Physician staffing needs in critical care departments

array:24 ["pii" => "S2173572717302060" "issn" => "21735727" "doi" => "10.1016/j.medine.2017.12.001" "estado" => "S300" "fechaPublicacion" => "2018-01-01" "aid" => "1123" "copyright" => "Elsevier España, S.L.U. and SEMICYUC" "copyrightAnyo" => "2017" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Med Intensiva. 2018;42:37-46" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2043 "formatos" => array:3 [ "EPUB" => 190 "HTML" => 1121 "PDF" => 732 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0210569117302851" "issn" => "02105691" "doi" => "10.1016/j.medin.2017.09.013" "estado" => "S300" "fechaPublicacion" => "2018-01-01" "aid" => "1123" "copyright" => "Elsevier España, S.L.U. y SEMICYUC" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Med Intensiva. 2018;42:37-46" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 6159 "formatos" => array:3 [ "EPUB" => 225 "HTML" => 4432 "PDF" => 1502 ] ] "es" => array:12 [ "idiomaDefecto" => true "cabecera" => "Artículo especial" "titulo" => "Estimación de las necesidades de profesionales médicos en los servicios de medicina intensiva" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "37" "paginaFinal" => "46" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Physician staffing needs in critical care departments" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "V. Gómez Tello, J. Ruiz Moreno, M. Weiss, E. González Marín, P. Merino de Cos, N. Franco Garrobo, A. Alonso Ovies, J.C. Montejo González, T. Iber, G. Marx, V. Córcoles González, F. Gordo Vidal, E. Palencia Herrejón, J. Roca Guiseris" "autores" => array:15 [ 0 => array:2 [ "nombre" => "V." "apellidos" => "Gómez Tello" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Ruiz Moreno" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Weiss" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "González Marín" ] 4 => array:2 [ "nombre" => "P." "apellidos" => "Merino de Cos" ] 5 => array:2 [ "nombre" => "N." "apellidos" => "Franco Garrobo" ] 6 => array:2 [ "nombre" => "A." "apellidos" => "Alonso Ovies" ] 7 => array:2 [ "nombre" => "J.C." "apellidos" => "Montejo González" ] 8 => array:2 [ "nombre" => "T." "apellidos" => "Iber" ] 9 => array:2 [ "nombre" => "G." "apellidos" => "Marx" ] 10 => array:2 [ "nombre" => "V." "apellidos" => "Córcoles González" ] 11 => array:2 [ "nombre" => "F." "apellidos" => "Gordo Vidal" ] 12 => array:2 [ "nombre" => "E." "apellidos" => "Palencia Herrejón" ] 13 => array:2 [ "nombre" => "J." "apellidos" => "Roca Guiseris" ] 14 => array:1 [ "colaborador" => "en nombre de la Sociedad Española de Medicina Intensiva y del German Board of Anesthesiologists" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173572717302060" "doi" => "10.1016/j.medine.2017.12.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572717302060?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569117302851?idApp=WMIE" "url" => "/02105691/0000004200000001/v2_201802080938/S0210569117302851/v2_201802080938/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173572717302072" "issn" => "21735727" "doi" => "10.1016/j.medine.2017.12.002" "estado" => "S300" "fechaPublicacion" => "2018-01-01" "aid" => "1087" "copyright" => "Elsevier España, S.L.U. and SEMICYUC" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Intensiva. 2018;42:47-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1538 "formatos" => array:3 [ "EPUB" => 168 "HTML" => 761 "PDF" => 609 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "Point of view" "titulo" => "Evolution to the early detection of severity. Where are we going?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "47" "paginaFinal" => "49" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Evolución a la detección precoz de gravedad. ¿Hacia dónde vamos?" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F. Gordo, R. Molina" "autores" => array:2 [ 0 => array:2 [ "nombre" => "F." "apellidos" => "Gordo" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Molina" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S021056911730205X" "doi" => "10.1016/j.medin.2017.06.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S021056911730205X?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572717302072?idApp=WMIE" "url" => "/21735727/0000004200000001/v1_201802081105/S2173572717302072/v1_201802081105/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2173572718300134" "issn" => "21735727" "doi" => "10.1016/j.medine.2017.09.001" "estado" => "S300" "fechaPublicacion" => "2018-01-01" "aid" => "1122" "copyright" => "Elsevier España, S.L.U. and SEMICYUC" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Med Intensiva. 2018;42:5-36" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3888 "formatos" => array:3 [ "EPUB" => 157 "HTML" => 2933 "PDF" => 798 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Consensus statement" "titulo" => "Diagnosis and treatment of catheter-related bloodstream infection: Clinical guidelines of the Spanish Society of Infectious Diseases and Clinical Microbiology and (SEIMC) and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC)" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "5" "paginaFinal" => "36" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Diagnóstico y tratamiento de la bacteriemia relacionada con catéter: guía de práctica clínica de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC) y de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC)" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1660 "Ancho" => 2520 "Tamanyo" => 270168 ] ] "descripcion" => array:1 [ "en" => "Approach to the management of a patient with suspicion of CRBSI. (1) Vancomycin (alternative daptomycin; see text for specific recommendations for this agent) plus antibiotic therapy to cover Gram-negative bacilli if: the femoral catheter is in place, the focus of Gram-negative infection is known, with a high index of colonization by Gram-negative bacilli or prolonged admission in ICU. As the patient is clinically stable, consider antifungal therapy (fluconazole) in patients with total parenteral nutrition, prolonged use of broad-spectrum antibiotics, malignancy, femoral catheterization, colonization due to Candida species at multiple sites or previous anti-anaerobic therapy. (2) Semi-quantitative or quantitative tip culture. (3) Catheter can be maintained only in patients without septic shock secondary to CRBSI, without intravascular devices, and if the culprit pathogen is a CoNS (except Staphylococcus lugdunensis) or a Gram-negative bacilli if the isolate is susceptible to antibiotics that are available for ALT. See <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> for management. (4) See text and <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> for choosing targeted treatment, duration of therapy, and need for echocardiography. (5) Vancomycin (alternative daptomycin; see text for specific recommendations of this agent) plus antibiotic therapy to cover Gram-negative bacilli plus an antifungal agent in patients with septic shock or in other patients if: total parenteral nutrition, prolonged use of broad-spectrum antibiotics, malignancy, femoral catheterization, colonization due to Candida species at multiple sites or intense previous anti-anaerobic therapy. Echinocandins, or liposomal amphotericin B as an alternative should be used only in patients with septic shock. Fluconazole is the drug of choice for the remainder of situations, except in patients colonized by fluconazole-resistant Candida spp. Patients with suppuration at the insertion site but without the other conditions should not receive antibiotic therapy active against Gram-negative bacilli and antifungal agents. DTP: differential time to positivity; QBC: quantitative blood culture." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F. Chaves, J. Garnacho-Montero, J.L. del Pozo, E. Bouza, J.A. Capdevila, M. de Cueto, M.Á. Domínguez, J. Esteban, N. Fernández-Hidalgo, M. Fernández Sampedro, J. Fortún, M. Guembe, L. Lorente, J.R. Paño, P. Ramírez, M. Salavert, M. Sánchez, J. Vallés" "autores" => array:18 [ 0 => array:2 [ "nombre" => "F." "apellidos" => "Chaves" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Garnacho-Montero" ] 2 => array:2 [ "nombre" => "J.L." "apellidos" => "del Pozo" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Bouza" ] 4 => array:2 [ "nombre" => "J.A." "apellidos" => "Capdevila" ] 5 => array:2 [ "nombre" => "M." "apellidos" => "de Cueto" ] 6 => array:2 [ "nombre" => "M.Á." "apellidos" => "Domínguez" ] 7 => array:2 [ "nombre" => "J." "apellidos" => "Esteban" ] 8 => array:2 [ "nombre" => "N." "apellidos" => "Fernández-Hidalgo" ] 9 => array:2 [ "nombre" => "M." "apellidos" => "Fernández Sampedro" ] 10 => array:2 [ "nombre" => "J." "apellidos" => "Fortún" ] 11 => array:2 [ "nombre" => "M." "apellidos" => "Guembe" ] 12 => array:2 [ "nombre" => "L." "apellidos" => "Lorente" ] 13 => array:2 [ "nombre" => "J.R." "apellidos" => "Paño" ] 14 => array:2 [ "nombre" => "P." "apellidos" => "Ramírez" ] 15 => array:2 [ "nombre" => "M." "apellidos" => "Salavert" ] 16 => array:2 [ "nombre" => "M." "apellidos" => "Sánchez" ] 17 => array:2 [ "nombre" => "J." "apellidos" => "Vallés" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572718300134?idApp=WMIE" "url" => "/21735727/0000004200000001/v1_201802081105/S2173572718300134/v1_201802081105/en/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "Special article" "titulo" => "Physician staffing needs in critical care departments" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "37" "paginaFinal" => "46" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "V. Gómez Tello, J. Ruiz Moreno, M. Weiss, E. González Marín, P. Merino de Cos, N. Franco Garrobo, A. Alonso Ovies, J.C. Montejo González, T. Iber, G. Marx, V. Córcoles González, F. Gordo Vidal, E. Palencia Herrejón, J. Roca Guiseris" "autores" => array:15 [ 0 => array:3 [ "nombre" => "V." "apellidos" => "Gómez Tello" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "J." "apellidos" => "Ruiz Moreno" "email" => array:1 [ 0 => "javiruiz@wanadoo.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "M." "apellidos" => "Weiss" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "E." "apellidos" => "González Marín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "P." "apellidos" => "Merino de Cos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 5 => array:3 [ "nombre" => "N." "apellidos" => "Franco Garrobo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "f" "identificador" => "aff0030" ] ] ] 6 => array:3 [ "nombre" => "A." "apellidos" => "Alonso Ovies" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "g" "identificador" => "aff0035" ] ] ] 7 => array:3 [ "nombre" => "J.C." "apellidos" => "Montejo González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "h" "identificador" => "aff0040" ] ] ] 8 => array:3 [ "nombre" => "T." "apellidos" => "Iber" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "i" "identificador" => "aff0045" ] ] ] 9 => array:3 [ "nombre" => "G." "apellidos" => "Marx" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "j" "identificador" => "aff0050" ] ] ] 10 => array:3 [ "nombre" => "V." "apellidos" => "Córcoles González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "k" "identificador" => "aff0055" ] ] ] 11 => array:3 [ "nombre" => "F." "apellidos" => "Gordo Vidal" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "l" "identificador" => "aff0060" ] ] ] 12 => array:3 [ "nombre" => "E." "apellidos" => "Palencia Herrejón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "m" "identificador" => "aff0065" ] ] ] 13 => array:3 [ "nombre" => "J." "apellidos" => "Roca Guiseris" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "n" "identificador" => "aff0070" ] ] ] 14 => array:1 [ "colaborador" => "on behalf of the Spanish Society of Intensive Care Medicine and the German Board of Anesthesiologists" ] ] "afiliaciones" => array:14 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Moncloa, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Universitari Sagrat Cor, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Klinik für Anästhesiologie, Universitätsklinikum, Ulm, Germany" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital Universitari Sagrat Cor, Barcelona, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital de Can Misses, Ibiza, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Universitario de Móstoles, Madrid, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Universitario de Fuenlabrada, Madrid, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital 12 de Octubre, Madrid, Spain" "etiqueta" => "h" "identificador" => "aff0040" ] 8 => array:3 [ "entidad" => "Stadtklinik Baden-Baden und des Kreiskrankenhauses Bühl, Institut f. Anästhesiologie und Intensivmedizin, Baden-Baden, Germany" "etiqueta" => "i" "identificador" => "aff0045" ] 9 => array:3 [ "entidad" => "Klinik für Operative Intensivmedizin und Intermediate Care, Aachen, Germany" "etiqueta" => "j" "identificador" => "aff0050" ] 10 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Complejo Hospitalario Universitario de Albacete, Albacete, Spain" "etiqueta" => "k" "identificador" => "aff0055" ] 11 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, Spain" "etiqueta" => "l" "identificador" => "aff0060" ] 12 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Infanta Leonor, Madrid, Spain" "etiqueta" => "m" "identificador" => "aff0065" ] 13 => array:3 [ "entidad" => "Servicio de Medicina Intensiva. Hospital Virgen de las Nieves, Granada, Spain" "etiqueta" => "n" "identificador" => "aff0070" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estimación de las necesidades de profesionales médicos en los servicios de medicina intensiva" ] ] "textoCompleto" => "IntroductionProductivity in critical care medicine departments (CCMD) is a complex issue, and costs are high, which is why it is absolutely justified to address the problem of the workforce sizing of intensivists. There have been intensive care (IC) societies that have elaborated recommendations on the needs for intensivists<a class="elsevierStyleCrossRefs" href="#bib0155">1,2</a> based on very different healthcare models on the management of critical patients (CP) rather than on adequacy analyses of the intensivists’ productivity by measuring the intensivist/bed ratios (the reference source is shown in <a class="elsevierStyleCrossRef" href="#sec0065">electronic tables 1</a>,<a class="elsevierStyleCrossRefs" href="#bib0165">3–11</a> 2<a class="elsevierStyleCrossRefs" href="#bib0155">1,2,12–15</a> and 3<a class="elsevierStyleCrossRefs" href="#bib0175">5,16,17</a> of <a class="elsevierStyleCrossRef" href="#sec0065">additional material</a>). In Spain, several recommendations have been proposed,<a class="elsevierStyleCrossRef" href="#bib0220">14</a> but all with the same philosophy of taking the doctor/bed ratio into consideration. Since they do not take productivity into consideration, such recommendations have called for reducing the number of intensivists. For all these reasons, in 2013, the Spanish Society of Intensive Care Medicine and Coronary Units established a technical taskforce of experts to assess the reference sources and recommendations from other similar societies, provide its own experience, and elaborate recommendations on the need for intensivists in the CCMD setting including their entire productivity, and a method to estimate the real number of intensivists needed (<a class="elsevierStyleCrossRef" href="#sec0065">see the spreadsheet provided in the additional material</a>). These recommendations should include the existing new trends on the management of CPs, issues of economic effectiveness and efficiency, and giving explicit value to the intensivists’ know-how.MethodologyThe technical taskforce including eight expert intensivists categorized productivity into the following five areas of knowledge (or 5 subcommittees) corresponding to five activities that make up the service portfolio of most CCMDs: (1) healthcare; (2) activities outside the ICU (AO-ICU); (3) research; (4) teaching; and (5) patient safety (PS) and clinical management (CM). Two senior intensivists joined this technical committee and collected all the feedback (FG, EP).The reference search included four databases: PubMed, Excerpta Medica data BASE (EMBASE), the Index of Scientific and Technical Literature of Latin America and the Caribbean (LILACS), and the Spanish Bibliographic Index of Health Sciences (IBECS); 845 references were found from the year 2000 (including prior quotations when needed) to the year 2015 that were reduced to 155 and then categorized based on the aforementioned five subcommittees.The results from each subcommittee are expressed in a double way. On the one hand, the activities to be conducted (healthcare, AO-ICU, teaching, research, and CM/PS) are listed, and, on the other hand, the time that every intensivist spends conducting each activity expressed in activity percentage. For the time estimate a double methodology was used based on whether we would be dealing with healthcare activities or less instrumental activities. When it comes to healthcare activities—internal (within the ICU) and outside the CCMD, they can easily be measured using experience and elaborated by consensus from the subcommittee, yet we are talking about illustrative time frames so that every CCMD can present its best value based on its structural reality and logistics, while making recommendations that the final value should be feasible and reproducible in case of authorship. When it comes to less instrumental activities—research, teaching, and CM/PS, assessment is more difficult both in its type and time spent, which is why choosing one qualitative criterion can always be arbitrary. In view of all this, one tool was used for the CM of CPs: the setting/productivity matrix of the critical patient (PMCP)<a class="elsevierStyleCrossRef" href="#bib0240">18</a> (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>) that stipulates what percentages of time each intensivist spends, based on his professional category, doing each and every one of the five activities associated with the management of CPs. This PMCP is generic yet associated to the singularities of each CCMD, in particular, being 100 the maximum percentage of time spent for allocation purposes. The PMCP makes no sense if we consider the ICU but not the CCMD when only implemented it to pick up the activity occurring inside and outside the ICU. The PMCP vertical axis describes the physical action setting of the team managing the CP (with allocated time percentages) and the PMCP horizontal axis shows the specific productivity (with allocated time percentages). It is assumed that depending on this or that autonomous community and this or that labor contract, every intensivist should have three possible annual schedules: 1825h (or 40h/week), or 1750h (or 38h/week), or 1711h (or 37.5h/week).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Finally, the time frames and activities established by every subcommittee were tabulated in a spreadsheet derived from another spreadsheet developed by 3 German authors (MW, TI and GM)<a class="elsevierStyleCrossRef" href="#bib0245">19</a> that these authors helped modify; such a spreadsheet was used as the basis for the ultimate spreadsheet proposal (<a class="elsevierStyleCrossRef" href="#sec0065">see additional material</a>). One expert physician savvy on spreadsheets and databases (EG) developed the final model.ResultsManagement and healthcare activities in the intensive care unitThe healthcare activities and estimate time frames occurring within the ICU are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> and they have to do with the hospitalizations of patients, with routine daily care, with hospital discharges, clinical sessions, and with extraordinary administrative procedures. The healthcare activities occurring within the ICU associate procedures and estimate time frames that are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>. Using the PMCP, the time percentages spent conducting healthcare activities within the ICU and tabulated by professional category are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Managerial and healthcare activities conducted outside the intensive care unitThe AO-ICU illustrates both the management of a CP outside the ICU (not necessarily an emergency) and the prevention of critical conditions, normally with regard to one or more organic dysfunctions. In other words, AO-ICU intends to improve morbimortality through: (1) the early detection of the CP outside the ICU; and (2) the early implementation of healthcare initiatives. The AO-ICU can be “instrumental” and “non-instrumental”, or respectively, activities associated with any given diagnostic and/or therapeutic procedure or activities associated with a certain type of patient—including, or not, the CP code. The “instrumental” activities requiring transfer of CPs outside the ICU to perform this or that diagnostic and/or therapeutic procedure such as CAT scans are shown in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>, as well as the 9 “non-instrumental” activities. The specific time frames of these “non-instrumental” activities are shown in <a class="elsevierStyleCrossRef" href="#sec0065">electronic Table 4 (see additional material</a>) including the four basic codes for the CP. These time frames are not an absolute written-in-stone description of the activities but are probably common to 90% of all Spanish CCMDs. See the differences and distinctive features based on whether the patient is: “non-critical”; “critical” (“reversible” or “reversible with limitations of life-support therapy”); “sub-critical”; and “post-critical”. The time percentages spent to AO-ICU by professional category are also shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>Research activitiesIn this document and for the sake of scientific research we have imagined a generic CCMD with the following percentage of intensivists to perform all of its activities: “physician assistant” 65–0%; “clinical director”: 20–25%; and “service director”: 10%. Neither doctors on call or residents were included basically because their duties have to do with healthcare and because they are on a training contract. The time percentages translated into hours for the sake of research using the PMCP and other activities performed by the intensivists are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. In the example showed and to make it easier, none of those seven doctors would practice prehospital AO-ICU. Always according to this matrix, the following would be the annual hour allocation for the three categories (physician assistant; clinical director, and service director): 175annual hours per physician (10%), that is, out of a team of 7 physicians with an overall annual contract of 1250h, an annual set of 1225h would be explicitly assigned to research, which is equivalent to 70% of a single physician's working day.Activities that have to do with teaching and collegeTraining needs to be continuing medical education (CME) after students become college graduates.<a class="elsevierStyleCrossRef" href="#bib0250">20</a> When it comes to college teaching this can be easily seen in the greater number of medical schools, elective subjects, use of simulations and objective, structured clinical assessments.<a class="elsevierStyleCrossRef" href="#bib0255">21</a> When it comes to post-graduate degree teaching<a class="elsevierStyleCrossRef" href="#bib0260">22</a> in order to do quality teaching in the CCMD, accreditations abiding not only by the specialty official program but also by the competences of the European program CoBaTrICE<a class="elsevierStyleCrossRefs" href="#bib0265">23,24</a> are required. Although CME is not regulated,<a class="elsevierStyleCrossRef" href="#bib0275">25</a> it is certainly necessary. The fact that the intensivists from a CCMD teach college degrees, post-graduate degrees and CME programs is clearly beneficial but requires time and effort that even though is hard to ponder on, should be taken into consideration when designing the staff of intensivists. How should we determine the time that specialists should spend teaching—both as instructors and teachers? One possible recommendation would be following the actual legislation.<a class="elsevierStyleCrossRefs" href="#bib0280">26,27</a> In order to make an approximate estimate of the time that intensivists should spend participating in CME programs and teaching, the rules and regulations published by different health systems from different autonomous communities such as the Health Department from the Community of Madrid<a class="elsevierStyleCrossRef" href="#bib0290">28</a> (shown in <a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>) should be observed. The additional material shows the activities that would be recognized as CME programs and teaching that give physicians points to promote their professional careers in compliance with the rules from the Health Department from the Community of Madrid. For example, and always from the perspective of this community, intensivists should dedicate 40h/year to training, and 20h/year to teaching. <a class="elsevierStyleCrossRef" href="#sec0065">additional material (electronic Table 5)</a> also shows the activities and amount of time that intensivists should spend teaching.<elsevierMultimedia ident="tbl0025"></elsevierMultimedia>Activities related to the patient's clinical management and safetyThere is no doubt that healthcare, teaching and research are still at the heart of all medical specialties, and during the last few decades, we have witnessed the birth of two new complementary concepts: CM and PS. When it comes to CPs, the CM is defined as the set of coordinate actions within a given CCMD aimed at achieving effectiveness and efficacy. The CCMD operates as a healthcare responsibility center in the understanding that the CP is managed both in and out of the ICU (e.g. expansion of the CCMD areas of competence and healthcare grading). It promotes and implements scientific knowledge for the management of CPs, while abiding by the clinical practice guidelines, and set of recommendations elaborated by its scientific committees and technical taskforces. CM refers to the participation of healthcare professionals in the management of the CCMD by promoting that these professionals establish not “what”—reserved for the hospital management and the corporate strategy, but “how” healthcare, teaching, and research should really be. The quality of healthcare aims at the CP, based on process management, and is carried out by healthcare professionals during the management of CPs, using the right competences and training, specific means, specific clinical information systems and documentation based on the existing medical literature.The CCMDs have the responsibility of defining, gathering, and analyzing all the information coming from the risk management system on achieving security goals, effective operational programs, and briefing on any PS-associated incidents. The activities and time spent on CM/PS are shown in <a class="elsevierStyleCrossRef" href="#sec0065">electronic Table 6 (see additional material)</a>. Adjusted by professional categories, each physician should spend a certain amount of time on CM/PS. These are percentages estimated by the experience accumulated, which means that they are, inevitably, generic. In order to make these percentages logical, the time percentages associated with “healthcare”; “teaching” and “research” adjusted by professional category should be on the record. When it comes to the PMCP, and assuming that a working day amounts to 1750h, the time percentages translated into hours for the CM/PS combo should be like the ones shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>, that shows the percentages of all the intensivists’ activities according to their professional setting. The overall time estimates for the hours spent on CM and PS, and the participation in hospital committees are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> too.DiscussionAfter reviewing the reference sources on the staff of intensivists, several important organizational conclusions can be drawn that can be generalized to the staffing models of the United States, Europe, and Spain; conclusions, however, that do not provide one valid, single rule to estimate when the intensivists are really needed. When it comes to Europe (where High Intensity Staffing is predominant), in its staffing recommendations, the ESCIM only provides one rule to make the calculation without giving any fixed numbers.<a class="elsevierStyleCrossRef" href="#bib0155">1</a> Recently, the World Federation of Societies of Intensive and Critical Care Medicine discussed the disparities, in the Western world, on the management of CPs,<a class="elsevierStyleCrossRef" href="#bib0295">29</a> including the amount of emergency rooms per 100,000 inhabitants, and the disparity of emergency rooms depending on whether we are in metropolitan or rural areas. It goes without saying that when non-Western countries are included in this analysis (World Federation), disparities are just huge.In Spain, the Standards of Healthcare in Intensive Care Units<a class="elsevierStyleCrossRef" href="#bib0220">14</a>—a model that was similar to the European one, were published in 2010:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">a.Level III Medical and Surgical Critical Care Unit: one full time intensivist for every 4–5 patients from 8:00 to 18:00h, plus one intensivist for every 12 patients from 18:00 to 8:00h—Saturdays and public holiday included.</li><li class="elsevierStyleListItem" id="lsti0010">b.Level II Medical and Surgical Critical Care Unit: one intensivist for every 6–10 patients from 8:00 to 18:00h—Saturdays and public holiday included, plus one intensivist from 18:00 to 8:00h.</li><li class="elsevierStyleListItem" id="lsti0015">c.Level I Medical and Surgical Critical Care Unit: one intensivist for every 8–12 patients.</li></ul>With such model disparity and low level of evidence in the reviewed medical literature we can only do approximate estimates of the intensivist/bed ratio, and adjust the Spanish model per hour and ICU healthcare level. The technical taskforce responsible for this document considered that even though these formulas are easy to get, they under or overestimate the workforce needed based on the level of activity. Not always a fixed number of beds is consistent, in a linear way, with this or that level of activity. These premises are based on a concept of a Spanish intensive care healthcare model characterized by CCMDs as structures that determine professional development, activity-based management (whether input-based, or intermediate results-based), the superficial distinction between healthcare/teaching/research in the daily work, the “convenience” and adaptation to the vertical hospital organization chart, and a full-time commitment to CPs, or the CCMD. It is evident that this situation can generate inefficiencies when the actual productivity is not adjusted to the estimated productivity based on the CCMD size, or case-mix.While trying to come up with an answer to a key question to the problem of what the workforce sizing of intensivists should be in ICUs in the United States, the capacity to sustain such staff and the structure of a controversial model of management of the CP in this country has been put into question.<a class="elsevierStyleCrossRef" href="#bib0300">30</a> Only in the United States, the authors identify a breach between the number of intensivists for the management of actual and future CPs; but if we really want to solve this problem, we should not hire or train more intensivists for the following reasons: (a) training is expensive; (b) if more intensivists were hired, they would probably not be assigned where, theoretically speaking, they are more widely needed—rural areas, but metropolitan areas; (c) the management of CPs is both inter and multidisciplinary; and (d) if this lack of intensivists is common to other 22 medical specialties, why should we make the intensivist management of CPs a priority and sideline other medical specialists? Basically, the problem of this lack of intensivists is more of an offer/supply mismatch rather than a real need, which would lead us to two possible solutions: (1) improving healthcare and not the number of intensivists; and (2) reducing the number of CPs by not allowing more new beds in ICUs through a specific legal framework, by establishing triage policies, and limiting the life-support therapies.One alternative approach that would help estimate more efficiently the actual need for intensivists would be to consider a model that incorporates the notion that the intensivist should follow the CP wherever he may be, and reject the notion that the physical structure conditions the number of intensivists. Other than keeping full-time commitment to the CP, the intensivist's management of healthcare should be implemented where needed (expansion of the CCMD). Even so, in Spain a CCMD should include a holistic healthcare spectrum and gradation system for the management of CPs such as ICUs, SICUs, medical emergency teams, emergency rooms, hospital floors, subcritical patients, post-critical patients, pre-hospital patients, etc. One way to contribute to the non-exclusive expansion of the CCMD would be process organization through functional units led by intensivists guaranteeing the observance of a certain healthcare continuum, both through competences and feasible economic plans (or when the simultaneous production of various outputs in a single institution is cheaper than the individual production of such outputs, such as the hospital management of CPs, and not just the ICU management of CPs).The professionals included in this model would be intensivists whose training is already defined in the official program of their specialty both through the CoBaTriCE program and the guides and protocols of every CCMD.<a class="elsevierStyleCrossRef" href="#bib0270">24</a> The CCMDs that abide by this model should have the participation of 24/7 full-time intensivists. There are several arguments to justify this statement: (a) healthcare reasons—since there are physicians responsible for every CP that guarantee the ongoing care of CPs and allow multidisciplinary and interdisciplinary interactions in and out of the ICU; (b) pedagogical reasons—teachers who already teach within the CCMD; (c) research reasons—basic, applied and translational research, since research activities are conducted within the CCMD; (d) CM reasons—generation of scale economies (price cut by concentration) projected into the future with higher healthcare and economic efficiency; the socialization of knowledge and a reduced variability in the clinical practice; and (e) PS reasons—implementation of a CP-specific risk management system. If we assume this CCMD model, those specialists working in such a model should perform ICU healthcare-oriented activities, AO-ICU, teaching and research activities, and initiatives aimed at promoting CM and PS. Thus, the actual activity of a CCMD cannot be based on the obsolete, rigid notion of the number of beds anymore, since this notion only includes the healthcare activity taking place within the CCMD assuming that there is a conceptual linearity among the structure, the possible severity and measurable activities. The medical staff should be reckoned by the CCMD actual overall productivity (outputs), regardless of the number of beds assigned, in all activities that have to do with the management of CPs. This productivity metrics includes the total number of activities performed every year divided by the time spent conducting every activity. The number of physicians should be obtained by dividing the overall activity time by the maximum number of annual hours established by the labor contract. Now, how can we make an estimate of this activity and assess it effectively? Well, we would start by assessing the amount of time spent implementing classic, routine healthcare activities, procedures for the management of UCI patients, plus EAUCI instrumental activities, and measurable and describable time frames in a potentially agreed range.If we take into account that in many CCMDs, the teaching and research activities happen outside the intensivists’ working schedule, it seems difficult to try to assess the necessary time, or time spent doing these less “instrumental” tasks such as teaching, research, CM, and PS. One approach to this would be to establish one illustrative PMCP with fixed scheduled activity percentages (healthcare, management, teaching, research). In this document, this tool has been used to be able to make an estimate of the research activity going on, and the activities aimed at implementing CM and PS. However, and because all matrixes are merely illustrative, a system with different levels of healthcare, service portfolios, and teaching/research capabilities cannot be imposed on all CCMDs as the only valid model. Different CCMDs will score different final percentages, making it hard to come up with the exact number of intensivists needed. Nevertheless, this can be a valid tool if we just wish to make estimates when the activity is hardly measurable, such as in this case. There is a different model, suggested by German authors<a class="elsevierStyleCrossRef" href="#bib0185">7</a> that we think may suit the reality of the proposed intensivist variable activity better. In this formula, the needs for intensivists follows the actual activity measured in hours, according to a available amount of hours, based on the legal working hours. Therefore, the measurement and quantification of activity is essential to know if what is being done equals a higher number than the hourly capabilities of the available “workforce”. To this end, the activities conducted in every CCMD and its available working hours are measured. Then the healthcare provided by the staff is divided by the time working load (days, shifts of different duration), while observing the organizational peculiarities of every CCMD. This model includes three sequential steps. The first step being the definition of the basic tasks within a services portfolio representative of most Spanish CCMDs. The second step being the estimate of illustrative, average time frames adjusted for the peculiarities of each CCMD, valid enough to allow external auditing. And the last step being the total number of yearly tasks and patients, that will later be multiplied by the estimate time frames for each task and patient. This is how we will achieve the sum of the annual working load, healthcare activities (at the ICU and AO-ICU), and non-healthcare activities (teaching, CME, research, CM and PS), that we will later divide by the average hours established by the labor contract—always within the legal framework and always being respectful of the PS, to finally achieve the right number of intensivists needed.The limitations of this paper already appear in the methodology. Time frames are illustrative and mainly based on the opinions of experts and medical literature. Time frames that should necessarily vary based on the structure and conditions of every CCMD, but also true and externally auditable time frames. The estimate method proposed requires a trustworthy, reliable, and sustainable clinical management information system. A priori this fact may be a barrier that makes estimation hard to achieve. In short, it will be a mandatory requirement for all CCMDs—documenting their healthcare activity through a minimal, basic set of data chosen by the CCMD, and providing diagnostic, severity, and procedural data. Failure to do so leads to a lack of transparency unfit for the needs of both patients and healthcare managers. The latter may not enlarge their roster of intensivists if not justified through documentation and proven through a comprehensive and externally auditable tool.To make the estimates easier for the professionals who decides to implement this proposal, as <a class="elsevierStyleCrossRef" href="#sec0065">additional material, the Excel spreadsheet</a>® adapted by Weiss<a class="elsevierStyleCrossRef" href="#bib0245">19</a> to the Spanish model mentioned has been included, with information on how to fill out its tabs, with generic recommendations and examples. This spreadsheet has been tested by the authors at their respective centers and the unpublished results obtained are very similar to one another—of course this is a temporary statement until the tests go public. Once the right number of intensivists has been achieved, the intensivists can be allocated in shifts and calls through specific regulations as shown on the spreadsheet. In this sense, the proposal from this technical taskforce establishes with the total number of physicians that are needed in a CCMD. The tool used to make the calculations helps achieve this number based on different labor contracts and schedules, but it is useless if we want to allocate the staff based on temporal segments (hours, days) consistent with higher peaks of activity. The hour estimate provided by this document is annual, and not hourly or weekday-based. Following a certain methodological coherence, the proposal intentionally runs away from giving any fixed recommendations on how to allocate the staff. And this is so based on the fact that it is impossible to contemplate every single situation of every single CCMD and center, not even arbitrarily estimate a supposedly majoritarian setting; every CCMD has its own organizational idiosyncrasy that determines the allocation of intensivists in shifts and calls. It is plain to see that this is something that worries the directors of CCMDs, and there is no doubt that not having some sort of drive on this regard can be frustrating.We did not want to betray the philosophy of our work and in order to help these professionals, we wanted to offer step-by-step premises for the allocation of intensivists in a CCMD: (1) quantify the number of CCMD admissions per hour and day of the week. The presence admissions of a certain kind (such as surgical block) should also be taken into consideration. (2) Write down the hourly and weekly allocation of this or that technique, important AO-ICU in the service portfolio of both the CCMD and the hospital; (3) assess the schedule assigned to teaching, research or CM/PS activities, especially when this happens outside the morning schedule; (4) draw charts including results for managers to see through one comprehensive proposal, while giving relevance to the most time-consuming tasks that are more important on both the healthcare and strategic levels. Always have the hospital mission statement present—mission, vision, values. It is useful to present the data from the spreadsheet suggested in this document; and (5) try to negotiate if it is contractually possible to reach an agreement with good-hearted staff on the actual demand. One of the limitations of this proposal is that it is not applicable during the CCMD first operational year in brand new hospitals, which is why it has been resized facing the possibility of future merges or growth. It is obvious that during the first year, the staffing needs will be different from the needs that may arise during longer time frames with more consolidated activities. Yet when it comes to staffing needs, comparisons with prior experiences can be useful if we wish to set a starting point and a 3–5-year horizon. Also, the estimate suggested could be drawn the very first year in order to document the activity trend.ConclusionsThe model of intensive medicine and that of all CCMDs needs to change following criteria of effectiveness and efficiency. The competences and tasks that an intensivist is required to do go far beyond the mere healthcare duties of an ICU (e.g. AO-ICU, teaching, research, risk management-RM, CM and PS) and cannot be estimated following uniform structural criteria. Every CCMD should be assessed individually when it comes to the actual overall productivity. Both the methodology and task and time description of every one of the aforementioned five specific activities enables every CCMD to use the tools assigned in an estimate-based spreadsheet by entering verifiable and auditable specific information—both in number and time, and then obtaining adjusted estimates. The tool based on the premise of information and not on supposed qualitative data is one management tool that can be understood, checked and, then, taken into consideration by all managing teams and healthcare systems, in an attempt to guarantee the intensivist that we are dealing with one methodology that can be put to the test. In sum, through a necessarily qualitative spreadsheet, we believe it is feasible to estimate the real needs of intensivist staffs both based on the expansion of the CCMD, and its maximum productivity (healthcare, AO-ICU, teaching, research, RM, CM and PS). Finally, the quantification of the number of intensivists involved in the overall productivity of every CCMD leads us to asking two different questions: What do physicians who work in a responsibility center—the CCMD produce that eats away a significant chunk of the hospital budget? And what intrinsic value do these physicians generate by grading their knowledge in five different activities?If we keep in mind that the short-term projection in healthcare, in the Western world, is that hospitals will be admitting more and more critical patients, and refer less critical or chronic patients to alternatives different than hospitalization (expansion), we can say that the need for CCMDs and well-prepared intensivists for the management of CPs will grow consequently. Maybe part of the intensivists’ mission who manage CPs should be facing this apparent paradox: do whatever necessary so that patients do not progress into CPs, and do whatever necessary when this progression actually happens.Conflict of interestsThe authors of this paper declare no conflicts of interest whatsoever." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres981804" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec949466" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres981803" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec949467" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methodology" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Results" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Management and healthcare activities in the intensive care unit" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Managerial and healthcare activities conducted outside the intensive care unit" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Research activities" ] 3 => array:2 [ "identificador" => "sec0035" "titulo" => "Activities that have to do with teaching and college" ] 4 => array:2 [ "identificador" => "sec0040" "titulo" => "Activities related to the patient's clinical management and safety" ] ] ] 7 => array:2 [ "identificador" => "sec0045" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0050" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflict of interests" ] 10 => array:2 [ "identificador" => "xack332639" "titulo" => "Acknowledgements" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-11-18" "fechaAceptado" => "2017-09-17" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec949466" "palabras" => array:3 [ 0 => "Activity" 1 => "Department of critical care medicine" 2 => "Intensive care unit" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec949467" "palabras" => array:3 [ 0 => "Actividad" 1 => "Servicio medicina intensiva" 2 => "Unidad de cuidados intensivos" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Departments of Critical Care Medicine are characterized by high medical assistance costs and great complexity. Published recommendations on determining the needs of medical staff in the DCCM are based on low levels of evidence and attribute excessive significance to the structural/welfare approach (physician-to-beds ratio), thus generating incomplete and minimalistic information. The Spanish Society of Intensive Care Medicine and Coronary Units established a Technical Committee of experts, the purpose of which was to draft recommendations regarding requirements for medical professionals in the ICU. The Technical Committee defined the following categories: (1) patient care-related aspects; (2) activities outside the ICU; (3) patient safety and clinical management aspects; (4) teaching; and (5) research. A subcommittee was established with experts pertaining to each activity category, defining criteria for quantifying the percentage time of the intensivists dedicated to each task, and taking into account occupational category. A quantitative method was applied, the parameters of which were the number of procedures or tasks and the respective estimated indicative times for patient care-related activities within or outside the context of the DCCM, as well as for teaching and research activities. Regarding non-instrumental activities, which are more difficult to evaluate in real time, a matrix of range versus productivity was applied, defining approximate percentages according to occupational category. All activities and indicative times were tabulated, and a spreadsheet was created that modified a previously designed model in order to perform calculations according to the total sum of hours worked and the hours stipulated in the respective work contract. The competencies needed and the tasks which a Department of Critical Care Medicine professional must perform far exceed those of a purely patient care-related character, and cannot be quantified using structural criteria. The method for describing the 5 types of activity, the quantification of specific tasks, the respective times needed for each task, and the generation of a spreadsheet led to the creation of a management instrument." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "Los servicios de medicina intensiva se asocian a una alta complejidad asistencial y un alto coste monetario. Las recomendaciones sobre el cálculo de las necesidades de intensivistas adolecen de baja evidencia y favorecen un criterio estructural y asistencial (proporción médico/camas), lo que origina modelos reduccionistas. La Sociedad Española de Medicina Intensiva y Unidades Coronarias constituyó una comisión técnica para redactar unas recomendaciones sobre la necesidad de intensivistas en los servicios de medicina intensiva. La comisión técnica definió 5 actividades: 1) asistencial; 2) actividades extra-UCI; 3) seguridad del paciente y gestión clínica; 4) docencia; y 5) investigación. Para cada actividad o categoría se crearon subcomités específicos que definieron criterios para cuantificar el porcentaje que supone cada tarea para los intensivistas por rango profesional. Para las actividades asistenciales dentro y fuera de la UCI, y también para las actividades docentes e investigadoras, se siguió un sistema cuantitativo del número de procedimientos o tareas por tiempos estimados. En relación con las actividades no instrumentales, más difíciles de evaluar en tiempo real, se siguió una matriz de ámbito/productividad, definiendo los porcentajes aproximados de tiempo dedicado por categoría profesional. Se elaboró una hoja de cálculo, modificando un modelo previo, atendiendo la suma de horas estipuladas por contrato. Las competencias exigidas van más allá de la asistencia intra-UCI, y no pueden calcularse bajo criterios estructurales. La metodología sobre 5 actividades, la cuantificación de sus tareas específicas y tiempos y la construcción de una hoja de cálculo generan un instrumento adecuado de gestión." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Gómez Tello V, Ruiz Moreno J, Weiss M, González Marín E, Merino de Cos P, Franco Garrobo N, et al. Estimación de las necesidades de profesionales médicos en los servicios de medicina intensiva. Med Intensiva. 2018;42:37–46." ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "The following is the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0065" ] ] ] ] "multimedia" => array:6 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "AO-ICU: activities outside the ICU; CD: clinical director; SD: service director; PA: physician assistant; IMR: internal medical residents; ICU: intensive care unit; SICU: semi-intensive care unit." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Setting/activity \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Healthcare subcommittee 1 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Teaching subcommittee 2 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Research subcommittee 3 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Clinical M. subcommittee 4 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">M. and safety subcommittee 5 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="5" align="left" valign="top">ICU</td><td class="td" title="table-entry " align="left" valign="top">PA 1 60% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PA 2 60% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PA 3 60% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CD 20% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20%<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SD 10% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15%<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="4" align="left" valign="top">SICU</td><td class="td" title="table-entry " align="left" valign="top">PA 4 30% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PA 5 30% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CD 10% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SD 5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="4" align="left" valign="top">Hospital floor</td><td class="td" title="table-entry " align="left" valign="top">PA 4 10% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PA 5 10% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CD 5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SD 5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Post-critical \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">PA 4 20% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="top">Emergency room</td><td class="td" title="table-entry " align="left" valign="top">PA 5 20% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CD 10% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SD 5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1662598.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "These specific percentages are interchangeable whenever a PA has a more significant participation in a safety committee or risk committee." ] ] ] "descripcion" => array:1 [ "en" => "PMCP pertaining to “healthcare”; “activities outside the ICU”; “research”; “clinical management”; and management and safety of a generic internal medicine unit with 5 physician assistants; 1 clinical director, and 1 service director." ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "CCMD: critical care medicine department." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Procedure \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Time (min) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Admission</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hospital reception of the patient \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Clinical medical examination \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Request diagnostic testing \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Write clinical history in the CCMD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Write down the therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Achieve basic diagnoses \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Interviews with other specialists involved \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Information for next shift staffing \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Combined pass (if it comes to that) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Daily routine</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Medical examination in the CCMD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Write down the clinical evolution \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Write down the therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Interhospital transfers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Interviews with other specialists (microbiology, radiodiagnosis, others) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Information to family members \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Reference search for the case \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Medical/nursing common goals \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Discharge or transfer</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Final medical examination \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gather documentation to write the report \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Write the report \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Contact the destination hospital and physicians in charge of the transfer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Special administrative proceedings</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Medical reports detailed for judiciary organizations and insurance companies \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Death certificate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Visits or shift changes</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">The following data will need to be entered: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Specify the number of sessions in business days, Saturdays, Sundays and public holidays \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Detail the number of doctors per patient \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Indicate time spent with every patient \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1662594.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Routine healthcare activity time frames in the CCMD." ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "CCMD: critical care medicine department; RRT: renal replacement therapy; ICU: intensive care unit." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Procedures \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Time (min) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Paracentesis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Insertion of venous catheters \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Insertion of arterial catheters \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diagnostic bronchoscopy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Interpretation of hemodynamic data (termodilution catheter/PiCCO) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Liver function monitoring system (LIMON and the like) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">RRT (heparin)/establish-change<a class="elsevierStyleCrossRef" href="#tblfn0010">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">RRT (citrate)/establish-change<a class="elsevierStyleCrossRef" href="#tblfn0010">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Segstaken–Blakemore probe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Monitoring of de hepatic dialysis<a class="elsevierStyleCrossRef" href="#tblfn0010">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">120 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Thromboelastography \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Decubitus position \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Blood transfusion/hemoderivatives/procoagulant agents (per unit)* \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Scheduled cardioversion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Insertion of thermodilution catheter (Swan/Picco/Lidco) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Extracorporeal membrane oxygenation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Measurement of intracranial pressure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Transcranial Doppler ultrasound \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lumbar puncture \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Endotracheal intubation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Non-invasive mechanical ventilation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patient transfer to/from the operating room \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patient isolation/day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Implantation of epidural catheter \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pericardiocentesis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Thoracocentesis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Transesophageal echocardiogram \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Transthoracic echocardiogram \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Thoracic drainage \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Percutaneous tracheostomy (dilation/plastic) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Temporary transvenous pacemaker \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Transcutaneous pacemaker \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Definitive pacemaker<a class="elsevierStyleCrossRef" href="#tblfn0015">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1662595.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "a" "nota" => "Whether it is done by intensivists." ] 1 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "b" "nota" => "Whether it is implanted by intensivists." ] ] ] "descripcion" => array:1 [ "en" => "Procedures performed at the intensive care unit." ] ] 3 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "AO-ICU: activities outside the ICU; ICU: intensive care unit." "tablatextoimagen" => array:2 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Procedure \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Time (min) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Coronary angiography (diagnostic/interventional) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75–90 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Medical examination<a class="elsevierStyleCrossRef" href="#tblfn0020">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Wiring/unwiring \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Transfer to a different hospital \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Transfer to the unit of hemodynamics in-house \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Brain angiography</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Medical examination<a class="elsevierStyleCrossRef" href="#tblfn0025">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">150 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Wiring/unwiring \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Transfer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Other angiographic procedures \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Medical examination<a class="elsevierStyleCrossRef" href="#tblfn0020">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Wiring/unwiring \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Transfer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CT scan \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Medical examination<a class="elsevierStyleCrossRef" href="#tblfn0020">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Wiring/unwiring \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Transfer time \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Medical examination<a class="elsevierStyleCrossRef" href="#tblfn0020">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Wiring/unwiring \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Transfer time \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1662596.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Instrumental activities in AO-ICU and time requirements</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Activity \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Time (min) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sedation and analgesia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cardioversion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Central venous vascular access \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Non-invasive mechanical ventilation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total parenteral nutrition \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">“ABC” (airway, breathing, circulation) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Advanced life-support \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Early inter-hospital transfer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Emergency medical teams \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1662593.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "a" "nota" => "Time based on whether the procedure takes place in the hospital or a reference center." ] 1 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "b" "nota" => "Take into account the presence of the intensivist in the room, if necessary." ] ] ] "descripcion" => array:1 [ "en" => "Techniques conducted outside the intensive care unit that require transfer and instrumental activities conducted outside the ICU." ] ] 4 => array:8 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at5" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Time \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Credits (career development program) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">CME</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Masters degree \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">300h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Graduate degree \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">150h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Accredited courses \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.75<a class="elsevierStyleCrossRef" href="#tblfn0030">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Training stays \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 month \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.25 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Teaching</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Degree, post-graduate degree, and CME \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lectures \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tutors \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Doctoral thesis defense (presented and passed) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 thesis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1662597.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0030" "etiqueta" => "a" "nota" => "Equivalent to two credits in CME." ] ] ] "descripcion" => array:1 [ "en" => "Teaching and continuing medical education (CME) in the Autonomous Community of Madrid." ] ] 5 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.pdf" "ficheroTamanyo" => 149875 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib0155" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Improvement EWGoQ. Recommendations on basic requirements for intensive care units: structural and organizational aspects" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Valentin" 1 => "P. Ferdinande" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-011-2300-7" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2011" "volumen" => "37" "paginaInicial" => "1575" "paginaFinal" => "1587" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21918847" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0160" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intensivist/patient ratios in closed ICUs: a statement from the Society of Critical Care Medicine Task force on ICU staffing" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N.S. Ward" 1 => "B. Afessa" 2 => "R. Kleinpell" 3 => "S. Tisherman" 4 => "M. Ries" 5 => "M. Howell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/CCM.0b013e3182741478" "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2013" "volumen" => "41" "paginaInicial" => "638" "paginaFinal" => "645" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23263586" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0165" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Introduction of a 14-hour work shift model for housestaff in the medical ICU" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "B. Afessa" 1 => "C.C. Kennedy" 2 => "K.W. Klarich" 3 => "T.R. Aksamit" 4 => "J.C. Kolars" 5 => "R.D. Hubmayr" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.128.6.3910" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2005" "volumen" => "128" "paginaInicial" => "3910" "paginaFinal" => "3915" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16354863" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0170" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of alternative intensivist staffing schedules on physician and patient outcomes in the intensive care unit" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N.A. Ali" 1 => "K. Wolf" 2 => "J. Hammersley" 3 => "S. Hoffmann" 4 => "J. O’Brien" 5 => "G. Phillips" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2011" "volumen" => "183" "paginaInicial" => "A1026" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0175" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nighttime intensivist staffing and mortality among critically ill patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D.J. Wallace" 1 => "D.C. Angus" 2 => "A.E. Barnato" 3 => "A.A. Kramer" 4 => "J.M. Kahn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMsa1201918" "Revista" => array:6 [ "tituloSerie" => "New Eng J Med" "fecha" => "2012" "volumen" => "366" "paginaInicial" => "2093" "paginaFinal" => "2101" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22612639" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0180" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Do intensivist staffing patterns influence hospital mortality following ICU admission? A systematic review and meta-analyses" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.E. Wilcox" 1 => "C.A. Chong" 2 => "D.J. Niven" 3 => "G.D. Rubenfeld" 4 => "K.M. Rowan" 5 => "H. Wunsch" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/CCM.0b013e318292313a" "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2013" "volumen" => "41" "paginaInicial" => "2253" "paginaFinal" => "2274" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23921275" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0185" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hospitalists and intensivists in the medical ICU: a prospective observational study comparing mortality and length of stay between two staffing models" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "K.R. Wise" 1 => "V.A. Akopov" 2 => "B.R. Williams Jr." 3 => "M.S. Ido" 4 => "K.V. Leeper Jr." 5 => "D.D. Dressler" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Hospl Med" "fecha" => "2012" "volumen" => "7" "paginaInicial" => "183" "paginaFinal" => "189" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0190" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of admission time on mortality in an intensive care unit in Mainland China: a propensity score matching analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.J. Ju" 1 => "G.W. Tu" 2 => "Y. Han" 3 => "H.Y. He" 4 => "Y.Z. He" 5 => "H.L. Mao" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/cc12734" "Revista" => array:5 [ "tituloSerie" => "Crit Care" "fecha" => "2013" "volumen" => "17" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23705948" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1054139X15006667" "estado" => "S300" "issn" => "1054139X" ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0195" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hospital mortality in relation to staff workload: a 4-year study in an adult intensive-care unit" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "W.O. Tarnow-Mordi" 1 => "C. Hau" 2 => "A. Warden" 3 => "A.J. Shearer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2000" "volumen" => "356" "paginaInicial" => "185" "paginaFinal" => "189" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10963195" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0200" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A randomized trial of nighttime physician staffing in an intensive care unit" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.P. Kerlin" 1 => "D.S. Small" 2 => "E. Cooney" 3 => "B.D. Fuchs" 4 => "L.M. Bellini" 5 => "M.E. Mikkelsen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1302854" "Revista" => array:7 [ "tituloSerie" => "New Eng J Med" "fecha" => "2013" "volumen" => "368" "paginaInicial" => "2201" "paginaFinal" => "2209" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23688301" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S019567011500314X" "estado" => "S300" "issn" => "01956701" ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0205" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The organization of intensive care unit physician services" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P.J. Pronovost" 1 => "D.A. Thompson" 2 => "C.G. Holzmueller" 3 => "T. Dorman" 4 => "L.L. Morlock" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.CCM.0000281860.37528.F8" "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2007" "volumen" => "35" "paginaInicial" => "2256" "paginaFinal" => "2261" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17717492" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0210" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidelines on critical care services and personnel: recommendations based on a system of categorization of three levels of care" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.T. Haupt" 1 => "C.E. Bekes" 2 => "R.J. Brilli" 3 => "L.C. Carl" 4 => "A.W. Gray" 5 => "M.S. Jastremski" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.CCM.0000094227.89800.93" "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2003" "volumen" => "31" "paginaInicial" => "2677" "paginaFinal" => "2683" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14605541" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0215" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recommendations on minimal requirements for Intensive Care Departments. Members of the Task Force of the European Society of Intensive Care Medicine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P. Ferdinande" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "1997" "volumen" => "23" "paginaInicial" => "226" "paginaFinal" => "232" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9069011" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0220" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Unidades de cuidados intensivos estándares y recomendaciones 2010 [consulted 26 Dec 2013]. Available in: <a href="http://www.msssi.gob.es/organizacion/sns/planCalidadSNS/docs/UCI.pdf">http://www.msssi.gob.es/organizacion/sns/planCalidadSNS/docs/UCI.pdf</a>" ] ] ] 14 => array:3 [ "identificador" => "bib0225" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Proposal of a flexible structural-organizing model for the Intensive Care Units" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Iapichino" 1 => "D. Radrizzani" 2 => "C. Rossi" 3 => "A. Pezzi" 4 => "A. Anghileri" 5 => "S. Boffelli" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Minerva Anestesiol" "fecha" => "2007" "volumen" => "73" "paginaInicial" => "501" "paginaFinal" => "506" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17912203" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1054139X15002931" "estado" => "S300" "issn" => "1054139X" ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0230" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Continuity of care in intensive care units: a cluster-randomized trial of intensivist staffing" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N.A. Ali" 1 => "J. Hammersley" 2 => "S.P. Hoffmann" 3 => "J.M. O’Brien Jr." 4 => "G.S. Phillips" 5 => "M. Rashkin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Respir Critic Care Med" "fecha" => "2011" "volumen" => "184" "paginaInicial" => "803" "paginaFinal" => "808" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0235" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Twenty-four-hour intensivist presence: a pilot study of effects on intensive care unit patients, families, doctors, and nurses" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Garland" 1 => "D. Roberts" 2 => "L. Graff" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Respir Critic Care Med" "fecha" => "2012" "volumen" => "185" "paginaInicial" => "738" "paginaFinal" => "743" "itemHostRev" => array:3 [ "pii" => "S0195670115002649" "estado" => "S300" "issn" => "01956701" ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0240" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comisión de necesidades de médicos intensivistas de la Sociedad Española de Medicina Intensiva Crítica y Unidades Coronarias. Critically ill setting/productivity grid (CISPG): Proposal for distribution of productive time of intensivists in a Critical Care Medicine Department (CCMD) considering óutreach" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Ruiz Moreno" 1 => "J.M. Nicolás Arfelis" 2 => "V. Gómez Tello" 3 => "M.J. Esteve Paños" 4 => "R. Corcuera Romero de la Devesa" 5 => "E. González Marín" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2015" "volumen" => "3" "numero" => "Suppl 1" "paginaInicial" => "A481" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0245" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Calculation of personnel requirement ‘intensive care medicine’ 2012 – revision of the 2008 calculation tool for the medical profession" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Weiss" 1 => "G. Marx" 2 => "D.A. Vagts" 3 => "A. Schleppers" 4 => "W. Leidinger" 5 => "N. Sehn" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Anasthesiol Intensivmed Notfallmed" "fecha" => "2012" "volumen" => "53" "numero" => "Suppl. 3" "paginaInicial" => "S50" "paginaFinal" => "S62" ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0250" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ley 44/2003, de 21 de noviembre, de ordenación de las profesiones sanitarias. Boletín oficial del Estado [Internet]. 2015 [pp. 41442–58] [consulted 12 Nov 2014] Available in: <a href="https://www%20boe%20es/buscar/pdf/2003/BOE-A-2003-21340-consolidado%20pdf%202015">https://www boe es/buscar/pdf/2003/BOE-A-2003-21340-consolidado pdf 2015</a>" ] ] ] 20 => array:3 [ "identificador" => "bib0255" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Real Decreto-Ley 183/2008, de 8 de febrero, por el que se determinan y clasifican las especialidades en Ciencias de la Salud y se desarrollan determinados aspectos del sistema de formación sanitaria especializada. Boletín oficial del Estado [Internet]. 2015 [consulted 12 Nov 2014]. Available in: <a href="http://www%20boe%20es/boe/dias/2008/02/21/pdfs/A10020-10035%20pdf%202015">http://www boe es/boe/dias/2008/02/21/pdfs/A10020-10035 pdf 2015</a>" ] ] ] 21 => array:3 [ "identificador" => "bib0260" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Real Decreto-Ley 1146/2006, de 6 de octubre, por el que se regula la relación laboral especial de residencia para la formación de especialistas en Ciencias de la Salud. Boletín Oficial del Estado [Internet]. 2015 [consulted 12 Nov 2014]. Available in: <a href="https://www%20boe%20es/buscar/pdf/2006/BOE-A-%202006-17498-consolidado%20pdf%202015">https://www boe es/buscar/pdf/2006/BOE-A- 2006-17498-consolidado pdf 2015</a>" ] ] ] 22 => array:3 [ "identificador" => "bib0265" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An international survey of training in adult intensive care medicine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H. Barrett" 1 => "J.F. Bion" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-005-2583-7" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2005" "volumen" => "31" "paginaInicial" => "553" "paginaFinal" => "561" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15750798" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0270" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Development of core competencies for an international training programme in intensive care medicine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.F. Bion" 1 => "H. Barrett" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-006-0215-5" "Revista" => array:7 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2006" "volumen" => "32" "paginaInicial" => "1371" "paginaFinal" => "1383" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16841214" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0010782412007536" "estado" => "S300" "issn" => "00107824" ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0275" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "MSSI. 2015 [consulted 6 Feb 2015]. Available in: <a href="https://www%20msssi%20gob%20es/profesionales/formacion/formaci%26oacute;nContinuada/introduccion%20htm%202015">https://www msssi gob es/profesionales/formacion/formaciónContinuada/introduccion htm 2015</a>" ] ] ] 25 => array:3 [ "identificador" => "bib0280" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ley 9/1987, de 12 de junio, de Órganos de Representación, Determinación de las Condiciones de Trabajo y Participación del Personal al servicio de las Administraciones Públicas. Boletín Oficial del Estado [Internet]. 2015 [consulted 18 Dec 2015]. Available in: <a href="https://www%20boe%20es/boe/dias/1987/06/17/pdfs/A18284-18290%20pdf%202015">https://www boe es/boe/dias/1987/06/17/pdfs/A18284-18290 pdf 2015</a>" ] ] ] 26 => array:3 [ "identificador" => "bib0285" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ley 55/2003, de 16 de diciembre, del Estatuto Marco del Personal Estatutario de los Servicios de Salud. Boletín oficial del Estado [Internet]. 2015 [consulted 18 Dec 2015]. Available in: <a href="https://www%20boe%20es/boe/dias/2003/12/17/pdfs/A44742-44763%20pdf%202015">https://www boe es/boe/dias/2003/12/17/pdfs/A44742-44763 pdf 2015</a>" ] ] ] 27 => array:3 [ "identificador" => "bib0290" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Acuerdo de 25 de enero de 2007, del Consejo de Gobierno de la Comunidad de Madrid, por el que se aprueba el Acuerdo de 5 de diciembre de 2006 alcanzado en la Mesa Sectorial de sanidad entre la Consejería de Sanidad y Consumo y las organizaciones sindicales presentes en la misma sobre carrera profesional de licenciados sanitarios y diplomados sanitarios 2015 [6 Feb 2015]. Available in: <a href="http://www.madrid.org/wleg/servlet/Servidor?opcion=VerHtml%26nmnorma=6145%26%20cdestado=P">http://www.madrid.org/wleg/servlet/Servidor?opcion=VerHtml&nmnorma=6145& cdestado=P</a>" ] ] ] 28 => array:3 [ "identificador" => "bib0295" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "What is an intensive care unit? A report of the task force of the World Federation of Societies of Intensive and Critical Care Medicine" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.C. Marshall" 1 => "L. Bosco" 2 => "N.K. Adhikari" 3 => "B. Connolly" 4 => "J.V. Díaz" 5 => "T. Dorman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcrc.2016.07.015" "Revista" => array:6 [ "tituloSerie" => "J Crit Care" "fecha" => "2017" "volumen" => "37" "paginaInicial" => "270" "paginaFinal" => "276" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27612678" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0300" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The myth of the workforce crisis: why the United States does not need more intensivist physicians" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.M. Kahn" 1 => "G.D. Rubenfeld" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.201408-1477CP" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2015" "volumen" => "191" "paginaInicial" => "128" "paginaFinal" => "134" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25474081" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack332639" "titulo" => "Acknowledgements" "texto" => "We wish to thank Dr. Lluis Blanch, MD; Dr. Ricard Ferrer, MD, and Dr. Rafael Fernández, MD for their help while writing this paper. Also, we wish to thank the German Board of Anesthesiologists for their consent to use and the spreadsheet early iteration." "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004200000001/v1_201802081105/S2173572717302060/v1_201802081105/en/main.assets" "Apartado" => array:4 [ "identificador" => "72380" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Special articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004200000001/v1_201802081105/S2173572717302060/v1_201802081105/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572717302060?idApp=WMIE"]

Statistics

Special article

Physician staffing needs in critical care departments

Estimación de las necesidades de profesionales médicos en los servicios de medicina intensiva

V. Gómez Telloa, J. Ruiz Morenob,

Corresponding author

javiruiz@wanadoo.es

Corresponding author.

, M. Weissc, E. González Marínd, P. Merino de Cose, N. Franco Garrobof, A. Alonso Oviesg, J.C. Montejo Gonzálezh, T. Iberi, G. Marxj, V. Córcoles Gonzálezk, F. Gordo Vidall, E. Palencia Herrejónm, J. Roca Guiserisn, on behalf of the Spanish Society of Intensive Care Medicine and the German Board of Anesthesiologists

a Servicio de Medicina Intensiva, Hospital Moncloa, Madrid, Spain

b Servicio de Medicina Intensiva, Hospital Universitari Sagrat Cor, Barcelona, Spain

c Klinik für Anästhesiologie, Universitätsklinikum, Ulm, Germany

d Servicio de Urgencias, Hospital Universitari Sagrat Cor, Barcelona, Spain

e Servicio de Medicina Intensiva, Hospital de Can Misses, Ibiza, Spain

f Servicio de Medicina Intensiva, Hospital Universitario de Móstoles, Madrid, Spain

g Servicio de Medicina Intensiva, Hospital Universitario de Fuenlabrada, Madrid, Spain

h Servicio de Medicina Intensiva, Hospital 12 de Octubre, Madrid, Spain

i Stadtklinik Baden-Baden und des Kreiskrankenhauses Bühl, Institut f. Anästhesiologie und Intensivmedizin, Baden-Baden, Germany

j Klinik für Operative Intensivmedizin und Intermediate Care, Aachen, Germany

k Servicio de Medicina Intensiva, Complejo Hospitalario Universitario de Albacete, Albacete, Spain

l Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, Spain

m Servicio de Medicina Intensiva, Hospital Infanta Leonor, Madrid, Spain

n Servicio de Medicina Intensiva. Hospital Virgen de las Nieves, Granada, Spain

Read

11553

Times
was read the article

3359

Total PDF

8194

Total HTML

Share statistics

 array:24 [
  "pii" => "S2173572717302060"
  "issn" => "21735727"
  "doi" => "10.1016/j.medine.2017.12.001"
  "estado" => "S300"
  "fechaPublicacion" => "2018-01-01"
  "aid" => "1123"
  "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and SEMICYUC"
  "copyrightAnyo" => "2017"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "cita" => "Med Intensiva. 2018;42:37-46"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 2043
    "formatos" => array:3 [
      "EPUB" => 190
      "HTML" => 1121
      "PDF" => 732
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0210569117302851"
      "issn" => "02105691"
      "doi" => "10.1016/j.medin.2017.09.013"
      "estado" => "S300"
      "fechaPublicacion" => "2018-01-01"
      "aid" => "1123"
      "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; y SEMICYUC"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "fla"
      "cita" => "Med Intensiva. 2018;42:37-46"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 6159
        "formatos" => array:3 [
          "EPUB" => 225
          "HTML" => 4432
          "PDF" => 1502
        ]
      ]
      "es" => array:12 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Art&#237;culo especial</span>"
        "titulo" => "Estimaci&#243;n de las necesidades de profesionales m&#233;dicos en los servicios de medicina intensiva"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "37"
            "paginaFinal" => "46"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Physician staffing needs in critical care departments"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "V&#46; G&#243;mez Tello, J&#46; Ruiz Moreno, M&#46; Weiss, E&#46; Gonz&#225;lez Mar&#237;n, P&#46; Merino de Cos, N&#46; Franco Garrobo, A&#46; Alonso Ovies, J&#46;C&#46; Montejo Gonz&#225;lez, T&#46; Iber, G&#46; Marx, V&#46; C&#243;rcoles Gonz&#225;lez, F&#46; Gordo Vidal, E&#46; Palencia Herrej&#243;n, J&#46; Roca Guiseris"
            "autores" => array:15 [
              0 => array:2 [
                "nombre" => "V&#46;"
                "apellidos" => "G&#243;mez Tello"
              ]
              1 => array:2 [
                "nombre" => "J&#46;"
                "apellidos" => "Ruiz Moreno"
              ]
              2 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Weiss"
              ]
              3 => array:2 [
                "nombre" => "E&#46;"
                "apellidos" => "Gonz&#225;lez Mar&#237;n"
              ]
              4 => array:2 [
                "nombre" => "P&#46;"
                "apellidos" => "Merino de Cos"
              ]
              5 => array:2 [
                "nombre" => "N&#46;"
                "apellidos" => "Franco Garrobo"
              ]
              6 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "Alonso Ovies"
              ]
              7 => array:2 [
                "nombre" => "J&#46;C&#46;"
                "apellidos" => "Montejo Gonz&#225;lez"
              ]
              8 => array:2 [
                "nombre" => "T&#46;"
                "apellidos" => "Iber"
              ]
              9 => array:2 [
                "nombre" => "G&#46;"
                "apellidos" => "Marx"
              ]
              10 => array:2 [
                "nombre" => "V&#46;"
                "apellidos" => "C&#243;rcoles Gonz&#225;lez"
              ]
              11 => array:2 [
                "nombre" => "F&#46;"
                "apellidos" => "Gordo Vidal"
              ]
              12 => array:2 [
                "nombre" => "E&#46;"
                "apellidos" => "Palencia Herrej&#243;n"
              ]
              13 => array:2 [
                "nombre" => "J&#46;"
                "apellidos" => "Roca Guiseris"
              ]
              14 => array:1 [
                "colaborador" => "en nombre de la Sociedad Espa&#241;ola de Medicina Intensiva y del German Board of Anesthesiologists"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2173572717302060"
          "doi" => "10.1016/j.medine.2017.12.001"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572717302060?idApp=WMIE"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569117302851?idApp=WMIE"
      "url" => "/02105691/0000004200000001/v2_201802080938/S0210569117302851/v2_201802080938/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2173572717302072"
    "issn" => "21735727"
    "doi" => "10.1016/j.medine.2017.12.002"
    "estado" => "S300"
    "fechaPublicacion" => "2018-01-01"
    "aid" => "1087"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and SEMICYUC"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "sco"
    "cita" => "Med Intensiva. 2018;42:47-9"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1538
      "formatos" => array:3 [
        "EPUB" => 168
        "HTML" => 761
        "PDF" => 609
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Point of view</span>"
      "titulo" => "Evolution to the early detection of severity&#46; Where are we going&#63;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "47"
          "paginaFinal" => "49"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Evoluci&#243;n a la detecci&#243;n precoz de gravedad&#46; &#191;Hacia d&#243;nde vamos&#63;"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "F&#46; Gordo, R&#46; Molina"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "F&#46;"
              "apellidos" => "Gordo"
            ]
            1 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Molina"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S021056911730205X"
        "doi" => "10.1016/j.medin.2017.06.008"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S021056911730205X?idApp=WMIE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572717302072?idApp=WMIE"
    "url" => "/21735727/0000004200000001/v1_201802081105/S2173572717302072/v1_201802081105/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S2173572718300134"
    "issn" => "21735727"
    "doi" => "10.1016/j.medine.2017.09.001"
    "estado" => "S300"
    "fechaPublicacion" => "2018-01-01"
    "aid" => "1122"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and SEMICYUC"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Med Intensiva. 2018;42:5-36"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3888
      "formatos" => array:3 [
        "EPUB" => 157
        "HTML" => 2933
        "PDF" => 798
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Consensus statement</span>"
      "titulo" => "Diagnosis and treatment of catheter-related bloodstream infection&#58; Clinical guidelines of the Spanish Society of Infectious Diseases and Clinical Microbiology and &#40;SEIMC&#41; and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units &#40;SEMICYUC&#41;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "5"
          "paginaFinal" => "36"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Diagn&#243;stico y tratamiento de la bacteriemia relacionada con cat&#233;ter&#58; gu&#237;a de pr&#225;ctica cl&#237;nica de la Sociedad Espa&#241;ola de Enfermedades Infecciosas y Microbiolog&#237;a Cl&#237;nica &#40;SEIMC&#41; y de la Sociedad Espa&#241;ola de Medicina Intensiva&#44; Cr&#237;tica y Unidades Coronarias &#40;SEMICYUC&#41;"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1660
              "Ancho" => 2520
              "Tamanyo" => 270168
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Approach to the management of a patient with suspicion of CRBSI&#46; &#40;1&#41; Vancomycin &#40;alternative daptomycin&#59; see text for specific recommendations for this agent&#41; plus antibiotic therapy to cover Gram-negative bacilli if&#58; the femoral catheter is in place&#44; the focus of Gram-negative infection is known&#44; with a high index of colonization by Gram-negative bacilli or prolonged admission in ICU&#46; As the patient is clinically stable&#44; consider antifungal therapy &#40;fluconazole&#41; in patients with total parenteral nutrition&#44; prolonged use of broad-spectrum antibiotics&#44; malignancy&#44; femoral catheterization&#44; colonization due to Candida species at multiple sites or previous anti-anaerobic therapy&#46; &#40;2&#41; Semi-quantitative or quantitative tip culture&#46; &#40;3&#41; Catheter can be maintained only in patients without septic shock secondary to CRBSI&#44; without intravascular devices&#44; and if the culprit pathogen is a CoNS &#40;except <span class="elsevierStyleItalic">Staphylococcus lugdunensis</span>&#41; or a Gram-negative bacilli if the isolate is susceptible to antibiotics that are available for ALT&#46; See <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> for management&#46; &#40;4&#41; See text and <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> for choosing targeted treatment&#44; duration of therapy&#44; and need for echocardiography&#46; &#40;5&#41; Vancomycin &#40;alternative daptomycin&#59; see text for specific recommendations of this agent&#41; plus antibiotic therapy to cover Gram-negative bacilli plus an antifungal agent in patients with septic shock or in other patients if&#58; total parenteral nutrition&#44; prolonged use of broad-spectrum antibiotics&#44; malignancy&#44; femoral catheterization&#44; colonization due to <span class="elsevierStyleItalic">Candida</span> species at multiple sites or intense previous anti-anaerobic therapy&#46; Echinocandins&#44; or liposomal amphotericin B as an alternative should be used only in patients with septic shock&#46; Fluconazole is the drug of choice for the remainder of situations&#44; except in patients colonized by fluconazole-resistant <span class="elsevierStyleItalic">Candida</span> spp&#46; Patients with suppuration at the insertion site but without the other conditions should not receive antibiotic therapy active against Gram-negative bacilli and antifungal agents&#46; DTP&#58; differential time to positivity&#59; QBC&#58; quantitative blood culture&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "F&#46; Chaves, J&#46; Garnacho-Montero, J&#46;L&#46; del Pozo, E&#46; Bouza, J&#46;A&#46; Capdevila, M&#46; de Cueto, M&#46;&#193;&#46; Dom&#237;nguez, J&#46; Esteban, N&#46; Fern&#225;ndez-Hidalgo, M&#46; Fern&#225;ndez Sampedro, J&#46; Fort&#250;n, M&#46; Guembe, L&#46; Lorente, J&#46;R&#46; Pa&#241;o, P&#46; Ram&#237;rez, M&#46; Salavert, M&#46; S&#225;nchez, J&#46; Vall&#233;s"
          "autores" => array:18 [
            0 => array:2 [
              "nombre" => "F&#46;"
              "apellidos" => "Chaves"
            ]
            1 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Garnacho-Montero"
            ]
            2 => array:2 [
              "nombre" => "J&#46;L&#46;"
              "apellidos" => "del Pozo"
            ]
            3 => array:2 [
              "nombre" => "E&#46;"
              "apellidos" => "Bouza"
            ]
            4 => array:2 [
              "nombre" => "J&#46;A&#46;"
              "apellidos" => "Capdevila"
            ]
            5 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "de Cueto"
            ]
            6 => array:2 [
              "nombre" => "M&#46;&#193;&#46;"
              "apellidos" => "Dom&#237;nguez"
            ]
            7 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Esteban"
            ]
            8 => array:2 [
              "nombre" => "N&#46;"
              "apellidos" => "Fern&#225;ndez-Hidalgo"
            ]
            9 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Fern&#225;ndez Sampedro"
            ]
            10 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Fort&#250;n"
            ]
            11 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Guembe"
            ]
            12 => array:2 [
              "nombre" => "L&#46;"
              "apellidos" => "Lorente"
            ]
            13 => array:2 [
              "nombre" => "J&#46;R&#46;"
              "apellidos" => "Pa&#241;o"
            ]
            14 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "Ram&#237;rez"
            ]
            15 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Salavert"
            ]
            16 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "S&#225;nchez"
            ]
            17 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Vall&#233;s"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572718300134?idApp=WMIE"
    "url" => "/21735727/0000004200000001/v1_201802081105/S2173572718300134/v1_201802081105/en/main.assets"
  ]
  "en" => array:21 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Special article</span>"
    "titulo" => "Physician staffing needs in critical care departments"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "37"
        "paginaFinal" => "46"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "V&#46; G&#243;mez Tello, J&#46; Ruiz Moreno, M&#46; Weiss, E&#46; Gonz&#225;lez Mar&#237;n, P&#46; Merino de Cos, N&#46; Franco Garrobo, A&#46; Alonso Ovies, J&#46;C&#46; Montejo Gonz&#225;lez, T&#46; Iber, G&#46; Marx, V&#46; C&#243;rcoles Gonz&#225;lez, F&#46; Gordo Vidal, E&#46; Palencia Herrej&#243;n, J&#46; Roca Guiseris"
        "autores" => array:15 [
          0 => array:3 [
            "nombre" => "V&#46;"
            "apellidos" => "G&#243;mez Tello"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          1 => array:4 [
            "nombre" => "J&#46;"
            "apellidos" => "Ruiz Moreno"
            "email" => array:1 [
              0 => "javiruiz&#64;wanadoo&#46;es"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "Weiss"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "E&#46;"
            "apellidos" => "Gonz&#225;lez Mar&#237;n"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "P&#46;"
            "apellidos" => "Merino de Cos"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "N&#46;"
            "apellidos" => "Franco Garrobo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "aff0030"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "A&#46;"
            "apellidos" => "Alonso Ovies"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">g</span>"
                "identificador" => "aff0035"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "J&#46;C&#46;"
            "apellidos" => "Montejo Gonz&#225;lez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">h</span>"
                "identificador" => "aff0040"
              ]
            ]
          ]
          8 => array:3 [
            "nombre" => "T&#46;"
            "apellidos" => "Iber"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">i</span>"
                "identificador" => "aff0045"
              ]
            ]
          ]
          9 => array:3 [
            "nombre" => "G&#46;"
            "apellidos" => "Marx"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">j</span>"
                "identificador" => "aff0050"
              ]
            ]
          ]
          10 => array:3 [
            "nombre" => "V&#46;"
            "apellidos" => "C&#243;rcoles Gonz&#225;lez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">k</span>"
                "identificador" => "aff0055"
              ]
            ]
          ]
          11 => array:3 [
            "nombre" => "F&#46;"
            "apellidos" => "Gordo Vidal"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">l</span>"
                "identificador" => "aff0060"
              ]
            ]
          ]
          12 => array:3 [
            "nombre" => "E&#46;"
            "apellidos" => "Palencia Herrej&#243;n"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">m</span>"
                "identificador" => "aff0065"
              ]
            ]
          ]
          13 => array:3 [
            "nombre" => "J&#46;"
            "apellidos" => "Roca Guiseris"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">n</span>"
                "identificador" => "aff0070"
              ]
            ]
          ]
          14 => array:1 [
            "colaborador" => "on behalf of the Spanish Society of Intensive Care Medicine and the German Board of Anesthesiologists"
          ]
        ]
        "afiliaciones" => array:14 [
          0 => array:3 [
            "entidad" => "Servicio de Medicina Intensiva&#44; Hospital Moncloa&#44; Madrid&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Medicina Intensiva&#44; Hospital Universitari Sagrat Cor&#44; Barcelona&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Klinik f&#252;r An&#228;sthesiologie&#44; Universit&#228;tsklinikum&#44; Ulm&#44; Germany"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Servicio de Urgencias&#44; Hospital Universitari Sagrat Cor&#44; Barcelona&#44; Spain"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "Servicio de Medicina Intensiva&#44; Hospital de Can Misses&#44; Ibiza&#44; Spain"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
          5 => array:3 [
            "entidad" => "Servicio de Medicina Intensiva&#44; Hospital Universitario de M&#243;stoles&#44; Madrid&#44; Spain"
            "etiqueta" => "f"
            "identificador" => "aff0030"
          ]
          6 => array:3 [
            "entidad" => "Servicio de Medicina Intensiva&#44; Hospital Universitario de Fuenlabrada&#44; Madrid&#44; Spain"
            "etiqueta" => "g"
            "identificador" => "aff0035"
          ]
          7 => array:3 [
            "entidad" => "Servicio de Medicina Intensiva&#44; Hospital 12 de Octubre&#44; Madrid&#44; Spain"
            "etiqueta" => "h"
            "identificador" => "aff0040"
          ]
          8 => array:3 [
            "entidad" => "Stadtklinik Baden-Baden und des Kreiskrankenhauses B&#252;hl&#44; Institut f&#46; An&#228;sthesiologie und Intensivmedizin&#44; Baden-Baden&#44; Germany"
            "etiqueta" => "i"
            "identificador" => "aff0045"
          ]
          9 => array:3 [
            "entidad" => "Klinik f&#252;r Operative Intensivmedizin und Intermediate Care&#44; Aachen&#44; Germany"
            "etiqueta" => "j"
            "identificador" => "aff0050"
          ]
          10 => array:3 [
            "entidad" => "Servicio de Medicina Intensiva&#44; Complejo Hospitalario Universitario de Albacete&#44; Albacete&#44; Spain"
            "etiqueta" => "k"
            "identificador" => "aff0055"
          ]
          11 => array:3 [
            "entidad" => "Servicio de Medicina Intensiva&#44; Hospital Universitario del Henares&#44; Coslada&#44; Madrid&#44; Spain"
            "etiqueta" => "l"
            "identificador" => "aff0060"
          ]
          12 => array:3 [
            "entidad" => "Servicio de Medicina Intensiva&#44; Hospital Infanta Leonor&#44; Madrid&#44; Spain"
            "etiqueta" => "m"
            "identificador" => "aff0065"
          ]
          13 => array:3 [
            "entidad" => "Servicio de Medicina Intensiva&#46; Hospital Virgen de las Nieves&#44; Granada&#44; Spain"
            "etiqueta" => "n"
            "identificador" => "aff0070"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Estimaci&#243;n de las necesidades de profesionales m&#233;dicos en los servicios de medicina intensiva"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Productivity in critical care medicine departments &#40;CCMD&#41; is a complex issue&#44; and costs are high&#44; which is why it is absolutely justified to address the problem of the workforce sizing of intensivists&#46; There have been intensive care &#40;IC&#41; societies that have elaborated recommendations on the needs for intensivists<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1&#44;2</span></a> based on very different healthcare models on the management of critical patients &#40;CP&#41; rather than on adequacy analyses of the intensivists&#8217; productivity by measuring the intensivist&#47;bed ratios &#40;the reference source is shown in <a class="elsevierStyleCrossRef" href="#sec0065">electronic tables 1</a>&#44;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">3&#8211;11</span></a> 2<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1&#44;2&#44;12&#8211;15</span></a> and 3<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;16&#44;17</span></a> of <a class="elsevierStyleCrossRef" href="#sec0065">additional material</a>&#41;&#46; In Spain&#44; several recommendations have been proposed&#44;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> but all with the same philosophy of taking the doctor&#47;bed ratio into consideration&#46; Since they do not take productivity into consideration&#44; such recommendations have called for reducing the number of intensivists&#46; For all these reasons&#44; in 2013&#44; the Spanish Society of Intensive Care Medicine and Coronary Units established a technical taskforce of experts to assess the reference sources and recommendations from other similar societies&#44; provide its own experience&#44; and elaborate recommendations on the need for intensivists in the CCMD setting including their entire productivity&#44; and a method to estimate the real number of intensivists needed &#40;<a class="elsevierStyleCrossRef" href="#sec0065">see the spreadsheet provided in the additional material</a>&#41;&#46; These recommendations should include the existing new trends on the management of CPs&#44; issues of economic effectiveness and efficiency&#44; and giving explicit value to the intensivists&#8217; know-how&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Methodology</span><p id="par0010" class="elsevierStylePara elsevierViewall">The technical taskforce including eight expert intensivists categorized productivity into the following five areas of knowledge &#40;or 5 subcommittees&#41; corresponding to five activities that make up the service portfolio of most CCMDs&#58; &#40;1&#41; healthcare&#59; &#40;2&#41; activities outside the ICU &#40;AO-ICU&#41;&#59; &#40;3&#41; research&#59; &#40;4&#41; teaching&#59; and &#40;5&#41; patient safety &#40;PS&#41; and clinical management &#40;CM&#41;&#46; Two senior intensivists joined this technical committee and collected all the feedback &#40;FG&#44; EP&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The reference search included four databases&#58; PubMed&#44; Excerpta Medica data BASE &#40;EMBASE&#41;&#44; the Index of Scientific and Technical Literature of Latin America and the Caribbean &#40;LILACS&#41;&#44; and the Spanish Bibliographic Index of Health Sciences &#40;IBECS&#41;&#59; 845 references were found from the year 2000 &#40;including prior quotations when needed&#41; to the year 2015 that were reduced to 155 and then categorized based on the aforementioned five subcommittees&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The results from each subcommittee are expressed in a double way&#46; On the one hand&#44; the activities to be conducted &#40;healthcare&#44; AO-ICU&#44; teaching&#44; research&#44; and CM&#47;PS&#41; are listed&#44; and&#44; on the other hand&#44; the time that every intensivist spends conducting each activity expressed in activity percentage&#46; For the time estimate a double methodology was used based on whether we would be dealing with healthcare activities or less instrumental activities&#46; When it comes to healthcare activities&#8212;internal &#40;within the ICU&#41; and outside the CCMD&#44; they can easily be measured using experience and elaborated by consensus from the subcommittee&#44; yet we are talking about illustrative time frames so that every CCMD can present its best value based on its structural reality and logistics&#44; while making recommendations that the final value should be feasible and reproducible in case of authorship&#46; When it comes to less instrumental activities&#8212;research&#44; teaching&#44; and CM&#47;PS&#44; assessment is more difficult both in its type and time spent&#44; which is why choosing one qualitative criterion can always be arbitrary&#46; In view of all this&#44; one tool was used for the CM of CPs&#58; the setting&#47;productivity matrix of the critical patient &#40;PMCP&#41;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41; that stipulates what percentages of time each intensivist spends&#44; based on his professional category&#44; doing each and every one of the five activities associated with the management of CPs&#46; This PMCP is generic yet associated to the singularities of each CCMD&#44; in particular&#44; being 100 the maximum percentage of time spent for allocation purposes&#46; The PMCP makes no sense if we consider the ICU but not the CCMD when only implemented it to pick up the activity occurring inside and outside the ICU&#46; The PMCP vertical axis describes the physical action setting of the team managing the CP &#40;with allocated time percentages&#41; and the PMCP horizontal axis shows the specific productivity &#40;with allocated time percentages&#41;&#46; It is assumed that depending on this or that autonomous community and this or that labor contract&#44; every intensivist should have three possible annual schedules&#58; 1825<span class="elsevierStyleHsp" style=""></span>h &#40;or 40<span class="elsevierStyleHsp" style=""></span>h&#47;week&#41;&#44; or 1750<span class="elsevierStyleHsp" style=""></span>h &#40;or 38<span class="elsevierStyleHsp" style=""></span>h&#47;week&#41;&#44; or 1711<span class="elsevierStyleHsp" style=""></span>h &#40;or 37&#46;5<span class="elsevierStyleHsp" style=""></span>h&#47;week&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Finally&#44; the time frames and activities established by every subcommittee were tabulated in a spreadsheet derived from another spreadsheet developed by 3 German authors &#40;MW&#44; TI and GM&#41;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a> that these authors helped modify&#59; such a spreadsheet was used as the basis for the ultimate spreadsheet proposal &#40;<a class="elsevierStyleCrossRef" href="#sec0065">see additional material</a>&#41;&#46; One expert physician savvy on spreadsheets and databases &#40;EG&#41; developed the final model&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Results</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Management and healthcare activities in the intensive care unit</span><p id="par0030" class="elsevierStylePara elsevierViewall">The healthcare activities and estimate time frames occurring within the ICU are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> and they have to do with the hospitalizations of patients&#44; with routine daily care&#44; with hospital discharges&#44; clinical sessions&#44; and with extraordinary administrative procedures&#46; The healthcare activities occurring within the ICU associate procedures and estimate time frames that are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46; Using the PMCP&#44; the time percentages spent conducting healthcare activities within the ICU and tabulated by professional category are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Managerial and healthcare activities conducted outside the intensive care unit</span><p id="par0035" class="elsevierStylePara elsevierViewall">The AO-ICU illustrates both the management of a CP outside the ICU &#40;not necessarily an emergency&#41; and the prevention of critical conditions&#44; normally with regard to one or more organic dysfunctions&#46; In other words&#44; AO-ICU intends to improve morbimortality through&#58; &#40;1&#41; the early detection of the CP outside the ICU&#59; and &#40;2&#41; the early implementation of healthcare initiatives&#46; The AO-ICU can be &#8220;instrumental&#8221; and &#8220;non-instrumental&#8221;&#44; or respectively&#44; activities associated with any given diagnostic and&#47;or therapeutic procedure or activities associated with a certain type of patient&#8212;including&#44; or not&#44; the CP code&#46; The &#8220;instrumental&#8221; activities requiring transfer of CPs outside the ICU to perform this or that diagnostic and&#47;or therapeutic procedure such as CAT scans are shown in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#44; as well as the 9 &#8220;non-instrumental&#8221; activities&#46; The specific time frames of these &#8220;non-instrumental&#8221; activities are shown in <a class="elsevierStyleCrossRef" href="#sec0065">electronic Table 4 &#40;see additional material</a>&#41; including the four basic codes for the CP&#46; These time frames are not an absolute written-in-stone description of the activities but are probably common to 90&#37; of all Spanish CCMDs&#46; See the differences and distinctive features based on whether the patient is&#58; &#8220;non-critical&#8221;&#59; &#8220;critical&#8221; &#40;&#8220;reversible&#8221; or &#8220;reversible with limitations of life-support therapy&#8221;&#41;&#59; &#8220;sub-critical&#8221;&#59; and &#8220;post-critical&#8221;&#46; The time percentages spent to AO-ICU by professional category are also shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Research activities</span><p id="par0040" class="elsevierStylePara elsevierViewall">In this document and for the sake of scientific research we have imagined a generic CCMD with the following percentage of intensivists to perform all of its activities&#58; &#8220;physician assistant&#8221; 65&#8211;0&#37;&#59; &#8220;clinical director&#8221;&#58; 20&#8211;25&#37;&#59; and &#8220;service director&#8221;&#58; 10&#37;&#46; Neither doctors on call or residents were included basically because their duties have to do with healthcare and because they are on a training contract&#46; The time percentages translated into hours for the sake of research using the PMCP and other activities performed by the intensivists are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; In the example showed and to make it easier&#44; none of those seven doctors would practice prehospital AO-ICU&#46; Always according to this matrix&#44; the following would be the annual hour allocation for the three categories &#40;physician assistant&#59; clinical director&#44; and service director&#41;&#58; 175<span class="elsevierStyleHsp" style=""></span>annual hours per physician &#40;10&#37;&#41;&#44; that is&#44; out of a team of 7 physicians with an overall annual contract of 1250<span class="elsevierStyleHsp" style=""></span>h&#44; an annual set of 1225<span class="elsevierStyleHsp" style=""></span>h would be explicitly assigned to research&#44; which is equivalent to 70&#37; of a single physician&#39;s working day&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Activities that have to do with teaching and college</span><p id="par0045" class="elsevierStylePara elsevierViewall">Training needs to be continuing medical education &#40;CME&#41; after students become college graduates&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a> When it comes to college teaching this can be easily seen in the greater number of medical schools&#44; elective subjects&#44; use of simulations and objective&#44; structured clinical assessments&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a> When it comes to post-graduate degree teaching<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> in order to do quality teaching in the CCMD&#44; accreditations abiding not only by the specialty official program but also by the competences of the European program CoBaTrICE<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">23&#44;24</span></a> are required&#46; Although CME is not regulated&#44;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> it is certainly necessary&#46; The fact that the intensivists from a CCMD teach college degrees&#44; post-graduate degrees and CME programs is clearly beneficial but requires time and effort that even though is hard to ponder on&#44; should be taken into consideration when designing the staff of intensivists&#46; How should we determine the time that specialists should spend teaching&#8212;both as instructors and teachers&#63; One possible recommendation would be following the actual legislation&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">26&#44;27</span></a> In order to make an approximate estimate of the time that intensivists should spend participating in CME programs and teaching&#44; the rules and regulations published by different health systems from different autonomous communities such as the Health Department from the Community of Madrid<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a> &#40;shown in <a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41; should be observed&#46; The additional material shows the activities that would be recognized as CME programs and teaching that give physicians points to promote their professional careers in compliance with the rules from the Health Department from the Community of Madrid&#46; For example&#44; and always from the perspective of this community&#44; intensivists should dedicate 40<span class="elsevierStyleHsp" style=""></span>h&#47;year to training&#44; and 20<span class="elsevierStyleHsp" style=""></span>h&#47;year to teaching&#46; <a class="elsevierStyleCrossRef" href="#sec0065">additional material &#40;electronic Table 5&#41;</a> also shows the activities and amount of time that intensivists should spend teaching&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Activities related to the patient&#39;s clinical management and safety</span><p id="par0050" class="elsevierStylePara elsevierViewall">There is no doubt that healthcare&#44; teaching and research are still at the heart of all medical specialties&#44; and during the last few decades&#44; we have witnessed the birth of two new complementary concepts&#58; CM and PS&#46; When it comes to CPs&#44; the CM is defined as the set of coordinate actions within a given CCMD aimed at achieving effectiveness and efficacy&#46; The CCMD operates as a healthcare responsibility center in the understanding that the CP is managed both in and out of the ICU &#40;e&#46;g&#46; expansion of the CCMD areas of competence and healthcare grading&#41;&#46; It promotes and implements scientific knowledge for the management of CPs&#44; while abiding by the clinical practice guidelines&#44; and set of recommendations elaborated by its scientific committees and technical taskforces&#46; CM refers to the participation of healthcare professionals in the management of the CCMD by promoting that these professionals establish not &#8220;what&#8221;&#8212;reserved for the hospital management and the corporate strategy&#44; but &#8220;how&#8221; healthcare&#44; teaching&#44; and research should really be&#46; The quality of healthcare aims at the CP&#44; based on process management&#44; and is carried out by healthcare professionals during the management of CPs&#44; using the right competences and training&#44; specific means&#44; specific clinical information systems and documentation based on the existing medical literature&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The CCMDs have the responsibility of defining&#44; gathering&#44; and analyzing all the information coming from the risk management system on achieving security goals&#44; effective operational programs&#44; and briefing on any PS-associated incidents&#46; The activities and time spent on CM&#47;PS are shown in <a class="elsevierStyleCrossRef" href="#sec0065">electronic Table 6 &#40;see additional material&#41;</a>&#46; Adjusted by professional categories&#44; each physician should spend a certain amount of time on CM&#47;PS&#46; These are percentages estimated by the experience accumulated&#44; which means that they are&#44; inevitably&#44; generic&#46; In order to make these percentages logical&#44; the time percentages associated with &#8220;healthcare&#8221;&#59; &#8220;teaching&#8221; and &#8220;research&#8221; adjusted by professional category should be on the record&#46; When it comes to the PMCP&#44; and assuming that a working day amounts to 1750<span class="elsevierStyleHsp" style=""></span>h&#44; the time percentages translated into hours for the CM&#47;PS combo should be like the ones shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#44; that shows the percentages of all the intensivists&#8217; activities according to their professional setting&#46; The overall time estimates for the hours spent on CM and PS&#44; and the participation in hospital committees are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> too&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">After reviewing the reference sources on the staff of intensivists&#44; several important organizational conclusions can be drawn that can be generalized to the staffing models of the United States&#44; Europe&#44; and Spain&#59; conclusions&#44; however&#44; that do not provide one valid&#44; single rule to estimate when the intensivists are really needed&#46; When it comes to Europe &#40;where High Intensity Staffing is predominant&#41;&#44; in its staffing recommendations&#44; the ESCIM only provides one rule to make the calculation without giving any fixed numbers&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> Recently&#44; the World Federation of Societies of Intensive and Critical Care Medicine discussed the disparities&#44; in the Western world&#44; on the management of CPs&#44;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a> including the amount of emergency rooms per 100&#44;000 inhabitants&#44; and the disparity of emergency rooms depending on whether we are in metropolitan or rural areas&#46; It goes without saying that when non-Western countries are included in this analysis &#40;World Federation&#41;&#44; disparities are just huge&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">In Spain&#44; the Standards of Healthcare in Intensive Care Units<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a>&#8212;a model that was similar to the European one&#44; were published in 2010&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">a&#46;</span><p id="par0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Level III Medical</span>&#160;and Surgical&#160;<span class="elsevierStyleItalic">Critical Care</span>&#160;Unit&#58; one full time intensivist for every 4&#8211;5 patients from 8&#58;00 to 18&#58;00<span class="elsevierStyleHsp" style=""></span>h&#44; plus one intensivist for every 12 patients from 18&#58;00 to 8&#58;00<span class="elsevierStyleHsp" style=""></span>h&#8212;Saturdays and public holiday included&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">b&#46;</span><p id="par0075" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Level II Medical</span>&#160;and Surgical&#160;<span class="elsevierStyleItalic">Critical Care</span>&#160;Unit&#58; one intensivist for every 6&#8211;10 patients from 8&#58;00 to 18&#58;00<span class="elsevierStyleHsp" style=""></span>h&#8212;Saturdays and public holiday included&#44; plus one intensivist from 18&#58;00 to 8&#58;00<span class="elsevierStyleHsp" style=""></span>h&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">c&#46;</span><p id="par0080" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Level I Medical</span>&#160;and Surgical&#160;<span class="elsevierStyleItalic">Critical Care</span>&#160;Unit&#58; one intensivist for every 8&#8211;12 patients&#46;</p></li></ul></p><p id="par0085" class="elsevierStylePara elsevierViewall">With such model disparity and low level of evidence in the reviewed medical literature we can only do approximate estimates of the intensivist&#47;bed ratio&#44; and adjust the Spanish model per hour and ICU healthcare level&#46; The technical taskforce responsible for this document considered that even though these formulas are easy to get&#44; they under or overestimate the workforce needed based on the level of activity&#46; Not always a fixed number of beds is consistent&#44; in a linear way&#44; with this or that level of activity&#46; These premises are based on a concept of a Spanish intensive care healthcare model characterized by CCMDs as structures that determine professional development&#44; activity-based management &#40;whether input-based&#44; or intermediate results-based&#41;&#44; the superficial distinction between healthcare&#47;teaching&#47;research in the daily work&#44; the &#8220;convenience&#8221; and adaptation to the vertical hospital organization chart&#44; and a full-time commitment to CPs&#44; or the CCMD&#46; It is evident that this situation can generate inefficiencies when the actual productivity is not adjusted to the estimated productivity based on the CCMD size&#44; or case-mix&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">While trying to come up with an answer to a key question to the problem of what the workforce sizing of intensivists should be in ICUs in the United States&#44; the capacity to sustain such staff and the structure of a controversial model of management of the CP in this country has been put into question&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a> Only in the United States&#44; the authors identify a breach between the number of intensivists for the management of actual and future CPs&#59; but if we really want to solve this problem&#44; we should not hire or train more intensivists for the following reasons&#58; &#40;a&#41; training is expensive&#59; &#40;b&#41; if more intensivists were hired&#44; they would probably not be assigned where&#44; theoretically speaking&#44; they are more widely needed&#8212;rural areas&#44; but metropolitan areas&#59; &#40;c&#41; the management of CPs is both inter and multidisciplinary&#59; and &#40;d&#41; if this lack of intensivists is common to other 22 medical specialties&#44; why should we make the intensivist management of CPs a priority and sideline other medical specialists&#63; Basically&#44; the problem of this lack of intensivists is more of an offer&#47;supply mismatch rather than a real need&#44; which would lead us to two possible solutions&#58; &#40;1&#41; improving healthcare and not the number of intensivists&#59; and &#40;2&#41; reducing the number of CPs by not allowing more new beds in ICUs through a specific legal framework&#44; by establishing triage policies&#44; and limiting the life-support therapies&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">One alternative approach that would help estimate more efficiently the actual need for intensivists would be to consider a model that incorporates the notion that the intensivist should follow the CP wherever he may be&#44; and reject the notion that the physical structure conditions the number of intensivists&#46; Other than keeping full-time commitment to the CP&#44; the intensivist&#39;s management of healthcare should be implemented where needed &#40;expansion of the CCMD&#41;&#46; Even so&#44; in Spain a CCMD should include a holistic healthcare spectrum and gradation system for the management of CPs such as ICUs&#44; SICUs&#44; medical emergency teams&#44; emergency rooms&#44; hospital floors&#44; subcritical patients&#44; post-critical patients&#44; pre-hospital patients&#44; etc&#46; One way to contribute to the non-exclusive expansion of the CCMD would be process organization through functional units led by intensivists guaranteeing the observance of a certain healthcare continuum&#44; both through competences and feasible economic plans &#40;or when the simultaneous production of various outputs in a single institution is cheaper than the individual production of such outputs&#44; such as the hospital management of CPs&#44; and not just the ICU management of CPs&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The professionals included in this model would be intensivists whose training is already defined in the official program of their specialty both through the CoBaTriCE program and the guides and protocols of every CCMD&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a> The CCMDs that abide by this model should have the participation of 24&#47;7 full-time intensivists&#46; There are several arguments to justify this statement&#58; &#40;a&#41; healthcare reasons&#8212;since there are physicians responsible for every CP that guarantee the ongoing care of CPs and allow multidisciplinary and interdisciplinary interactions in and out of the ICU&#59; &#40;b&#41; pedagogical reasons&#8212;teachers who already teach within the CCMD&#59; &#40;c&#41; research reasons&#8212;basic&#44; applied and translational research&#44; since research activities are conducted within the CCMD&#59; &#40;d&#41; CM reasons&#8212;generation of scale economies &#40;price cut by concentration&#41; projected into the future with higher healthcare and economic efficiency&#59; the socialization of knowledge and a reduced variability in the clinical practice&#59; and &#40;e&#41; PS reasons&#8212;implementation of a CP-specific risk management system&#46; If we assume this CCMD model&#44; those specialists working in such a model should perform ICU healthcare-oriented activities&#44; AO-ICU&#44; teaching and research activities&#44; and initiatives aimed at promoting CM and PS&#46; Thus&#44; the actual activity of a CCMD cannot be based on the obsolete&#44; rigid notion of the number of beds anymore&#44; since this notion only includes the healthcare activity taking place within the CCMD assuming that there is a conceptual linearity among the structure&#44; the possible severity and measurable activities&#46; The medical staff should be reckoned by the CCMD actual overall productivity &#40;outputs&#41;&#44; regardless of the number of beds assigned&#44; in all activities that have to do with the management of CPs&#46; This productivity metrics includes the total number of activities performed every year divided by the time spent conducting every activity&#46; The number of physicians should be obtained by dividing the overall activity time by the maximum number of annual hours established by the labor contract&#46; Now&#44; how can we make an estimate of this activity and assess it effectively&#63; Well&#44; we would start by assessing the amount of time spent implementing classic&#44; routine healthcare activities&#44; procedures for the management of UCI patients&#44; plus EAUCI instrumental activities&#44; and measurable and describable time frames in a potentially agreed range&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">If we take into account that in many CCMDs&#44; the teaching and research activities happen outside the intensivists&#8217; working schedule&#44; it seems difficult to try to assess the necessary time&#44; or time spent doing these less &#8220;instrumental&#8221; tasks such as teaching&#44; research&#44; CM&#44; and PS&#46; One approach to this would be to establish one illustrative PMCP with fixed scheduled activity percentages &#40;healthcare&#44; management&#44; teaching&#44; research&#41;&#46; In this document&#44; this tool has been used to be able to make an estimate of the research activity going on&#44; and the activities aimed at implementing CM and PS&#46; However&#44; and because all matrixes are merely illustrative&#44; a system with different levels of healthcare&#44; service portfolios&#44; and teaching&#47;research capabilities cannot be imposed on all CCMDs as the only valid model&#46; Different CCMDs will score different final percentages&#44; making it hard to come up with the exact number of intensivists needed&#46; Nevertheless&#44; this can be a valid tool if we just wish to make estimates when the activity is hardly measurable&#44; such as in this case&#46; There is a different model&#44; suggested by German authors<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> that we think may suit the reality of the proposed intensivist variable activity better&#46; In this formula&#44; the needs for intensivists follows the actual activity measured in hours&#44; according to a available amount of hours&#44; based on the legal working hours&#46; Therefore&#44; the measurement and quantification of activity is essential to know if what is being done equals a higher number than the hourly capabilities of the available &#8220;workforce&#8221;&#46; To this end&#44; the activities conducted in every CCMD and its available working hours are measured&#46; Then the healthcare provided by the staff is divided by the time working load &#40;days&#44; shifts of different duration&#41;&#44; while observing the organizational peculiarities of every CCMD&#46; This model includes three sequential steps&#46; The first step being the definition of the basic tasks within a services portfolio representative of most Spanish CCMDs&#46; The second step being the estimate of illustrative&#44; average time frames adjusted for the peculiarities of each CCMD&#44; valid enough to allow external auditing&#46; And the last step being the total number of yearly tasks and patients&#44; that will later be multiplied by the estimate time frames for each task and patient&#46; This is how we will achieve the sum of the annual working load&#44; healthcare activities &#40;at the ICU and AO-ICU&#41;&#44; and non-healthcare activities &#40;teaching&#44; CME&#44; research&#44; CM and PS&#41;&#44; that we will later divide by the average hours established by the labor contract&#8212;always within the legal framework and always being respectful of the PS&#44; to finally achieve the right number of intensivists needed&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The limitations of this paper already appear in the methodology&#46; Time frames are illustrative and mainly based on the opinions of experts and medical literature&#46; Time frames that should necessarily vary based on the structure and conditions of every CCMD&#44; but also true and externally auditable time frames&#46; The estimate method proposed requires a trustworthy&#44; reliable&#44; and sustainable clinical management information system&#46; A priori this fact may be a barrier that makes estimation hard to achieve&#46; In short&#44; it will be a mandatory requirement for all CCMDs&#8212;documenting their healthcare activity through a minimal&#44; basic set of data chosen by the CCMD&#44; and providing diagnostic&#44; severity&#44; and procedural data&#46; Failure to do so leads to a lack of transparency unfit for the needs of both patients and healthcare managers&#46; The latter may not enlarge their roster of intensivists if not justified through documentation and proven through a comprehensive and externally auditable tool&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">To make the estimates easier for the professionals who decides to implement this proposal&#44; as <a class="elsevierStyleCrossRef" href="#sec0065">additional material&#44; the Excel spreadsheet</a><span class="elsevierStyleSup">&#174;</span> adapted by Weiss<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a> to the Spanish model mentioned has been included&#44; with information on how to fill out its tabs&#44; with generic recommendations and examples&#46; This spreadsheet has been tested by the authors at their respective centers and the unpublished results obtained are very similar to one another&#8212;of course this is a temporary statement until the tests go public&#46; Once the right number of intensivists has been achieved&#44; the intensivists can be allocated in shifts and calls through specific regulations as shown on the spreadsheet&#46; In this sense&#44; the proposal from this technical taskforce establishes with the total number of physicians that are needed in a CCMD&#46; The tool used to make the calculations helps achieve this number based on different labor contracts and schedules&#44; but it is useless if we want to allocate the staff based on temporal segments &#40;hours&#44; days&#41; consistent with higher peaks of activity&#46; The hour estimate provided by this document is annual&#44; and not hourly or weekday-based&#46; Following a certain methodological coherence&#44; the proposal intentionally runs away from giving any fixed recommendations on how to allocate the staff&#46; And this is so based on the fact that it is impossible to contemplate every single situation of every single CCMD and center&#44; not even arbitrarily estimate a supposedly majoritarian setting&#59; every CCMD has its own organizational idiosyncrasy that determines the allocation of intensivists in shifts and calls&#46; It is plain to see that this is something that worries the directors of CCMDs&#44; and there is no doubt that not having some sort of drive on this regard can be frustrating&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">We did not want to betray the philosophy of our work and in order to help these professionals&#44; we wanted to offer step-by-step premises for the allocation of intensivists in a CCMD&#58; &#40;1&#41; quantify the number of CCMD admissions per hour and day of the week&#46; The presence admissions of a certain kind &#40;such as surgical block&#41; should also be taken into consideration&#46; &#40;2&#41; Write down the hourly and weekly allocation of this or that technique&#44; important AO-ICU in the service portfolio of both the CCMD and the hospital&#59; &#40;3&#41; assess the schedule assigned to teaching&#44; research or CM&#47;PS activities&#44; especially when this happens outside the morning schedule&#59; &#40;4&#41; draw charts including results for managers to see through one comprehensive proposal&#44; while giving relevance to the most time-consuming tasks that are more important on both the healthcare and strategic levels&#46; Always have the hospital mission statement present&#8212;mission&#44; vision&#44; values&#46; It is useful to present the data from the spreadsheet suggested in this document&#59; and &#40;5&#41; try to negotiate if it is contractually possible to reach an agreement with good-hearted staff on the actual demand&#46; One of the limitations of this proposal is that it is not applicable during the CCMD first operational year in brand new hospitals&#44; which is why it has been resized facing the possibility of future merges or growth&#46; It is obvious that during the first year&#44; the staffing needs will be different from the needs that may arise during longer time frames with more consolidated activities&#46; Yet when it comes to staffing needs&#44; comparisons with prior experiences can be useful if we wish to set a starting point and a 3&#8211;5-year horizon&#46; Also&#44; the estimate suggested could be drawn the very first year in order to document the activity trend&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conclusions</span><p id="par0125" class="elsevierStylePara elsevierViewall">The model of intensive medicine and that of all CCMDs needs to change following criteria of effectiveness and efficiency&#46; The competences and tasks that an intensivist is required to do go far beyond the mere healthcare duties of an ICU &#40;e&#46;g&#46; AO-ICU&#44; teaching&#44; research&#44; risk management-RM&#44; CM and PS&#41; and cannot be estimated following uniform structural criteria&#46; Every CCMD should be assessed individually when it comes to the actual overall productivity&#46; Both the methodology and task and time description of every one of the aforementioned five specific activities enables every CCMD to use the tools assigned in an estimate-based spreadsheet by entering verifiable and auditable specific information&#8212;both in number and time&#44; and then obtaining adjusted estimates&#46; The tool based on the premise of information and not on supposed qualitative data is one management tool that can be understood&#44; checked and&#44; then&#44; taken into consideration by all managing teams and healthcare systems&#44; in an attempt to guarantee the intensivist that we are dealing with one methodology that can be put to the test&#46; In sum&#44; through a necessarily qualitative spreadsheet&#44; we believe it is feasible to estimate the real needs of intensivist staffs both based on the expansion of the CCMD&#44; and its maximum productivity &#40;healthcare&#44; AO-ICU&#44; teaching&#44; research&#44; RM&#44; CM and PS&#41;&#46; Finally&#44; the quantification of the number of intensivists involved in the overall productivity of every CCMD leads us to asking two different questions&#58; What do physicians who work in a responsibility center&#8212;the CCMD produce that eats away a significant chunk of the hospital budget&#63; And what intrinsic value do these physicians generate by grading their knowledge in five different activities&#63;</p><p id="par0130" class="elsevierStylePara elsevierViewall">If we keep in mind that the short-term projection in healthcare&#44; in the Western world&#44; is that hospitals will be admitting more and more critical patients&#44; and refer less critical or chronic patients to alternatives different than hospitalization &#40;expansion&#41;&#44; we can say that the need for CCMDs and well-prepared intensivists for the management of CPs will grow consequently&#46; Maybe part of the intensivists&#8217; mission who manage CPs should be facing this apparent paradox&#58; do whatever necessary so that patients do not progress into CPs&#44; and do whatever necessary when this progression actually happens&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conflict of interests</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors of this paper declare no conflicts of interest whatsoever&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:12 [
        0 => array:3 [
          "identificador" => "xres981804"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec949466"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres981803"
          "titulo" => "Resumen"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec949467"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Methodology"
        ]
        6 => array:3 [
          "identificador" => "sec0015"
          "titulo" => "Results"
          "secciones" => array:5 [
            0 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Management and healthcare activities in the intensive care unit"
            ]
            1 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Managerial and healthcare activities conducted outside the intensive care unit"
            ]
            2 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Research activities"
            ]
            3 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Activities that have to do with teaching and college"
            ]
            4 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Activities related to the patient&#39;s clinical management and safety"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Conclusions"
        ]
        9 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Conflict of interests"
        ]
        10 => array:2 [
          "identificador" => "xack332639"
          "titulo" => "Acknowledgements"
        ]
        11 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2016-11-18"
    "fechaAceptado" => "2017-09-17"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec949466"
          "palabras" => array:3 [
            0 => "Activity"
            1 => "Department of critical care medicine"
            2 => "Intensive care unit"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec949467"
          "palabras" => array:3 [
            0 => "Actividad"
            1 => "Servicio medicina intensiva"
            2 => "Unidad de cuidados intensivos"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Departments of Critical Care Medicine are characterized by high medical assistance costs and great complexity&#46; Published recommendations on determining the needs of medical staff in the DCCM are based on low levels of evidence and attribute excessive significance to the structural&#47;welfare approach &#40;physician-to-beds ratio&#41;&#44; thus generating incomplete and minimalistic information&#46; The Spanish Society of Intensive Care Medicine and Coronary Units established a Technical Committee of experts&#44; the purpose of which was to draft recommendations regarding requirements for medical professionals in the ICU&#46; The Technical Committee defined the following categories&#58; &#40;1&#41; patient care-related aspects&#59; &#40;2&#41; activities outside the ICU&#59; &#40;3&#41; patient safety and clinical management aspects&#59; &#40;4&#41; teaching&#59; and &#40;5&#41; research&#46; A subcommittee was established with experts pertaining to each activity category&#44; defining criteria for quantifying the percentage time of the intensivists dedicated to each task&#44; and taking into account occupational category&#46; A quantitative method was applied&#44; the parameters of which were the number of procedures or tasks and the respective estimated indicative times for patient care-related activities within or outside the context of the DCCM&#44; as well as for teaching and research activities&#46; Regarding non-instrumental activities&#44; which are more difficult to evaluate in real time&#44; a matrix of range versus productivity was applied&#44; defining approximate percentages according to occupational category&#46; All activities and indicative times were tabulated&#44; and a spreadsheet was created that modified a previously designed model in order to perform calculations according to the total sum of hours worked and the hours stipulated in the respective work contract&#46; The competencies needed and the tasks which a Department of Critical Care Medicine professional must perform far exceed those of a purely patient care-related character&#44; and cannot be quantified using structural criteria&#46; The method for describing the 5 types of activity&#44; the quantification of specific tasks&#44; the respective times needed for each task&#44; and the generation of a spreadsheet led to the creation of a management instrument&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Los servicios de medicina intensiva se asocian a una alta complejidad asistencial y un alto coste monetario&#46; Las recomendaciones sobre el c&#225;lculo de las necesidades de intensivistas adolecen de baja evidencia y favorecen un criterio estructural y asistencial &#40;proporci&#243;n m&#233;dico&#47;camas&#41;&#44; lo que origina modelos reduccionistas&#46; La Sociedad Espa&#241;ola de Medicina Intensiva y Unidades Coronarias constituy&#243; una comisi&#243;n t&#233;cnica para redactar unas recomendaciones sobre la necesidad de intensivistas en los servicios de medicina intensiva&#46; La comisi&#243;n t&#233;cnica defini&#243; 5 actividades&#58; 1&#41; asistencial&#59; 2&#41; actividades extra-UCI&#59; 3&#41; seguridad del paciente y gesti&#243;n cl&#237;nica&#59; 4&#41; docencia&#59; y 5&#41; investigaci&#243;n&#46; Para cada actividad o categor&#237;a se crearon subcomit&#233;s espec&#237;ficos que definieron criterios para cuantificar el porcentaje que supone cada tarea para los intensivistas por rango profesional&#46; Para las actividades asistenciales dentro y fuera de la UCI&#44; y tambi&#233;n para las actividades docentes e investigadoras&#44; se sigui&#243; un sistema cuantitativo del n&#250;mero de procedimientos o tareas por tiempos estimados&#46; En relaci&#243;n con las actividades no instrumentales&#44; m&#225;s dif&#237;ciles de evaluar en tiempo real&#44; se sigui&#243; una matriz de &#225;mbito&#47;productividad&#44; definiendo los porcentajes aproximados de tiempo dedicado por categor&#237;a profesional&#46; Se elabor&#243; una hoja de c&#225;lculo&#44; modificando un modelo previo&#44; atendiendo la suma de horas estipuladas por contrato&#46; Las competencias exigidas van m&#225;s all&#225; de la asistencia intra-UCI&#44; y no pueden calcularse bajo criterios estructurales&#46; La metodolog&#237;a sobre 5 actividades&#44; la cuantificaci&#243;n de sus tareas espec&#237;ficas y tiempos y la construcci&#243;n de una hoja de c&#225;lculo generan un instrumento adecuado de gesti&#243;n&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0035">Please cite this article as&#58; G&#243;mez Tello V&#44; Ruiz Moreno J&#44; Weiss M&#44; Gonz&#225;lez Mar&#237;n E&#44; Merino de Cos P&#44; Franco Garrobo N&#44; et al&#46; Estimaci&#243;n de las necesidades de profesionales m&#233;dicos en los servicios de medicina intensiva&#46; Med Intensiva&#46; 2018&#59;42&#58;37&#8211;46&#46;</p>"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0150" class="elsevierStylePara elsevierViewall">The following is the supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0065"
          ]
        ]
      ]
    ]
    "multimedia" => array:6 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">AO-ICU&#58; activities outside the ICU&#59; CD&#58; clinical director&#59; SD&#58; service director&#59; PA&#58; physician assistant&#59; IMR&#58; internal medical residents&#59; ICU&#58; intensive care unit&#59; SICU&#58; semi-intensive care unit&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Setting&#47;activity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Healthcare subcommittee 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Teaching subcommittee 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Research subcommittee 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Clinical M&#46;<br>subcommittee 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">M&#46; and safety subcommittee 5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="5" align="left" valign="top"><span class="elsevierStyleItalic">ICU</span></td><td class="td" title="table-entry  " align="left" valign="top">PA 1 60&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PA 2 60&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PA 3 60&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CD 20&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#37;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SD 10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#37;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="4" align="left" valign="top"><span class="elsevierStyleItalic">SICU</span></td><td class="td" title="table-entry  " align="left" valign="top">PA 4 30&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PA 5 30&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CD 10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SD 5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Hospital floor</span></td><td class="td" title="table-entry  " align="left" valign="top">PA 4 10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PA 5 10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CD 5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SD 5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Post-critical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PA 4 20&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Emergency room</span></td><td class="td" title="table-entry  " align="left" valign="top">PA 5 20&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CD 10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SD 5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1662598.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">These specific percentages are interchangeable whenever a PA has a more significant participation in a safety committee or risk committee&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">PMCP pertaining to &#8220;healthcare&#8221;&#59; &#8220;activities outside the ICU&#8221;&#59; &#8220;research&#8221;&#59; &#8220;clinical management&#8221;&#59; and management and safety of a generic internal medicine unit with 5 physician assistants&#59; 1 clinical director&#44; and 1 service director&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">CCMD&#58; critical care medicine department&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Procedure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Time &#40;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Admission</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hospital reception of the patient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Clinical medical examination&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Request diagnostic testing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Write clinical history in the CCMD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Write down the therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Achieve basic diagnoses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Interviews with other specialists involved&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Information for next shift staffing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Combined pass &#40;if it comes to that&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Daily routine</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Medical examination in the CCMD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Write down the clinical evolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Write down the therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Interhospital transfers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Interviews with other specialists &#40;microbiology&#44; radiodiagnosis&#44; others&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Information to family members&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Reference search for the case&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Medical&#47;nursing common goals&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Discharge or transfer</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Final medical examination&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Gather documentation to write the report&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Write the report&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Contact the destination hospital and physicians in charge of the transfer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Special administrative proceedings</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Medical reports detailed for judiciary organizations and insurance companies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Death certificate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Visits or shift changes</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>The following data will need to be entered&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Specify the number of sessions in business days&#44; Saturdays&#44; Sundays and public holidays&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Detail the number of doctors per patient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Indicate time spent with every patient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1662594.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Routine healthcare activity time frames in the CCMD&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">CCMD&#58; critical care medicine department&#59; RRT&#58; renal replacement therapy&#59; ICU&#58; intensive care unit&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Procedures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Time &#40;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Paracentesis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Insertion of venous catheters&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Insertion of arterial catheters&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diagnostic bronchoscopy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Interpretation of hemodynamic data &#40;termodilution catheter&#47;PiCCO&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Liver function monitoring system &#40;LIMON and the like&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">RRT &#40;heparin&#41;&#47;establish-change<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">RRT &#40;citrate&#41;&#47;establish-change<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Segstaken&#8211;Blakemore probe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Monitoring of de hepatic dialysis<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">120&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Thromboelastography&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Decubitus position&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Blood transfusion&#47;hemoderivatives&#47;procoagulant agents &#40;per unit&#41;<span class="elsevierStyleSup">&#42;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Scheduled cardioversion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Insertion of thermodilution catheter &#40;Swan&#47;Picco&#47;Lidco&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Extracorporeal membrane oxygenation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Measurement of intracranial pressure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Transcranial Doppler ultrasound&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lumbar puncture&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Endotracheal intubation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Non-invasive mechanical ventilation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patient transfer to&#47;from the operating room&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patient isolation&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Implantation of epidural catheter&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pericardiocentesis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Thoracocentesis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Transesophageal echocardiogram&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Transthoracic echocardiogram&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Thoracic drainage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Percutaneous tracheostomy &#40;dilation&#47;plastic&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Temporary transvenous pacemaker&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Transcutaneous pacemaker&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Definitive pacemaker<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1662595.png"
              ]
            ]
          ]
          "notaPie" => array:2 [
            0 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Whether it is done by intensivists&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Whether it is implanted by intensivists&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Procedures performed at the intensive care unit&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">AO-ICU&#58; activities outside the ICU&#59; ICU&#58; intensive care unit&#46;</p>"
          "tablatextoimagen" => array:2 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Procedure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Time &#40;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Coronary angiography &#40;diagnostic&#47;interventional&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&#8211;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Medical examination<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Wiring&#47;unwiring&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Transfer to a different hospital&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Transfer to the unit of hemodynamics in-house&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Brain angiography</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Medical examination<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Wiring&#47;unwiring&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Transfer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Other angiographic procedures</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Medical examination<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Wiring&#47;unwiring&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Transfer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">CT scan</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Medical examination<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Wiring&#47;unwiring&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Transfer time&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">MR</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Medical examination<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Wiring&#47;unwiring&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Transfer time&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1662596.png"
              ]
            ]
            1 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Instrumental activities in AO-ICU and time requirements</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Activity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Time &#40;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sedation and analgesia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cardioversion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Central venous vascular access&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Non-invasive mechanical ventilation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total parenteral nutrition&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8220;ABC&#8221; &#40;airway&#44; breathing&#44; circulation&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Advanced life-support&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Early inter-hospital transfer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Emergency medical teams&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1662593.png"
              ]
            ]
          ]
          "notaPie" => array:2 [
            0 => array:3 [
              "identificador" => "tblfn0020"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Time based on whether the procedure takes place in the hospital or a reference center&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0025"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Take into account the presence of the intensivist in the room&#44; if necessary&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Techniques conducted outside the intensive care unit that require transfer and instrumental activities conducted outside the ICU&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0025"
        "etiqueta" => "Table 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at5"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Time&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Credits &#40;career development program&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">CME</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Masters degree&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">300<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Graduate degree&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">150<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Accredited courses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;75<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Training stays&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 month&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Teaching</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Degree&#44; post-graduate degree&#44; and CME&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Lectures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Tutors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4<span class="elsevierStyleHsp" style=""></span>months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Doctoral thesis defense &#40;presented and passed&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 thesis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1662597.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0030"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Equivalent to two credits in CME&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Teaching and continuing medical education &#40;CME&#41; in the Autonomous Community of Madrid&#46;</p>"
        ]
      ]
      5 => array:5 [
        "identificador" => "upi0005"
        "tipo" => "MULTIMEDIAECOMPONENTE"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "Ecomponente" => array:2 [
          "fichero" => "mmc1.pdf"
          "ficheroTamanyo" => 149875
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:30 [
            0 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Improvement EWGoQ&#46; Recommendations on basic requirements for intensive care units&#58; structural and organizational aspects"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Valentin"
                            1 => "P&#46; Ferdinande"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-011-2300-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2011"
                        "volumen" => "37"
                        "paginaInicial" => "1575"
                        "paginaFinal" => "1587"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21918847"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intensivist&#47;patient ratios in closed ICUs&#58; a statement from the Society of Critical Care Medicine Task force on ICU staffing"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46;S&#46; Ward"
                            1 => "B&#46; Afessa"
                            2 => "R&#46; Kleinpell"
                            3 => "S&#46; Tisherman"
                            4 => "M&#46; Ries"
                            5 => "M&#46; Howell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/CCM.0b013e3182741478"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2013"
                        "volumen" => "41"
                        "paginaInicial" => "638"
                        "paginaFinal" => "645"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23263586"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Introduction of a 14-hour work shift model for housestaff in the medical ICU"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "B&#46; Afessa"
                            1 => "C&#46;C&#46; Kennedy"
                            2 => "K&#46;W&#46; Klarich"
                            3 => "T&#46;R&#46; Aksamit"
                            4 => "J&#46;C&#46; Kolars"
                            5 => "R&#46;D&#46; Hubmayr"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.128.6.3910"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2005"
                        "volumen" => "128"
                        "paginaInicial" => "3910"
                        "paginaFinal" => "3915"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16354863"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of alternative intensivist staffing schedules on physician and patient outcomes in the intensive care unit"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46;A&#46; Ali"
                            1 => "K&#46; Wolf"
                            2 => "J&#46; Hammersley"
                            3 => "S&#46; Hoffmann"
                            4 => "J&#46; O&#8217;Brien"
                            5 => "G&#46; Phillips"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2011"
                        "volumen" => "183"
                        "paginaInicial" => "A1026"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nighttime intensivist staffing and mortality among critically ill patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "D&#46;J&#46; Wallace"
                            1 => "D&#46;C&#46; Angus"
                            2 => "A&#46;E&#46; Barnato"
                            3 => "A&#46;A&#46; Kramer"
                            4 => "J&#46;M&#46; Kahn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMsa1201918"
                      "Revista" => array:6 [
                        "tituloSerie" => "New Eng J Med"
                        "fecha" => "2012"
                        "volumen" => "366"
                        "paginaInicial" => "2093"
                        "paginaFinal" => "2101"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22612639"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Do intensivist staffing patterns influence hospital mortality following ICU admission&#63; A systematic review and meta-analyses"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;E&#46; Wilcox"
                            1 => "C&#46;A&#46; Chong"
                            2 => "D&#46;J&#46; Niven"
                            3 => "G&#46;D&#46; Rubenfeld"
                            4 => "K&#46;M&#46; Rowan"
                            5 => "H&#46; Wunsch"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/CCM.0b013e318292313a"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2013"
                        "volumen" => "41"
                        "paginaInicial" => "2253"
                        "paginaFinal" => "2274"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23921275"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hospitalists and intensivists in the medical ICU&#58; a prospective observational study comparing mortality and length of stay between two staffing models"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "K&#46;R&#46; Wise"
                            1 => "V&#46;A&#46; Akopov"
                            2 => "B&#46;R&#46; Williams Jr&#46;"
                            3 => "M&#46;S&#46; Ido"
                            4 => "K&#46;V&#46; Leeper Jr&#46;"
                            5 => "D&#46;D&#46; Dressler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Hospl Med"
                        "fecha" => "2012"
                        "volumen" => "7"
                        "paginaInicial" => "183"
                        "paginaFinal" => "189"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of admission time on mortality in an intensive care unit in Mainland China&#58; a propensity score matching analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;J&#46; Ju"
                            1 => "G&#46;W&#46; Tu"
                            2 => "Y&#46; Han"
                            3 => "H&#46;Y&#46; He"
                            4 => "Y&#46;Z&#46; He"
                            5 => "H&#46;L&#46; Mao"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/cc12734"
                      "Revista" => array:5 [
                        "tituloSerie" => "Crit Care"
                        "fecha" => "2013"
                        "volumen" => "17"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23705948"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1054139X15006667"
                          "estado" => "S300"
                          "issn" => "1054139X"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hospital mortality in relation to staff workload&#58; a 4-year study in an adult intensive-care unit"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "W&#46;O&#46; Tarnow-Mordi"
                            1 => "C&#46; Hau"
                            2 => "A&#46; Warden"
                            3 => "A&#46;J&#46; Shearer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2000"
                        "volumen" => "356"
                        "paginaInicial" => "185"
                        "paginaFinal" => "189"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10963195"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A randomized trial of nighttime physician staffing in an intensive care unit"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;P&#46; Kerlin"
                            1 => "D&#46;S&#46; Small"
                            2 => "E&#46; Cooney"
                            3 => "B&#46;D&#46; Fuchs"
                            4 => "L&#46;M&#46; Bellini"
                            5 => "M&#46;E&#46; Mikkelsen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1302854"
                      "Revista" => array:7 [
                        "tituloSerie" => "New Eng J Med"
                        "fecha" => "2013"
                        "volumen" => "368"
                        "paginaInicial" => "2201"
                        "paginaFinal" => "2209"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23688301"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S019567011500314X"
                          "estado" => "S300"
                          "issn" => "01956701"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The organization of intensive care unit physician services"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "P&#46;J&#46; Pronovost"
                            1 => "D&#46;A&#46; Thompson"
                            2 => "C&#46;G&#46; Holzmueller"
                            3 => "T&#46; Dorman"
                            4 => "L&#46;L&#46; Morlock"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.CCM.0000281860.37528.F8"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2007"
                        "volumen" => "35"
                        "paginaInicial" => "2256"
                        "paginaFinal" => "2261"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17717492"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines on critical care services and personnel&#58; recommendations based on a system of categorization of three levels of care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;T&#46; Haupt"
                            1 => "C&#46;E&#46; Bekes"
                            2 => "R&#46;J&#46; Brilli"
                            3 => "L&#46;C&#46; Carl"
                            4 => "A&#46;W&#46; Gray"
                            5 => "M&#46;S&#46; Jastremski"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.CCM.0000094227.89800.93"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2003"
                        "volumen" => "31"
                        "paginaInicial" => "2677"
                        "paginaFinal" => "2683"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14605541"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Recommendations on minimal requirements for Intensive Care Departments&#46; Members of the Task Force of the European Society of Intensive Care Medicine"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "P&#46; Ferdinande"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "1997"
                        "volumen" => "23"
                        "paginaInicial" => "226"
                        "paginaFinal" => "232"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9069011"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Unidades de cuidados intensivos est&#225;ndares y recomendaciones 2010 &#91;consulted 26 Dec 2013&#93;&#46; Available in&#58; <a href="http://www.msssi.gob.es/organizacion/sns/planCalidadSNS/docs/UCI.pdf">http&#58;&#47;&#47;www&#46;msssi&#46;gob&#46;es&#47;organizacion&#47;sns&#47;planCalidadSNS&#47;docs&#47;UCI&#46;pdf</a>"
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Proposal of a flexible structural-organizing model for the Intensive Care Units"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Iapichino"
                            1 => "D&#46; Radrizzani"
                            2 => "C&#46; Rossi"
                            3 => "A&#46; Pezzi"
                            4 => "A&#46; Anghileri"
                            5 => "S&#46; Boffelli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Minerva Anestesiol"
                        "fecha" => "2007"
                        "volumen" => "73"
                        "paginaInicial" => "501"
                        "paginaFinal" => "506"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17912203"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1054139X15002931"
                          "estado" => "S300"
                          "issn" => "1054139X"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Continuity of care in intensive care units&#58; a cluster-randomized trial of intensivist staffing"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46;A&#46; Ali"
                            1 => "J&#46; Hammersley"
                            2 => "S&#46;P&#46; Hoffmann"
                            3 => "J&#46;M&#46; O&#8217;Brien Jr&#46;"
                            4 => "G&#46;S&#46; Phillips"
                            5 => "M&#46; Rashkin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Am J Respir Critic Care Med"
                        "fecha" => "2011"
                        "volumen" => "184"
                        "paginaInicial" => "803"
                        "paginaFinal" => "808"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Twenty-four-hour intensivist presence&#58; a pilot study of effects on intensive care unit patients&#44; families&#44; doctors&#44; and nurses"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Garland"
                            1 => "D&#46; Roberts"
                            2 => "L&#46; Graff"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Critic Care Med"
                        "fecha" => "2012"
                        "volumen" => "185"
                        "paginaInicial" => "738"
                        "paginaFinal" => "743"
                        "itemHostRev" => array:3 [
                          "pii" => "S0195670115002649"
                          "estado" => "S300"
                          "issn" => "01956701"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comisi&#243;n de necesidades de m&#233;dicos intensivistas de la Sociedad Espa&#241;ola de Medicina Intensiva Cr&#237;tica y Unidades Coronarias&#46; Critically ill setting&#47;productivity grid &#40;CISPG&#41;&#58; Proposal for distribution of productive time of intensivists in a Critical Care Medicine Department &#40;CCMD&#41; considering &#243;utreach"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Ruiz Moreno"
                            1 => "J&#46;M&#46; Nicol&#225;s Arfelis"
                            2 => "V&#46; G&#243;mez Tello"
                            3 => "M&#46;J&#46; Esteve Pa&#241;os"
                            4 => "R&#46; Corcuera Romero de la Devesa"
                            5 => "E&#46; Gonz&#225;lez Mar&#237;n"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2015"
                        "volumen" => "3"
                        "numero" => "Suppl 1"
                        "paginaInicial" => "A481"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Calculation of personnel requirement &#8216;intensive care medicine&#8217; 2012 &#8211; revision of the 2008 calculation tool for the medical profession"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Weiss"
                            1 => "G&#46; Marx"
                            2 => "D&#46;A&#46; Vagts"
                            3 => "A&#46; Schleppers"
                            4 => "W&#46; Leidinger"
                            5 => "N&#46; Sehn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anasthesiol Intensivmed Notfallmed"
                        "fecha" => "2012"
                        "volumen" => "53"
                        "numero" => "Suppl&#46; 3"
                        "paginaInicial" => "S50"
                        "paginaFinal" => "S62"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Ley 44&#47;2003&#44; de 21 de noviembre&#44; de ordenaci&#243;n de las profesiones sanitarias&#46; Bolet&#237;n oficial del Estado &#91;Internet&#93;&#46; 2015 &#91;pp&#46; 41442&#8211;58&#93; &#91;consulted 12 Nov 2014&#93; Available in&#58; <a href="https://www%20boe%20es/buscar/pdf/2003/BOE-A-2003-21340-consolidado%20pdf%202015">https&#58;&#47;&#47;www boe es&#47;buscar&#47;pdf&#47;2003&#47;BOE-A-2003-21340-consolidado pdf 2015</a>"
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Real Decreto-Ley 183&#47;2008&#44; de 8 de febrero&#44; por el que se determinan y clasifican las especialidades en Ciencias de la Salud y se desarrollan determinados aspectos del sistema de formaci&#243;n sanitaria especializada&#46; Bolet&#237;n oficial del Estado &#91;Internet&#93;&#46; 2015 &#91;consulted 12 Nov 2014&#93;&#46; Available in&#58; <a href="http://www%20boe%20es/boe/dias/2008/02/21/pdfs/A10020-10035%20pdf%202015">http&#58;&#47;&#47;www boe es&#47;boe&#47;dias&#47;2008&#47;02&#47;21&#47;pdfs&#47;A10020-10035 pdf 2015</a>"
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Real Decreto-Ley 1146&#47;2006&#44; de 6 de octubre&#44; por el que se regula la relaci&#243;n laboral especial de residencia para la formaci&#243;n de especialistas en Ciencias de la Salud&#46; Bolet&#237;n Oficial del Estado &#91;Internet&#93;&#46; 2015 &#91;consulted 12 Nov 2014&#93;&#46; Available in&#58; <a href="https://www%20boe%20es/buscar/pdf/2006/BOE-A-%202006-17498-consolidado%20pdf%202015">https&#58;&#47;&#47;www boe es&#47;buscar&#47;pdf&#47;2006&#47;BOE-A- 2006-17498-consolidado pdf 2015</a>"
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An international survey of training in adult intensive care medicine"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46; Barrett"
                            1 => "J&#46;F&#46; Bion"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-005-2583-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2005"
                        "volumen" => "31"
                        "paginaInicial" => "553"
                        "paginaFinal" => "561"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15750798"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Development of core competencies for an international training programme in intensive care medicine"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;F&#46; Bion"
                            1 => "H&#46; Barrett"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-006-0215-5"
                      "Revista" => array:7 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2006"
                        "volumen" => "32"
                        "paginaInicial" => "1371"
                        "paginaFinal" => "1383"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16841214"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0010782412007536"
                          "estado" => "S300"
                          "issn" => "00107824"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "MSSI&#46; 2015 &#91;consulted 6 Feb 2015&#93;&#46; Available in&#58; <a href="https://www%20msssi%20gob%20es/profesionales/formacion/formaci%26oacute;nContinuada/introduccion%20htm%202015">https&#58;&#47;&#47;www msssi gob es&#47;profesionales&#47;formacion&#47;formaci&#243;nContinuada&#47;introduccion htm 2015</a>"
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Ley 9&#47;1987&#44; de 12 de junio&#44; de &#211;rganos de Representaci&#243;n&#44; Determinaci&#243;n de las Condiciones de Trabajo y Participaci&#243;n del Personal al servicio de las Administraciones P&#250;blicas&#46; Bolet&#237;n Oficial del Estado &#91;Internet&#93;&#46; 2015 &#91;consulted 18 Dec 2015&#93;&#46; Available in&#58; <a href="https://www%20boe%20es/boe/dias/1987/06/17/pdfs/A18284-18290%20pdf%202015">https&#58;&#47;&#47;www boe es&#47;boe&#47;dias&#47;1987&#47;06&#47;17&#47;pdfs&#47;A18284-18290 pdf 2015</a>"
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Ley 55&#47;2003&#44; de 16 de diciembre&#44; del Estatuto Marco del Personal Estatutario de los Servicios de Salud&#46; Bolet&#237;n oficial del Estado &#91;Internet&#93;&#46; 2015 &#91;consulted 18 Dec 2015&#93;&#46; Available in&#58; <a href="https://www%20boe%20es/boe/dias/2003/12/17/pdfs/A44742-44763%20pdf%202015">https&#58;&#47;&#47;www boe es&#47;boe&#47;dias&#47;2003&#47;12&#47;17&#47;pdfs&#47;A44742-44763 pdf 2015</a>"
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Acuerdo de 25 de enero de 2007&#44; del Consejo de Gobierno de la Comunidad de Madrid&#44; por el que se aprueba el Acuerdo de 5 de diciembre de 2006 alcanzado en la Mesa Sectorial de sanidad entre la Consejer&#237;a de Sanidad y Consumo y las organizaciones sindicales presentes en la misma sobre carrera profesional de licenciados sanitarios y diplomados sanitarios 2015 &#91;6 Feb 2015&#93;&#46; Available in&#58; <a href="http://www.madrid.org/wleg/servlet/Servidor?opcion=VerHtml%26nmnorma=6145%26%20cdestado=P">http&#58;&#47;&#47;www&#46;madrid&#46;org&#47;wleg&#47;servlet&#47;Servidor&#63;opcion&#61;VerHtml&#38;nmnorma&#61;6145&#38; cdestado&#61;P</a>"
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "What is an intensive care unit&#63; A report of the task force of the World Federation of Societies of Intensive and Critical Care Medicine"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;C&#46; Marshall"
                            1 => "L&#46; Bosco"
                            2 => "N&#46;K&#46; Adhikari"
                            3 => "B&#46; Connolly"
                            4 => "J&#46;V&#46; D&#237;az"
                            5 => "T&#46; Dorman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jcrc.2016.07.015"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Crit Care"
                        "fecha" => "2017"
                        "volumen" => "37"
                        "paginaInicial" => "270"
                        "paginaFinal" => "276"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27612678"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The myth of the workforce crisis&#58; why the United States does not need more intensivist physicians"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;M&#46; Kahn"
                            1 => "G&#46;D&#46; Rubenfeld"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.201408-1477CP"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2015"
                        "volumen" => "191"
                        "paginaInicial" => "128"
                        "paginaFinal" => "134"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25474081"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:4 [
        "identificador" => "xack332639"
        "titulo" => "Acknowledgements"
        "texto" => "<p id="par0140" class="elsevierStylePara elsevierViewall">We wish to thank Dr&#46; Lluis Blanch&#44; MD&#59; Dr&#46; Ricard Ferrer&#44; MD&#44; and Dr&#46; Rafael Fern&#225;ndez&#44; MD for their help while writing this paper&#46; Also&#44; we wish to thank the German Board of Anesthesiologists for their consent to use and the spreadsheet early iteration&#46;</p>"
        "vista" => "all"
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735727/0000004200000001/v1_201802081105/S2173572717302060/v1_201802081105/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "72380"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Special articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004200000001/v1_201802081105/S2173572717302060/v1_201802081105/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572717302060?idApp=WMIE"
]

Article information

ISSN: 21735727
Original language: English

DOI:10.1016/j.medine.2017.12.001

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 October	76	41	117
2024 September	104	45	149
2024 August	171	57	228
2024 July	222	48	270
2024 June	210	60	270
2024 May	117	42	159
2024 April	105	52	157
2024 March	140	40	180
2024 February	240	44	284
2024 January	160	50	210
2023 December	210	47	257
2023 November	179	62	241
2023 October	136	47	183
2023 September	134	54	188
2023 August	133	48	181
2023 July	161	59	220
2023 June	148	43	191
2023 May	146	58	204
2023 April	89	45	134
2023 March	196	64	260
2023 February	145	49	194
2023 January	149	34	183
2022 December	153	49	202
2022 November	159	54	213
2022 October	183	64	247
2022 September	130	55	185
2022 August	131	72	203
2022 July	64	57	121
2022 June	77	43	120
2022 May	68	43	111
2022 April	54	46	100
2022 March	86	73	159
2022 February	60	53	113
2022 January	86	41	127
2021 December	68	58	126
2021 November	61	51	112
2021 October	96	53	149
2021 September	69	50	119
2021 August	62	55	117
2021 July	49	36	85
2021 June	61	31	92
2021 May	91	58	149
2021 April	201	77	278
2021 March	248	38	286
2021 February	606	39	645
2021 January	106	29	135
2020 December	89	33	122
2020 November	87	33	120
2020 October	87	47	134
2020 September	68	27	95
2020 August	63	25	88
2020 July	55	38	93
2020 June	63	21	84
2020 May	78	34	112
2020 April	63	24	87
2020 March	49	18	67
2020 February	125	44	169
2020 January	64	43	107
2019 December	62	21	83
2019 November	64	52	116
2019 October	47	21	68
2019 September	42	29	71
2019 August	49	50	99
2019 July	52	49	101
2019 June	36	34	70
2019 May	61	47	108
2019 April	29	34	63
2019 March	32	39	71
2019 February	39	43	82
2019 January	40	37	77
2018 December	46	43	89
2018 November	62	45	107
2018 October	113	39	152
2018 September	57	11	68
2018 August	27	14	41
2018 July	31	18	49
2018 June	59	22	81
2018 May	11	4	15
2018 March	0	1	1
2018 February	4	4	8
2018 January	0	1	1

Show all

Indexed in:

Follow us:

Subscribe:

Statistics

Indexed in:

Follow us:

Subscribe:

Statistics

Subscribe to our newsletter