TY - JOUR T1 - PErceptions of appropriateness of care in the intensive care unit—reply AU - Piers RD, Azoulay E, Benoit DD Y1 - 2012/04/04 N1 - 10.1001/jama.2012.395 JO - JAMA SP - 1370 EP - 1372 VL - 307 IS - 13 N2 - 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. SN - 0098-7484 M3 - doi: 10.1001/jama.2012.395 UR - http://dx.doi.org/10.1001/jama.2012.395 ER -