BackgroundThe aim of the study was to understand the current status of intensive care unit (ICU) in order to optimize the resources achieving the best possible care.MethodsThe study analyzed the status of ICU settings based on the Taiwan National Health Insurance database between March 2004 and February 2009.ResultsA total of 1,028,364 ICU patients were identified. The age was 65 ± 18 years, and 61% of the patients were male. The total ICU bed occupancy rate was 83.8% which went up to 87.3% during winter. The ICU bed occupancy was 94.4% in major medical centers. The ICU stay was 6.5 ± 0.5 days, and the overall ICU mortality rate was 20.2%. The hospital stay was 16.4 ± 16.8 days, and the average cost of total hospital stay was approximately US$5,186 per patient.ConclusionsThe rate of ICU bed occupancy was dependent on seasonal changes, and it reached near full capacity in major medical centers in Taiwan. The ICU beds were distributed based on the categories of hospitals in order to achieve a reasonable cost efficiency. ICU faces many challenges to maintain and improve quality care because of the increasing cost of state-of-the-art technologies and dealing with aging population.
Objectives: Perioperative bleeding sometimes results in severe consequence. An understanding of hemostasis approaches is crucial in managing the operations. This review aims to show the development of hemostasis in surgery around the world including China. MethOds: Literature in PUBMED was searched between 2009 and 2014; search terms included hemostasis and surgery; filters included human, English and clinical trials. A similar search was done in Chinese CNKI database. Searching results were carefully reviewed and studies compatible with our inclusion criteria were then selected. Results: From an initial search which yielded 99 references in PUBMED and 50 references in CNKI, 54 articles in PUBMED and 16 articles in CNKI were included in the review. Operations in 11 subjects were involved in these articles. We found that conventional hemostasis (classic technique of tying and knots, resorbable ligature) was gradually replaced by novel techniques such as bipolar tissue sealant device, ultrasound scalpel, hempclips, blue-violet light emitting diode irradiation, Ankaferd Blood Stopper, etc. Fibrin sealant, collagen hemostat and chitosan gel had important roles to be supplement. Certain drugs (tranexamic acid, Fibrinogen concentrate, hemocoagulase, etc) used perioperatively could be efficient too. On the other hand, some new techniques (vascular clips) failed to show significant benefits in some subjects (thyroid surgery). Furthermore, some techniques (bipolar coagulation) might affect the postoperative function of certain organs (ovary). While some techniques (harmonic scalpel) could save the whole cost in hospital, most could not. Information in China was similar with the world. cOnclusiOns: Some of the novel hemostasis approaches in surgery could decrease blood loss perioperatively as well as reduce operative time, hospital stay, the rate of complications and the whole cost. However, some shortcomings still exist and more correlative researches should be performed in the future.
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