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[重症监护与急诊医学的过度使用及可持续性]

[Intensive care and emergency medicine overuse and sustainability].

作者信息

Kochanek M, Berek M, Janssens U, Kitz V, Wilkens F M

机构信息

Medizinische Fakultät und Uniklinik Köln, Klinik I für Innere Medizin, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.

Centrum für Integrierte Onkologie Aachen Bonn Köln Düsseldorf, Köln, Deutschland.

出版信息

Med Klin Intensivmed Notfmed. 2025 Feb;120(1):22-29. doi: 10.1007/s00063-024-01224-x. Epub 2024 Dec 9.

Abstract

This review examines the issue of overtreatment and overdiagnosis in the context of intensive care and emergency medicine and its relationship to sustainability. It shows that the intensive use of resources, both human and technology, is often associated with risks of overuse, especially in critical medical situations. More diagnostic and therapeutic measures are often taken than necessary, leading to both stress for the patient and a high consumption of resources. One of the main problems is the often difficult distinction between necessary and excessive treatment. Uncertainty in acute care, coupled with legal concerns, often leads to defensive medicine. This means that, for safety reasons, physicians initiate more diagnostic tests and treatments than are clinically necessary. There are also economic disincentives in the healthcare system that encourage overtreatment. The paper also discusses the role of guidelines, particularly with respect to patient preferences. These can help to avoid unnecessary admissions to the intensive care unit and thus contribute to sustainability. The discussion shows that sustainability should not be at odds with high-quality patient care. Rather, treatment options should also be considered in terms of their contribution to sustainability, without neglecting the individual needs of patients.

摘要

本综述探讨了重症监护和急诊医学背景下的过度治疗和过度诊断问题及其与可持续性的关系。研究表明,人力和技术等资源的密集使用往往伴随着过度使用的风险,尤其是在危急医疗情况下。通常会采取比必要更多的诊断和治疗措施,这既给患者带来压力,又导致资源的高消耗。主要问题之一是往往难以区分必要治疗和过度治疗。急性护理中的不确定性,再加上法律问题,常常导致防御性医疗。这意味着,出于安全考虑,医生会进行比临床必要更多的诊断测试和治疗。医疗保健系统中也存在鼓励过度治疗的经济诱因。本文还讨论了指南的作用,特别是在患者偏好方面。这些指南有助于避免不必要的重症监护病房收治,从而促进可持续性。讨论表明,可持续性不应与高质量的患者护理相悖。相反,在考虑治疗方案时,也应考量其对可持续性的贡献,同时不能忽视患者的个体需求。

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