Utilitarismus: Die richtige Medizin für die Pandemie

Zusammenfassung Die Pandemie hat Knappheit sichtbar gemacht und einige Länder zur Rationierung des Zugangs zu Intensivbehandlungen gezwungen. Die Vorhaltung von Betten und Personal auf Intensivstationen müssen vor dem Ausbruch einer Pandemie geplant werden. Die Allokationsregeln für den Aufbau und die Nutzung der Intensivmedizin sollten utilitaristischen Normen folgen. Wir illustrieren dies für die Planung und Nutzung von stationären Vorhalteleistungen. Zudem beschäftigen wir uns mit den Gründen, welche die regulierenden Eingriffe eines Staates rechtfertigen und kritisieren dessen inkonsistentes Handeln bei den massiven Einschränkungen während der Lockdowns im Vergleich zum zögerlichen Vorgehen beim Impfen. Abstract: Utilitarianism Before and During the Pandemic The pandemic reveals shortages and forces some countries to ration access to intensive care. The supply of ICU beds and personal needs to be determined before the pandemic hits. The rules for planning and use of capacities can be the same and follow utilitarian norms. We illustrate this for the hold-back capacities in acute hospital care. In addition, we deal with the reasons that justify the regulatory measures and criticize the inconsistent attitude of governments with regard to the massive containment measures in the lockdowns as compared to the absence of any compulsion within vaccination programs.

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The post-ICU presentation screen (PICUPS) and rehabilitation prescription (RP) for intensive care survivors part I: Development and preliminary clinimetric evaluation

Journal of the Intensive Care Society ◽

10.1177/1751143720988715 ◽

2021 ◽

pp. 175114372098871 ◽

Cited By ~ 1

Author(s):

Lynne Turner-Stokes ◽

Evelyn J Corner ◽

Richard J Siegert ◽

Craig Brown ◽

Sarah Wallace ◽

...

Keyword(s):

Intensive Care ◽

Hospital Care ◽

Care Pathway ◽

Acute Hospital ◽

Full Scale ◽

Test Theory ◽

Clinical Tool ◽

Acute Hospital Care ◽

Item Level ◽

Rehabilitation Needs

Background Patients who have had prolonged stays in intensive care have ongoing rehabilitation needs. This is especially true of COVID-19 ICU patients, who can suffer diverse long-term ill effects. Currently there is no systematic data collection to guide the needs for therapy input for either of these groups nor to inform planning and development of rehabilitation services. These issues could be resolved in part by the systematic use of a clinical tool to support decision-making as patients progress from the Intensive Care Unit (ICU), through acute hospital care and onwards into rehabilitation. We describe (i) the development of such a tool (the Post-ICU Presentation Screen (PICUPS)) and (ii) the subsequent preparation of a person-centred Rehabilitation Prescription (RP) to travel with the patient as they continue down the care pathway. Methods PICUPS development was led by a core group of experienced clinicians representing the various disciplines involved in post-ICU rehabilitation. Key constructs and item-level descriptors were identified by group consensus. Piloting was performed as part of wider clinical engagement in 26 acute hospitals across England. Development and validation of such a tool requires clinimetric analysis, and this was based on classical test theory. Teams also provided feedback about the feasibility and utility of the tool. Results Initial PICUPS design yielded a 24-item tool. In piloting, a total of 552 records were collated from 314 patients, of which 121 (38.5%) had COVID-19. No obvious floor or ceiling effects were apparent. Exploratory factor analysis provided evidence of uni-dimensionality with strong loading on the first principal component accounting for 51% of the variance and Cronbach’s alpha for the full-scale score 0.95 – although a 3-factor solution accounted for a further 21%. The PICUPS was responsive to change both at full scale- and item-level. In general, positive responses were seen regarding the tool’s ability to describe the patients during their clinical course, engage and flag the relevant professionals needed, and to inform what should be included in an RP. Conclusions The PICUPS tool has robust scaling properties as a clinical measure and is potentially useful as a tool for identifying rehabilitation needs as patients step down from ICU and acute hospital care.

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