Respiratory care

呼吸护理
  • 文章类型: Editorial
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  • 文章类型: Journal Article
    背景:这篇叙述性综述旨在探讨人工智能(AI)在呼吸护理中的现状和未来前景。目的是提供有关AI在该领域的潜在影响的见解。
    方法:对相关文献和研究进行了综合分析,以检查AI在呼吸护理中的应用并确定进步的领域。分析包括对远程监控的研究,早期发现,智能通风系统,和协作决策。
    结果:获得的结果突出了AI在呼吸护理中的转化潜力。AI算法在基于患者特定数据实现量身定制的治疗计划方面显示出了有希望的能力。使用人工智能设备进行远程监控,可以向医疗保健提供者提供实时反馈。加强患者护理。人工智能算法还证明了在早期阶段检测呼吸状况的能力,导致及时干预和改善结果。此外,AI可以通过持续监测优化机械通气,提高患者舒适度,减少并发症。协作式人工智能系统有可能增强医疗保健专业人员的专业知识,导致更准确的诊断和有效的治疗策略。
    结论:通过改善诊断,AI有可能彻底改变呼吸护理,治疗计划,和病人监测。虽然挑战和道德考虑仍然存在,人工智能在这一领域的变革性影响怎么强调都不为过。通过利用这篇叙事评论的进步和见解,医疗保健专业人员和研究人员可以继续利用人工智能的力量来改善患者的预后并加强呼吸护理实践。
    根据调查结果,未来的研究应该集中在改进人工智能算法以提高其准确性,可靠性,和可解释性。此外,应该注意解决道德问题,确保数据隐私,并建立监管框架,以管理呼吸护理中人工智能的负责任实施。
    BACKGROUND: This narrative review aims to explore the current state and future perspective of artificial intelligence (AI) in respiratory care. The objective is to provide insights into the potential impact of AI in this field.
    METHODS: A comprehensive analysis of relevant literature and research studies was conducted to examine the applications of AI in respiratory care and identify areas of advancement. The analysis included studies on remote monitoring, early detection, smart ventilation systems, and collaborative decision-making.
    RESULTS: The obtained results highlight the transformative potential of AI in respiratory care. AI algorithms have shown promising capabilities in enabling tailored treatment plans based on patient-specific data. Remote monitoring using AI-powered devices allows for real-time feedback to health-care providers, enhancing patient care. AI algorithms have also demonstrated the ability to detect respiratory conditions at an early stage, leading to timely interventions and improved outcomes. Moreover, AI can optimize mechanical ventilation through continuous monitoring, enhancing patient comfort and reducing complications. Collaborative AI systems have the potential to augment the expertise of health-care professionals, leading to more accurate diagnoses and effective treatment strategies.
    CONCLUSIONS: By improving diagnosis, AI has the potential to revolutionize respiratory care, treatment planning, and patient monitoring. While challenges and ethical considerations remain, the transformative impact of AI in this domain cannot be overstated. By leveraging the advancements and insights from this narrative review, health-care professionals and researchers can continue to harness the power of AI to improve patient outcomes and enhance respiratory care practices.
    UNASSIGNED: Based on the findings, future research should focus on refining AI algorithms to enhance their accuracy, reliability, and interpretability. In addition, attention should be given to addressing ethical considerations, ensuring data privacy, and establishing regulatory frameworks to govern the responsible implementation of AI in respiratory care.
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  • 文章类型: Journal Article
    背景:目前尚不清楚为什么在丹麦医院接受治疗的慢性阻塞性肺疾病(COPD)急性加重的患者中有17%在30天内再次入院。出院是多方面的。然而,准备过程和护士的努力对于确保成功出院至关重要。
    目的:探讨住院COPD患者出院准备过程。
    方法:使用建构主义扎根理论,我们使用参与者观察法观察了两个肺部医学病房的11名护士的工作。数据收集和分析使用持续的比较过程进行,包括三个阶段:初始,有针对性和理论性。
    结果:我们确定了COPD患者从两个肺部内科病房出院时影响护士的重要观点。我们产生了关于护士如何将各种观点整合到出院处理中的实质性理论。该理论包含三种放电方法:共同创造,犹豫和社交。共同创造方法侧重于患者和相关参与以及系统的任务解决方案,嵌入生物心理社会过程中,旨在实现安全和可持续的排放。相比之下,犹豫不决的方法侧重于根据系统要求和同事的期望出院。最后,社交方法侧重于为患者和同事创造愉快的出院体验。
    结论:本研究阐明了护士在为COPD患者出院时采用的三种不同方法。共同创造过程包括患者参与和系统的任务解决,结合了生物心理社会过程。相比之下,其他方法在范围上更有限:犹豫的方法旨在和谐和合议,而社交方法侧重于确保每个人都有愉快的出院体验。因此,护士应注意他们采用的方法以及与之相关的价值观,以优化他们对出院流程的管理。
    BACKGROUND: It remains unclear why 17% of patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) treated in Danish hospitals are readmitted within 30 days. Hospital discharge is multifaceted. However, the preparation process and nurses\' efforts may be essential in ensuring a successful discharge.
    OBJECTIVE: To explore the process of preparing discharge for patients with COPD in a hospital setting.
    METHODS: Using constructivist grounded theory, we observed 11 nurses\' work at two pulmonary medical wards using participant observation. Data collection and analysis were conducted using a constant comparative process encompassing three phases: initial, focused and theoretical.
    RESULTS: We identified important perspectives influencing nurses when patients with COPD are discharged from two pulmonary medical wards. We generated a substantial theory of how nurses integrate various perspectives into their handling of hospital discharge. The theory contains three discharge approaches: co-creating, hesitating and socialising. The co-creating approach focuses on patient and relative involvement and systematic task solution, embedded in a biopsychosocial process, aiming to achieve a safe and sustainable discharge. In contrast, the hesitating approach focuses on discharging patients in line with system requirements and colleagues\' expectations. Finally, the socialising approach focuses on creating a pleasant discharge experience for patients and colleagues alike.
    CONCLUSIONS: This study illuminates three distinct approaches adopted by nurses when discharging a patient with COPD. The co-creating process encompasses patient involvement and systematic task resolution, incorporating a biopsychosocial process. In contrast, the other approaches are more limited in scope: the hesitating approach aims for harmony and collegial consensus, while the socialising approach focuses on ensuring a pleasant discharge experience for everyone. Nurses should therefore be mindful of the approach they adopt and the values associated with it in order to optimise their management of hospital discharge processes.
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  • 文章类型: Review
    统计分析是研究过程的重要组成部分。建议研究人员从计划研究的那一刻起就包括一名统计学家。统计计划告知研究过程,包括样本量要求和最可靠的数据收集。一旦收集到数据,进行描述性和推断性统计分析。这项分析的结果确定了调查结果是否重要,这导致了对研究结果的解释。统计计划和分析对于研究者的重要性是不言而喻的。然而,对于已发表论文的读者来说,具有一些统计分析知识也很重要。这允许对已发表手稿的所有方面进行批判性审查。本文的目的是回顾一些基本的统计概念,从而使读者成为文献的更好的消费者。
    Statistical analysis is an important part of the research process. Researchers are advised to include a statistician from the moment that the study is being planned. The statistical plan informs the research process, including sample size requirements and the most robust data collection. Once the data are collected, descriptive and inferential statistical analyses are performed. The results of this analysis determine whether the findings are significant, which leads to an interpretation of the findings. The importance of the statistical plan and analysis for the researcher is self-evident. However, it is also important for the reader of published papers to have some knowledge of statistical analysis. This allows critical review of all aspects of the published manuscript. The intent of this paper is to review some basic statistical concepts and thus allow the reader to become a better consumer of the literature.
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  • 文章类型: Journal Article
    哮喘是一种慢性疾病,影响全球数百万青少年和年轻人(AYA)。从儿童护理到成人护理的过渡对这一人群提出了独特的挑战,影响他们的自我管理,生活质量和整体健康结果。本系统评价旨在巩固关于AYA在从儿童到AYA的过渡期内哮喘患者所遇到的挑战的现有证据,以及AYA哮喘患者的过渡护理的关键要素,包括所取得的结果。最终提高结果。
    在PubMed,Embase,Medline,Scopus,和WebofScience从成立到2023年10月2日,提供当前可用文献的概述。主要的定量和定性研究,如果他们关注AYA在过渡过程中遇到的哮喘挑战和/或过渡护理的组成部分并评估其结局,则可以考虑在同行评审的期刊上发表的有关AYA确诊为哮喘的论文。
    本系统文献综述共初步确定了855项研究,纳入了6篇文献。确定了AYA患有哮喘的几个挑战,包括维持药物依从性,承担责任和参与的必要性,了解他们的状况及其严重程度,感觉被排除在护理系统之外,缺乏参与。确定的过渡护理组件包括用于医疗数据传输的标准化形式,联合协商,并提供几个更长的协商。
    一些国际哮喘护理指南建议在AYA合并哮喘的护理中实施过渡计划。此类过渡计划应包括全面和个性化的方法,以解决所面临的若干挑战,确保过渡后的最佳结果。然而,到目前为止,关于促进良好结局的过渡期护理的有效组成部分的数据被发现是有限的.此系统综述强调了需要进行更大的研究来评估过渡计划组成部分的影响。
    UNASSIGNED: Asthma is a chronic condition that affects millions of adolescents and young adults (AYA) worldwide. The transition from pediatric to adult care presents unique challenges for this population, affecting their self-management, quality of life and overall health outcomes. This systematic review aims to consolidate the available evidence on challenges encountered by AYA with asthma during the transition period from child to AYA and on the key elements of transitional care for AYAs with asthma including the outcomes achieved, ultimately enhancing outcomes.
    UNASSIGNED: A systematic literature search was performed in PubMed, Embase, Medline, Scopus, and Web of Science from their inception to October 2, 2023, to provide an overview of currently available literature. Primary quantitative and qualitative studies, published in peer-reviewed journals that focused on AYA with a confirmed diagnosis of asthma were considered if they focused on challenges encountered by AYA with asthma during the transition process and/or components of transitional care and their outcomes assessed.
    UNASSIGNED: A total of 855 studies were initially identified and 6 articles were included in this systematic literature review. Several challenges experienced by AYA with asthma were identified including maintaining medication adherence, the need to take responsibility and being involved, understanding their condition and its severity, feeling left out of the care system, and experiencing a lack of engagement. The identified transitional care components included a standardized form for medical data transmission, a joint consultation and to offer several longer consultations.
    UNASSIGNED: Several international guidelines for asthma care recommend implementing transition programs in the care for AYA with asthma. Such transition programs should include a comprehensive and individualized approach addressing several challenges faced, to ensure optimal outcomes post-transition. However, to date, data on effective components of transitional care facilitating good outcomes were found to be limited. This systematic review underscores the need for larger studies evaluating the effect of the components of transition programs.
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  • 文章类型: Case Reports
    我们介绍了一个三岁的非洲裔美国男性,出生在学期,最初在6个月时出现细支气管炎,此后反复出现呼吸窘迫和住院。病人还有严重的湿疹,发育迟缓,和反复发作的病毒性疾病。尽管各种专家进行了全面评估,比如肺病学,过敏,和胃肠病学,根本原因仍然难以捉摸。这种情况的鉴别诊断如下:严重的持续性哮喘,可能与CDHR3,高IgE综合征等基因突变有关,Wiskott-Aldrich综合征的非典型表现,严重胃食管反流病(GERD)伴吸入性肺炎。这个病人的慢性病导致了一些发育后果,包括体重增加失败和可能的缺氧性脑病,导致认知和运动里程碑延迟以及言语延迟。积极的医疗管理,尤其是长期的全身性类固醇,引起人们对未来并发症的担忧。通过这个案子,我们强调彻底的检查和跨学科的方法来诊断和管理未知的免疫疾病的重要性,以及一致的儿科初级保健随访,以评估发展和协调必要的支持。这里,我们的目标是通过制定全面的鉴别诊断,并探索慢性呼吸系统疾病可导致儿童患者言语和认知延迟等发育缺陷的各种方式,来解决儿科呼吸窘迫症状独特表现方面的研究空白.这项研究呼吁进一步研究遗传对哮喘的影响,GERD的各种介绍,预防病毒性疾病,替代疗法尽量减少类固醇的使用,了解慢性呼吸窘迫对儿童认知和语言发育的影响。彻底的检查和跨学科方法对于有效的诊断和管理至关重要。
    We present a case of a three-year-old African American male, born at term, who initially presented with bronchiolitis at six months and has since experienced recurrent episodes of respiratory distress and hospitalizations. The patient also has severe eczema, developmental delays, and recurrent viral illnesses. Despite thorough evaluations from various specialists, such as pulmonology, allergy, and gastroenterology, the underlying cause remained elusive. The differential diagnosis for this case is as follows: severe persistent asthma with a possible link to genetic mutations such as CDHR3, hyper-IgE syndrome, atypical presentation of Wiskott-Aldrich syndrome, and severe gastroesophageal reflux disease (GERD) with aspiration pneumonitis. This patient\'s chronic condition has contributed to several developmental consequences, including failure to gain weight and possible hypoxic encephalopathy, leading to delays in cognitive and motor milestones and speech delays. Aggressive medical management, especially long-term systemic steroids, raises concerns about future complications. Through this case, we highlight the importance of thorough workups and an interdisciplinary approach to diagnosing and managing an unknown immune condition, as well as consistent pediatric primary care follow-up to assess development and coordinate necessary support. Here, we aim to address a gap in research on the unique presentations of pediatric respiratory distress symptoms by formulating a comprehensive differential diagnosis and exploring the various ways that chronic respiratory illness can contribute to developmental deficits such as speech and cognitive delays in pediatric patients. This study calls for further research into genetic contributions to asthma, diverse presentations of GERD, prevention of viral illnesses, alternative treatments minimizing steroid use, and an understanding of the impact of chronic respiratory distress on cognitive and language development in children. Thorough workups and interdisciplinary approaches are essential for effective diagnosis and management.
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  • 文章类型: Journal Article
    新生儿学是一个快速发展的专业,从1900年代初开始,在孵化器中展示早产儿,到今天,在最先进的新生儿重症监护病房治疗复杂的疾病过程。在知识不断发展的过程中,药物,技术提供了从错误和错误治疗中学习的机会。从过去的错误中学习的能力现在改善了我们的护理,并说明了我们所做的一切都需要谦卑和警惕。本文探讨了在我们展望未来的过去所犯的错误。
    Neonatology has been a rapidly growing specialty, starting in the early 1900s with premature infants displayed in incubator shows, to today with complex disease processes treated in state-of-the-art neonatal intensive care units. Along the way evolving knowledge, medications, and technology provided opportunities to learn from mistakes and misguided treatments. The ability to learn from past mistakes improves our care now and illustrates the need for humility and vigilance in everything we do. This article explores errors made in the past as we look forward to the future.
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  • 文章类型: Journal Article
    了解慢性阻塞性肺疾病(COPD)患者在日常生活中使用活动监测仪的经历可以支持医疗保健技术的利用,以增加身体活动并支持自我管理。这项定性研究旨在探索COPD患者在日常生活中在家中使用活动监测器的体验。
    在2018年8月至2020年6月期间,对7名COPD患者进行了半结构化面对面或电话采访。参与者在过去一年中都使用了活动监视器(Fitbit,Garmin,或AppleWatch)。使用解释现象学分析(IPA)对访谈进行了深入分析。
    四个主题,使用IPA开发,强调参与者与活动监视器的互动,并将其融入他们的生活:(1)监测活动的激励特征,(2)设定可实现的目标的重要性,(3)培养知识和意识,(4)融入日常生活,进行自我管理。
    活动监测仪被认为对COPD患者有益且有用,不仅仅是为了监控他们的活动,也有助于自我管理他们的病情。活动监测器可能是COPD康复和医疗保健服务中的有用工具。
    活动监测仪有利于慢性阻塞性肺疾病(COPD)患者监测其身体活动并支持COPD的自我管理。患有COPD的人可以看到并理解他们的活动水平,设定活动目标,并从客观监测的活动中增加他们的动机。活动监控器可以帮助支持个人目标设定并促进所有权,但是需要支持来设定可实现和现实的目标。医疗保健从业人员需要意识到使用活动监测器对精神或身体健康和福祉的潜在负面影响,并支持COPD患者管理压力和实现目标的期望。
    UNASSIGNED: Understanding the experiences of people with Chronic Obstructive Pulmonary Disease (COPD) using activity monitors in daily life could support the utilisation of technology within healthcare to increase physical activity and support self-management. This qualitative study aimed to explore the experiences of people with COPD using activity monitors at home in everyday life.
    UNASSIGNED: Semi-structured face-to-face or telephone interviews were conducted with seven people with COPD between August 2018 and June 2020. Participants had all used an activity monitor within the last year (Fitbit, Garmin, or Apple Watch). Interviews were analysed in-depth using Interpretative Phenomenological Analysis (IPA).
    UNASSIGNED: Four themes, developed using IPA, highlight participants\' engagement with activity monitors and integrating them into their lives: (1) Motivational features to monitor activity, (2) Importance of setting achievable goals, (3) Developing knowledge and awareness, and (4) Integration into everyday life for self-management.
    UNASSIGNED: Activity monitors were perceived to be beneficial and useful to people with COPD, not just for monitoring their activity, but also helping to self-manage their condition. Activity monitors may be a useful tool within rehabilitation and healthcare services for COPD.
    Activity monitors were beneficial for people with Chronic Obstructive Pulmonary Disease (COPD) to monitor their physical activity and support self-management of their COPD.People with COPD could see and make sense of their activity levels, set activity goals and increase their motivation from the objectively monitored activity.Activity monitors can help to support individual goal setting and facilitate ownership, but support is needed to set achievable and realistic goals.Healthcare practitioners need to be aware of the potential negative effects of using activity monitors on mental or physical health and wellbeing and support people with COPD to manage pressure and expectations of meeting their goals.
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  • 文章类型: Case Reports
    Contarini综合征是一种情况,其中双侧胸腔积液的发生归因于两侧的不同原因。对于临床医生来说,进行双侧胸腔穿刺术的决定可能具有挑战性。特别是患有多种合并症的老年患者。一名75岁的亚裔男子,既往有痴呆症和吞咽困难病史,表现为呼吸困难,被带到我们的急诊科。影像学检查显示双侧胸腔积液和多发性肋骨骨折。双侧胸腔穿刺术提示右肺有渗出物胸腔积液,左肺有出血性胸腔积液。鉴于结果,我们确定右侧胸腔积液的病因是由吸入性肺炎引起的肺炎旁积液,而左侧出血性胸腔积液是由于肋骨骨折。在开始抗生素治疗并放置双侧引流管后,病人的病情明显改善。该病例强调了考虑双侧胸腔穿刺术的重要性,尤其是老年病人。
    Contarini\'s syndrome is a condition in which the occurrence of bilateral pleural effusions is attributed to different causes for each side. The decision to perform bilateral thoracentesis can be challenging for clinicians, particularly in elderly patients with multiple comorbidities. A 75-year-old Asian man with a past medical history of dementia and dysphagia presenting with dyspnea was brought to our emergency department. Imaging studies revealed bilateral pleural effusions and multiple costal fractures. The results of bilateral thoracentesis indicated an exudate pleural effusion in the right lung and a hemorrhagic pleural effusion in the left lung. Given the results, we determined the etiology of the right pleural effusion to be a parapneumonic effusion resulting from aspiration pneumonia, while the left hemorrhagic pleural effusion was due to costal fractures. After initiating treatment with antibiotics and placement of bilateral drainage tubes, the patient\'s condition improved remarkably. This case underscores the importance of considering bilateral thoracentesis, particularly in geriatric patients.
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  • 文章类型: Journal Article
    呼吸治疗师(RT)有望保持最新技术,治疗,研究,以及提供高质量患者护理的最佳实践。他们必须具备解释的技能,评估,并有助于循证实践。然而,RTs通常依赖于其他专业的研究,这些专业可能无法完全满足他们的特定需求,导致他们的实践指导不足。此外,没有从RTs的角度探索知识差距和研究需求,以提高他们的实践和患者的结果.指导这项研究的研究问题是:(i)感知到的以实践为导向的知识差距是什么?(ii)根据呼吸治疗专家的说法,整个呼吸治疗行业的必要研究重点是什么?
    使用半结构化焦点小组与来自加拿大七个实践领域的40位专家RT进行了定性描述研究。使用定性内容分析对数据进行分析。
    我们确定了四个主要主题,这些主题与这些专家认为呼吸治疗行业的实践导向差距和必要的研究重点有关:1)RTs的系统级影响,2)优化呼吸治疗方法,3)呼吸治疗专业的奖学金和4)呼吸治疗教育。
    这些发现建立了对当前差距和需要进一步调查的RT的具体需求的基本理解。与会者强烈强调了考虑呼吸治疗专业的广度和深度的研究重点的重要性,强调了呼吸疗法的复杂性及其在实践中的应用。
    从这项研究中获得的独特见解突出了知识差距和研究需求。这些发现为进一步探索铺平了道路,话语,和研究旨在了解RT的具体贡献和要求。
    UNASSIGNED: Respiratory therapists (RTs) are expected to stay updated on technology, treatments, research, and best practices to provide high-quality patient care. They must possess the skills to interpret, evaluate, and contribute to evidence-based practices. However, RTs often rely on research from other professions that may not fully address their specific needs, leading to insufficient guidance for their practice. Additionally, there has been no exploration of knowledge gaps and research needs from RTs\' perspectives to enhance their practice and patient outcomes. The research questions guiding this study were: (i) what are the perceived practice-oriented knowledge gaps? and (ii) what are the necessary research priorities across the respiratory therapy profession according to experts in respiratory therapy?
    UNASSIGNED: A qualitative description study was conducted using semi-structured focus groups with 40 expert RTs from seven areas of practice across Canada. Data was analyzed using qualitative content analysis.
    UNASSIGNED: We identified four major themes relating to what these experts perceive as the practice-oriented gaps and necessary research priorities across the respiratory therapy profession: 1) system-level impact of RTs, 2) optimizing respiratory therapy practices, 3) scholarship on the respiratory therapy profession and 4) respiratory therapy education.
    UNASSIGNED: The findings establish a fundamental understanding of the current gaps and the specific needs of RTs that require further investigation. Participants strongly emphasized the significance of research priorities that consider the breadth and depth of the respiratory therapy profession, which underscores the complex nature of respiratory therapy and its application in practice.
    UNASSIGNED: The unique insights garnered from this study highlight the knowledge gaps and research needs specific to RTs. These findings pave the way for further exploration, discourse, and research aimed at understanding the specific contributions and requirements of RTs.
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