2012] [Indexed: 10/28/2022]
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Mancebo J, Hall J. Is the Doctor In? Views on the Deployment of Intensivists from Both Sides of the Atlantic. Am J Respir Crit Care Med 2012; 185:696-7. [DOI: 10.1164/rccm.201201-0149ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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