ContextIntensive care unit (ICU) physician staffing varies widely, and its
association with patient outcomes remains unclear.ObjectiveTo evaluate the association between ICU physician staffing and patient
outcomes.Data SourcesWe searched MEDLINE (January 1, 1965, through September 30, 2001) for
the following medical subject heading (MeSH) terms: intensive
care units, ICU, health resources/utilization, hospitalization, medical staff,
hospital organization and administration, personnel staffing and scheduling,
length of stay, and LOS. We also used the
following text words: staffing, intensivist, critical, care, and specialist. To identify observational
studies, we added the MeSH terms case-control study and retrospective study. Although we searched for non–English-language
citations, we reviewed only English-language articles. We also searched EMBASE,
HealthStar (Health Services, Technology, Administration, and Research), and
HSRPROJ (Health Services Research Projects in Progress) via Internet Grateful
Med and The Cochrane Library and hand searched abstract proceedings from intensive
care national scientific meetings (January 1, 1994, through December 31, 2001).Study SelectionWe selected randomized and observational controlled trials of critically
ill adults or children. Studies examined ICU attending physician staffing
strategies and the outcomes of hospital and ICU mortality and length of stay
(LOS). Studies were selected and critiqued by 2 reviewers. We reviewed 2590
abstracts and identified 26 relevant observational studies (of which 1 included
2 comparisons), resulting in 27 comparisons of alternative staffing strategies.
Twenty studies focused on a single ICU.Data SynthesisWe grouped ICU physician staffing into low-intensity (no intensivist
or elective intensivist consultation) or high-intensity (mandatory intensivist
consultation or closed ICU [all care directed by intensivist]) groups. High-intensity
staffing was associated with lower hospital mortality in 16 of 17 studies
(94%) and with a pooled estimate of the relative risk for hospital mortality
of 0.71 (95% confidence interval [CI], 0.62-0.82). High-intensity staffing
was associated with a lower ICU mortality in 14 of 15 studies (93%) and with
a pooled estimate of the relative risk for ICU mortality of 0.61 (95% CI,
0.50-0.75). High-intensity staffing reduced hospital LOS in 10 of 13 studies
and reduced ICU LOS in 14 of 18 studies without case-mix adjustment. High-intensity
staffing was associated with reduced hospital LOS in 2 of 4 studies and ICU
LOS in both studies that adjusted for case mix. No study found increased LOS
with high-intensity staffing after case-mix adjustment.ConclusionsHigh-intensity vs low-intensity ICU physician staffing is associated
with reduced hospital and ICU mortality and hospital and ICU LOS.

/pdf/physician-staffing-patterns-and-clinical-outcomes-in-5b3j8ptzj2.pdf

Physician Staffing Patterns and Clinical Outcomes in Critically Ill Patients: A Systematic Review

Physician Staffing Patterns and Clinical Outcomes in Critically Ill Patients

Background Enteroviruses can cause outbreaks of hand-foot-and-mouth disease (characterized by vesicular lesions on the hands, feet, and oral mucosa) or herpangina, usually without life-threatening manifestations. In 1998 an epidemic of enterovirus 71 infection caused hand-foot-and-mouth disease and herpangina in thousands of people in Taiwan, some of whom died. Methods We assessed the epidemiologic aspects of this outbreak. Cases of hand-foot-and-mouth disease or herpangina in ambulatory patients were reported to the Taiwan Department of Health by a mean of 818 sentinel physicians. Severe cases in hospitalized patients were reported by 40 medical centers and regional hospitals. Viruses were isolated by 10 hospital laboratories and the department of health. Results The sentinel physicians reported 129,106 cases of hand-foot-and-mouth disease or herpangina in two waves of the epidemic, which probably represents less than 10 percent of the estimated total number of cases. There were 405 patients with severe ...

https://www.nejm.org/doi/pdf/10.1056/NEJM199909233411301

An epidemic of enterovirus 71 infection in Taiwan. Taiwan Enterovirus Epidemic Working Group.

First isolated in California, USA, in 1969, enterovirus 71 (EV71) is a major public health issue across the Asia-Pacific region and beyond. The virus, which is closely related to polioviruses, mostly affects children and causes hand, foot, and mouth disease with neurological and systemic complications. Specific receptors for this virus are found on white blood cells, cells in the respiratory and gastrointestinal tract, and dendritic cells. Being an RNA virus, EV71 lacks a proofreading mechanism and is evolving rapidly, with new outbreaks occurring across Asia in regular cycles, and virus gene subgroups seem to differ in clinical epidemiological properties. The pathogenesis of the severe cardiopulmonary manifestations and the relative contributions of neurogenic pulmonary oedema, cardiac dysfunction, increased vascular permeability, and cytokine storm are controversial. Public health interventions to control outbreaks involve social distancing measures, but their effectiveness has not been fully assessed. Vaccines being developed include inactivated whole-virus, live attenuated, subviral particle, and DNA vaccines.

/pdf/virology-epidemiology-pathogenesis-and-control-of-10y7cnozkc.pdf

Virology, epidemiology, pathogenesis, and control of enterovirus 71.

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Logistic Regression A Self Learning Text

Fatal enterovirus 71 encephalomyelitis

Impact of 24 hour critical care physician staffing on case-mix adjusted mortality in paediatric intensive care.

Risk factors for hemorrhage in severe dengue infections.

Preventive transfusion in Dengue shock syndrome-is it necessary?

Objectives: To determine the association between severity of sepsis with outcome and severity of illness in children with multiple organ dysfunction syndrome (MODS). Materials: Four hundred and ninety-five consecutive paediatric intensive care unit (PICU) admissions were analysed. multiple organ dysfunction syndrome was defined as simultaneous dysfunction of 2 organ system and sepsis by the American College of Chest Physicians and Society of Critical Care Medicine Consensus Conference definition. Results: Eighty-four patients developed MODS. The incidence of sepsis, severe sepsis and septic shock in these patients was 10.7%, 23.8% and 17.9%, respectively. Worsening categories of sepsis were associated with: (1) a higher mean admission Paediatric Risk of Mortality (PRISM II): 36.6 ± 25.9, 56.8 ± 32.1 and 73.6 ± 28.5%, respectively (P = 0.005), (2) a larger number of organ dysfunctions: mean MODS index of 37%, 46% and 58%, respectively (P = 0.007), and (3) a higher mortality: 22.2%, 65% and 80%, respectively (P = 0.03). Conclusion: Presence of sepsis, severe sepsis and septic shock was associated with an increasing severity of illness, increased number of organ dysfunctions and a distinct risk of mortality among critically ill children.

Adrian Yu Teik Goh

Papers

Fatal enterovirus 71 encephalomyelitis

Impact of 24 hour critical care physician staffing on case-mix adjusted mortality in paediatric intensive care.

Risk factors for hemorrhage in severe dengue infections.

Preventive transfusion in Dengue shock syndrome-is it necessary?

Sepsis, severe sepsis and septic shock in paediatric multiple organ dysfunction syndrome.