Critical Care(重症照顾):概念分析

目的"Critical Care"(重症照顾)和"Intensive Care Unit"(重症监护室)这两个术语在实际工作中描述一个医疗场所时经常被互换使用。对"Critical Care"的口语化使用使得其准确定义具有挑战性。本文旨在对"Critical Care"进行概念分析,制定其操作性定义(operational definition),明确其内涵。方法采用Walker和Avant八步法来指导本研究。检索数据库(CINAHL、Scopus、PubMed、ProQuest Dissertation Abstracts和Med line in EBSCO)中"Critical Care"相关文献,包括1990--2022年以英文撰写发表的质性和量性研究论文。结果.共检索到439篇论文,其中47篇符合纳人标准。"Critical Care"的概念属性包括:1)对疾病/损伤的不适应;2)收治标准;3)高精医疗技术;4)专业的医疗护理人员。前因是疾病/损伤进展到危急状况,患者身体和心理功能都明显下降,后续影响是死亡或存活(有或没有ICU治疗后综合症)。结论重症监护环境的高技术含量特性使关于“Critical Care"的描述更具挑战性。对此术语进行概念分析有助于明确其内涵和范围,为未来研究提供参考,促进相关评估工具的开发,深入了解重症监护环境中的医疗护理工作本质。

Point-of-care continuous ^(13)C-methacetin breath test improves decision making in acute liver disease: Results of a pilot clinical trial

AIM: To assess the role of the 13C-methacetin breath test (MBT) in patients with acute liver disease. METHODS: Fifteen patients with severe acute liver disease from diverse etiologies were followed-up with 13C-MBT during the acute phase of their illnesses (range 3-116 d after treatment). Patients fasted for 8 h and ingested 75 mg of methacetin prior to the MBT. We compared results from standard clinical assessment, serum liver enzymes, synthetic function, and breath test scores. RESULTS: Thirteen patients recovered and two patients died. In patients that recovered, MBT parameters improved in parallel with improvements in lab results. Evidence of consistent improvement began on day 3 for MBT parameters and between days 7 and 9 for blood tests. Later convergence to normality occurred at an average of 9 d for MBT parameters and from 13 to 28 d for blood tests. In both patients that died, MBT parameters remained low despite fluctuating laboratory values. CONCLUSION: The 13C-MBT provides a rapid, noninvasive assessment of liver function in acute severe liver disease of diverse etiologies. The results of this pilot clinical trial suggest that the MBT may offer greater sensitivity than standard clinical tests for managing patients with severe acute liver disease.