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Intensive care unit versus high-dependency care unit admission on mortality in patients with septic shock: a retrospective cohort study using Japanese claims data / 敗血症性ショック患者の死亡率に関する集中治療室への入室と高依存性治療室への入室の比較:日本のDPCデータベースを用いた過去起点コホート研究Endo, Koji 25 March 2024 (has links)
京都大学 / 新制・課程博士 / 博士(医学) / 甲第25157号 / 医博第5043号 / 京都大学大学院医学研究科医学専攻 / (主査)教授 石見 拓, 教授 西浦 博, 教授 江木 盛時 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM
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JAG HAR INTE GÅTT I DERAS SKOR : Sjuksköterskors erfarenheter av att vårda patienter med beroendeproblematik.Mähler, Ann-Charlott, Nilsson, Filippa January 2018 (has links)
Background: Patients with a substance abuse disorder can experience that caregivers lack knowledge and understanding about how the disorder affects their life and health. The patients’ sufferings are not only caused by the disorder but also the physical, psychological and social aspects that might be a reason for, or a result of the substance abuse disorder. To provide care to these patients hence places special demands on nurses’ approaches. Aim: To describe nurses' experiences of caring for patients with substance abuse disorder. Method: A systematic review with a descriptive synthesis. Result: Nurses have experiences that it is engaging and rewarding to care for patients with substance abuse disorder. The result shows that the nurses have experiences that it is difficult and complicated to care for patients with substance abuse disorder and that it can be associated with fear, insecurity, organizational challenges and challenges in keeping a professional relation to patients who are socially exposed and have an unpredictable behavior. The result also points out the presence of prejudices and generalized attitudes towards the patients. There are also examples of experiences that the approach, experience and education can improve and facilitate the care. Conclusion: In order to provide an equal and successful care for patients, substance abuse disorder should be considered equal to other diseases and nurses need to regard the patient's living conditions. Keywords: caring relationship, dependency care, experiences, literature study, nurses, substance abuse disorder / Bakgrund: Patienter med beroendeproblematik kan uppleva att vårdpersonal saknar kunskap och förståelse för hur beroendet påverkar deras livssituation och hälsa. Patienternas lidande är inte bara orsakat av beroendet i sig utan påverkas även av fysiska, psykiska och sociala aspekter, vilka kan vara en orsak till eller en följd av missbruket. Att vårda dessa patienter ställer därför speciella krav på sjuksköterskors förhållningssätt. Syfte: Att beskriva sjuksköterskors erfarenheter av att vårda patienter med beroendeproblematik. Metod: En systematisk litteraturstudie med beskrivande syntes. Resultat: Sjuksköterskor har erfarenheter av att det är engagerande och givande att vårda patienter med beroendeproblematik. I resultatet framkommer vidare att sjuksköterskorna erfar att det är svårt och komplicerat att vårda patienter med beroendeproblematik och att det kan vara förknippat med rädsla, osäkerhet, organisatoriska utmaningar samt utmaningar i att förhålla sig professionella till patienter som är socialt utsatta och har ett oberäkneligt beteende. Resultatet visar också att det förekommer fördomar om och generaliserade attityder kring patienterna. Sjuksköterskans förhållningssätt, erfarenhet och utbildning kan förbättra och underlätta vården. Slutsats: För att ge en jämlik och framgångsrik vård bör beroendeproblematik jämställas med andra sjukdomar och sjuksköterskor behöver ta hänsyn till patientens livsförhållanden. Nyckelord: beroendeproblematik, beroendevård, erfarenheter, litteraturstudie, sjuksköterskor, vårdande relation.
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Understanding the principles of non-invasive positive pressure ventilationRoberts, Alexandra 06 July 2021 (has links)
No / Non-invasive positive pressure ventilation (NPPV) provides respiratory support to patients without the need for invasive intubation. Although it has been used for several years in critical care, NPPV has come to prominence as a management option for certain patients with respiratory complications of coronavirus disease 2019 (COVID-19). This has led to increased care provision by nurses with little or no experience and expertise in critical care and NPPV. This article provides an overview of the principles of NPPV and its use in type 1 and type 2 respiratory failure. It explains the pathophysiology of several conditions that often lead to respiratory failure and how NPPV can mitigate respiratory failure and improve gas exchange. An individualised assessment of the patient’s suitability for NPPV and an evaluation of the effectiveness of the therapy are crucial to ensure its safe and effective use. Nurses also have an important role in providing explanations and support to patients.
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High Dependency Care provision in Obstetric Units remote from tertiary referral centres and factors influencing care escalation : a mixed methods studyJames, Alison January 2017 (has links)
Background Due to technological and medical advances, increasing numbers of pregnant and post natal women require higher levels of care, including maternity high dependency care (MHDC). Up to 5% of women in the UK will receive MHDC, although there are varying opinions as to the defining features and definition of this care. Furthermore, limited evidence suggests that the size and type of obstetric unit (OU) influences the way MHDC is provided. There is robust evidence indicating that healthcare professionals must be able to recognise when higher levels of care are required and escalate care appropriately. However, there is limited evidence examining the factors that influence a midwife to decide whether MHDC is provided or a woman’s care is escalated away from the OU to a specialist unit. Research Aims 1. To obtain a professional consensus regarding the defining features of and definition for MHDC in OUs remote from tertiary referral units. 2. To examine the factors that influence a midwife to provide MHDC or request the escalation of care (EoC) away from the OU. Methods An exploratory sequential mixed methods design was used: Delphi survey: A three-round modified Delphi survey of 193 obstetricians, anaesthetists, and midwives across seven OUs (annual birth rates 1500-4500) remote from a tertiary referral centre in Southern England. Round 1 (qualitative) involved completion of a self-report questionnaire. Rounds 2/3 (quantitative); respondents rated their level of agreement or disagreement against five point Likert items for a series of statements. First round data were analysed using qualitative description. The level of consensus for the combined percentage of strongly agree / agree statements was set at 80% for the second and third rounds Focus Groups: Focus groups with midwives across three OUs in Southern England (annual birth rates 1700, 4000 and 5000). Three scenarios in the form of video vignettes were used as triggers for the focus groups. Scenario 1; severe pre-eclampsia, physiologically unstable 2; major postpartum haemorrhage requiring invasive monitoring 3; recent admission with chest pain receiving facial oxygen and continuous ECG monitoring. Two focus groups were conducted in each of the OUs with band 6 / 7 midwives. Data were analysed using a qualitative framework approach. Findings Delphi survey: Response rates for the first, second and third rounds were 44% (n=85), 87% (n=74/85) and 90.5% (n= 67/74) respectively. Four themes were identified (conditions, vigilance, interventions, and service delivery). The respondents achieved consensus regarding the defining features of MHDC with the exceptions of post-operative care and post natal epidural anaesthesia. A definition for MHDC was agreed, although it reflected local variations in service delivery. MHDC was equated with level 2 care (ICS, 2009) although respondents from the three smallest OUs agreed it also comprised level 1 care. The smaller OUs were less likely to provide MHDC and had a more liberal policy of transferring women to intensive care. Midwives in the smaller OUs were more likely to escalate care to ICU than doctors. Focus Groups: Factors influencing midwives’ EoC decisions included local service delivery, patient specific / professional factors, and guidelines to a lesser extent. ‘Fixed’ factors the midwives had limited or no opportunity to change included the proximity of the labour ward to the ICU and the availability of specialist equipment. Midwives in the smallest OU did not have access to the facilities / equipment for MHDC provision and could not provide it. Midwives in the larger OUs provided MHDC but identified varying levels of competence and used ‘workarounds’ to facilitate care. A woman’s clinical complexity and potential for physiological deterioration were influential as to whether MHDC was assessed as appropriate. Midwifery staffing levels, skill mix and workload (variable factors) could also be influential. Differences of opinion were noted between midwives working in the same OUs and varying reliance was placed on clinical guidelines. Conclusion Whilst a consensus on the defining features of, and definition for MHDC has been obtained, the research corroborates previous evidence that local variations exist in MHDC provision. Given midwives from the larger OUs had variable opinions as to whether MHDC could be provided, there may be inequitable MHDC provision at a local level. Organisationally robust systems are required to promote safe, equitable MHDC care including MHDC education and training for midwives and precise EoC guidelines (so workarounds are minimised). The latter must take into consideration local service delivery and the ‘variable’ factors that influence midwives’ EoC decisions.
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