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| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 林能白 | |
| dc.contributor.author | Xue-Ming Wu | en |
| dc.contributor.author | 吳學明 | zh_TW |
| dc.date.accessioned | 2021-06-16T03:38:26Z | - |
| dc.date.available | 2016-09-14 | |
| dc.date.copyright | 2015-09-14 | |
| dc.date.issued | 2015 | |
| dc.date.submitted | 2015-03-18 | |
| dc.identifier.citation | 【中文文獻】
1. 行政院衛生福利部統計處：http://www.mohw.gov.tw/cht/DOS/ 2. 台灣臨床成效指標：http://tcpi.tjcha.org.tw/tcpi/ 3. 行政院衛生福利部醫事司醫院緊急醫療能力分級評定：http://www.mohw.gov.tw/cht/DOMA/DM1.aspx?f_list_no=608&fod_list_no=773 4. 陳志金。團隊資源管理(TRM)臉書粉絲團：http://www.facebook.com/TRM1234 5. 趙嘉倫。台大醫網，2006 年1月。 6. 林瑞萍。改善急性心肌損傷病患之預後及縮短直接介入性心導管治療之院內策略評估，2008。 7. 李統立。急性心肌梗塞發生率、基本特質、資源利用及預後之探討，2011。 8. 陳志杰。團隊資源管理用於醫療人員團隊互動與工作績效之研究，2011。 9. 石崇良，醫療團隊合作與病人安全。澄清醫護管理雜誌，2013年2月。 10. 林世崇，心肌梗塞之重新定義與臨床分類。內科學誌，2013年4月。 【英文文獻】 1. Libby P. Current concepts of the pathogenesis of the acute coronary syndromes. Circulation. 2001;104(3):365-72. 2. Glass CK1, Witztum JL. Atherosclerosis: The Road Ahead. Cell. 2001;104(4): 503-16. 3. XH Yu, YC Fu, DW Zhang, et al. Foam cells in atherosclerosis. Clin Chim Acta. 2013;424:245-52. 4. HC Stary, AB Chandler, RE Dinsmore, et al. A definition of initial, fatty streak, and intermediate lesions of atherosclerosis. Circulation. 1994;89(5):2462-78. 5. Ito H. Etiology and clinical implications of microvascular dysfunction in patients with acute myocardial infarction. Int Heart J. 2014;55(3):185-9. 6. KJ Moore, I Tabas. The cellular biology of macrophages in atherosclerosis. Cell. 2011; 145(3): 341–355. 7. J Sanz, PR Moreno, V Fuster, et al. The year in atherothrombosis. J Am Coll Cardiol. 2013;62(13):1131-43. 8. Kumar A, Kar S, Fay WP. Thrombosis, physical activity, and acute coronary syndromes. J Appl Physiol. 2011;111(2):599-605. 9. Falk E, Nakano M, Bentzon JF, et al. Update on acute coronary syndromes: the pathologists’ view. Eur Heart J. 2013;34(10):719-28. 10. Steg PG, James SK, Atar D, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012;33(20):2569-619. 11. O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127(4):e362-425. 12. Chiam PT, Liew R. Adjunctive pharmacologic agents and mechanical devices in primary percutaneous coronary intervention. Ann Acad Med Singapore. 2010;39 (3):230-6. 13. Yunoki K, Naruko T, Sugioka K, et al. Thrombus aspiration therapy and coronary thrombus components in patients with acute ST-elevation myocardial infarction. J Atheroscler Thromb. 2013;20(6):524-37. 14. Kireyev D, Tan HC, Poh KK. Management of acute ST-elevation myocardial infarction: reperfusion options. Ann Acad Med Singapore. 2010 Dec;39(12):927-7. 15. Blankenship JC, Skelding KA, Scott TD, et al. Predictors of reperfusion delay in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention from the HORIZONS-AMI trial. Am J Cardiol. 2010;106(11):1527-33. 16. Horst MA, Stuart JJ, McKinsey N, et al. Process factors affecting door to percutaneous coronary intervention for acute myocardial infarction patients. Am J Med Qual. 2012;27(1):16-20. 17. Dasari TW, Roe MT, Chen AY, et al. Impact of time of presentation on process performance and outcomes in ST-segment-elevation myocardial infarction: a report from the American Heart Association: Mission Lifeline program. Circ Cardiovasc Qual Outcomes. 2014;7(5):656-63. 18. Sorita A, Ahmed A, Starr SR, et al. Off-hour presentation and outcomes in patients with acute ischemic stroke: a systematic review and meta-analysis. Eur J Intern Med. 2014;25(4):394-400. 19. Helve S, Viikilä J, Laine M, et al. Trends in treatment delays for patients with acute ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. BMC Cardiovasc Disord. 2014;14:115. 20. Krumholz HM, Herrin J, Miller LE, et al. Improvements in door-to-balloon time in the United States, 2005 to 2010. Circulation. 2011;124(9):1038-45. 21. Bradley EH, Curry LA, Webster TR, et al. Achieving rapid door-to-balloon times: how top hospitals improve complex clinical systems. Circulation. 2006;113(8): 1079-85. 22. Chua SK, Cheng JJ, Shyu KG, et al. Improvement in door-to-balloon (D2B) time in acute ST-elevation myocardial infarction through the D2B alliance--experience of 15 primary percutaneous coronary intervention centers in Taiwan. Circ J. 2013;77 (2):383-9. 23. Zarich SW, Sachdeva R, Fishman R, et al. Effectiveness of a multidisciplinary quality improvement initiative in reducing door-to-balloon times in primary angioplasty. J Interv Cardiol. 2004;17(4):191-5. 24. Caputo RP, Kosinski R, Walford G, et al. Effect of continuous quality improvement analysis on the delivery of primary percutaneous revascularization for acute myocardial infarction: a community hospital experience. Catheter Cardiovasc Interv. 2005;64(4):428-33. 25. Bradley EH, Herrin J, Wang Y, et al. Strategies for reducing the door-to-balloon time in acute myocardial infarction. N Engl J Med. 2006;355(22):2308-20. 26. Ahmar W, Quarin T, Ajani A, et al. Improvement in door-to-balloon times in management of acute ST-segment elevation myocardial infarction STEMI through the initiation of ‘Code AMI’. Intern Med J. 2008;38(9):714-8. 27. Diercks DB, Kontos MC, Chen AY, et al. Utilization and impact of pre-hospital electrocardiograms for patients with acute ST-segment elevation myocardial infarction : data from the NCDR (National Cardiovascular Data Registry) ACTION (Acute Coronary Treatment and Intervention Outcomes Network) registry. J Am Coll Cardiol. 2009;53(2):161-6. 28. Caudle JM, Piggott Z, Dostaler S, et al. Impact of a rapid access protocol on decreasing door-to-balloon time in acute ST elevation myocardial infarction. CJEM. 2009;11(1):29-35. 29. Niles NW, Conley SM, Yang RC, et al. Primary percutaneous coronary intervention for patients presenting with ST-segment elevation myocardial infarction: process improvement in a rural ST-segment elevation myocardial infarction receiving center. Prog Cardiovasc Dis. 2010;53(3):202-9. 30. Bajaj S, Parikh R, Gupta N, et al. 'Code STEMI' protocol helps in achieving reduced door-to-balloon times in patients presenting with acute ST-segment elevation myocardial infarction during off-hours. J Emerg Med. 2012;42(3):260-6. 31. Qiu JP, Zhang Q, Lu JD, et al. Direct ambulance transport to catheterization laboratory reduces door-to-balloon time in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: the DIRECT-STEMI study. Chin Med J (Engl). 2011;124(6):805-10. 32. Chen KC, Yen DH, Chen CD, et al. Effect of emergency department in-hospital tele-electrocardiographic triage and interventional cardiologist activation of the infarct team on door-to-balloon times in ST-segment-elevation acute myocardial infarction. Am J Cardiol. 2011;107(10):1430-5. 33. Wang YC, Lo PH, Chang SS, et al. Reduced door-to-balloon times in acute ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. Int J Clin Pract. 2012;66(1):69-76. 34. Sardi GL, Loh JP, Torguson R, et al. Real-time, two-way interaction during ST-segment elevation myocardial infarction management improves door-to-balloon times. Cardiovasc Revasc Med. 2014;15(5):263-8. 35. Pedersen SH, Galatius S, Hansen PR, et al. Field triage reduces treatment delay and improves long-term clinical outcome in patients with acute ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. J Am Coll Cardiol. 2009;54(24):2296-302. 36. Parikh SV, Treichler DB, DePaola S, et al. Systems-based improvement in door-to-balloon times at a large urban teaching hospital: a follow-up study from Parkland Health and Hospital System. Circ Cardiovasc Qual Outcomes. 2009;2 (2):116-22. 37. Cheung GS, Tsui KL, Lau CC, et al. Primary percutaneous coronary intervention for ST elevation myocardial infarction: performance with focus on timeliness of treatment. Hong Kong Med J. 2010;16(5): 347-53. 38. Daudelin DH, Sayah AJ, Kwong M, et al. Improving use of prehospital 12-lead ECG for early identification and treatment of acute coronary syndrome and ST-elevation myocardial infarction. Circ Cardiovasc Qual Outcomes. 2010;3(3): 316-23. 39. Fan CM, Lai CL, Li AH, et al. Reducing the door-to-balloon time for ST-segment elevation myocardial infarction: The result of a hospital quality improvement initiative. J Taiwan Emerg Med. 2010; 12:107-113. 40. O'Mahony S, Mazur E, Charney P , et al. Use of multidisciplinary rounds to simultaneously improve quality outcomes, enhance resident education, and shorten length of stay. J Gen Intern Med. 2007;22(8):1073-9. 41. Neily J, Mills PD, Yinong YX, et al. Association between implementation of a medical team training program and surgical morbidity. JAMA. 2010;304(15): 1693-1700. 42. Casserly B, Baram M, Walsh P, et al. Implementing a collaborative protocol in a sepsis intervention program: lessons learned. Lung. 2011;189(1):11-9. 43. Christensen D, Maaløe R, Jensen NM, et al. Quality of care using a multidisciplinary team in the emergency room. Dan Med Bull. 2011;58(6):A4227. 44. Ford AL, Williams JA, Spencer M, et al. Reducing door-to-needle times using Toyota's lean manufacturing principles and value stream analysis. Stroke. 2012;43(12):3395-8. 45. Arroliga AC, Pollard CL, Wilde CD, et al. Reduction in the incidence of ventilator-associated pneumonia: a multidisciplinary approach. Respir Care. 2012;57(5):688-96. 46. Muntlin Athlin A, von Thiele Schwarz U, Farrohknia N. Effects of multidisciplinary teamwork on lead times and patient flow in the emergency department: a longitudinal interventional cohort study. Scand J Trauma Resusc Emerg Med. 2013;21(1):76. 47. Jiménez-Almonacid P, Gruss E, Jiménez-Toscano M, et al. Multidisciplinary approach to hemodialysis graft dysfunction and thrombosis. Nefrologia. 2013; 33(5):692-8. 48. Hsu YC, Jerng JS, Chang CW, et al. Integrating team resource management program into staff training improves staff's perception and patient safety in organ procurement and transplantation: the experience in a university-affiliated medical center in Taiwan. BMC Surg. 2014;14:51. 49. Flynn A, Moscucci M, Share D et al. Trends in door-to-balloon time and mortality in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Arch Intern Med. 2010;170(20):1842-9. 50. Rathore SS, Curtis JP, Chen J, et al. Association of door-to-balloon time and mortality in patients admitted to hospital with ST elevation myocardial infarction: national cohort study. BMJ. 2009;338:b1807. 51. Shiomi H, Nakagawa Y, Morimoto T, et al. Association of onset to balloon and door to balloon time with long term clinical outcome in patients with ST elevation acute myocardial infarction having primary percutaneous coronary intervention: observational study. BMJ. 2012;344:e3257. 52. Menees DS, Peterson ED, Wang Y, et al. Door-to-balloon time and mortality among patients undergoing primary PCI. N Engl J Med. 2013;369(10):901-9. 53. Casella G, Ottani F, Ortolani P, et al. Off-hour primary percutaneous coronary angioplasty does not affect outcome of patients with ST-Segment elevation acute myocardial infarction treated within a regional network for reperfusion: The REAL (Registro Regionale Angioplastiche dell'Emilia-Romagna) registry. JACC Cardiovasc Interv. 2011;4(3):270-8. 54. Wang TY, Fonarow GC, Hernandez AF, et al. The dissociation between door-to-balloon time improvement and improvements in other acute myocardial infarction care processes and patient outcomes. Arch Intern Med. 2009;169(15):1411-9. 55. Song YB, Hahn JY, Gwon HC, et al. The impact of initial treatment delay using primary angioplasty on mortality among patients with acute myocardial infarction: from the Korea acute myocardial infarction registry. J Korean Med Sci. 2008;23(3): 357-64. 56. Park YH, Kang GH, Song BG, et al. Factors related to prehospital time delay in acute ST-segment elevation myocardial infarction. J Korean Med Sci. 2012;27(8): 864-9. 57. Swaminathan RV, Wang TY, Kaltenbach LA, et al. Nonsystem reasons for delay in door-to-balloon time and associated in-hospital mortality: a report from the National Cardiovascular Data Registry. J Am Coll Cardiol. 2013;61(16):1688-95. 58. Nallamothu BK, Normand SL, Wang Y, et al. Relation between door-to-balloon times and mortality after primary percutaneous coronary intervention over time: a retrospective study. Lancet. 2014;S0140-6736(14)61932-2. [Epub ahead of print] | |
| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/54783 | - |
| dc.description.abstract | 背景與目的：心血管疾病一直是全世界最主要的健康問題之一。在國內，心血管疾病也高居國人十大死因的第二位，其中以急性ST段上升型心肌梗塞對病患的生命危害最為嚴重。這些病患到醫院急診室就醫至完成緊急心導管冠狀動脈氣球擴張術的這一段時間(DTB時間)，能否在九十分鐘內完成，已經被列為評估一間醫院是否具有執行緊急心導管手術能力的必要標準。經過分析，行政院衛生福利部桃園醫院過去在這個品質指標上表現並不理想。因此本院希望能藉由團隊資源管理的實施來提升照護品質，並縮短急性ST段上升型心肌梗塞病患的DTB時間。此研究的目的，在評估此方式之成效。
方法：以回溯性研究法分析桃園醫院自2009年1月至2012年12月收治之急性ST段上升型心肌梗塞並接受緊急心導管介入性治療之病患。本院於2011年1月開始針對實施緊急心導管介入性治療的團隊，實施團隊資源管理(TRM)的教育訓練。我們以2009年1月1日到2010年12月31日收治的病患為對照組，2011年2月1日到2013年1月31日收治的病患則為介入組，以比較實施TRM前後病患的DTB時間及臨床預後。 結果：病患平均的DTB時間由TRM實施前的107分鐘降到82.6分鐘(p<0.05)：DTB時間小於90分鐘內的達成率也由34%進步到79% (p<0.05)。實施TRM前後，兩組病患的臨床預後包括加護病房住院天數、總住院天數及不良心血管事件發生率等，皆無統計上顯著的差異。但DTB時間大於90分鐘的病患，有較差的臨床預後。 結論：本研究顯示，藉由團隊資源管理的實施，可以有效縮短急性ST段上升型心肌梗塞病患的DTB時間，並提高DTB時間在九十分鐘內的達成率。 | zh_TW |
| dc.description.abstract | Background and Objectives: The ST-segment elevation myocardial infarction (STEMI) patients need rapid primary percutaneous coronary intervention (PCI) to get good outcomes. The aim of this study is to assess the effect of implementing team resource management (TRM) in managing STEMI patients in Taoyuan General Hospital.
Methods: This study includes STEMI patients, who underwent primary PCI in Taoyuan General Hospital. These patients are divided into two study groups: one group consists of 109 STEMI patients, who were admitted to our hospital during the pre-TRM period (from January, 2009 to December, 2010) and the other group consists of 97 STEMI patients, who were admitted to our hospital during the post-TPM period (from February, 2011 to January, 2013). We analyze the DTB times and clinical outcomes of both groups. Results: The mean DTB time of post-TRM group is significantly shorter than that of the pre-TRM group (82.6±14.5 vs 107±27 min; p<0.001). Four intervals of DTB time (door to ECG, ECG to CV doctor, CV doctor to PCI team, and ER to cath room) are all significantly shorter after the implementation of TRM. The clinical outcomes (days of ICU stay, total admission days, and major adverse cardiac events) are not different between these two groups. However, patients with longer DTB time (> 90 min) have higher MACE rate. Conclusion: Implementation of TRM at our institution significantly reduces DTB times of STEMI patients. However, the clinical outcomes are not improved by TRM. | en |
| dc.description.provenance | Made available in DSpace on 2021-06-16T03:38:26Z (GMT). No. of bitstreams: 1 ntu-104-R00848034-1.pdf: 3310500 bytes, checksum: 68a2052323cb19251753e49195cdf9cc (MD5) Previous issue date: 2015 | en |
| dc.description.tableofcontents | 第一章 緒論 1
第一節 研究背景與動機 1 第二節 研究目的 4 第三節 研究重要性 5 第二章 文獻探討 6 第一節 冠狀動脈疾病與急性心肌梗塞 6 第二節 緊急心導管介入治療 11 第三節 改善病患到院至完成心導管冠狀動脈氣球擴張術(DTB)時間之研究 13 第四節 團隊資源管理 22 第三章 研究方法 30 第一節 研究對象 30 第二節 研究架構與假說 32 第三節 資料收集 33 第四節 團隊資源管理實施方法 35 第五節 研究變項操作型定義與屬性 37 第六節 資料處理與統計方法 46 第四章 研究結果 47 第一節 病患的基本特質 47 第二節 病患心導管檢查與治療結果的分析 51 第三節 病患至急診就醫時段的分析 53 第四節 不同就醫時段病患DTB時間及其中各個時間區段(A-F)的分析 54 第五節 TRM實施前後病患DTB時間及其中各個時間區段(A-F)的分析 56 第六節 病患臨床預後的分析 61 第五章 討論 64 第一節 研究方法之討論 64 第二節 研究結果之討論 66 第三節 研究限制 72 第六章 結論與建議 74 第一節 結論 74 第二節 建議 76 參考文獻 77 附件一 急診心肌梗塞病人啟動緊急心導管手術處置查檢表 86 附件二 醫學倫理及人體試驗審查委員會證明書 87 | |
| dc.language.iso | zh-TW | |
| dc.subject | 緊急心導管介入性治療 | zh_TW |
| dc.subject | DTB時間 | zh_TW |
| dc.subject | 團隊資源管理 | zh_TW |
| dc.subject | 品質改善 | zh_TW |
| dc.subject | 急性心肌梗塞 | zh_TW |
| dc.subject | primary percutaneous coronary intervention | en |
| dc.subject | door to balloon time | en |
| dc.subject | team resource management | en |
| dc.subject | quality improvement | en |
| dc.subject | acute myocardial infarction | en |
| dc.title | 團隊資源管理對急性ST段上升型心肌梗塞病患照護品質影響之研究 | zh_TW |
| dc.title | Effect of Team Resource Management on Quality of Care in Patients with Acute ST-elevation Myocardial Infarction | en |
| dc.type | Thesis | |
| dc.date.schoolyear | 103-2 | |
| dc.description.degree | 碩士 | |
| dc.contributor.oralexamcommittee | 楊銘欽,趙嘉倫 | |
| dc.subject.keyword | DTB時間,團隊資源管理,品質改善,急性心肌梗塞,緊急心導管介入性治療, | zh_TW |
| dc.subject.keyword | door to balloon time,team resource management,quality improvement,acute myocardial infarction,primary percutaneous coronary intervention, | en |
| dc.relation.page | 87 | |
| dc.rights.note | 有償授權 | |
| dc.date.accepted | 2015-03-19 | |
| dc.contributor.author-college | 公共衛生學院 | zh_TW |
| dc.contributor.author-dept | 健康政策與管理研究所 | zh_TW |
| 顯示於系所單位： | 健康政策與管理研究所 | |
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