医学ppt课件血液成份及输血疗法.ppt

根据三原色原理叠加后的单色形成了第三种颜色并脱离了原本的单色颜色更加丰富象征着产品在原有空间的组合中产生了突破性的变化 * Intensive communication: Four-year follow-up from a clinical practice study Ri 王信堯 Lilly: Crit Care Med, Volume 31(5) Supplement.May 2003.S394-S399 Preface Fear, air hunger, pain, anxiety of dying Hospice care, intensive care ? End of life care, option ? Ineffective life support moving to a comfort-focused care plan Lilly: Crit Care Med, Volume 31(5) Supplement.May 2003.S394-S399 Introduction Purpose: moving dying patients from ineffective lift support to comfort-focused care plan When to decide? Where the decision made? What memberships? Why do it? How to do? Intensive communication- the bridge between ICU support to comfort care Lilly: Crit Care Med, Volume 31(5) Supplement.May 2003.S394-S399 Intensive communication The uniform application of a process of communication moving dying patients to comfort-focused care Noncoercive, patient and family-centered, multidisciplinary process Primary outcome variables --- length of ICU stay and mortality Secondary outcome varibles --- agreement among providers, team, patient, family Lilly: Crit Care Med, Volume 31(5) Supplement.May 2003.S394-S399 Methods (1) 2891 adult patients admitted to ICU during 4-yr period from Oct. 31, 1998, to Sept. 30, 2002 10-bed medical ICU 1 attending physician, 2~3 residents, 3 interns, and 45 nurses (in shifts). Admission decision: physician not part of ICU team Discharge decision: critical care physician Lilly: Crit Care Med, Volume 31(5) Supplement.May 2003.S394-S399 Methods (2) Initial meeting: within 72 hrs of ICU admission Criteria: 1. Predicted ICU stay = 5 days 2. Predicted mortality of 25 % 3. Function status potentially irreversible and sufficient to preclude eventual return to home Lilly: Crit Care Med, Volume 31(5) Supplement.May 2003.S394-S399 Methods (3) Memberships: attending intensivists, nurse, house office