The Common Sense Guide to Improving Palliative Care

The Common Sense Guide to Improving Palliative Care pdf epub mobi txt 电子书 下载 2026

出版者:Oxford University Press
作者:Joanne Lynn
出品人:
页数:272
译者:
出版时间:2007
价格:Lin Noyes Simon et. al.
装帧:Paperback
isbn号码:9780195310412
丛书系列:
图书标签:
  • Palliative Care
  • End-of-Life Care
  • Healthcare
  • Patient Care
  • Medical
  • Family Support
  • Communication
  • Quality of Life
  • Ethics
  • Grief and Loss
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具体描述

Written by the leading quality improvement experts and clinicians, The Common Sense Guide to Improving Palliative Care provides a quick and easy "how-to" introduction to quality improvement in palliative care. Each chapter features a case study that illustrates how successful quality improvement teams work and includes dozens of ideas for change that most groups can put into practice - now! In today's healthcare settings, too many patients and families suffer needlessly for dozens of reasons. Healthcare teams can and must take charge of reform. With equal measures of proven, practical advice and encouragement, The Common Sense Guide enables them to do just that in a wide array of settings.

深入理解与实践:现代疼痛管理与姑息治疗的里程碑 本书聚焦于二十一世纪医疗领域最复杂、最富有人文关怀的分支——疼痛管理和姑息治疗的最新进展、伦理困境及其最佳实践路径。 它不仅仅是一本教科书或指南,更是一份为所有临床工作者、政策制定者以及患者家属准备的,关于如何在疾病的各个阶段,尤其是面对慢性或危重疾病时,最大化患者生命质量的深度剖析。 第一部分:疼痛科学的革新与精细化分型 疼痛,作为人类最古老的主诉之一,其背后的神经生物学机制在近十年间获得了革命性的突破。本书首先系统梳理了当前疼痛科学的前沿发现,超越了简单的“伤害信号”模型,深入探讨了中枢敏化(Central Sensitization)、炎症级联反应在慢性疼痛维持中的作用,以及遗传多态性如何影响个体对镇痛药物的反应差异。 1. 慢性疼痛的神经可塑性与心理声学模型: 详细阐述了慢性疼痛如何从一种“症状”转变为一种独立的“疾病”。重点分析了疼痛矩阵(Pain Matrix)中的功能性连接障碍,以及疼痛记忆的形成机制。书中引入了基于神经可塑性的干预策略,强调认知行为疗法(CBT)、接纳与承诺疗法(ACT)在重塑患者对疼痛的感知中的核心地位。 2. 复杂性区域疼痛综合征(CRPS)的诊断与多模式干预: 针对这一顽固性疼痛障碍,本书提供了基于证据的诊断流程图,并详述了交感神经阻滞、脊髓电刺激(SCS)以及新兴的靶向神经递质疗法的临床应用指征。 3. 药物治疗的精准化: 摒弃“一刀切”的阿片类药物使用模式,本书对阿片类药物的药代动力学、耐受性、依赖性风险进行了深入分析。同时,重点介绍了非阿片类镇痛剂(如某些抗惊厥药、抗抑郁药在神经病理性疼痛中的应用)、局部麻醉剂的持续输注技术,以及大麻素类药物(Cannabinoids)在特定难治性疼痛中的潜力与局限性。 第二部分:姑息治疗的范式转换与整合实践 本书将姑息治疗(Palliative Care)从传统的“临终关怀”概念中解放出来,明确界定其为一种跨学科、主动性的、贯穿疾病全程的照护模式。 1. 早期整合:从诊断之日起的姑息支持: 探讨了如何将姑息治疗团队在疾病早期——例如在确诊癌症、心力衰竭或严重慢性阻塞性肺病(COPD)时——整合进常规治疗方案中。通过多项关键性临床试验的数据分析,展示了早期姑息干预如何显著改善症状控制、减轻抑郁焦虑,并延长部分患者的生存期。 2. 症状管理的深度策略: 针对最常见的、影响生活质量的症状提供详尽的应对方案: 呼吸困难(Dyspnea): 不仅仅关注氧疗,更深入讲解了阿片类药物(如低剂量吗啡)的雾化吸入、非侵入性通气支持以及心理技巧在缓解呼吸窘迫中的作用。 疲劳与恶病质: 探讨了营养支持、轻度运动干预,以及激素治疗(如皮质类固醇)在改善癌症相关疲劳中的平衡点。 其他顽固性症状: 对谵妄(Delirium)的快速识别与管理,以及恶心呕吐的复杂病因分析与针对性用药方案进行了详述。 3. 跨学科团队的协作蓝图: 本部分强调了姑息治疗的本质是团队合作。详细描述了疼痛专家、肿瘤学家、社工、心理学家、呼吸治疗师乃至营养师在共同管理一位复杂患者时所需遵守的沟通协议和角色分工。 第三部分:沟通艺术、伦理决策与照护的连续性 在疾病末期,有效的沟通和坚实的伦理框架是提供有尊严照护的基石。本书花费大量篇幅聚焦于“人”的维度,而非仅仅是“疾病”的技术层面。 1. 告知的艺术与“坏消息”的传递: 介绍并批判性地评估了多种告知模式(如SPIKES、ONC-DIP),强调在传递灾难性诊断或预后信息时,如何保持同理心、尊重患者的文化背景和认知能力。讨论了“保护性不知情”(Protective Non-Disclosure)的伦理争议。 2. 预先医疗照护计划(Advance Care Planning, ACP)的实施: 详细指导临床工作者如何启动并引导关于生命末期干预(如复苏、插管、透析的意愿)的严肃对话。本书提供了实用的工具和脚本,帮助家庭成员和医疗团队在情绪紧张的环境下达成清晰的共识。 3. 临终决策中的伦理与法律边界: 深入探讨了生命支持的撤除与限制(Withdrawing/Withholding Life-Sustaining Treatment)的法律基础与伦理准则。对安乐死(Euthanasia)和辅助自杀(Physician-Assisted Suicide, PAS)在不同司法管辖区下的实践差异进行了客观的比较分析,引导读者形成基于专业伦理的立场。 4. 哀伤辅导与专业人员的自我关怀: 认识到患者家属哀伤的复杂性,本书提供了持续的哀伤支持模型。同时,针对一线姑息治疗工作者长期暴露于痛苦和死亡情境所带来的“替代性创伤”或“同情疲劳”,提出了有效的专业自我保护和减压策略。 结论与未来展望 全书以对姑息治疗未来发展趋势的展望作结,包括人工智能在症状预测中的应用、远程姑息医疗(Tele-palliative Care)的推广,以及如何将高质量的姑息护理推广至资源匮乏地区,确保所有患者都能享有生命质量的权利。 本书的目标读者包括: 肿瘤科医生、麻醉科医师、重症监护专家、全科医生、精神科医生、护士、临终关怀机构管理者,以及所有致力于减轻人类痛苦的医疗专业人士。它是一份兼具学术深度与临床实用性的必备参考资料。

作者简介

Ekta Chaudhry, M.B.B.S, MHSA , is a quality improvement specialist who consults with organizations nationwide. She has co-directed various palliative care collaboratives in effort to improve care for patients nearing end of life.

Lin Simon has worked improving care for people with dementia for over twenty years and brings clinical experiences to the book. She has participated in several regional collaboratives and has worked with nurses at the bedside in long term care to improve care of older adults.

Anne M. Wilkinson, M.S., Ph.D. , Dr. Wilkinson is a Senior Social and Behavioral Scientist with the RAND Corporation, a non-profit policy analysis think tank and also Director, The Palliative Care Policy Center, a research and educational center focusing on policy and quality improvement issues related to end of life care. She has served as principal investigator on a number of studies ranging from the evaluation of state nursing facility regulations on dementia care in nursing homes, systematic reviews of the evidence base for evaluating quality end-of-life care, to conducting focus groups of family caregivers CHF and COPD patients to investigate the caregiving experience.

Janice Lynch Schuster has worked with Joanne Lynn, M.D., for almost a decade. She is the co-author of Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians. She has written materials for many agencies and organizations, including the National Institute on Aging, and for publications, such as The Washington Post.

Joanne Lynn, M.D., a Senior Natural Scientist with RAND, works to improve care for persons facing serious, eventually fatal, chronic illness (www.MediCaring.org). For thirty years, she attended nursing homes, home, and hospice patients. She was Professor of Medicine and led the SUPPORT project. Dr. Lynn has anchored a dozen quality improvement collaboratives. Her publications include The Handbook for Mortals , a book for the public Improving Care for the End of Life , a guide to CQI for managers and clinicians; and Sick to Death and Not Going to Take it Any More! , a guide to policy reform for the last years of life.

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