25 research outputs found
Framework to Support the Process of Decision-Making on Life-Sustaining Treatments in the ICU: Results of a Delphi Study
Objectives: To develop a consensus framework that can guide the process of decision-making on continuing or limiting life-sustaining treatments in ICU patients, using evidence-based items, supported by caregivers, patients, and surrogate decision makers from multiple countries. Design: A three-round web-based international Delphi consensus study with a priori consensus definition was conducted with experts from 13 countries. Participants reviewed items of the decision-making process on a seven-point Likert scale or with open-ended questions. Questions concerned terminology, content, and timing of decision-making steps. The summarized results (including mean scores) and expert suggestions were presented in the subsequent round for review. Setting: Web-based surveys of international participants representing ICU physicians, nurses, former ICU patients, and surrogate decision makers. Patients: Not applicable. Interventions: Not applicable. Measurements and Main Results: In three rounds, respectively, 28, 28, and 27 (of 33 invited) physicians together with 12, 10, and seven (of 19 invited) nurses participated. Patients and surrogates were involved in round one and 12 of 27 responded. Caregivers were mostly working in university affiliated hospitals in Northern Europe. During the Delphi process, most items were modified in order to reach consensus. Seven items lacked consensus after three rounds. The final consensus framework comprises the content and timing of four elements; three elements focused on caregiver-surrogate communication (admission meeting, follow-up meeting, goals-of-care meeting); and one element (weekly time-out meeting) focused on assessing preferences, prognosis, and proportionality of ICU treatment among professionals. Conclusions: Physicians, nurses, patients, and surrogates generated a consensus-based framework to guide the process of decision-making on continuing or limiting life-sustaining treatments in the ICU. Early, frequent, and scheduled family meetings combined with a repeated multidisciplinary time-out meeting may support decisions in relation to patient preferences, prognosis, and proportionality
Estimativa do intervalo pĂłs-morte em um canino (Canis lupus familiaris Linnaeus 1758) pela entomologia forense em Cabedelo-PB, Brasil: relato de caso
Performance, carcass characteristics and non-carcass components of Texel Ă Santa InĂȘs lambs fed fat sources and monensin
Conversion of cerrado into agricultural land in the south-western Amazon: carbon stocks and soil fertility
Biologia floral e sistema reprodutivo de Byrsonima coccolobifolia (Kunth) em uma savana amazĂŽnica
Isotopic view of vegetation and carbon and nitrogen cycles in a cerrado ecosystem, southeastern Brazil
HistĂłria da educação brasileira: a produção cientĂfica na biblioteca eletrĂŽnica SCIELO
A Study Of Octanol/water Partition Coefficient Of Polychlorinated Biphenyls (pcbs) Using Topological Indices [estudo Do Coeficiente De Partição Octanol-ågua De Bifenilas Policloradas (pcbs) Utilizando Parùmetros Topológicos]
A model based on chemical structure was developed for the accurate prediction of octanol/water partition coefficient (Kow) of polychlorinated biphenyls (PCBs), which are molecules of environmental interest. Partial least squares (PLS) was used to build the regression model. Topological indices were used as molecular descriptors. Variable selection was performed by Hierarchical Cluster Analysis (HCA). In the modeling process, the experimental Kow measured for 30 PCBs by thin-layer chromatography - retention time (TLC-RT) has been used. The developed model (Q2 = 0,990 and r2 = 0,994) was used to estimate the log Kow values for the 179 PCB congeners whose Kow data have not yet been measured by TLC-RT method. The results showed that topological indices can be very useful to predict the Kow.263312318Rachdawong, P., Christensen, E.R., (1997) Environ. Sci. Technol., 31, p. 2686Ballschmiter, K., Zell, M., (1980) Fresenius' J. Anal. 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