Importance: Recent reports identify that among hospitalized coronavirus disease 2019 patients, 30% require ICU care. Understanding ICU resource needs remains an essential component of meeting current and projected needs of critically ill coronavirus disease 2019 patients. Objectives: This study queried U.S. ICU clinician perspectives on challenging aspects of care in managing coronavirus disease 2019 patients, current and anticipated resource demands, and personal stress. Design, Setting, and Participants: Using a descriptive survey methodology, an anonymous web-based survey was administered from April 7, 2020, to April 22, 2020 (email and newsletter) to query members of U.S. national critical care organizations. Measurements and Main Results: Through a 16-item descriptive questionnaire, ICU clinician perceptions were assessed regarding current and emerging critical ICU needs in managing the severe acute respiratory syndrome coronavirus 2 infected patients, resource levels, concerns about being exposed to severe acute respiratory syndrome coronavirus 2, and perceived level of personal stress. A total of 9,120 ICU clinicians responded to the survey, representing all 50 U.S. states, with 4,106 (56.9%) working in states with 20,000 or more coronavirus disease 2019 cases. The 7,317 respondents who indicated their profession included ICU nurses (n = 6,731, 91.3%), advanced practice providers (nurse practitioners and physician assistants; n = 334, 4.5%), physicians (n = 212, 2.9%), respiratory therapists (n = 31, 0.4%), and pharmacists (n = 30, 0.4%). A majority (n = 6,510, 88%) reported having cared for a patient with presumed or confirmed coronavirus disease 2019. The most critical ICU needs identified were personal protective equipment, specifically N95 respirator availability, and ICU staffing. Minimizing healthcare worker virus exposure during care was believed to be the most challenging aspect of coronavirus disease 2019 patient care (n = 2,323, 30.9%). Nurses report a high level of concern about exposing family members to severe acute respiratory syndrome coronavirus 2 (median score of 10 on 0-10 scale). Similarly, the level of concern reached the maximum score of 10 in ICU clinicians who had provided care to coronavirus disease 2019 patients. Conclusions: This national ICU clinician survey identifies continued concerns regarding personal protective equipment supplies with the chief issue being N95 respirator availability. As the pandemic continues, ICU clinicians anticipate a number of limited resources that may impact ICU care including personnel, capacity, and surge potential, as well as staff and subsequent family members exposure to severe acute respiratory syndrome coronavirus 2. These persistent concerns greatly magnify personal stress, offering a therapeutic target for professional organization and facility intervention efforts.

Our study demonstrates a lack of well-designed studies addressing drug class combination-associated AKI. The combination of NSAIDs and diuretics with or without additional renin-angiotensin aldosterone agents had the strongest level of evidence. Despite limitations, the information included in this review may result in additional scrutiny about combining certain individual nephrotoxic drugs.

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Effects of dietary iron deficiency on growth, the distribution of hemoglobin (Hb) at rest and during exercise, the characteristics of muscle fiber types, and glycogen depletion patterns were studied in newly weaned male mice. Forty-eight mice were randomly divided into iron-deficient and control diet groups. Severe iron deficiency impaired general growth, but growth was restored following iron repletion. The mean +/- SEM blood Hb concentrations at rest after 7 weeks were 5.8 +/- 0.7 and 12.5 +/- 0.3 g/dl in iron-deficient and control groups, respectively. The mice fed iron-deficient diet for 7 weeks had an increased Hb level of 10.9 +/- 0.5 g/dl 1 week after an i.p. injection of Imferon (1.25 mg Fe). The Hb contents in brain and gastrocnemius as well as whole body were lowered by iron deficiency. Iron-deficient anemic mice tended to increase the percent distribution of Hb to brain during exercise. This value was significantly greater than in control and iron-treated groups. The iron-deficient group had relatively less glycogen than controls, but no significant tendency in glycogen depletion pattern was observed in any fiber types. It is suggested that decreased Hb content in working muscles due, in part, to greater distribution to brain could be one of the limiting factors for work performance in anemic individuals. It is further suggested that decrease in oxidative muscle fibers as well as the decreased concentration and/or activities of oxidative substances may also be one of the limiting factors.

OBJECTIVES: There is little understanding on the true cost of operating room time in Canada despite the fact that surgical care is paid for by a single payer facing increasing cost constraints. The objective of the review was to analyze how OR costs are currently conceived of in Canadian hospitals. Additionally, a micro costing approach was used to estimate the actual cost using a bottom-up approach. METHODS: A literature search was conducted to determine how Canadian hospitals perceived the value of one hour of operating time. Studies satisfying the defined criteria were compared in terms of methodology and inclusion and exclusion of specific resources in their perception of their institution's OR expenditure. All costs were adjusted to 2014 Canadian dollars. Additionally, we conducted an independent bottom-up micro-costing analysis of Canadian operating room time. Completion of the literature review prior to micro costing ensured a robust and comprehensive approach was used. Costs were obtained using peer-reviewed literature and from a large Canadian hospital network. RESULTS: Specific search and inclusion criteria resulted in the inclusion of 5 studies in our analysis. The cost of OR time ranged greatly from $621.60 to $2288.94 per hour. All studies obtained the cost of OR time using a top-down case-costing approach informed with data from their respective finance departments. Each study was conducted at a different Canadian hospital and OR costs were perceived in strikingly different ways. Additionally, many of the studies lacked sufficient methodological details providing a challenge when comparing approaches. The bottom-up micro case-costing approach incorporated more than 30 individual costs and resulted in an OR hourly cost of $1200. CONCLUSIONS: In Canada, there is little consensus between institutions of how to capture the costs of OR time. A bottom-up micro costing approach allowed for a different perspective and a more detailed analysis.OBJECTIVES: In less developed nations public resources are scarce and medicines are often not adequate, nor accessible for much of the population. Only limited quantitative data are available for analysis of the pharmaceutical expenditure in Mongolia. METHODS: Retrospective data collection on pharmaceutic expenditure from government issued reports were collected and analysed for the period of six years starting from 2009 until 2014. RESULTS: The gross domestic product (GDP) was 11.52 billion USD in 2013 in Mongolia and the proportion of total health expenditure (THE) was 566.5 billion Mongolian National Tugrug (MNT) or 301.4 million USD. For 2014, the total pharmaceutical expenditure (TPE) was 81.3 billion MNT or 11.6% of the THE. The public pharmaceutical expenditure (PPE) per capita was 28727.9 MNT or 15.3 USD in 2013. Mongolia is a developing country and the public expenditure on pharmaceuticals per capita was in the mid-range of developing country expenditure. The funding source of pharmaceuticals in Mongolia was analysed and the external source played a minimal ro...