Focus on ethics and palliative care in the intensive care unit.
Focus on ethics and palliative care in the intensive care unit.
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重点关注重症监护病房的伦理和姑息治疗。
DOI：
10.1007/s00134-019-05602-4
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发表时间：
2019
影响因子：
38.9
通讯作者：
Curtis,JRandall
中科院分区：
文献类型：
--
作者：
Courtright,KatherineR;Benoit,DominiqueD;Curtis,JRandall
这篇聚焦社论重点介绍了过去两年在重症监护医学(ICM)和其他杂志上发表的关于危重患者及其家人的预后和姑息治疗策略的论文，包括5篇原创研究论文、1篇系统综述、1篇务实综述、6篇《最新动态》、2篇《了解疾病》和1篇社论。过去几十年的重症监护研究带来了许多治疗和技术进步，从而改善了ICU的存活率，但改善以患者和家庭为中心的护理的干预措施并没有跟上步伐[1，2]。然而，新出现的文献表明，在患者、家属和医疗保健专业人员之间建立伙伴关系的基础上，对危重护理的综合方法重新给予了关注。ICM最近发表的一篇社论强调了这种努力的一个关键组成部分，该社论提供了ICU姑息治疗的十项循证原则[3]。这一框架建立在以下认识的基础上：为所有危重病人提供姑息治疗的同时提供最高质量的危重护理，以解决症状、就护理目标进行沟通、家庭支持、共同决策，在某些情况下甚至是死亡。ICU临床医生负责在所有这些领域提供初级或基本的姑息治疗，但往往缺乏这样做的教育和培训。与患者和家属就预后不良进行高质量的讨论仍然是ICU临床医生最艰巨的任务之一[4]，在我们日益多元化的社会中，越来越需要纳入关于严重疾病、死亡和死亡的不同文化信仰、价值观和态度，这一任务变得更加复杂[5]。有许多在线资源和InPerson研讨会可用于支持ICU临床医生在初级姑息治疗方面的教育，并有机会衡量此类干预措施对以患者和家庭为中心的结果的质量的影响[3]。对ICU中以家庭为中心的护理的更好的理解将促进研究和政策努力，以减少家人在亲人危重疾病期间和之后经常经历的心理负担。对ICU以家庭为中心的护理的最新临床实践指南的摘要强调了进行此类努力的重要性，但也注意到，根据当前证据的质量，所有23项建议都被评级为薄弱[6]。自那以后，已经有了一项高质量的阶梯式、整群随机试验，描述了在五个ICU的1420名危重患者的代理人中进行多组分家庭支持干预的影响[7]。干预由护士领导，包括在整个ICU过程中与家属的日常沟通和临床医生-家庭会议的程序化。这一干预措施减少了ICU的住院时间，改善了代理人对沟通质量和以患者和家庭为中心的护理的看法，但没有影响代理人在ICU后的抑郁或创伤后应激症状。在ICU被证明是一项普遍的挑战后，评估家庭的心理结果是一项普遍的挑战，至少部分原因是在检测用于评估此类结果的量表的反应性方面持续存在困难[8]。然而，最近在9个ICU进行的一项大型准实验研究使用创伤后应激障碍短期筛查量表测试了信息手册和网站对显示创伤后应激症状显著减少的家庭的影响[9]。尽管这两项研究代表了
This focus editorial highlights papers on prognostic and palliative care strategies for critically ill patients and their families that were published in Intensive Care Medicine (ICM) and other journals in the last 2 years, including five original research papers, one systematic review, one pragmatic review, six “what’s new”, two “understanding the disease”, and one editorial. The past several decades of critical care research have led to numerous treatment and technological advances resulting in improved ICU survival, but interventions to improve patient-and family-centered care have not kept pace [1, 2]. However, emerging literature suggests there is a renewed focus on comprehensive approaches to critical care grounded in partnerships between patients, families, and healthcare professionals. A key component of such efforts is highlighted in a recently published ICM editorial that provides ten evidence-based principles of palliative care in the ICU [3]. This framework builds on the recognition that the highest quality critical care is provided simultaneously with, not independently from, palliative care for all critically ill patients to address symptoms, communication about goals of care, family support, shared decision-making, and in some cases, dying. ICU clinicians are responsible for providing primary or basic palliative care in all of these domains, yet often lack the education and training to do so. Having a high-quality discussion about poor prognosis with patients and families remains one of the most daunting tasks for ICU clinicians [4], and has been further complicated by an increasing need to incorporate diverse cultural beliefs, values, and attitudes around serious illness, dying, and death in our increasingly multi-cultural societies [5]. There are many online resources and inperson workshops available to support ICU clinicians’ education in primary palliative care, and opportunities to measure the impact of such interventions on the quality of patient-and family-centered outcomes [3]. An improved understanding of family-centered care in the ICU will advance research and policy efforts to reduce the psychological burdens frequently experienced by families during and after critical illness of a loved one. A summary of the latest clinical practice guideline for family-centered care in the ICU highlights the importance of pursuing such efforts, but also notes that all 23 recommendations were graded as weak based on the quality of current evidence [6]. There has since been a high-quality stepped-wedge, cluster-randomized trial that describes the impact of a multicomponent familysupport intervention among surrogates of 1420 critically ill patients across five ICUs [7]. The intervention was led by nurses and involved daily communication with families and protocolized clinician–family meetings throughout the ICU course. This intervention resulted in a reduced ICU length of stay and improvements in surrogates’ perception of the quality of communication and the patient-and family-centeredness of care, but did not impact surrogates’ symptoms of depression or posttraumatic stress after the ICU. Assessing families’ psychological outcomes after the ICU has proven to be a pervasive challenge due, at least in part, to a persistent difficulty in detecting responsiveness of the scales used to assess such outcomes [8]. However, a recent large quasi-experimental study conducted across 9 ICUs tested the impact of an informational brochure and website for families showing a significant reduction in posttraumatic stress symptoms using the Short Screening Scale for Posttraumatic Stress Disorder [9]. Although these two studies represent
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花生凝集素结合作为活化 T 谱系淋巴细胞的标记。
DOI：
--
发表时间：
1982
期刊：
Thymus
影响因子：
--
作者：
Chervenak,R;Cohen,JJ
通讯作者：
Cohen,JJ
放射骨髓嵌合体中胸腺内 T 细胞的分化及其在 T 细胞迁移至脾脏中的作用。
影响因子：
4.4
作者：
K. Hirokawa;T. Sado;S. Kubo;H. Kamisaku;K. Hitomi;M. Utsuyama
通讯作者：
M. Utsuyama
影响因子：
15.3
作者：
J. Kadish;R. Basch
通讯作者：
R. Basch
骨髓移植后辐照后胸腺细胞再生 I. 骨髓中胸腺细胞祖细胞的再生和定量
DOI：
--
发表时间：
1981
期刊：
Cell and tissue kinetics
影响因子：
--
作者：
W. Boersma;I. Betel;R. Daculsi;G. Westen
通讯作者：
G. Westen
辐射骨髓嵌合体中胸腺再生早期事件的表型特征
影响因子：
6.2
作者：
S. Sharrow;A. Singer;U. Hammerling;B. Mathieson
通讯作者：
B. Mathieson