对西南地区5家三甲医院重症监护病房(intensive care unit,ICU)的15名医护人员进行面对面的深度访谈,对影响医护人员为病人做出临终决策的因素进行研究。影响ICU医护人员做出临终决策的原因包括:紧张的医患关系、欠缺对安宁疗护的认知...对西南地区5家三甲医院重症监护病房(intensive care unit,ICU)的15名医护人员进行面对面的深度访谈,对影响医护人员为病人做出临终决策的因素进行研究。影响ICU医护人员做出临终决策的原因包括:紧张的医患关系、欠缺对安宁疗护的认知、医疗卫生政策限制、经济因素。其中,影响ICU医护人员做出临终决策最主要的因素是病人的经济情况和当前的医疗法规,而不是病人的病情及病人自主权。应从医学、经济、政策法律和教育四方面建立有效的应对机制,使ICU临终决策实践有法可依、有章可循,有效保护医护人员、病人及家属的利益。展开更多
[目的]系统评价重症监护室(ICU)临终病人家属决策的情感体验和需求,为医院开展ICU临终决策支持工作提供依据。[方法]计算机检索外文数据库PubMed、EMbase、the Cochrane Library、Web of Science、CINAHL、PsyCINFO以及中文数据库中国知...[目的]系统评价重症监护室(ICU)临终病人家属决策的情感体验和需求,为医院开展ICU临终决策支持工作提供依据。[方法]计算机检索外文数据库PubMed、EMbase、the Cochrane Library、Web of Science、CINAHL、PsyCINFO以及中文数据库中国知网(CNKI)、万方数据资源系统、中国生物医学文献数据库(CBM)、维普数据库(VIP),收集关于ICU临终病人家属决策体验的质性研究。检索时限2009年1月1日—2019年1月1日。采用澳大利亚JBI循证卫生保健中心质性研究质量评价标准对文献进行评价,并采用汇集性整合方法对结果进行整合。[结果]共纳入13项研究,提炼出45个完整的研究结果,归类成6个新类别,综合成2个整合结果。整合结果1:家属因复杂的心理活动、沉重的精神负担、诸多的不确定性,故而陷入决策困境。整合结果2:家属希望发挥角色的积极作用,渴求外界支持。[结论]临床工作人员应深刻地认识到ICU临终病人家属存在的决策困境和需求,给予决策支持,提高决策质量,更好地展现医院的人文关怀和医疗服务质量。展开更多
There has been a significant decline in cardiovascular morbidity and mortality amidst pervasive advances in care, including percutane- ous revascularization, mechanical circulatory support, and transcatheter valvular ...There has been a significant decline in cardiovascular morbidity and mortality amidst pervasive advances in care, including percutane- ous revascularization, mechanical circulatory support, and transcatheter valvular therapies. While advancing therapies may add significant longevity, they also bring about new end-of-life decision-making challenges for patients and their families who also must weigh the advan- tages of reduced mortality to the possibility of longer lives consisting of high morbidity, frailty, pain, and poor quality of living. Advance care entails options of withholding or withdrawing therapies, and has become a familiar part of cardiovascular care for older patients in Western countries. However, as advanced cardiovascular practices extend to developing countries, the interrelated concept of advance care is rarely straight forward as it is affected by local cultural traditions and mores, and can lead to very different inferences and use. This paper discusses the concepts of advance care planning, surrogate decision-making, orders for resuscitation and futility in patients with cardiac dis- ease with comparisons of West to East, focusing particularly on the United States versus India.展开更多
Remanufacturing is a key enabler for sustainable production due to its effectiveness in closing the loop on material flows, extending product life cycle and reducing production waste and emission. In this paper, a hol...Remanufacturing is a key enabler for sustainable production due to its effectiveness in closing the loop on material flows, extending product life cycle and reducing production waste and emission. In this paper, a holistic decision support tool to facilitate the product end-of-life （EOL） strategy planning, specifically using remanufactur- ing as a key strategy is presented. The proposed model incorporates checklist methods to evaluate the viability of conducting remanufactufing for a product and its compo- nents. An optimization model for determining the Pareto set of optimal EOL strategies that correspond to maximum economic profit and minimum environmental impact is presented. Since determination of this Pareto set via enu- meration of all EOL strategies is prohibitively time-con- suming, even for a product with a small number of components, genetic algorithm （GA）, specifically NSGA-II has been utilized to achieve rapid calculation of the set of optimum EOL strategies. This NSGA-II method permits extensive sensitivity analysis to understand thoroughly the impact of situational variables, such as reverse logistic cost, technology and replacement part availability, etc., on the EOL decision making, i.e., Pareto front, and thus leading to improved strategy planning and better product design. The case study involving EOL treatment of two types of desktop phones is described to illustrate the utility of the proposed methodology.展开更多
文摘对西南地区5家三甲医院重症监护病房(intensive care unit,ICU)的15名医护人员进行面对面的深度访谈,对影响医护人员为病人做出临终决策的因素进行研究。影响ICU医护人员做出临终决策的原因包括:紧张的医患关系、欠缺对安宁疗护的认知、医疗卫生政策限制、经济因素。其中,影响ICU医护人员做出临终决策最主要的因素是病人的经济情况和当前的医疗法规,而不是病人的病情及病人自主权。应从医学、经济、政策法律和教育四方面建立有效的应对机制,使ICU临终决策实践有法可依、有章可循,有效保护医护人员、病人及家属的利益。
文摘[目的]系统评价重症监护室(ICU)临终病人家属决策的情感体验和需求,为医院开展ICU临终决策支持工作提供依据。[方法]计算机检索外文数据库PubMed、EMbase、the Cochrane Library、Web of Science、CINAHL、PsyCINFO以及中文数据库中国知网(CNKI)、万方数据资源系统、中国生物医学文献数据库(CBM)、维普数据库(VIP),收集关于ICU临终病人家属决策体验的质性研究。检索时限2009年1月1日—2019年1月1日。采用澳大利亚JBI循证卫生保健中心质性研究质量评价标准对文献进行评价,并采用汇集性整合方法对结果进行整合。[结果]共纳入13项研究,提炼出45个完整的研究结果,归类成6个新类别,综合成2个整合结果。整合结果1:家属因复杂的心理活动、沉重的精神负担、诸多的不确定性,故而陷入决策困境。整合结果2:家属希望发挥角色的积极作用,渴求外界支持。[结论]临床工作人员应深刻地认识到ICU临终病人家属存在的决策困境和需求,给予决策支持,提高决策质量,更好地展现医院的人文关怀和医疗服务质量。
文摘There has been a significant decline in cardiovascular morbidity and mortality amidst pervasive advances in care, including percutane- ous revascularization, mechanical circulatory support, and transcatheter valvular therapies. While advancing therapies may add significant longevity, they also bring about new end-of-life decision-making challenges for patients and their families who also must weigh the advan- tages of reduced mortality to the possibility of longer lives consisting of high morbidity, frailty, pain, and poor quality of living. Advance care entails options of withholding or withdrawing therapies, and has become a familiar part of cardiovascular care for older patients in Western countries. However, as advanced cardiovascular practices extend to developing countries, the interrelated concept of advance care is rarely straight forward as it is affected by local cultural traditions and mores, and can lead to very different inferences and use. This paper discusses the concepts of advance care planning, surrogate decision-making, orders for resuscitation and futility in patients with cardiac dis- ease with comparisons of West to East, focusing particularly on the United States versus India.
文摘Remanufacturing is a key enabler for sustainable production due to its effectiveness in closing the loop on material flows, extending product life cycle and reducing production waste and emission. In this paper, a holistic decision support tool to facilitate the product end-of-life （EOL） strategy planning, specifically using remanufactur- ing as a key strategy is presented. The proposed model incorporates checklist methods to evaluate the viability of conducting remanufactufing for a product and its compo- nents. An optimization model for determining the Pareto set of optimal EOL strategies that correspond to maximum economic profit and minimum environmental impact is presented. Since determination of this Pareto set via enu- meration of all EOL strategies is prohibitively time-con- suming, even for a product with a small number of components, genetic algorithm （GA）, specifically NSGA-II has been utilized to achieve rapid calculation of the set of optimum EOL strategies. This NSGA-II method permits extensive sensitivity analysis to understand thoroughly the impact of situational variables, such as reverse logistic cost, technology and replacement part availability, etc., on the EOL decision making, i.e., Pareto front, and thus leading to improved strategy planning and better product design. The case study involving EOL treatment of two types of desktop phones is described to illustrate the utility of the proposed methodology.
