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Outcome in patients...
Outcome in patients perceived as receiving excessive care across different ethical climates: a prospective study in 68 intensive care units in Europe and the USA.
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Benoit, D D (author)
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Jensen, H I (author)
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- Malmgren, Johan (author)
- Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för anestesiologi och intensivvård,Institute of Clinical Sciences, Department of Anesthesiology and Intensive care
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Metaxa, V (author)
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Reyners, A K (author)
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Darmon, M (author)
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Rusinova, K (author)
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Talmor, D (author)
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Meert, A P (author)
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Cancelliere, L (author)
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Zubek, L (author)
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Maia, P (author)
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Michalsen, A (author)
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Vanheule, S (author)
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Kompanje, E J O (author)
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Decruyenaere, J (author)
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Vandenberghe, S (author)
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Vansteelandt, S (author)
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Gadeyne, B (author)
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Van den Bulcke, B (author)
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Azoulay, E (author)
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Piers, R D (author)
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- 2018
- 2018
- English.
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In: Intensive care medicine. - 1432-1238. ; 44:7, s. 1039-1049
- Related links:
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https://gup.ub.gu.se...
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https://doi.org/10.1...
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Abstract
Subject headings
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- Whether the quality of the ethical climate in the intensive care unit (ICU) improves the identification of patients receiving excessive care and affects patient outcomes is unknown.In this prospective observational study, perceptions of excessive care (PECs) by clinicians working in 68 ICUs in Europe and the USA were collected daily during a 28-day period. The quality of the ethical climate in the ICUs was assessed via a validated questionnaire. We compared the combined endpoint (death, not at home or poor quality of life at 1 year) of patients with PECs and the time from PECs until written treatment-limitation decisions (TLDs) and death across the four climates defined via cluster analysis.Of the 4747 eligible clinicians, 2992 (63%) evaluated the ethical climate in their ICU. Of the 321 and 623 patients not admitted for monitoring only in ICUs with a good (n = 12, 18%) and poor (n = 24, 35%) climate, 36 (11%) and 74 (12%), respectively were identified with PECs by at least two clinicians. Of the 35 and 71 identified patients with an available combined endpoint, 100% (95% CI 90.0-1.00) and 85.9% (75.4-92.0) (P = 0.02) attained that endpoint. The risk of death (HR 1.88, 95% CI 1.20-2.92) or receiving a written TLD (HR 2.32, CI 1.11-4.85) in patients with PECs by at least two clinicians was higher in ICUs with a good climate than in those with a poor one. The differences between ICUs with an average climate, with (n = 12, 18%) or without (n = 20, 29%) nursing involvement at the end of life, and ICUs with a poor climate were less obvious but still in favour of the former.Enhancing the quality of the ethical climate in the ICU may improve both the identification of patients receiving excessive care and the decision-making process at the end of life.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin (hsv//swe)
- HUMANIORA -- Filosofi, etik och religion (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine (hsv//eng)
- HUMANITIES -- Philosophy, Ethics and Religion (hsv//eng)
Keyword
- Age Factors
- Europe
- Humans
- Intensive Care Units
- ethics
- Organizational Culture
- Prospective Studies
- Quality of Life
- Unnecessary Procedures
Publication and Content Type
- ref (subject category)
- art (subject category)
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To the university's database
- By the author/editor
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Benoit, D D
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Jensen, H I
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Malmgren, Johan
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Metaxa, V
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Reyners, A K
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Darmon, M
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show more...
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Rusinova, K
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Talmor, D
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Meert, A P
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Cancelliere, L
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Zubek, L
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Maia, P
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Michalsen, A
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Vanheule, S
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Kompanje, E J O
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Decruyenaere, J
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Vandenberghe, S
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Vansteelandt, S
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Gadeyne, B
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Van den Bulcke, ...
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Azoulay, E
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Piers, R D
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show less...
- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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- HUMANITIES
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HUMANITIES
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and Philosophy Ethic ...
- Articles in the publication
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Intensive care m ...
- By the university
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University of Gothenburg