The Eldicus prospective, observational study of triage decision making in European intensive care units. Part II: intensive care benefit for the elderly.

Rationale: Life and death triage decisions are made daily by intensive care unit physicians. Admission to an intensive care unit is denied when intensive care unit resources are constrained, especially for the elderly.

Objective: To determine the effect of intensive care unit triage decisions on mortality and intensive care unit benefit, specifically for elderly patients.

The Eldicus prospective, observational study of triage decision making in European intensive care units: part I--European Intensive Care Admission Triage Scores.

Objective: Life and death triage decisions are made daily by intensive care unit physicians. Scoring systems have been developed for prognosticating intensive care unit mortality but none for intensive care unit triage. The objective of this study was to develop an intensive care unit triage decision rule based on 28-day mortality rates of admitted and refused patients.

Exclusion of older people from clinical trials: professional views from nine European countries participating in the PREDICT study.

Background: There has been concern about under-representation of older people in clinical trials. The PREDICT study reported that older people and those with co-morbidity continue to be excluded unjustifiably from clinical trials. However, there is no information about differences of opinion on these issues between EU countries.

The persistent exclusion of older patients from ongoing clinical trials regarding heart failure.

Background: Much clinical research of relevance to elderly patients examines individuals who are younger than those who have the disease in question. A good example is heart failure. Therefore, we investigated the extent of exclusion of older individuals in ongoing clinical trials regarding heart failure.

Implications of ICU triage decisions on patient mortality: a cost-effectiveness analysis.

Introduction: Intensive care is generally regarded as expensive, and as a result beds are limited. This has raised serious questions about rationing when there are insufficient beds for all those referred. However, the evidence for the cost effectiveness of intensive care is weak and the work that does exist usually assumes that those who are not admitted do not survive, which is not always the case.

The Budapest Meeting 2005 intensified networking on ethics of science: the case of reproductive cloning, germline gene therapy and human dignity.

This paper reports on the meeting of the Sounding Board of the EU Reprogenetics Project that was held in Budapest, Hungary, 6-9 November 2005. The Reprogenetics Project runs from 2004 until 2007 and has a brief to study the ethical aspects of human reproductive cloning and germline gene therapy. Discussions during The Budapest Meeting are reported in depth in this paper as well as the initiatives to involve the participating groups and others in ongoing collaborations with the goal of forming an integrated network of European resources in the fields of ethics of science.

International Programme for Resource Use in Critical Care (IPOC)--a methodology and initial results of cost and provision in four European countries.

Background: A standardized top-down costing method is not currently available internationally. An internally validated method developed in the UK was modified for use in critical care in different countries. Costs could then be compared using the World Health Organization's Purchasing Power Parities (WHO PPPs).

SAPS 3--From evaluation of the patient to evaluation of the intensive care unit. Part 1: Objectives, methods and cohort description.

Objective: Risk adjustment systems now in use were developed more than a decade ago and lack prognostic performance. Objective of the SAPS 3 study was to collect data about risk factors and outcomes in a heterogeneous cohort of intensive care unit (ICU) patients, in order to develop a new, improved model for risk adjustment.

Design: Prospective multicentre, multinational cohort study.

SAPS 3--From evaluation of the patient to evaluation of the intensive care unit. Part 2: Development of a prognostic model for hospital mortality at ICU admission.

Objective: To develop a model to assess severity of illness and predict vital status at hospital discharge based on ICU admission data.

Design: Prospective multicentre, multinational cohort study.

Patients And Setting: A total of 16,784 patients consecutively admitted to 303 intensive care units from 14 October to 15 December 2002.

Comparative costing analysis of intensive care services between Hungary and United Kingdom.

Objective: The study presents the findings of the first National Intensive Care Cost Block Analysis in Hungary.

Methods: There were 13 Intensive Care Units (ICUs) involved in this study: 5 University Hospitals, 6 District County Hospitals and 2 City Hospitals. The annual costs of ICUs were measured by "top-down" approach based on Cost Block Method.

The cost of a hospital ward in Europe: is there a methodology available to accurately measure the costs?

Costing health care services has become a major requirement due to an increase in demand for health care and technological advances. Several studies have been published describing the computation of the costs of hospital wards. The objective of this article is to examine the methodologies utilised to try to describe the basic components of a standardised method, which could be applied throughout Europe.

Evaluation of a local anaesthesia regimen following mastectomy.

Breast surgery can be emotionally distressing and physically painful. Acute pain following surgery is often related mainly to the axillary surgery and is aggravated by arm and shoulder movement. We conducted a prospective double-blind, randomised, placebo-controlled trial to determine the influence of local anaesthetic irrigation of axillary wound drains on postoperative pain during the first 24 h following a modified Patey mastectomy (mastectomy with complete axillary node clearance).

Economies of scale in British intensive care units and combined intensive care/high dependency units.

Objective: To estimate the relationship between size of intensive care unit and combined intensive care/high dependency units and average costs per patient day.

Design: Retrospective data analysis. Multiple regression of average costs on critical care unit size, controlling for teaching status, type of unit, occupancy rate and average length of stay.

Nondrug costs of therapy in acute care--are they important?

Drug acquisition costs are only a proportion of the total costs associated with drug therapy. The relevance of these costs are often not appreciated. However, they impact on the Intensive Care Unit via resources and quality of care.

Definitions and methods of cost assessment: an intensivist's guide. ESICM section on health research and outcome working group on cost effectiveness.

Objective: To define the different types of costs incurred in the care of critically ill patients and to describe some of the most commonly used methods for measuring and allocating these costs.

Design: Literature review. Definitions for opportunity, direct and indirect, fixed, variable, marginal, and total costs are described and interpreted in the context of the critical care setting.

Descriptive patient data as an explanation for the variation in average daily costs in intensive care.

Intensive care patients require therapy that can vary considerably in type, duration and cost, so making it extremely difficult to predict patient resource use. Few studies measure actual costs; usually average daily costs are calculated and these do not reflect the variation in resource use between individual patients. The aim of this study was to analyse a data set of 193 critically ill adult patients to look for associations between routinely collected descriptive data and patient-specific costs.

Variations in expenditure between adult general intensive care units in the UK.

This paper presents the findings from the second pilot study of the cost block method in 21 adult general intensive care units (ICUs). The aim of this study was to explore the possible reasons for the variation in cost identified in a previous pilot study of 11 ICUs. Data were collected for the six cost blocks for the financial year 1996/97.

Cost considerations for the use of low-air-loss bed therapy in adult intensive care.

The aim of this study was to consider the costs of low-air-loss bed therapy in the adult intensive care unit (ICU). A retrospective cost analysis was performed on 269 consecutive patients, 63 of whom had received low-air-loss bed therapy. Patients' APACHE II scores, length of stay (LOS), average daily TISS and ICU outcomes were also collected.

The patient-related costs of care for sepsis patients in a United Kingdom adult general intensive care unit.

Objective: To determine the patient-related costs of care for critically ill patients with severe sepsis or early septic shock.

Design: Retrospective, longitudinal, observational study during a 10-month period.

Setting: Adult general intensive care unit (ICU) in a university hospital located in the United Kingdom.

The development of a method for comparative costing of individual intensive care units. The Intensive Care Working Group on Costing.

Intensive care is one of the most costly areas of hospital care. Unfortunately, because of the diversity of case mix, costing intensive care is difficult. Many described costing methods previously are limited by being cumbersome, laborious to apply and expensive.

Evaluation of proposed casemix criteria as a basis for costing patients in the adult general intensive care unit.

This study analyses the relationship between the actual patient-related costs of care calculated for 145 patients admitted sequentially to an adult general intensive care unit and a number of factors obtained from a previously described consensus of opinion study. The factors identified in the study were suggested as potential descriptors for the casemix in an intensive care unit that could be used to predict the costs of care. Significant correlations between the costs of care and severity of illness, workload and length of stay were found but these failed to predict the costs of care with sufficient accuracy to be used in isolation to define isoresource groups in the intensive care unit.

The impact of the ageing population on intensive care provision.

This paper explores the impact of the ageing population on the health service and intensive care provision. The concept of rationing is discussed. The paper concludes that age alone is not a reliable prediction of outcome (e.

A new method of accurately identifying costs of individual patients in intensive care: the initial results.

Objectives: To analyse the patient-related and non-patient-related costs of intensive care using an activity-based costing methodology.

Design: A retrospective cost analysis of 68 patients admitted sequentially over a 10-week period.

Setting: The Adult General Intensive Care Unit of the Royal Hallamshire Hospital, Sheffield.