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

Purpose: 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. Methods: 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. Results: 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. Conclusion: 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

Triplet state dynamics in Poly(2,5-pyridine diyl)

Pulse radiolysis was used to determine the triplet state energy (2.3 eV) of Poly(2,5-pyridine diyl) (PPY) film which was found to be coincident with the emission energy. Detailed time-resolved photoluminescence (PL) and pump-probe measurements have been applied to study the photoexcited state relaxation dynamics. In films, a very large spectral red-shift (~0.35 eV) for the PL occurred within the first 100 ps whereas no spectral red-shift was observed for the PPY in solution. This result shows clear evidence for the evolution of short-lived singlet emission (S1-->S0) at ~450 nm to long-lived triplet emission (T1-->S0) at ~520 nm for the PPY thin film. Streak camera measurement indicates the long live component has a decay time constant of several ns. The picosecond photo-induced triplet state absorption (T1-->T2 transition) peaks at ~600 nm as measured by pump-probe which is consistent with both the radiolysis and cw photo-induced absorption measurements. A triplet lifetime of ~6 ns is measured which is again consistent with the streak camera measurement. These results lead us to believe that the long live component of the emission from PPY film is in fact phosphorescence. Furthermore, there is evidence that oxygen plays a very important role in the fast triplet radiative lifetime in PPY films.http://www.sciencedirect.com/science/article/B6TY7-41XMFCG-6/1/e8eb864b0a7e6582ef22a9cc934d62d