Papers by Kateřina Rusinová
BackgroundProviding palliative care, including end-of-life decisions (EOLD), seems to be modified... more BackgroundProviding palliative care, including end-of-life decisions (EOLD), seems to be modified during the COVID-19 pandemic with potential burden of moral distress (MD) to health care providers (HCPs) We seek to assess the practice of palliative care during the COVID-19 pandemic in the Czech Republic focusing on the level of moral distress and its possible modifiable factors.MethodsBetween June 16, 2021, and September 16, 2021, a national, cross-sectional study in intensive care units (ICU) in Czech Republic was performed. Physicians and nurses working in ICU during the COVID-19 pandemic were included in the study. For questionnaire development ACADEMY and CHERRIES guide and checklist were used. A multivariate logistic regression model was used to analyses possible modifiable factors of MD.ResultsIn total, 313 HCPs (14.5% out of all opened questionnaires) fully completed the survey. Results showed that 51.8% (n = 162) of respondents were exposed to MD during the COVID-19 pandemic...
Critical Care
Background Providing palliative care at the end of life (EOL) in intensive care units (ICUs) seem... more Background Providing palliative care at the end of life (EOL) in intensive care units (ICUs) seems to be modified during the COVID-19 pandemic with potential burden of moral distress to health care providers (HCPs). We seek to assess the practice of EOL care during the COVID-19 pandemic in ICUs in the Czech Republic focusing on the level of moral distress and its possible modifiable factors. Methods Between 16 June 2021 and 16 September 2021, a national, cross-sectional study in intensive care units (ICUs) in Czech Republic was performed. All physicians and nurses working in ICUs during the COVID-19 pandemic were included in the study. For questionnaire development ACADEMY and CHERRIES guide and checklist were used. A multivariate logistic regression model was used to analyse possible modifiable factors of moral distress. Results In total, 313 HCPs (14.5% out of all HCPs who opened the questionnaire) fully completed the survey. Results showed that 51.8% (n = 162) of respondents were...
Urgentní medicína : časopis pro neodkladnou lékařskou péči., 2009
Casopis lekaru ceskych, 2019
Palliative care is an important constituent of widely accepted quality care standard in seriously... more Palliative care is an important constituent of widely accepted quality care standard in seriously ill patients. The needs of these patients in perioperative setting or in intensive care are considerable for attending teams. Principal issues discussed include excellent communication skills during decision making before a high-risk surgery, and risk-benefit weighting in order to respect patients values and preferences. This article, based on examples of interventions in both perioperative care and in intensive care units, aims to demonstrate a complex integrated palliative approach.
Casopis lekaru ceskych, 2021
The quality of end-of-life care of hospitalized patients is an important topic, but so far little... more The quality of end-of-life care of hospitalized patients is an important topic, but so far little explored in the Czech Republic. The aim of this study was to map the factors influencing the end-of-life care decision-making process in selected Czech hospitals and to describe it based on data from medical records and from the perspective of a doctor. The research included data obtained from the medical records of 240 deceased patients (mean age 76.9 years, 41.6% women). The research sample of medical doctors who commented on the decision-making about end-of-life care for these patients consisted of 369 physicians (mean age 35.9 years, 61% women). The results pointed to persistent deficiencies in the written recording of the care goals, prognosis, and possible decision to limit care. Medical doctors limit health care primarily based on consensus among physicians, the patient is usually not invited to the decision-making process. Patient preferences for the end-of-life period are in mo...
Vnitřní lékařství, 2019
Paliativní medicína je specializovaný obor pečující o pacienty se závažným onemocněním. Prokazate... more Paliativní medicína je specializovaný obor pečující o pacienty se závažným onemocněním. Prokazatelně zlepšuje kvalitu života prostřednictvím symptomatické léčby, léčby bolesti a úlevy od stresu a zátěže spojených se závažnou diagnózou. Je indikovaná současně s kurativní léčbou v kterémkoliv věku nebo fázi onemocnění [1]. Časná a terminální paliativní péče jako dva odlišné koncepty Zatímco terminální paliativní péče se soustředí především na management symptomů bezprostředního umírání, časná paliativní péče poskytuje příležitost pacientovi a jeho blízkým se dobře orientovat v trajektorii onemocnění, získat podporu pro vyrovnání se s diagnózou [2], zvýšit kvalitu rozhodování mezi alternativami postupu tak, aby odpovídaly hodnotám a preferencím pacienta, dále mít realistická očekávání výsledku léčby, včas anticipovat další vývoj tak, aby se na něj pacient i rodina mohli dobře připravit (schéma 1) [3].
Intensive Care Medicine, 2018
Purpose: Whether the quality of the ethical climate in the intensive care unit (ICU) improves the... more 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.
Vnitr̆ní lékar̆ství, 2009
Intensive Care Medicine, 2013
Terminalni stadium demence je faze, kdy onemocněni přechazi do ireverzibilni výrazne nesoběstacno... more Terminalni stadium demence je faze, kdy onemocněni přechazi do ireverzibilni výrazne nesoběstacnosti v zakladnich sebeobslužných aktivitach s nutnosti trvale osetřovatelske pece. V clanku je věnovana pozornost podavani kognitiv, schopnosti rozhodovani a principu autonomie u těchto pacientů. Je diskutovana indikace intenzivni a resuscitacni pece, role paliativni lecby a některe postupy při leceni komplikaci. Dale je zmiňovan význam komunikace s pacientem a pecovatelem i problematika umistěni do ustavniho zařizeni.
Journal of Critical Care, 2013
Purpose: To determine bioenergetic gain of 2 different citrate anticoagulated continuous hemodiaf... more Purpose: To determine bioenergetic gain of 2 different citrate anticoagulated continuous hemodiafiltration (CVVHDF) modalities and a heparin modality. Materials and Methods: We compared the bio-energetic gain of citrate, glucose and lactate between 29 patients receiving 2.2% acid-citrate-dextrose with calcium-containing lactate-buffered solutions (ACD/ Ca plus /lactate), 34 on 4% trisodium citrate with calcium-free low-bicarbonate buffered fluids (TSC/ Ca min /bicarbonate), and 18 on heparin with lactate buffering (Hep/lactate). Results: While delivered CVVHDF dose was about 2000 mL/h, total bioenergetic gain was 262kJ/h (IQR 230-284) with ACD/Ca plus /lactate, 20 kJ/h (8-25) with TSC/Ca min /bicarbonate (P b .01) and 60 kJ/h (52-76) with Hep/lactate. Median patient delivery of citrate was 31.2 mmol/h (25-34.7) in ACD/ Ca plus /lactate versus 14.8 mmol/h (12.4-19.1) in TSC/Ca min /bicarbonate groups (P b .01). Median delivery of glucose was 36.8 mmol/h (29.9-43) in ACD/Ca plus /lactate, and of lactate 52.5 mmol/h (49.2-59.1) in ACD/Ca plus /lactate and 56.1 mmol/h (49.6-64.2) in Hep/lactate groups. The higher energy delivery with ACD/Ca plus /lactate was partially due to the higher blood flow used in this modality and the calcium-containing dialysate. ☆ ClinicalTrials.gov Identifier: NCT01361581. Journal of Critical Care (2012) xx, xxx-xxx
Intensive Care Medicine, 2009
Objective Therapeutic advances have improved survival in patients with myeloma (MM) over the past... more Objective Therapeutic advances have improved survival in patients with myeloma (MM) over the past decade. We investigated whether survival has also improved in critically ill myeloma patients. Design Retrospective study. Setting Intensive care unit. Patient Consecutive myeloma patients admitted to a teaching hospital ICU between 1990 and 2006. We compared three year-of-admission groups (1990–1995, 1996–2001, and 2002–2006) that matched changes in myeloma treatment (chemotherapy only, stem cell transplantation, and new molecules, respectively). Intervention None. Measurements and main results We included 196 patients. Reasons for ICU admission and patient characteristics were similar across groups; however, less use of conventional chemotherapy and radiotherapy and greater use of steroids were noted in the more recent periods. Over time, vasopressors and invasive mechanical ventilation were used decreasingly, and noninvasive ventilation increasingly, to treat acute respiratory failure. Hospital mortality decreased from 75% in 1990–1995 to 49% in 1996–2001 and 40% in 2002–2006 (P = 0.0007). Mortality was associated with poor performance status [OR 2.27, 95% CI (1.04–4.99)], need for mechanical ventilation [OR 4.33, 95% CI (1.86–10.10)], need for vasopressors [OR 2.57, 95% CI (1.12–5.86)], and admission for an event related to myeloma progression [OR 2.77, 95% CI (1.13–6.79)]. ICU admission within 48 h after hospital admission was associated with lower mortality [OR 0.28, 95% CI (0.19–0.89)]. Conclusion Hospital mortality decreased significantly over the last 15 years in myeloma patients admitted to the ICU. Risk factors for death were organ failure and poor chronic health status. Early ICU admission was associated with lower mortality, suggesting opportunities for further improving survival.
Blood Purification, 2012
measured anions (d-UA) correlated with mean difference of citrate concentrations (p ! 0.0001, r 2... more measured anions (d-UA) correlated with mean difference of citrate concentrations (p ! 0.0001, r 2 = 0.66). The estimated caloric load of the citrate modalities was 5,536 8 1,385 kJ/ 24 h. Conclusions: ACD might represent a significant load of metabolic substrates, particularly if used with lactate buffer. Systemic delivery of citrate can be predicted using d-UA in the extracorporeal circuit.
Critical Care Medicine, 2009
Qualitative research and its methods stem from the social sciences and can be used to describe an... more Qualitative research and its methods stem from the social sciences and can be used to describe and interpret complex phenomena that involve individuals' views, beliefs, preferences, and subjective responses to places and people. Thus, qualitative research explores the many subjective factors that may influence patient outcomes, staff well-being, and healthcare quality, yet fail to lend themselves to the hypothesis-testing approach that characterizes quantitative research. Qualitative research is valuable in the intensive care unit to explore organizational and cultural issues and to gain insight into social interactions, healthcare delivery processes, and communication. Qualitative research generates explanatory models and theories, which can then serve to devise interventions, whose efficacy can be studied quantitatively. Thus, qualitative research works synergistically with quantitative research, providing new impetus to the research process and a new dimension to research findings. Qualitative research starts with conceptualizing the research question, choosing the appropriate qualitative strategy, and designing the study; rigorous methods specifically designed for qualitative research are then used to conduct the study, analyze the data, and verify the findings. The researcher is the data-collecting instrument, and the data are the participants' words and behaviors. Data coding methods are used to describe experiences, discover themes, and build theories. In this review, we outline the rationale and methods for conducting qualitative research to inform critical care issues. We provide an overview of available qualitative methods and explain how they can work in close synergy with quantitative methods. To illustrate the effectiveness of combining different research methods, we will refer to recent qualitative studies conducted in the intensive care unit.
American Journal of Respiratory and Critical Care Medicine, 2009
Rationale: Many sources of conflict exist in intensive care units (ICUs). Few studies recorded th... more Rationale: Many sources of conflict exist in intensive care units (ICUs). Few studies recorded the prevalence, characteristics, and risk factors for conflicts in ICUs. Objectives: To record the prevalence, characteristics, and risk factors for conflicts in ICUs. Methods: One-day cross-sectional survey of ICU clinicians. Data on perceived conflicts in the week before the survey day were obtained from 7,498 ICU staff members (323 ICUs in 24 countries). Measurements and Main Results: Conflicts were perceived by 5,268 (71.6%) respondents. Nurse-physician conflicts were the most common (32.6%), followed by conflicts among nurses (27.3%) and staff-relative conflicts (26.6%). The most common conflict-causing behaviors were personal animosity, mistrust, and communication gaps. During end-of-life care, the main sources of perceived conflict were lack of psychological support, absence of staff meetings, and problems with the decision-making process. Conflicts perceived as severe were reported by 3,974 (53%) respondents. Job strain was significantly associated with perceiving conflicts and with greater severity of perceived conflicts. Multivariate analysis identified 15 factors associated with perceived conflicts, of which 6 were potential targets for future intervention: staff working more than 40 h/wk, more than 15 ICU beds, caring for dying patients or providing preand postmortem care within the last week, symptom control not ensured jointly by physicians and nurses, and no routine unit-level meetings. Conclusions: Over 70% of ICU workers reported perceived conflicts, which were often considered severe and were significantly associated with job strain. Workload, inadequate communication, and end-of-life care emerged as important potential targets for improvement.
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Papers by Kateřina Rusinová