Intensive care unit physician staffing: financial modeling of the Leapfrog standard.

Objective: To evaluate from a hospital's perspective the costs and savings, over a 1-yr period, of implementing The Leapfrog Group's Intensive Care Unit Physician Staffing (IPS) standard compared with the existing standard of nonintensivist staffing in adult intensive care units.

Design: Using published data, we developed a financial model of costs and savings for 6-, 12- and 18-bed intensive care units using conservative estimates for all variables. Sensitivity analyses, including a best-case and worst-case scenario, were performed to evaluate the impact of changing assumptions on the outcome of the model.

Study protocol: The Improving Care of Acute Lung Injury Patients (ICAP) study.

Introduction: The short-term mortality benefit of lower tidal volume ventilation (LTVV) for patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS) has been demonstrated in a large, multi-center randomized trial. However, the impact of LTVV and other critical care therapies on the longer-term outcomes of ALI/ARDS survivors remains uncertain. The Improving Care of ALI Patients (ICAP) study is a multi-site, prospective cohort study that aims to evaluate the longer-term outcomes of ALI/ARDS survivors with a particular focus on the effect of LTVV and other critical care therapies.

Ventilatory management of acute lung injury and acute respiratory distress syndrome.

Context: The acute lung injury and acute respiratory distress syndrome are critical illnesses associated with significant morbidity and mortality. Mechanical ventilation is the cornerstone of supportive therapy. However, despite several important advances, the optimal strategy for ventilation and adjunctive therapies for patients with acute lung injury and acute respiratory distress syndrome is still evolving.

Lysolipid incorporation in dipalmitoylphosphatidylcholine bilayer membranes enhances the ion permeability and drug release rates at the membrane phase transition.

The enhanced permeability of lipid bilayer membranes at their gel-to-liquid phase transition has been explained using a "bilayer lipid heterogeneity" model, postulating leaky interfacial regions between still solid and melting liquid phases. The addition of lysolipid to dipalmitoylphosphatidylcholine bilayers dramatically enhances the amount of, and speed at which, encapsulated markers or drugs are released at this, already leaky, phase transition through these interfacial regions. To characterize and attempt to determine the mechanism behind lysolipid-generated permeability enhancement, dithionite permeability and doxorubicin release were measured for lysolipid and non-lysolipid, containing membranes.

A system factors analysis of "line, tube, and drain" incidents in the intensive care unit.

Objective: To analyze the system factors related to "line, tube, and drain" (LTD) incidents in the intensive care unit (ICU).

Design: Voluntary, anonymous Web-based patient safety reporting system.

Setting: Eighteen ICUs in the United States.

A systematic review of the Charlson comorbidity index using Canadian administrative databases: a perspective on risk adjustment in critical care research.

The Charlson index is commonly used for risk adjustment in critical care health services research. However, the literature supporting this methodology has not been thoroughly explored. We systematically reviewed the literature related to administrative database adaptations of the Charlson index.

The efficacy of sirolimus- and paclitaxel-eluting stents: a meta-analysis of randomized controlled trials.

Background: Drug-eluting stents prevent in-stent restenosis after percutaneous coronary intervention, and differences between sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) may exist in the rates of target lesion revascularization, death, myocardial infarction and stent thrombosis.

Objective: To compare the efficacy of SES and PES with the efficacy of bare-metal stents for de novo coronary lesions in patients with stable or unstable angina.

Methods: A meta-analysis of randomized trials from MEDLINE, EMBASE and other electronic databases and conference proceedings was conducted.

Studying outcomes of intensive care unit survivors: measuring exposures and outcomes.

Background: Measurement of long-term outcomes and the patient and intensive care unit (ICU) factors predicting them present investigators with unique challenges. There is little systematic guidance for measuring these outcomes and exposures within the ICU setting. As a result measurement methods are often variable and non-comparable across studies.

Studying outcomes of intensive care unit survivors: the role of the cohort study.

Background: As research focuses on long-term patient outcomes and the "real world" effectiveness of intensive care unit (ICU) therapies, the cohort study is increasingly being used in critical care research.

Methods: Using examples of prior cohort studies in intensive care, we review the key elements of this research design and evaluate its advantages and limitations for critical care research. Furthermore, through a systematic search of the literature we summarize data from 70 prior published cohort studies of medium- and long-term outcomes in adult critical care medicine.

Test of the Epstein-Plesset model for gas microparticle dissolution in aqueous media: effect of surface tension and gas undersaturation in solution.

The gas from a free air bubble will readily dissolve in water, driven by two main factors: the concentration (undersaturation) of dissolved gas in the aqueous solution and the surface tension of the gas bubble-water interface via a Laplace overpressure in the bubble that this creates. This paper experimentally and theoretically investigates each of these effects individually. To study the effects of surface tension, single- and double-chain surfactants were utilized to control and define interfacial conditions of the microbubble in saturated solution.

Quality of life in adult survivors of critical illness: a systematic review of the literature.

Objective: To determine how the quality of life (QOL) of intensive care unit (ICU) survivors compares with the general population, changes over time, and is predicted by baseline characteristics.

Design: Systematic literature review including MEDLINE, EMBASE, CINAHL and Cochrane Library. Eligible studies measured QOL > or = 30 days after ICU discharge using the Medical Outcomes Study 36-item Short Form (SF-36), EuroQol-5D, Sickness Impact Profile, or Nottingham Health Profile in representative populations of adult ICU survivors.

Projected incidence of mechanical ventilation in Ontario to 2026: Preparing for the aging baby boomers.

Objective: The aging baby boomers are expected to have a significant impact on the healthcare system. Mechanical ventilation is an age-dependent, costly, and relatively nondiscretionary medical service that may be particularly affected by the aging population. We forecast the future incidence of mechanical ventilation to the year 2026 to understand the impact of aging baby boomers on critical care resources.

Impact of a lead-safe training program on workers conducting renovation, painting, and maintenance activities.

Objective: An important source of lead exposure is lead-based paint that is disturbed when unsafe work practices are used during renovation, remodeling, and maintenance activities. This study explores the success of a pilot lead-safe skills training program for home improvement contractors and their employees (including renovators, remodelers, and painters) and small property owners.

Methods: The study evaluates whether attendees at eight-hour lead-safe work practices training courses learned and retained information about lead exposure; developed and retained positive attitudes toward lead-safe work practices; and developed lasting, positive behavioral intentions to use lead-safe work practice skills and techniques.

A system factors analysis of airway events from the Intensive Care Unit Safety Reporting System (ICUSRS).

Objective: To evaluate the contributing and limiting factors for airway events reported in the Intensive Care Unit Safety Reporting System (ICUSRS) developed in partnership with the Society of Critical Care Medicine.

Design: Analysis of system factors in airway vs. nonairway events reported to a voluntary, anonymous, Web-based patient safety reporting system (the ICUSRS).

Troponin I and T levels in renal failure patients without acute coronary syndrome: a systematic review of the literature.

Background: Debate surrounds the interpretation of troponin assays for the diagnosis and prognosis of cardiac disease in patients with renal failure.

Objectives: To systematically review the diagnostic and prognostic test characteristics of quantitative serum cardiac troponin I (cTnI) and T (cTnT) in renal failure patients without acute coronary syndrome (ACS) symptoms.

Methods: English-language literature was identified through searching MEDLINE from 1966 to August 2003 and reviewing reference lists.

West Nile virus infection in the intensive care unit: a case series and literature review.

Background: West Nile virus (WNV) is a rapidly spreading infectious disease in North America. Critical care issues related to WNV are not well described.

Objectives: Three cases of severe WNV meningoencephalitis with flaccid paralysis are reported and relevant critical care issues are highlighted.

Mechanical ventilation in Ontario, 1992-2000: incidence, survival, and hospital bed utilization of noncardiac surgery adult patients.

Objective: Mechanical ventilation is a common therapy used in caring for critically ill patients, but its epidemiology is poorly understood. We describe population-based, temporal trends in the incidence, survival, and hospital bed utilization of mechanically ventilated, noncardiac surgery adult patients.

Design: Retrospective, observational cohort study using linked administrative databases.

Intensive care unit physician staffing: financial modeling of the Leapfrog standard.

Objective: To evaluate from a hospital's perspective the costs and savings, over a 1-yr period, of implementing The Leapfrog Group's Intensive Care Unit Physician Staffing (IPS) standard compared with the existing standard of nonintensivist staffing in adult intensive care units.

Design: Using published data, we developed a financial model of costs and savings for 6-, 12- and 18-bed intensive care units using conservative estimates for all variables. Sensitivity analyses, including a best-case and worst-case scenario, were performed to evaluate the impact of changing assumptions on the outcome of the model.

Patient care seeking barriers and tuberculosis programme reform: a qualitative study.

The patient's perspective, including his/her socio-economic and cultural environment, is an important consideration for tuberculosis control programmes. Through semi-structured interviews, this qualitative research studies the barriers to successful care seeking faced by 202 adult patients with pulmonary tuberculosis in urban Zambia. Three common, interdependent themes explain patient barriers to successful care seeking: (1) number of health care encounters and duration of illness prior to diagnosis; (2) existing financial constraints and additional unrecognized patient costs; and (3) travel distances.

Comparative metabolism of 2,4-dichlorophenoxyacetic acid (2,4-D) in rat and dog.

1. There is a significant species difference in the toxicity of 2,4-dichlorophenoxyacetic acid (2,4-D). The oral no overall adverse effect level (NOAEL) for chronic toxicity of 2,4-D in rat is 5 mg kg(-1) day(-1) and in dog is 1 mg kg(-1) day(-1).

A province-wide study of the association between hospital resource allocation and length of stay.

The relationship between hospital resource allocation and clinical efficiency is poorly understood. Within the single-payer healthcare system in Ontario, Canada, the association between hospital spending patterns and length of stay was studied using data from 1117090 patient discharges in 1997/8 at 162 of 171 acute care hospitals. A weighted regression model was created using an overall hospital length of stay index (actual length of stay divided by predicted length of stay) as the dependent variable.