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Evaluation of a Standardized Program for Training Practicing Anesthesiologists in Ultrasound‐Guided Regional Anesthesia Skills
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![点击此处可从《Journal of ultrasound in medicine》网站下载免费的PDF全文](/ch/ext_images/free.gif)
88.
Use of the Physician Orders for Life‐Sustaining Treatment Program in the Clinical Setting: A Systematic Review of the Literature
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![点击此处可从《Journal of the American Geriatrics Society》网站下载免费的PDF全文](/ch/ext_images/free.gif)
Susan E. Hickman PhD Elisabeth Keevern BSN Bernard J. Hammes PhD 《Journal of the American Geriatrics Society》2015,63(2):341-350
The Physician Orders for Life‐Sustaining Treatment (POLST) form is a palliative care tool that contains standardized, actionable medical orders. It is designed to ensure that patient treatment preferences are elicited, communicated, and honored throughout the healthcare system. A systematic review of the literature was conducted to evaluate what is currently known about the POLST program and identify directions for future research. Twenty‐three research studies focused on POLST use in the clinical setting were identified. A majority of studies have been conducted all or in part in Oregon, with chart review the most frequently used methodology. Research suggests that POLST is most commonly used in older, white patients who are near the end of life. A nonphysician facilitator usually prepares the POLST form for the physician to review and sign. The orders documented on POLST reflect a wide degree of individualization, with only approximately one‐third of patients having orders reflecting the lowest level of treatment in all POLST form sections. Clinicians have generally positive attitudes regarding use of POLST yet report a wide range of challenges. POLST alters treatment in a way that is consistent with orders. However, evidence that POLST reflects patient or surrogate treatment preferences is lacking. Research is needed to evaluate the quality of POLST decisions, explore the experiences of patients and their surrogates, develop decision‐support tools, improve clinician education, and assess the effect of POLST on care outcomes through intervention and population‐based studies. 相似文献
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The Montreal Cognitive Assessment—Basic: A Screening Tool for Mild Cognitive Impairment in Illiterate and Low‐Educated Elderly Adults
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Comparative effectiveness of a bioengineered living cellular construct vs. a dehydrated human amniotic membrane allograft for the treatment of diabetic foot ulcers in a real world setting
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![点击此处可从《Wound repair and regeneration》网站下载免费的PDF全文](/ch/ext_images/free.gif)
Robert S. Kirsner MD PhD Michael L. Sabolinski MD Nathan B. Parsons RN BSN Michelle Skornicki MPH William A. Marston MD 《Wound repair and regeneration》2015,23(5):737-744
We evaluated the comparative effectiveness of a bioengineered living cellular construct (BLCC) and a dehydrated human amnion/chorion membrane allograft (dHACM) for the treatment of diabetic foot ulcers (DFUs). Using a wound care–specific electronic medical record database, we assessed real‐world outcomes in 218 patients with 226 DFUs receiving treatment in 2014 at 99 wound care centers. The analysis included DFUs ≥1 and <25 cm2 with duration <=1 year and area reduction ≤20% in 14 days prior to treatment (N=163, BLCC; N=63, dHACM). The average baseline areas and durations were 6.0 cm2 and 4.4 months for BLCC and 5.2 cm2 and 4.6 months for dHACM, respectively. Patients treated with dHACM had more applications compared to those treated with BLCC (median 3.0 vs. 2.0) (p=0.003). A Cox model adjusted for key covariates including area and duration found the median time to closure for BLCC was 13.3 weeks compared to 26 weeks for dHACM, and the proportion of wounds healed were significantly higher for BLCC by 12 weeks (48% vs. 28%) and 24 weeks (72% vs. 47%) (p=0.01). Treatment with a bioengineered living cellular technology increased the probability of healing by 97% compared with a dehydrated amniotic membrane (hazard ratio = 1.97 [95% confidence interval 1.17, 3.33], p=0.01). 相似文献