Sex Differences in Treatment of Adult Intensive Care Patients: A Systematic Review and Meta-Analysis.

OBJECTIVES: To evaluate and synthesize the available literature on sex differences in the treatment of adult ICU patients. DATA SOURCES: MEDLINE and EMBASE. STUDY SELECTION: Two reviewers independently screened publications to identify observational studies of adult ICU patients that explicitly examined the association between sex and ICU treatment-specifically, mechanical ventilation, renal replacement therapy, and length of stay. DATA EXTRACTION: We extracted data independently and in duplicate: mean age, illness severity, use of mechanical ventilation and renal replacement therapy, and length of stay in ICU and hospital. We assessed risk of bias using the Newcastle-Ottawa Scale. We used a DerSimonian-Laird random-effects model to calculate pooled odds ratios (ORs) and mean differences between women and men. DATA SYNTHESIS: We screened 4,098 publications, identifying 21 eligible studies with 545,538 participants (42.7% women). The study populations ranged from 246 to 261,255 participants (median 4,420). Most studies (76.2%) were at high risk of bias in at least one domain, most commonly representativeness or comparability. Women were less likely than men to receive invasive mechanical ventilation (OR, 0.83; 95% CI, 0.77-0.89; I2 = 90.4%) or renal replacement therapy (OR, 0.79; 95% CI, 0.70-0.90; I2 = 76.2%). ICU length of stay was shorter in women than men (mean difference, -0.24 d; 95% CI, -0.37 to -0.12; I2 = 89.9%). These findings persisted in meta-analysis of data adjusted for illness severity and other confounders and also in sensitivity analysis excluding studies at high risk of bias. There was no significant sex difference in duration of mechanical ventilation or hospital length of stay. CONCLUSIONS: Women were less likely than men to receive mechanical ventilation or renal replacement therapy and had shorter ICU length of stay than men. There is substantial heterogeneity and risk of bias in the literature; however, these findings persisted in sensitivity analyses.

Sex differences in illness severity and mortality among adult intensive care patients: A systematic review and meta-analysis.

PURPOSE: To investigate the association between sex and illness severity and mortality of ICU patients. METHODS: We performed systematic searches of MEDLINE and EMBASE for observational studies of adult ICU patients that explicitly examined the association between sex and illness severity or mortality. We used a random effects model to calculate standardised mean differences in illness severity scores and pooled odds ratios for mortality of women compared to men. RESULTS: We identified 21 studies with 505,138 participants in total (43.1% women). There was substantial heterogeneity among studies. Only two studies were at low risk of bias overall. At ICU admission, there was a pattern of higher illness severity scores among women (standardised mean difference 0.04, 95% CI -0.01-0.09). Women had higher risk-adjusted mortality than men at ICU discharge (OR 1.25 95% CI 1.03-1.50) and 1 year (OR 1.08, 95% CI 1.02-1.13), however this finding was not robust to sensitivity analysis. CONCLUSIONS: Women tend to have higher illness severity scores at ICU admission. Women also appear to have higher risk-adjusted mortality than men at ICU discharge and at 1 year. Given the heterogeneity and risk of bias in the existing literature, additional studies are needed to confirm or refute these findings.

Game of Hospitals.

BACKGROUND: Systems of health care is a key learning area in medical curricula. An understanding of the health care system with regards to reducing medical errors, improving efficiency in the provision of care and cost containment is recognised as being difficult to teach. CONTEXT: A game-based session was designed and executed as part of a medical student conference. This session incorporated numerous aspects of systems of health care, including teamwork, the efficient and equitable allocation of resources, safety, quality, medical errors, structure of health care systems and political influences in the delivery of health care. INNOVATION: Game of Hospitals employs experiential learning, enhanced by role-play and competition. Students take on roles as hospital administrators and doctors to negotiate complex clinical and administrative problems. The scenarios explore themes, and highlight patient outcomes and the finite nature of resources. Student experiences were observed and questionnaire evaluations attempted to explore student perceptions. An understanding of the health care system … is recognised as being difficult to teach IMPLICATIONS: Game of Hospitals appears to be a popular learning activity. Observations during the game demonstrated the active involvement of participants, and questionnaire evaluation revealed this to be a favourite session at the student conference. This paper presents a detailed explanation of the set-up and rules for the game in the hope that others can adopt and modify the game to suit their local context.