Clinics in Integrated Care最新文献

Pandemics such as COVID - 19 bring significant challenges for all health services, especially those in low-to low-middle income countries, where access to supplement and expand services may be difficult. For these countries with a limited workforce the loss of key workers to the illness itself or the need to self-isolate following contact can paralyse service delivery. This article looks at some of the issues that may arise and strategies to overcome them. It includes a case study from Viet Nam illustrating the need for a rapid integrated response to contact and prevent further outbreaks. Caring for COVID - 19 patients is a heavily dependent on the skills and expertise of the nurses. There is therefore a need to share nursing interventions that can be implemented without major resource implications in all hospital departments.

Older adults, the largest medication consumer group worldwide, are virtually excluded from participating in clinical trials that investigate the efficacy and safety of drugs. The consequent lack of robust evidence regarding the effects of medicines in the older population is concerning in view of the ever-increasing medication exposure and the high risk of adverse drug reactions (ADRs) in this group. Furthermore, a number of age-related alterations in pharmacokinetics and the inter-individual variability in homeostatic capacity suggest caution when translating the evidence from trials conducted in younger and healthier participants into the routine management of older patients. Several decision tools have been developed to prevent inappropriate prescribing and polypharmacy in older adults; however, additional research is warranted to justify their widespread clinical use. The role of traditional disease-centered end points, based on objective markers of response, might also need revisiting and complementation with measures of self-rated health, particularly in older patients who may also be frail or have a poor quality of life. This article provides an overview of medication management in older adults, particularly in relation with trends in prescribing, polypharmacy and inappropriate medication use, and the development of decision tools that might facilitate an individualized therapeutic plan in this group.

COVID-19 is a new highly infectious disease with an incompletely described clinical course, which has caused a pandemic, with Europe being identified as the third epicentre. COVID-19 has placed unprecedented pressure on critical care services which is likely to stretch resources beyond capacity. The situation is exacerbated by increased staff absence from self-isolation and illness, increased referral of patients with suspected or confirmed COVID-19 who develop respiratory failure, and limited availability of Extra Corporeal Membrane Oxygenation (ECMO) services. In addition, there is the ongoing challenge of patients being transferred between departments and hospitals for ongoing care. In consequence, as current needs continue to rise, innovative approaches are needed to redress shortages and support the continuance of services. This article provides an overview of severe COVID-19 infection, outlining treatment strategies and nursing processes that will need to develop and extend in response to this evolving situation.

This article focuses on the critical care nurse's role in the management of patients with COVID-19 who require invasive ventilation in order to improve outcomes and prevent complications. The nature of COVID-19 is such that many patients deteriorate rapidly and for members of this group requiring intubation and invasive ventilation, different approaches to airway management and ventilatory support are required. In order to reduce the risk of complications and an overview of invasive ventilation, including commonly used modes, potential complications, nursing care, weaning and extubation are all described. COVID-19 presents several challenges as the disease progresses, hypoxemia may worsen, and the patient can develop Acute Respiratory Distress Syndrome. Therefore, additional treatment strategies including the use of the prone position and the use of nitric oxide and prostacyclin nebulisers have been included. The strategies presented in this article are relevant to both critical care nurses and those re-deployed to intensive care units where nurses will inevitably be involved in the management of patients requiring invasive ventilation. Weaning these patients off invasive ventilation is multi-factorial and may be short or long term. A multi-disciplinary weaning plan, the principles, stages/phases, and speed of weaning with expected parameters prior extubation are explained. Planned and unplanned extubation with the serious complications of the latter as the patient may not be ready and may require emergency re-intubation resulting in setbacks should be avoided.

Severe COVID-19 causes significant numbers of patients to develop respiratory symptoms that require increasing interventions. Initially, the treatment for severe respiratory failure included early intubation and invasive ventilation, as this was deemed preferable to be more effective than Non-Invasive Ventilation (NIV). However, emerging evidence has shown that NIV may have a more significant and positive role than initially thought. NIV includes Continuous Positive Airway Pressure (CPAP) and Bi-Level Positive Airway Pressure (BiPAP). CPAP is the method of choice with the use of BiPAP for those with complex respiratory conditions who contract COVID-19. The use of High Flow Nasal Oxygen (HFNO) remains contentious with different perspectives in how this modality can be used to treat respiratory failure in COVID-19.

Current thinking suggests that NIV and HFNO may be an appropriate bridging adjunct in the early part of the disease progress and may prevent the need for intubation or invasive ventilation. Patients requiring NIV or HFNO may be nursed in locations outside of the critical care unit. Therefore, this article reviews the different types of NIV and HFNO, indications and the nursing care.

With the major scale up of critical care services to respond to the increasing numbers of patients with severe COVID-19 infection, nurses need to be able to rapidly assess patients. While many patients present with signs of viral pneumonia and may develop respiratory failure, it is essential that the subsequent systemic complications are also recognized. Due to the unprecedented numbers of patients requiring critical care, many of them will initially have to be managed in emergency departments and acute wards until a critical care bed becomes available. In this article, the assessment of a patient with suspected or confirmed severe COVID-19 has been presented initially from a ward perspective, followed by that of critical care, using the Airway, Breathing, Circulation, Disability and Exposure (ABCDE) approach. This article has been specifically designed to enable nurses to systematically assess patients and prioritise care.