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Background The use of electronic health records (EHRs) to support the organization and delivery of healthcare is evolving rapidly. However, little is known regarding potential variation in access to EHRs by provider type or care setting. This paper reports on observed variation in the perceptions of access to EHRs by a wide range of cancercareproviders covering diverse cancercare settings in Ontario, Canada. Methods Perspectives were sought regarding EHR access and health record completeness for cancer patients as part of an internet survey of 5663 cancercareproviders and administrators in Ontario. Data were analyzed using a multilevel logistic regression model. Provider type, location of work, and access to computer or internet were included as covariates in the model. Results A total of 1997 of 5663 (35%) valid responses were collected. Focusing on data from cancercareproviders (N = 1247), significant variation in EHR access and health record completeness was observed between provider types, location of work, and level of computer access. Providers who worked in community hospitals were half as likely as those who worked in teaching hospitals to have access to their patients' EHRs (OR 0.45 95% CI: 0.24–0.85, p < 0.05) and were six times less likely to have access to other organizations' EHRs (OR 0.15 95% CI: 0.02–1.00, p < 0.05). Compared to surgeons, nurses (OR 3.47 95% CI: 1.80–6.68, p < 0.05), radiation therapists/physicists (OR 7.86 95% CI: 2.54–25.34, p < 0.05), and other clinicians (OR 4.92 95% CI: 2.15–11.27, p < 0.05) were more likely to report good access to their organization's EHRs. Conclusion Variability in access across different provider groups, organization types, and geographic locations illustrates the fragmented nature of EHR adoption in the cancer system. Along with focusing on technological aspects of EHR adoption within organizations, it is essential that there is cross-organizational and cross-provider access to EHRs to ensure patient continuity of care, system efficiency, and high quality care.
BACKGROUND: In order to support cancer patients, nurses need to identify different physio-psycho- social needs of patients using a holistic approach. Focusing on Quality of Life (QoL) is congruent with the philosophy of a holistic approach in nursing. The main aim of this research study thus was to identify the level of agreement between cancer patients and nurses about cancer patients’ QoL. METHODS: The study was a survey which was completed in 2008. 166 cancer patients and 95 nurses were conveniently recruited from three major hospitals in Adelaide, Australia. Each patient and nurse was invited to complete the World Health Organization Quality of Life Brief (WHOQoL-BREF) questionnaire separately. This questionnaire considers QoL across four domains or dimensions: physical health, psychological health, social relationship and environment. RESULTS: The proportion of the exact agreement between the two groups was 34.9%, 34.5%, 33.8% and 36.9% for the physical, psychological, social relationship, and environmental QoL domains, respectively. CONCLUSIONS: Results may indicate that nurses do not have a holistic understanding of cancer patients’ QoL. QoL tools like the World Health Organization Quality of Life Brief (WHOQoL-BREF) might be used as guidelines for nurses to assess cancer patients’ QoL rather than relying heavily on their perceptions and intuitions. The results provide some implications for Iran.
BackgroundThe Oral Care Study Section of the Multinational Association of Supportive Care in Cancer (MASCC) and the International Society for Oral Oncology (ISOO) conducted a survey on clinical practices of oral\\/dental management of cancer patients among supportive health careproviders. The main purpose was to evaluate the knowledge and current practice for preventing and managing oral side effects associated with
Gerry J. Barker; Joel B. Epstein; Karen B. Williams; Meir Gorsky; Judith E. Raber-Durlacher
OBJECTIVE Little is known about the effects of lung cancer on intimate and sexual relationships. This study explores health careprovider, patient, and partner perspectives on: 1) the effects of lung cancer on physical and emotional intimacy, 2) the ways in which intimacy affects the experience of living with lung cancer, and 3) communication about intimacy and sexuality in the context of lung cancer. METHODS Qualitative, in-depth interviews with 8 cancercareproviders and 13 married couples (ages 43–79) affected by lung cancer were conducted and audiotaped in the clinical setting. Interviews were transcribed, iteratively analyzed, and coded according to the above domains. Coding was performed independently by members of an interdisciplinary team; inter-rater reliability was assessed using the kappa statistic; and analyses were summarized by domain. RESULTS Most cancercareproviders and couples affected by lung cancer believed intimacy and sexuality issues were salient, yet few reported discussing these. Couples described negative and positive effects of cancer on intimacy. Negative effects were driven by cancer or its treatment, including physical and psychological effects. Positive effects included an increase in non-coital physical closeness and appreciation of the spouse. Age was perceived as an important factor influencing the relationship between lung cancer and intimacy. CONCLUSIONS Emotional intimacy and sexuality are important concerns for couples affected by lung cancer. The findings suggest previously unrecognized positive effects of lung cancer on emotional and physical intimacy. Couples affected by lung cancer and providers believe these issues are relevant for lung cancercare.
Lindau, Stacy Tessler; Surawska, Hanna; Paice, Judith; Baron, Shirley R.
Nurse practitioners working in family or primary care often need to incorporate specialty care knowledge into their practice. Knowledge of breast cancer staging, treatment, common side effects, and possible long-term sequelae is critically important for primary care nurse practitioners caring for women with a history of breast cancer. The unique considerations of breast cancer staging, treatment, and long-term effects are
Mary Ann Zalewski; Susan Beikman; Shannon Ferrari; Kathleen Slavish; Margaret Rosenzweig
Abstract Objective: In the cancer setting, e-counseling interventions may be uniquely beneficial as they spare patients the cost and burden of traveling to a hospital or clinic for psychosocial care. However, the prevalence of e-counseling among psychosocial cancercareproviders is unknown, as are the training needs with regard to e-counseling among this group of professionals. Thus, our group conducted an online professional training needs assessment with psychosocial cancercareproviders. Subjects and Methods: Participants (n=120) were recruited from the listservs of the Health Psychology Division of the American Psychological Association, the Society of Behavioral Medicine—Cancer Special Interest Group, the American Psychosocial Oncology Society, and the Association of Oncology Social Work. All completed a 14-item online survey. Results: Although 84% of participants stated that e-counseling could be important to their clinical work with cancer patients and survivors, 88% reported that they did not have the skills to effectively conduct e-counseling, and 81% reported that there were no adequate e-counseling educational opportunities. When asked about future training opportunities, participants reported a preference for online training versus live training (p<0.001). Conclusions: Overall, the results highlight the need for online training programs in e-counseling for psychosocial cancercareproviders. The training of psychosocial cancercareproviders in e-counseling is a critical first step towards increasing implementation of e-counseling interventions and using the Internet to deliver effective interventions to cancer patients in need.
The care of patients with cancer who have cardiac disease is dispersed both sequentially and concurrently across multiple providers, and an important goal of education is communication among the providers regarding change of therapy, toxicity of therapy, and symptom assessments. Changes must be made to improve the delivery of cardiac care in patients with cancer and cancer survivors. Therefore, the authors propose a multilevel approach that includes short, targeted curriculum for housestaff training programs in internal medicine, family medicine, pediatrics, cardiology and oncology; increasing presence at national meetings of internists, oncologists and cardiologists; and an Internet-based repository of core information. PMID:21749887
PURPOSE We wanted to assess the relationship between having a personal health careprovider and receiving colorectal cancer testing. METHODS Self-reported data were obtained from the United States 2004 Behavioral Risk Factor Surveillance System. Men and women aged 50 years and older were included, and associations of having a personal health careprovider, age, sex, race/ethnicity, education, income, and health insurance status with colorectal cancer testing were examined. Multiple logistic regression was performed on a final sample of 120,221 individuals. RESULTS Having at least 1 personal health careprovider significantly predicted up-to-date colorectal cancer testing in both the univariate (odds ratio [OR]=3.96; 95% confidence interval [CI] 3.56–4.41) and multiple regression models (OR = 2.91; 95% CI 2.58–3.28). Age, sex, race/ethnicity, education, income, and health insurance were also significantly associated with up-to-date colorectal cancer testing. CONCLUSIONS Having a personal health careprovider was associated with up-to-date colorectal cancer testing. Efforts to increase and support the primary care workforce are needed to improve up-to-date colorectal cancer screening rates.
BACKGROUND: Many patients with advanced cancer depend upon health careproviders for symptom assessment. The extent of agreement between patient and provider symptom assessments and the association of agreement with demographic- and disease-related factors was examined. METHODS: This cross-sectional study included 1933 patient-health careprovider dyads, from 11 European countries. Patients reported symptoms by using the four-point scales of the
Eivor A Laugsand; Mirjam AG Sprangers; Kristin Bjordal; Frank Skorpen; Stein Kaasa; Pål Klepstad
|Background: Patients are more likely to be screened for colorectal cancer if it is recommended by a health careprovider. Therefore, it is imperative that providers have access to the latest screening guidelines. Purpose: This practice-based project sought to identify Kentucky primary careproviders' preferred sources and methods of receiving…
New communication technologies represent a potentially valuable resource for cancercare and education. With the Internet and multimedia programs (e.g. CD-ROMs), health care consumers have access to a wealth of information about cancer and its treatment, can participate in online support groups, and can interact with medical experts across the globe. To be most effective, these interventions must be designed, developed, implemented, and evaluated using a sound conceptual framework that connects factors affecting utilization, the user's experience within the media environment, and post interaction outcomes. This essay presents two health communication frameworks, an expanded model of health care consumer-provider communication and a three-stage model of health promotion using interactive media, to help guide future research and development of innovative technologies for cancercare and education. PMID:12767594
Palliative care for children and adolescents with cancer includes interventions that focus on the relief of suffering, optimization of function, and improvement of quality of life at any and all stages of disease. This care is most effectively provided by a multidisciplinary team. Nurses perform an integral role on that team by identifying symptoms, providingcare coordination, and assuring clear communication. Several basic tenets appear essential to the provision of optimal palliative care. First, palliative care should be administered concurrently with curative therapy beginning at diagnosis and assuming a more significant role at end of life. This treatment approach, recommended by many medical societies, has been associated with numerous benefits including longer survival. Second, realistic, objective goals of care must be developed. A clear understanding of the prognosis by the patient, family, and all members of the medical team is essential to the development of these goals. The pediatric oncology nurse is pivotal in developing these goals and assuring that they are adhered to across all specialties. Third, effective therapies to prevent and relieve the symptoms of suffering must be provided. This can only be accomplished with accurate and repeated assessments. The pediatric oncology nurse is vital in providing these assessments and must possess a working knowledge of the most common symptoms associated with suffering. With a basic understanding of these palliative care principles and competency in the core skills required for this care, the pediatric oncology nurse will optimize quality of life for children and adolescents with cancer. PMID:23641169
Docherty, Sharron L; Thaxton, Cheryl; Allison, Courtney; Barfield, Raymond C; Tamburro, Robert F
Palliative care for children and adolescents with cancer includes interventions that focus on the relief of suffering, optimization of function, and improvement of quality of life at any and all stages of disease. This care is most effectively provided by a multidisciplinary team. Nurses perform an integral role on that team by identifying symptoms, providingcare coordination, and assuring clear communication. Several basic tenets appear essential to the provision of optimal palliative care. First, palliative care should be administered concurrently with curative therapy beginning at diagnosis and assuming a more significant role at end of life. This treatment approach, recommended by many medical societies, has been associated with numerous benefits including longer survival. Second, realistic, objective goals of care must be developed. A clear understanding of the prognosis by the patient, family, and all members of the medical team is essential to the development of these goals. The pediatric oncology nurse is pivotal in developing these goals and assuring that they are adhered to across all specialties. Third, effective therapies to prevent and relieve the symptoms of suffering must be provided. This can only be accomplished with accurate and repeated assessments. The pediatric oncology nurse is vital in providing these assessments and must possess a working knowledge of the most common symptoms associated with suffering. With a basic understanding of these palliative care principles and competency in the core skills required for this care, the pediatric oncology nurse will optimize quality of life for children and adolescents with cancer.
Docherty, Sharron L.; Thaxton, Cheryl; Allison, Courtney; Barfield, Raymond C.; Tamburro, Robert F.
The National Cancer Survivorship Resource Center (The Survivorship Center) began in 2010 as a collaboration between the American Cancer Society and the George Washington University Cancer Institute and was funded by the Centers for Disease Control and Prevention. The Survivorship Center aims to improve the overall health and quality of life of posttreatment cancer survivors. One key to addressing the needs of this ever-growing population is to develop clinical follow-up care guidelines that emphasize not only the importance of surveillance for cancer recurrence, but also address the assessment and management of the physical and psychosocial long-term and late effects that may result from having cancer and undergoing cancer treatment as well as highlight the importance of healthy behaviors that can reduce the risk of cancer recurrence, second primary cancers, and other chronic diseases. Currently, The Survivorship Center is coordinating the work of experts in oncology, primary care, and other health care professions to develop follow-up care guidelines for 10 priority cancer sites. PMID:23512728
Cowens-Alvarado, Rebecca; Sharpe, Katherine; Pratt-Chapman, Mandi; Willis, Anne; Gansler, Ted; Ganz, Patricia A; Edge, Stephen B; McCabe, Mary S; Stein, Kevin
Goals of work Cancer patients are offered more and more access to beauty care during their stay in the hospital. This kind of intervention\\u000a has not been evaluated yet. Primary objective of our research was to determine what type of evaluation strategy to be implemented\\u000a (as a supportive care with quality of life and\\/or medical benefits; as a service providing immediate
Philippe Amiel; Sarah Dauchy; Julie Bodin; Céline Cerf; Franck Zenasni; Elisabeth Pezant; Anne-Marie Teller; Fabrice André; Mario DiPalma
Background Little is known about the effect of provider continuity prior to the diagnosis of advanced lung cancer and end-of-life care. Methods Retrospective analysis of 69,247 Medicare beneficiaries aged 67 years or older diagnosed with Stage IIIB or IV lung cancer between January 1, 1993 and December 31, 2005 who died within two years of diagnosis. We examined visit patterns to a primary care physician (PCP) and/or any provider one year prior to the diagnosis of advanced lung cancer as measures of continuity of care. Outcome measures were hospitalization, ICU use and chemotherapy use during the last month of life, and hospice use during the last week of life. Results Seeing a PCP or any provider in the year prior to the diagnosis of advanced lung cancer increased the likelihood of hospitalization, ICU care, chemotherapy and hospice use during the end of life. Patients with 1–3, 4–7 or >7 visits to their PCP in the year prior to the diagnosis of lung cancer had 1.0 (reference), 1.08 (95% CI; 1.04–1.13), and 1.14 (95% CI; 1.08–1.19) odds of hospitalization during the last month of life, respectively. Odds of hospice use during the last week of life were higher in patients with visits to multiple PCPs (OR 1.10: 95% CI; 1.06–1.15) compared to those whose visits were all to the same PCP. Conclusion Provider continuity in the year prior to the diagnosis of advanced lung cancer was not associated with lower use of aggressive care during end of life. Our study did not have information on patient preferences and result should be interpreted accordingly.
Sharma, Gulshan; Wang, Yue; Graham, James E.; Kuo, Yong-Fang; Goodwin, James S.
This paper describes a psycho-oncology consultation model of care (POCM) that provides a framework for psychosocial clinical work with cancer patients. Goals for care are addressed that follow the recommendations of the Institute of Medicine report advocating care for the "whole patient." Specific goals include reducing distress and symptoms, building on the patient's existing strengths, enhancing self-efficacy, expanding the patient's repertoire of healthy coping strategies, and addressing informational needs. Specific interventions are described that clinicians can implement in order to address the above goals. The paper also addresses the unique challenges encountered in working with cancer patients, as well as programmatic difficulties that are inherent in providing mental health care in a medical setting. PMID:20799056
|Context: Rural women in the United States experience disparity in breast cancer diagnosis and treatment when compared to their urban counterparts. Given the 11% chance of lifetime occurrence of breast cancer for women overall, the continuum of breast cancer screening, diagnosis, treatment, and recovery are of legitimate concern to rural women and…
A visiting nursing service was provided for a 90-year-old male patient with terminal stage of pancreatic cancer whose prognosis was to live for two to three months. We provided nursing service not only for the patient's pain control but also for the member of the family by giving specific nursing tips as well as mental support. After the patient passed away, the eldest daughter was quoted saying "we could do everything we wanted to from home nursing care." It appeared that she was totally satisfied with our nursing service. We concluded the following caregiver roles based on this clinical example: 1) Try to alleviate a terminal patient's pain as much as possible so that the patient and the family will be at ease. 2) Arrange the care giver's anxiety individually. 3) Guide the care giver a specific know-how that can be accomplished and let the patient and the care giver choose which one they want. 4) Teach the process of the withholding and with drawing of life and try to consolidate the purpose of nursing intentions among the care givers. 5) Respect the patient and caregiver and make the best out of the situation by being flexible. PMID:20443306
Breast cancer is uncommon in pregnancy, but obstetrical careproviders should nevertheless be familiar with the presenting signs and symptoms. The incidence of breast cancer in pregnancy and the postpartum period ranges from 2.3 to 40 cases per 100 000 women. Over 90% of patients with breast cancer in pregnancy or during lactation present with a palpable mass, and most often (84%) these are self-reported by patients. Less frequently, breast cancer will present as breast erythema, breast swelling, bloody nipple discharge, or local or distant metastasis. The histology of tumours appears to be similar in women who are pregnant or recently delivered and in age-matched women who are not pregnant. However, the stage of disease at diagnosis is more advanced in women who are pregnant or recently delivered and consequently incurs a worst prognosis, likely due to a delay in diagnosis. Although the majority of palpable breast masses are benign, breast examinations should routinely be performed in pregnant women, and identified masses should be promptly evaluated. PMID:21501537
Buré, Lionel A; Azoulay, Laurent; Benjamin, Alice; Abenhaim, Haim A
Research to understand the sources of stress and job satisfaction in pediatric oncology staff is limited. The aim of the authors' qualitative study was to describe the key work-related demands and rewards in relation to working closely with parents from the perspective of health careproviders (HCPs). Semistructured interviews were conducted with 13 doctors, 9 nurses, 5 social workers, and 6 child life specialists. Line-by-line, focused, and theoretical coding was used to establish categories and themes. Constant comparisons were used to examine the relationships within and across codes and categories. Interviewing continued until no new themes emerged. HCPs found it rewarding when they established close or long-term relationships with parents and to helped families through the entire cancer journey, including palliative care. HCPs found it challenging to work with complex families; with parents who are demanding, rude, or angry; with parents who have differing views about the treatments and palliative care; and with having to relay bad news to parents. Future research could explore the relationship between the factors that the authors have identified and burnout syndrome. PMID:22415857
Despite rising medical costs within the US healthcare system, quality and outcomes are not improving. Without significant policy reform, the cost-quality imbalance will reach unsustainable proportions in the foreseeable future. The rising cost of healthcare in part results from an expanding aging population with an increasing number of life-threatening diseases. This is further compounded by a growing arsenal of high-cost therapies. In no medical specialty is this more apparent than in the area of oncology. Numerous attempts to reduce costs have been attempted, often with limited benefit and brief duration. Because physicians directly or indirectly control or influence the majority of medical care costs, physician behavioral changes must occur to bend the healthcare cost curve in a sustainable fashion. Experts within academia, health policy, and business agree that a significant paradigm change in stakeholder collaboration will be necessary to accomplish behavioral change. Such a collaboration has been pioneered by Blue Cross Blue Shield of Michigan and Physician Resource Management, a highly specialized oncology healthcare consulting firm with developmental and ongoing technical, analytic, and consultative support from Cardinal Health Specialty Solutions, a division of Cardinal Health. We describe a successful statewide collaboration between payers and providers to create a cancer clinical care pathways program. We show that aligned stakeholder incentives can drive high levels of provider participation and compliance in the pathways that lead to physician behavioral changes. In addition, claims-based data can be collected, analyzed, and used to create and maintain such a program. PMID:22694114
... any particular health careprovider or his/her experience. NASS attempts to provide information that is up-to-date, but in no way guarantees the accuracy of the information provided. It is the user's responsibility to determine the provider’s qualifications and appropriateness ...
|Purpose: Distance to provider might be an important barrier to timely diagnosis and treatment for cancer patients who qualify for Medicaid coverage. Whether driving time or driving distance is a better indicator of travel burden is also of interest. Methods: Driving distances and times from patient residence to primary careprovider were…
Scoggins, John F.; Fedorenko, Catherine R.; Donahue, Sara M. A.; Buchwald, Dedra; Blough, David K.; Ramsey, Scott D.
In recent years nurse practitioners have expanded their repertoire of ob/gyn skills to include the provision of infertility care. To minimize the stresses involved in an infertility investigation, couples benefit from a careprovider who can educate them about the factors, testing, and treatments involved in infertility. They also need a provider who can support them emotionally through a work-up that touches upon the sensitive aspects of their sexuality, partner relationship, and self-esteem. Nurse practitioners have demonstrated an aptitude in providing competent medical care and health education in the context of a therapeutic relationship. Utilization of the physician/nurse practitioners collaborative team approach offers one successful model for integrating nurse practitioners into the practice of infertility. PMID:6562266
Fifty-seven studies were reviewed to identify the prevalence of compassion fatigue among cancer-careproviders, instruments used to detect it and means of prevention and treatment. Conclusions were limited by an ambiguous definition of compassion fatigue that fails to adequately differentiate it from related constructs (e.g. burnout, secondary traumatic stress) and the modest number of cancer-related studies found. However, evidence suggests
Nadine Najjar; Louanne W. Davis; Kathleen Beck-Coon; Caroline Carney Doebbeling
Background Palliative cancercare aims to improve quality of life and ultimately quality of dying, while prolonging life is not an objective anymore when death nears. The question is, however, whether these perspectives on palliative care are congruent with the perspectives of immigrant families with a Turkish or Moroccan background. Methods A qualitative design was used as we were looking for the personal views of 'very ill' cancer patients with a Turkish or Moroccan background, their family members and their Dutch careproviders. We interviewed 83 people, involved in 33 cases to obtain information about their views, values and norms on 'good care'. Results The main concerns about 'good care' expressed by Turkish and Moroccan families were: maximum treatment and curative care until the end of their lives, never having hope taken away, devoted care by their families, avoiding shameful situations, dying with a clear mind and being buried in their own country. Their views conflict, to some extent, with the dominant principles in palliative care, for example, the emphasis on quality of life and advanced care planning, which includes discussing diagnosis and prognosis with the patient. Conclusions Patients and their families with a Turkish or Moroccan background often have different ideas about 'good care' than their Dutch careproviders. As many of them are aiming at cure until the end of life, they find 'good palliative care' a contradiction in terms.
Research demonstrates considerable inequalities in service delivery and health outcomes for people with cancer living outside large metropolitan cities. Semi-structured interviews with 11 professionals providing grief and loss support for people with cancer and their families in rural, regional, and remote areas Western Australia revealed the challenges they faced in delivering such support. The data are presented in four themes - Inequity of regional versus metropolitan services, Strain of the 'Jack of all trades' role, Constraints to accessing professional development, and Challenges in delivering post-bereavement services. These challenges are likely to be of growing concern given that populations are declining in rural areas as Australia becomes increasingly urban. The findings have implications in enhancing the loss and grief support services available in rural, regional, and remote Western Australia, including those grieving the death of a loved one through cancer. PMID:23834431
Background The use of opioid medications as treatment for chronic non-cancer pain remains controversial. Little information is currently\\u000a available regarding healthcare providers' attitudes and beliefs about this practice among older adults. This study aimed to\\u000a describe primary careproviders' experiences and attitudes towards, as well as perceived barriers and facilitators to prescribing\\u000a opioids as a treatment for chronic pain among older
Aerin Spitz; Alison A Moore; Maria Papaleontiou; Evelyn Granieri; Barbara J Turner; M Carrington Reid
Background There is a need for improvement of information provision and post-treatment care for cancer survivors. A Survivorship Care Plan (SCP) is recommended by the American Institute of Medicine and the Dutch Health Council, which is a summary of patients' course of treatment as a formal document, and includes recommendations for subsequent cancer surveillance, management of late effects, and strategies for health promotion. Until now, evidence on the effects of implementing the SCP in clinical practice is lacking. The rationale and study design of a pragmatic cluster randomized trial, aiming to assess the impact of SCP care in routine clinical practice, is presented. Methods/Design A web-based patient registration system 'Registrationsystem Oncological GYnecology' (ROGY) is used by gynecologists in the South of the Netherlands since 2006. A personalized SCP can automatically be generated out of ROGY. In this pragmatic cluster randomized controlled trial, 12 hospitals are randomized to either 'usual care' or 'SCP care'. In patients with 'usual care', the gynecologist providescare as usual. In patients with 'SCP care', information about the tumor stage and treatment is personally discussed with the patient and a document is handed to the patient. Prospectively, all patients diagnosed with endometrial or ovarian cancer in the participating hospitals will be approached for study participation. Patients will complete questionnaires after surgery, and before additional treatment, and after 6, 12, 18 and 24 months. In addition, health careproviders will be asked their opinion about implementation of SCP care. Primary outcome is defined as patient satisfaction with information provision and care. Secondary outcomes are illness perception, health-related quality of life, health care use, prevalence, course and referral rate of survivors with psychosocial distress, and health careproviders' evaluation of SCP care. Discussion The ROGY Care trial will help to gain insight into the impact of SCP care on patient reported outcomes, and on the evaluation of cancer survivors and health careproviders of the different elements of the SCP. Therefore, results will contribute to efforts to improve quality of care for cancer survivors. Trial registration Trial Registration: http://www.ClinicalTrials.gov. Identifier: NCT01185626 Medical Research Ethics Committee Reference Number: NL33429.008.10 Grant Reference Number: UVT2010-4743
Vietnamese women living in the United States have a cervical cancer incidence rate that is five times that of White women. The low rate of cervical cancer screening among this high-risk population contributes to this disparity. In 2004, the National Cancer Institute collaborated with the Vietnamese American Medical Association to conduct a short needs assessment questionnaire (Pap Test Barriers Questionnaire
Background The purpose of this study was to assess the knowledge, practices, and opinions of dentists and dental hygienists in New York State regarding oral cancer prevention and early detection. Method We sent questionnaires to a stratified random sample of dentists and dental hygienists selected from a list of licensed oral health careproviders in New York State. We analyzed responses to the questionnaires, and we derived descriptive statistics. Results The effective response rate was 55% and 65% among dentists and dental hygienists, respectively. About 85% of dentists and 78% of dental hygienists reported providing annual oral cancer examination to their patients aged 40 and above. Although a majority assessed tobacco use, fewer practitioners assessed alcohol use. Both dentists and dental hygienists lacked knowledge in some aspects of risk factors, signs, and symptoms of oral cancer. However, dentists had significantly higher knowledge scores than dental hygienists. Conclusion Dentists and dental hygienists in New York State are knowledgeable about oral cancer, but there are gaps in the knowledge of certain risk factors and in the oral cancer examination technique.
GAJENDRA, SANGEETA; CRUZ, GUSTAVO D.; KUMAR, JAYANTH V
Colorectal cancer screening (CRCS) rates are low among men and women who seek health care at federally qualified health centers (FQHCs). This study explores health careproviders' perspectives about their patient's motivators and impediments to CRCS and receptivity to preparatory education. A mixed methods design consisting of in-depth interviews, focus groups, and a short survey is used in this study. The participants of this study are 17 health careproviders practicing in FQHCs in the Tampa Bay area. Test-specific patient impediments and motivations were identified including fear of abnormal findings, importance of offering less invasive fecal occult blood tests, and need for patient-centered test-specific educational materials in clinics. Opportunities to improve provider practices were identified including providers' reliance on patients' report of symptoms as a cue to recommend CRCS and overemphasis of clinic-based guaiac stool tests. This study adds to the literature on CRCS test-specific motivators and impediments. Providers offered unique approaches for motivating patients to follow through with recommended CRCS and were receptive to in-clinic patient education. Findings readily inform the design of educational materials and interventions to increase CRCS in FQHCs. PMID:23943277
Gwede, Clement K; Davis, Stacy N; Quinn, Gwendolyn P; Koskan, Alexis M; Ealey, Jamila; Abdulla, Rania; Vadaparampil, Susan T; Elliott, Gloria; Lopez, Diana; Shibata, David; Roetzheim, Richard G; Meade, Cathy D
Purpose: Stage at diagnosis is the most important prognostic indictor for oral and oropharyngeal squamous cell cancers (SCCs). Unfortunately, approximately 50% of these cancers are identified late (stage III or IV). We set out to examinationine the detection patterns of oral and oropharyngeal SCCs and to determine whether detection of these cancers by various health careproviders was associated with
Jon D. Holmes; Eric J. Dierks; Louis D. Homer; Bryce E. Potter
Family doctor - how to choose one; Primary careprovider - how to choose one; Doctor - how to choose a family doctor ... A PCP is your main health careprovider in non-emergency ... and teach healthy lifestyle choices Identify and treat common ...
Historically, primary health care services for women have been vastly inadequate. It was not until 1990, when the National Institutes of Health established the Office of Research on Women's Health, that the United States began to acknowledge the importance of providing primary care services to women. Even today, women continue to be a greatly underserved population when it comes to primary health care services. Midwives are ideal providers of health promotion services for women because their entire philosophy of care centers on the promotion of women's health throughout the lifecycle. PMID:10772740
Large scale disasters such as hurricanes, earthquakes and radiologic emergencies pose significant risks to both patients and patient careproviders. In an era of declining federal funding for emergency preparedness training (EPT), the importance of state and local initiatives to provide EPT has increased. Unfortunately, few US regions have performed workforce assessments of their patient careproviders to measure levels of preparedness, record training preferences and assess EPT needs. This project summarizes the preliminary findings the Center for Health Professional Training and Emergency Response's (CHPTER) workforce assessment of nearly 400 patient careproviders in South and North Carolina.
Scott, Lancer A.; Crumpler, Jason; Tolley, Jessica; Jones, E. Morgan; Wahlquist, Amy E.
Summary \\u000a Objective: Previous research suggests that women with mental illness may be at increased risk for breast and cervical cancer. This qualitative\\u000a study of patients and primary care and mental health providers explored challenges to accessing and providing breast and cervical\\u000a cancer screening for women with mental illness.\\u000a \\u000a \\u000a Method: Key informant patient and provider participants were recruited from a community
BACKGROUND: Palliative cancercare aims to improve quality of life and ultimately quality of dying, while prolonging life is not an objective anymore when death nears. The question is, however, whether these perspectives on palliative care are congruent with the perspectives of immigrant families with a Turkish or Moroccan background. METHODS: A qualitative design was used as we were looking
Fuusje M de Graaff; Anneke L Francke; Maria ETC van den Muijsenbergh; Sjaak van der Geest
In a consumer-driven health care model, consumers, armed with information, would select providers based on quality and cost, thus increasing competition. This synthesis examines the availability of quality information and the evidence of how consumers use such information to choose a provider. Key findings include: information is publicly available from multiple sources regarding hospitals, but not individual doctors. Hospital information is predominantly made available online; but this limits awareness and access. Awareness is low overall, but highest among well-educated, healthy people. Even when consumers are aware of the data available, they rarely use it because they do not find it relevant: they do not foresee needing a hospital soon; are happy with their current provider; or did not find information pertinent to their specific health condition or hospital. While there is some evidence that hospitals that do poorly on public quality scorecards lose market share, there is better evidence that the providers themselves react to the quality scores by addressing care problems. Studies consistently show that consumers value health care quality and want information, but instead they rely on input from friends, family and their personal physicians about the quality of providers. PMID:22051936
Cancer breakthrough pain is a flare in pain that “breaks through” well-controlled persistent cancer pain. Although the condition is highly prevalent, the concept of cancer breakthrough pain is not well understood and is therefore underdiagnosed and undertreated. The purpose of this review is to examine the roles the health-care practitioner and patient\\/family caregiver play in the undertreatment of breakthrough pain.
Aim The aim of this study was to assess Chinese breast cancer patients’ and health careproviders’ (HCPs) perceptions of psychosocial\\u000a clinical guidelines developed by the Australian National Health and Medical Research Council’s National Breast Cancer Centre.\\u000a \\u000a \\u000a \\u000a Materials and methods A convenience sample of Hong Kong Chinese women diagnosed with breast cancer was recruited. In addition, all surgeons and\\u000a clinical\\/medical oncologists registered
Wendy Wing Tak Lam; Cecilia Fabrizio; Ella Ho; Lillian Chan; Richard Fielding
Purpose To determine the impact of age and health status on adjuvant treatment recommendations for older patients with breast cancer from the perspective of medical oncologists and primary care physicians with geriatric expertise. Patients and Methods One hundred fifty-one oncologists and 158 primary care physicians with geriatric expertise participated in an online survey. The survey described hypothetical patients of varying ages (70, 75, 80, and 85 years) and health status (good, average, and poor) who had node-positive, hormone receptor–positive, human epidermal growth factor receptor 2 (HER-2)/neu–negative; and hormone receptor–negative, HER-2/neu–positive breast cancers. The effects of patient age and health status on the survey participants’ adjuvant treatment recommendations were examined using generalized estimation equation methods. Results The majority of both oncologists and primary care physicians recommended some form of adjuvant therapy for patients of all ages (70, 75, 80, and 85 years) and health status. Both oncologists and primary careproviders were less likely to recommend adjuvant treatment as a patient's age increased or health status declined (P < .0001). There were no significant differences in treatment recommendations among primary care physicians and oncologists for patients with hormone receptor–negative, HER-2/neu–positive tumors (P = .54). However, primary careproviders were more likely than oncologists to recommend no adjuvant treatment for patients age 75 years or older with hormone receptor–positive, HER-2/neu–negative tumors (P < .01). Conclusion Age and health status influence oncologists’ and primary careproviders’ adjuvant treatment recommendations. Evidence-based guidelines for breast cancer treatment in older adults taking into account age and health status are needed.
Purpose Colorectal cancer (CRC) screening remains underutilized in the United States. Prior studies reporting the cost effectiveness of randomized interventions to improve CRC screening have not been replicated in the setting of small physician practices. We recently conducted a randomized trial evaluating an academic detailing intervention in 264 small practices in geographically diverse New York City communities. The objective of this secondary analysis is to assess the cost effectiveness of this intervention. Methods A total of 264 physician offices were randomly assigned to usual care or to a series of visits from trained physician educators. CRC screening rates were measured at baseline and 12 months. The intervention costs were measured and the incremental cost-effectiveness ratio (ICER) was derived. Sensitivity analyses were based on varying cost and effectiveness estimates. Results Academic detailing was associated with a 7% increase in CRC screening with colonoscopy. The total intervention cost was $147,865, and the ICER was $21,124 per percentage point increase in CRC screening rate. Sensitivity analyses that varied the costs of the intervention and the average medical practice size were associated with ICERs ranging from $13,631 to $36,109 per percentage point increase in CRC screening rates. Conclusion A comprehensive, multicomponent academic detailing intervention conducted in small practices in metropolitan New York was clinically effective in improving CRC screening rates, but was not cost effective.
Shankaran, Veena; Luu, Thanh Ha; Nonzee, Narissa; Richey, Elizabeth; McKoy, June M.; Graff Zivin, Joshua; Ashford, Alfred; Lantigua, Rafael; Frucht, Harold; Scoppettone, Marc; Bennett, Charles L.; Sheinfeld Gorin, Sherri
... Name: Organization Type: Hospice Multi-Location Hospice Provider Palliative CareProvider Area Served: Country: UNITED STATES State: County ... Privacy Informacion en Español Copyright National Hospice and Palliative Care Organization 1731 King Street, Suite 100 Alexandria, Virginia ...
... Information Clinical Trials Resources and Publications How do health careproviders diagnose endometriosis? Page Content Surgery is currently ... under a microscope, to confirm the diagnosis. 1 Health careproviders may also use imaging methods to produce ...
... Guide to Safe Sleep Family Life Listen A Child CareProvider's Guide to Safe Sleep Article Body Did ... Caused By: Immunizations Vomiting or choking What can child careproviders do? Follow these guidelines to help protect ...
At least 1 in 5 Americans die while using intensive care service-a number that is expected to increase as society ages. Many of these deaths involve withholding or withdrawing life-sustaining therapies. In these situations, the role of intensive care nurses shifts from providing aggressive care to end-of-life care. While hospice and palliative care nurses typically receive specialized support to cope with death and dying, intensive care nurses usually do not receive this support. Understanding the experiences of intensive care nurses in providingcare at the end of life is an important first step to improving terminal care in the intensive care unit (ICU). This phenomenological research study explores the experiences of intensive care nurses who provide terminal care in the ICU. The sample consisted of 18 registered nurses delivering terminal care in an ICU that participated in individual interviews and focus groups. Colaizzi's steps for data analysis were used to identify themes within the context of nursing. Three major themes consisted of (1) barriers to optimal care, (2) internal conflict, and (3) coping. Providing terminal care creates significant personal and professional struggles among ICU nurses. PMID:20551742
Home careprovider networks can help agencies serve more people more effectively. Before joining a health careprovider network, however, agencies must analyze several factors and find partners who share the same business and health care philosophies. Using the guidelines in this article, agencies can be confident of better decisions for their businesses. PMID:10176761
Nurse practitioners and other primary care health providers in the United States increasingly interact with clients of diverse cultures, races, and ethnic backgrounds. If this interaction is not culturally competent, underutilization of health care services, perceived noncompliance, frustration, anger, and, ultimately, inequities in the health status of clients can result. Providing culturally competent care that fosters positive health outcomes is
|This directory profiles numerous organizational support services for family day careproviders in the Kansas City metropolitan area. The first chapter, on operating a family day care home, concerns licensing and registration, the processes of starting and marketing a day care business, zoning and municipal regulation, and substitute providers.…
The current study uses telephone interview data gathered from 647 randomly-selected child careproviders (92 center-based directors, 230 center-based providers, and 325 family child careproviders) to describe one state's child care workforce and the individual beliefs, pragmatic concerns, and current regulations that may operate as barriers to providers' professional development. Results indicate meaningful differences among the three groups' demographic
A relatively new concept termed "relationship marketing" is examined in terms of its usefulness for providers targeting employers as direct purchasers of health care services. The discussion includes (1) a consideration of why employers' rhetoric about health care purchasing practices has so far exceeded the reality of change and (2) ways in which relationship marketing can be adopted by providers to influence the health care purchasing practices of organizational buyers. PMID:10289936
This concept analysis includes the definition, characteristics, boundaries, preconditions, and outcomes of the concept of trust between the family and health careprovider. Based on the results of this concept analysis, trust between the family and health careprovider is defined as a process, consisting of varying levels, that evolves over time and is based on mutual intention, reciprocity, and
The job satisfaction of physicians, nurse practitioners, and physician assistants was assessed during the course of a multicenter study of Army primary care clinics. All providers in nine clinics at three medical centers who were engaged in adult or family care were invited to participate in the study. Questionnaires on job satisfaction and other practice style variables were completed by 26 physicians, 19 nurse practitioners, and 13 physician assistants (46, 76, and 41% of eligible providers, respectively). Analysis revealed a broad range of job satisfaction in the sample. However, average levels of job satisfaction were not significantly different across the three groups of primary careproviders. Autonomy and collaboration were significant predictors of job satisfaction. It is clear that changes in health care systems that reduce, or appear to reduce, the primary careprovider's autonomy in clinical matters are likely to reduce provider satisfaction as well. PMID:10050571
Objective To assess current concussion management practices of primary careproviders. Methods An 11 item questionnaire was mailed to primary careproviders in the state of Maine, with serial mailings to non?respondents. Results Over 50% of the questionnaires were completed, with nearly 70% of primary careproviders indicating that they routinely use published guidelines as a tool in managing patients with concussion. Nearly two thirds of providers were aware that neuropsychological tests could be used, but only 16% had access to such tests within a week of injury. Conclusions Primary careproviders are using published concussion management guidelines with high frequency, but many are unable to access neuropsychological testing when it is required.
Health careproviders exert a significant influence on parental pediatric vaccination decisions. We conducted hour-long interviews with traditional and alternative health careproviders in which we explored a range of associations between vaccination perceptions and practice. A key finding was that the Health Belief Model constructs of perceived susceptibility to and severity of either an illness or an adverse vaccine event partially explained health careprovider (HCP) beliefs about the risks or benefits of vaccination, especially among alternative careproviders. Low or high perceived susceptibility to a vaccine-preventable disease (VPD) or of the severity of a given VPD affects whether an HCP will promote or oppose pediatric vaccination recommendations. Beyond these perceptions, health and vaccination beliefs are affected by the contextual factors of personal experience, group norms, immunology beliefs, and beliefs about industry and government. Building powerful affective heuristics might be critical to balancing the forces that defeat good public health practices. PMID:23964059
Text Version... read the full Fact Sheet for Health CareProviders that ... of Peramivir is 600 mg once a day, administered intravenously for 5 to 10 days. ... More results from www.fda.gov/downloads/drugs/drugsafety
A fact sheet that describes the role of palliative care, which is comfort care given to a patient who has a serious or life-threatening disease, such as cancer, from the time of diagnosis and throughout the course of illness.
The cancercare system is increasingly complex, marked by multiple hand-offs between primary care and specialty providers, inadequate communication among providers, and lack of clarity about a “medical home” (the ideal accountable careprovider) for cancer patients. Patients and families often cite such difficulties as information deficits, uncoordinated care, and insufficient psychosocial support. This article presents a review of the challenges of delivering well coordinated, patient-centered cancercare in a complex modern healthcare system. An examination is made of the potential role of information technology (IT) advances to help both providers and patients. Using the published literature as background, a review is provided of selected work that is underway to improve communication, coordination, and quality of care. Also discussed are additional challenges and opportunities to advancing understanding of how patient data, provider and patient involvement, and informatics innovations can support high-quality cancercare.
Clauser, Steven B.; Wagner, Edward H.; Bowles, Erin J. Aiello; Tuzzio, Leah; Greene, Sarah M.
Though economics is usually outcome-oriented, it is often argued that processes matter as well. Utility is not only derived from outcomes, but also from the way this outcome is accomplished. Providingcare on a voluntary basis may especially be associated with such process utility. In this paper, we discuss the process utility from providing informal care. We test the hypothesis that informal caregivers derive utility not only from the outcome of informal care, i.e. that the patient is adequately cared for, but also from the process of providing informal care. We present empirical evidence of process utility on the basis of a large sample of Dutch caregivers (n=950). We measure process utility as the difference in happiness between the current situation in which the care recipient is cared for by the caregiver and the hypothetical situation that someone else takes over the care tasks, all other things equal. Other background characteristics on patient and caregiver characteristics, objective and subjective caregiver burden and quality of life are also presented and related to process utility. Our results show that process utility exists and is substantial and therefore important in the context of informal care. Almost half of the caregivers (48.2%) derive positive utility from informal care and on average happiness would decline if informal care tasks were handed over to someone else. Multivariate regression analysis shows that process utility especially relates to caregiver characteristics (age, gender, general happiness, relation to patient and difficulties in performing daily activities) and subjective caregiver burden, whereas it also depends on the number of hours of careprovided (objective burden). These results strengthen the idea of supporting the use of informal care, but also that of keeping a close eye on the position of carers. PMID:16098415
Brouwer, Werner B F; van Exel, N Job A; van den Berg, Bernard; van den Bos, Geertruidis A M; Koopmanschap, Marc A
The purpose of Nonviolent or Empathic Communication Training is to facilitate the flow of information necessary for people to work cooperatively and resolve differences effectively. Such training is widely used in medical communities where the communication with patients and the cooperation between team members are of critical importance for the effectiveness of the treatment. Communication skills are of particular importance for health careproviders dealing with patients having chronic diseases such as haemophilia. In addition to the difficulties inherent to the chronicity of the disease, the HIV contamination has dramatically impaired the relationships between patients and health careproviders, creating a lot of pain, still alive in both parties. The purpose of this presentation is to offer to health careproviders and patients some tools to deal with their feelings and restore effective, compassionate and fulfilling communication. PMID:9873751
This qualitative study examined perceptions of foster-careproviders, service providers, and juvenile-court judges regarding privatized foster-care services in Kansas. Kansas was the first state to privatize all foster care, adoption, and family-preservation services. Most states report either beginning to implement managed-care principles in their child welfare services or exploring this option. Fifty-eight interviews with 33 participants (youth in out-of-home placements,
Kristen R. Humphrey; Ann P. Turnbull; H. Rutherford Turnbull III
Women have served aboard auxiliary U.S. Navy ships as integrated members of the shipboard work force since 1978. In 1994, women first started serving aboard combatant ships with the inclusion of women in the work force of the aircraft carrier USS Dwight D Eisenhower (CVN 69). The provision of the highest standard of medical care for both men and women is a priority at all levels in the U.S. Navy. This study assesses the perceptions of shipboard health careproviders regarding their ability to provide adequate women's health care. This evaluation was performed by conducting a personal interview with the senior health careprovider of each of 32 ships on which women are integrated members of the work force. Medical department representatives reported that most ships have training programs for birth control (90.6%), sexually transmitted diseases (96.9%), and the Navy pregnancy policy (84.4%). Health careproviders also reported limitations in available supplies (i.e., contraceptives, pregnancy tests, and sexually transmitted disease tests). PMID:9339078
... and Giving Support For Health Professionals Get Involved Lung HelpLine Questions about your lung health? Ask an ... Cancer > Treating Lung Cancer > Preparing for Treatment Your Lung CancerCare Team Each member of you cancer ...
Societies depend heavily on women for health care, yet women's own health needs are frequently neglected, their contributions to health development undervalued, and their working conditions ignored. The increasing recognition of the need for universally accessible primary health care and of people's right and duty to participate individually and collectively in their own care makes it vital to critically examine the role and status of women in its provision. A question which arises is whether the low status and prestige accorded to primary health stems from the fact that it is primarily women who provided it, or, rather, are women the main providers of such care because it is still regarded as unprestigious work and therefore to be left largely to women. Whatever the answer, the status and prestige of primary health care and the workers who provide it must be raised. To help address the problems and devise some solutions, the World Health Organization (WHO) convened consultations in 1980 and 1982. At the 1st consultation, priority issues concerning women as health careproviders were identified and suggestions made for case studies and on analyses on specific issues. These were to be carried out in 17 developing and developed countries. The 2nd consultation brought together policy analysts and decision makers from the countries concerned who examined the findings and proposed concrete activities at the international and the national level. It became clear that any comprehensive strategy designed to raise the status of women who provide health care and make their workload less onerous must focus on the following elements: educational and training; attitudes about women; health education; policies and opportunities for employment; support systems; and infrastructure development. These elements are discussed separately here, yet it should be remembered that the participants in the consultation continually stressed their interdependence. Education of women for health work must be seen in the context of the type and length of the general education that they receive. The recruitment of women to training programs will require special efforts. Once women's self-esteem increases they are likely to receive more respect and consideration from men. To acquire this self-esteem, women must organize and support each other. Changes are called for in the attitudes towards each other of health careproviders working in the formal and nonformal sectors. To provide health education for women is to train health educators for the community. Every plan for national development must include employment policies and strategies for their implementation. PMID:6649593
Singapore is a small country, but it is ideally and centrally located to conveniently serve not only its population but also patients from the surrounding regions. It’s economy is sufficiently strong to maintain highly sophisticated and expensive equipment to manage a high level of healthcare, including oncology services. Cancer incidences in Singapore are on an upward trend based on the report of the Singapore Cancer Registry for the period of 2001-2005. Cancer is the number one cause of death in Singapore. The three most common cancers for males in Singapore, in decreasing occurrences, are colorectal, lung, and prostate. For females, the three most common cancers are breast, colorectal, lung cancers. Technological advances and advances in anti-cancer drugs have transformed cancer management leading to improved outcomes worldwide and in Singapore as well. The epidemiology and management of these common cancers in Singapore are presented. While Singapore presently has five radiotherapy centres (3 public, 2 private) to service its population of 4.5 million and regional needs, the government has plans to expand its radiotherapy services to accommodate the aging population and the rising expectations of increasingly affluent cancer patients seeking advanced cancercare. The current and future initiatives spearheaded by Singapore to achieve excellence in this aspect are discussed.
To deal with the suffering caused by childhood cancer, patients and their families use different coping strategies, among which, spirituality appears a way of minimizing possible damage. In this context, the purpose of the present study was to analyze the influence of spirituality in childhood cancercare, involving biopsychosocial aspects of the child, the family, and the health care team facing the disease. To accomplish this purpose, a nonsystematic review of literature of articles on national and international electronic databases (Scientific Electronic Library Online [SciELO], PubMed, and Latin American and Caribbean Health Sciences Literature [LILACS]) was conducted using the search terms “spirituality,” “child psychology,” “child,” and “cancer,” as well as on other available resources. After the search, 20 articles met the eligibility criteria and were included in the final sample. Our review showed that the relation between spirituality and health has lately become a subject of growing interest among researchers, as a positive influence of spirituality in the people’s welfare was noted. Studies that were retrieved using the mentioned search strategy in electronic databases, independently assessed by the authors according to the systematic review, showed that spirituality emerges as a driving force that helps pediatric patients and their families in coping with cancer. Health care workers have been increasingly attentive to this dimension of care. However, it is necessary to improve their knowledge regarding the subject. The search highlighted that spirituality is considered a source of comfort and hope, contributing to a better acceptance of his/her chronic condition by the child with cancer, as well as by the family. Further up-to-date studies facing the subject are, thus, needed. It is also necessary to better train health care practitioners, so as to provide humanized care to the child with cancer.
Lima, Nadia Nara Rolim; do Nascimento, Vania Barbosa; de Carvalho, Sionara Melo Figueiredo; Neto, Modesto Leite Rolim; Moreira, Marcial Moreno; Brasil, Aline Quental; Junior, Francisco Telesforo Celestino; de Oliveira, Gislene Farias; Reis, Alberto Olavo Advincula
|Context: Pesticide exposure is an important environmental and occupational health risk for agricultural workers and their families, but health careproviders receive little training in it. Objective: To evaluate the medical resources available to providerscaring for patients, particularly farmworkers, exposed to pesticides and to recommend a…
Hiott, Ann E.; Quandt, Sara A.; Early, Julie; Jackson, David S.; Arcury, Thomas A.
|This series of leaflets provides information for family day careproviders on nine topics. Age differences and developmental stages are emphasized. The first topic concerns ways to help young children get along with others. Self-esteem is emphasized, and methods for helping children develop self-esteem are listed. The second leaflet discusses…
California Univ., Berkeley. Cooperative Extension Service.
|A resource for child caregivers providing family day care for infants and toddlers, this book is designed to provide information and suggestions in a format that is easy to follow, and in language that is easy to read. Chapter 1 gives tips on "baby-proofing" the home, as well as ideas for toys, equipment, and how to integrate a baby into the…
ABSTRACT OBJECTIVE To increase primary careproviders’ awareness and use of genetic services; increase their knowledge of genetic issues; increase their confidence in core genetic competencies; change their attitudes toward genetic testing for hereditary diseases; and increase their confidence as primary care genetic resources. DESIGN Participants completed a workshop and 3 questionnaires: a baseline questionnaire, a survey that provided immediate feedback on the workshop itself, and a follow-up questionnaire 6 months later. SETTING Ontario. PARTICIPANTS Primary careproviders suggested by deans of nursing, midwifery, family medicine, and obstetric programs, as well as coordinators of nurse practitioner programs, in Ontario and by the Ontario College of Family Physicians. INTERVENTION A complex educational intervention was developed, including an interactive workshop and PowerPoint educational modules on genetic topics for participants’ use (available at www.mtsinai.on.ca/FamMedGen/). MAIN OUTCOME MEASURES Awareness and use of genetic services, knowledge of genetics, confidence in core clinical genetic skills, attitudes toward genetic testing, and teaching activities related to genetics. RESULTS The workshop was attended by 29 participants; of those, 21 completed the baseline questionnaire and the 6-month follow-up questionnaire. There was no significant change found in awareness or reported use of genetic services. There was significant improvement in self-assessed knowledge of (P = .001) and confidence in (P = .005) skills related to adult-onset genetic disorders. There were significant increases in confidence in many core genetic competencies, including assessing risk of hereditary disorders (P = .033), deciding who should be offered referral for genetic counseling (P = .003), discussing prenatal testing options (P = .034), discussing benefits, risks, and limitations of genetic testing (P = .033), and describing what to expect at a genetic counseling session (P = .022). There was a significant increase in the number of primary careproviders agreeing that genetic testing was beneficial in the management of adult-onset diseases (P = .031) and in their confidence in being primary care genetic resources for adult-onset genetic disorders (P = .006). CONCLUSION Educational interventions that include interactive peer resource workshops and educational modules can increase knowledge of and confidence in the core competencies needed for the delivery of genetic services in primary care.
Carroll, June C.; Rideout, Andrea L.; Wilson, Brenda J.; Allanson, Judith MD; Blaine, Sean M.; Esplen, Mary Jane; Farrell, Sandra A.; Graham, Gail E.; MacKenzie, Jennifer; Meschino, Wendy; Miller, Fiona; Prakash, Preeti; Shuman, Cheryl; Summers, Anne; Taylor, Sherry
A service robot especially a care-providing robot, works in the vicinity of a human body and is sometimes even in direct contact with it. Conventional safety methods and precautions in industrial robotics are not applicable to such robots. This paper presents a safety approach for designing the safe care-providing robot FRIEND. The approach is applied in each step of design iteratively to identify and assess the potential hazards during design. The steps are explained briefly in this work. The main contribution of this paper is verification of safety requirements using the Ramadge-Wonham (RW) framework. The greater complexity of the tasks the robot will perform, the more complex is the identification of safety requirements. Use of this framework led us to analyze the requirements and verify them formally, systematically and on a modular basis. In our approach human-robot interaction (HRI) is also modeled by a set of uncontrolled events that may happen any time during operation. Subsequently the safety requirements are modified to consider these interactions. As a result the safety module behaves like a controller, running in parallel with the system, which maintains the system safe and works according to the safety requirements by enabling the admissible sequences of events. PMID:22275681
...Implementation specifications: Health careproviders. 162.410 Section...Standard Unique Health Identifier for Health CareProviders Â§ 162.410 Implementation specifications: Health careproviders. (a) A covered...
...Implementation specifications: Health careproviders. 162.410 Section...Standard Unique Health Identifier for Health CareProviders Â§ 162.410 Implementation specifications: Health careproviders. (a) A covered...
... Information Clinical Trials Resources and Publications How do health careproviders diagnose Klinefelter syndrome? Page Content The only ... karyotype (pronounced care-EE-oh-type ) test. A health careprovider will take a small blood or skin ...
Despite substantial evidence that patients with cancer commonly have significant psychosocial problems, for which we have evidence-based treatments, many patients still do not receive adequate psychosocial care. This means that we risk prolonging life without adequately addressing the quality of that life. There are many challenges to improving the current situation, the major one of which is organizational. Many cancer centers lack a system of psychosocial care that is integrated with the cancercare of the patient. Psychosocial care encompasses a range of problems (emotional, social, palliative, and logistical). The integration must occur with the cancercare of the patient at all stages (from screening to palliative care) and across all clinical sites of care (inpatient and outpatient cancer services as well as primary care). In this article, we consider the challenges we face if we are to provide such integrated psychosocial services. We focus on the collaborative care service model. This model comprises systematic identification of need, integrated delivery of care by care managers, appropriate specialist supervision, and the stepping of care based on systematic measurement of outcomes. Several trials of this approach to the management of depression in patients with cancer have found it to be both feasible to deliver and effective. It provides a model for services to meet other psychosocial needs. We conclude by proposing the key components of an integrated psychosocial service that could be implemented now and by considering what we need to do next if we are to succeed in providing better and more comprehensive care to our patients. PMID:22412139
\\u000a This chapter describes a video-based approach to assisting physicians and other health workers to become culturally competent\\u000a in prevention\\/intervention work with low-income African Americans. This approach is based on the successful Urban Cancer Project,\\u000a a National Cancer Institute funded collaboration between social scientists, a comprehensive cancer center, and a video-production\\u000a company (see, Marks et al., 2004).
OBJECTIVE: To assess family physicians' and specialists' involvement in cancer follow-up care and how this involvement is perceived by cancer patients. DESIGN: Self-administered survey. SETTING: A health region in New Brunswick. PARTICIPANTS: A nonprobability cluster sample of 183 participants. MAIN OUTCOME MEASURES: Patients' perceptions of cancer follow-up care. RESULTS: More than a third of participants (36%) were not sure which physician was in charge of their cancer follow-up care. As part of follow-up care, 80% of participants wanted counseling from their family physicians, but only 20% received it. About a third of participants (32%) were not satisfied with the follow-up careprovided by their family physicians. In contrast, only 18% of participants were dissatisfied with the follow-up careprovided by specialists. Older participants were more satisfied with cancer follow-up care than younger participants. CONCLUSION: Cancer follow-up care is increasingly becoming part of family physicians' practices. Family physicians need to develop an approach that addresses patients' needs, particularly in the area of emotional support.
|Camp Fire's Special Sitters Project addresses the need for respite care experienced by parents of disabled children. The project trains teenagers to care for young handicapped children and links the teenagers with parents who call for babysitting service. The project has been successfully replicated in five communities. (Author/JDD)|
The number of cancer survivors has been steadily increasing due in part to the aging population and advancements in cancercare and treatment. Of the current 13.7 million cancer survivors in the United States, most are 65 or older. Aging changes and the presence of comorbidities add complexity to the care of cancer survivors. In addition. common long-term cancer-related symptoms and late effects of cancer treatments provide challenges to nurses and other health professionals caring for older cancer survivors. Transition from oncology care to primary or shared care requires understanding of detailed information about the specific cancer diagnosis, treatments received, and recommendations for follow-up care to prevent recurrence, recognize treatment-associated health effects, and understand strategies for health promotion. Nurses in all practice areas will care for cancer survivors and must be prepared to deliver safe and effective care. PMID:23980661
This paper presents a clinician's views on the current status of family-focused cancercare and on future directions for supportive interventions to help families cope with cancer. Development considerations, special or high-risk groups, and a family assessment framework are discussed. Finally, recommendations on future care opportunities are proposed.
In most species, males do not abandon offspring or reduce paternal care when they are cuckolded by other males. This apparent lack of adjustment of paternal investment with the likelihood of paternity presents a potential challenge to our understanding of what drives selection for paternal care. In a comparative analysis across birds, fish, mammals, and insects we identify key factors that explain why cuckolded males in many species do not reduce paternal care. Specifically, we show that cuckolded males only reduce paternal investment if both the costs of caring are relatively high and there is a high risk of cuckoldry. Under these circumstances, selection is expected to favour males that reduce paternal effort in response to cuckoldry. In many species, however, these conditions are not satisfied and tolerant males have outcompeted males that abandon young.
Griffin, Ashleigh S.; Alonzo, Suzanne H.; Cornwallis, Charlie K.
Any health care facility is the stage for a specific kind of relationship between a person requiring care and a caregiver qualified to give it. When this place is enclosed, because the hospitalised patients also happen to be prisoners, does the nursing relationship exist with the same authenticity? This is what Michèle Tréguer works to ensure on a daily basis at the national public health facility of Fresnes. An interview with a nurse of conviction. PMID:23477086
IN BRIEF Disparities in diabetes care are prevalent in the United States. This article provides an overview of these disparities and discusses both potential causes and efforts to address them to date. The authors focus the discussion on aspects relevant to the patient-provider dyad and provide practical considerations for the primary careprovider’s role in helping to diminish and eliminate disparities in diabetes care.
White, Richard O.; Beech, Bettina M.; Miller, Stephania
... Information Clinical Trials Resources and Publications How do health careproviders diagnose Asperger syndrome? Page Content If you ... concerns about your child's development, talk the child's health careprovider right away. The provider can examine the ...
Abstract Objective Patients and palliative care experts endorse the importance of spiritual care for seriously ill patients and their families. However, little is known about spiritual care during serious illness, and whether it satisfies patients' and families' needs. The objective of this study was to describe spiritual care received by patients and families during serious illness, and test whether the provider and the type of care is associated with satisfaction with care. Methods Cross-sectional interview with 38 seriously ill patients and 65 family caregivers about spiritual care experiences. Results The 103 spiritual care recipients identified 237 spiritual careproviders; 95 (41%) were family or friends, 38 (17%) were clergy, and 66 (29%) were health careproviders. Two-thirds of spiritual careproviders shared the recipient's faith tradition. Recipients identified 21 different types of spiritual care activities. The most common activity was help coping with illness (87%) and the least common intercessory prayer (4%). Half of recipients were very or somewhat satisfied with spiritual care, and half found it very helpful for facilitating inner peace and meaning making. Satisfaction with spiritual care did not differ by provider age, race, gender, role, or frequency of visits. Types of care that helped with understanding or illness coping were associated with greater satisfaction with care. Conclusion Seriously ill patients and family caregivers experience spiritual care from multiple sources, including health careproviders. Satisfaction with this care domain is modest, but approaches that help with understanding and with coping are associated with greater satisfaction.
Dobbs, Debra; Usher, Barbara M.; Williams, Sharon; Rawlings, Jim; Daaleman, Timothy P.
BackgroundPain is the most commonly reported symptom in primary care and is a leading cause of disability. Primary careproviders (PCPs) face numerous challenges in caring for patients with chronic pain including communication and relational difficulties.
Marianne S. Matthias; Amy L. Parpart; Kathryn A. Nyland; Monica A. Huffman; Dawana L. Stubbs; Christy Sargent; Matthew J. Bair
... related to the costs of cancercare. Download ASCO’s free booklet, Managing the Cost of CancerCare, ... Order printed copies of the booklet from the ASCO University Bookstore . Help Support Cancer.Net Cancer Types ...
SUMMARY Undergraduate courses in British medical schools are changing following recommendations from the General Medical Council. Increasing emphasis has been placed on teaching in the community. Nottingham Medical School has pioneered the teaching of basic clinical skills in primary care during the pre-clinical course to help produce an integrated curriculum. This qualitative study evaluated the first two years of the
A survey questionnatre, assessing general attitudes toward the importance of nutrition m the prevention of disease and the maintenance of good health, was administered to physicians, nurses, dentists, and technicians at five U. S. Army medical centers. The various groups of health care specialists differed significantly on many items concerning the importance of good nutrition and eating habits for maintenance
The conditions of day care quality under which infants direct secure attachment behaviors toward their day careproviders were examined. Two groups of 12- to 18-month-old infants, who were experiencing either 1:4 or 1:7 caregiver-to-infant ratios, and their day careproviders, were observed while they interacted in their day care centers.…
This paper discusses the CARE (Cancer Attitude Risk Education) system, an interactive user friendly hypermedia information system that will allow users to learn more about various aspects of cancer such as risk factors, diagnosis and available treatment options. The CARE system provides information to the user through various means like text, video, graphics, photographs, animation and sound. A defining feature of the CARE system is that it collects information from the user as well as disseminating information. The CARE system collects items such as name, age, gender and answers to risk assessment questions as the user browses through the system. The data collected through the CARE system is valuable to cancer researchers and support groups.
Fotouhi, Farshad A.; Chander, Prem M.; Ragan, Don P.; Porter, Arthur
... and Publications How do health careproviders diagnose Turner syndrome? Page Content Health careproviders use a combination ... the X chromosomes is partially or completely missing. Turner syndrome also can be diagnosed during pregnancy by testing ...
...false Implementation specifications: Health careproviders. 162.410 Section 162.410 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATIVE DATA...ADMINISTRATIVE REQUIREMENTS Standard Unique Health Identifier for Health CareProviders...
The purpose of this descriptive study was to examine the knowledge and practices of military health careproviders regarding the use of emergency contraception. A cross-sectional convenience sample was used to survey 435 military health careproviders at ...
... Information Clinical Trials Resources and Publications How do health careproviders diagnose traumatic brain injury (TBI)? Page Content To diagnose TBI, health careproviders may use one or more tests that ...
... Information Clinical Trials Resources and Publications How do health careproviders diagnose Cushing’s syndrome? Page Content Diagnosing Cushing’s ... easily recognized when it is fully developed, but health careproviders try to diagnose and treat it well ...
... Information Clinical Trials Resources and Publications How do health careproviders diagnose pregnancy loss or miscarriage? Page Content ... light spotting, or bleeding, she should contact her health careprovider immediately. For diagnosis, the woman may need ...
... Information Clinical Trials Resources and Publications How do health careproviders diagnose neural tube defects? Page Content Neural ... AFP, as well as high levels of acetylcholinesterase; health careproviders might conduct this test to confirm high ...
... Information Clinical Trials Resources and Publications How do health careproviders diagnose Rett syndrome? Page Content Blood Test ... Rett syndrome may not always be present, so health careproviders also need to evaluate the child's symptoms ...
... Information Clinical Trials Resources and Publications How do health careproviders diagnose birth defects? Page Content Diagnosis of ... to begin before health problems occur. Prenatal Screening Health careproviders recommend that certain pregnant women, including those ...
... Information Clinical Trials Resources and Publications How do health careproviders diagnose Menkes disease? Page Content Screening Newborns ... 3 months old. To diagnose Menkes disease, a health careprovider will order blood tests to measure the ...
... Information Clinical Trials Resources and Publications How do health careproviders diagnose IDDs? Page Content The diagnosis of ... 1 This type of test will help the health careprovider examine the ability of a person to ...
... Information Clinical Trials Resources and Publications How do health careproviders diagnose bacterial vaginosis (BV)? Page Content Diagnosis ... BV requires a vaginal exam by a qualified health careprovider and the laboratory testing of fluid collected ...
... Information Clinical Trials Resources and Publications How do health careproviders diagnose PKU? Page Content Nearly all cases ... disabilities. 2 How are newborns tested for PKU? Health careproviders conduct a PKU screening test using a ...
... Information Clinical Trials Resources and Publications How do health careproviders diagnose POI? Page Content The key signs ... having periods for 4 months or longer, her health careprovider may take these steps to diagnose the ...
... Information Clinical Trials Resources and Publications How do health careproviders diagnose osteogenesis imperfecta? Page Content If OI is moderate or severe, health careproviders usually diagnose it during prenatal ultrasound at ...
... Information Clinical Trials Resources and Publications How do health careproviders diagnose Prader-Willi syndrome? Page Content In ... a "floppy" body and weak muscle tone, a health careprovider may conduct genetic testing for Prader-Willi ...
... Dear Health CareProvider Letter: Fluvirin and Agriflu (Influenza Virus Vaccine) Pre-Filled Syringes. ... July 20, 2010. Dear Health CareProvider,. ... More results from www.fda.gov/biologicsbloodvaccines/safetyavailability
We discuss the effects of managed care on the structure of the health care delivery system, focusing on managed-care-induced consolidation among health careproviders. We empirically investigate the relationship between HMO market share and mammography providers. We find evidence of consolidation: increases in HMO activity are associated with reductions in the number of mammography providers and with increases in the number of services produced by remaining providers. We also find that increases in HMO market share are associated with reductions in costs for mammography and with increases in waiting times for appointments, but not with worse health outcomes. PMID:10558503
While there have been no reported cases as yet on the subject of ERISA preemption of claims arising from utilization review decisions by providers, it will unquestionably be a significant issue facing providers that participate in capitated arrangements. If preemption is determined not to be available, providers will be exposed to risks from which health plans are currently shielded. Providers conducting utilization review should be following this issue as it develops, but should also be obtaining insurance for this risk to the extent it is available (e.g., it will not be available for punitive damages). Providers should also consider negotiating provisions in their contracts with health plans to the effect that any utilization review conducted by the provider is on behalf of the health plan and that the provider's utilization review activities will be covered under the health plan's liability insurance. PMID:10151241
Due to public health and safety concerns, discharge planning is increasingly prioritized by correctional systems when preparing prisoners for their reintegration into the community. Annually, private correctional health care vendors provide $3 billion of health care services to inmates in correctional facilities throughout the U.S., but rarely are contracted to provide transitional health care. A discussion with 12 people representing five private nationwide correctional health careproviders highlighted the barriers they face when implementing transitional health care and what templates of services health care companies could provide to state and counties to enhance the reentry process.
Conditions of older care recipients and their careproviders are supposed to affect each other, in light of a dialectical perspective. A possibility is the reciprocal influences between a care recipient's quality of life and his or her careprovider's burnout. A study of the possibility surveyed 232 Hong Kong Chinese older care recipients, their professional careproviders, and primary
The United States and the European Union (EU) vary widely in approaches to ensuring affordable health care coverage for our respective populations. Such variations stem from differences in the political systems and beliefs regarding social welfare. These variations are also reflected in past and future initiatives to provide high quality cancer survivorship care. The United States spends considerably more on health care compared to most European countries, often with no proven benefit. In the United States, individuals with chronic illnesses, such as cancer survivors, often experience difficulties affording insurance and maintaining coverage, a problem unknown to EU countries with national health insurance. This article reviews health policy development over time for the United States and EU and the impact for cancer survivors. For the United States, the impact of the Affordable Care Act on improving access to affordable care for cancer survivors is highlighted. For the EU, the importance of multiple-morbidity disease management, cancer plan development, and pan-European data collection for monitoring cancer outcomes is addressed. Given predicted workforce shortages and ever-increasing numbers of aging cancer survivors on both sides of the Atlantic, sharing lessons learned will be critical. PMID:23695931
Virgo, Katherine S; Bromberek, Julia L; Glaser, Adam; Horgan, Denis; Maher, Jane; Brawley, Otis W
: Cancer survivors are at risk for recurrences, new cancers, and late and long-term effects of cancer treatments. Health promotion and management of comorbid conditions remain a standard of care for cancer survivors. Nurse practitioners should collaborate with oncology specialists using a shared-care model in delivering survivorship care. PMID:24141542
|Written for child caregivers, this booklet provides very basic information about child abuse and neglect, discusses early warnings that signal when a family is in trouble or when a child is at risk, and indicates how caregivers can helpfully intervene. Also suggested are ways caregivers might protect themselves against the charge of child abuse.…
|Child careproviders are likely to be the professionals who most frequently interact with families with young children. Thus, infant and toddler child careproviders are uniquely positioned to recognize and respond to families' needs for information and support. This article describes knowledge, skills, and strategies that support child care…
Seibel, Nancy L.; Gillespie, Linda G.; Temple, Tabitha
|This position paper proposes that the State of Minnesota initiate a voluntary registration program for day careproviders who care for the children of one family in the parents' or provider's home. A brief discussion of the utilization of child care services on a national and state level focuses especially on parental preference for informal…
|Context: Rural patients have limited access to dermatologic care. Farmworkers have high rates of skin disease and limited access to care. Purpose: This exploratory study assessed whether teledermatology consultations could help meet the needs of health careproviders for farmworkers in rural clinics. Methods: Dermatologists provided 79…
Vallejos, Quirina M.; Quandt, Sara A.; Feldman, Steven R.; Fleischer, Alan B., Jr.; Brooks, Thanh; Cabral, Gonzalo; Heck, Judy; Schulz, Mark R.; Verma, Amit; Whalley, Lara E.; Arcury, Thomas A.
The aim of any health care service is to provide optimal quality care to clients and families regardless of their ethnic group. As today's Australian society comprises a multicultural population that encompasses clients with different cultural norms and values, this study examined undergraduate nursing students' self-efficacy in providing transcultural nursing care. A sample of 196 nursing students enrolled in the
... salud para tÃ Newsletters Events Newsroom Navigating the Health Care System Advice Columns from Dr. Carolyn Clancy AHRQ ... 3 2012 Consumers Learning To Recognize High-Value Health CareProviders By Carolyn M. Clancy, M.D. As ...
... caregiver.va.gov Questions to Ask a Veteran’s Health CareProviders . The list of questions below can help ... you accept? . Planning for Discharge from the Hospital/Health Care Facility . As part of the process of planning ...
Cancer patient navigation (PN) programs have been shown to increase access to and utilization of cancercare for poor and underserved individuals. Despite mounting evidence of its value, cancer patient navigation is not universally understood or provided. We describe five PN programs and the range of tasks their navigators provide across the cancercare continuum (education and outreach, screening, diagnosis and staging, treatment, survivorship, and end-of-life). Tasks are organized by their potential to make cancer services understandable, available, accessible, affordable, appropriate, and accountable. Although navigators perform similar tasks across the five programs, their specific approaches reflect differences in community culture, context, program setting, and funding. Task lists can inform the development of programs, job descriptions, training, and evaluation. They also may be useful in the move to certify navigators and establish mechanisms for reimbursement for navigation services.
Braun, Kathryn L.; Kagawa-Singer, Marjorie; Holden, Alan E. C.; Burhansstipanov, Linda; Tran, Jacqueline H.; Seals, Brenda F.; Corbie-Smith, Giselle; Tsark, JoAnn U.; Harjo, Lisa; Foo, Mary Anne; Ramirez, Amelie G.
Data governance is characterised from broader definitions of governance. These characteristics are then mapped to a framework that provides a practical representation of the concepts. This representation is further developed with operating models and roles. Several information related scenarios covering both clinical and non-clinical domains are considered in information terms and then related back to the data governance framework. This assists the reader in understanding how data governance would help address the issues or achieve a better outcome. These elements together enable the reader to gain an understanding of the data governance framework and how it applies in practice. Finally, some practical advice is offered for establishing and operating data governance as well as approaches for justifying the investment. PMID:24018525
The word altruism is derived from the Latin alteri huic meaning to this other and literally means to express a regard for others as a principle for action. Fung (1988) [JAMA, Vol. 260, No. 17, p. 2509] describes altruism as caring for no obvious reward other than the belief that someone else will benefit or avoid harm. Altruism represents an
The purpose of this study was to obtain feedback from family medicine residents and clinic nurses regarding a colorectal cancer screening (CRCS) intervention. Focus groups were used to ask participants three questions about their perceptions of the intervention and subsequent patient screening behaviors. Content analysis and constant comparison were used to yield two meaningful themes from the participant responses: patient-specific issues and study design issues. Patient-specific issues included: lack of education and fear, finances and insurance coverage, and compliance. Study design issues included: lack of time, a need for reminders to discuss CRCS with patients, quality of the nurse's role, and a need for better clinical staff education and awareness. Results show ways to significantly improve future implementation of the CRCS intervention. Ultimately, future use of clinic-based CRCS interventions could be vastly improved by utilizing strategies to promote teamwork and increase the sense of mutual ownership among clinic staff. PMID:22826203
Intensive careproviders who care for traumatized populations often face multiple traumas for extended periods and are vulnerable to developing lasting symptoms of compassion fatigue and secondary traumatization. Symptoms are often not recognizable until compassion fatigue or secondary traumatization negatively affects the providers' ability to care for their patients. More attention needs to be given to the care of the provider to ensure high-quality patient care, decrease turnover in the profession, and increase productivity. This article provides a framework for the development of an educational module for healthcare providers' self-care. This educational module created the opportunity to share with providers (a) how to explore their own professional experience; (b) how to recognize the different symptoms of compassion fatigue, primary traumatization, and secondary traumatization; (c) factors related to grief reactions; and (d) personal and professional strategies to decrease compassion fatigue and secondary traumatization. PMID:20683299
Current health care policy mandates that the unique health needs of various cultures be met and barriers to health care minimized. Birth occurs in the context of culture and religion, and an understanding of culture and religious beliefs are important for health careproviders who are challenged to provide culturally sensitive care to diverse populations. This article provides a broad background discussion of Islam for the non-Muslim. A discussion of the care of the Muslim family during the childbearing process, highlighting specific issues related to modesty and privacy, female traditional dress and covering, dietary requirements, and newborn care, are provided. Part 2 in the series will present unique risk factors, health care beliefs, breast-feeding practices, issues related to end-of-life decisions and withdrawal of support, and death rituals that may be unique to Muslim families. PMID:12881935
|With proper care, most children with asthma can lead normal, active lives and can enter school with the same abilities as other children. For this purpose, the Asthma Information Packet for Early Care and Education Providers was designed to cover the following topics: (1) Basic information; (2) How to improve early care and education environments…
Regardless of the type of small business, marketing research shows that understanding how consumers\\/clients select a particular product or service is useful when formulating a promotional program. Traditionally, marketing research results have seldom been applied to the world of child care, but child careproviders have a valuable “product” to market. Child care research indicates that the most important three
With proper care, most children with asthma can lead normal, active lives and can enter school with the same abilities as other children. For this purpose, the Asthma Information Packet for Early Care and Education Providers was designed to cover the following topics: (1) Basic information; (2) How to improve early care and education environments…
A residency requirement has been proposed as a prerequisite for all pharmacists providing direct patient care. This editorial explores the basis for requiring a residency, direct patient care offered by pharmacists with or without a residency, needs to increase interprofessional team-based health care, importance of distinguishing levels of pharmacy practice, role of pharmacy technicians, availability of residency positions, and future of pharmacy residencies. All PharmD graduates should be able to provide a certain level of direct patient care, including medication therapy management services, without completing a residency, and residency programs should be offered for complex levels of direct patient care in all practice settings. PMID:20923948
Purpose The purpose of this study was to describe provider characteristics African American pregnant women identified as important when interacting with their prenatal careproviders in an outpatient office setting. Study Design and Method A descriptive qualitative design was used to explore provider characteristics desired by African American women receiving prenatal care at two inner-city hospital–based obstetric clinics. A total of 22 African American women between the ages of 19 and 28 years participated in the study. Findings Four major provider characteristic themes emerged from the data: (a) demonstrating quality patient–provider communication, (b) providing continuity of care, (c) treating the women with respect, and (d) delivering compassionate care. Discussion and Conclusion An overarching theme revealed by the data analysis was the desire by African American women in this study to have their prenatal providers know and remember them. They wanted their providers to understand the context of their lives from their prenatal interactions. Incorporating findings from this study to improve patient–provider interactions during prenatal care could provide an increased understanding of the many complex variables affecting African American women’s lives. Implications for Practice and Research Prenatal careprovides an opportunity for African American women to develop a trusting relationship with a provider. Developing models of prenatal care congruent with the realities of African American women’s lives has the potential to improve patient–provider interactions and potentially affect birth outcomes.
Canadians are experiencing increased life expectancy and chronic illness requiring end-of-life care. There is limited research on the multiple roles for family members providing home-based palliative care. Based on a larger ethnographic study of client-family-provider relationships in home-based palliative care, this qualitative secondary analysis explores the enactment of multiple roles for family members providing home-based palliative care to seniors with advanced cancer. Family members had multiple expectations to providecare but felt their expectations of services were unmet. The process of enacting multiple roles was depicted by three interrelated themes: balancing, re-prioritizing, and evolving. Positive and negative health responses resulted from attempts to minimize personal health while simultaneously maintaining health. "True" family-centred care was found to be lacking, but should be a goal of health professionals involved in end-of-life care. PMID:19158043
Clemmer, Sarah J; Ward-Griffin, Catherine; Forbes, Dorothy
As the number of eating disorder cases rises, primary careproviders are increasingly called upon to diagnose and treat eating disorder patients. Unfortunately, few primary careproviders have the necessary experience and training to adequately treat these patients. The Eating Disorder Curriculum for Primary CareProviders has been specifically designed to addresses this lack of training and improve the rate of early detection. This is accomplished through basic didactic sessions and individualized instruction on the specifics of manualized treatment in the primary care setting. PMID:16864379
BACKGROUND AND OBJECTIVES Information about primary care physicians’ (PCPs) and oncologists’ involvement in cancer-related follow-up care, and care coordination practices, is lacking but essential to improving cancer survivors’ care. This study assesses PCPs’ and oncologists’ self-reported roles in providingcancer-related follow-up care for survivors who are within five years of completing cancer treatment. METHODS In 2009, the National Cancer Institute and American Cancer Society conducted a nationally-representative survey of PCPs (n=1014) and medical oncologists (n=1125) (response rate=57.6%; cooperation rate=65.1%). Mailed questionnaires obtained information on physicians’ roles in providingcancer-related follow-up care to early-stage breast and colon cancer survivors; personal and practice characteristics; beliefs about and preferences for follow-up care; and care coordination practices. RESULTS Over 50% of PCPs reported providingcancer-related follow-up care for survivors, mainly by co-managing with an oncologist. In contrast, over 70% of oncologists reported fulfilling these roles by providing the care themselves. In adjusted analyses, PCP co-management was associated with: specialty, training in late or long-term effects of cancer, higher cancer patient volume, favorable attitudes about PCP care involvement, preference for a shared model of survivorship care, and receipt of treatment summaries from oncologists. Among oncologists, only preference for a shared care model was associated with co-management with PCPs. CONCLUSIONS PCPs and oncologists differ in their involvement in cancer-related follow-up care of survivors, with co-management more often reported by PCPs than by oncologists. Given anticipated national shortages of PCPs and oncologists, study results suggest that improved communication and coordination between these providers is needed to ensure optimal delivery of follow-up care to cancer survivors.
Klabunde, Carrie N.; Han, Paul K. J.; Earle, Craig C.; Smith, Tenbroeck; Ayanian, John Z.; Lee, Richard; Ambs, Anita; Rowland, Julia H.; Potosky, Arnold L.
|The purpose of this handbook is to show how communities can initiate a successful recruitment campaign for family day careproviders. In 11 chapters, discussion focuses on (1) the need for recruitment; (2) the recruitment process; (3) determining day care need; (4) conducting provider surveys; (5) incentive programs; (6) training classes; (7)…
|In an effort to explain the high turnover rate among family day care (FDC) providers, a study of the effects of perceived social support, job satisfaction, and the establishment of boundaries between a family day careprovider's nuclear family and her FDC system was conducted. Analysis of data gathered from a mail survey of over 300 currently and…
Background and Objective Patient-provider language barriers may play a role in health-care disparities, including obtaining colorectal cancer (CRC)\\u000a screening. Professional interpreters and language-concordant providers may mitigate these disparities.\\u000a \\u000a \\u000a \\u000a \\u000a Design, Subjects, and Main Measures We performed a retrospective cohort study of individuals age 50 years and older who were categorized as English-Concordant\\u000a (spoke English at home, n?=?21,594); Other Language-Concordant (did not speak English at
Amy Linsky; Nathalie McIntosh; Howard Cabral; Lewis E. Kazis
A significant development in our changing society is the great number of young children cared for outside the home. Finding quality child care is an ongoing challenge for all parents who work outside the home, and is especially difficult for parents of children with special health care needs (CSHCN). Many child careproviders feel inadequately prepared to care for these
Providing quality palliative care is a daunting task profoundly impacted by diminished patient capacity at the end of life. Alzheimer disease (AD) is a disorder that erases our memories and is projected to increase dramatically for decades to come. By the time the patients with AD reach the end stage of the disease, the ability of patients to provide pertinent subjective complaints of pain and discomfort would have vanished. Historical perspectives of palliative care, exploration of the AD process, ethical issues, and crucial clinical considerations are provided to improve the understanding of disease progression and quality of care for patients with end-stage AD. PMID:22811214
The authors report the results of a symposium on improving the standards of care for patients with cancer pain. The symposium was sponsored by the Advisory Committee on Cancer Control of the National Cancer Institute of Canada and was held Apr. 8 to 10, 1994, in Toronto. Participants included experts on control of cancer pain and on diffusion techniques, patients with cancer and representatives of regulatory agencies. They suggested the following strategies to improve outcomes in patients with cancer pain. Processes for accreditation of health care institutions should require documentation of cancer pain, its treatment and its outcome. Tertiary care facilities that providecancer treatment should have expert, subspecialty, multidisciplinary programs for pain control and should provide adequate psychosocial support to patients suffering cancer pain. The Canadian Cancer Society should conduct a public-education campaign to encourage patients to report pain to health careproviders. The National Cancer Institute of Canada should foster research on cancer pain by restructuring its process for review of pain-research protocols. Examinations for professionals who care for patients with cancer should include a defined number of questions concerning pain and symptom control. Provincial programs to monitor prescribing through the use of triplicate prescription pads should have an educational as well as regulatory purpose.
Over the past two decades, paediatric palliative care has emerged as both a primary approach and as its own medical subspecialty, the overall aim of which is to ease suffering for children with life-threatening illness and their families through a concurrent model of care. However, most discussions have been focused on the transition to palliative care when no realistic hope for cure exists. We believe that, because the course of cancer is so unpredictable, this idea is misleading. Indeed, palliative care is increasingly being recognized as being about not just how to cope with the process of dying, but also about how to engage in living when faced with a life-threatening illness. This article will examine our current understanding of several areas of palliative care, with the ultimate message that palliative care is simply a novel term for the total care of a child and family, an approach that should be applied consistently and concurrently regardless of disease status. By improving familiarity with palliative care and building relationships with palliative care specialists, the paediatric oncology clinician will ensure that the best care possible for children and families is provided, regardless of outcome. PMID:23337915
Orem's Supportive-Educative system theory provided a conceptual foundation to care for a young mother's critical needs to learn how to care for her infant. Esthetic and ethical patterns of knowing were particularly useful in implementing the needed education. By employing these patterns of knowing, the student nurses could more accurately plan the most effective approach to teaching this new mother,
|These guidelines are the product of a new Pediatric Asthma Initiative aimed at integrating environmental management of asthma into pediatric health care. This document outlines competencies in environmental health relevant to pediatric asthma that should be mastered by primary health careproviders, and outlines the environmental interventions…
The report is a new in-depth study of the sacrifices American families make to provide home care to elderly parents, spouses, and other relatives. It examines the demographics of elderly Americans who have difficulty caring for themselves for a period of ...
Individuals at high risk for hereditary cancers often receive genetic counseling and testing at tertiary care centers; however,\\u000a they may receive care for long-term management of their cancer risk in community settings. Communication of genetic test results\\u000a to health careproviders outside of tertiary care settings can facilitate the long-term management of high risk individuals.\\u000a This study assessed women’s communication
K. Ready; B. K. Arun; K. M. Schmeler; A. Uyei; J. K. Litton; K. H. Lu; C. C. Sun; S. K. Peterson
... care for children and young adults. This study was created to gain new knowledge and educate cancer survivors ... Adult Cancers . Journey Forward is a program that was created by the National Coalition for Cancer Survivorship, the ...
Because there is increasing demand for critical careproviders in the United States, many medical ICUs for adults have begun to integrate nurse practitioners and physician assistants into their medical teams. Studies suggest that such advanced practice providers (APPs), when appropriately trained in acute care, can be highly effective in helping to deliver high-quality medical critical care and can be important elements of teams with multiple providers, including those with medical house staff. One aspect of building an integrated team is a practice model that features appropriate coding and billing of services by all providers. Therefore, it is important to understand an APP's scope of practice, when they are qualified for reimbursement, and how they may appropriately coordinate coding and billing with other team providers. In particular, understanding when and how to appropriately code for critical care services (Current Procedural Terminology [CPT] code 99291, critical care, evaluation and management of the critically ill or critically injured patient, first 30-74 min; CPT code 99292, critical care, each additional 30 min) and procedures is vital for creating a sustainable program. Because APPs will likely play a growing role in medical critical care units in the future, more studies are needed to compare different practice models and to determine the best way to deploy this talent in specific ICU settings. PMID:23460162
McCarthy, Christine; O'Rourke, Nancy C; Madison, J Mark
... Home Living with Bowel Control Problems Resources Bowel Control Awareness Campaign Home Resources for Health CareProviders ... do I tell my doctor about my bowel control problem? The more details and examples you can ...
|Explores the role of clinical librarians in providing information services to patients, as they accompany health professionals during daily patient care activities, and examines two projects evaluating clinical librarianship. (CWM)|
... Talk With Your Health CareProvider About High Cholesterol Partnership for HEALTH Here are some questions to ... prevention.va.gov and April 2009 If your cholesterol is in the desirable range and you are ...
... FDA alerts patients and health careproviders not to use budesonide solution ... The US Food and Drug Administration is alerting patients and health ... More results from www.fda.gov/drugs/drugsafety
...DEPARTMENT OF HOMELAND SECURITY PERSONNEL CHILD DEVELOPMENT SERVICES General Â§ 55.13 Family child careproviders. When appropriated...to the cost of services at Coast Guard child development centers. 33 CFR Ch. I...
Provider profiling as a means to describe and compare the performance of health care professionals has gained momentum in the past decade. As a key component of pay-for-performance programs profiling has been increasingly used to identify top-performing providers. However, rigorous examination of the performance of statistical methods for profiling when used to classify top-performing providers is lacking. The objective of this study was to compare the classification accuracy of three methods for identifying providers exceeding performance thresholds and to analyze data on satisfaction with mental health careproviders at Group Health Cooperative using these methods. Questionnaire data on patient satisfaction with mental health careproviders at Group Health Cooperative was collected between April 2008 and January 2010. Simulated data were used to compare the classification accuracy of alternative statistical methods. We evaluated sensitivity, specificity, and root mean squared error of alternative statistical methods using simulated data. For Group Health providers, we compared agreement of alternative approaches to classification. We found that when between-provider variability in performance was low, all three methods exhibited poor classification accuracy. When used to evaluate mental health careprovider performance, we found substantial uncertainty in the estimates and poor agreement across methods. Based on these findings, we recommend providing uncertainty estimates for provider rankings and caution against the use of any classification method when between-provider variability is low. PMID:23565050
Ding, Victoria Y; Hubbard, Rebecca A; Rutter, Carolyn M; Simon, Gregory E
Because of the difficulty of finding time for professional and personal development, many family child care (FCC) providers are isolated in their work environment. This practicum study developed a provider-initiated support network to reduce this isolation. The local FCC association provided advertising about the formation of the network. A group…
|Because of the difficulty of finding time for professional and personal development, many family child care (FCC) providers are isolated in their work environment. This practicum study developed a provider-initiated support network to reduce this isolation. The local FCC association provided advertising about the formation of the network. A group…
Primary care physicians and clinics have become the frontline of health care for most Americans-they are the first point of contact and the source of both treatment and referrals. Psychosocial problems, such as difficulty with finances, family, housing, and work, are associated with a high demand for medical care in primary care practice, yet little is known about the prevalence of psychosocial problems in primary care settings. The purpose of this study is to assess the type and level of psychosocial problems in primary care patients by examining patient and provider perceptions at the Veterans Affairs Greater Los Angeles Healthcare System (VAGLAHS). A purposive sample of 684 veterans and a convenience sample of 59 providers anonymously completed the Social Needs Checklist. Patients reported an average of five psychosocial problems, with finances, personal stress, transportation, employment, and legal issues being the most prevalent. Thirty-two percent of patients indicated a desire to see a social worker. Provider and patient differences were compared. Provider estimates of patients' problems were consistently lower than patient estimates in all psychosocial problem areas except need for nursing home placement and problem drinking or drug use. Implications for social work in primary care are discussed. PMID:20182986
Background Aboriginal Australians have a lower rate of utilisation of palliative care services than the general population. This study aimed to explore careproviders’ experiences and concerns in providing palliative care for Aboriginal people, and to identify opportunities for overcoming gaps in understanding between them and their Aboriginal patients and families. Methods In-depth, qualitative interviews with urban, rural and remote palliative careproviders were undertaken in inpatient and community settings in Western Australia. Interviews were audio-recorded, transcribed verbatim and coded independently by two researchers with QSR NVivo 10 software used to help manage data. Data analysis was informed by multiple theoretical standpoints, including the social ecological model, critical cultural theories and the ‘cultural security’ framework. Thematic analysis was carried out that identified patterns within data. Results Fifteen palliative careproviders were interviewed. Overall they reported lack of understanding of Aboriginal culture and being uncertain of the needs and priorities of Aboriginal people during end-of-life care. According to several participants, very few Aboriginal people had an understanding of palliative care. Managing issues such as anger, denial, the need for non-medical support due to socioeconomic disadvantage, and dealing with crises and conflicts over funeral arrangements were reported as some of the tensions between Aboriginal patients and families and the service providers. Conclusion Early referral to palliative care is important in demonstrating and maintaining a caring therapeutic relationship. Paramount to meeting the needs for Aboriginal patients was access to appropriate information and logistical, psychological and emotional support. These were often seen as essential but additional to standard palliative care services. The broader context of Aboriginal history and historical distrust of mainstream services was seen to impinge on Aboriginal people’s willingness and ability to accept care and support from these services. This context needs to be understood and acknowledged at the system level. More cultural safety training was requested by careproviders but it was not seen as replacing the need for an Aboriginal worker in the palliative care team.
One way in which the psychosocial needs of cancer patients can be addressed is through support groups, which are often recommended to patients by healthcare professionals. The present study aimed to assess the effectiveness of Gilda's Club in meeting the needs of cancer patients during their first year of membership and whether their experience with this organization was a positive
Diabetes is a life-long illness condition that many diabetic patients end up with related complications resulted largely from lacking of proper supports. The success of diabetes care relies mainly on patient's daily self-care activities and careproviders' continuous support. However, the self-care activities are socially bounded with patient's everyday schedules that can easily be forgotten or neglected and the care support from providers has yet been fully implemented. This study develops a Web 2.0 diabetes care support system for patients to integrate required self-care activities with different context in order to enhance patient's care knowledge and behavior adherence. The system also supports care managers in a health service center to conduct patient management through collecting patient's daily physiological information, sharing care information, and maintaining patient-provider relationships. After the development, we evaluate the acceptance of the system through a group of nursing staffs. PMID:21369781
Although primary care is fundamental to health system performance, the United States has undervalued and underinvested in primary care for decades. This brief describes how the Affordable Care Act will begin to address the neglect of America's primary care system and, wherever possible, estimates the potential impact these efforts will have on patients, providers, and payers. The health reform law includes numerous provisions for improving primary care: temporary increases in Medicare and Medicaid payments to primary careproviders; support for innovation in the delivery of care, with an emphasis on achieving better health outcomes and patient care experiences; enhanced support of primary careproviders; and investment in the continued development of the primary care workforce. PMID:21261124
Human trafficking is a major public health problem, both domestically and internationally. Health careproviders are often the only professionals to interact with trafficking victims who are still in captivity. The expert assessment and interview skills of providers contribute to their readiness to identify victims of trafficking. The purpose of this article is to provide clinicians with knowledge on trafficking and give specific tools that they may use to assist victims in the clinical setting. Definitions, statistics, and common health care problems of trafficking victims are reviewed. The role of the health careprovider is outlined through a case study and clinical practice tools are provided. Suggestions for future research are also briefly addressed. PMID:20732668
A family-practice residency program has been involved in providing direct patient care to a number of Native communities in a remote area of Manitoba. The residents and preceptors have providedcare on site in the communities, as well as being the primary referral services in the tertiary-care setting. During the 12 years of the program's evolution much experience was gained in dealing with a generally high-risk obstetric population whose care was complicated by such factors as language barriers, distance, and economic and social circumstances. The author of this article reviews the nature of the program and the issues, medical and other, that it deals with, making some reference to experience of similar populations elsewhere.
We assess the satisfaction of mental health providers using four dimensions from the medical practice literature--degree of autonomy, relationship with patients, compensation, and administrative burden--and extend current work on professional satisfaction to include frontline service providers rather than only psychiatrists or other physicians. In contrast to results reported for primary care settings, we find that the impact of managed care on satisfaction is minimal for the mental health providers in our study of a Medicaid capitation demonstration in the southeastern US. Instead, variables relevant to everyday working conditions have an important effect on job satisfaction. PMID:19002581
Isett, Kimberley R; Ellis, Alan R; Topping, Sharon; Morrissey, Joseph P
Aims: The aim of the current study was to explore the extent of knowledge health careproviders working in primary health care units in Aydin, Turkey, had about emergency contraception (EC), to determine whether they provide EC counseling, and to understand the barriers and misconceptions in this context. Methods: A total of 120 health care professionals working in primary health
This paper examines version 6 of the Standards of Care for Gender Identity Disorders (SOC) of the World Professional Association of Transgender Health. The SOC help providers to “understand the parameters within which they may offer assistance to” transgender clients. Flexibility is one of the strengths of the SOC, allowing for customization both at the client and provider level. Treatment
Background: As newborn screening (NBS) expands to meet a broader definition of benefit, the scope of parental consent warrants reconsideration. Methods: We conducted a mixed methods study of health careprovider attitudes toward consent for NBS, including a survey (n = 1,615) and semi-structured interviews (n = 36). Results: Consent practices and attitudes varied by provider but the majority supported
F. A. Miller; R. Z. Hayeems; J. C. Carroll; B. Wilson; J. Little; J. Allanson; J. P. Bytautas; M. Paynter; R. Christensen; P. Chaktraborty
This publication provides an introduction to earthquake safety for child careproviders based in their homes and those based in larger facilities. You can never tell when there will be an earthquake, but you can take steps to reduce or avoid damage, injur...
... provider can perform developmental screening to determine the nature of delays in a child. If a health careprovider suspects the child has Fragile X syndrome, he/she can refer parents to a clinical geneticist, who can perform a genetic test for Fragile X syndrome. 2 National Fragile ...
OBJECTIVE: To examine associations of patient ratings of communication by health careproviders with patient language (English vs Spanish)\\u000a and ethnicity (Latino vs white).\\u000a \\u000a \\u000a METHODS: A random sample of patients receiving medical care from a physician group association concentrated on the West Coast was\\u000a studied. A total of 7,093 English and Spanish language questionnaires were returned for an overall response
Leo S. Morales; William E. Cunningham; Julie A. Brown; Honghu Liu; Ron D. Hays
The aim of any health care service is to provide optimal quality care to clients and families regardless of their ethnic group. As today's Australian society comprises a multicultural population that encompasses clients with different cultural norms and values, this study examined undergraduate nursing students' self-efficacy in providing transcultural nursing care. A sample of 196 nursing students enrolled in the first and fourth year of a pre-registration nursing program in a Western Australian University were invited to participate in a survey incorporating a transcultural self-efficacy tool (TSET) designed by Jeffery [Unpublished instrument copyrighted by author, 1994]. The findings revealed that fourth year students, exposed to increased theoretical information and clinical experience, had a more positive perception of their self-efficacy in providing transcultural nursing skills than the first year students. In addition, the study found that age, gender, country of birth, languages spoken at home and previous work experience did not influence the nursing students' perception of self-efficacy in performing transcultural care. The study supports the notion that educational preparation and relevant clinical experience is important in providing nursing students with the opportunity to develop self-efficacy in performing effective and efficient transcultural nursing in today's multicultural health care system. It is for this reason that educators need to focus on providing students with relevant theoretical information and ensure sufficient clinical exposure to support student learning in the undergraduate program. PMID:15312951
BACKGROUND Alcohol misuse is a common and well-documented source of morbidity and mortality. Brief primary care alcohol counseling has been shown to benefit patients with alcohol misuse. OBJECTIVE To describe alcohol-related discussions between primary careproviders and patients who screened positive for alcohol misuse. DESIGN An exploratory, qualitative analysis of audiotaped primary care visits containing discussions of alcohol use. PARTICIPANTS Participants were 29 male outpatients at a Veterans Affairs (VA) General Internal Medicine Clinic who screened positive for alcohol misuse and their 14 primary careproviders, all of whom were participating in a larger quality improvement trial. MEASUREMENTS Audiotaped visits with any alcohol-related discussion were transcribed and coded using grounded theory and conversation analysis, both qualitative research techniques. RESULTS Three themes were identified: (1) patients disclosed information regarding their alcohol use, but providers often did not explore these disclosures; (2) advice about alcohol use was typically vague and/or tentative in contrast to smoking-related advice, which was more common and usually more clear and firm; and (3) discomfort on the part of the provider was evident during alcohol-related discussions. LIMITATIONS Generalizability of findings from this single-site VA study is unknown. CONCLUSION Findings from this single site study suggest that provider discomfort and avoidance are important barriers to evidence-based brief alcohol counseling. Further investigation into current alcohol counseling practices is needed to determine whether these patterns extend to other primary care settings, and to inform future educational efforts.
McCormick, Kinsey A; Cochran, Nancy E; Back, Anthony L; Merrill, Joseph O; Williams, Emily C; Bradley, Katharine A
As HIV-related prophylactic and therapeutic research findings continue to evolve, the Health Resources and Services Administration (HRSA) of the Public Health Service has created multidisciplinary mechanisms to disseminate new treatment options and educate primary careproviders at rural and urban sites throughout our nation's health care system. HRSA has implemented (a) the International State-of-the-Art HIV Clinical Conference Call Series, (b) the national network of AIDS Education and Training Centers, (c) the nationwide HIV Telephone Consultation Service, and (d) the Clinical Issues Subcommittee of the HRSA AIDS Advisory Committee. These collaborative and comprehensive efforts at HIV information dissemination target physicians, nurses, physician assistants, dentists, clinical pharmacists, mental health careproviders, case managers, and allied health professionals. The sites where they providecare include public health clinics; county, State and Federal correctional facilities; private practice offices; community and academic hospitals; military and Veterans Administration facilities; hemophilia centers; schools of medicine, nursing, and dentistry; departments of health; chronic care facilities; visiting nurse and home care agencies; health maintenance organizations; and Indian Health Service clinics and hospitals.
Objectives This article describes successful institutionally-based programs for providing high quality palliative care to people with cancer and their family members. Challenges and opportunities for program development are also described. Data Sources Published literature from 2000 to present describing concurrent oncology palliative care clinical trials, standards and guidelines were reviewed. Conclusion Clinical trials have demonstrated feasibility and positive outcomes and formed the basis for consensus guidelines that support concurrent oncology palliative care models. Implications for nursing practice Oncology nurses should advocate for all patients with advanced cancer and their families to have access to concurrent oncology palliative oncology care from the time of diagnosis with a life-limiting cancer.
Bakitas, Marie; Bishop, Margaret Firer; Caron, Paula; Stephens, Lisa
Background Internet mailing lists are an important and increasingly common way for cancer survivors to find information and support. Most studies of these mailing lists have investigated lists dedicated to one type of cancer, most often breast cancer. Little is known about whether the lessons learned from experiences with breast cancer lists apply to other cancers. Objectives The aim of the study was to compare the structural characteristics of 10 Internet cancer-related mailing lists and identify the processes by which cancer survivors provide support. Methods We studied a systematic 9% sample of email messages sent over five months to 10 cancer mailing lists hosted by the Association of Cancer Online Resources (ACOR). Content analyses were used to compare the structural characteristics of the lists, including participation rates and members’ identities as survivors or caregivers. We used thematic analyses to examine the types of support that list members provided through their message texts. Results Content analyses showed that characteristics of list members and subscriber participation rates varied across the lists. Thematic analyses revealed very little “off topic” discussion. Feedback from listowners indicated that they actively modeled appropriate communication on their lists and worked to keep discussions civil and focused. In all lists, members offered support much more frequently than they requested it; survivors were somewhat more likely than caregivers to offer rather than to ask for support. The most common topics in survivors’ messages were about treatment information and how to communicate with health careproviders. Although expressions of emotional support were less common than informational support, they appeared in all lists. Many messages that contained narratives of illness or treatment did not specifically ask for help but provided emotional support by reassuring listmates that they were not alone in their struggles with cancer. Survivors’ explicit expressions of emotional support tended to be messages that encouraged active coping. Such messages also provided senders with opportunities to assume personally empowering “helper” roles that supported self-esteem. Conclusions Many cancer survivors use the Internet to seek informational and emotional support. Across 10 lists for different cancers, informational support was the main communication style. Our finding of an emphasis on informational support is in contrast to most prior literature, which has focused on emotional support. We found the most common expressions of support were offers of technical information and explicit advice about how to communicate with health careproviders. Topics and proportions of informational and emotional support differed across the lists. Our previous surveys of ACOR subscribers showed that they join the lists primarily to seek information; this qualitative study shows that they can and do find what they seek. They also find opportunities to play rewarding roles as support givers.
Lyons, Elizabeth J; Frydman, Gilles; Forlenza, Michael; Rimer, Barbara K
Cancer treatment can have a significant impact on an individual's quality of life. In particular, body image and sexuality can be compromised. There is increasing evidence that conversations about these specific consequences are not happening often between cancer patients and health careproviders, especially in busy ambulatory settings. This study was undertaken to explore the perspectives of cancercareproviders regarding the conversations about sexuality that happen following a cancer diagnosis. There was a desire to understand more about the barriers that exist with regards to having this conversation in daily practice. Thirty-four cancercare professionals (nurses, physicians, social workers and radiation therapists) were interviewed to explore their experiences in having conversations about sexuality. Transcripts were subjected to a standard qualitative content and theme analysis. Six themes emerged from the analysis. Overall, participants acknowledged treatment can have an impact on a patient's sexuality. For the most part, any conversations about sexuality topics occurred during informed consent processes before treatment began or when a patient raised a question about a side effect. However, these conversations rarely covered more than the physical side effects and did not focus on the impact of those side effects on emotional and personal relationships or intimacy. Most providers waited for patients to raise any concerns and expressed their own personal discomfort and lack of training in holding these types of conversations. They perceived the conversations as difficult for themselves and for patients. The findings support the need to clarify role expectations for cancer nurses, as well as other members of the cancercare team, about patient care regarding sexuality, and the provision of education to support the expected role. PMID:24028036
Fitch, Margaret I; Beaudoin, Gerry; Johnson, Beverley
This qualitative study aimed to describe, from the perspective of domestic violence survivors, what helped victims in health care encounters improve their situation and thus their health, and how disclosure to and identification by health careproviders were related to these helpful experiences. Semi-structured, open-ended interviews were conducted with a purposeful sample of survivors in the San Francisco Bay Area. Data were analyzed using constant comparative techniques and interpretative processes. Twenty-five women were interviewed, the majority being white and middle-class, with some college education. Two overlapping phenomena related to helpful experiences emerged: (1) the complicated dance of disclosure by victims and identification by health careproviders, and (2) the power of receiving validation (acknowledgment of abuse and confirmation of patient worth) from a health careprovider. The women described a range of disclosure and identification behaviors from direct to indirect or tacit. They also described how-with or without direct identification or disclosure-validation provided "relief," "comfort," "planted a seed," and "started the wheels turning" toward changing the way they perceived their situations, and moving them toward safety. Our data suggest that if health careproviders suspect domestic violence, they should not depend on direct disclosure, but rather assume that the patient is being battered, acknowledge that battering is wrong, and confirm the patient's worth. Participants described how successful validation may take on tacit forms that do not jeopardize patient safety. After validating the patient's situation and worth, we suggest health careproviders document the abuse and plan with the patient for safety, while offering ongoing validation, support, and referrals. PMID:10466514
Gerbert, B; Abercrombie, P; Caspers, N; Love, C; Bronstone, A
This literature review investigates nurses' attitudes towards providing artificial nutrition and hydration (ANH) in the palliative care setting. Various factors that influence nurses' attitudes are examined. While some of the findings have limited generalisability because of the dearth of evidence originating from the UK, United States and western Europe, the issues should still be considered. It is recommended that more research is carried out examining nurses' attitudes towards providing ANH in palliative care in the UK, to gain a better understanding of the factors that may influence decision making. PMID:23431937
OBJECTIVE: To determine the incidence and variability of antibiotic use in facilities which provide chronic care and to determine how\\u000a often clinical criteria for infection are met when antibiotics are prescribed in these facilities.\\u000a \\u000a \\u000a DESIGN: A prospective, 12-month, observational cohort study.\\u000a \\u000a \\u000a \\u000a \\u000a SETTING: Twenty-two facilities which provide chronic care in southwestern Ontario.\\u000a \\u000a \\u000a \\u000a \\u000a PARTICIPANTS: Patients who were treated with systemic antibiotics over
Mark Loeb; Andrew E. Simor; Lisa Landry; Stephen Walter; Margaret McArthur; JoAnn Duffy; Debora Kwan; Allison McGeer
Attitudes of health careproviders and medical and nursing students (n = 513) towards tattooed adults and adolescents were examined. No respondent group had mean scores reflecting a positive attitude towards tattooed persons. Overall, physicians (MDs) and registered nurses (RNs) rated tattooed people less positively than did students. Womens' attitudes were consistently less favourable than those of men, especially towards tattooed professional women. Attitudes towards tattooed adolescents were generally less positive than attitudes towards the adult groups. Research has found that negative attitudes impact patient care. This study suggests that tattooed persons, especially adolescents, may be at risk of being negatively perceived when they seek health care. Increased efforts are needed to assure that those with tattoos receive non-judgemental and sensitive care. PMID:9663867
Obstructive sleep apnea (OSA) is a sleep disorder affecting 18 million Americans. The prevalence of OSA is increasing due to an epidemic rise in obesity, which is a major contributing factor. The primary treatment for OSA is continuous positive airway pressure, designed to maintain a patent airway for unobstructed breathing. OSA patients may experience postoperative hypoventilation due to residual anesthetic, analgesic requirements, and other comorbidities. Postoperative health careproviders must be prepared to assess for hypoventilation and intervene using evidence-based interventions to improve outcomes. It is incumbent that the PACU nurse be aware of and implement evidence-based clinical guidelines for patients with OSA. Therefore, the purpose of this manuscript is to (1) describe the physiology, comorbidities, diagnosis, and treatment of OSA; (2) identify the effects of anesthesia in persons with OSA; (3) discuss clinical guidelines; and (4) describe implications for care in an effort to improve health outcomes in persons with OSA during the perianesthesia period. PMID:23021446
Diffee, Pamela D; Beach, Michelle M; Cuellar, Norma G
AbstractIntroductionThere is a little consensus on how to manage the supportive and palliative care needs of people with lung cancer once they have completed initial treatment. We aimed to gain insights into the perspectives of clinicians and service users as to how primary care could provide better care in collaboration with lung cancer specialists.MethodsWe conducted a qualitative study encompassing (a)
G Highet; S A Murray; C Campbell; M Kendall; P Rainey; R Neal; P Rose; C Anandan; E Amoakwa; D Weller
Factorial surveys were used to examine community-based long-term careproviders' judgments about consumers' need for advance care planning (ACP) and comfort levels in discussing ACP. Providers (448 registered nurses and social workers) judged vignettes based on hypothetical consumers. Hierarchical linear models indicated providers judged consumers who were older, had end-stage diagnoses, multiple emergency department visits, and uninvolved caregivers as most in need of ACP. These variables explained 10% of the variance in judgments. Providers' beliefs about ACP predicted judgments of need for ACP and comfort level in discussing ACP. Provider characteristics explained more variance in comfort levels (44%) than in judgments of need (20%). This study demonstrates the need for tailored educational programs to increase comfort levels and address ACP misconceptions. PMID:23125397
Breast cancer and cervical cancer are major contributors to morbidity and mortality among Vietnamese Canadian women. Vietnamese women are at risk because of their low participation rate in cancer-preventative screening programmes. Drawing from the results of a larger qualitative study, this paper reports factors that influence Vietnamese women's participation in breast and cervical cancer screening from the healthcare providers' perspectives. The women participants' perspective was reported elsewhere. Semistructured interviews were conducted with six healthcare providers. Analysis of these interviews reveals several challenges which healthcare providers encountered in their clinical practice. These include the physicians' cultural awareness about the private body, patient's low socioeconomic status, the healthcare provider-patient relationship, and limited institutional support. This is the first Canadian study to identify the healthcare providers' perspective on giving breast and cervical cancer preventive care to the Vietnamese immigrant women. The insight gained from these healthcare providers' experiences are valuable and might be helpful to healthcare professionals caring for immigrant women of similar ethno-cultural backgrounds. Recommendations for the promotion of breast cancer and cervical cancer screening among Vietnamese women include: (i) effort should be made to recruit Vietnamese-speaking female healthcare professionals for breast and cervical health-promotion programmes; (ii) reduce woman-physicians hierarchical relationship and foster effective doctor-patient communication; (iii) healthcare providers must be aware of their own cultural beliefs, values and attitudes that they bring to their practice; and (iv) more institutional support and resources should be given to both Vietnamese Canadian women and their healthcare providers. PMID:18476858
Background Like all health care consumers, pregnant women have the right to make autonomous decisions about their medical care. However, this right has created confusion for a number of maternity care stakeholders, particularly in situations when a woman’s decision may lead to increased risk of harm to the fetus. Little is known about careproviders’ perceptions of this situation, or of their legal accountability for outcomes experienced in pregnancy and birth. This paper examined maternity careproviders’ attitudes and beliefs towards women’s right to make autonomous decisions during pregnancy and birth, and the legal responsibility of professionals for maternal and fetal outcomes. Methods Attitudes and beliefs around women’s autonomy and health professionals’ legal accountability were measured in a sample of 336 midwives and doctors from both public and private health sectors in Queensland, Australia, using a questionnaire available online and in paper format. Student’s t-test was used to compare midwives’ and doctors’ responses. Results Both maternity care professionals demonstrated a poor understanding of their own legal accountability, and the rights of the woman and her fetus. Midwives and doctors believed the final decision should rest with the woman; however, each also believed that the needs of the woman may be overridden for the safety of the fetus. Doctors believed themselves to be ultimately legally accountable for outcomes experienced in pregnancy and birth, despite the legal position that all health care professionals are responsible only for adverse outcomes caused by their own negligent actions. Interprofessional differences were evident, with midwives and doctors significantly differing in their responses on five of the six items. Conclusions Maternity care professionals inconsistently supported women’s right to autonomous decision making during pregnancy and birth. This finding is further complicated by careproviders’ poor understanding of legal accountability for outcomes experienced in pregnancy and birth. The findings of this study support the need for guidelines on decision making in pregnancy and birth for maternity care professionals, and for recognition of interprofessional differences in beliefs around the rights of the woman, her fetus and health professionals in order to facilitate collaborative practice.
In 2005, the Level III neonatal intensive care unit (NICU) at Rush University Medical Center initiated a demonstration project employing breastfeeding peer counselors, former parents of NICU infants, as direct lactation careproviders who worked collaboratively with the NICU nurses. This article describes the conceptualization, implementation, and evaluation of this program and provides templates for other NICUs that wish to incorporate breastfeeding peer counselors with the goal of providing quality, evidence-based lactation care. PMID:23563112
Meier, Paula P; Engstrom, Janet L; Rossman, Beverly
As cancer is the leading cause of death worldwide, every nurse will be required to care for patients with the condition at some point in his/her career. However, non-specialized oncology nurses are often ill-prepared to nurse patients suffering from cancer. This literature review aims to provide an overview of current trends and developments in cancercare nursing in an attempt to identify the range of previous research pertaining to caring for patients with cancer on non-specialist wards. The review finds that non-specialized cancer nurses report a lack of education and training with regard to cancercare and cancer treatments, which acts as a barrier to providing quality nursing care. Emotional and communication issues with patients and their families can also cause non-specialist nurses significant distress. International research has shown that specialist oncology nurses make a considerable difference to physical and psychosocial patient care. It is therefore paramount that non-speciality nurses' educational needs are met to develop clinical competence and to provide supportive holistic care for both patients and their families. PMID:20622795
Although yoga has been practiced in Eastern culture for thousands of years as part of life philosophy, classes in the United States only recently have been offered to people with cancer. The word yoga is derived from the Sanskrit root yuj, meaning to bind, join, and yoke. This reflection of the union of the body, mind, and spirit is what differentiates yoga from general exercise programs. Yoga classes in the United States generally consist of asanas (postures), which are designed to exercise every muscle, nerve, and gland in the body. The postures are combined with pranayama, or rhythmic control of the breath. As a complementary therapy, yoga integrates awareness of breath, relaxation, exercise, and social support--elements that are key to enhancing quality of life in patients with cancer. Yoga practice may assist cancer survivors in managing symptoms such as depression, anxiety, insomnia, pain, and fatigue. As with all exercise programs, participants need to be aware of potential risks and their own limitations. The purpose of this article is to familiarize nurses with yoga as a complementary therapy, including current research findings, types of yoga, potential benefits, safety concerns, teacher training, and ways to integrate yoga into cancercare. PMID:18258582
Describes the transformation of women from babysitters to child care professionals as a result of becoming a family child careprovider in the U.S. military Family Child Care (FCC) program. Discusses application process, orientation training, the use of peer mentors, initial setup, inspections, enrollment, caregiver training, and accreditation.…
Examines how health care reform might be structured to provide support for a package of primary care services for children of all socioeconomic strata. An insurance-like financing system, such as the special Medicaid payment system adopted by New York State for public and nonprofit primary health care programs, may be useful as a model for a…
BACKGROUND: Placebo interventions can have meaningful effects for patients. However, little is known about the circumstances of their use in clinical practice. We aimed to investigate to what extent and in which way Swiss primary careproviders use placebo interventions. Furthermore we explored their ideas about the ethical and legal issues involved. METHODS: 599 questionnaires were sent to general practitioners
Margrit Fässler; Markus Gnädinger; Thomas Rosemann; Nikola Biller-Andorno
Recent studies project a significant shortage of U.S. health careproviders within the next decade. To address southeastern Kentucky's persistent undersupply of medical professionals, a multi-county Health Career Enrichment Camp for rising 9th and 10th grade students was implemented in 2008. This report describes the annual camp's development and preliminary outcomes. PMID:22643617
Gross, David A; Bates, Pamela; Knox, Tamara L; Gayheart, Michael W
... and/or discrimination. Lesbians need support to find healthy ways to cope and reduce stress. 9. Intimate Partner Violence Contrary to stereotypes, some lesbians experience violence in their intimate relationships. However, health careproviders do not ask lesbians about intimate partner ...
Primary careproviders (PCPs) usually do not explore patient suicidality during routine visits. Factors that predict PCP attitudes toward the assessment and treatment of suicidality were examined via an online survey of 195 practicing PCPs affiliated with medical schools in the United States. PCPs who perceived themselves as competent to work with…
|Introduction: A continuing education (CE) program based on the theory of planned behavior was designed to understand and improve health careproviders' practice patterns in screening, assessing, and treating and/or referring patients with diabetes for depression treatment. Methods: Participants completed assessments of attitudes, confidence,…
Providing access Ï„Î¿ medical care for our nation's poor and underserved is a problem of growing significance and immensity. The 1980s have brought the most robust economic expansion in America's history. But the growing number of our citizens without health insurance casts a dark shadow over this prosperity. Our leaders boast of statistics that show more Americans employed than at
China has one of the fastest growing HIV epidemics in the world with an increase in reported cases of about 30% yearly (UNAIDS, 2004). As the epidemic has grown, there have been several studies of health careprovider attitudes towards HIV in China over the last 15 years. While attitudes have evolved, misconceptions about transmission of HIV, low levels of
Community (district) nurses play a significant role in assisting and supporting bereaved informal carers (family members and friends) of recently decease clients of palliative care. Bereavement care demands a wide range of competencies including clinical decision-making. To date, little has been known about the decision-making role of community nurses in Australia. The aim of this study was to conduct in-depth examination of an existing data set generated from semi-structured interviews of 10 community nurses providing follow-up bereavement care home visits within an area health service of a metropolitan region of Sydney, Australia. A grounded theory approach to data analysis generated a model, which highlights an interaction between 'the relationship','the circumstances' (surrounding the bereavement),'the psychosocial variant', 'the mix of nurses', 'the workload', and 'the support' available for the bereaved and for community nurses, and elements of 'the visit' (central to bereavement care). The role of community nurses in bereavement care is complex, particularly where decision-making is discretionary and contingent on multiple variables that effect the course of the family's grief. The decision model has the potential to inform community nurses in their support of informal carers, to promote reflective practice and professional accountability, ensuring continuing competence in bereavement care. PMID:23653962
A consortium was formed by ten long?term careproviders and three colleges and universities to permit extensive staff training of both professionals and para?professionals. By sharing educational resources the providers could develop better programs than any could individually. Anticipated advantages included being able to repeat programs, extending the subjects of in?service education, and developing a network of training consultants. Unanticipated
Lucille Nahemow; James Casey; Bonnie Belanger Gauthier; Richard Lusky; Mary Alice Wolf
The purpose of this study is to investigate the relationships among critical care nurses' attitudes, subjective norms, perceived behavioral control, and intentions to provide culturally congruent care to Arab Muslims. The provision of culturally congruent care is contingent on understanding nurses' motivational influences for providing culture care. Significant relationships among critical care nurses' behavioral beliefs, normative beliefs, control beliefs, intentions, and demographic variables supported the need for culture-specific debriefing sessions, underscored the importance of collaborative practice and interdisciplinary learning models, and established an evidence-based foundation for the design of culturally informed approaches to nursing education and service. PMID:18217234
Objective: African Americans are often viewed as ineffective communicators during medical encounters. However, most previous studies have been conducted among noncancer populations and based on the perceptions of health careproviders (HCP) and researchers. This study aimed to explore African American cancer patients' perspectives of HCPs' communication behaviors and how these communication patterns facilitate or hinder their cancer management and
A wide range of resources are available to enhance the communication and education of women. The patient's attitude should connote a sense of rights as a patient and allow for the request of information from the health careprovider without discomfort. Women should take the initiative in selecting their physicians and pharmacists, with recognition that a comfortable dialogue can be initiated and is essential to good health care.Self-education on a particular health condition before visiting the physician allows the patient to formulate questions to ask the physician. PMID:19313192
PRIMARY CAREPROVIDERS SHOULD BE AWARE OF TWO NEW DEVELOPMENTS IN NICOTINE ADDICTION AND SMOKING CESSATION: 1) the emergence of a novel nicotine delivery system known as the electronic (e-) cigarette; and 2) new reports of residual environmental nicotine and other biopersistent toxicants found in cigarette smoke, recently described as "thirdhand smoke". The purpose of this article is to provide a clinician-friendly introduction to these two emerging issues so that clinicians are well prepared to counsel smokers about newly recognized health concerns relevant to tobacco use. E-cigarettes are battery powered devices that convert nicotine into a vapor that can be inhaled. The World Health Organization has termed these devices electronic nicotine delivery systems (ENDS). The vapors from ENDS are complex mixtures of chemicals, not pure nicotine. It is unknown whether inhalation of the complex mixture of chemicals found in ENDS vapors is safe. There is no evidence that e-cigarettes are effective treatment for nicotine addiction. ENDS are not approved as smoking cessation devices. Primary care givers should anticipate being questioned by patients about the advisability of using e-cigarettes as a smoking cessation device. The term thirdhand smoke first appeared in the medical literature in 2009 when investigators introduced the term to describe residual tobacco smoke contamination that remains after the cigarette is extinguished. Thirdhand smoke is a hazardous exposure resulting from cigarette smoke residue that accumulates in cars, homes, and other indoor spaces. Tobacco-derived toxicants can react to form potent cancer causing compounds. Exposure to thirdhand smoke can occur through the skin, by breathing, and by ingestion long after smoke has cleared from a room. Counseling patients about the hazards of thirdhand smoke may provide additional motivation to quit smoking. PMID:21475626
Kuschner, Ware G; Reddy, Sunayana; Mehrotra, Nidhi; Paintal, Harman S
Objective To assess students' perceptions of their preparedness to perform advanced pharmacy practice competencies. Design The Preparedness to Provide Pharmaceutical Care (PREP) survey was modified and administered to each class at a Midwestern university from 2005-2008. Factor analysis and 1-way ANOVA with multiple comparisons were applied to assess the effectiveness of changes made in the pharmacy curriculum. Assessment Factor analysis yielded patterns similar to those reported in the literature. Students rated themselves highest on the psychological aspects and lowest on the administrative aspects of care. Perceived pharmaceutical care skills grew as students progressed through the curriculum, and changes in coursework were reflected in the competencies. Conclusion Students’ perceived competencies (ie, communication, psychological, technical, administrative) were similar to those at other institutions and perceptions of competencies increased in a manner consistent with actual program outcomes.
The multiple relationships involved in home-based end-of-life care have received little systematic analysis. As part of a focused ethnographic study examining client-caregiver-provider relational care experiences within the sociocultural context of home-based end-of-life care, this article describes the provision of end-of-life care to older adults with advanced cancer from the perspective of family caregivers. Data were collected through in-depth interviews (n = 16) with 4 family caregivers and participant observations in each of the 4 households over a 6- to 8-month period. Family caregiving in home-based end-of-life care was portrayed in this study as 3 dialectical relational care experiences: (1) prioritizing care recipient needs-ignoring own needs, (2) feeling connected-feeling isolated, and (3) juggling to manage-struggling to survive. Study findings suggest that the sociocultural context of end-of-life care is not conducive to quality care and provide several insights for future directions in nursing practice, policy, and research. PMID:23023791
Ward-Griffin, Catherine; McWilliam, Carol L; Oudshoorn, Abram
Colon cancer therapies have improved patient outcomes significantly over the last decades in both the adjuvant and metastatic settings. With the introduction of a number of novel agents, both traditional chemotherapies and biologically targeted agents, the need to identify subgroups that are likely and not likely to respond to a particular treatment regimen is paramount. This will allow patients who are likely to benefit to receive optimal care, while sparing those unlikely to benefit from unnecessary toxicity and cost. With the identification of several novel biomarkers and a variety of technologies to interrogate the genome, we are already able to rapidly study patient tumor or blood samples and normal tissues to generate a large dataset of aberrations within the cancer. How to digest this complex information to obtain accurate, reliable, and meaningful results that will allow us to provide truly personalized care for colon cancer patients is just starting to be addressed. In this article, we briefly review the history of colon cancer treatment, with an emphasis on current clinical standards that incorporate a ‘personalized medicine’ approach. We then review strategies which will potentially improve our ability to individualize therapy in the future.
Catenacci, Daniel V.T.; Kozloff, Mark; Kindler, Hedy L.; Polite, Blase
...Enter Into Provider Agreements for Extended Care Services AGENCY: Department of Veterans...provider agreements to obtain extended care services from non-VA providers. In addition...rulemaking proposes to include home health care, palliative care, and...
Context: Few telemedicine projects have systematically examined provider satisfaction and attitudes. Purpose: To determine the acceptability and perceived impact on primary careproviders' (PCP) practices of a randomized clinical trial of the use of telemedicine to electronically deliver health care services to Medicare patients with diabetes in…
Tudiver, Fred; Wolff, L. Thomas; Morin, Philip C.; Teresi, Jeanne; Palmas, Walter; Starren, Justin; Shea, Steven; Weinstock, Ruth S.
A guide for primary-careproviders for the identification and care of fetal alcohol-exposed children is provided. Section headings include: (1) what every clinician should know about alcohol use disorders in women, (2) what every clinician should know abo...
|Context: Few telemedicine projects have systematically examined provider satisfaction and attitudes. Purpose: To determine the acceptability and perceived impact on primary careproviders' (PCP) practices of a randomized clinical trial of the use of telemedicine to electronically deliver health care services to Medicare patients with diabetes in…
Tudiver, Fred; Wolff, L. Thomas; Morin, Philip C.; Teresi, Jeanne; Palmas, Walter; Starren, Justin; Shea, Steven; Weinstock, Ruth S.
|Identifies three major areas of concern in relationship between health careproviders and dying patients: (1) nature of difficulties and stresses associated with terminal care; (2) education of providers for work; and (3) influence of organizational structure and institutionalized values on services for dying patients and families. Reviews…
Recognizing the importance of maintaining a safe and healthy child care setting, this manual for home or center child careproviders contains information and guidelines to help providers maintain child health and reduce sickness and injuries. Part 1, "Introduction," describes how diseases are spread and how to prevent and prepare for unintentional…
|Recognizing the importance of maintaining a safe and healthy child care setting, this manual for home or center child careproviders contains information and guidelines to help providers maintain child health and reduce sickness and injuries. Part 1, "Introduction," describes how diseases are spread and how to prevent and prepare for…
Vaccination anxieties grew into a public health issue during the 2008 failed measles and rubella immunization campaign in Ukraine. Here I explore how health careproviders bend official immunization policies as they navigate media scares about vaccines, parents' anxieties, public health officials' insistence on the need for vaccination, and their own sense of expertise and authority. New hierarchies are currently being renegotiated, and I follow health careproviders as they attempt to parcel out their new position in the Ukrainian society and beyond. Public health control is reframed in a postsocialist context as a condition of acceptance into the European community as a sanitary democracy, and a contestation point between citizens and state. I untangle how relationships between citizens and states shape the construction of medical risk. PMID:22338289
Currently, one of every 13 U.S. residents is foreign born. A 1991 survey of certified nurse-midwives (CNMs) indicated that 51% of the respondents serve immigrant women. Using a case study approach, this article illustrates barriers to health care experienced by foreign-born women and demonstrates how cultural competence increases provider effectiveness in meeting the unique needs of this population. Effective primary
Background Weight stigma is pervasive in Western society and in healthcare settings, and has a negative impact on victims’ psychological and physical health. In the context of an increasing focus on the management of overweight and obese women during and after pregnancy in research and clinical practice, the current studies aimed to examine the presence of weight stigma in maternity care. Addressing previous limitations in the weight stigma literature, this paper quantitatively explores the presence of weight stigma from both patient and careprovider perspectives. Methods Study One investigated associations between pre-pregnancy body mass index (BMI) and experiences of maternity care from a state-wide, self-reported survey of 627 Australian women who gave birth in 2009. Study Two involved administration of an online survey to 248 Australian pre-service medical and maternity careproviders, to investigate their perceptions of, and attitudes towards, providingcare for pregnant patients of differing body sizes. Both studies used linear regression analyses. Results Women with a higher BMI were more likely to report negative experiences of care during pregnancy and after birth, compared to lower weight women. Pre-service maternity careproviders perceived overweight and obese women as having poorer self-management behaviours, and reported less positive attitudes towards caring for overweight or obese pregnant women, than normal-weight pregnant women. Even careproviders who reported few weight stigmatising attitudes responded less positively to overweight and obese pregnant women. Conclusions Overall, these results provide preliminary evidence that weight stigma is present in maternity care settings in Australia. They suggest a need for further research into the nature and consequences of weight stigma in maternity care, and for the inclusion of strategies to recognise and combat weight stigma in maternity care professionals’ training.
The Institute of Medicine has emphasized the roles of multidisciplinary treatment planning, evidence-based clinical practice guidelines, and regionalization of healthcare in optimizing the quality of cancercare. We discuss these critical elements as they pertain to head and neck cancercare. PMID:23910477
Research findings concerning the role of gender in patient-physician interactions can inform considerations about the role of gender in patient-dental careprovider interactions. Medical research showed that gender differences in verbal and nonverbal communication in medical settings exist and that they affect the outcomes of these interactions. The process of communication is shaped by gender identities, gender stereotypes, and attitudes. Future research needs to consider the cultural complexity and diversity in which gender issues are embedded and the degree to which ongoing value change will shape gender roles and in turn interactions between dental patients and their providers. PMID:23570810
ABSTRACT Efforts to redesign primary care require multiple supports. Two potential members of the primary care team—practice facilitator and care manager—can play important but distinct roles in redesigning and improving care delivery. Facilitators, also known as quality improvement coaches, assist practices with coordinating their quality improvement activities and help build capacity for those activities—reflecting a systems-level approach to improving quality, safety, and implementation of evidence-based practices. Care managers provide direct patient care by coordinating care and helping patients navigate the system, improving access for patients, and communicating across the care team. These complementary roles aim to help primary care practices deliver coordinated, accessible, comprehensive, and patient-centered care.
Taylor, Erin Fries; Machta, Rachel M.; Meyers, David S.; Genevro, Janice; Peikes, Deborah N.
Objective. To compare second- and third-year pharmacy students' competence, attitudes, and self-confidence in providing diabetes care before and after completing a hand-on diabetes training program and to determine if the program had an impact on students' attitude and self-confidence based on their year in the curriculum. Design. The program included classroom lectures and hands-on learning sessions in 5 facets of diabetes care. Pre- and post-test instruments measured students' competence, attitudes, and confidence in diabetes care. Assessment. Students' competence and the mean overall confidence score significantly improved after completing the program, while mean overall attitude score did not. Third-year students had significantly higher confidence scores than did second-year students on both pre- and post-program tests. No significant difference was found for attitude scores between second- and third-year students. Conclusion. The hands-on learning program was an effective approach to training pharmacy students in diabetes care, improving both their competence and confidence. PMID:24052656
Objective. To compare second- and third-year pharmacy students’ competence, attitudes, and self-confidence in providing diabetes care before and after completing a hand-on diabetes training program and to determine if the program had an impact on students’ attitude and self-confidence based on their year in the curriculum. Design. The program included classroom lectures and hands-on learning sessions in 5 facets of diabetes care. Pre- and post-test instruments measured students’ competence, attitudes, and confidence in diabetes care. Assessment. Students’ competence and the mean overall confidence score significantly improved after completing the program, while mean overall attitude score did not. Third-year students had significantly higher confidence scores than did second-year students on both pre- and post-program tests. No significant difference was found for attitude scores between second- and third-year students. Conclusion. The hands-on learning program was an effective approach to training pharmacy students in diabetes care, improving both their competence and confidence.
Responding to growing concerns regarding the safety, quality, and efficacy of cancercare in the United States, the Institute of Medicine (IOM) of the National Academy of Sciences commissioned a comprehensive review of cancercare delivery in the US health care system in the late 1990s. The National Cancer Policy Board (NCPB), a 20-member board with broad representation, performed this review. In its review, the NCPB focused on the state of cancercare delivery at that time, its shortcomings, and ways to measure and improve the quality of cancercare. The NCPB described an ideal cancercare system in which patients would have equitable access to coordinated, guideline-based care and novel therapies throughout the course of their disease. In 1999, the IOM published the results of this review in its influential report, Ensuring Quality CancerCare. The report outlined 10 recommendations, which, when implemented, would: 1) improve the quality of cancercare, 2) increase the current understanding of quality cancercare, and 3) reduce or eliminate access barriers to quality cancercare. Despite the fervor generated by this report, there are lingering doubts regarding the safety and quality of cancercare in the United States today. Increased awareness of medical errors and barriers to quality care, coupled with escalating health care costs, has prompted national efforts to reform the health care system. These efforts by health careproviders and policymakers should bridge the gap between the ideal state described in Ensuring Quality CancerCare and the current state of cancercare in the United States. PMID:22045610
Synopsis The Individualized Care Planning and Coordination Model is designed to integrate palliative care principles and practices into the ongoing care of children with cancer. Application of the model helps clinicians to generate a comprehensive individualized care plan that is implemented through Individualized Care Coordination processes as detailed here. Clinicians’ strong desire to provide compassionate, competent and sensitive care to the seriously ill child and the child’s family can be effectively translated into clinical practice through these processes. “To cure sometimes, to relieve often, to comfort always -- this is our work.” Author Unknown
Baker, Justin N; Hinds, Pamela S; Spunt, Sheri L; Barfield, Raymond C; Allen, Caitlin; Powell, Brent C; Anderson, Lisa H; Kane, Javier R
This paper considers three types of provider-client interactions that influence quantity of health care use: rationing, effort, and persuasion. By rationing, we refer to a quantity limit set by a provider; effort, the productive inputs supplied by a provider to increase a client's demand; persuasion, the unproductive inputs used by a provider to induce a client's demand. We construct a theoretical model incorporating all three mechanisms as special cases. When the general model is specialized into one of three mechanisms, a set of empirical implications emerges. We test for the presence of each mechanism using data of patients receiving outpatient treatment for alcohol abuse in the Maine Addiction Treatment System. We find evidence for rationing and persuasion, but not effort. PMID:15556245
Lien, Hsien-Ming; Albert Ma, Ching-To; McGuire, Thomas G
This study reports on a skills-enhancement training series for direct care workers providing personal assistance under a waiver for Medicaid home care services. Designed to increase professionalism, the training was part of a federally funded state-level initiative to promote change in the community-based long-term-care system. A linear improvement in the ratings of training quality was documented, with the module on
Constance L. Coogle; Rita Jablonski; Jason A. Rachel; Iris A. Parham
Providing perioperative care for patients with hip fractures can present major challenges for the anaesthesiologist. These patients often have multiple comorbidities, the deterioration of any one of which may have precipitated the fall. A careful balance has to be achieved between minimising the time before operation and spending time to optimise their medical status. This review will present insights into preoperative patient assessment and optimization in this group of patients from the anaesthesiologists' perspective. In particular, it will highlight important medical issues of concern that may alter anaesthetic risks and management. With a greater understanding of what these issues are, potentially a more prompt and integrated approach to managing these patients may be made. Hopefully, this would result in minimising last minute cancellations due to medical reasons for these patients. PMID:21057994
Fibromyalgia is a chronic widespread pain disorder commonly associated with comorbid symptoms, including fatigue and nonrestorative sleep. As in the management of other chronic medical disorders, the approach for fibromyalgia management follows core principles of comprehensive assessment, education, goal setting, multimodal treatment including pharmacological (eg, pregabalin, duloxetine, milnacipran) and nonpharmacological therapies (eg, physical activity, behavioral therapy, sleep hygiene, education), and regular education and monitoring of treatment response and progress. Based on these core management principles, this review presents a framework for primary careproviders through which they can develop a patient-centered treatment program for patients with fibromyalgia. This proactive and systematic treatment approach encourages ongoing education and patient self-management and is designed for use in the primary care setting.
Arnold, Lesley M.; Clauw, Daniel J.; Dunegan, L. Jean; Turk, Dennis C.
...governing payment for other non-VA health careproviders. Because the newly applicable...methodology for in- and outpatient health care professional services provided...FR 78901. We explained: Home Health Care and Hospice Care [T]he...
Purpose\\/Objective: 1) To identify if lesbians delay seeking health care because of sexual identity issues. 2) To examine the frequency of sexual identity disclosure for both lesbians and heterosexual women to health careprovider (HCP). 3) To identify the methods used by HCPs, lesbians, and heterosexual women to disclose sexual identity. 4) To identify lesbians' perceptions of how disclosure of
Mary Ann A. van Dam; Audrey S. Koh; Suzanne L. Dibble
Background Placebo interventions can have meaningful effects for patients. However, little is known about the circumstances of their use in clinical practice. We aimed to investigate to what extent and in which way Swiss primary careproviders use placebo interventions. Furthermore we explored their ideas about the ethical and legal issues involved. Methods 599 questionnaires were sent to general practitioners (GPs) and paediatricians in private practice in the Canton of Zurich in Switzerland. To allow for subgroup analysis GPs in urban, suburban, and rural areas as well as paediatricians were selected in an even ratio. Results 233 questionnaires were completed (response rate 47%). 28% of participants reported that they never used placebo interventions. More participants used impure placebos therapeutically than pure placebos (57% versus 17%, McNemar's ?2 = 78, p < 0.001). There is not one clear main reason for placebo prescription. Placebo use was communicated to patients mostly as being "a drug or a therapy" (64%). The most frequently chosen ethical premise was that they "can be used as long as the physician and the patient work together in partnership" (60% for pure and 75% for impure placebos, McNemar's ?2 = 12, p < 0.001). A considerable number of participants (11–38%) were indecisive about statements regarding the ethical and legal legitimacy of using placebos. Conclusion The data obtained from Swiss primary careproviders reflect a broad variety of views about placebo interventions as well as a widespread uncertainty regarding their legitimacy. Primary careproviders seem to preferentially use impure as compared to pure placebos in their daily practice. An intense debate is required on appropriate standards regarding the clinical use of placebo interventions among medical professionals.
Fassler, Margrit; Gnadinger, Markus; Rosemann, Thomas; Biller-Andorno, Nikola
OBJECTIVES: This study provides a snapshot of the current state of primary care workforce (PCW) serving China's grassroots communities and examines the factors associated with their job satisfaction. METHODS: Data for the study were from the 2011 China Primary Care Workforce Survey, a nationally representative survey that provides the most current assessment of community-based PCW. Outcome measures included 12 items on job satisfaction. Covariates included intrinsic and extrinsic factors associated with job satisfaction. In addition, PCW type (ie, physicians, nurses, public health, and village doctors) and practice setting (ie, rural versus urban) were included to identify potential differences due to the type of PCW and practice settings. RESULTS: The overall satisfaction level is rather low with only 47.6% of the Chinese PCW reporting either satisfied or very satisfied with their job. PCW are least satisfied with their income level (only 8.6% are either satisfied or very satisfied), benefits (12.8%), and professional development (19.5%). They (particularly village doctors) are also dissatisfied with their workload (37.2%). Lower income and higher workload are the two major contributing factors toward job dissatisfaction. Conclusion To improve the general satisfaction level, policymakers must provide better pay and benefits and more opportunities for career development, particularly for village doctors. PMID:23388523
Improving the efficiency with which clinical research studies are conducted can lead to faster medication innovation and decreased time to market for new drugs. To increase this efficiency, the parties involved in a regulated clinical research study, namely, the sponsor, the clinical investigator and the regulatory body, each with their own software applications, need to exchange data seamlessly. However, currently, the clinical research and the clinical care domains are quite disconnected because each use different standards and terminology systems. In this article, we describe an initial implementation of the Semantic Framework developed within the scope of SALUS project to achieve interoperability between the clinical research and the clinical care domains. In our Semantic Framework, the core ontology developed for semantic mediation is based on the shared conceptual model of both of these domains provided by the BRIDG initiative. The core ontology is then aligned with the extracted semantic models of the existing clinical care and research standards as well as with the ontological representations of the terminology systems to create a model of meaning for enabling semantic mediation. Although SALUS is a research and development effort rather than a product, the current SALUS knowledge base contains around 4.7 million triples representing BRIDG DAM, HL7 CDA model, CDISC standards and several terminology ontologies. In order to keep the reasoning process within acceptable limits without sacrificing the quality of mediation, we took an engineering approach by developing a number of heuristic mechanisms. The results indicate that it is possible to build a robust and scalable semantic framework with a solid theoretical foundation for achieving interoperability between the clinical research and clinical care domains. PMID:23008263
OBJECTIVE:In this era of cost containment, gastroenterologists must demonstrate that they provide effective and efficient care. The aim of this study was to evaluate the process and outcomes of careprovided by gastroenterologists and generalist physicians (internists, family physicians, general surgeons) for GI conditions.METHODS:We conducted a systematic literature review using a MEDLINE search of English language articles (January 1980 to
Dawn Provenzale; Joshua Ofman; Ian Gralnek; Linda Rabeneck; Raymond Koff; Douglas McCrory
A multilevel approach that enhances the cultural competence of clinicians and healthcare systems is suggested as one solution to reducing racial/ethnic disparities in healthcare. The primary objective of this cross-sectional study was to determine if there is a relationship between the cultural competence of primary careproviders and the clinics where they work. Forty-nine providers from 23 clinics in Baltimore, Maryland and Wilmington, Delaware, USA. completed an on-line survey which included items assessing provider and clinic cultural competence. Using simple linear regression, it was found that providers with attitudes reflecting greater cultural motivation to learn were more likely to work in clinics with a higher percent of nonwhite staff, and those offering cultural diversity training and culturally adapted patient education materials. More culturally appropriate provider behavior was associated with a higher percent of nonwhite staff in the clinic, and culturally adapted patient education materials. Enhancing provider and clinic cultural competence may be synergistic strategies for reducing healthcare disparities.
Paez, Kathryn A; Allen, Jerilyn K; Carson, Kathryn A; Cooper, Lisa A
OBJECTIVE To determine the incidence and variability of antibiotic use in facilities which provide chronic care and to determine how often clinical criteria for infection are met when antibiotics are prescribed in these facilities. DESIGN A prospective, 12-month, observational cohort study. SETTING Twenty-two facilities which provide chronic care in southwestern Ontario. PARTICIPANTS Patients who were treated with systemic antibiotics over the study period. MEASUREMENTS Characteristics of antibiotic prescriptions (name, dose, duration, and indication) and clinical features of randomly selected patients who were treated with antibiotics. RESULTS A total of 9,373 courses of antibiotics were prescribed for 2,408 patients (66% of all patients in study facilities). The incidence of antibiotic prescriptions in the facilities ranged from 2.9 to 13.9 antibiotic courses per 1,000 patient-days. Thirty-six percent of antibiotics were prescribed for respiratory tract infections, 33% for urinary infections, and 13% for skin and soft tissue infections. Standardized surveillance definitions of infection were met in 49% of the 1,602 randomly selected patients who were prescribed antibiotics. Diagnostic criteria for respiratory, urinary, and skin infection were met in 58%, 28%, and 65% of prescriptions, respectively. One third of antibiotic prescriptions for a urinary indication were for asymptomatic bacteriuria. Adverse reactions were noted in 6% of prescriptions for respiratory and urinary infections and 4% of prescriptions for skin infection. CONCLUSIONS Antibiotic use is frequent and highly variable amongst patients who receive chronic care. Reducing antibiotic prescriptions for asymptomatic bacteriuria represents an important way to optimize antibiotic use in this population.
Primary care physicians and clinics have become the frontline of health care for most Americans—they are the first point of contact and the source of both treatment and referrals. Psychosocial problems, such as difficulty with finances, family, housing, and work, are associated with a high demand for medical care in primary care practice, yet little is known about the prevalence
Karra Bikson; James McGuire; Jessica Blue-Howells; Leah Seldin-Sommer
A new report suggests that poor communication between emergency and primary careproviders has had a negative impact on care, and that this interface requires significant improvement if the country is to move toward more cost-effective care delivery models that prioritize quality. There are no easy solutions to the problem, but some health care organizations are making strides by using alternative communications modalities and by finding ways to strengthen the relationships between emergency and primary care physicians. Health systems and affiliated PCPs who utilize electronic health records (EHR) are better able to coordinate care with each other, but EHRs are not a silver bullet to the problem. In addition to documenting care tasks in the medical record, scribes can fill in care-coordination gaps by making follow-up calls to PCPs or specialists, or sending pages where appropriate. Some health systems are seeking to address prob lematic handoffs between the ED and PCPs by developing protocols that include care-coordination steps for diagnoses that are associated with high ED utilization. PMID:21675151
...Standard unique health identifier for health careproviders. 162.406 Section...Standard Unique Health Identifier for Health CareProviders Â§ 162.406 Standard unique health identifier for health careproviders. (a)...
This was the third Evanston Northwestern Healthcare/Northwestern Universitysponsored conference on outcomes management. The conference was built around two interconnected themes that focused on activities essential for improving cancercare: expanding and...
Home care nursing (HCN) improves the management of symptoms in breast and colorectal cancer patients who take the oral chemotherapy drug capecitabine, according to a study published online November 16, 2009, in the Journal of Clinical Oncology.
The complex environmental context must be considered as we move forward to improve cancercare and, ultimately, patient and population outcomes. The cancercare continuum represents several care types, each of which includes multiple technical and communication steps and interfaces among patients, providers, and organizations. We use two case scenarios to 1) illustrate the variability, diversity, and interaction of factors from multiple levels that affect care quality and 2) discuss research implications and provide hypothetical examples of multilevel interventions. Each scenario includes a targeted literature review to illustrate contextual influences upon care and sets the stage for theory-informed interventions. The screening case highlights access issues in older women, and the survivorship case illustrates the multiple transition challenges faced by patients, families, and organizations. Example interventions show the potential gains of implementing intervention strategies that work synergistically at multiple levels. While research examining multilevel intervention is a priority, it presents numerous study design, measurement, and analytic challenges. PMID:22623591
The high level of religious participation in the United States provides a venue for parish nursing, a holistic nursing specialty that emphasizes the relationship between spirituality and health. This descriptive study measured two aspects of spirituality (spiritual perspective and spiritual well-being) in a national sample of parish nurses and described variables related to their practice. Furthermore, it qualitatively examined the provision of spiritual care to clients in this parish nurse sample. Parish nurses scored high in spiritual perspective and spiritual well-being and reported an emphasis on health promotion and education in their activities. Three views of spiritual interventions (ideal, general, and specific) were reported. Types of spiritual interventions typically fell into one of four categories: religious, interactional, relational, and professional. PMID:11482050
Text Version... important to communicate new information 42 promptly to health care practitioners involved in prescribing or dispensing a drug, or in caring for 43 ... More results from www.fda.gov/downloads/drugs/guidancecomplianceregulatoryinformation
Long-term information needs are increasingly important as more people are diagnosed with cancer and living well beyond initial diagnosis and treatment. Consequently, cancer is joining the ranks of chronic conditions (e.g., asthma, diabetes) for which ongoing, long-term surveillance and management should be the model of care. However, the post-treatment period is fraught with uncertainty for patients and careproviders. The "who, what, and when" of follow-up care, in particular, can be complex and confusing. Therefore, survivorship care plans (SCPs) are recommended. The Minnesota Cancer Alliance, a coalition working to improve quality of life for cancer survivors, developed a patient-focused SCP. This user-friendly SCP could be considered for use in patient care--particularly by nurses, who are well suited and positioned to implement SCPs. PMID:23715704
African Americans are disproportionately burdened with colorectal cancer. Although incidence and mortality rates have declined in the past two decades, the disparity in health outcomes has progressively increased. This comprehensive review examines the existing literature regarding racial disparities in colorectal cancer screening, stage at diagnosis, and treatment to determine if differences exist in the quality of care delivered to African
Jamillah Berry; Kevin Bumpers; Vickie Ogunlade; Roni Glover; Sharon Davis; Margaret Counts-Spriggs; John Kauh; Christopher Flowers
Positive social support has been associated with medication adherence and slowed disease progression among people living with HIV. The nature of support within the medical context itself has not been adequately investigated, however. The purpose of our study was to describe HIV health careproviders' perspectives on informal supporter-oriented health care and whether and how the involvement of patients' adult informal supporters in health care and health care decision making is helpful or beneficial. We conducted in-depth qualitative interviews with 11 HIV specialists between March and September, 2005. Using directed qualitative content analysis, we first describe the frequency and course of others' involvement and the type of support provided. We then situate these findings within the context of role theory and consider the meaning they have in terms of the negotiated relationships among and between patients, providers, and informal supporters. Finally, we provide research and clinical recommendations based on these findings that are designed to improve patient care. PMID:21709129
Cancer screening guidelines are developed by numerous agencies. These guidelines are often conflicting leaving the primary care physician in a difficult position. He (she) is requested to choose the best test for his or her patients taking into consideration the principles of screening, the test cost and most importantly the patient's emotional and physical well-being. Screening for some cancers, like lung cancer, has been considered of no benefit. Other cancers, like breast, colon, cervix and prostate, have been the subject of numerous recommendations: For breast cancer, clinical examination and mammography are recommended every 1-2 years for women between 50 to 70 years. For cervical cancer, PAP smear is suggested every 1-3 years and for colorectal cancer, a yearly fecal occult blood, sigmoidoscopy or colonoscopy every 5-10 years. Annual serum prostate specific antigen (PSA) and digital rectal examination screening for prostate cancer are still controversial. PMID:12243426
Ashkar, K; Bulbul, M; Sharara, A; Hourani, M; Hamadeh, G N
Cancer is increasing in incidence and prevalence worldwide, and the WHO has recently included cancer and its treatments as\\u000a a health priority in developed and developing countries. The cultural diversity of oncology patients is bound to increase,\\u000a and cultural sensitivity and competence are now required of all oncology professionals. A culturally competent cancercare\\u000a leads to improved therapeutic outcome and
While federal law establishes guidelines that designated facilities must follow in providing information about a patient's rights regarding self-determination in the health care decision-making process, state law determines the decision-making process and the legal requirements pertaining thereto. A person's capacity to make health care decisions or to have the authority and capacity to delegate the right to make such decisions is a legal conclusion based on statutory and common law principles. This article discusses the legal perspective of capacity in health care decision making and the legal framework of the question of whether or not a person has the capacity to make health care decisions. Western civilization's concepts of personal autonomy and self-determination are at the core of health care decision making, but health careproviders must be aware that other cultures do not always share that value system. Sensitivity to multicultural diversity in this context is imperative to maintain individual self-esteem and respect, both for the patient and the patient's family. PMID:16765870
Few studies had compared health careproviders' and patients' perceptions of the importance of various factors on patient satisfaction. Subjects of this study were 292 health careproviders and 137 inpatients in a tertiary-care military hospital. Physicia...
...Provider-Preventable Conditions Including Health Care-Acquired Conditions AGENCY: Centers...of the Patient Protection and Affordable Care Act of 2010 which directs the Secretary...providing medical assistance for health care-acquired conditions. It would also...
While the discipline of psychosocial oncology is rela- tively new in the field of cancercare, many if not most health careproviders, would say that it is a vital compo- nent of clinical care and its application is necessary to improve the patient experience along the cancercare continuum from diagnosis, treatment, recurrent dis- ease, palliative care and survivorship.
The President's Cancer Panel (PCP) has begun a series of regional meetings over the next nine months to hear testimony from all 50 states addressing the question, "Why don't all Americans get the best available care"?
OBJECTIVES. Intravenous drug users are at high risk for medical illness, yet many are medically underserved. Most methadone treatment programs have insufficient resources to provide medical care. The purpose of this study was to test the efficacy of providing medical care at a methadone clinic site vs referral to another site. METHODS. Patients with any of four target medical conditions were randomized into an on-site group offered medical care at the methadone treatment clinic and a referred group offered medical care at a nearby clinic. Entry to treatment and use of medical services were analyzed. RESULTS. Of 161 intravenous drug users evaluated, 75 (47%) had one or more of the target medical conditions. Fifty-one were randomized. In the on-site group (n = 25), 92% received medical treatment; in the referred group (n = 26), only 35% received treatment. CONCLUSIONS. Providing medical care at a methadone treatment program site is more effective than the usual referral procedure and is a valuable public health intervention.
Umbricht-Schneiter, A; Ginn, D H; Pabst, K M; Bigelow, G E
Compelling public interest is propelling national efforts to advance the evidence base for cancer treatment and control measures and to transform the way in which evidence is aggregated and applied. Substantial investments in health information technology, comparative effectiveness research, health care quality and value, and personalized medicine support these efforts and have resulted in considerable progress to date. An emerging initiative, and one that integrates these converging approaches to improving health care, is "rapid-learning health care." In this framework, routinely collected real-time clinical data drive the process of scientific discovery, which becomes a natural outgrowth of patient care. To better understand the state of the rapid-learning health care model and its potential implications for oncology, the National Cancer Policy Forum of the Institute of Medicine held a workshop entitled "A Foundation for Evidence-Driven Practice: A Rapid-Learning System for CancerCare" in October 2009. Participants examined the elements of a rapid-learning system for cancer, including registries and databases, emerging information technology, patient-centered and -driven clinical decision support, patient engagement, culture change, clinical practice guidelines, point-of-care needs in clinical oncology, and federal policy issues and implications. This Special Article reviews the activities of the workshop and sets the stage to move from vision to action. PMID:20585094
Abernethy, Amy P; Etheredge, Lynn M; Ganz, Patricia A; Wallace, Paul; German, Robert R; Neti, Chalapathy; Bach, Peter B; Murphy, Sharon B
This article is focused on children providing and financing long-term care for their elderly parent. The aim of this work is to highlight the interactions that may take place among siblings when deciding whether or not to become a caregiver. We look at families with two children using data from the Survey of Health, Ageing and Retirement in Europe; our sample contains 314 dependent elderly and their 628 adult children. In order to identify the interactions between siblings, we have specified a two-person discrete game model. To estimate this model, without invoking the 'coherency' condition, we have added an endogenous selection rule to solve the incompleteness problem arising from multiplicity or absence of equilibrium. Our empirical results suggest that the three classical effects identified by Manski could potentially explain the observed correlation between the siblings' caregiving behaviour. Correlated effects alone appear to be weak. Contextual interactions and endogenous interactions reveal cross-effects. The asymmetric character of the endogenous interactions is our most striking result. The younger child's involvement appears to increase the net benefit of caregiving for the elder one, whereas the elder child's involvement decreases the net benefit of caregiving for the younger child. PMID:19634124
Provision of sexually transmitted disease (STD) care for sexually active adolescents has been neglected in developing countries, although this is changing. Available evidence indicates that STDs are a serious problem among adolescents (10–19 years), especially in rural areas where services are limited for any age group. Curative care is hampered by the inadequacy of the syndromic approach for identifying adolescents
|After birth, newborns and their caregivers are seen routinely and frequently in pediatric primary care settings. The close succession of visits in the first few months of life puts pediatric primary care professionals in a unique position to enhance infant mental health by developing strong relationships with caregivers, supporting babies and…
Background: There is general consensus that the size of the US physician workforce now exceeds the health care needs of the American public. There is a greater proportion of specialists than primary care physicians, a specialty mix different from that of most other developed countries. Methods: The Colorado Board of Medical Examiners sent a one-page questionnaire to all physicians licensed
George E. Fryer; Rachel Consoli; Thomas J. Miyoshi; Susan M. Dovey; Robert L. Phillips; Larry A. Green
The social and institutional context of health-care reform in Eastern Europe has important implications for cervical cancer screening and prevention. The incidence and mortality from cervical cancer in Bulgaria and Romania have risen, which is in sharp contrast to the steady decline in most other countries in Europe during the last 2 decades. To analyze these dynamics we conducted a multi-component study of health systems and psychosocial aspects of cervical cancer screening in Bulgaria and Romania. Following the disappearance of organized preventive programs, the initiative for cervical cancer screening has shifted to providers and clients and depends on the way they perceive their responsibility and interpret their own and each other's roles in prevention. We focus on how providers construct women and their role in prevention of cervical cancer through their accounts. The analysis identified several discourses and themes in providers' constructions of women's responsibility for prevention of disease. These include responsible women as 'intelligent' and 'cultured'; non-attenders as 'irresponsible' and 'negligent'; women as needing monitoring and sanctioning; and women as 'victims' of health-care reform. We discuss the implications for health-care reform and health promotion. PMID:16603297
Introduction Oncology health care professionals frequently lack the background to implement needed survivorship activities and follow-up care. The purpose of this project is to assist providers in the clarification and initiation of potentially durable changes in survivorship care by developing a health professional curriculum, recruiting participants, implementing the course, conducting course evaluation and following participants’ defined goals over time. Materials and methods The curriculum was developed based on recommendations from the Institute of Medicine Report-From Cancer Patient to Cancer Survivor—Lost in Transition. Three concepts were used to structure the course: cancer survivorship quality of life, changing practice via performance improvement, and principles of adult education. Expert faculty designed and implemented the curriculum and teaching methods using adult learning principles and an interactive approach. Competitively-selected, two-person interdisciplinary teams for the first course (July 12–15, 2006, Pasadena, California) were selected based on stated interests, three projected goals, and letters of commitment from administrators. Results Participants represented 52 cancercare settings from 28 states. Teams included Nurses (48.1%), Social Workers (20.7%), Physicians (18.8%), Directors/Administrators (6.6%), Psychologists (2.8%), and others (3%). The institutional barriers identified by teams were lack of survivorship knowledge (94 %), financial constraints (61%), lack of administrative support (6%), and staff philosophy that excluded survivorship (15%). Evaluation of content from the first course was consistently positive. Conclusions Dissemination of survivorship education for health care professionals stimulates participants to define and begin to implement goals for improving survivors’ care. Implications for cancer survivors A training program such as the one described provides professional knowledge regarding survivorship that has the potential to facilitate change in the health care that cancer survivors receive thus ideally improving long term health and well being.
Patients may experience wounds at or near the end of life that are difficult to treat and may not be amenable to healing. In these cases, hospice and palliative care may be considered. Palliative care approaches include stabilization of existing wounds, prevention of new wounds, and symptom management with a focus on quality of life. Treatment goals for nonhealing wounds at the end of life include managing exudate, controlling odor, maximizing mobility and function, preventing infection, and controlling pain and other symptoms. Complementary components of palliative care are also instituted including communication and psychosocial support for patients and families. PMID:20463544
Letizia, MariJo; Uebelhor, Jonathan; Paddack, Elizabeth
PURPOSE Clinician time alone with an adolescent has a major impact on disclosure of risk behavior. This study sought to describe primary care clinicians’ patterns of delivering time alone, decision making about introducing time alone to adolescents and their parents, and experiences delivering confidential services. METHODS We undertook qualitative interviews with 18 primary care clinicians in urban health centers staffed by specialists in pediatrics, family medicine, and adolescent medicine. RESULTS The annual preventive care visit is the primary context for provision of time alone with adolescents; clinicians consider the parent-child dynamic and the nature of the chief complaint for including time alone during visits for other than preventive care. Time constraints are a major barrier to offering time alone more frequently. Clinicians perceive that parental discomfort with time alone is rare. Many clinicians wrestle with internal conflict about providing confidential services to adolescents with serious health threats and regard their role as facilitating adolescent-parent communication. Health systems factors can interfere with delivery of confidential services, such as inconsistent procedures for determining whether unaccompanied youth would be seen. CONCLUSION Despite competing time demands, clinicians report commitment to offering time alone during preventive care visits and infrequently offer it at other times. Experienced clinicians can gain skills in the art of managing complex relationships between adolescents and their parents. Office systems should be developed that enhance the consistency of delivery of confidential services.
McKee, M. Diane; Rubin, Susan E.; Campos, Giselle; O'Sullivan, Lucia F.
INTRODUCTION: Pediatric primary careproviders (PCPs) are being asked to care for children with mental health (MH) disorders but cite inadequate training as a barrier. An intensive workshop may improve the PCPs' level of knowledge and lead to an increase in quality care for children with MH disorders. We compared pediatric PCPs' knowledge, comfort, and practice in the evaluation and management of pediatric patients with attention deficit-hyperactivity disorder, depression, anxiety, and autism spectrum disorders before and after a 2-day educational workshop. METHOD: Study participants (n = 30) were recruited from rural areas of Pennsylvania. A pre- and posttest design was used. A 15-question multiple choice knowledge test and a 19-question survey of comfort and practice were administered before and after the workshop. RESULTS: The mean knowledge test number correct increased from 9.19 before the workshop to 12.23 after the workshop (p < .0001). Survey scores increased from 34.6 before the workshop to 44.14 after the workshop (p < .0001). DISCUSSION: Intensive workshops may be an effective method of training PCPs on provision of MH care in pediatric primary care practice. PMID:23651700
Burka, Stacy D; Van Cleve, Susan N; Shafer, Sheree; Barkin, Jennifer L
The aim of this study was to explore how cancer patients with progressive disease perceived and experienced supportive care at the different stages of their cancer journey and to compare this to the perceptions of health care professionals. It was a single centre study using qualitative data obtained from two focus group interviews in an independent centre for specialist palliative care. Eight patients attending the centre were interviewed in two focus groups to ascertain their views on the supportive care that they had experienced during the course of their illness, focusing on: time of diagnosis, acute treatment phase and palliative care phase. Themes that emerged from the analysis of the interview transcripts using the QSR NUD*IST (version 4) software package included the following: manner in which diagnosis was revealed, information made available to family and friends, patients' acceptance of cancer; service provision such as a named contact person, choices in treatment and care, problems of limited resources; feelings of being unsupported, and ways in which supportive care could be improved. PMID:16112527
Fincham, Lorraine; Copp, Gina; Caldwell, Kay; Jones, Louise; Tookman, Adrian
Institutional pharmaceutical services have widely evolved over the past 20-30 years. Hospital pharmacy practice has changed from a profession concerned chiefly with the bulk preparation and distribution of drug products to one centred on ensuring optimal drug therapy. Whereas hospital pharmacists were charged with maintaining large drug stock on nursing units, many of them now provide individualized patient therapies. The practice of hospital pharmacy has therefore become one encompassing all aspects of drug therapy, from the procurement of drugs and drug delivery devices, their preparation and distribution, to their most appropriate selection and use for each patient. Hospital pharmacy services have traditionally had little involvement at the key stages in patients' hospital care. This leads to the conclusion that the model of clinical pharmacy practice adopted by many pharmacy department hospitals is no longer appropriate for the demands of today's health-care services. Reviews many new models proposed for clinical pharmacy practice including an integrated model for providing a pharmaceutical care management approach in the health-care system. This model is a response to the failures of traditional drug therapy. It is primarily an idea about how health professionals and patient should integrate their work to obtain outcomes important to patients and clinicians. PMID:11729625
... important to patients coping with cancer. Spirituality and religion may have different meanings. Serious illness, such as ... information on end-of-life issues.) Spirituality and religion may have different meanings. The terms spirituality and ...
This report describes findings from focus group meetings with Managed Care Organizations held to help inform the Health Care Financing Administration (HCFA) about (1) what information managed care plans and providers need and want, and (2) how such inform...
...Publication of Model Notices for Health Care Continuation Coverage Provided...Reconciliation Act (COBRA) and Other Health Care Continuation Coverage, as Required...of the availability of the Model Health Care Continuation Coverage Notices...
...Publication of Model Notices for Health Care Continuation Coverage Provided...Reconciliation Act (COBRA) and Other Health Care Continuation Coverage, as Required...of the Availability of the Model Health Care Continuation Coverage Notices...
... Medicare , Medicaid , and the Older Americans Act, cover home care for those who meet their criteria. Some people may qualify for Medicare, a government health insurance program for the elderly or disabled that is administered by the Centers ...
Cancer mainly affects individuals aged 65 and over, so that supportive care for cancer treatment concerns mostly elderly patients.\\u000a Age is a risk factor for increased incidence and severity of chemotherapy-related toxicity and also for the emergence of different\\u000a forms of toxicity including delirium and malnutrition; in addition age may modulate the perception of pain and the response\\u000a to analgesics,
Trust in health careproviders and the health care system are essential. This study examined factors associated with trust in providers and distrust in the health care system among minority HIV-positive and -negative women.Interviews were conducted and laboratory tests performed with 102 women from the Women's Interagency HIV Study Bronx site. Interviews collected information about trust in providers, distrust in
C. O. Cunningham; N. L. Sohler; L. Korin; W. Gao; K. Anastos
|The efficiency of public day care centers in Sweden was studied by collecting data on inputs and services for about 200 centers and analyzing the information by data envelopment analysis. Results show large differences in efficiencies among centers, but these differences have few systematic relations to quality. (SLD)|
|Reviews the rural physician shortage and related policy and research needs. Discusses geographic distribution of physicians, quality of rural care, rural recruitment and retention, rural residency training, factors in medical education affecting entry into rural practice, physician productivity and income, reimbursement, federal and state…
Hart, L. Gary; Salsberg, Edward; Phillips, Debra M.; Lishner, Denise M.
Background. Homicide of women (femicide) by intimate partners is the most serious form of violence against women. The purpose of this analysis of a larger multisite study was to describe health care use in the year prior to murder of women by their intimate partner in order to identify opportunities for intervention to prevent femicide.Methods. A sample of femicide cases
Phyllis W. Sharps; Jane Koziol-McLain; Jacquelyn Campbell; Judith McFarlane; Carolyn Sachs; Xiao Xu
Outcome measures have been widely touted as a valuable tool to guarantee quality assurance in healthcare settings. Recently, a number offactors have conspired to make outcome-based measurement more feasible. This paper describes the advantages of utilizing outcome measures, continuous quality improvement methods and consumer based input to ensure excellence in long term care.
Joan Hyde; Jennifer Hillygus; Becca Levy; Sue Levkoff
Clinical Pathways (CPs) are artifacts that clinicians are in- creasingly introducing in their practices in order to deal with health problems in the most efiective, e-cient and agreed way. As a result of an observational study at a Neonatol- ogy Intensive Care Unit, we identifled that most CPs are still paper-based. Although perceived useful even on paper, the physicians advocated
Although the rate for childhood cancer has remained relatively stable for the past 2 decades, there have been drastic declines in mortality due to early diagnosis and improvements in therapy. Now over 75% of children diagnosed with cancer survive more than 5 years. The pediatric dental professional plays an important role in the prevention, stabilization, and treatment of oral and dental problems that can compromise the child's health and quality of life before, during, and after the cancer treatment. This manuscript discusses recommendations for the dental care of the pediatric oncology patient. PMID:15080359
African Americans are disproportionately burdened with colorectal cancer. Although incidence and mortality rates have declined in the past two decades, the disparity in health outcomes has progressively increased. This comprehensive review examines the existing literature regarding racial disparities in colorectal cancer screening, stage at diagnosis, and treatment to determine if differences exist in the quality of care delivered to African Americans. A comprehensive review of relevant literature was performed. Two databases (EBSCOHOST Academic Search Premier and Scopus) were searched from 2000 to 2007. Articles that assessed racial disparities in colorectal cancer screening, stage of disease at diagnosis, and treatment were selected. The majority of studies identified examined colorectal cancer screening outcomes. Although racial disparities in screening have diminished in recent years, African American men and women continue to have higher colorectal cancer incidence and mortality rates and are diagnosed at more advanced stages. Several studies regarding stage of disease at diagnosis identified socioeconomic status (SES) and health insurance status as major determinants of disparity. However, some studies found significant racial disparities even after controlling for these factors. Racial disparities in treatment were also found at various diagnostic stages. Many factors affecting disparities between African Americans and Whites in colorectal cancer incidence and mortality remain unexplained. Although the importance of tumor biology, genetics, and lifestyle risk factors have been established, prime sociodemographic factors need further examination to understand variances in the care of African Americans diagnosed with colorectal cancer. PMID:19197679
Loretta Ford, the pioneer of nurse practitioners, was the recipient of the Crystal Trailblazer Award from the American College of Nurse Practitioners in February 2003. In her acceptance speech, the stated that "in some ways, the profession had expanded beyond my wildest dreams," but cautioned against the medicalization of the NP role: "The profession is rooted in nursing ... and we enhance, advance, and influence through nursing." She added: "Medical and nursing interdependency sets the stage for the highest level of care. No one profession can deliver comprehensive health care themselves." NNPs, functioning collaboratively with neonatologists as part of a multidisciplinary team, illustrate the truth of Ford's words. They have clearly and unequivocally made significant strides during the past 20 years. Their achievements and contributions have been many but their potential has yet to be reached. PMID:14508891
To better understand if reported delayed\\/forgone care and dissatisfaction with care for children with special health care\\u000a needs (CSHCN) are associated with the parent’s perception of health careproviders’ cultural competency. National survey.\\u000a Fifty United States and the District of Columbia yielding 750 families per state and District of Columbia with CSHCN ? 18 years\\u000a participated in the 2005–06 National Survey of CSHCN.
Cheryl I. KerfeldJeanne; Jeanne M. Hoffman; Marcia A. Ciol; Deborah Kartin
... Information Clinical Trials Resources and Publications How do health careproviders diagnose preeclampsia, eclampsia, and HELLP syndrome? Page Content A health careprovider should check a pregnant woman's blood pressure ...
... Information Clinical Trials Resources and Publications How do health careproviders diagnose precocious puberty & delayed puberty? Page Content ... and analyzing his or her medical history, a health careprovider may perform tests to diagnose precocious puberty, ...
Providing comprehensive care for patients with cancer is complex with regard to severe treatment-related side effects. Hundreds of thousands of patients with cancer visit the emergency department (ED) each year, and more than half report multiple visits. In the United States, few of the National Cancer Institute-designated cancer centers have an ED specifically for patients with cancer. EDs often are an overcrowded and expensive way in which to care for the urgent needs of patients with cancer. In addition, a looming shortage exists for both primary careproviders and oncologists who can address symptom issues. As the Affordable Care Act is implemented, more patients will enter the healthcare system, placing a demand on providers that the current supply cannot meet. A report from the Institute of Medicine advocates that nurse practitioners (NPs) are more than competent to provide for the unique urgent care needs of patients with cancer. The aim of this article is to describe an NP-led urgent care center for patients with cancer and how that care center provides access to vital, expeditious, and cost-effective care. PMID:23899989
Barriers to ethical and effective health care in rural communities have been well-documented; however, less is known about strategies rural providers use to overcome such barriers. This study compared adaptations by rural and urban health careproviders. Physical and behavioral health careproviders were randomly selected from licensure lists for eight groups to complete a survey; 1,546 (52%) responded. Replies
Mark E. Johnson Chr Cody L. Chipp; Laura W. Roberts
A research project to evaluate a respite care program for caregivers of patients with Alzheimer's disease and related conditions provided information relevant to service providers of respite care. Providers must under-stand the psychological needs of caregivers that enter into their willingness to use respite care. Caregiving equity, caregiving modeling, the moral imperative of caregiving, caregiving as a challenge, caregiving as
There is a compelling need to integrate spirituality into the provision of quality palliative care by oncology professionals. Patients and families report the importance of spiritual, existential, and religious concerns throughout the cancer trajectory. Leading palliative care organizations have developed guidelines that define spiritual care and offer recommendations to guide the delivery of spiritual services. There is growing recognition that all team members require the skills to provide generalist spiritual support. Attention to person-centered, family-focused oncology care requires the development of a health care environment that is prepared to support the religious, spiritual, and cultural practices preferred by patients and their families. These existential concerns become especially critical at end of life and following the death for family survivors. Oncology professionals require education to prepare them to appropriately screen, assess, refer, and/or intervene for spiritual distress. PMID:24051617
Poor communication and collaboration between members of a patient's health care team can result in medical errors and poor quality of care. The purpose of this study was to assess communication and consensus regarding patient care goals between members of...
B. Evanoff P. Potter L. Wolf D. Grayson C. Dunagan
... GUIDE TO THE HIPAA PRIVACY RULE: When Health CareProviders May Communicate About You with Your Family, Friends, or Others Involved In Your Care U.S. Department of Health and Human Services • Office ...
1. DEFINITION • Mucositis is the inflammatory reaction that occurs when cancer treatments break down the continually dividing epithelial cells lining the GI tract, particularly in the oral cavity, leaving the mucosal tissue open to ulceration and infection • Mucositis can occur anywhere along the digestive tract from the mouth to the anus. Stomatitis (mouth and oropharynx), oesophagitis (oesophagus), gastritis
This study analyzed the content of sun-care product advertisements in five major U.S. parenting magazines with high circulation: Family Circle, Parents, Family Fun, Parenting (Early Years), and Parenting (School Years). The study examined what information sun-care product advertisements tell parents about skin cancer prevention and about sunscreen use for themselves or for their children based on the Health Belief Model concepts of perceived benefits and perceived barriers. Results showed that the most commonly mentioned benefit of the product was that it blocks ultraviolet A (UVA) and ultraviolet B (UVB) rays. One-third of the ads promoted the product's effectiveness in overcoming four of the barriers that prevent people from using sunscreens: eye irritation, skin irritation, an unpleasant smell, and the need to reapply sunscreen too often or after physical activity. However, only a few of the ads provided information about the consequences of unprotected sun exposure or mentioned methods of sun protection or skin cancer prevention other than sunscreen use. We discuss the implications of these messages for parents' ability to understand correctly how to protect their children from damaging sun exposure. PMID:23066971
The Inside Knowledge: Get the Facts About Gynecologic Cancer campaign raises awareness of the five main types of gynecologic cancer: cervical, ovarian, uterine, vaginal, and vulvar. It encourages women to pay attention to their bodies and know what is normal for them so they can recognize the warning signs of gynecologic cancers and seek medical care. This report provides an overview of the development of this national campaign. PMID:21933006
Rim, Sun Hee; Polonec, Lindsey; Stewart, Sherri L; Gelb, Cynthia A
This paper argues that continuous training for child care staff is an important element in improving quality of day care provision. Evidence from the day care field, the school effectiveness literature and adult education is cited. Theories of education and learning are used to examine the design of effective approaches to training for day careproviders. More specifically, Kolb's model
|The population of older adults in the United States is growing in size and diversity, presenting challenges to health careproviders and patients in the context of health care decision making (DM), including obtaining informed consent for treatment, advance care planning, and deliberations about end-of-life care options. Although existing…
|Caring for Quality and Partners in Family Child Care are home visiting programs designed to improve the quality of home-based child care. This article describes the experiences of two different home visitors to demonstrate how programs such as these can help providers improve the overall quality of care, increase children's development, and lead…
McCabe, Lisa A.; Peterson, Shira M.; Baker, Amy C.; Dumka, Marsha; Brach, Mary Jo; Webb, Diana
Caring for Quality and Partners in Family Child Care are home visiting programs designed to improve the quality of home-based child care. This article describes the experiences of two different home visitors to demonstrate how programs such as these can help providers improve the overall quality of care, increase children's development, and lead…
McCabe, Lisa A.; Peterson, Shira M.; Baker, Amy C.; Dumka, Marsha; Brach, Mary Jo; Webb, Diana
Addressed to individuals providing unregulated child care in their homes, this booklet presents basic recordkeeping and tax rules. The booklet discusses the following topics: (1) child care regulations, focusing on the benefits of being regulated; (2) the business of child care, listing possible tax deductions; (3) the tax consequences of caring…
...governing payments for certain non-VA health care, 38 CFR 17.56, applicable to...rule, we estimate that each home health care and hospice provider that does...negotiated contracts offer home health care or hospice care to veterans...
Purpose/Objectives: To describe the survivorship experience of young adult patients with thyroid cancer.Research Approach: A qualitative, descriptive study.Setting: Four Canadian provinces, with most participants from Ontario.Participants: 12 young adult thyroid cancer survivors who participated in a larger study on follow-up care needs consisting of 55 young adult cancer survivors.Methodologic Approach: Telephone interviews were conducted with cancer survivors who were diagnosed from age 18-39 years and were 1-5 years post-treatment.Findings: All 12 thyroid cancer survivors discussed the feeling that their cancer experiences often were downplayed because thyroid cancer is labeled as the "good" cancer. Many said that they were not considered real patients with cancer by healthcare providers and other patients with cancer, and they were unable or unwilling to access support programs or assistance from healthcare providers.Conclusions: Cancer can have an impact on a person's life regardless of the prognosis. Being diagnosed with thyroid cancer at a young age can pose additional challenges because of the lack of available support to address needs specific to young adults.Interpretation: Healthcare providers must recognize the needs of thyroid cancer survivors and encourage them to access supportive services.Knowledge Translation: Patients with thyroid cancer believe that their needs often are overlooked because of high survival rates, and they have difficulty accessing support resources and finding help. Young adults with cancer often have unique support needs. Support needs may not be the same for all young adult patients with cancer, and those needs should be recognized and addressed. PMID:24161638
Siemens new free PSA test is intended to be used in conjunction with the ADVIA Centaur PSA test to determine the percent free PSA value in men aged 50 years or older with total PSA values between 4 and 10 ng\\/mL and digital rectal exam (DRE) results non-suspicious for cancer. The percent free PSA value can be used to help
This Special Listing of Current Cancer Research Projects is a publication of the International Cancer Research Data Bank (ICRDB) Program of the National Cancer Institute. Each Listing contains descriptions of ongoing projects in one selected cancer research area. The research areas include: Infectious disease in cancer patients; Immunological aspects of supportive care of cancer patients; Nutritional evaluation and support of cancer patients; Pain management of cancer patients.
Frequently, primary careproviders continue to manage the overall medical care of cancer patients. With newer and often more potent antitumor agents, patients may present to their local physicians with drug-induced toxicities such as hypertension induced by vascular endothelial growth factor (VEGF) inhibitors. It is imperative that these healthcare providers are aware of basic aspects of this drug class, as its use has increased significantly in the last several years. Uncontrolled or malignant hypertension due to these agents should be recognized readily and treated early to prevent more severe outcomes. This overview provides a brief background on the role of VEGF and angiogenesis in tumor metabolism as well as theories of the mechanism of VEGF inhibitors and hypertension. Helpful clinical practice aspects including the types of inhibitors used in the United States and their pharmacologic characteristics will be discussed. Also, diagnosis and treatment of hypertension induced by vascular endothelial growth factors are reviewed. A summary of key aspects of this drug class and hypertension is included.
To better understand the challenges faced by primary careproviders in rural locations in providingcare for children with complex chronic conditions (CCC), the authors conducted a cross-sectional survey of primary careproviders (N = 132), including physicians, nurse practitioners, and physician assistants, in community settings in 6 counties in northwest North Carolina. Pediatric practices were significantly less likely to be located in rural areas. Practices in rural areas were more likely to be small, with fewer staff members (odds ratio [OR] = 7) and providers (OR = 15) compared with practices in nonrural areas. Additionally, nonrural practices were 3 times as likely as rural practices to have a larger clientele of children with CCC. A majority of primary careproviders (77%) reported difficulty caring for children with CCC. Strategies for supporting primary careproviders are needed to enable them to providecare for the growing number of children with CCC. PMID:22345634
Murphy, Kelly L; Kobayashi, Daisuke; Golden, Shannon L; Nageswaran, Savithri
Primary care settings are the gateway through which the majority of Latinos access care for their physical and mental health concerns. This study explored the perspectives of primary careproviders regarding their Latino patients, particularly, issues impacting their patients’ access to and utilization of services. Interviews were conducted with eight primary careproviders—and analyzed using consensual qualitative research methods. In addition, observations were conducted of the primary care setting to contextualize providers’ perspectives. Providers indicated that care for Latinos was impacted by several domains: (a) practical/instrumental factors that influence access to care; (b) cultural and personal factors that shape patients’ presentations and views about physical and mental health and treatment practices; (c) provider cultural competence; and (d) institutional factors which highlight the context of care. In addition to recommendations for research and practice, the need for interdisciplinary collaboration between psychology and medicine in reducing ethnic minority disparities was proposed.
Valdez, Carmen R.; Dvorscek, Michael J.; Budge, Stephanie L.; Esmond, Sarah
Integrated care for medical conditions is essential for persons with serious mental illness (SMI). This qualitative study describes mental health provider perspectives regarding barriers and facilitators of integrated care for patients with SMI. We interviewed providers from a national sample of Veterans Health Administration facilities that scored in the top or bottom percentile in medical care quality. Providers from high-performing sites reported substantial in-person contacts with general medical providers, while providers from low-performing sites reported stigma and limited communication with medical providers as major concerns. Interventions to improve mental health and medical provider communication may facilitate integrated care for persons with SMI. PMID:21735302
Kilbourne, Amy M; Greenwald, Devra E; Bauer, Mark S; Charns, Martin P; Yano, Elizabeth M
Managers of early childhood education programs know that it is imperative that their organization's collective energy be focused in a single direction, one that has been envisioned and determined by the organization's leadership, with input from all who will affect or be affected by it. A mission statement provides a constant reminder within an…
Purpose: The aim of this study was to document the experience and patient satisfaction with providing pediatric surgery consultations and follow-up appointments to remote locations via audiovisual telecommunications technology. Methods: From January 2000 to April 2001, 16 consecutive pediatric general surgery clinics were reviewed for the type of patient (new or review), the diagnosis, the adequacy and accuracy of the
As the healthcare industry continues to recognize the strategic implications of branding, more providers will undertake an identity change to better position themselves in competitive markets. The paper examines specific healthcare branding decisions, the reasons prompting brand name decisions and the marketing implications for a change in brand name. PMID:10127924
Goals of workAs medical care for cancer has become more specialized in diagnosis, treatment has become more technical and fragmented. In order to help cancer patients and their families, we developed a coordinated program called the Stanford Cancer Supportive Care Program (SCSCP) at the Center for Integrative Medicine at Stanford Hospital and Clinics. The Stanford Cancer Supportive Care Program was
Ernest Rosenbaum; Holly Gautier; Pat Fobair; Eric Neri; Bernadette Festa; Margaret Hawn; Alexandra Andrews; Nama Hirshberger; Sabrina Selim; David Spiegel
Background: Various groups have called for a national sys- tem to monitor the quality of cancercare. The validity of cancer registry data for quality of cancercare has not been well studied. We investigated the validity of such informa- tion in the California Cancer Registry. Methods: We com- pared registry data associated with care with data ab- stracted from
Jennifer L. Malin; Katherine L. Kahn; John Adams; Lorna Kwan; Marianne Laouri; Patricia A. Ganz
Health care reform and, especially, managed care may have important consequences for providers of mental health treatment to sexual assault victims and sexual offenders. This study is an initial effort to identify the impact of changes in health care delivery systems on specialist providers. A survey was mailed to 380 therapists in Washington state who were identified as having specialized
Grandparents are regular providers of free child care. Similar to any other form of child care, availability of grandparent-provided child care affects fertility and labor market decisions of women positively. We find that women in Germany, residing close to parents or in-laws are more likely to have children and that as mothers they are more likely to hold a regular
Recent research has revealed child care settings and providers to be important influences on children's developing behaviors. Yet most research on children's nutritional development has focused on home settings and parents. Thus, through semistructured interviews with child careproviders, this study aimed to develop a better understanding of the strategies they perceive to encourage healthy eating in child care settings.
VHA administers VA's health care system and strives to provide high-quality, safe care to veterans. Concerns continue about the quality of care VHA delivers, but many physicians and dentists, referred to as providers, receive performance-based pay and awa...
Since the proliferation of managed care organizations and the expansion of the central role of the primary careprovider in the early 1990s, certified nurse-midwives and certified midwives have debated the merits and drawbacks of their inclusion in this category of provider. The present article explores the history of primary care and reviews the most commonly accepted definition of primary
|Canadians are experiencing increased life expectancy and chronic illness requiring end-of-life care. There is limited research on the multiple roles for family members providing home-based palliative care. Based on a larger ethnographic study of client-family-provider relationships in home-based palliative care, this qualitative secondary…
Clemmer, Sarah J.; Ward-Griffin, Catherine; Forbes, Dorothy
This article discusses the mandatory and discretionary authority vested in the Secretary of the US Department of Health and Human Services (DHHS) regarding whether or not to exclude health careproviders from participation in one or all of the federal health care programs including Medicare and Medicaid. This article also provides guidance to providers that if they open up a
BackgroundPatient satisfaction is related to the perception of care. Some patients prefer, and are more satisfied with, providers of the same gender, race or religious faith. This study examined emergency medical provider attitudes towards, as well as patient and provider characteristics that are associated with, accommodating such requests.MethodsA survey administered to a convenience sample of participants at the 2007 American
Aasim I Padela; Sandra M Schneider; Hua He; Zarina Ali; Thomas M Richardson
Purpose/Objectives: To evaluate the process of survivorship care plan (SCP) completion and to survey oncology staff and primary care physicians (PCPs) regarding challenges of implementing SCPs.Design: Descriptive pilot study.Setting: Two facilities in Vermont, an urban academic medical center and a rural community academic cancer center.Sample: 17 oncology clinical staff created SCPs, 39 PCPs completed surveys, and 58 patients (breast or colorectal cancer) participated in a telephone survey.Methods: Using Journey Forward tools, SCPs were created and presented to patients. PCPs received the SCP with a survey assessing its usefulness and barriers to delivery. Oncology staff were interviewed to assess perceived challenges and benefits of SCPs. Qualitative and quantitative data were used to identify challenges to the development and implementation process as well as patient perceptions of the SCP visit.Main Research Variables: SCP, healthcare provider perception of barriers to completion and implementation, and patient perception of SCP visit.Findings: Oncology staff cited the time required to obtain information for SCPs as a challenge. Completing SCPs 3-6 months after treatment ended was optimal. All participants felt advanced practice professionals should complete and review SCPs with patients. The most common challenge for PCPs to implement SCP recommendations was insufficient knowledge of cancer survivor issues. Most patients found the care plan visit very useful, particularly within six months of diagnosis.Conclusions: Creation time may be a barrier to widespread SCP implementation. Cancer survivors find SCPs useful, but PCPs feel insufficient knowledge of cancer survivor issues is a barrier to providing best follow-up care. Incorporating SCPs in electronic medical records may facilitate patient identification, appropriate staff scheduling, and timely SCP creation.Implications for Nursing: Oncology nurse practitioners are well positioned to create and deliver SCPs, transitioning patients from oncology care to a PCP in a shared-care model of optimal wellness. Institution support for the time needed for SCP creation and review is imperative for sustaining this initiative.Knowledge Translation: Accessing complete medical records is an obstacle for completing SCPs. A 3-6 month window to develop and deliver SCPs may be ideal. PCPs perceive insufficient knowledge of cancer survivor issues as a barrier to providing appropriate follow-up care. PMID:24161636
Dulko, Dorothy; Pace, Claire M; Dittus, Kim L; Sprague, Brian L; Pollack, Lori A; Hawkins, Nikki A; Geller, Berta M
Introduction A severe healthcare worker shortage in sub-Saharan Africa is inhibiting the expansion of HIV treatment. Task shifting, the transfer of antiretroviral therapy (ART) management and initiation from doctors to nurses and other non-physician clinicians, has been proposed to address this problem. However, many health officials remain wary about implementing task shifting policies due to concerns that non-physicians will providecare inferior to physicians. To determine if non-physician-provided HIV care does result in equivalent outcomes to physician-providedcare, a meta-analysis was performed. Methods Online databases were searched using a predefined strategy. The results for four primary outcomes were combined using a random effects model with sub-groups of non-physician-managed ART and -initiated ART. TB diagnosis rates, adherence, weight gain and patient satisfaction were summarized qualitatively. Results Mortality (N=59,666) had similar outcomes for non-physicians and physicians, with a hazard ratio of 1.05 (CI: 0.88–1.26). The increase in CD4 levels at one year, as a difference in means of 2.3 (N=17,142, CI: ?12.7–17.3), and viral failure at one year, as a risk ratio of 0.89 (N=10,344, CI: 0.65–1.23), were similar for physicians and non-physicians. Interestingly, loss to follow-up (LTFU) (N=53,435) was reduced for non-physicians with a hazard ratio of 0.72 (CI: 0.56–0.94). TB diagnosis rates, adherence and weight gain were similar for non-physicians and physicians. Patient satisfaction appeared higher for non-physicians in qualitative components of studies and was attributed to non-physicians spending more time with patients as well as providing more holistic care. Conclusions Non-physician-provided HIV care results in equivalent outcomes to careprovided by physicians and may result in decreased LTFU rates.
Emdin, Connor A; Chong, Nicholas J; Millson, Peggy E
Bibliotherapy is a form of self-administered treatment in which structured materials provide a means to alleviate distress. Although the treatment has evidence of effectiveness, evaluations of bibliotherapy have typically focused on outcomes, and the perspectives of both the client and the service provider have been understudied. In the present study, eleven users of a bibliotherapy scheme were interviewed regarding their experiences of bibliotherapy. In addition, five referring practitioners to the scheme were also interviewed. Thematic analyses revealed three super-ordinate themes in the transcripts: participants' personal experiences of the bibliotherapy scheme factors that facilitate change and the influence of the professionals involved. The implications of these findings for bibliotherapy schemes are considered. PMID:20146202
BACKGROUND.During the past 2 decades, family-centered care has evolved as the standard of care for children with special health care needs. A major principle of family-centered care is a strong partnership between the family and provider, working together to address issues and barriers to accessing comprehensive care and related services. The federal Maternal and Child Health Bureau defines a positive
Diana Denboba; Merle G. McPherson; Mary Kay Kenney; Bonnie Strickland; Paul W. Newacheck
We examined case studies of 3 rural Midwestern communities to assess local health care systems’ response to rapidly growing Latino populations. Currently, clinics provide free or low-cost care, and schools, public health, social services, and religious organizations connect Latinos to the health care system. However, many unmet health care needs result from lack of health insurance, limited income, and linguistic and cultural barriers. Targeted safety net funding would help meet Latino health care needs in rural communities with limited resources.
Casey, Michelle M.; Blewett, Lynn A.; Call, Kathleen T.
The discovery of HIV/AIDS prompted a profusion of research focusing on the disease and its causes. Though the bulk of this research emphasizes behavioural risk factors, treatment and disease progression, researcher efforts are beginning to examine the public's attitude toward individuals who are HIV-positive or have developed AIDS. Utilizing Weiner's Attribution Theory, the current study examines the beliefs of social service providers who work directly with individuals affected by HIV/AIDS. Forty-six (28 female and 18 male) HIV/AIDS social service providers from three community-based organizations were asked to read a hypothetical scenario depicting an individual at-risk for HIV/AIDS because of multiple high-risk behaviours. The gender of the target was manipulated and at the conclusion of the scenario participants completed a questionnaire designed to assess attributions. Results of the study show that social service providers who perceive individuals as more responsible for their illness report increased anger, attribute more blame and express less willingness to help those at-risk for HIV/AIDS. This research suggests that despite growing numbers of media campaigns and national distribution of information regarding the disease and its transmission, in general, people continue to stigmatize and place blame on those at-risk. PMID:12204156
Introduction The emotional burden associated with the diagnosis of cancer is sometimes overshadowed by financial burden sustained by patient and the family. This is especially relevant for a developing country as there is limited state support for cancer treatment. We conducted this study to estimate the cost of cancercare for two major types of cancer and to assess the perception of patients and families regarding the burden of the cost for undergoing cancer treatment at a private tertiary care hospital. Methods This cross-sectional study was conducted at day care and radiotherapy unit of Aga Khan University, Hospital (AKUH) Karachi, Pakistan. All adult patients with breast and head & neck cancers diagnosed for 3 months or more were included. Data was collected using a structured questionnaire and analysed using SPSS. Results Sixty seven patients were interviewed during the study period. The mean and median monthly income of these patients was 996.4 USD and 562.5 USD respectively. Comparatively the mean and median monthly cost of cancercare was 1093.13 USD and 946.42 USD respectively. The cost of the treatment either fully or partially was borne by the family in most cases (94%). The financial burden of cancer was perceived as significant by 28 (42%) patients and unmanageable by 18 (27%) patients. This perceived level of burden was associated significantly with average monthly income (p = <0.001). Conclusion Our study indicates that the financial burden of cancercare is substantial and can be overwhelming. There is a desperate need for treatment support programs either by the government or other welfare organisations to support individuals and families who are already facing a difficult and challenging situation.
This project was initiated to provide ongoing training for long-term care personnel in Oregon; emphasis was placed on continuity through coordination with groups and associations involved in long-term care. Five objectives were: to initiate communication ...
... to Talk Tips Time To Talk With Your Health CareProviders: 4 Tips To Start the Conversation When ... fully informed and can help patients make wise health care decisions. Here are 4 tips to help you ...
... abdominal pain in the elderly, but affects outcome Health Care Costs and Financing Increasing premiums and other costs ... with HIV have different communication styles with their health careproviders than whites Research Activities, June 2011, No. ...
... 489-4900 · email@example.com Hepatitis B and Health CareProviders What You Need To Know What is ... virus. How can I protect myself as a health care worker? The Centers for Disease Control and Prevention ( ...
... 512-1800 . Important lead hazard information for families, child careproviders and schools. C ERTIFIED FIR M LEAD- ... YOUR HOME FOR LEAD-BASED PAINT Older homes, child care facilities, and schools are more likely to contain ...
Cultural competence in oncology requires the acquisition of specific knowledge, clinical skills, and attitudes that facilitate\\u000a effective cross-cultural negotiation in the clinical setting, thus, leading to improved therapeutic outcomes and decreased\\u000a disparities in cancercare. Cultural competence in oncology entails a basic knowledge of different cultural attitudes and\\u000a practices of communication of the truth and of decision-making styles throughout the
This paper presents a qualitative investigation of the work-family support roles of a sample of 29 child careproviders serving low-income families in the Chicago area (16 family, friend, and neighbor providers (FFN), 7 licensed family child careproviders (FCC), and 6 center-based teachers). Providers report offering low-income parents…
In this chapter the "communication compass" is introduced. It defines the key elements of communication and provides a language with which to communicate about communication in cancercare. The communication compass consists of two axes. One axis defines the associated perspectives of the clinician and the patient, the other axis the content of information and emotional experience. "Two lovers sat on a park bench with their bodies touching each other, holding hands in the moonlight. There was silence between them. So profound was their love for each other, they needed no words to express it." (Samuel Johnson). Sometimes communication just flows. There are these special moments, as fleeting as they are intense. Often communication is stuck. It is as if we speak another language and never manage to understand one another. The lovers on the park bench need no words to express what they feel, neither do they need words to speak about communication. Where communication gets stuck, we need a suitable language to speak about communication. Professional communication cannot be learned from a cookbook. Most of all it implies a readiness to communicate, which means openness to the other. The old adage that it is impossible not to communicate is only true if no criterion of quality is applied. As soon as some mutual understanding is implied in the definition of communication, the fact that it is at all possible to communicate becomes a miracle. Since there is an important gap between theory and practice, we created a tool that aims to bridge that gap. We call it the communication compass. It does not propose a model of "ideal communication," but provides a language with which to examine and analyze specific situations and to determine what the pitfalls and possibilities are. It is useful as a tool for identifying communicational difficulties in daily clinical practice and it can serve as a model for training basic communication skills. PMID:17073187
CONTEXT: By providing information and possibly shaping parents' preferences, health-careproviders are thought to play a critical role in parental decisions to enroll their infants in research. Yet, little is known about health-careproviders' beliefs about research with newborns. Previous studies suggest that parents and health-careproviders are often at odds regarding attitudes towards research.OBJECTIVE: To examine the attitudes of
Nalini Singhal; Kathleen Oberle; Amy Darwish; Ellen Burgess
There is growing evidence that follow-up for patients with early breast cancer (ebc) can be effectively carried out by the primary health careprovider if a plan is in place. Here, we present data from a recent survey conducted in Ontario indicating that a shared-care model could work if communication between all health professionals involved in the care of ebc patients were to be improved. Patients and primary careproviders benefit when the specialist provides written information about what their roles are and what to expect. Primary careproviders need to have easy access to the specialist to discuss areas of concern. Patients also need to share responsibility for their care, ensuring that they attend follow-up visits on a regular basis and that they discuss areas of concern with their primary health careprovider. A shared-care model has the potential to provide the best care for the least cost to the health system.
Over the past 15 years, the multidisciplinary team management of many medical conditions especially cancers has increasingly taken a prominent role in patient management in many hospitals and medical centres in the developed countries. In the United Kingdom, it began to gain prominence following the Calman-Heine report in 1995 which suggested that each Cancer Unit in a hospital should have in place arrangements for non-surgical oncological input into services, with a role for a non-surgical oncologist. The report further suggested that a lead clinician with a well established interest in cancercare should be appointed to organise and coordinate the whole range of cancer services provided within the Cancer Unit. Many people have argued that the multidisciplinary team management of patients has resulted in better care and improved survival. However, there are barriers to the optimal effectiveness of the multidisciplinary team. This paper aims to review various studies on the effectiveness of the multidisciplinary team in the management of cancer patients and also discuss some of the barriers to the multidisciplinary team.
Family physicians take pride in addressing the totality of a patient's experience of disease and are skilled in a multidisciplinary approach to care. As such, they have an important role to play in managing adult cancer pain. Although 75% to 90% of cancer patients could receive adequate pain relief from routine pharmacologic therapies delivered by family physicians, pain continues to be undertreated in this population. Pain is a global experience affecting the whole person. Our role as patient advocates and educators makes us well suited to participate in the current national attempt to redress the lack of attention to this important component of suffering. This article reviews commonly seen cancer pain syndromes, with specific recommendations concerning assessment, reassessment, management, and indications for consultation. PMID:15575030
Personalized medicine is revolutionizing cancercare and creating new expectations among oncologists and patients. At present the benefit is still marginal, however, and must be understood as incremental. In addition, cultural and resource disparities limit the sustainability of new cancer therapies on a global scale. Adequate instruments are needed to enable our exercise of sound and honest judgment in distinguishing breakthrough treatments from those that yield only marginal or doubtful improvements, and to develop strategies for formulation and correct application of balanced guidelines for sustainable cancercare. Professionalism requires that the acquisition of knowledge and skills go hand in hand with moral education in the intellectual virtues of humility, perseverance, adaptability, communicativeness, and commitment to resist self-deception or conflicts of interest. Hidden curricula undermine the moral values of medicine: these must be understood and uncovered. We should possess a special body of knowledge, skills, and values that allow us to change our practices when appropriate and to be stewards of society's limited resources through proper communication with our patients and families. In the era of personalized oncology and global issues of sustainability, professional authenticity and integrity in cancer clinical practice are key to bridging the gaps between true and false expectations of patients and the public. PMID:23714485
Many are calling for the expansion of the patient-centered medical home model into rural and underserved populations as a transformative strategy to address issues of access, efficiency, quality, and sustainability in the delivery of health care. Patient-centered medical homes have been touted as a promising cost-saving model for comprehensive management of persons with chronic diseases and disabilities, but it is unclear how rural practitioners in medically underserved areas will implement the patient-centered medical home. This article examines how the Patient Protection & Affordable Care Act of 2010 will enhance rural providers' ability to provide patient-centered care and services contemplated under the Act in a comprehensive, coordinated, cost-effective way despite leaner budgets and health workforce shortages. PMID:21378505
Bolin, Jane N; Gamm, Larry; Vest, Joshua R; Edwardson, Nick; Miller, Thomas R
Background Medicare managed care may offer enrollees lower out-of-pocket costs and provide benefits that are not available in the traditional fee-for-service Medicare program. However, managed care plans may also restrict provider choice in an effort to control costs. We compared rates of voluntary disenrollment from Medicare managed care to traditional fee-for-service Medicare among Medicare managed care enrollees with and without a cancer diagnosis. Methods We identified Medicare managed care enrollees aged 65 years or older who were diagnosed with a first primary breast (n = 28?331), colorectal (n = 26?494), prostate (n = 29?046), or lung (n = 31?243) cancer from January 1, 1995, through December 31, 2002, in Surveillance, Epidemiology, and End Results (SEER) cancer registry records linked with Medicare enrollment files. Cancer patients were pair-matched to cancer-free enrollees by age, sex, race, and geographic location. We estimated rates of voluntary disenrollment to fee-for-service Medicare in the 2 years after each cancer patient’s diagnosis, adjusted for plan characteristics and Medicare managed care penetration, by use of Cox proportional hazards regression. Results In the 2 years after diagnosis, cancer patients were less likely to disenroll from Medicare managed care than their matched cancer-free peers (for breast cancer, adjusted hazard ratio [HR] for disenrollment = 0.78, 95% confidence interval [CI] = 0.74 to 0.82; for colorectal cancer, HR = 0.84, 95% CI = 0.80 to 0.88; for prostate cancer, HR = 0.86, 95% CI = 0.82 to 0.90; and for lung cancer, HR = 0.81, 95% CI = 0.76 to 0.86). Results were consistent across strata of age, sex, race, SEER registry, and cancer stage. Conclusion A new cancer diagnosis between 1995 and 2002 did not precipitate voluntary disenrollment from Medicare managed care to traditional fee-for-service Medicare.
Ishill, Nicole; Riley, Gerald F.; Bach, Peter B.; Gonen, Mithat; Begg, Colin B.; Schrag, Deborah
Background: There is evidence that delays in treatment result in increased psy- chosocial morbidity for patients diagnosed with cancer. We evaluated waiting times for care among cancer patients treated by surgeons affiliated with regional cancer centres in Ontario. Methods: Dates for 5 key events related to the surgical management of a patient with cancer were collected by a convenience sample
Marko Simunovic; Anna Gagliardi; David McCready; Angela Coates; Mark Levine; Denny DePetrillo
Summary The incidence of breast cancer is low in India, but rising. Breast cancer is the commonest cancer of urban Indian women and the second commonest in the rural women. Owing to the lack of awareness of this disease and in absence of a breast cancer screening program, the majority of breast cancers are diagnosed at a relatively advanced stage. The quality of care available for breast cancer patients varies widely according to where the patient is treated. Although there are some centers of excellence providing multimodality protocol-based treatment at par with the best anywhere in the world, the vast majority of breast cancer patients undergo inadequate and inappropriate treatment due to lack of high-quality infrastructure and sometimes skills, and above all financial resources. The recent emphasis on health education, early diagnosis of cancers, and more public facilities for cancer treatment are expected to bring about the much needed improvement in breast cancercare in India.
Reproductive health among cancer survivors is an important quality of life issue. Certain cancer therapies have known fertility risks. There is an existing cohort of adolescents and young adults (AYA) cancer survivors that, seen less frequently in clinical care settings than active patients, are likely not having discussions of fertility and other reproductive health issues. A survivor or healthcare provider can easily assume that the window of opportunity for fertility preservation has passed, however emerging research has shown this may not be the case. Recent data demonstrates a close relationship between fertility and other late effects to conclude that ongoing assessment during survivorship is warranted. Some fertility preservation procedures have also been shown to mitigate common late effects. This review explores the link between late effects from treatment and common comorbidities from infertility, which may exacerbate these late effects. This review also highlights the relevance of fertility discussions in the AYA survivorship population.
BACKGROUND Nearly one-third of office visits for cancer are handled by primary care physicians. Yet, few studies examine patient perspectives on these physicians' roles in their cancer follow-up care or their care preferences. METHODS We explored survivor preferences through qualitative, semistructured, in-depth interviews drawing on patients recruited from 2 National Cancer Institute-designated comprehensive cancer centers and 6 community hospitals. We recruited a purposive sample of early-stage breast and prostate cancer survivors aged 47 to 80 years, stratified by age, race, and length of time from and location of cancer treatment. Survivors were at least 2 years beyond completion of their active cancer treatment RESULTS Forty-two survivors participated in the study. Most participants expressed strong preferences to receive follow-up care from their cancer specialists (52%). They described the following barriers to the primary care physician's engagement in follow-up care: (1) lack of cancer expertise, (2) limited or no involvement with original cancercare, and (3) lack of care continuity. Only one-third of participants (38%) believed there was a role for primary care in cancer follow-up care and suggested the following opportunities: (1) performing routine cancer-screening tests, (2) supplementing cancer and cancer-related specialist care, and (3) providing follow-up medical care when "enough time has passed" or the survivors felt that they could reintegrate into the noncancer population. CONCLUSION Survivors have concerns about seeing their primary care physician for cancer-related follow-up care. Research interventions to address these issues are necessary to enhance the quality of care received by cancer survivors. PMID:22966105
Hudson, Shawna V; Miller, Suzanne M; Hemler, Jennifer; Ferrante, Jeanne M; Lyle, Jennifer; Oeffinger, Kevin C; Dipaola, Robert S
This paper details one of the findings of a large phenomenological study into the effects of nurse-patient encounters on clinical learning and practice. Every nurse faces the challenge of caring for a patient with cancer at some point in his or her nursing career. The participants, 392 nurses, were asked to discuss a care episode from their practice and the impact this encounter had on clinical learning and practice. The data collection method was by way of a written narrative/clinical exemplar. Meaning units and themes were identified using the Nvivo computer program. The procedural method of Giorgi was followed in all phases of analysis. The participants provided a detached description of the patients' diagnoses but tended to become emotive when discussing the cancer treatment experience. Nurses detailed care episodes with insight and understanding of the consequences of cancer for the patient. Nurses used powerful language to illustrate the enormity of the cancer experience for the patient and family. Although the nurses recognized the emotional impact themselves, they attempted to understate it. Participants spoke of their frustration and their sadness when describing the nurse-patient encounters. The life-threatening potential of cancer for the patient and the perception of potential or actual suffering do impact on nurses, their learning and their clinical practice. This is particularly evident when the cancer experience for the patient is not predictable. Participants clearly felt the influence of patients' cancer experience, personally and professionally. Participants detailed learning from the encounters and reflected with great insight on themselves and their practice. Identifying the learning potential of nurse-patient encounters can contribute to change in clinical practice. PMID:17394519
|Twenty-two family day careproviders and twelve home visitors from seven Massachusetts agency-sponsored family day care systems completed two-part questionnaires investigating their perceptions of their own and each other's ideal and actual "on the job" behavior. Provider-questionnaire items focused on (1) physical environment of home, personal…
Health care resources are scarce, and future funding increases are less likely than in the past; reorientation of health services to more efficient and effective delivery is as timely as ever. In this light, we consider the recent funding decision by the Government to provide $16 million over the next 4 years for cancer coordination nurses. While the intricacies of the role are still being defined, it is likely that cancercare coordinators could benefit patients in terms of access to and timeliness of care, and patient satisfaction. Our research into the role shows that many coordinating activities for cancer patients are already being done, but often in an ad hoc manner by a number of different personnel. Thus, we estimate that the likely 'true' incremental cost of cancercare coordinators is in fact relatively low when considered in opportunity cost terms because the cancercare coordinator will be able to free up time for other staff enabling them to providecare elsewhere in the health system and reduce tasks being unnecessarily repeated. The funding of cancercare coordinators is a great opportunity to improve the timeliness of care and improve the experience of patients through their cancer journey, but the success of these roles depends on the leadership provided, peer support, continual appraisal and the resources available. PMID:24150268
Collinson, Lucie; Foster, Rachel H; Stapleton, Maria; Blakely, Tony
The population of older adults in the United States is growing in size and diversity, presenting challenges to health careproviders and patients in the context of health care decision making (DM), including obtaining informed consent for treatment, advance care planning, and deliberations about end-of-life care options. Although existing literature addresses providers' need to attend to patients' cultural values and beliefs on these issues, less attention has been paid to how the corresponding values and beliefs of providers color the care they deliver and their assessments of older adults' DM capacity. The provider's challenge is to understand her own unacknowledged anxieties, prejudices, and fears around such charged issues as truth telling, individual agency, capacity, death and dying, and the value of life itself and address their impact on the delivery of care. A social constructivist perspective and the clinical concept of cultural countertransference are proposed as aides in achieving this awareness and improving care. PMID:22403162
Monitoring the current status of cancercare is essential for effective cancer control and high-quality cancercare. To address the information needs of patients and physicians in Japan, hospital-based cancer registries are operated in 397 hospitals designated as cancercare hospitals by the national government. These hospitals collect information on all cancer cases encountered in each hospital according to precisely defined coding rules. The Center for Cancer Control and Information Services at the National Cancer Center supports the management of the hospital-based cancer registry by providing training for tumor registrars and by developing and maintaining the standard software and continuing communication, which includes mailing lists, a customizable web site and site visits. Data from the cancercare hospitals are submitted annually to the Center, compiled, and distributed as the National Cancer Statistics Report. The report reveals the national profiles of patient characteristics, route to discovery, stage distribution, and first-course treatments of the five major cancers in Japan. A system designed to follow up on patient survival will soon be established. Findings from the analyses will reveal characteristics of designated cancercare hospitals nationwide and will show how characteristics of patients with cancer in Japan differ from those of patients with cancer in other countries. The database will provide an infrastructure for future clinical and health services research and will support quality measurement and improvement of cancercare. Researchers and policy-makers in Japan are encouraged to take advantage of this powerful tool to enhance cancer control and their clinical practice. PMID:23448800
Cancer patients at the end of life often take many medications and are at risk for drug interactions. The purpose of this study was to describe the epidemiology of potential drug interactions in cancer patients receiving supportive care exclusively. We retrospectively reviewed the charts of consecutive adult cancer outpatients attending palliative care clinics at the Princess Margaret Hospital, Toronto, Canada.
Rachel P. Riechelmann; Camilla Zimmermann; Sheray N. Chin; Lisa Wang; Aoife O'Carroll; Sanaz Zarinehbaf; Monika K. Krzyzanowska
Background: Information on the costs of medical care for patients enrolled in clinical trials is needed by policymakers evaluating ways to facilitate clinical research in a managed care environment. We examined the direct costs of medical care for patients enrolled in cancer clinical trials at a large health maintenance organization (HMO). Methods: Costs for 135 patients who entered 22 cancer
Bruce H. Fireman; Louis Fehrenbacher; Elisabeth P. Gruskin; G. Thomas Ray
Monitoring and assistive technologies for the older adults, by sensing and recording activities and status, provide an objective record of a patient's functioning within natural environments. Yet the data derived from these technologies do not directly address the clinical aims of health careproviders. We conducted focus groups with health careproviders who work with older adults to elicit their
Current guidelines for the evaluation and treatment of obesity recommend referring individuals with binge eating disorder (BED) to a mental health professional. However, it is unclear how familiar primary careproviders are with BED. The purpose of this study was to assess providers' familiarity with BED diagnosis and treatment. Providers in two primary care clinics completed a questionnaire, which assessed
Lillian Huang Cummins; Erin C. Dunn; Leora Rabin; Joan Russo; Katherine Anne Comtois; Barbara S. McCann
Identified factors related to the recruitment, training, and retention of family child care (FCC) providers in two rural communities who participated in an FCC training program. Findings point to the relative success of efforts to recruit and train high quality family child careproviders and the relative difficulty of retaining these providers…
The purpose of this exploratory study is to identify facilitators and barriers to care coordination between medical and early intervention (EI) providers for children with special health care needs and their families. Fifty adults participated in one of six focus groups. Participants included parents\\/caregivers, pediatricians, hospital therapy providers, and EI providers. Guiding questions were designed to obtain participants perceptions. All
Margaret E. ONeil; Roger I. Ideishi; Kim Nixon-Cave; Alan Kohrt
|Health careproviders can play a key role in influencing clients to initiate and maintain use of the female condom, an underused method for HIV/STI and pregnancy prevention. In 2001-2002, based on semistructured interviews with 78 health careproviders from four types of settings in New York City, we found that most providers had seen the female…
Mantell, Joanne E.; West, Brooke S.; Sue, Kimberly; Hoffman, Susie; Exner, Theresa M.; Kelvin, Elizabeth; Stein, Zena A.
JOGNN 13 Objective: To provide an overview of the litera- ture regarding lesbian experiences of childbirth and to offer health careproviders guidance in supporting the childbearing lesbian couple. Data Sources: A search of the literature from 1980 through 2004 was conducted using PsycINFO, Ovid, PubMed, Ebscohost, and CINAHL, and the key words, lesbian, childbirth, parenting health careprovid- ers,
The management of prostate cancer is complicated by the multitude of treatment options, the lack of proven superiority of one modality of management, and the presence of physician bias. Care at a multidisciplinary prostate cancer clinic offers patients the relative convenience of consultation with physicians of multiple specialties within the confines of a single visit and appears to serve as a venue in which patients can be counseled regarding the risks and benefits of available therapies in an open and interactive environment. Physician bias may be minimized in such an environment, and patient satisfaction rates are high. Available data suggest that low-risk patients who are seen at a multidisciplinary prostate cancer clinic appear to select active surveillance in greater proportion. However, relatively few studies have investigated the other added value that multidisciplinary clinics provide to the patient or health care system, and therefore, additional studies assessing the impact of multidisciplinary care in the management of patients with prostate cancer are needed. PMID:23763881
Aizer, Ayal A; Paly, Jonathan J; Efstathiou, Jason A
Background In larger parts of the Middle East palliative care is still misunderstood among health professionals, cancer patients and the public at large. One reason to that is because the term does not obviously communicate the intent of this clinical discipline, which is lending better quality of life while combating cancer. Further, culture, tradition and religion have contributed to this misgiving and confusion especially at the terminal stage of the disease. Methods The Middle East Cancer Consortium jointly with the American Society of Clinical Oncology, the American Oncology Nursing Society, the San Diego Hospice Center for Palliative Medicine and the Children's Hospital & Clinics of Minnesota initiated a series of training courses and workshops in the Middle East to provide updated training to physicians, nurses, social workers and psychologists from throughout the region with basic concepts of palliative care and pain managements in adults and children cancers. Results During the past 6 years hundreds of professionals took part in these educational and training activities, thereby creating the core of trained caregivers who start to make the change in their individual countries. Conclusions The outcome of consecutive training activities can overcome geopolitical instabilities, and yield a genuine change in approach of both regulators, medical administrators, medical staff and the public; as to the important contribution of palliative care services to the welfare of the patient and his/her family.
Silbermann, M.; Arnaout, M.; Daher, M.; Nestoros, S.; Pitsillides, B.; Charalambous, H.; Gultekin, M.; Fahmi, R.; Mostafa, K.A.H.; Khleif, A.D.; Manasrah, N.; Oberman, A.
The objective of this study is to verify the relevance and utilization of communication strategies in palliative care. This is a multicenter qualitative study using a questionnaire, performed from August of 2008 to July of 2009 with 303 health care professionals who worked with patients receiving palliative care. Data were subjected to descriptive statistical analysis. Most participants (57.7%) were unable to state at least one verbal communication strategy, and only 15.2% were able to describe five signs or non-verbal communication strategies. The verbal strategies most commonly mentioned were those related to answering questions about the disease/treatment. Among the non-verbal strategies used, the most common were affective touch, looking, smiling, physical proximity, and careful listening. Though professionals have assigned a high degree of importance to communication in palliative care, they showed poor knowledge regarding communication strategies. Final considerations include the necessity of training professionals to communicate effectively in palliative care. PMID:22773483
Trovo de Araújo, Monica Martins; da Silva, Maria Júlia Paes
This study evaluated primary careproviders' (PCPs, pediatricians, and nurse practitioners) knowledge, current practices, and perceived barriers to childhood obesity prevention and treatment, with an emphasis on first-year well-child care visits. A questionnaire was distributed to 192 PCPs in the primary care network at The Children's Hospital of Philadelphia (CHOP) addressing (i) knowledge of obesity and American Academy of Pediatrics
Jordan G. Spivack; Maggie Swietlik; Evaline Alessandrini; Myles S. Faith
|The purpose of this qualitative interpretive design was to explore the perspectives of researchers, health careproviders, policy makers, and decision makers on key risks, concerns, and emerging issues related to home care safety that would inform a line of research inquiry. Defining safety specifically in this home care context has yet to be…
In 2004, the Commission on Dental Accreditation (CODA) adopted a new standard that directs dental and dental hygiene programs to prepare dental professionals for the care of persons with special health care needs. This article reviews the demographics of individuals with special needs, documents that most dental schools provide their students with very limited educational opportunities related to the care
H. Barry Waldman; Sanford J. Fenton; Steven P. Perlman; Debra A. Cinotti
Objective: Children with special health care needs are known to be at increased risk of all forms of child maltreatment when compared to children without such needs. We describe a health care team’s experience providing medical evaluations for suspected child maltreatment to children with special health care needs.Method: Consecutive cases seen as outpatients in the Abuse Referral Clinic for Children
|This article examines motivations for entering family day care work as they relate to responsibilities of motherhood and the prominence of these motivations for the women providing day care within and across groups of workers. Using data from a large-scale representative survey of family day care workers in Illinois, the author examines the range…
In young children, the eating environment is an important social context within which eating behaviors develop. Among many low-income young children, the responsibility for feeding may have shifted from family members to child careproviders because these children spend the majority of their day in child care settings. To examine the influence of feeding among low-income children in child care
Sheryl O. Hughes; Heather Patrick; Thomas G. Power; Jennifer O. Fisher; Cheryl B. Anderson; Theresa A. Nicklas
...Agreements for State Home Nursing Home Care AGENCY: Department of Veterans Affairs...agreements with State homes for the nursing home care of certain disabled veterans. This rulemaking...in law that revises how VA will pay for careprovided to these veterans and...
A descriptive correlational design was used to examine the relationship between the self-care agency of caregivers providing dependent-care to a spouse with cancer and a set of variables assessing the family system. The following basic conditioning factors associated with the family system were selected for this study: family culture, family resources, level of dependent-care, and caregiver burden. Spouses (N =
This interim final rule amends Department of Veterans Affairs (VA) regulations to allow VA to enter into contracts or provider agreements with State homes for the nursing home care of certain disabled veterans. This rulemaking is required to implement a change in law that revises how VA will pay for careprovided to these veterans and authorizes VA to use provider agreements to pay for such care. The change made by this law applies to all careprovided to these veterans in State homes on and after February 2, 2013. PMID:23227571
Objective Our understanding of optimum health care delivery for cancer survivors is limited by the lack of a patient-centred perspective. The objectives of the present study were to explore the views of breast and colorectal cancer survivors on their routine follow-up care, with respect to needs, preferences, and quality of follow-up, and their views on cancer specialist– compared with family physician (fp)–led follow-up care. Methods In Nova Scotia, Canada, 23 cancer survivors (13 breast, 10 colorectal) participated in either a focus group or a one-on-one interview. Participants were asked to reflect upon their lives as cancer survivors and on the type and quality of care and support they received during the follow-up period. Each focus group or interview was transcribed verbatim, and the transcripts were audited and subjected to a thematic analysis. Results Six themes were identified: My care is my responsibilityHow I receive information on follow-up careI have many care needsI want to be prepared and informedThe role of my fp in my cancer experience and follow-up careThe role of media Survivors often characterized the post–primary treatment experience as lacking in information and preparation for follow-up and providing inadequate support to address many of the care needs prevalent in survivor populations. Despite valuing fp participation in follow-up care, many survivors continued to receive comfort and reassurance from specialist care. Conclusions Our findings point to the need to implement strategies that better prepare breast cancer and colorectal cancer survivors for post-treatment care and that reassure survivors of the ability of their fp to provide quality care during this period.
Urquhart, R.; Folkes, A.; Babineau, J.; Grunfeld, E.
BACKGROUND We wanted to determine the type of outpatient medical care reported by young adult survivors of childhood cancer and to examine factors associated with limited medical care. METHODS We analyzed data from 9,434 adult childhood cancer survivors enrolled in a retrospective cohort study who completed a baseline questionnaire. They had a mean age of 26.8 years (range 18 to 48 years), 47% were female, 12% were minorities, and 16% were uninsured. Four self-reported outcome measures were used to determine outpatient medical care in a 2-year period: general contact with the health care system, general physical examination, cancer-related medical visit, and medical visit at a cancer center. RESULTS Eighty-seven percent reported general medical contact, 71.4% a general physical examination, 41.9% a cancer-related visit, and 19.2%, a visit at a cancer center. Factors associated with not reporting a general physical examination, a cancer-related visit, or a cancer center visit included no health insurance (odds ratio [OR] = 2.34; 95% confidence interval [CI], 1.97–2.77), male sex (OR = 1.65; 95% CI, 1.44–1.88), lack of concern for future health (OR = 1.57; 95% CI, 1.36–1.82), and age 30 years or older in comparison with those 18 to 29 years (OR = 1.56; 95% CI, 1.35–1.81). The likelihood of reporting a cancer-related visit or a general physical examination decreased significantly as the survivor aged or the time from cancer diagnosis increased. This trend was also significant for those treated with therapies associated with substantial risk for cardiovascular disease or breast cancer. CONCLUSIONS Primary care physicians provide health care for most of this growing high-risk population. To optimize risk-based care, it is critical that cancer centers and primary care physicians develop methods to communicate effectively and longitudinally.
Oeffinger, Kevin C.; Mertens, Ann C.; Hudson, Melissa M.; Gurney, James G.; Casillas, Jacqueline; Chen, Hegang; Whitton, John; Yeazel, Mark; Yasui, Yutaka; Robison, Leslie L.
Communication problems due to language and cultural differences between health care professionals and patients are widely\\u000a recognized. Finns are described as more silent whereas one concurrent large immigrant group, the Somalis, are described as\\u000a more open in their communication. The aim of the study was to explore physicians-nurses\\/midwives’ communication when providing\\u000a reproductive and maternity health care to Somali women in
Filio Degni; Sakari Suominen; Birgitta Essén; Walid El Ansari; Katri Vehviläinen-Julkunen
Increasingly, cancer-related Web sites have been developed to provide information for patients. More needs to be done to understand the experience of men with cancer using the Internet. Heideggerian hermeneutics is the interpretive approach used to guide this study. Fifteen men with cancer who used the Internet were recruited through a prostate cancer support group and snowball sampling. Participants were individually interviewed and asked to tell stories of Internet use and practices. Transcribed interviews provided data for interpretive analysis. The overall constitutive pattern describing the men's experience is "cancer diagnosis as a problem to be solved." Five related themes included (1) seeking disease and treatments information from the Internet for decision making, to become comfortable with treatment plan; (2) organizing information to facilitate provider encounters and to monitor for reoccurrence; (3) evaluating Web information by credibility and usability with trust in the physician influencing the end decision point; (4) symptom management by knowing possibilities by hearing patient stories; and (5) navigating through the healthcare system politics and power. Men with cancer are incorporating Internet use into their cancer journey. They perceive changing provider-patient relationships when they participate in treatment decisions and monitor for reoccurrence. PMID:20975535
This paper provides an overview of issues in the integration of genetic (related to hereditary DNA) and genomic (related to genes and their functions) information in cancercare for individuals and families who are part of health care systems worldwide, from low to high resourced. National and regional cancer plans have the potential to integrate genetic and genomic information with a goal of identifying and helping individuals and families with and at risk of cancer. Healthcare professionals and the public have the opportunity to increase their genetic literacy and communication about cancer family history to enhance cancer control, prevention, and tailored therapies. PMID:24001763
In recent years, the media has portrayed long-term care in a negative light, with exposè news stories on skilled nursing facilities, personal care homes, and hospitals that provide long-term care. There have been few positive news stories to counter the negative ones, and there is concern that the public perception of long-term care is inaccurate. The authors conducted the following
This study describes emergency physicians' perspectives on the challenges and benefits to providing palliative care in an academic, urban, public hospital in Los Angeles. Participants underwent a semi-structured interview on their training and experiences related to palliative care, perceptions of providing palliative care, and their recommendations for education and training in this area. Overall, respondents felt that palliative care is not prioritized appropriately, leading patients to be unaware of their options for end-of-life care. Providing educational materials and courses that have been developed from the ED perspective should be included in ongoing continuing medical education. Having a palliative care team that is responsive to the needs of the ED will further enhance collaboration with the ED. Future research should focus on understanding the range of benefits to having palliative care in the ED. PMID:22136262
Stone, Susan C; Mohanty, Sarita; Grudzen, Corita R; Shoenberger, Jan; Asch, Steve; Kubricek, Katrina; Lorenz, Karl A
Palliative care developments in the region represented by the Middle East Cancer Consortium, provides the first comprehensive review and comparative analysis of palliative care in MECC members, Cyprus,Egypt,Israel, Jordan,Palestinian Authority,and Turkey....
|A pilot program at the University of California, Davis, that incorporated skilled nursing facility training into the required curriculum of their primary care internal medicine residency is described. The goal was to increase the residents' knowledge in the care of geriatric patients. (MLW)|
The contemporary management of breast cancer is a complex endeavor that requires a truly collaborative team approach, characterized by ongoing communication and active information-sharing among the multiple disciplines involved. Programs designed to provide comprehensive breast cancer management by a team of multidisciplinary specialists were introduced in the late 1970s and have been increasing slowly. Patients attending comprehensive breast centers receive care from a broad-based multidisciplinary team that most often includes surgeons, radiologists, pathologists, medical oncologists, radiation oncologists, plastic/reconstructive surgeons, primary care physicians, gynecologists, nurses, social workers, patient advocates, and genetic risk counselors. At the heart of comprehensive, interdisciplinary breast care is the consensus planning conference that brings together team members on a regular basis to discuss individual patient cases and develop comprehensive treatment plans. This interactive and dynamic forum has become integral to the interdisciplinary management of breast diseases and results in an increased level of communication between the participating health-care professionals and the patients they treat. Several professional organizations, most prominently the American Society of Breast Disease, promote and support an interdisciplinary approach to breast care. PMID:15526830
Latinos are overrepresented among the uninsured in the U.S., and rural Latinos face a variety of barriers to accessing quality health care. The present study investigated the degree to which Latinos with diabetes living in non-metropolitan towns in the state of Iowa receive the recommended diabetes care services from health careproviders vis-à-vis access to care. Four process measures were selected from the American Diabetes Association standards of medical care for diabetes: glycated hemoglobin tests, comprehensive foot examination, dilated eye examination, and cholesterol test. Results from this research found that just over half (54%) of the sample received all four of these diabetes care services. Adjusted logistic regression analysis showed patients were four times more likely to receive the set of four diabetes care services at a community health center than at a private doctor's office. These community clinics deserve additional attention as more Latino immigrants move to the Midwest. PMID:21841292
New health care delivery and payment models in the private sector are being shaped by active collaboration between health insurance plans and providers. We examine key characteristics of several of these private accountable care models, including their overall efforts to improve the quality, efficiency, and accountability of care; their criteria for selecting providers; the payment methods and performance measures they are using; and the technical assistance they are supplying to participating providers. Our findings show that not all providers are equally ready to enter into these arrangements with health plans and therefore flexibility in design of these arrangements is critical. These findings also hold lessons for the emerging public accountable care models, such as the Medicare Shared Savings Program-underscoring providers' need for comprehensive and timely data and analytic reports; payment tailored to providers' readiness for these contracts; and measurement of quality across multiple years and care settings. PMID:21900663
Lesbian, gay, bisexual, transgender, and queer (LGBTQ) identified patients report receiving substandard care from healthcare providers. They face the fear and disturbing reality of discrimination when accessing health care. Without culturally sensitive treatment, nursing and other health professions do not properly care for this population. Following the recent trend towards awareness and need for inclusion of LGBTQ populations in healthcare, this paper provides a summary of the current literature on the treatment and needs of LGBTQ people and describes focus groups conducted to explore perceptions regarding provider behaviors. It concludes with a list of behaviors that enhance or impede quality care that can serve as a guide for healthcare professionals. PMID:23721392
Rounds, Kelsey E; McGrath, Barbara Burns; Walsh, Elaine
Successful adaptation to chronic illness is enhanced by active client-health careprovider partnerships. The purposes of this article are to (a) examine the health care partnership needs of western rural women with chronic illness who participated in a computer-based support and education project, (b) describe how the role of the women in the partnership can be maximized by the use of a personal health record and improving health literacy, and (c) discuss ways health careproviders can enhance their role in the partnership by careful listening and creating environments conducive to forging productive client-provider partnerships. PMID:20651303
Cudney, Shirley; Weinert, Clarann; Kinion, Elizabeth
Early childhood is a critical period for shaping and influencing feeding and lifestyle behaviors that have implications for future weight and health. With more women in the workforce, families have become reliant on child care. Thus, the child-feeding relationship has become a shared responsibility between the parent and child-careprovider. Little is known about the impact of child-careproviders on
This qualitative study examined caregivers' perceptions of and stories about their interactions with nonhospice health careproviders. The sample included 27 family caregivers who provided the majority of in-home physical care and emotional support to the elders for at least 6 months. Caregivers described some startling interactions that suggest the need to reevaluate health care professionals' abilities and attitudes concerning their treatment and communication with family caregivers and their elders dying from life-limiting illnesses. PMID:20375703
ObjectiveProvision of high quality patient-centered care is fundamental to eliminating healthcare disparities in breast cancer. We investigated physicians’ experiences communicating with limited English proficient (LEP) breast cancer patients.
Leah S. Karliner; E. Shelley Hwang; Dana Nickleach; Celia P. Kaplan
Background/Aims For over four years, CRN Cancer Communication Research Center (CCRC)-affiliated investigators have conducted research into patient-centered cancer communication and care coordination. One of 5 National Cancer Institute-funded Centers of Excellence in Cancer Communication Research, the CRN CCRC is the only center whose primary focus is studying and improving clinical care. This abstract describes CCRC research, lessons learned, and future directions. Methods CCRC research studies include two RO1-type projects; one focuses on enhancing communication and coordination through innovative use of nurse navigators in oncology care; the other focuses on understanding and improving clinician-patient communication related to breakdowns in cancercare. CCRC pilot studies have explored diverse topics including improving communication to reduce home medication errors in pediatric oncology, clinician-patient communication around prostate cancer screening decisions, the relationship between "oral" health literacy and colorectal cancer screening, and direct-to-consumer communication about genetic testing. An NCI-funded supplement explored stakeholders' views on collecting patient reports of cancer-related communication, while another examined the feasibility of cancer prognostic tools in clinical practice. Results Setting CCRC studies in CRN clinical systems has provided the distinct advantage of allowing researchers to examine feasibility as well as effectiveness of interventions. Patients, clinicians and clinical leaders have all expressed support for CCRC efforts to improve communication and care coordination, acknowledging the importance of communication in cancercare. At the same time, leaders and clinicians are conscious of increasing time constraints, competing priorities, and limited resources. Patients are willing to share their experiences and insights, as long as doing so does not jeopardize their care, or distract them from their battle with cancer. Conclusions Patient-centered communication and care coordination are central to quality cancercare. CCRC research projects have engendered support and enthusiasm among the clinical systems, but have also faced significant challenges. Ultimately, the CCRC has provided CRN researchers with opportunities to develop and test multi-level interventions focusing on cancer communication and care coordination in clinical systems. Going forward, CCRC-affiliated researchers look forward to implementing systems for collecting patient reports of communication experiences across the cancercare continuum, and to expanding communication research capabilities within the CRN. PMID:24085869
Background/Aims For over four years, CRN Cancer Communication Research Center (CCRC)-affiliated investigators have conducted research into patient-centered cancer communication and care coordination. One of 5 National Cancer Institute-funded Centers of Excellence in Cancer Communication Research, the CRN CCRC is the only center whose primary focus is studying and improving clinical care. This abstract describes CCRC research, lessons learned, and future directions. Methods CCRC research studies include two RO1-type projects; one focuses on enhancing communication and coordination through innovative use of nurse navigators in oncology care; the other focuses on understanding and improving clinician-patient communication related to breakdowns in cancercare. CCRC pilot studies have explored diverse topics including improving communication to reduce home medication errors in pediatric oncology, clinician-patient communication around prostate cancer screening decisions, the relationship between “oral” health literacy and colorectal cancer screening, and direct-to-consumer communication about genetic testing. An NCI-funded supplement explored stakeholders’ views on collecting patient reports of cancer-related communication, while another examined the feasibility of cancer prognostic tools in clinical practice. Results Setting CCRC studies in CRN clinical systems has provided the distinct advantage of allowing researchers to examine feasibility as well as effectiveness of interventions. Patients, clinicians and clinical leaders have all expressed support for CCRC efforts to improve communication and care coordination, acknowledging the importance of communication in cancercare. At the same time, leaders and clinicians are conscious of increasing time constraints, competing priorities, and limited resources. Patients are willing to share their experiences and insights, as long as doing so does not jeopardize their care, or distract them from their battle with cancer. Conclusions Patient-centered communication and care coordination are central to quality cancercare. CCRC research projects have engendered support and enthusiasm among the clinical systems, but have also faced significant challenges. Ultimately, the CCRC has provided CRN researchers with opportunities to develop and test multi-level interventions focusing on cancer communication and care coordination in clinical systems. Going forward, CCRC-affiliated researchers look forward to implementing systems for collecting patient reports of communication experiences across the cancercare continuum, and to expanding communication research capabilities within the CRN.
Changing healthcare policy will undoubtedly affect the healthcare environment in which providers function. The current Fee for Service reimbursement model will be replaced by Value-Based Purchasing, where higher quality and more efficient care will be emphasized. Because of this, large healthcare organizations and individual providers must adapt to incorporate performance outcomes into patient care. Here, we present a Continuing Medical Education (CME)-based initiative at the City of Hope National Cancer Center that we believe can serve as a model for using CME as a value added component to achieving such a goal. PMID:23608956
Gendered definitions of care influence breast cancer survivors’ coping strategies, sense of entitlement to care, and ultimately\\u000a their capacity to receive care. Using qualitative data from 60 intensive interviews, this study examines how gendered definitions\\u000a of care influence women’s experiences as care-receivers. Findings indicate that negotiating gender boundaries to care for\\u000a the self is both empowering and stigmatizing. Women with
|A resource guide for family day careproviders in Massachusetts was developed as an initiative of the state Office for Children. Chapters are as follows: (1) Getting Ready to Do Family Day Care (e.g., definitions, provider qualifications, preparing your home, assistants, complaints); (2) Partnership with Parents (e.g., interviews, trial period,…
The benefits of movement are enhanced when children with disabilities move with their nondisabled peers. This study sought to determine the effects of a motor development training program on child careproviders in order to promote movement-based activities and perceived competence in this area. Twenty child careproviders were assigned to either…
As part of a statewide dementia-specific training collaborative, data were collected from nursing assistants and aides who provide paid Alzheimer's care. This study explored the relevance of previous education and practical experiences to specific constructs associated with worker recruitment and retention. Direct-careproviders with prior training in gerontology and geriatrics had lower levels of extrinsic job satisfaction and career resilience
Constance L. Coogle; Iris A. Parham; Katherine A. Young
The purpose of this phenomenological pilot study was to describe the experience that nurses have in providing spiritual care to their patients and\\/or patients' family members. Three nurses with a variety of clinical backgrounds were interviewed to elicit their experience of providing spiritual care. The data were analyzed using Colaizzi's method to reveal seven themes: the spiritual nurse, capturing the
...2012-10-01 2012-10-01 false Medical or other remedial careprovided by licensed...HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions Â§ 440.60 Medical or other remedial careprovided by...
A survey of 414 child careproviders in southeastern Wisconsin reveals that cost as well as low wages and lack of benefits for workers can constrain providers from pursuing improvements to child-care quality. Of survey respondents, approximately half of whom are home-based and half center-based, 13% have at least three of five structural factors…
Semistructured interviews were conducted with 23 health care professionals who work with pregnant women in a preliminary study to understand health careproviders’ attitudes regarding current food safety recommendations for pregnant women and interest in education and patient materials on food safety during pregnancy. Only 8 of 23 interviewed currently provided food safety information to their pregnant clients. Limited understanding
Shelly Morales; Patricia A. Kendall; Lydia C. Medeiros; Virginia Hillers; Mary Schroeder
|The authors conducted a needs assessment among students and health-careproviders of a southwestern university health center with the goal of developing health-care -provider training addressing substance-abuse screening and intervention. They collected data from focus groups of undergraduate students and structured interviews and questionnaires…
This study used a hermeneutical methodology to explore how Computer Mediated Communication (CMC) can be used to provide pastoral care to youth in a high tech world. The research was motivated by the writers desire to find ways to be in communication with youth and provide pastoral care to them during their adolescent years. The thesis will explore computer mediated
C hoosing a Primary Health CareProvider (PCP) Remember Having a PCP is important so you can have regular check-ups. You should feel comfortable with ... for information on how to find a primary health careprovider (PCP) is a smart decision, because routine ...
C hoosing a Primary Health CareProvider (PCP) Choosing a PCP Check-Ups How to Find a PCP When to Visit Your PCP Health Plans If ... Qualifications of PCPs Confidentiality Going to a primary health careprovider (PCP) is a very important part of ...
Providing health care that considers environmental determinants of health, environmental impact on health, and outcomes attributed to environmental issues is complex due to the need for providers to be competent not only in social and health sciences, but...
Youth with special health care needs (YSHCN) encounter unique challenges in the transition from pediatric to adult healthcare. Although discussing transition with healthcare providers can be beneficial, it is unclear whether the providers' scope of practi...
In 1989, the Department of Veterans Affairs (VA) identified six primarily psychiatric hospitals in which 38 patient deaths may have occurred due to likely quality-of-care problems in the medical treatment these individuals received. Before this, in 1988, ...
Literature related to health care professionals dealing with stress of cancercare is still in its infancy. The authors distinguish papers of general interest (the most frequent), papers identifying stressors, and papers about stress consequences. Most of them recognize death of the patients as a major stressor for health care professionals. There are also additional stressors specific to health care
Nicole Delvaux; Darius Razavi; Christine Farvacques
This research study examined health careproviders' attitudes and practices on the purpose and use of advance directives in a military health care setting. This research modified a study conducted by the End Of Life Study Group from the University of Nort...
Background Continuity is an important aspect of quality of care, especially for complex patients in the community. We explored provider perceptions of continuity through a system’s lens. The circle of care was used as the system. Methods Soft systems methodology was used to understand and improve continuity for end of life patients in two communities. Participants: Physicians, nurses, pharmacists in two communities in British Columbia, involved in end of life care. Two debates/discussion groups were completed after the interviews and initial analysis to confirm findings. Interview recordings were qualitatively analyzed to extract components and enablers of continuity. Results 32 provider interviews were completed. Findings from this study support the three types of continuity described by Haggerty and Reid (information, management, and relationship continuity). This work extends their model by adding features of the circle of care that influence and enable continuity: Provider Connectedness the sense of knowing and trust between providers who share care of a patient; a set of ten communication patterns that are used to support continuity across the circle of care; and environmental factors outside the circle that can indirectly influence continuity. Conclusions We present an extended model of continuity of care. The components in the model can support health planners consider how health care is organized to promote continuity and by researchers when considering future continuity research.
Fifty-five state and territorial commissioners of mental health and chiefs of psychiatry at 158 Department of Veterans Affairs medical centers were surveyed about current policies related to psychiatrists' roles as primary careproviders in state and VA facilities. About half the respondents indicated that psychiatrists provided primary medical care or indicated interest in having psychiatrists provide such care. Less than half of this group limited such care to specific patient populations, and less than 25 percent required specific training for providers. The survey results indicate that opportunities for psychiatrists to provide primary care exist in many state and VA facilities but that no generally accepted guidelines or training standards for such practice have been developed. PMID:9219305
Under the Affordable Care Act, the new Center for Medicare and Medicaid Innovation will guide a number of experimental programs in health care payment and delivery. Among the most ambitious of the reform models is the accountable care organization (ACO), which will offer providers economic rewards if they can reduce Medicare's cost growth in their communities. However, the dismal history of provider-led attempts to manage costs suggests that this program is unlikely to accomplish its objectives. What's more, if ACOs foster more market concentration among providers, they have the potential to shift costs onto private insurers. This paper proposes a more flexible payment model for providers and private insurers that would divide health care services into three categories: long-term, low-intensity primary care; unscheduled care, including unscheduled emergency services; and major clinical interventions that usually involve hospitalization or organized outpatient care. Each category of care would be paid for differently, with each containing different elements of financial risk for the providers. Health plans would then be encouraged to provide logistical and analytic support to providers in managing health costs in these categories. PMID:21209435
Background As part of a comprehensive study on the primary health care system in Iraq, we sought to explore primary careproviders’ perspectives about the main problems influencing the provision of primary care services and opportunities to improve the system. Methods A qualitative study based on four focus groups involving 40 primary careproviders from 12 primary health care centres was conducted in Erbil governorate in the Iraqi Kurdistan region between July and October 2010. A topic guide was used to lead discussions and covered questions on positive aspects of and current problems with the primary care system in addition to the priority needs for its improvement. The discussions were fully transcribed and the qualitative data was analyzed by content analysis, followed by a thematic analysis. Results Problems facing the primary care system included inappropriate health service delivery (irrational use of health services, irrational treatment, poor referral system, poor infrastructure and poor hygiene), health workforce challenges (high number of specialists, uneven distribution of the health workforce, rapid turnover, lack of training and educational opportunities and discrepancies in the salary system), shortage in resources (shortage and low quality of medical supplies and shortage in financing), poor information technology and poor leadership/governance. The greatest emphasis was placed on poor organization of health services delivery, particularly the irrational use of health services and the related overcrowding and overload on primary careproviders and health facilities. Suggestions for improving the system included application of a family medicine approach and ensuring effective planning and monitoring. Conclusions This study has provided a comprehensive understanding of the factors that negatively affect the primary care system in Iraq’s Kurdistan region from the perspective of primary careproviders. From their experience, primary careproviders have a role in informing the community and policy makers about the main problems affecting this system, though improvements to the health care system must be taken up at the national level and involve other key stakeholders.
We developed this program for primary careproviders (PCPs) and public health professionals (PHPs) who are interested in increasing their understanding of the genetics of common chronic diseases and of the implications of genetics and genomics for their fields. The program differs from virtually all previous educational efforts in genetics for health professionals in that it focuses on the genetics of common chronic disease and on the broad principles that emerge when one views disease from the perspectives of variation and individuality, which are at the heart of thinking genetically. The CD-ROM introduces users to content that will improve their understanding of topics such as: • A framework for genetics and common disease; • Basic information on genetics, genomics, genetic medicine, and public health genetics, all in the context of common chronic disease; • The status of research on genetic contributions to specific common diseases, including a review of research methods; • Genetic/environmental interaction as the new “central dogma” of public health genetics; • The importance of taking and analyzing a family history; • The likely impact of potential gene discovery and genetic testing on genetic counseling and risk assessment and on the practices of PCPs and PHPs; • Stratification of populations into low-, moderate-, and high-risk categories; • The potential role of PCPs and PHPs in identifying high-risk individuals and families, in providing limited genetics services, and in referring to clinical genetics specialists; the potential for standard referral algorithms; • Implications of genetic insights for diagnosis and treatment; • Ethical, legal, and social issues that arise from genetic testing for common chronic diseases; and • Specific prevention strategies based on understanding of genetics and genetic/ environmental interactions. The interactive content – developed by experts in genetics, primary care, and public health – is organized around two case studies designed to appeal to primary careproviders (thrombophilia) and public health professionals (development of a screening grogram for colorectal cancer). NCHPEG has distributed more than 0000 copies of the CD-ROM to NCHPEG member organizations and to other organizations and individuals in response to requests. The program also is available at www.nchpeg.org.
McInerney, Joseph D.; Greendale, Karen; Peay, Holly L.
Although the scientific understanding of the pathophysiology of asthma and the quality of asthma therapies have significantly improved over the past 30 years, asthma morbidity remains high and preventive care low for inner-city children. This article focuses on 4 major challenges to providing preventive care (family and patient attitudes and beliefs, lack of access to quality medical care, psychosocial factors, environmental factors) based on prior evidence and the authors' observation of these challenges in research with inner-city children with asthma over the past decade. Cost issues related to preventive care are addressed, and recommendations provide for pediatric nurses. PMID:23659811
Butz, Arlene M; Kub, Joan; Bellin, Melissa H; Frick, Kevin D
Objective To understand how proximity to safety net clinics and hospitals affects a variety of measures of access to care and service use by uninsured persons. Data Sources The 1998–1999 Community Tracking Study household survey, administered primarily by telephone survey to households in 60 randomly selected communities, linked to data on community health centers, other free clinics, and safety net hospitals. Study Design Instrumental variable estimation of multivariate regression models of several measures of access to care (having a usual source of care, unmet or delayed medical care needs, ambulatory service use, and overnight hospital stays) against endogenous measures of distances to the nearest community health center and safety net hospital, controlling for characteristics of uninsured persons and other area characteristics that are related to access to care. The models are estimated with data from a nationally representative sample of uninsured people. Principal Findings Shorter distances to the nearest safety net providers increase access to care for uninsured persons. Failure to account for the endogeneity of distance to safety net providers on access to care generally leads to finding little or no safety net effects on access. Conclusions Closer proximity to the safety net increases access to care for uninsured persons. However, the improvements in access to care are relatively small compared with similar measures of access to care for insured persons. Modest expansion of the safety net is unlikely to provide a full substitute for insurance coverage expansions.
Objective: The objective of the present paper was to determine the association between parent-provider communication and parent ratings of satisfaction and quality of care for a group of parents of children identified with a psychosocial problem. Methods: A sample of 804 parents of children with psychosocial concerns enrolled in the Child Behavior Study (CBS) was used for the present analyses. As part of the CBS, parents of children with psychosocial problems answered questions that assessed parent-provider communication and parent ratings of satisfaction and quality of care. Results: Overall, parents reported good communication with their child's provider. Eighty-two percent of parents were very satisfied with the care received and 68% reported a very high quality of care. Parent-provider communication (e.g., collaboration and mutual understanding) was strongly related to parental reports of both satisfaction and quality of care. Conclusions: Parent-provider communication is an important correlate of parental report of satisfaction and quality of care. Involvement of parents in the treatment planning process was particularly important in determining satisfaction and quality ratings within this sample. Practice Implications: When working with families with identified psychosocial concerns, the use of collaboration and an empathic style by providers may enhance the quality of care parents report receiving from their primary care clinicians.
Hart, Chantelle Nobile; Kelleher, Kelly J.; Drotar, Dennis; Scholle, Sarah Hudson
We have been developing a VR system to provide patients with emotional support and to encourage them to assume an active life against cancer, since patients with an active lifestyle survive longer than those with a passive lifestyle. A possible explanation for this latter fact is that psychological stimulation may also activate the endocrine system and the immune system. Both systems may be able to rapidly repair tissue damaged by cancer and change the characteristics of the cancer itself. Although microelectrical analysis and molecular and genetic analyses are rapidly solving the riddles of the relationship between the brain and thought, we think that our VR research for palliative medicine may also play an important role in this area with regard to the development of new tools for treatment and support. This notion is based on the hypothesis that the brain can reorganize itself to compensate for irrationality or inappropriateness through pharmacological adaptation and/or anatomical regeneration of synapses. Another reason why VR research in palliative medicine is useful is that VR techniques represent not only an enhanced human-machine interface, but also an enhanced human communication technology. VR technology may also be used to help patients accept their disease. The mental state of a patient in the terminal stage of cancer changes step by step from denial of cancer, hope for a new treatment for cancer, suspicion of medical treatment, uneasiness regarding their future life, irritation, depression, and acceptance or despair. We plan to develop a new type of counseling system in medical cyberspace to provide mental care. It can also be used for group therapy or humor therapy to reduce loneliness. In summary, we conclude that VR technology can be applied to palliative medicine (1) to support communication between the patient and others, (2) to provide psychological support to treat neurosis and help to stabilize the patient's mental state, and (3) to actually treat cancer. PMID:10175345
Purpose To describe parents’ perspectives of health careprovider actions that helped or did not around the time of infant/child’s intensive care unit (ICU) death. Semistructured interviews with 63 parents (Black, White, and Hispanic) 7 months post infant/child death were audio-recorded, transcribed, analyzed, and themes identified. Findings What helped most: compassionate, sensitive staff; understandable explanations of infant’s/child’s condition; experienced, competent nurses; providers did everything to help infant/child; and parents’ involvement in care decisions. What did not help: insensitive, nonsupportive staff; conflict between providers and parents; communication problems around the death; inexperienced nurses and doctors; parents not understanding child’s disease, care, complications. Conclusions Compassionate, sensitive staff and understandable explanations of children’s conditions were most helpful; insensitive, nonsupportive staff least helpful by gender, racial group, or care setting. Conflict between providers and parents was most problematic for minority parents and mothers.
Brooten, Dorothy; Youngblut, JoAnne M.; Seagrave, Lynn; Caicedo, Carmen; Hawthorne, Dawn; Hidalgo, Ivette; Roche, Rosa
The need for oral health services among patients with HIV, especially those in advanced stages of disease and those who smoke, has been well documented. Patients receiving HIV-related home care services provide an opportunity for assessment of oral health and smoking cessation needs; however, the majority of home careproviders lack formal training to provide these services, thus interprofessional collaborations may be of value. This study assessed the oral health and smoking cessation practices of a random sample of 81 HIV home careproviders. Results showed very favorable attitudes toward providing these services with some differences across disciplines. More than 70% of nurses would like to receive additional training in comprehensive oral health assessment by dental professionals. The study provides evidence for the potential of expanding these services for patients with HIV through interprofessional collaboration, in particular with nurses and dentists. PMID:22506858
A sharp increase in the number of diagnosed concussions has been observed for the traditional adultathlete, as well as the young recreational athlete. An enhancing awareness and growing concern has been noted for the potentially larger number of concussions that go undiagnosed and the unknown capability for long-term complications associated with this injury. This increase in concussion awareness has appropriately led to an enhanced utilization of the health-care system for concussion evaluation and management. As is always the case in the practice of medicine, it is important for healthcare providers, from all points of entry in the healthcare system, to provide consistent management for the best outcomes for any disease process. Millions of sport-related concussions occur each year in the United States, placing a large demand on the healthcare system. Utilization of appropriate and congruent treatment plans during the medical discourse when transferring care of patients between providers is paramount. In the co-management model of care, subspecialists lend expertise to assist primary-careproviders (PCPs) in gaining the core competencies necessary to provide appropriate levels of care for certain conditions. Increased use of co-management could make the health-care system more efficient and collaborative, leading to: increased access for patients, lower overall costs, and improved quality of care and health outcomes. Co-management allows patients and families to have access to the expert knowledge of subspecialist while receiving more of their care from their PCP, increasing their comfort and making treatment more convenient. The intent of this paper is to distribute an algorithm created by a multidisciplinary group of medical providers to provide a rational approach, congruent with the standard of care, for the primary-careprovider to institute an individualized stepwise progression. PMID:23061213
Being adequately prepared for an experience such as cancer empowers patients, lowers distress, improves coping, supports self-management, promotes recovery, and improves quality of life. However, patients with cancer report unmet informational and support needs across the cancer trajectory. The purpose of this article is to describe the relationship of information preparation and patient outcomes, identify information and support needs across the cancer trajectory, and describe the role of oncology nurses in the delivery of high-quality patient-centered cancercare. The middle range theory of "Carrying On" was used to identify information and support needs during different phases of the cancer trajectory from treatment to survivorship. The authors concluded that nurses should engage the patient in a relational exchange of information; provide concrete, understandable information across specific times in the cancer experience; and use creative approaches to minimize barriers in meeting patient needs to achieve high-quality patient-centered cancercare. PMID:23715703
Community-based stroke care in Japan is currently provided in acute hospitals, convalescent rehabilitation units, general practices, sanatorium-type wards, nursing care facilities, and in-home/commuting care services. We conducted a nationwide survey to identify factors influencing cooperation among the various providers of community-based stroke care. We sent questionnaires to 11,178 facilities and assessed the independent variables of excellent and fair cooperation among the careproviders. Of the providers that responded, 66% were engaged in medical practice or long-term care for stroke patients. The following independent variables were inversely associated with excellent or fair cooperation in the community: area with the higher population density among 3 groups divided by tertile threshold (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.41-0.69), facilities covered by long-term care insurance (OR, 0.27; 95% CI, 0.22-0.34), and insufficient communication with local government (OR, 0.19; 95% CI, 0.14-0.24). Positive independent variables of excellent or fair cooperation were the sharing of patient information in the community (OR, 2.53; 95% CI, 1.78-3.66), use of a scale for assessing activities of daily living (OR, 1.93; 95% CI, 1.42-2.63), appropriate utilization of care support managers (OR, 1.91; 95% CI, 1.43-2.55), and adequate comprehension of the long-term care insurance system (OR, 1.54; 95% CI, 1.24-1.92). Our findings suggest that improved communication between healthcare providers and local government, along with appropriate attention to the problems facing providers covered by long-term care insurance, may improve community-based stroke care in Japan. PMID:20692854
The family is an important resource in elderly care. It is of great interest if persons who might be in need of care in the future would use this resource. Our study assessed wishes and expectations regarding family care in a representative sample of the general population (??45 years, N?=?1,445) using questionnaires. Logistic regressions were performed to analyze the potential impact on the willingness to use or provide family care. One quarter of the participants reported experience in family care. In case of own need 62.9% of participants would prefer careprovided by relatives and 56.7% would prefer professional care. Participants are more likely to use family care if they report having relatives, are experienced in care of relatives or do not associate old age with being a burden, e.g. report low values in the image of age "being a burden/demanding". Perceived willingness of the relatives to providecare is more likely if there is little regional distance to the relatives, in male participants and if participants talked about future care with their relatives. Besides structural factors, negative images of old age might have a negative influence on the willingness to use family care. Talking about care in old age seems to have a positive impact. PMID:22842889
Spangenberg, L; Glaesmer, H; Brähler, E; Strauß, B
This pilot study examined the relationship between youth and careprovider self-reports of depressive symptoms assessed through the Patient Health Questionnaire and reports of youth physical and psychosocial functioning assessed by PedsQL4.0 in a rural outpatient overweight pediatric population (N = 66 child and careprovider pairs). The relationship between youth body mass index (BMI), youth and careprovider depression, youth quality of life (QOL), careprovider perception of youth QOL, and youth and careprovider congruence of QOL perceptions was examined. Paired t tests were completed to assess the differences between QOL scores for youth and careproviders for subgroups based on age, age and gender, and age and race. The mean age of youth participants was 11.9 years; youth BMI ranged from 26.76 to 54.10 (M = 37.20). Our results showed that there are significant differences in youth and careproviders' perceptions of QOL when specific demographic categories are assessed by age, gender, and race. PMID:22055385
Pratt, Keeley J; Lamson, Angela L; Lazorick, Suzanne; Swanson, Melvin S; Cravens, Jaclyn; Collier, David N
This final rule establishes the standard for a unique health identifier for health careproviders for use in the health care system and announces the adoption of the National Provider Identifier (NPI) as that standard. It also establishes the implementation specifications for obtaining and using the standard unique health identifier for health careproviders. The implementation specifications set the requirements that must be met by "covered entities": Health plans, health care clearinghouses, and those health careproviders who transmit any health information in electronic form in connection with a transaction for which the Secretary has adopted a standard (known as "covered health careproviders"). Covered entities must use the identifier in connection with standard transactions. The use of the NPI will improve the Medicare and Medicaid programs, and other Federal health programs and private health programs, and the effectiveness and efficiency of the health care industry in general, by simplifying the administration of the health care system and enabling the efficient electronic transmission of certain health information. This final rule implements some of the requirements of the Administrative Simplification subtitle F of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). PMID:14968800
Purpose. To evaluate the accuracy of insurance claims data indicating underutilization of primary care visits by children with special health care needs (CSHCN). Design. The study was a retrospec- tive comparison of p rimary careprovider (PCP) utilization by 1,131 CSHCN, using secondary data from electronic claims-and-encounters data- bases in a Medicaid health maintenance organization (HMO) and a commercial HMO.
Previous research on fathers as child-careproviders indicates a need to study the father’s role in child care in the context\\u000a of different economic cycles. Using data from the 1988, 1991, and 1993 panels of the Survey of Income and Program Participation,\\u000a we examine whether father’ availability and the couple’s economic resources are differentially related to child care by fathers
Aboriginal Canadians experience a disproportionate burden of ill-health and have endured a history of racism in accessing and using health care. Meanwhile, this population is rapidly growing, resulting in an urgent need to facilitate better quality of living and dying in many ways, including through enhancing (cultural) access to palliative care. In this article, we report the findings from a qualitative case study undertaken in rural British Columbia, Canada through exploring the perceptions of Aboriginal palliative care in a region identified as lacking in formal palliative care services and having only a limited Aboriginal population. Using interview data collected from 31 formal and informal palliative careproviders (May-September 2008), we thematically explore not only the existing challenges and contradictions associated with the prioritisation and provision of Aboriginal palliative care in the region in terms of (in)visibility but also identify the elements necessary to enhance such care in the future. The implications for service providers in rural regions are such that consideration of the presence of small, and not always 'visible', populations is necessary; while rural careproviders are known for their resilience and resourcefulness, increased opportunities for meaningful two-way knowledge exchange with peers and consultation with experts cannot be overlooked. Doing so will serve to enhance culturally accessible palliative care in the region in general and for Aboriginal peoples specifically. This analysis thus contributes to a substantial gap in the palliative care literature concerning service providers' perceptions surrounding Aboriginal palliative care as well as Aboriginal peoples' experiences with receiving such care. Given the growing Aboriginal population and continued health inequities, this study serves to not only increase awareness but also create better living and dying conditions in small but incremental ways. PMID:20500225
Context: Mid-level providers comprise an increasing proportion of the health care workforce and play a key role in providing health services in rural and underserved areas. Although women comprise the majority of mid-level providers, they are less likely to work in a rural area than men. Maldistribution of health providers between urban and rural…
|Investigated possible causes for the high turnover rate among family day-care (FDC) providers by examining the effects of perceived social support, job satisfaction, and the establishment of boundaries between the FDC provider's nuclear family and her FDC system. Stable providers were more likely than nonstable providers to report high job…
Context It has long been a concern that professional liability problems disproportionately affect the delivery of obstetrical services to women living in rural areas. Michigan, a state with a large number of rural communities, is considered to be at risk for a medical liability crisis. Purpose This study examined whether higher malpractice burden on obstetric providers was associated with an increased likelihood of discontinuing obstetric care and whether there were rural-urban differences in the relationship. Methods Data on 500 obstetrician-gynecologists and family physicians who had provided obstetric care at some point in their career (either currently or previously) were obtained from a statewide survey in Michigan. Statistical tests and multivariate regression analyses were performed to examine the interrelationship among malpractice burden, rural location, and discontinuation of obstetric care. Findings After adjusting for other factors that might influence a physician’s decision about whether to stop obstetric care, our results showed no significant impact of malpractice burden on physicians’ likelihood to discontinue obstetric care. Rural-urban location of the practice did not modify the nature of this relationship. However, family physicians in rural Michigan had a nearly four fold higher likelihood of withdrawing obstetric care when compared to urban family physicians. Conclusions The higher likelihood of rural family physicians to discontinue obstetric care should be carefully weighed in future interventions to preserve obstetric care supply. More research is needed to better understand the practice environment of rural family physicians and the reasons for their withdrawal from obstetric care.
Xu, Xiao; Siefert, Kristine A.; Jacobson, Peter D.; Lori, Jody R.; Gueorguieva, Iana; Ransom, Scott B.
In recent years, the media has portrayed long-term care in a negative light, with exposè news stories on skilled nursing facilities, personal care homes, and hospitals that provide long-term care. There have been few positive news stories to counter the negative ones, and there is concern that the public perception of long-term care is inaccurate. The authors conducted the following study to evaluate how the West Virginia consumer perceives and defines long-term care and if there is a difference in that perception as compared with healthcare workers' perceptions and definitions of long-term care. The results of the study indicate that the respondents' education level, not occupation, has the most significant influence on respondents' definitions and perceptions of long-term care. Respondents felt that although media articles are informative, they are not accurate, and that long-term care is a needed service they would consider both for themselves and for a loved one. The results of the study suggest that current marketing strategies employed by nursing homes are working, as respondents largely believe that long-term care is provided in nursing homes and