资源描述：
《医学课件血液成份及输血疗法》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。
1、Intensivecommunication:Four-yearfollow-upfromaclinicalpracticestudyRi王信堯JournalReadingLilly:CritCareMed,Volume31(5)Supplement.May2003.S394-S399PrefaceFear,airhunger,pain,anxietyofdyingHospicecare,intensivecare?Endoflifecare,option?Ineffectivelifesupp
2、ortmovingtoacomfort-focusedcareplanLilly:CritCareMed,Volume31(5)Supplement.May2003.S394-S399IntroductionPurpose:movingdyingpatientsfromineffectiveliftsupporttocomfort-focusedcareplanWhentodecide?Wherethedecisionmade?Whatmemberships?Whydoit?Howtodo?In
3、tensivecommunication-thebridgebetweenICUsupporttocomfortcareLilly:CritCareMed,Volume31(5)Supplement.May2003.S394-S399IntensivecommunicationTheuniformapplicationofaprocessofcommunicationmovingdyingpatientstocomfort-focusedcareNoncoercive,patientandfam
4、ily-centered,multidisciplinaryprocessPrimaryoutcomevariables---lengthofICUstayandmortalitySecondaryoutcomevaribles---agreementamongproviders,team,patient,familyLilly:CritCareMed,Volume31(5)Supplement.May2003.S394-S399Methods(1)2891adultpatientsadmitt
5、edtoICUduring4-yrperiodfromOct.31,1998,toSept.30,200210-bedmedicalICU1attendingphysician,2~3residents,3interns,and45nurses(inshifts).Admissiondecision:physiciannotpartofICUteamDischargedecision:criticalcarephysicianLilly:CritCareMed,Volume31(5)Supple
6、ment.May2003.S394-S399Methods(2)Initialmeeting:within72hrsofICUadmissionCriteria:1.PredictedICUstay>=5days2.Predictedmortalityof>25%3.FunctionstatuspotentiallyirreversibleandsufficienttoprecludeeventualreturntohomeLilly:CritCareMed,Volume31(5)Supplem
7、ent.May2003.S394-S399Methods(3)Memberships:attendingintensivists,nurse,houseofficer,family,patient(ifpossible)Othermembers:outsideexpert,socialworkers,psychiatrist,evensecurityexpertInitialintroductions,open-endedquestionsandpatientcurrentstatusandcu
8、re“Redflags“----FinalinterventionsLilly:CritCareMed,Volume31(5)Supplement.May2003.S394-S399Methods(4)Discussionobjects:1.Reviewthemedicalfactsandoptionsfortreatment2.Patient’sperspectives,acceptabilityofrisks,anddiscomfortofcriticalcare3.Agreeonacare
