Prevalence of perceptions of inappropriate care among intensive care unit healthcare providers and reasons why disproportional care is continued : the APPROPRICUS study

C

Characteristics of the flank magnetopause: Cluster observations

The magnetopause is a current sheet forming the boundary between the geomagnetic field on one side and the shocked solar wind on the other side. This paper discusses properties of the low-latitude dawn and dusk flanks of the magnetopause. The reported results are based on a large number of measurements obtained by the Cluster satellites during magnetopause traversals. Using a combination of single-spacecraft and multispacecraft techniques, we calculated macroscopic features such as thickness, location, and motion of the magnetopause. The results show that the typical flank magnetopause is significantly thicker than the dayside magnetopause and also possesses a pronounced and persistent dawn-dusk asymmetry. Thicknesses vary from 150 to 5000 km, with an median thickness of around 1400 km at dawn and around 1150 km at dusk. Current densities are on average higher on dusk, suggesting that the total current at dawn and dusk are similar. Solar wind conditions and the interplanetary magnetic field cannot fully explain the observed dawn-dusk asymmetry. For a number of crossings we were also able to derive detailed current density profiles. The profiles show that the magnetopause often consists of two or more adjacent current sheets, each current sheet typically several ion gyroradii thick and often with different current direction. This demonstrates that the flank magnetopause has a structure that is more complex than the thin, one-dimensional current sheet described by a Chapman-Ferraro layer

Combined modality treatment using extrapleural pneumonectomy for malignant pleural mesothelioma: a single centre experience

status: publishe

Inappropriate care in European ICUs confronting views from nurses and junior and senior physicians

BACKGROUND: ICU care providers oft en feel that the care given to a patient may be inconsistent with their professional knowledge or beliefs. This study aimed to assess differences in, and reasons for, perceived inappropriate care (PIC) across ICU care providers with varying levels of decision-making power. METHODS: We present subsequent analysis from the Appropricus Study, a cross-sectional study conducted on May 11, 2010, which included 1,218 nurses and 180 junior and 227 senior physicians in 82 European adult ICUs. The study was designed to evaluate PIC. The current study focuses on differences across health-care providers regarding the reasons for PIC in real patient situations. RESULTS: By multivariate analysis, nurses were found to have higher PIC rates compared with senior and junior physicians. However, nurses and senior physicians were more distressed by perceived disproportionate care than were junior physicians (33%, 25%, and 9%, respectively; P 5.026). A perceived mismatch between level of care and prognosis (mostly excessive care) was the most common cause of PIC. Th e main reasons for PIC were prognostic uncertainty among physicians, poor team and family communication, the fact that no one was taking the initiative to challenge the inappropriateness of care, and financial incentives to provide excessive care among nurses. Senior physicians, compared with nurses and junior physicians, more frequently reported pressure from the referring physician as a reason. Family-related factors were reported by similar proportions of participants in the three groups. CONCLUSIONS: ICU care providers agree that excessive care is a true issue in the ICU. However, they diff er in the reasons for the PIC, reflecting the roles each caregiver has in the ICU. Nurses charge physicians with a lack of initiative and poor communication, whereas physicians more oft en ascribe prognostic uncertainty. Teaching ICU physicians to deal with prognostic uncertainty in more adequate ways and to promote ethical discussions in their teams may be pivotal to improving moral distress and the quality of patient care

Why intensivists continue disproportional patient care, results from the APPROPICUS study

24th ESICM annual congress Berlin Germany 1-5 october 2011. abstract 0401 S106Intensive Care Medicineinfo:eu-repo/semantics/publishe

Preliminary results from the APPROPICUS study (Appropriateness of care in the ICUS)

23rd ESICM Annual Congress. Barcelona Spain 9 -1 3October 2010. Intensive Care Medicine. Abstract 1200 (S387).info:eu-repo/semantics/publishe