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Published in: Intensive Care Medicine 9/2005

01-09-2005 | Review

Studying outcomes of intensive care unit survivors: measuring exposures and outcomes

Authors: Dale M. Needham, David W. Dowdy, Pedro A. Mendez-Tellez, Margaret S. Herridge, Peter J. Pronovost

Published in: Intensive Care Medicine | Issue 9/2005

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Abstract

Background

Measurement of long-term outcomes and the patient and intensive care unit (ICU) factors predicting them present investigators with unique challenges. There is little systematic guidance for measuring these outcomes and exposures within the ICU setting. As a result measurement methods are often variable and noncomparable across studies.

Methods

We use examples from the critical care literature to describe measurement as it relates to three key elements of clinical studies: subjects, outcomes and exposures, and time. Using this framework we review the principles and challenges of measurement and make recommendations for long-term outcomes research in the field of critical care medicine.

Discussion

Relevant challenges discussed include: (a) selection bias and heterogeneity of ICU research subjects, (b) appropriate selection and measurement of outcome and exposure variables, and (c) accounting for the effect of time in the exposure-outcome relationship, including measurement of baseline data and time-varying variables.

Conclusions

Addressing these methodological challenges will advance research aimed at improving the long-term outcomes of ICU survivors.
Appendix
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Literature
1.
go back to reference Watson RS, Annane D (2002) Assessing outcomes in critical care. J Intensive Care Med 17:103–111 Watson RS, Annane D (2002) Assessing outcomes in critical care. J Intensive Care Med 17:103–111
3.
go back to reference White E, Hunt JR, Casso D (1998) Exposure measurement in cohort studies: the challenges of prospective data collection. Epidemiol Rev 20:43–56PubMed White E, Hunt JR, Casso D (1998) Exposure measurement in cohort studies: the challenges of prospective data collection. Epidemiol Rev 20:43–56PubMed
4.
go back to reference Willett WC, Colditz GA (1998) Approaches for conducting large cohort studies. Epidemiol Rev 20:91–99PubMed Willett WC, Colditz GA (1998) Approaches for conducting large cohort studies. Epidemiol Rev 20:91–99PubMed
6.
go back to reference Pappachan JV, Millar B, Bennett ED, Smith GB (1999) Comparison of outcome from intensive care admission after adjustment for case mix by the APACHE III prognostic system. Chest 115:802–810CrossRefPubMed Pappachan JV, Millar B, Bennett ED, Smith GB (1999) Comparison of outcome from intensive care admission after adjustment for case mix by the APACHE III prognostic system. Chest 115:802–810CrossRefPubMed
7.
go back to reference Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 283:2008–2012CrossRefPubMed Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 283:2008–2012CrossRefPubMed
8.
go back to reference Esteban A, Fernandez-Segoviano P, Frutos-Vivar F, Aramburu JA, Najera L, Ferguson ND, Alia I, Gordo F, Rios F (2004) Comparison of clinical criteria for the acute respiratory distress syndrome with autopsy findings. Ann Intern Med 141:440–445PubMed Esteban A, Fernandez-Segoviano P, Frutos-Vivar F, Aramburu JA, Najera L, Ferguson ND, Alia I, Gordo F, Rios F (2004) Comparison of clinical criteria for the acute respiratory distress syndrome with autopsy findings. Ann Intern Med 141:440–445PubMed
9.
go back to reference Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Intensive Care Med 29:530–538PubMed Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Intensive Care Med 29:530–538PubMed
10.
go back to reference Ferguson ND, Kacmarek RM, Chiche JD, Singh JM, Hallett DC, Mehta S, Stewart TE (2004) Screening of ARDS patients using standardized ventilator settings: influence on enrollment in a clinical trial. Intensive Care Med 30:1111–1116CrossRefPubMed Ferguson ND, Kacmarek RM, Chiche JD, Singh JM, Hallett DC, Mehta S, Stewart TE (2004) Screening of ARDS patients using standardized ventilator settings: influence on enrollment in a clinical trial. Intensive Care Med 30:1111–1116CrossRefPubMed
11.
go back to reference Rothman KJ, Greenland S (1998) Modern epidemiology. Lippincott-Raven, Philadelphia Rothman KJ, Greenland S (1998) Modern epidemiology. Lippincott-Raven, Philadelphia
12.
go back to reference Damiano AM (1996) The sickness impact profile. In: Spilker B (ed) Quality of life and pharmacoeconomics in clinical trials. Lippincott-Raven, Philadelphia, pp 347–354 Damiano AM (1996) The sickness impact profile. In: Spilker B (ed) Quality of life and pharmacoeconomics in clinical trials. Lippincott-Raven, Philadelphia, pp 347–354
13.
go back to reference Angus DC, Carlet J (2003) Surviving intensive care: a report from the 2002 Brussels Roundtable. Intensive Care Med 29:368–377PubMed Angus DC, Carlet J (2003) Surviving intensive care: a report from the 2002 Brussels Roundtable. Intensive Care Med 29:368–377PubMed
14.
go back to reference Fletcher SN, Kennedy DD, Ghosh IR, Misra VP, Kiff K, Coakley JH, Hinds CJ (2003) Persistent neuromuscular and neurophysiologic abnormalities in long-term survivors of prolonged critical illness. Crit Care Med 31:1012–1016CrossRefPubMed Fletcher SN, Kennedy DD, Ghosh IR, Misra VP, Kiff K, Coakley JH, Hinds CJ (2003) Persistent neuromuscular and neurophysiologic abnormalities in long-term survivors of prolonged critical illness. Crit Care Med 31:1012–1016CrossRefPubMed
15.
go back to reference Kress JP, Gehlbach B, Lacy M, Pliskin N, Pohlman AS, Hall JB (2003) The long-term psychological effects of daily sedative interruption on critically ill patients. Am J Respir Crit Care Med 168:1457–1461CrossRefPubMed Kress JP, Gehlbach B, Lacy M, Pliskin N, Pohlman AS, Hall JB (2003) The long-term psychological effects of daily sedative interruption on critically ill patients. Am J Respir Crit Care Med 168:1457–1461CrossRefPubMed
16.
go back to reference Orme J Jr, Romney JS, Hopkins RO, Pope D, Chan KJ, Thomsen G, Crapo RO, Weaver LK (2003) Pulmonary function and health-related quality of life in survivors of acute respiratory distress syndrome. Am J Respir Crit Care Med 167:690–694CrossRefPubMed Orme J Jr, Romney JS, Hopkins RO, Pope D, Chan KJ, Thomsen G, Crapo RO, Weaver LK (2003) Pulmonary function and health-related quality of life in survivors of acute respiratory distress syndrome. Am J Respir Crit Care Med 167:690–694CrossRefPubMed
17.
go back to reference Herridge MS, Cheung AM, Tansey CM, Matte-Martyn A, Diaz-Granados N, Al Saidi F, Cooper AB, Guest CB, Mazer CD, Mehta S, Stewart TE, Barr A, Cook D, Slutsky AS (2003) One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med 348:683–693CrossRefPubMed Herridge MS, Cheung AM, Tansey CM, Matte-Martyn A, Diaz-Granados N, Al Saidi F, Cooper AB, Guest CB, Mazer CD, Mehta S, Stewart TE, Barr A, Cook D, Slutsky AS (2003) One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med 348:683–693CrossRefPubMed
18.
go back to reference Hunt JR, White E (1998) Retaining and tracking cohort study members. Epidemiol Rev 20:57–70PubMed Hunt JR, White E (1998) Retaining and tracking cohort study members. Epidemiol Rev 20:57–70PubMed
19.
go back to reference Urban N, Anderson GL, Tseng A (1993) Effects on response rates and costs of stamps vs business reply in a mail survey of physicians. J Clin Epidemiol 46:455–459CrossRefPubMed Urban N, Anderson GL, Tseng A (1993) Effects on response rates and costs of stamps vs business reply in a mail survey of physicians. J Clin Epidemiol 46:455–459CrossRefPubMed
20.
go back to reference Maheux B, Legault C, Lambert J (1989) Increasing response rates in physicians’ mail surveys: an experimental study. Am J Public Health 79:638–639PubMed Maheux B, Legault C, Lambert J (1989) Increasing response rates in physicians’ mail surveys: an experimental study. Am J Public Health 79:638–639PubMed
21.
go back to reference Vincent JL, Angus DC, Artigas A, Kalil A, Basson BR, Jamal HH, Johnson G, III, Bernard GR (2003) Effects of drotrecogin alfa (activated) on organ dysfunction in the PROWESS trial. Crit Care Med 31:834–840CrossRefPubMed Vincent JL, Angus DC, Artigas A, Kalil A, Basson BR, Jamal HH, Johnson G, III, Bernard GR (2003) Effects of drotrecogin alfa (activated) on organ dysfunction in the PROWESS trial. Crit Care Med 31:834–840CrossRefPubMed
22.
go back to reference Black NA, Jenkinson C, Hayes JA, Young D, Vella K, Rowan KM, Daly K, Ridley S (2001) Review of outcome measures used in adult critical care. Crit Care Med 29:2119–2124CrossRefPubMed Black NA, Jenkinson C, Hayes JA, Young D, Vella K, Rowan KM, Daly K, Ridley S (2001) Review of outcome measures used in adult critical care. Crit Care Med 29:2119–2124CrossRefPubMed
23.
go back to reference Hayes JA, Black NA, Jenkinson C, Young JD, Rowan KM, Daly K, Ridley S (2000) Outcome measures for adult critical care: a systematic review. Health Technol Assess 4:1–111 Hayes JA, Black NA, Jenkinson C, Young JD, Rowan KM, Daly K, Ridley S (2000) Outcome measures for adult critical care: a systematic review. Health Technol Assess 4:1–111
24.
go back to reference Gordon SM, Jackson JC, Ely EW, Burger C, Hopkins RO (2004) Clinical identification of cognitive impairment in ICU survivors: insights for intensivists. Intensive Care Med 30:1997–2008CrossRefPubMed Gordon SM, Jackson JC, Ely EW, Burger C, Hopkins RO (2004) Clinical identification of cognitive impairment in ICU survivors: insights for intensivists. Intensive Care Med 30:1997–2008CrossRefPubMed
25.
go back to reference Jackson JC, Gordon SM, Ely EW, Burger C, Hopkins RO (2004) Research issues in the evaluation of cognitive impairment in intensive care unit survivors. Intensive Care Med 30:2009–2016CrossRefPubMed Jackson JC, Gordon SM, Ely EW, Burger C, Hopkins RO (2004) Research issues in the evaluation of cognitive impairment in intensive care unit survivors. Intensive Care Med 30:2009–2016CrossRefPubMed
26.
go back to reference Jones C, Skirrow P, Griffiths RD, Humphris G, Ingleby S, Eddleston J, Waldmann C, Gager M (2004) Post-traumatic stress disorder-related symptoms in relatives of patients following intensive care. Intensive Care Med 30:456–460CrossRefPubMed Jones C, Skirrow P, Griffiths RD, Humphris G, Ingleby S, Eddleston J, Waldmann C, Gager M (2004) Post-traumatic stress disorder-related symptoms in relatives of patients following intensive care. Intensive Care Med 30:456–460CrossRefPubMed
27.
go back to reference Im K, Belle SH, Schulz R, Mendelsohn AB, Chelluri L (2004) Prevalence and outcomes of caregiving after prolonged (>or=48 hours) mechanical ventilation in the ICU. Chest 125:597–606CrossRefPubMed Im K, Belle SH, Schulz R, Mendelsohn AB, Chelluri L (2004) Prevalence and outcomes of caregiving after prolonged (>or=48 hours) mechanical ventilation in the ICU. Chest 125:597–606CrossRefPubMed
28.
go back to reference American Thoracic Society (2002) Understanding costs and cost-effectiveness in critical care: report from the second American Thoracic Society workshop on outcomes research. Am J Respir Crit Care Med 165:540–550PubMed American Thoracic Society (2002) Understanding costs and cost-effectiveness in critical care: report from the second American Thoracic Society workshop on outcomes research. Am J Respir Crit Care Med 165:540–550PubMed
29.
go back to reference Shorr AF (2002) An update on cost-effectiveness analysis in critical care. Curr Opin Crit Care 8:337–343CrossRefPubMed Shorr AF (2002) An update on cost-effectiveness analysis in critical care. Curr Opin Crit Care 8:337–343CrossRefPubMed
30.
go back to reference Vincent C, Taylor-Adams S, Stanhope N (1998) Framework for analysing risk and safety in clinical medicine. BMJ 316:1154–1157PubMed Vincent C, Taylor-Adams S, Stanhope N (1998) Framework for analysing risk and safety in clinical medicine. BMJ 316:1154–1157PubMed
31.
go back to reference Pronovost PJ, Wu AW, Sexton JB (2004) Acute decompensation after removing a central line: practical approaches to increasing safety in the intensive care unit. Ann Intern Med 140:1025–1033PubMed Pronovost PJ, Wu AW, Sexton JB (2004) Acute decompensation after removing a central line: practical approaches to increasing safety in the intensive care unit. Ann Intern Med 140:1025–1033PubMed
32.
go back to reference Heyland DK, Guyatt G, Cook DJ, Meade M, Juniper E, Cronin L, Gafni A (1998) Frequency and methodologic rigor of quality-of-life assessments in the critical care literature. Crit Care Med 26:591–598CrossRefPubMed Heyland DK, Guyatt G, Cook DJ, Meade M, Juniper E, Cronin L, Gafni A (1998) Frequency and methodologic rigor of quality-of-life assessments in the critical care literature. Crit Care Med 26:591–598CrossRefPubMed
33.
go back to reference Buijk SE, Mouton JW, Gyssens IC, Verbrugh HA, Bruining HA (2002) Experience with a once-daily dosing program of aminoglycosides in critically ill patients. Intensive Care Med 28:936–942CrossRefPubMed Buijk SE, Mouton JW, Gyssens IC, Verbrugh HA, Bruining HA (2002) Experience with a once-daily dosing program of aminoglycosides in critically ill patients. Intensive Care Med 28:936–942CrossRefPubMed
34.
go back to reference Deziel-Evans LM, Murphy JE, Job ML (1986) Correlation of pharmacokinetic indices with therapeutic outcome in patients receiving aminoglycosides. Clin Pharm 5:319–324PubMed Deziel-Evans LM, Murphy JE, Job ML (1986) Correlation of pharmacokinetic indices with therapeutic outcome in patients receiving aminoglycosides. Clin Pharm 5:319–324PubMed
35.
go back to reference Freeman CD, Nicolau DP, Belliveau PP, Nightingale CH (1997) Once-daily dosing of aminoglycosides: review and recommendations for clinical practice. J Antimicrob Chemother 39:677–686CrossRefPubMed Freeman CD, Nicolau DP, Belliveau PP, Nightingale CH (1997) Once-daily dosing of aminoglycosides: review and recommendations for clinical practice. J Antimicrob Chemother 39:677–686CrossRefPubMed
36.
go back to reference Nicolau DP, Freeman CD, Belliveau PP, Nightingale CH, Ross JW, Quintiliani R (1995) Experience with a once-daily aminoglycoside program administered to 2:184 adult patients. Antimicrob Agents Chemother 39:650–655PubMed Nicolau DP, Freeman CD, Belliveau PP, Nightingale CH, Ross JW, Quintiliani R (1995) Experience with a once-daily aminoglycoside program administered to 2:184 adult patients. Antimicrob Agents Chemother 39:650–655PubMed
37.
go back to reference Spruit MA, Nemery B, Decramer M (2003) Survivors of the acute respiratory distress syndrome. N Engl J Med 348:2149–2150CrossRef Spruit MA, Nemery B, Decramer M (2003) Survivors of the acute respiratory distress syndrome. N Engl J Med 348:2149–2150CrossRef
38.
go back to reference Hopkins RO, Weaver LK, Pope D, Orme JF, Bigler ED, Larson-LOHR V (1999) Neuropsychological sequelae and impaired health status in survivors of severe acute respiratory distress syndrome. Am J Respir Crit Care Med 160:50–56PubMed Hopkins RO, Weaver LK, Pope D, Orme JF, Bigler ED, Larson-LOHR V (1999) Neuropsychological sequelae and impaired health status in survivors of severe acute respiratory distress syndrome. Am J Respir Crit Care Med 160:50–56PubMed
39.
go back to reference Hopkins RO, Weaver LK, Collingridge D, Parkinson RB, Chan KJ, Orme JF Jr (2005) Two-year cognitive, emotional, and quality-of-life outcomes in acute respiratory distress syndrome. Am J Respir Crit Care Med 171:340–347CrossRefPubMed Hopkins RO, Weaver LK, Collingridge D, Parkinson RB, Chan KJ, Orme JF Jr (2005) Two-year cognitive, emotional, and quality-of-life outcomes in acute respiratory distress syndrome. Am J Respir Crit Care Med 171:340–347CrossRefPubMed
40.
go back to reference Bernard GR, Vincent JL, Laterre PF, LaRosa SP, Dhainaut JF, Lopez-Rodriguez A, Steingrub JS, Garber GE, Helterbrand JD, Ely EW, Fisher CJJ (2001) Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 344:699–709CrossRefPubMed Bernard GR, Vincent JL, Laterre PF, LaRosa SP, Dhainaut JF, Lopez-Rodriguez A, Steingrub JS, Garber GE, Helterbrand JD, Ely EW, Fisher CJJ (2001) Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 344:699–709CrossRefPubMed
41.
go back to reference Angus DC, Laterre PF, Helterbrand JD, Ely EW, Ball DE, Garg R, Weissfeld LA, Bernard GR (2004) The effect of drotrecogin alfa (activated) on long-term survival after severe sepsis. Crit Care Med 32:2199–2206PubMed Angus DC, Laterre PF, Helterbrand JD, Ely EW, Ball DE, Garg R, Weissfeld LA, Bernard GR (2004) The effect of drotrecogin alfa (activated) on long-term survival after severe sepsis. Crit Care Med 32:2199–2206PubMed
42.
go back to reference Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, Truman B, Speroff T, Gautam S, Margolin R, Hart RP, Dittus R (2001) Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA 286:2703–2710CrossRefPubMed Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, Truman B, Speroff T, Gautam S, Margolin R, Hart RP, Dittus R (2001) Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA 286:2703–2710CrossRefPubMed
43.
go back to reference Diggle PJ, Liang K-Y, Zeger SL (1994) Analysis of longitudinal data. Oxford University Press, New York Diggle PJ, Liang K-Y, Zeger SL (1994) Analysis of longitudinal data. Oxford University Press, New York
44.
go back to reference Rubinson L, Diette GB, Song X, Brower RG, Krishnan JA (2004) Low caloric intake is associated with nosocomial bloodstream infections in patients in the medical intensive care unit. Crit Care Med 32:350–357CrossRefPubMed Rubinson L, Diette GB, Song X, Brower RG, Krishnan JA (2004) Low caloric intake is associated with nosocomial bloodstream infections in patients in the medical intensive care unit. Crit Care Med 32:350–357CrossRefPubMed
45.
go back to reference Konopad E, Noseworthy TW, Johnston R, Shustack A, Grace M (1995) Quality of life measures before and one year after admission to an intensive care unit. Crit Care Med 23:1653–1659CrossRefPubMed Konopad E, Noseworthy TW, Johnston R, Shustack A, Grace M (1995) Quality of life measures before and one year after admission to an intensive care unit. Crit Care Med 23:1653–1659CrossRefPubMed
46.
go back to reference Angus DC, Musthafa AA, Clermont G, Griffin MF, Linde-Zwirble WT, Dremsizov TT, Pinsky MR (2001) Quality-adjusted survival in the first year after the acute respiratory distress syndrome. Am J Respir Crit Care Med 163:1389–1394PubMed Angus DC, Musthafa AA, Clermont G, Griffin MF, Linde-Zwirble WT, Dremsizov TT, Pinsky MR (2001) Quality-adjusted survival in the first year after the acute respiratory distress syndrome. Am J Respir Crit Care Med 163:1389–1394PubMed
47.
go back to reference Wehler M, Geise A, Hadzionerovic D, Aljukic E, Reulbach U, Hahn EG, Strauss R (2003) Health-related quality of life of patients with multiple organ dysfunction: individual changes and comparison with normative population. Crit Care Med 31:1094–1101CrossRefPubMed Wehler M, Geise A, Hadzionerovic D, Aljukic E, Reulbach U, Hahn EG, Strauss R (2003) Health-related quality of life of patients with multiple organ dysfunction: individual changes and comparison with normative population. Crit Care Med 31:1094–1101CrossRefPubMed
48.
go back to reference Graf J, Koch M, Dujardin R, Kersten A, Janssens U (2003) Health-related quality of life before, 1 month after, and 9 months after intensive care in medical cardiovascular and pulmonary patients. Crit Care Med 31:2163–2169CrossRefPubMed Graf J, Koch M, Dujardin R, Kersten A, Janssens U (2003) Health-related quality of life before, 1 month after, and 9 months after intensive care in medical cardiovascular and pulmonary patients. Crit Care Med 31:2163–2169CrossRefPubMed
49.
go back to reference Ridley SA, Chrispin PS, Scotton H, Rogers J, Lloyd D (1997) Changes in quality of life after intensive care: comparison with normal data. Anaesthesia 52:195–202CrossRefPubMed Ridley SA, Chrispin PS, Scotton H, Rogers J, Lloyd D (1997) Changes in quality of life after intensive care: comparison with normal data. Anaesthesia 52:195–202CrossRefPubMed
50.
go back to reference Hofhuis J, Hautvast JL, Schrijvers AJ, Bakker J (2003) Quality of life on admission to the intensive care: can we query the relatives? Intensive Care Med 29:974–979PubMed Hofhuis J, Hautvast JL, Schrijvers AJ, Bakker J (2003) Quality of life on admission to the intensive care: can we query the relatives? Intensive Care Med 29:974–979PubMed
51.
go back to reference Brower RG, Mattay MA, Morris A, Schoenfeld D, Thompson BT, Wheeler A (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med 342:1301–1308CrossRefPubMed Brower RG, Mattay MA, Morris A, Schoenfeld D, Thompson BT, Wheeler A (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med 342:1301–1308CrossRefPubMed
Metadata
Title
Studying outcomes of intensive care unit survivors: measuring exposures and outcomes
Authors
Dale M. Needham
David W. Dowdy
Pedro A. Mendez-Tellez
Margaret S. Herridge
Peter J. Pronovost
Publication date
01-09-2005
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 9/2005
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-005-2656-7

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