RT Journal
A1 Piers RD, Azoulay E, Benoit DD
T1 PErceptions of appropriateness of care in the intensive care unit—reply
JF JAMA
JO JAMA
YR 2012
FD April 4
VO 307
IS 13
SP 1370
OP 1372
DO 10.1001/jama.2012.395
UL http://dx.doi.org/10.1001/jama.2012.395
AB 
In Reply: Drs Nagamatsu and Yamashita suggest important possible determinants of perceptions of appropriateness of care. However, in keeping with our study's aim, we sought to collect subjective perceptions from bedside clinicians. Perceived inappropriateness of care ranged between 8% and 49% across participating countries in our study and was related to differences in the ethical environment—the worse the ethical climate, the higher the prevalence of perceptions of inappropriate care. While we acknowledge that national laws, health care structures, and other societal factors have an important influence on perceptions of appropriateness of care, as shown in the examples given by Nagamatsu and Yamashita, we believe that actual perceptions are the most important targets for efforts to improve care for patients and working environments for clinicians across nations and cultures.