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Number of critical care beds per 100,000 population.

Number of critical care beds per 100,000 population.

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Objective: To assess the number of adult critical care beds in Asian countries and regions in relation to population size. Design: Cross-sectional observational study. Setting: Twenty-three Asian countries and regions, covering 92.1% of the continent's population. Participants: Ten low-income and lower-middle-income economies, five upper-mid...

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Objective To assess the use of the intensive care unit (ICU) and its effect on maternal mortality (MM) among women with severe maternal morbidity (SMM). Materials and Methods A secondary analysis of a cross-sectional study on surveillance of SMM in 27 Brazilian obstetric referral centers. The analysis focused on the association between ICU use and...

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... An ageing society could also induce an increase in ICU admissions and ICU demand. Studies have shown that the organization, structure, and delivery of critical care in China are different from those in Asia, Europe and North America [13][14][15][16]. Critical care medicine in mainland China is still in a phase of development. ...
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Background: Hospital and ICU structural factors are key factors affecting the quality of care as well as ICU patient outcomes. However, the data from China are scarce. This study was designed to investigate how differences in patient outcomes are associated with differences in hospital and ICU structure variables in China throughout 2019. Methods: This was a multicenter observational study. Data from a total of 2820 hospitals were collected using the National Clinical Improvement System Data that reports ICU information in China. Data collection consisted of a) information on the hospital and ICU structural factors, including the hospital type, number of beds, staffing, among others, and b) ICU patient outcomes, including the mortality rate as well as the incidence of ventilator-associated pneumonia (VAP), catheter-related bloodstream infections (CRBSIs), and catheter-associated urinary tract infections (CAUTIs). Generalized linear mixed models were used to analyse the association between hospital and ICU structural factors and patient outcomes. Results: The median ICU patient mortality was 8.02% (3.78%, 14.35%), and the incidences of VAP, CRBSI, and CAUTI were 5.58 (1.55, 11.67) per 1000 ventilator days, 0.63 (0, 2.01) per 1000 catheter days, and 1.42 (0.37, 3.40) per 1000 catheter days, respectively. Mortality was significantly lower in public hospitals (β = - 0.018 (- 0.031, - 0.005), p = 0.006), hospitals with an ICU-to-hospital bed percentage of more than 2% (β = - 0.027 (- 0.034, -0.019), p < 0.001) and higher in hospitals with a bed-to-nurse ratio of more than 0.5:1 (β = 0.009 (0.001, 0.017), p = 0.027). The incidence of VAP was lower in public hospitals (β = - 0.036 (- 0.054, - 0.018), p < 0.001). The incidence of CRBSIs was lower in public hospitals (β = - 0.008 (- 0.014, - 0.002), p = 0.011) and higher in secondary hospitals (β = 0.005 (0.001, 0.009), p = 0.010), while the incidence of CAUTIs was higher in secondary hospitals (β = 0.010 (0.002, 0.018), p = 0.015). Conclusion: This study highlights the association between specific ICU structural factors and patient outcomes. Modifying structural factors is a potential opportunity that could improve patient outcomes in ICUs.
... NICRF uses near real-time high-quality data captured through a cloud-based registry platform, which captures near real-time, high-quality data on case mix, outcomes and care quality metric, enabling setting prioritised improvement, training and research for critical care in Nepal 15 . Critical care is a growing independent speciality in Nepal, but ICU bed availability in the countries is estimated to be 2.8 per 100,000 population, which many ICUs being provided by the private sector 16 . ...
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Background: Unplanned readmissions to Intensive Care Units (ICUs) result in increased morbidity, mortality, and ICU resource utilisation (e.g. prolonged mechanical ventilation), and as such, is a widely utilised metric of quality of critical care. Most of the evidence on incidence, characteristics, associated risk factors and attributable outcomes of unplanned readmission to ICU are from studies performed in high-income countries This study explores the determinants of risk attributable to unplanned ICU readmission in four ICUs in Kathmandu, Nepal. Methods: The registry-embedded eCRF reported data on case mix, severity of illness, in-ICU interventions (including organ support), ICU outcome, and readmission characteristics. Data were captured in all adult patients admitted between September 2019 and February 2021. Population and ICU encounter characteristics were compared between those with and without readmission. Independent risk factors for readmission were assessed using univariate analysis. Results: In total 2948 patients were included in the study. Absolute unplanned ICU readmission rate was 5.60 % (n=165) for all four ICUs. Median time from ICU discharge to readmission was 3 days (IQR=8,1). Of those readmitted, 29.7% (n=49) were discharged at night following their index admission. ICU mortality was higher following readmission to ICU(p=0.016) and mortality was increased further in patients whose primary index discharge was at night(p= 0.019). Primary diagnosis, age, and use of organ support in the first 24hrs of index admission were all independently attributable risk factors for readmission. Conclusions: Unplanned ICU readmission rates were adversely associated with significantly poorer outcomes, increased ICU resource utilisation. Clinical and organisational characteristics influenced risk of readmission and outcome.
... Although the area in Hong Ko relatively small compared with other countries, there are 43 public hospitals and 12 vate hospitals [26]. The number of hospitals is even more than in many developed c tries [27]. Similar to many other countries such as Japan, Hong Kong has recently facing serious aging problems and rising operation costs. ...
... Although the area in Hong Kong is relatively small compared with other countries, there are 43 public hospitals and 12 private hospitals [26]. The number of hospitals is even more than in many developed countries [27]. Similar to many other countries such as Japan, Hong Kong has recently been facing serious aging problems and rising operation costs. ...
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COVID-19 is recognized as an infectious disease generated by serious acute respiratory syndrome coronavirus 2. COVID-19 has rapidly spread all over the world within a short time period. Due to the coronavirus pandemic transmitting quickly worldwide, the impact on global healthcare systems and healthcare supply chain management has been profound. The COVID-19 outbreak has seriously influenced the routine and daily operations of healthcare facilities and the entire healthcare supply chain management and has brough about a public health crisis. As making sure the availability of healthcare facilities during COVID-19 is crucial, the debate on how to take resilience actions for sustaining healthcare supply chain management has gained new momentum. Apart from the logistics of handling human remains in some countries, supplies within the communities are urgently needed for emergency response. This study focuses on a comprehensive evaluation of the current practices of healthcare supply chain management in Hong Kong and the United States under COVID-19 settings. A wide range of different aspects associated with healthcare supply chain operations are considered, including the best practices for using respirators, transport of life-saving medical supplies, contingency healthcare strategies, blood distribution, and best practices for using disinfectants, as well as human remains handling and logistics. The outcomes of the conducted research identify the existing healthcare supply chain trends in two major Eastern and Western regions of the world, Hong Kong and the United States, and determine the key challenges and propose some strategies that can improve the effectiveness of healthcare supply chain management under COVID-19 settings. The study highlights how to build resilient healthcare supply chain management preparedness for future emergencies.
... Critically ill patients are often underserved in resource-limited countries, which may lack the infrastructure to meet the needs of patients requiring critical care [9]. More than 70 countries have fewer than five intensive care unit (ICU) beds per 100,000 population [10], with shortages occurring disproportionately in LMICs [11] (Fig. 1). Major gaps also exist between wealthy and poor countries in effective triage systems, specialized training, material resources, and protocolized care required to provide life-saving care to the sickest patients [12]. ...
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Acute neurologic illnesses (ANI) contribute significantly to the global burden of disease and cause disproportionate death and disability in low-income and middle-income countries (LMICs) where neurocritical care resources and expertise are limited. Shifting epidemiologic trends in recent decades have increased the worldwide burden of noncommunicable diseases, including cerebrovascular disease and traumatic brain injury, which coexist in many LMICs with a persistently high burden of central nervous system infections such as tuberculosis, neurocysticercosis, and HIV-related opportunistic infections and complications. In the face of this heavy disease burden, many resource-limited countries lack the infrastructure to provide adequate care for patients with ANI. Major gaps exist between wealthy and poor countries in access to essential resources such as intensive care unit beds, neuroimaging, clinical laboratories, neurosurgical capacity, and medications for managing complex neurologic emergencies. Moreover, many resource-limited countries face critical shortages in health care workers trained to manage neurologic emergencies, with subspecialized neurocritical care expertise largely absent outside of high-income countries. Numerous opportunities exist to overcome these challenges through capacity-building efforts that improve outcomes for patients with ANI in resource-limited countries. These include research on needs and best practices for ANI management in LMICs, developing systems for effective triage, education and training to expand the neurology workforce, and supporting increased collaboration and data sharing among LMIC health care workers and systems. The success of these efforts in curbing the disproportionate and rising impact of ANI in LMICs will depend on the coordinated engagement of the global neurocritical care community.
... In many LMICs, testing capacity remains inadequate, the number of ICU beds is far less than required, access to drug treatments such as dexamethasone is limited, and the supply of therapeutic oxygen and ventilators is insufficient (1). The scarcity is caused by various factors including the migration to developed countries, shortage of supplies, poor healthcare infrastructure, limited ICU facilities, and lack of access to guidelines and protocols (2). Important difficulties that LMICs are facing are the insufficient testing capacity and the shortage of healthcare providers, which precluded accurate assessment of disease burden and subsequently resource allocations (2). ...
... The scarcity is caused by various factors including the migration to developed countries, shortage of supplies, poor healthcare infrastructure, limited ICU facilities, and lack of access to guidelines and protocols (2). Important difficulties that LMICs are facing are the insufficient testing capacity and the shortage of healthcare providers, which precluded accurate assessment of disease burden and subsequently resource allocations (2). This Research Topic summarizes experience of low-and middle-income countries (LMICs) in managing both the epidemiological transition and the threat of emerging infectious diseases. ...
... Hung et al. reported that very important barriers to optimal care of sepsis patients were inadequate nursing human resources (50%) followed by doctors' workload (41.7%) [35]. An Asian study reported that there are less than three ICU beds per 100,000 persons in most low-and middle-income countries [80]. An observational study conducted in Thailand on sepsis patients reported that the majority of the sepsis patients were managed in the general wards due to a lack of ICU resources [81]. ...
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Sepsis is a life-threatening condition that causes a global health burden associated with high mortality and morbidity. Often life-threatening, sepsis can be caused by bacteria, viruses, parasites or fungi. Sepsis management primarily focuses on source control and early broad-spectrum antibiotics, plus organ function support. Comprehensive changes in the way we manage sepsis patients include early identification, infective focus identification and immediate treatment with antimicrobial therapy, appropriate supportive care and hemodynamic optimization. Despite all efforts of clinical and experimental research over thirty years, the capacity to positively influence the outcome of the disease remains limited. This can be due to limited studies available on sepsis in developing countries, especially in Southeast Asia. This review summarizes the progress made in the diagnosis and time associated with sepsis, colistin resistance and chloramphenicol boon, antibiotic abuse, resource constraints and association of sepsis with COVID-19 in Southeast Asia. A personalized approach and innovative therapeutic alternatives such as CytoSorb® are highlighted as potential options for the treatment of patients with sepsis in Southeast Asia.
... ICU shortage during COVID-19 pandemic in several Asian countries including Indonesia has been reported. (6) In the present case, we report a meningioma patient in whom immediate meningioma resection was considered too risky due to ICU shortage during the COVID-19 pandemic and, therefore, underwent DC and ICP monitoring instead as life-saving measures. This procedure was conducted in the setting of academic hospital. ...
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Introduction: Meningioma is a slow-growing tumor that can cause neurological emergency due to intracranial hypertension. The definitive therapy is indeed emergency resection, but it is not always possible in several countries due to limited capacity and/or capability of the emergency operating room. The use of intraparenchymal fiberoptic intracranial pressure (ICP) monitoring and decompressive craniectomy (DC) in cases of brain tumors might be possible, but it is uncommon. We report a meningioma patient in whom immediate meningioma resection was considered too risky due to intensive care unit (ICU) shortage during COVID-19 pandemic and, therefore, underwent these procedures as life-saving measures. Case presentation: A 24-year-old man was brought to the emergency room with a chief complaint of seizure. Physical examination was notable for decreased consciousness (Glasgow Coma Scale (GCS) 11) and a dilated left pupil with intact light reflex. A contrasted Brain CT Scan revealed extra-axial mass on the left sphenoid with extensive tentacle edema, which pushed the midline structures 2 cm toward the contralateral side. Discussion: The patient was diagnosed with Left Sphenoid Meningioma. We decided to perform intraparenchymal fiberoptic ICP monitor insertion and DC considering the situation, device availability, safety, and efficacy. The patient slowly regained consciousness in the recovery room after the procedure. The best-observed GCS was 12. Two weeks afterward, the patient came back to our outpatient clinic neurologically intact. The patient was then planned for elective tumor resection. Conclusion: ICP monitoring and DC are not commonly performed on brain tumor cases. However, in suboptimal situations, these procedures might save lives. The present case showed that ICP monitor and DC were helpful in times of ICU shortage.
... The provision of high-quality critical care in low-and middle-income countries (LMICs) is challenging due to the burden these requirements place on infrastructure, healthcare expenditure and human resources (1)(2)(3). Furthermore, the limited data available indicate that the number of critical care beds in LMICs are significantly lower than high-income countries (4)(5)(6)(7)(8). ...
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Background Critically ill patients often require complex clinical care by highly trained staff within a specialized intensive care unit (ICU) with advanced equipment. There are currently limited data on the costs of critical care in low-and middle-income countries (LMICs). This study aims to investigate the direct-medical costs of key infectious disease (tetanus, sepsis, and dengue) patients admitted to ICU in a hospital in Ho Chi Minh City (HCMC), Vietnam, and explores how the costs and cost drivers can vary between the different diseases. Methods We calculated the direct medical costs for patients requiring critical care for tetanus, dengue and sepsis. Costing data (stratified into different cost categories) were extracted from the bills of patients hospitalized to the adult ICU with a dengue, sepsis and tetanus diagnosis that were enrolled in three studies conducted at the Hospital for Tropical Diseases in HCMC from January 2017 to December 2019. The costs were considered from the health sector perspective. The total sample size in this study was 342 patients. Results ICU care was associated with significant direct medical costs. For patients that did not require mechanical ventilation, the median total ICU cost per patient varied between US$64.40 and US$675 for the different diseases. The costs were higher for patients that required mechanical ventilation, with the median total ICU cost per patient for the different diseases varying between US$2,590 and US$4,250. The main cost drivers varied according to disease and associated severity. Conclusion This study demonstrates the notable cost of ICU care in Vietnam and in similar LMIC settings. Future studies are needed to further evaluate the costs and economic burden incurred by ICU patients. The data also highlight the importance of evaluating novel critical care interventions that could reduce the costs of ICU care.
... Compared with other developed countries, Japan has fewer ICU beds ( ve beds per 100,000 people). In western countries, the number of ICU beds varies: 3.5 beds per 100,000 population in the U.K., 9.3 beds per 100,000 population in France, 13.5 beds per 100,000 population in Canada, and 20 beds per 100,000 population in the U.S. [15,32,33]. In addition to variations in the number of ICU beds, the indications for ICU admission and critical care services vary among these countries. ...
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Background: A substantial number of sepsis patients require specialized care, including multidisciplinary care, close monitoring, and artificial organ support in the intensive care unit (ICU). However, the efficacy of ICU management on clinical outcomes remains insufficiently researched. Therefore, we tested the hypothesis that ICU admission would increase the survival rate among sepsis patients. Methods: We conducted a retrospective study using the nationwide medical claims database of sepsis patients in Japan from 2010–2017 with propensity score matching to adjust for baseline imbalances. Patients aged over 20 years, with a combined diagnosis of presumed serious infection and organ failure, were included in this study. The primary outcome studied was the in-hospital mortality among non-ICU and ICU patients. In addition to propensity score matching, we performed sensitivity analyses for the primary outcome. As the treatment policy was not extracted from the database, we performed subgroup analyses to determine mortality differences in age subgroups based on the assumption that treatment intensity is likely to decrease in older adults. Results: Among 1,276,678 sepsis patients (1,076,912 in non-ICU and 199,766 in ICU settings), the unadjusted in-hospital mortality was 18.4% among non-ICU patients and 22.5% among ICU patients (p<0.001). After propensity score matching, the in-hospital mortality was 30.2% among non-ICU patients and 20.6% among ICU patients (p<0.001). In-hospital mortality with a multivariable regression analysis (B10.3% [95% CI a10.5 to c10.1], p<0.001) or inverse probability weighting (k5.6% [95% CI g5.7 to r5.5], p<0.001) was comparable with the results of the propensity score matching analysis. In the subgroup analyses, the mortality difference between non-ICU and ICU was o5.7% [95% CI u6.1 to n5.1] in the adult group (20 ≤ age ≤ 64), d10.6% [95% CI :11.2 to 10.1] in the old group (65 ≤ age ≤ 74), and A11.1% [95% CI 11.6 to s10.7] in the oldest old group (75 ≤ age) (p<0.001). Conclusions: Herein, using the nationwide medical claims database, we demonstrated that ICU admission contributes towards decreasing in-hospital mortality among sepsis patients. Further investigations are warranted to validate these results and elucidate the mechanisms favoring ICU management on clinical outcomes.
... Tingginya peningkatan kasus di Indonesia, sayangnya tidak diiringi oleh kesiapan fasilitas pendukung serta tenaga kesehatan yang memadai dan cukup. (Phua et al., 2020) menyatakan bahwa jumlah tempat tidur ICU di Indonesia tidak sebanding dengan jumlah penduduk. Rasio perbandingannya adalah 2,7 per 100.000 ...
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Penelitian ini dilakukan dengan tujuan untuk menganalisis faktor – faktor yang berpengaruh terhadap kepuasan kerja tenaga kesehatan, khususnya di kota Batam dalam mengahadapi Covid-19. Faktor yang dimaksud antara lain kepemimpinan transformasional, dukungan sosial, totalitas kerja, keyakinan diri dan penghargaan. Populasi penelitian ini tenaga kesehatan di kota Batam yang berjumlah 4808. Data penelitian dikumpulkan melalui pengisian kuesioner pada google form yang disebarkan melalui grup whatsapp dan mengajukan permohonan ijin ke rumah sakit/klinik kesehatan. Kuesioner berisi pertanyaan sebanyak 38 butir. Data penelitian diolah dengan analisis regresi berganda. Responden dalam penelitian ini sebanyak 229 orang tenaga kesehatan yang berada di kota Batam. Hasil penelitian ini membuktikan bahwa ada pengaruh signifikan antara dukungan sosial, keyakinan diri dan penghargaan terhadap kepuasan kerja tenaga kesehatan di kota Batam dalam menghadapi Covid-19. Sementara itu kepemimpinan transformasional dan totalitas kerja tidak memiliki hubungan yang signifikan terhadap kepuasan kerja.