预测持久性严重疾病的挑战:一种定性研究
Kaitland M Byrd1, Madeline M Lagina1, Kathleen T Lee1
1Division of Pulmonary and Critical Care Medicine (K. M. B., M. M. L., K. T. L., H. C. P., and E. M. V.), Department of Internal Medicine, University of Michigan; the HSR Center of Innovation (H. C. P. and E. M. V.), Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI; the Department of Internal Medicine (A. T.), University of Pittsburgh Medical Center, Pittsburgh, PA; the Division of Allergy, Pulmonary and Critical Care Medicine (J. M. K.), Department of Medicine, University of Wisconsin, Madison, WI; the Division of Pulmonary and Critical Care (T. J. I.), School of Medicine, and the Department of Health Policy and Management (T. J. I.), School of Public Health, John Hopkins University, Baltimore, MD.
密集医生使用患者因素和疾病脚本进行预后,但临床挫折和顾问的投入往往会改变这些预测. 了解这些因素是改善ICU医疗决策的关键.
科学领域:
- 关键护理医学 关键护理医学
- 医疗决策 - - 医疗决策
- 预测 预测 预测 预测
背景情况:
- 密集型医生在预测关键事件方面面临挑战,例如新的休克或急性低氧呼吸衰竭 (AHRF),导致持续性关键疾病 (PerCI).
- 了解重症治疗师如何预测PerCI患者的预后,对于改善护理至关重要.
研究的目的:
- 探索密集医生用来预测患者新冲击风险的过程,AHRF和PerCI.
- 识别重症监护医生在ICU内预后时遇到的挑战.
主要方法:
- 与17名重症监护医生进行半结构面试,使用图表刺激回忆患者病例.
- 面试的定性内容分析,重点关注用于预测的信息和遇到的挑战.
主要成果:
- 强化治疗师在ICU入院时将患者因素置于背景,并使用疾病脚本 (疾病心理模型).
- 临床挫折和顾问的投入显著影响预后估计和预测的临床轨迹.
- 预后受到专家的专业知识和患者疾病的性质的影响.
结论:
- 强化治疗师的预后依赖于最初的患者数据和已建立的疾病脚本.
- 临床挫折和外部建议等动态因素经常改变预后,影响医疗决策.
- 建议对时间有限的试验进行进一步研究,以管理重症监护中的预后不确定性.
相关概念视频
Classification of Illness
An illness is a response to a disease in which the person's level of functioning is changed compared with a previous level. The general classification of illness includes acute and chronic.
Acute illness is severe...
Methods of Documentation VI: Case Management Model
For example, a patient with a chronic...
COPD: Pathogenesis and Clinical Features
The primary cause for the onset of COPD is cigarette smoking and exposure to air pollution. These hazardous factors initiate a chain reaction within the lungs, resulting in chronic inflammation, damage to the airways, and a...
Chronic Obstructive Pulmonary Disease-IV: Assessement and Diagnostic Studies
Medical History
Chronic Pancreatitis II: Collaborative Care
Assessment:
Cancer Survival Analysis

