我々は、この論文につながった研究に参加するためにスポールディングリハビリテーション病院を通してフレーミングハム、マサチューセッツ州またはアクセス外来診療の&quot;アメージング&quot;脳損傷のサバイバー支援グループのメンバーである14脳損傷の患者に感謝。研究のための資金やその他のサポートは、社会政策のためにヘラーの学校での保健政策のためのマサチューセッツ州の脳損傷協会、マサチューセッツ州リハビリテーション委員会の全州健康傷害のプログラム、および品質の医療研究シュナイダー機関のための機関により提供されたと管理、ブランダイス大学、医療サービスの研究や政策分析の博士課程の研修親睦を通じて。

<ol>
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最初の著者は、医療学校その他の教育会場を通してphotovoiceと写真惹起にトレーニングを提供します。第二著者は、開示には関係ありません。

回答者は、彼らの生きた経験が求められているときにのみ、患者は実際にそれが脳損傷と経験に関連するケアと一緒に暮らすようになるかを知ることができます。パートナーとなり、臨床現場における&quot;共同専門家&quot;の役割の役割を果たすさらに、多くの脳損傷の生存者のためのヘルスケアの目標は治癒ではなく、回復のように見えます。回復は、事前に怪我の状態に戻るには欲求を意味する。 Newly損傷患者は、負傷から回復することを望んでもよいが、長期生存者は、彼らが前の状態に戻ることができなくなることを受け入れている。彼らは（ローレンツ2010A）、認知物理的、感情的、さらには精神的な治癒が参照してください。彼らはさらに何年も彼らの傷害の後、時間の経過とともに進行し続けることを知覚する。自分たちの生活の写真を議論することは患者や臨床医が関心の人を中心とした領域を特定し、時間をかけて患者の進捗状況を認識し、理解に役立つことがあります。 臨床ケアに公正なプロセスを適用すると、患者が深く、すべての臨床判断の根拠を理解し、その役割と責任を受け入れ、彼らの経験を向上させることができる方法を模索、従事していることを意味します。フェアプロセスは、リハビリテーションの戦略に付着し、その治癒の進歩に行動を起こすために、患者のモチベーションを活性化する。プロバイダーは、臨床ケアに公正なプロセスを適用すると、患者とプロバイダの期待と目標をよりよい整列させることができる。写真は、対話の焦点となり、専門家だけでなく、経験と建物の関係を探求する患者に係合する。治療関係を改善することができる。さらに、金とMauborgneモデルによると、態度と行動の変化を生じることは改善の成果につながる可能性があります。 患者は、彼らが聞いたされていることを感じるように公正なプロセスで、臨床的相互作用の力は、よりバランスになることがあります。写真について議論し、その意味は、患者が解決策だけでなく、問題の一部になることができます。カメラを使用すると、公正なプロセスを実現する唯一の方法ではなく、それはすべての患者またはすべての臨床医のためのアプローチではありません。それは、患者を従事することが困難な状況下でのコミュニケーションを改善し、人間中心のケアを達成するためのツールと​​方法論です。

using visual and narrative methods to achieve fair process in clinical care

医学研究所は、品質改善の重要な領域として、患者中心性を計画しています。患者中心的主要な次元は、患者の価値観、嗜好、および発現のニーズの尊重です。まだこのような理解を獲得し、臨床の現場で質の高いケアにそれを翻訳に特有のアプローチが不足している。患者の視点の品質から、単純な概念ではないが、最高の5つのディメンションの観点から理解されています：技術的成果、意思決定の効率化、設備と利便性、情報と情緒的サポート、および全体的な患者の満足度。患者の視点から質へ、中央のプロセスと良好な成果を達成するために不可欠を考慮せずに、医療のアウトカムに焦点で、この5本柱の視点の結果から品質を考慮する失敗。本稿では、臨床現場で公正なプロセスの概念を適用することを主張する。フェアプロセスは、役割と責任についての期待値を設定し、コアの計画と継続的な評価を実施、意思決定の理論的根拠を説明する、患者と診断の問題と治療法を探索するために協調的なアプローチを使用することを含む。フェアプロセスは、臨床現場と医療の目​​標と戦略の開発の仕事に患者の専門知識をもたらすへの扉を開きます。本論文では、後天的脳損傷の生存者と慢性的な健康状態で生きている他者との臨床業務の公正なプロセスを達成するためにphotovoiceまたは写真誘出と呼ばれる革新的な視覚的なアプローチ、、のステップの図で手順を提供します。課題を特定のパートナー、強み、目標、および戦略として患者を従事する;臨床の現場でこの視覚的なツールと方法論を適用すると、患者 - プロバイダのコミュニケーションを強化し、時間の経過とともに進展の評価をサポートしています。臨床的相互作用に自分たちの生活の映像を持って来るために患者を求めることは、臨床的知識のギャップを照らすのに役立つような脳の損傷などの慢性疾患と共に生きる患者とのよりよい治療関係を築く、と治癒のための患者中心の目標と可能性を識別することができます。ここに示したプロセスは、臨床医、（プライマリーケア医師、リハビリテーション療法士、神経科、neuropsychologists、心理学者、およびその他）で使用することができるような後天的脳損傷などの慢性疾患、精神疾患、身体障害、HIV / AIDSと共に生きる人々と協力し、薬物乱用、または心的外傷後ストレス、そして上記の患者とその家族や介護者のタイプの支援団体のリーダーによる。

Watch this Scientific Journal Video about Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care at JoVE.com

Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

このホワイトペーパーでは、慢性的な健康状態で生きている患者のための臨床ケアに公正なプロセスを実現する革新的な視覚的なアプローチ（photovoiceまたは写真誘発）を示し、よりよい治療関係の構築、臨床知識のギャップを点灯し、治癒のために患者中心の目標と可能性を識別する。

臨床ケアのフ​​ェアプロセスを達成するために、Visualと物語メソッドの使用

The Institute of Medicine has targeted patient-centeredness as an important area of quality improvement. A major dimension of patient-centeredness is ...

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Ethical and Legal Aspects in Nursing

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SCIENTISTS IN ACTION

23.4K ビュー.  Brandeis University. このホワイトペーパーでは、慢性的な健康状態で生きている患者のための臨床ケアに公正なプロセスを実現する革新的な視覚的なアプローチ（photovoiceまたは写真誘発）を示し、よりよい治療関係の構築、臨床知識のギャップを点灯し、治癒のために患者中心の目標と可能性を識別する。

ビデオ: Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

Development of an Audio-based Virtual Gaming Environment to Assist with Navigation Skills in the Blind

Audio-based Environment Simulator (AbES) is virtual environment software designed to improve real world navigation skills in the blind. Using only audio based cues and set within the context of a video game metaphor, users gather relevant spatial information regarding a building's layout. This allows the user to develop an accurate spatial cognitive map of a large-scale three-dimensional space that can be manipulated for the purposes of a real indoor navigation task. After game play, participants are then assessed on their ability to navigate within the target physical building represented in the game. Preliminary results suggest that early blind users were able to acquire relevant information regarding the spatial layout of a previously unfamiliar building as indexed by their performance on a series of navigation tasks. These tasks included path finding through the virtual and physical building, as well as a series of drop off tasks. We find that the immersive and highly interactive nature of the AbES software appears to greatly engage the blind user to actively explore the virtual environment. Applications of this approach may extend to larger populations of visually impaired individuals.

Audio-based Environment Simulator (AbES) is virtual environment software designed to improve real world navigation skills in the blind.

ブラインドのナビゲーションスキルを支援するためにオーディオベースのバーチャル·ゲーム環境の開発

Audio-based Environment Simulator (AbES) is virtual environment software designed to improve real world navigation skills in the blind. Using only audio ...

医学

Dynamic Visual Tests to Identify and Quantify Visual Damage and Repair Following Demyelination in Optic Neuritis Patients

In order to follow optic neuritis patients and evaluate the effectiveness of their treatment, a handy, accurate and quantifiable tool is required to assess changes in myelination at the central nervous system (CNS). However, standard measurements, including routine visual tests and MRI scans, are not sensitive enough for this purpose. We present two visual tests addressing dynamic monocular and binocular functions which may closely associate with the extent of myelination along visual pathways. These include Object From Motion (OFM) extraction and Time-constrained stereo protocols. In the OFM test, an array of dots compose an object, by moving the dots within the image rightward while moving the dots outside the image leftward or vice versa. The dot pattern generates a camouflaged object that cannot be detected when the dots are stationary or moving as a whole. Importantly, object recognition is critically dependent on motion perception. In the Time-constrained Stereo protocol, spatially disparate images are presented for a limited length of time, challenging binocular 3-dimensional integration in time. Both tests are appropriate for clinical usage and provide a simple, yet powerful, way to identify and quantify processes of demyelination and remyelination along visual pathways. These protocols may be efficient to diagnose and follow optic neuritis and multiple sclerosis patients.
In the diagnostic process, these protocols may reveal visual deficits that cannot be identified via current standard visual measurements. Moreover, these protocols sensitively identify the basis of the currently unexplained continued visual complaints of patients following recovery of visual acuity. In the longitudinal follow up course, the protocols can be used as a sensitive marker of demyelinating and remyelinating processes along time. These protocols may therefore be used to evaluate the efficacy of current and evolving therapeutic strategies, targeting myelination of the CNS.

Object From Motion (OFM) and Time-constrained stereo protocols are sensitive tools to identify monocular and binocular dynamic visual function deficits, which are uniquely affected in optic neuritis patients. Furthermore, these tests may be used as quantitative noninvasive tools to assess the extent of myelination along visual pathways.

視神経炎患者における脱髄次のVisual損傷と修復を特定し、定量化するために、動的なビジュアルテスト

In order to follow optic neuritis patients and evaluate the effectiveness of their treatment, a handy, accurate and quantifiable tool is required to ...

Catheterization of the Carotid Artery and Jugular Vein to Perform Hemodynamic Measures, Infusions and Blood Sampling in a Conscious Rat Model

The success of a small animal model to study critical illness is, in part, dependent on the ability of the model to simulate the human condition. Intra-tracheal inoculation of a known amount of bacteria has been successfully used to reproduce the pathogenesis of pneumonia which then develops into sepsis. Monitoring hemodynamic parameters and providing standard clinical treatment including infusion of antibiotics, fluids and drugs to maintain blood pressure is critical to simulate routine supportive care in this model but to do so requires both arterial and venous vascular access. The video details the surgical technique for implanting carotid artery and common jugular vein catheters in an anesthetized rat. Following a 72 hr recovery period, the animals will be re-anesthetized and connected to a tether and swivel setup attached to the rodent housing which connects the implanted catheters to the hemodynamic monitoring system. This setup allows free movement of the rat during the study while continuously monitoring pressures, infusing fluids and drugs (antibiotics, vasopressors) and performing blood sampling.

Vascular accesses to measure hemodynamics, provide fluids and perform blood sampling are important to any small animal model study. We present a technique for implanting catheters into the carotid artery and the common jugular vein in an anesthetized rat for connecting to a system to perform monitoring, infusions and sampling.

配慮ラットモデルにおける血行動態の措置、煎茶や血液サンプリングを実行するために頸動脈と頸静脈のカテーテル

The success of a small animal model to study critical illness is, in part, dependent on the ability of the model to simulate the human condition. ...

Instillation and Fixation Methods Useful in Mouse Lung Cancer Research

The ability to instill live agents, cells, or chemicals directly into the lung without injuring or killing the mice is an important tool in lung cancer research. Although there are a number of methods that have been published showing how to intubate mice for pulmonary function measurements, none are without potential problems for rapid tracheal instillation in large cohorts of mice. In the present paper, a simple and quick method is described that enables an investigator to carry out such instillations in an efficient manner. The method does not require any special tools or lighting and can be learned with very little practice. It involves anesthetizing a mouse, making a small incision in the neck to visualize the trachea, and then inserting an intravenous catheter directly. The small incision is quickly closed with tissue adhesive, and the mice are allowed to recover. A skilled student or technician can do instillations at an average rate of 2 min/mouse. Once the cancer is established, there is frequently a need for quantitative histologic analysis of the lungs. Traditionally pathologists usually do not bother to standardize lung inflation during fixation, and analyses are often based on a scoring system that can be quite subjective. While this may sometime be sufficiently adequate for gross estimates of the size of a lung tumor, any proper stereological quantification of lung structure or cells requires a reproducible fixation procedure and subsequent lung volume measurement. Here we describe simple reliable procedures for both fixing the lungs under pressure and then accurately measuring the fixed lung volume. The only requirement is a laboratory balance that is accurate over a range of 1 mg&#8211;300 g. The procedures presented here thus could greatly improve the ability to create, treat, and analyze lung cancers in mice.

The goal of this paper is to describe simple methods that will greatly aid in the setup and analysis of mouse lungs with lung cancer or other pathologies. We present 3 protocols to simply and reliably carry out lung instillations, fixation, and lung volume measurements.

マウス肺癌研究における有用な点滴や固定方法

The ability to instill live agents, cells, or chemicals directly into the lung without injuring or killing the mice is an important tool in lung cancer ...

A Simple Mechanical Procedure to Create Limbal Stem Cell Deficiency in Mouse

Limbal stem cell deficiency (LSCD) is a state of malfunction or loss of limbal epithelial stem cells, after which the corneal epithelium is replaced with conjunctiva. Patients suffer from recurrent corneal defects, pain, inflammation, and loss of vision.
Previously, a murine model of LSCD was described and compared to two other models. The goal was to produce a consistent mouse model of LSCD that both mimics the phenotype in humans and lasts long enough to make it possible to study the disease pathophysiology and to evaluate new treatments. Here, the technique is described in more detail.
A motorized tool with a rotating burr has been designed to remove the rust rings from the corneal surface or to smooth the pterygium bed in patients. It is a suitable device to create the desired LSCD model. It is a readily available, easy-to-use tool with a fine tip that makes it appropriate for working on small eyes, as in mice. Its application prevents unnecessary trauma to the eye and it does not result in unwanted injuries, as often is the case with chemical injury models. As opposed to a blunt scraper, it removes the epithelium with the basement membrane. In this protocol, the limbal area was abraded two times, and then the whole corneal epithelium was shaved from limbus to limbus. To avoid stroma injury, care was taken not to brush the corneal surface once the epithelium was already removed.

The following article provides an easy, reproducible technique to effectively create a sustainable mouse model of limbal stem cell deficiency (LSCD). This animal model is useful in testing and comparing the efficacy of treatments for limbal stem cell diseases.

マウスで輪部幹細胞欠損を作成するための単純な機械的手順

Limbal stem cell deficiency (LSCD) is a state of malfunction or loss of limbal epithelial stem cells, after which the corneal epithelium is replaced with ...

A Model to Simulate Clinically Relevant Hypoxia in Humans

In case of apnea, arterial partial pressure of oxygen (pO2) decreases, while partial pressure of carbon dioxide (pCO2) increases. To avoid damage to hypoxia sensitive organs such as the brain, compensatory circulatory mechanisms help to maintain an adequate oxygen supply. This is mainly achieved by increased cerebral blood flow. Intermittent hypoxia is a commonly seen phenomenon in patients with obstructive sleep apnea. Acute airway obstruction can also result in hypoxia and hypercapnia. Until now, no adequate model has been established to simulate these dynamics in humans. Previous investigations focusing on human hypoxia used inhaled hypoxic gas mixtures. However, the resulting hypoxia was combined with hyperventilation and is therefore more representative of high altitude environments than of apnea. Furthermore, the transferability of previously performed animal experiments to humans is limited and the pathophysiological background of apnea induced physiological changes is poorly understood. In this study, healthy human apneic divers were utilized to mimic clinically relevant hypoxia and hypercapnia during apnea. Additionally, pulse-oximetry and Near Infrared Spectroscopy (NIRS) were used to evaluate changes in cerebral and peripheral oxygen saturation before, during, and after apnea.

Hypoxia simulation in humans has usually been performed by inhaling hypoxic gas mixtures. For this study, apneic divers were used to simulate dynamic hypoxia in humans. Additionally, physiological changes in desaturation and re-saturation kinetics were evaluated with non-invasive tools such as Near-Infrared-Spectroscopy (NIRS) and peripheral oxygenation saturation (SpO2).

モデルは、ヒトにおける臨床的に関連する低酸素症をシミュレートします

In case of apnea, arterial partial pressure of oxygen (pO2) decreases, while partial pressure of carbon dioxide (pCO2) increases. To avoid damage to ...

A Clinical Trial Assessing the Safety, Efficacy, and Delivery of Olive-Oil-Based Three-Chamber Bags for Parenteral Nutrition

Limited evidence exists to precisely estimate efficacy and safety differences between parenteral nutrition (PN) prepared using olive-oil-based three-chamber bags (3CBs) and soybean-oil-based compounded bags (CoBs) in hospitalized adult patients. We designed a multicenter, randomized, prospective, open-label, noninferiority protocol to compare the efficacy, safety, and distribution of olive-oil-based 3CBs and soybean-oil-based CoB formulations in adult Chinese patients requiring PN during surgical intervention. Subjects were randomized to receive either one of the study treatments using an interactive voice or web-based recognition system in accordance with the randomization code. Randomization was further stratified based on the study site and surgical category. Both treatment groups received similar amounts of calories and protein. In addition, the two study treatments contained a similar composition of the amino-acid component. The only difference between the two PN formulations was the lipid constitution. The duration of administration of study treatments was a minimum of 5 days up to a maximum of 14 days after the surgical procedure. The primary efficacy endpoint was serum prealbumin levels on day 5 of the study. Noninferiority was proved if the anti-log of the lower bound of the 95% confidence interval (CI) of the treatment difference was at least 0.80. Other efficacy measures included treatment preparation time; duration to achieve tolerability of oral nutrition; associated infectious complications; length of hospitalization; and laboratory assessment of markers of nutrition, inflammation, metabolism, and oxidative stress. A total of 458 patients were enrolled in the study. The results showed that olive-oil-based 3CBs were non-inferior to soybean-based CoBs, besides being well tolerated. The infection rate was found to be significantly lower in the olive-oil-based 3CB group. Thus, this study may be used as a reference for future research on lipid emulsion and 3CBs.

Here, we present a protocol for a study comparing the efficacy, safety, and delivery of olive-oil-based 3CB and soybean-oil-based CoB formulations in adults requiring parenteral nutrition. The results revealed that olive-oil-based 3CBs is non-inferior and well tolerated compared to soybean formulations.

非経た栄養のためのオリーブオイルベースの3チャンバーバッグの安全性、有効性、および送達を評価する臨床試験

Limited evidence exists to precisely estimate efficacy and safety differences between parenteral nutrition (PN) prepared using olive-oil-based ...

Observational Study Protocol for Repeated Clinical Examination and Critical Care Ultrasonography Within the Simple Intensive Care Studies

Longitudinal evaluations of critically ill patients by combinations of clinical examination, biochemical analysis and critical care ultrasonography (CCUS) may detect adverse events of interventions such as fluid overload at an early stage. The Simple Intensive Care Studies (SICS) is a research line that focuses on the prognostic and diagnostic value of combinations of clinical variables.
The SICS-I specifically focused on the use of clinical variables obtained within 24 h of acute admission for prediction of cardiac output (CO) and mortality. Its sequel, SICS-II, focuses on repeated evaluations during ICU admission. The first clinical examination by trained researchers is performed within 3 h after admission consisting of physical examination and educated guessing. The second clinical examination is performed within 24 h after admission and includes physical examination and educated guessing, biochemical analysis and CCUS assessments of heart, lungs, inferior vena cava (IVC) and kidney. This evaluation is repeated at days 3 and 5 after admission. CCUS images are validated by an independent expert, and all data is registered in an online secured database. Follow-up at 90 days includes registration of complications and survival status according to patient&#39;s medical charts and the municipal person registry. The primary focus of SICS-II is the association between venous congestion and organ dysfunction.
The purpose of publishing this protocol is to provide details on the structure and methods of this on-going prospective observational cohort study allowing answering multiple research questions. The design of the data collection of combined clinical examination and CCUS assessments in critically ill patients are explicated. The SICS-II is open for other centers to participate and is open for other research questions that can be answered with our data.

<meta charset="utf8"></head><body>簡易集中治療研究における反復臨床検査およびクリティカルケア超音波検査のための観察研究プロトコル

Structured protocols are necessary to provide answers on research questions in critically ill patients. The Simple Intensive Care Studies (SICS) provides an infrastructure for repeated measurements in critically ill patients including clinical examination, biochemical analysis and ultrasonography. SICS projects have specific focus but the structure is flexible to other investigations.

簡易集中治療研究における反復臨床検査およびクリティカルケア超音波検査のための観察研究プロトコル

Longitudinal evaluations of critically ill patients by combinations of clinical examination, biochemical analysis and critical care ultrasonography (CCUS) ...

Clinical Practice Protocol of Creative Music Therapy for Preterm Infants and Their Parents in the Neonatal Intensive Care Unit

Creative music therapy for preterm infants and their parents (CMT) has emerged as a promising family-integrated early intervention involving communicative musicality to improve infant development, parental well-being, and bonding. It aims at relaxing and nurturing the infant as well as promoting safety and social interaction for the parent-infant dyad. A music therapist specially trained in CMT hums or sings in an infant-directed, improvised, lullaby style continually adjusting to the individual needs, expressions, and breathing pattern of the preterm infant. Based on the principles of family-integrated care, the family is incorporated individually in the therapeutic process, namely by delivering CMT during kangaroo care (KC) and by motivating and facilitating parental vocal interaction with their infant to strengthen the parent-infant bonding. CMT aims at relaxing, stimulating, and coregulating premature infants at a time when many other interventions are still risky and can overwhelm the vulnerable patient group. CMT may be advantageous not by educating and teaching parents, but rather by uncovering the intuitive capacities of parenting that are often overshadowed by the traumatic experience of preterm birth. However, CMT can only be provided when the infants are clinically stable. CMT with parental integration is feasible when parents are available and receptive to participate. This paper presents a detailed protocol on how to use CMT to empower preterm infants and their families.

Creative music therapy for preterm infants and their parents has emerged as a promising family-integrated early intervention. We present a detailed protocol on how to use vocal interaction, humming, or singing to empower preterm infants and their families.

新生児集中治療室における早産児とその親のための創造的音楽療法の臨床実践プロトコル

Creative music therapy for preterm infants and their parents (CMT) has emerged as a promising family-integrated early intervention involving communicative ...

臨床ケアのフェアプロセスを達成するために、Visualと物語メソッドの使用

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ブラインドのナビゲーションスキルを支援するためにオーディオベースのバーチャル·ゲーム環境の開発

視神経炎患者における脱髄次のVisual損傷と修復を特定し、定量化するために、動的なビジュアルテスト

配慮ラットモデルにおける血行動態の措置、煎茶や血液サンプリングを実行するために頸動脈と頸静脈のカテーテル

マウス肺癌研究における有用な点滴や固定方法

マウスで輪部幹細胞欠損を作成するための単純な機械的手順

モデルは、ヒトにおける臨床的に関連する低酸素症をシミュレートします

非経た栄養のためのオリーブオイルベースの3チャンバーバッグの安全性、有効性、および送達を評価する臨床試験

簡易集中治療研究における反復臨床検査およびクリティカルケア超音波検査のための観察研究プロトコル

簡易集中治療研究における反復臨床検査およびクリティカルケア超音波検査のための観察研究プロトコル

新生児集中治療室における早産児とその親のための創造的音楽療法の臨床実践プロトコル

臨床ケアのフ​​ェアプロセスを達成するために、Visualと物語メソッドの使用

要約

さらに動画を探す

この動画の章

ブラインドのナビゲーションスキルを支援するためにオーディオベースのバーチャル·ゲーム環境の開発

視神経炎患者における脱髄次のVisual損傷と修復を特定し、定量化するために、動的なビジュアルテスト

配慮ラットモデルにおける血行動態の措置、煎茶や血液サンプリングを実行するために頸動脈と頸静脈のカテーテル

マウス肺癌研究における有用な点滴や固定方法

マウスで輪部幹細胞欠損を作成するための単純な機械的手順

モデルは、ヒトにおける臨床的に関連する低酸素症をシミュレートします

非経た栄養のためのオリーブオイルベースの3チャンバーバッグの安全性、有効性、および送達を評価する臨床試験

簡易集中治療研究における反復臨床検査およびクリティカルケア超音波検査のための観察研究プロトコル

簡易集中治療研究における反復臨床検査およびクリティカルケア超音波検査のための観察研究プロトコル

新生児集中治療室における早産児とその親のための創造的音楽療法の臨床実践プロトコル

臨床ケアのフェアプロセスを達成するために、Visualと物語メソッドの使用