安宁疗护服务质量影响因素的研究进展

文章分析了安宁疗护服务质量的研究现状,从个人相关因素、组织相关因素以及社会相关因素等方面对安宁疗护服务质量的影响因素进行综述,并提出建立家庭支持系统、加强医务人员教育培训、制定规范化政策和加强安宁疗护多学科团队建设的建议,旨在为后续相关干预研究提供参考依据。     

急诊患者安宁疗护需求筛查工具的研究进展

在急诊开展安宁疗护需求筛查是为可能受益的患者提供早期安宁疗护服务的关键。文章对国内外现有的急诊患者安宁疗护需求筛查工具的评估内容、心理测量学属性、适用人群、应用现状等进行综述,并对不同筛查工具进行比较分析,以期为我国急诊患者安宁疗护需求筛查工具的开发和临床应用提供思路。     

老年痴呆患者安宁疗护的研究进展

对开展老年痴呆患者安宁疗护的必要性、影响因素进行综述,提出实施老年痴呆患者安宁疗护的策略,包括：完善症状管理措施、推进预立医疗照护计划的实施、建立健全安宁疗护相关法律政策、推进中医安宁疗护,旨在为老年痴呆患者安宁疗护的发展提供参考。     

社区老年慢性病人群安宁疗护需求现状及影响因素分析

目的 ：调查社区老年慢性病人群安宁疗护需求现状并分析其影响因素,为提升社区老年护理服务质量提供参考。方法 ：本研究为横断面研究设计,采用便利抽样法,于2022年2月—3月在湖南省长沙市4个社区选取302例老年慢性病患者作为研究对象,使用一般资料调查表和中文版安宁疗护需求筛查工具进行调查,采用Logistic回归分析影响因素。结果 ：17.9%的老年慢性病群体具有安宁疗护需求;Logistic回归方程结果显示,患慢性病时间越长（OR=1.461,95%CI:1.017～2.099）、自理能力越差（OR=3.265,95%CI:1.189～8.964）以及自评健康状况越差（OR=3.622,95%CI:1.871～7.009）是安宁疗护需求的独立危险因素。结论 ：社区老年慢性病人群安宁疗护需求现状处于中等偏下水平,其主要影响因素为慢性病病程、自理能力以及自评健康状况。初级卫生保健人员可对社区老年慢性病群体进行安宁疗护需求筛查,并对其提供及时、有针对性的安宁疗护服务,提高老年慢性病群体的生活质量。     

心力衰竭患者安宁疗护准入评估指标的范围综述

目的对心力衰竭患者安宁疗护准入评估相关文献进行综述, 明确国内外心力衰竭患者安宁疗护准入评估指标及对应的评估标准或评估工具。方法以范围综述方法为框架, 计算机检索PubMed、Web of Science、Cochrane Library、Embase、中国知网、万方数据库、中国生物医学文献数据库和维普网, 检索时限均为建库至2022年4月30日。纳入心力衰竭患者安宁疗护准入评估相关的原始研究及综述, 由2名研究者独立筛选和提取资料。结果最终纳入文献15篇。文献整合结果显示, 心力衰竭患者安宁疗护准入评估指标包括疾病进展、患者需求、医疗资源利用及医疗机构情况4个类别, 包含患者预计生存期、心脏功能、高危生物标志物、运动状态、并发症与合并症、晚期治疗、患者主观意愿、复杂症状缓解需求、社会支持需求、多次非计划入院、住院时间延长和医疗机构软硬件资源12个评估指标及对应的评估标准或评估工具。结论心力衰竭患者安宁疗护准入评估指标内容全面, 但部分指标评估标准不明确, 整体缺乏共识。未来研究者可在现有研究的基础上遴选敏感性较好的评价指标, 构建心力衰竭患者安宁疗护准入评估标准, 并在临床实践中加以...     

国内外安宁疗护分级诊疗研究进展

介绍安宁疗护分级诊疗的概述、需求现状、相关模式、医护人员对安宁疗护分级诊疗知信行现状,以期为安宁疗护分级诊疗的实施与推广提供依据。     

患者报告结局在安宁疗护中的应用进展

目前,患者报告结局在安宁疗护领域中已得到一定的应用.本研究从患者报告结局的测量内容、评估工具和应用效果3方面进行阐述,提出患者报告结局在安宁疗护中应用的机遇与挑战,旨在促进患者报告结局在国内安宁疗护领域的应用,为促进决策、制定有效护理措施、提高晚期患者的照护体验及质量提供参考.     

安宁疗护对恶性肿瘤死亡患者住院费用的影响分析

目的 了解安宁疗护对恶性肿瘤死亡患者住院费用的影响。方法 回顾性收集2010年10月至2019年12月南京大学医学院附属鼓楼医院肿瘤科死亡病例共302例,比较接受安宁疗护的患者与未接受安宁疗护患者的资料,通过影响因素分析了解安宁疗护在住院费用中所起的作用。结果与未接受安宁疗护的恶性肿瘤死亡患者相比,接受安宁疗护的恶性肿瘤死亡患者平均住院费用、治疗费、检查费、药费、护理费均低于非安宁疗护组（均P＜0.001）。单因素分析结果显示,安宁疗护、医疗支付方式与住院费用有关(均P＜0.05)。多元线性逐步回归分析结果显示,安宁疗护是影响住院费用的主要因素(P=0004)。结论 安宁疗护可在一定程度上降低恶性肿瘤终末期患者的住院费用,医疗支付方式也可影响恶性肿瘤终末期患者的住院费用,应采取综合性措施控制住院费用,减轻患者经济负担。     

终末期肾病病人安宁疗护需求研究进展

从症状控制需求、心理疏导需求、信息与沟通需求、灵性需求、优逝准备需求、哀伤抚慰需求方面阐述终末期肾病病人的安宁疗护需求内容,归纳应用于终末期肾病病人安宁疗护需求的评估工具,分析病人需求未被满足的原因,以期为我国开展终末期肾病病人的安宁疗护提供参考。     

儿童安宁疗护应用研究进展

目的 通过对儿童安宁疗护的应用研究进展进行综述,以供国内临床实践参考.方法 检索国内外相关文献,从儿童安宁疗护概念、儿童安宁疗护国内外开展现状及临床应用等方面进行总结归纳.结果 发现儿童安宁疗护临床应用主要包含心理管理、疼痛管理、其它症状管理、家庭支持管理4个方面,并根据其干预措施中的不足,提出要开展专科化儿童安宁疗护...     

Delivering Palliative Care to Hospitalized Oncology Patients: A Scoping Review

ContextEarly, longitudinal integration of palliative care (PC) is recommended for patients with advanced cancer, in both inpatient and outpatient settings. Despite the growth of specialty PC teams in the last decade, the majority of PC is still delivered in the inpatient setting using a traditional referral-based consult delivery model. However, traditional consultation can lead to significant variation or delay in inpatient PC utilization. New care delivery models and strategies are emerging to deliver PC to hospitalized oncology patients who would most benefit from their services and to better align with professional society recommendations.ObjectivesTo identify different care models to deliver PC to ho`spitalized oncology patients and summarize their impact on patient and health system-related outcomes.MethodsWe conducted a scoping review of peer-reviewed articles from 2006 to 2021 evaluating delivery of PC to oncology patients in acute inpatient care. We abstracted study characteristics, the study's intervention and comparison arms, and outcomes related to specialty PC intervention.ResultsWe identified four delivery models that have been reported to deliver PC: 1) traditional referral-based consultation, 2) criterion-based or “triggered” consultation, 3) co-rounding with primary inpatient team, and 4) PC clinicians serving as the primary team. We summarize the known outcomes data from each model, and compare the benefits and limitations of each model.ConclusionOur findings provide guidance to health systems about care delivery models to deploy and implement inpatient PC resources to best serve their unique populations.     

Volunteer Involvement in Advance Care Planning: A Scoping Review

ContextVolunteer involvement may support organizations to initiate and operationalize complex interventions such as advance care planning (ACP).ObjectivesA scoping review was conducted to map existing research on volunteer involvement in ACP and to identify gaps in current knowledge base.MethodsWe followed the PRISMA extension for Scoping Reviews (PRISMA-ScR) guidelines. The review included studies of any design reporting original research. ACP was defined as any intervention aimed at supporting people to consider and communicate their current and future health treatment goals in the context of their own preferences and values. Studies were included if they reported data relating to volunteers at any stage in the delivery of ACP.ResultsOf 11 studies identified, nine different ACP models (initiatives to improve uptake of ACP) were described. Most of the models involved volunteers facilitating ACP conversations or advance care directive completion (n = 6); and three focused on ACP education, training, and support. However, a framework for volunteer involvement in ACP was not described; the studies often provided limited detail of the scope of volunteers' roles in ACP, and in three of the models, volunteers delivered ACP initiatives in addition to undertaking other tasks, in their primary role as a volunteer navigator. Increased frequency of ACP conversation or documentation was most commonly used to evaluate the effectiveness of the studies, with most showing a trend toward improvement.ConclusionsCurrent literature on volunteer involvement in ACP is lacking a systematic approach to implementation. We suggest future research should focus on person-centered outcomes related to ACP to evaluate the effectiveness of volunteer involvement.     

Frailty in a Post-Acute Care Population: A Scoping Review

Frailty is a complex and growing phenomenon facing health care providers throughout the continuum of care. Frailty is not well understood in post-acute care (PAC) settings. The purpose of this scoping review was to summarize current evidence of frailty impact on outcomes and frailty mitigation initiatives in PAC. Three major publication databases were searched from January 2000 to June 2017 that identified 18 articles specifically addressing frailty in PAC. Three themes were identified: scales used to measure frailty, factors that led to an adverse outcome or diagnosis of frailty, and interventions to address frailty in PAC. Scales used to measure frailty were dominated by physical factors and scarce on nutrition and social support. Functional decline, grip strength, gait speed, polypharmacy, and nutrition were identified in the studies as factors that identify frailty and are associated with poor outcomes. All these frailty characteristics compromise patients’ ability to benefit from rehabilitation, which further establishes the importance of PAC providers to identify, prevent, and treat frailty. Intervention studies had mixed outcomes, suggesting a need for further development in this area. The findings of this scoping review highlight the need for a comprehensive multidimensional assessment of frailty risks in PAC.

The Role of Palliative Care in Burns: A Scoping Review

ContextPatients with severe burns may face distressing symptoms with a high risk of mortality as a result of their injury. The role of palliative care in burns management remains unclear.ObjectiveTo appraise the literature on the role of palliative care in burns management.MethodsWe used scoping review with searches in 12 databases from their inception to August 2019. The citation retrieval and retention are reported in a PRISMA statement.Findings39 papers comprising of 30 primary studies (26 from high-income and four from middle-income countries), four reviews, two editorials, two guidelines, and one expert board review document were retained in the review. Palliative care is used synonymously with comfort and end-of-life care in burns literature. Comfort care is mostly initiated when active treatment is withheld (early deaths) or withdrawn (late deaths), limiting its overall benefits to burn patients, their families, and health care professionals. Futility decisions are usually complex and challenging, particularly for patients in the late death category, and it is unclear if these decisions result in timely commencement of comfort care measures. Three comfort care pathways were identified, but it remained unclear how these pathways evaluated “good death” or supported the family which creates the need for the development of other evidence-based guidelines.ConclusionPalliative care is applicable in burns management, but its current role is mostly confined to the end-of-life period, suggesting that it is not been fully integrated in the management process. Evidence-based guidelines are needed to support the integration and delivery of palliative care in the burn patient population.     

Palliative Ultrasound for Home Care Hospice Patients

The evolving relationship between emergency and palliative medicine is expected to benefit patients of each. Two collaborative care encounters involving home hospice patients are discussed. Portable bedside ultrasound was performed in the home to diagnose ascites and to guide palliative paracentesis. Specific interventions and outcomes are reported. The interface of emergency and palliative care and the use of paracentesis in cancer palliation are briefly reviewed. It is concluded that home‐performed ultrasound and ultrasound‐guided procedures are promising palliative modalities for care at the end of life. ACADEMIC EMERGENCY MEDICINE 2010; 17:293–296 © 2010 by the Society for Academic Emergency Medicine     

晚期癌症患者的临终关怀护理

总结了102例晚期癌症患者实施临终关怀的经验。包括尽可能满足患者的各项生理与心理需求,并积极争取患者家属和社会的支持和理解,使其体面、安详地走完自己最后人生。认为晚期癌症患者的临终关怀护理是非常必要的,也是非常有意义的。     

Stroke Patients in Long-Term Care

The closest relatives of 29 permanently institutionalized stroke patients were interviewed about their relationship to the patient before and after stroke, the functional ability of the patient before and after stroke, and their opinion of an appropriate care setting for the patient. The patients had all been independent before stroke, but were now dependent on help with most primary activities of daily living. Twelve patients had severe communicative difficulties. Most relatives could not suggest a realistic alternative to nursing home care, due to the patients' severe disabilities and extensive need for care. One patient was, however, later discharged to a sheltered living facility in accordance with her relative's wishes. One-third of the relatives expressed need for more information and support and wanted to take part in a support group. The nursing staff need high competency in providing good care for the patients and offering psychological support to the relatives, and should include the relatives in the overall treatment plan.     

Occupational Therapy Interventions and Outcomes Measured in Residential Care: A Scoping Review

Abstract

Aims: This scoping review identified the interventions and outcome measures used by occupational therapists working with older adults in residential care facilities.

Methods: A five-step approach was used to retrieve and screen studies from five databases. Included studies described an occupational therapy intervention with older adults living in residential care facilities, were published in English, between 1990 and 2019 in a peer-reviewed publication. Data were mapped using domains of the Canadian Model of Occupational Performance and Engagement.

Results: Findings from 51 studies revealed that occupational therapists most commonly implemented occupations as the intervention with little focus on aspects of the environment. Outcomes predominantly measured person factors and less commonly occupational performance and engagement.

Conclusion: The exploration of the past foci of practice and measurement of therapeutic impact enables occupational therapists to consider how their practice can enhance future occupational performance and engagement of residential care facility residents.     

开展以家庭为中心的脑卒中护理

综述了国内外近年来在实行以家庭为中心的脑卒中护理方面取得的进展，指出其必要性及其优势，以及开展此护理护士需要具备的知识与技能。