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Sample records for hospice center model

  1. The Hospice Concept of Care: A Family Centered Approach.

    ERIC Educational Resources Information Center

    Story, Marilyn

    This description of the Cedar Valley Hospice program emphasizes palliative and supportive care for terminally ill patients and their families. The history of the hospice movement is outlined along with a description of the Cedar Valley program and the results of a 1980 program evaluation. The appendices contain a statement of the hospice goals and…

  2. The Island Hospice model of palliative care

    PubMed Central

    Khumalo, Thembelihle; Maasdorp, Valerie

    2016-01-01

    There has been a substantial increase in cancer detections in Africa over years, and it has also been noted that higher number of individuals are affected by the later stages of cancer that lead to death. When it comes to cancer care, Zimbabwe is no exception with its ongoing palliative care related research, though still in its infancy. The need for advanced and more accessible palliative care to assist the vulnerable has been intensified by this increase in cancer prevalence. Island Hospice, which is a centre of excellence in palliative care has varying elements of the models that it employs to engage those most in need of palliative assistance, especially children and financially-challenged individuals. PMID:27563349

  3. The Island Hospice model of palliative care.

    PubMed

    Khumalo, Thembelihle; Maasdorp, Valerie

    2016-01-01

    There has been a substantial increase in cancer detections in Africa over years, and it has also been noted that higher number of individuals are affected by the later stages of cancer that lead to death. When it comes to cancer care, Zimbabwe is no exception with its ongoing palliative care related research, though still in its infancy. The need for advanced and more accessible palliative care to assist the vulnerable has been intensified by this increase in cancer prevalence. Island Hospice, which is a centre of excellence in palliative care has varying elements of the models that it employs to engage those most in need of palliative assistance, especially children and financially-challenged individuals. PMID:27563349

  4. African Americans and Hospice Care: A Culture-Centered Exploration of Enrollment Disparities.

    PubMed

    Dillon, Patrick J; Basu, Ambar

    2016-11-01

    Over the past decade, scholars and practitioners have called for efforts to reduce disparities in the cost and quality of end-of-life care; a key contributor to these disparities is the underuse of hospice care by African American patients. While previous studies have often relied on interviewing minority individuals who may or may not have been terminally ill and of whom few were using hospice care services, this essay draws upon the culture-centered approach to report the findings of a grounded theory analysis of 39 interviews with 26 African American hospice patients (n = 10) and lay caregivers (n = 16). Participants identified several barriers to hospice enrollment and reported how they were able to overcome these barriers by reframing/prioritizing cultural values and practices, creating alternative goals for hospice care, and relying on information obtained outside the formal health system. These findings have implications for understanding hospice experiences, promoting hospice access, and improving end-of-life care. PMID:27007165

  5. Documenting the impact of hospice.

    PubMed

    Merriman, M P

    1999-01-01

    Hospice care has had an impact at many levels--on individual patients and families, on the health care industry, and on society. However, no comprehensive body of evidence has been generated that documents the impact of hospice care in terms that are meaningful to competitors, referral sources, and consumers. In part, this is because of the many challenges for evaluating hospice care. This paper describes recent efforts in the documentation of the value of hospice which have focused on outcomes measurement by individual providers rather than on large scale studies. Several groups are working to develop reliable measurement tools, to support standardized measurement in large numbers of hospices, and to collect information for benchmarking and comparison. Measurement of the impact of hospice care will set standards for other providers of end-of-life care and will document the expertise and knowledge of hospice professionals. Once established as centers of excellence in care of the dying, hospices will be well positioned for whatever delivery models may evolve for end-of-life care. PMID:10839010

  6. Hospice Care

    MedlinePlus

    ... Page Resize Text Printer Friendly Online Chat Hospice Care What is Hospice Care? When is Hospice Care ... Family Counseling and Support Services What is Hospice Care? Hospice programs are available to help terminally ill ...

  7. Hospice care

    MedlinePlus

    Palliative care - hospice; End-of-life care - hospice; Dying - hospice; Cancer - hospice ... Hospice care helps people with illnesses that cannot be cured and who are nearing death. The goal is to ...

  8. Use of remote blood releasing system for red cell transfusion in hospice care center

    PubMed Central

    Chan, Kwok Ying; Leung, Rock Yuk Yan; Cheung, Ka Chi; Lam, Clarence; Koo, Eleanor; Ng, Sylvia

    2016-01-01

    Objectives: It is quite common to have advanced cancer or end-stage renal disease patients for regular or even frequent blood transfusion in palliative care. However, due to geographical reason in some hospice centers, blood transfusion is sometimes difficult if blood bank is closed during non-office hour or not available. Methods: Here, we reported a new blood releasing system, that is, remote blood releasing system, that could be used safely by nursing staff alone when the blood bank was closed during the night time and holiday. Results: On-call nursing staff could collect red cells successful in these two cases. Conclusion: The new blood releasing system seems useful. However, larger sample sizes and longer period of study are required to estimate its efficacy and safety. The provision of antibody-positive red cells and platelet remained a limitation of this system. PMID:27489720

  9. Hospice Care

    MedlinePlus

    ... term inpatient or respite care related to the terminal diagnosis. You can stop hospice at any time. ... http: / / www. hospicefoundation. org/ uploads/ hic_ fs_ hospice. pdf Additional Resource for Veterans: VA Guide to Long ...

  10. Hospice care

    MedlinePlus

    Hospice care helps people with illnesses that cannot be cured and who are nearing death. The goal ... give comfort and peace instead of a cure. Hospice care provides: Support for the patient and the ...

  11. Hospice Care

    MedlinePlus

    ... provide more information about hospice. National Hospice and Palliative Care Organization 1–800–658–8898 (helpline) 1–877– ... http://www.caringinfo.org The National Hospice and Palliative Care Organization’s Caring Connections website offers information and publications ...

  12. Selling hospice.

    PubMed

    Halabi, Sam

    2014-01-01

    Americans are increasingly turning to hospice services to provide them with medical care, pain management, and emotional support at the end of life. The increase in the rates of hospice utilization is explained by a number of factors including a "hospice movement" dating to the 1970s which emphasized hospice as a tool to promote dignity for the terminally ill; coverage of hospice services by Medicare beginning in 1983; and, the market for hospice services provision, sustained almost entirely by governmental reimbursement. On the one hand, the growing acceptance of hospice may be seen as a sign of trends giving substance to the death-with-dignity movement and the growing strength of end-of-life decision-makers and planners who integrate medical, community, family and spiritual networks. On the other hand, the precise relationship between the death-with-dignity and commercial processes driving hospice utilization rates are not well understood. On May 2, 2013, the U.S. Government intervened in a lawsuit brought by former hospice employees alleging that behind Vitas Innovative Hospice Care, the largest for-profit hospice service provider in the United States, lie an intricate web of incentives for patient intake nurses, physicians and marketers which not only drove hospice patients to use more expensive (and medically unnecessary) crisis care services, but influenced patient and family decisions as to whether or not to discontinue curative treatment. The corporate, investment, and regulatory history behind Vitas provides an important insight into the market realities behind Americans' embrace of hospice care and the risks to patient autonomy and health that accompany the commercialization of this ethically and morally complex health care service. PMID:25565612

  13. Hospice Care

    MedlinePlus

    ... support. The goal of the care is to help people who are dying have peace, comfort, and dignity. The caregivers try to control pain and other symptoms so a person can remain as alert and comfortable as possible. Hospice programs also provide services to support a patient's family. Usually, a hospice ...

  14. Hospice Care

    MedlinePlus

    ... nurses, social workers, spiritual counselors, home health aides, bereavement counselors and volunteers. The hospice team helps patients ... patient's family doctor Expert management of physical symptoms Bereavement and support groups for families What is bereavement ...

  15. Two Models of Caregiver Strain and Bereavement Adjustment: A Comparison of Husband and Daughter Caregivers of Breast Cancer Hospice Patients

    ERIC Educational Resources Information Center

    Bernard, Lori L.; Guarnaccia, Charles A.

    2003-01-01

    Purpose: Caregiver bereavement adjustment literature suggests opposite models of impact of role strain on bereavement adjustment after care-recipient death--a Complicated Grief Model and a Relief Model. This study tests these competing models for husband and adult-daughter caregivers of breast cancer hospice patients. Design and Methods: This…

  16. The Effect of Hospice on Hospitalizations of Nursing Home Residents

    PubMed Central

    Zheng, Nan Tracy; Mukamel, Dana B.; Friedman, Bruce; Caprio, Thomas V.; Temkin-Greener, Helena

    2014-01-01

    Objectives Hospice enrollment is known to reduce risk of hospitalizations for nursing home residents who use it. We examined whether residing in facilities with a higher hospice penetration: 1) reduces hospitalization risk for non-hospice residents; and 2) decreases hospice-enrolled residents’ hospitalization risk relative to hospice-enrolled residents in facilities with a lower hospice penetration. Method Medicare Beneficiary File, Inpatient and Hospice Claims, Minimum Data Set Version 2.0, Provider of Services File and Area Resource File. Retrospective analysis of long-stay nursing home residents who died during 2005-2007. Overall, 505,851 non-hospice (67.66%) and 241,790 hospice-enrolled (32.34%) residents in 14,030 facilities nationwide were included. We fit models predicting the probability of hospitalization conditional on hospice penetration and resident and facility characteristics. We used instrumental variable method to address the potential endogeneity between hospice penetration and hospitalization. Distance between each nursing home and the closest hospice was the instrumental variable. Main Findings In the last 30 days of life, 37.63% of non-hospice and 23.18% of hospice residents were hospitalized. Every 10% increase in hospice penetration leads to a reduction in hospitalization risk of 5.1% for non-hospice residents and 4.8% for hospice-enrolled residents. Principal Conclusions Higher facility-level hospice penetration reduces hospitalization risk for both non-hospice and hospice-enrolled residents. The findings shed light on nursing home end-of-life care delivery, collaboration among providers and cost benefit analysis of hospice care. PMID:25304181

  17. The Grief Group: A University and Hospice Collaboration

    ERIC Educational Resources Information Center

    O'Neill, Daniel; Fry, Michele

    2013-01-01

    This report describes a joint effort of a community hospice and a university counseling center to provide a campus grief group for university students led by a hospice counselor and a counseling center clinical psychologist. Hospice provided a curriculum outlining topics and activities for each of the group's six meetings. Notices announcing…

  18. Symposium: Hospices.

    ERIC Educational Resources Information Center

    Mental Retardation, 1984

    1984-01-01

    Concepts and practices associated with the hospice movement are described as a threat to persons with mental retardation. Three responses and a rejoinder discuss issues of equality of treatment, legal consent, definition of "quality of life," government legislation, public and private funding, and human service patterns. (JW)

  19. Hospice Enrollment, Local Hospice Utilization Patterns, and Rehospitalization in Medicare Patients

    PubMed Central

    Holden, Timothy R.; Smith, Maureen A.; Bartels, Christie M.; Campbell, Toby C.; Yu, Menggang

    2015-01-01

    Abstract Background: Rehospitalizations are prevalent and associated with decreased quality of life. Although hospice has been advocated to reduce rehospitalizations, it is not known how area-level hospice utilization patterns affect rehospitalization risk. Objectives: The study objective was to examine the association between hospice enrollment, local hospice utilization patterns, and 30-day rehospitalization in Medicare patients. Methods: With a retrospective cohort design, 1,997,506 hospitalizations were assessed between 2005 and 2009 from a 5% national sample of Medicare beneficiaries. Local hospice utilization was defined using tertiles representing the percentage of all deaths occurring in hospice within each Hospital Service Area (HSA). Cox proportional hazard models were used to assess the relationship between 30-day rehospitalization, hospice enrollment, and local hospice utilization, adjusting for patient sociodemographics, medical history, and hospital characteristics. Results: Rates of patients dying in hospice were 27% in the lowest hospice utilization tertile, 41% in the middle tertile, and 53% in the highest tertile. Patients enrolled in hospice had lower rates of 30-day rehospitalization than those not enrolled (2.2% versus 18.8%; adjusted hazard ratio [HR], 0.12; 95% confidence interval [CI], 0.118–0.131). Patients residing in areas of low hospice utilization were at greater rehospitalization risk than those residing in areas of high utilization (19.1% versus 17.5%; HR, 1.05; 95% CI, 1.04–1.06), which persisted beyond that accounted for by individual hospice enrollment. Conclusions: Area-level hospice utilization is inversely proportional to rehospitalization rates. This relationship is not fully explained by direct hospice enrollment, and may reflect a spillover effect of the benefits of hospice extending to nonenrollees. PMID:25879990

  20. Medicare Hospice Benefits

    MedlinePlus

    ... Medic are covers You can get a one-time only hospice consultation with a hospice medical director or hospice doctor to discuss your care options and management of your pain and symptoms. You can get ...

  1. Home Economists and Hospice: A Needed Combination.

    ERIC Educational Resources Information Center

    Story, Marilyn D.

    1983-01-01

    Hospice is a family-centered concept of care which needs home economists from all subject-matter areas in volunteer or paid professional roles. In turn, home economists can grow personally as well as professionally through their involvement with hospice. (Author)

  2. 42 CFR 418.312 - Data submission requirements under the hospice quality reporting program.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... with CMS-approved vendors to collect the CAHPS® Hospice Survey data on their behalf and submit the data to the Hospice CAHPS® Data Center. (e) If the hospice's total, annual, unique, survey-eligible... exempt from the CAHPS® Hospice Survey reporting requirements in the current calendar year. In order...

  3. American Hospice Foundation

    MedlinePlus

    ... AHF worked to improve access to quality hospice care through public education, professional training, and consumer advocacy. Our vision was that hospice would be an integral part of our society, culture, and belief systems. ...

  4. Operational and financial performance of newly established hospices.

    PubMed

    McCue, Michael J; Thompson, Jon M

    2006-01-01

    The objective of the study was to examine the financial and operating performance of newly established, free- standing hospices relative to existing, freestanding hospices. A nonparametric median test was used to compare the median values of operating and financial performance measures between newly established hospices and existing hospices. Operating and financial data were measured for the 2 groups using cost report data from the Centers for Medicare and Medicaid Services. The authors sampled 44 new, freestanding hospices and selected 312 freestanding existing hospices and analyzed their data over 2 years from 2002 to 2003. The study found that 91% of these new hospices were owned by for-profit organizations and were located in the southern region of the United States. New hospices served fewer patients; however, they had a longer length of stay compared to existing hospices. They offered fewer imaging services and radiation therapy services. New hospices generated significantly higher revenue but incurred significantly higher expenses. The results suggest that longer lengths of stay allow these newer hospices to increase revenue and improve overall profitability. PMID:17060288

  5. Hospice: Morality and Economics.

    ERIC Educational Resources Information Center

    Gibson, Donald E.

    1984-01-01

    Examines hospice concepts and proposals to identify moral problems presented. Particular attention is given to the relationship between the hospice concept's alleged humanitarianism and emphasis on cost-efficiency. Suggests that cost emphasis raises serious questions about the meaning of hospice concepts. (JAC)

  6. The costs of a pediatric hospice program.

    PubMed Central

    Schweitzer, S O; Mitchell, B; Landsverk, J; Laparan, L

    1993-01-01

    The recent literature on economic issues of hospice care leaves several questions unanswered. The most important issue concerns how this type of care can be made financially attractive to patients and families for whom it is a medical option. A major study of a home-based pediatric hospice program permitted a more careful analysis than was previously feasible of the charges for hospice care and how those charges are paid. Data on provider utilization and duration in the program were obtained retrospectively on 177 patients. Costs of incidental expenditures and indirect costs were obtained prospectively from the families of 27 patients. A cost model was developed which is general enough to be used by other hospitals that might contemplate establishing a similar hospice program. Our findings are that insurance coverage, especially for publicly funded patients, is likely to be a major impediment for families deciding whether or not to use a hospice program at home. PMID:8434095

  7. Characteristics of Hospice Patients Utilizing Hospice Facilities

    PubMed Central

    Chung, Kyusuk; Burke, Sloane C.

    2014-01-01

    Given the increasing popularity of a hospice inpatient/residential facility (HIRF) among hospice patients and their family members, examining who uses HIRFs has been of increasing importance. Using the 2007 National Home and Hospice Care Survey (NHHCS), we found that about 14% of hospice patients received care in a HIRF in 2007. Characteristics of patients associated with HIRF use largely match the industry norm for a general inpatient level of care, and include: having no caregiver, or having an incapable caregiver; having imminent death; and being directly admitted to a hospice after discharge from a hospital. Given a recent stricter enforcement of reimbursement rules, however, we call for close monitoring of any change in the number of HIRF beds—particularly in rural and low-income urban areas. PMID:23264662

  8. 42 CFR 418.112 - Condition of participation: Hospices that provide hospice care to residents of a SNF/NF or ICF/IID.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... hospice care to residents of a SNF/NF or ICF/IID. 418.112 Section 418.112 Public Health CENTERS FOR... participation: Hospices that provide hospice care to residents of a SNF/NF or ICF/IID. In addition to meeting... residents of a SNF/NF or ICF/IID must abide by the following additional standards. (a) Standard:...

  9. 42 CFR 418.112 - Condition of participation: Hospices that provide hospice care to residents of a SNF/NF or ICF/IID.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... hospice care to residents of a SNF/NF or ICF/IID. 418.112 Section 418.112 Public Health CENTERS FOR... participation: Hospices that provide hospice care to residents of a SNF/NF or ICF/IID. In addition to meeting... residents of a SNF/NF or ICF/IID must abide by the following additional standards. (a) Standard:...

  10. 42 CFR 418.112 - Condition of participation: Hospices that provide hospice care to residents of a SNF/NF or ICF/MR.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... hospice care to residents of a SNF/NF or ICF/MR. 418.112 Section 418.112 Public Health CENTERS FOR...: Hospices that provide hospice care to residents of a SNF/NF or ICF/MR. In addition to meeting the... of a SNF/NF or ICF/MR must abide by the following additional standards. (a) Standard:...

  11. 42 CFR 418.112 - Condition of participation: Hospices that provide hospice care to residents of a SNF/NF or ICF/IID.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... hospice care to residents of a SNF/NF or ICF/IID. 418.112 Section 418.112 Public Health CENTERS FOR... participation: Hospices that provide hospice care to residents of a SNF/NF or ICF/IID. In addition to meeting... residents of a SNF/NF or ICF/IID must abide by the following additional standards. (a) Standard:...

  12. 42 CFR 418.112 - Condition of participation: Hospices that provide hospice care to residents of a SNF/NF or ICF/MR.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Condition of participation: Hospices that provide hospice care to residents of a SNF/NF or ICF/MR. 418.112 Section 418.112 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Conditions of...

  13. Essential Elements of an Effective Prison Hospice Program.

    PubMed

    Cloyes, Kristin G; Rosenkranz, Susan J; Berry, Patricia H; Supiano, Katherine P; Routt, Meghan; Shannon-Dorcy, Kathleen; Llanque, Sarah M

    2016-05-01

    As the number of prison inmates facing end-stage chronic illness grows, more prisons across the U.S. must address the need for end-of-life care. Many will likely need to develop a plan with potentially limited resources and external support. This case study presents one long-running model of care, the Louisiana State Penitentiary Prison Hospice Program. Based on field observations and in-depth interviews with hospice staff, inmate volunteers and corrections officers, we identify five essential elements that have contributed to the long-term operation of this program: patient-centered care, an inmate volunteer model, safety and security, shared values, and teamwork. We describe key characteristics of each of these elements, discuss how they align with earlier recommendations and research, and show how their integration supports a sustained model of prison end-of-life care. PMID:25735806

  14. Essential Elements of an Effective and Sustainable Prison Hospice Program

    PubMed Central

    Cloyes, Kristin G.; Rosenkranz, Susan J.; Berry, Patricia H.; Supiano, Katherine P.; Routt, Meghan; Shannon-Dorcy, Kathleen; Llanque, Sarah M.

    2015-01-01

    As the number of prison inmates facing end-stage chronic illness grows, more prisons across the U.S. must address the need for end-of-life care. Many will likely need to develop a plan with potentially limited resources and external support. This case study presents one long-running model of care, the Louisiana State Penitentiary Prison Hospice Program. Based on field observations and in-depth interviews with hospice staff, inmate volunteers and corrections officers, we identify five essential elements that have contributed to the long-term operation of this program: patient-centered care, an inmate volunteer model, safety and security, shared values, and teamwork. We describe key characteristics of each of these elements, discuss how they align with earlier recommendations and research, and show how their integration supports a sustained model of prison end-of-life care. PMID:25735806

  15. Hospice: Rehabilitation in Reverse

    PubMed Central

    Jeyaraman, Senthilkumar; Kathiresan, Ganesan; Gopalsamy, Kavitha

    2010-01-01

    Hospice care is about quality of life at a time when a person has an illness for which curative measures are no longer possible, and for which a physician has determined the patient has a life expectancy of about six months or less, a hospice program can support the process of death and dying in a compassionate way. A growing trend is to utilize physical therapy more frequently in hospice. Physical therapy has several vital roles in hospice care as follows: maximizing functional ability and comfort to enhance quality of life; assuring patient and care giver safety; helping people redesign their lives and life goals; providing support around physical, emotional and spiritual issues at the end of life. The purpose of this review is to provide 1) a description of hospice care, 2) an explanation of the roles of physical therapists in hospice care. PMID:21217999

  16. Spatial practices and the home as hospice.

    PubMed

    McGann, Sarah

    2011-01-01

    The modern hospice movement emerged in the late 1960s largely as a reaction to the way in which death and dying were dealt with in the hospital building. From the early development of the hospice movement, setting was considered to be very important. Hospice buildings were more residential and "homely" than their hospital counterparts. However, with the widespread development of "hospice home-care" programmes in the 1980s, this emphasis on place and setting changed, and along with it the meaning of the term "hospice" has changed. The current claim of the hospice movement is that "hospice" is a philosophy of care not a building or place.Home is now widely considered to be the best place to die, a place of familiar surroundings and the company of family and friends. The modern preference to die at home relies on traditional models of home, family and community. Dying at home was at one time commonplace and envisioned within the design of the home, and caring was a normal expectation of key family members. In modern society, however, dying is generally not a considered function within the design brief of the home and families may be unable, through economic, geographical or other reasons, to be carers. Thus, for some, home may not be the best place to die and family may not be the best carer. As a result, many people, despite their preference for home, still end up dying in the hospital building. This paper discusses the spatial issues surrounding the concept of home as hospice and questions the universal suitability of the contemporary home as a hospice. PMID:23393541

  17. 42 CFR 418.400 - Individual liability for coinsurance for hospice care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... care. 418.400 Section 418.400 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Coinsurance § 418.400 Individual liability for coinsurance for hospice care. An individual who has filed an election for hospice care...

  18. 42 CFR 418.400 - Individual liability for coinsurance for hospice care.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... care. 418.400 Section 418.400 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Coinsurance § 418.400 Individual liability for coinsurance for hospice care. An individual who has filed an election for hospice care...

  19. 42 CFR 418.402 - Individual liability for services that are not considered hospice care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... considered hospice care. 418.402 Section 418.402 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Coinsurance § 418.402 Individual liability for services that are not considered hospice care. Medicare payment to the...

  20. Psychological contracts of hospice nurses.

    PubMed

    Jones, Audrey Elizabeth; Sambrook, Sally

    2010-12-01

    Psychological contracts have been described as individuals' beliefs regarding the obligations, expectations, and contributions that exist between them and their employer. They can be influenced by the organization's culture and philosophy, through human resources policies, and through the employee's personality and characteristics. Owing to the recent economic crisis, hospices in the UK are currently in a transitional phase and are being expected to demonstrate efficiencies that might be more in line with a business model than a health-care environment. This may conflict with the philosophical views of hospice nurses. To support nurses through this transition, it might be helpful to understand the antecedents of hospice nurses' behaviour and how they construct their psychological contracts. Failure to offer adequate support might lead to negative outcomes such as a desire to leave the organisation, poorer quality work, or disruptive behaviour. This study used a modified grounded theory approach involving in-depth interviews to explore the context and content of the psychological contracts of hospice nurses in the UK. Four main themes emerged: the types of psychological contracts formed, how the contracts are formed, their contents, and the breaches and potential violations the nurses perceive. PMID:21240104

  1. Hospice Care in the United States: The Process Begins.

    ERIC Educational Resources Information Center

    Buckingham, Robert W.

    1982-01-01

    The hospice concept represents a return to humanistic medicine, to care within the patient's community, for family-centered care, and the view of the patient as a person. Medical, governmental, and educational institutions have recognized the profound urgency for the advocacy of the hospice concept. (Author)

  2. Estimating goodwill: an application of Pine's procedures for hospices.

    PubMed

    Doka, Kenneth J; Pine, Vanderlynn

    2004-01-01

    Hospice care is a philosophy as well as a business. As a business, especially in the current healthcare environment, it is subject to many of the same forces that affect other businesses, such as acquisitions, sales, and mergers. Yet, estimating the value of a hospice is problematic, since its most valued asset (the reputation and goodwill that it has generated within the communities it serves) is intangible. This article explores the problem of assessing the value of a hospice, applying Pine's model for estimating goodwill in funeral service as a useful approach for hospices. The article offers assumptions for assessment and examples of suggested approaches. PMID:15315192

  3. Hospice care in Calgary

    PubMed Central

    Spice, Ronald; Lau, Monica; Perez, Grace; Turley, Nathan; Turin, Tanvir Chowdhury

    2016-01-01

    Abstract Objective To explore Calgary family physicians’ knowledge about hospices, their attitudes toward the referral process, and their understanding of barriers to referral for hospice care. Design Surveys were mailed to 400 randomly selected participants. The survey contained 18 questions related to hospice care, physician experience, attitudes, and perceived barriers to making a hospice referral. Setting Calgary, Alta. Participants Family physicians. Main outcome measures Survey responses were analyzed quantitatively using the 2 goodness-of-fit test, Kruskal-Wallis tests, and logistic regression analyses to examine univariate associations. Qualitative analysis of open-ended questions was done by content analysis and thematic coding. Results In total, 104 surveys were mailed back. Family physicians agreed that palliative care in a hospice setting can greatly improve quality of life for patients, but only 2 of 6 knowledge questions about hospice care were answered correctly by most. Family physicians with special areas of interest or subspecialties were more likely to feel well-informed about hospice referrals (P = .017), indicated a higher comfort level discussing hospice and palliative care (P = .030), and were less likely to defer discussing it with patients (P = .023). Physicians with a special interest in palliative medicine were more likely to correctly answer the knowledge questions (P < .034) and to be familiar with the referral process (P < .001), patient eligibility (P < .001), and the palliative home care program (P = .003). Qualitative analysis revealed support for palliative home care and consultation services but concerns about caregiver coping and family issues. Concerns about disengagement of family physicians and uncertainty about the referral process are obstacles to referral. Conclusion While Calgary family physicians are appreciative of hospice care, there are knowledge gaps. It is important to engage family physicians in the referral

  4. The Rural Hospice: Integrating Formal and Informal Helping Systems.

    ERIC Educational Resources Information Center

    Jenkins, Lowell; Cook, Alicia S.

    1981-01-01

    Describes the implementation of the hospice philosophy in rural areas and provides a model of how formal helping systems and natural helping networks can work together effectively. Suggests the emergence of the hospice can reorient social workers to the basic concepts of helping. (Author/JAC)

  5. Findings from a nursing scholarship study tour to inform a proposal for a day hospice model in South Australia.

    PubMed

    Swetenham, Kate

    2014-02-01

    South Australia releases national and international travel scholarships every year to the nursing and midwifery workforce to enable them to undertake observational site visits to inform the development of service models that can be introduced into care practices back in South Australia. Ten sites across New Zealand, Canada, and the UK agreed to host a site visit as part of a scholarship to look at day hospice (DH) programmes. The author undertook an observational study that included participation in DH programmes and discussions with staff and patients. There were many similarities across the three countries, in particular in the structure of the programmes, the staff makeup, and the support of the volunteer workforce. Two distinct models were observed: social and medical. Each has its value and both need to be incorporated to ensure services and participants have their needs met. Based on the site visits and other research, the author devised a proposal for South Australia to commence with a time-limited sessional group DH programme with a focus on maintenance of function for participants coupled with caregiver education and information provision. PMID:24577215

  6. Making the Transition to Hospice: Exploring Hospice Professionals' Perspectives

    ERIC Educational Resources Information Center

    Waldrop, Deborah P.; Rinfrette, Elaine S.

    2009-01-01

    Hospice care is available for 6 months before death but the length of use varies widely, suggesting that there are different perspectives on the appropriate timing for this transition. This qualitative study explored hospice professionals' views on the appropriate timing for and communication about hospice. Ethnography of team meetings informed…

  7. The Developmental Transition from Living with to Dying From Cancer: Hospice Decision-making

    PubMed Central

    Waldrop, Deborah; Meeker, Mary Ann; Kutner, Jean S.

    2016-01-01

    Despite increasing utilization of hospice care, older adults with cancer enroll in hospice for shorter periods of time than those with other life-limiting illnesses. How older adults with cancer and their family members consider hospice is unknown. The purpose of this study was to compare decision-making in late-stage cancer in people who enrolled in hospice with those who declined. Concepts from the Carroll and Johnson (1990) decision-making framework guided the development of a hospice decision-making model. The study design was exploratory-descriptive, cross-sectional and used a 2-group comparison. Qualitative and quantitative data were collected in the same interview. Open-ended questions were used to explore the illness trajectory and decision-making process. The interrelationships between functional ability, quality of life and social support with hospice decision-making were assessed using the Katz, QLQ-30 and Lubben Social Network Scales. Study participants included 42 older adults with cancer who had been offered hospice enrollment (24 non-hospice and 18 hospice) and 38 caregivers (15 non-hospice and 23 hospice); N=80. The decisional model illustrates that the Recognition of Advanced Cancer and Information and Communication Needs were experienced similarly by both groups. There was interaction between the decisional stages: Formulation of Awareness and Generation of Alternatives that informed the Evaluation of Hospice but these stages were different in the hospice and non-hospice groups. The hospice enrollment decision represents a critical developmental juncture which is accompanied by a transformed identity and substantive cognitive shift. Increased attention to the psychosocial and emotional issues that accompany this transition are important for quality end-of-life care. PMID:26176303

  8. The Developmental Transition From Living With to Dying From Cancer: Hospice Decision Making.

    PubMed

    Waldrop, Deborah; Meeker, Mary Ann; Kutner, Jean S

    2015-01-01

    Despite increasing utilization of hospice care, older adults with cancer enroll in hospice for shorter periods of time than those with other life-limiting illnesses. How older adults with cancer and their family members consider hospice is unknown. The purpose of this study was to compare decision making in late-stage cancer in people who enrolled in hospice with those who declined. Concepts from the Carroll and Johnson (1990) decision-making framework guided the development of a hospice decision-making model. The study design was exploratory-descriptive, cross-sectional, and used a two-group comparison. Qualitative and quantitative data were collected in the same interview. Open-ended questions were used to explore the illness trajectory and decision-making process. The interrelationships between functional ability, quality of life, and social support with hospice decision making were assessed using the Katz, QLQ-30, and Lubben Social Network Scales. Study participants included 42 older adults with cancer who had been offered hospice enrollment (24 non-hospice and 18 hospice) and 38 caregivers (15 non-hospice and 23 hospice); N = 80. The decisional model illustrates that the recognition of advanced cancer and information and communication needs were experienced similarly by both groups. There was interaction between the decisional stages: formulation of awareness and generation of alternatives that informed the evaluation of hospice but these stages were different in the hospice and non-hospice groups. The hospice enrollment decision represents a critical developmental juncture, which is accompanied by a transformed identity and substantive cognitive shift. Increased attention to the psychosocial and emotional issues that accompany this transition are important for quality end-of-life care. PMID:26176303

  9. Hospice Care in America

    MedlinePlus

    ... iii 4. Survey of Team Attitudes and Relationships (STAR)  iv ( www. nhpco. org/ star) • Job satisfaction (hospice-specific) • Salary ranges • Provider-level ... to national estimates and peer groups. iv The STAR national summary report is available for purchase by ...

  10. The U.S. hospice movement: issues in development.

    PubMed Central

    Osterweis, M; Champagne, D S

    1979-01-01

    A grass-roots hospice care movement is underway in the United States modeled after recently popularized British hospice programs. Hospice care is intended to help the terminally ill maintain a personally acceptable quality of life until death. Attention should be given to ensuring the future viability of this service option by allowing for experimentation with and adaptation of existing models, and by integrating it with the overall health care system. Issues to be considered in integrating hospice care include utilization of existing resources, regional planning, standards and licensure, and reimbursement opportunities. Although hospice care may not have an immediate cost savings impact on the health care system, it could develop this capacity in the future. Such impact would not only assure a stable financial base for hospice care but would also affect bed use generally. Continuing dialogue among providers, consumers, and policy makers of various backgrounds is necessary to the effective and appropriate development of hospice care in the U.S. PMID:434281

  11. Hospice care in the nursing home setting: a review of the literature.

    PubMed

    Stevenson, David G; Bramson, Jeffrey S

    2009-09-01

    The U.S. Medicare hospice benefit has expanded considerably into the nursing home (NH) setting in recent years. This literature review focuses on the provision of NH hospice, exploring its growth and the impact of such care on NH residents, cost and efficiency implications for NHs and government, and policy challenges and important areas for future research. Although hospice utilization is relatively modest among NH residents, its increased availability holds great promise. As an alternative to traditional NH care, hospice has been shown to provide high-quality end-of-life care and offer benefits, such as reduced hospitalizations and improved pain management. The provision of NH hospice also has been shown to have positive effects on nonhospice residents, suggesting indirect benefits on NH clinical practices. Importantly, the expansion of hospice in NHs brings challenges, on both clinical and policy dimensions. Research has shown that NH-hospice collaborations require effective communication around residents' changing care needs and that a range of barriers can impede the integration of hospice and NH care. Moreover, the changing case mix of hospice patients, including increased hospice use by individuals with conditions such as dementia, presents challenges to Medicare's hospice payment and eligibility policies. To date, there has been little research comparing hospice costs, service intensity, and quality of care across settings, reflecting the fact that few comparative data have been available to researchers. The Centers for Medicare & Medicaid Services have taken steps toward collecting these data, and further research is needed to shed light on what refinements, if any, are necessary for the Medicare hospice program. PMID:19735904

  12. Hospice Core Professions' Views on Interdisciplinary Teams: A Qualitative Investigation.

    PubMed

    Kobayashi, Rie; McAllister, Carolyn A

    2016-01-01

    The hospice interdisciplinary team (IDT) has been recognized as an ideal model for interprofessional collaboration. To address the manner in which interdisciplinary practices are perceived by team members, this study explored profession-based similarities and differences in perceptions among the four core hospice IDT members (physicians, nurses, social workers, and spiritual care providers) as well as experiences on the IDT. Semistructured interviews with 20 hospice professionals, 5 from each profession, were completed. Findings suggested that while hospice professions share some perceptions and experiences about hospice team membership, strengths of and barriers to teamwork, and individual members' contribution to the team, significant profession-based differences exist largely in the area of hospice team membership beyond the core members, type of language and descriptions used, perceptions of causes and effects of barriers to teamwork, and understandings of how team effectiveness is evaluated. Changes at the team-based, organizational, policy, and educational levels are needed to further maximize strengths of individual hospice IDT member and team qualities. PMID:27462950

  13. Same Agency, Different Teams: Perspectives From Home and Inpatient Hospice Care

    PubMed Central

    Hurley, Susan Lysaght; Barg, Frances K.; Strumpf, Neville; Ersek, Mary

    2015-01-01

    Tremendous growth in hospice over the past 30 years in the United States has increased the number of terminally ill patients dying at home. Recently, however, more hospice patients are dying at inpatient facilities. To understand the varying perceptions about care in the home and inpatient hospice, we conducted semistructured interviews with 24 interdisciplinary team (IDT) members and analyzed the data using the constant comparative method. Core interdisciplinary tasks, including identifying the focus of energy, tailoring family caregiver involvement, acknowledging who is in charge, and knowing both sides differed in the home and inpatient settings. Despite the overarching umbrella of hospice care, home and inpatient hospice settings create different foci for IDT members, burdens and privileges for family caregivers, and control of the care plan. Key differences between home and inpatient hospice processes of care highlight the complexity of patient-centered end-of-life care in the United States. PMID:25294344

  14. Hospice Eligibility and Election: Does Policy Prepare Us to Meet the Need?

    PubMed

    Wallace, Cara L

    2015-01-01

    A 7-point policy model is used to examine policy on hospice eligibility and election in the United States. Despite the growth of hospice, many eligible patients continue to lack access due to difficulties experienced by providers in discerning 6-month prognoses among chronically ill patients, the inability of patients to elect hospice alongside curative care, and limited reimbursement for hospice providers. Though the landscape of dying has evolved, with more deaths occurring later in life from chronic illness, Medicare hospice eligibility requirements have historically remained the same. Utilization would increase if hospice agencies were able to provide fewer restrictions by including ongoing treatments such as transfusions, intravenous nutrition, or palliative radiation. Hospices would be more likely to enroll critically ill patients who require some ongoing curative measures if Medicare reimbursement rates were higher, and patients would be more likely to seek hospice earlier if Medicare election policies were altered to allow concurrent care. Participation would also be increased by extending hospice eligibility past the traditional prognosis of 6 months. Though expansion in public spending of hospice care has been met with some opposition, current research suggests that potential savings due to decreased costs in acute care is promising. PMID:26161945

  15. 42 CFR 418.110 - Condition of participation: Hospices that provide inpatient care directly.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... inpatient care directly. 418.110 Section 418.110 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Conditions of... management. (i) The hospice must address real or potential threats to the health and safety of the...

  16. 42 CFR 418.110 - Condition of participation: Hospices that provide inpatient care directly.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... inpatient care directly. 418.110 Section 418.110 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Conditions of... management. (i) The hospice must address real or potential threats to the health and safety of the...

  17. Characteristics of hospice patients utilizing hospice inpatient/residential facilities.

    PubMed

    Chung, Kyusuk; Burke, Sloane C

    2013-11-01

    Given the increasing popularity of a hospice inpatient/residential facility (HIRF) among hospice patients and their family members, examining who uses HIRFs has been of increasing importance. Using the 2007 National Home and Hospice Care Survey (NHHCS), we found that about 14% of the hospice patients received care in an HIRF in 2007. Characteristics of patients associated with HIRF use largely match the industry norm for a general inpatient level of care and include having no caregiver or having an incapable caregiver; having imminent death; and being directly admitted to a hospice after discharge from a hospital. Given a recent stricter enforcement of reimbursement rules, however, we call for close monitoring of any change in the number of HIRF beds--particularly in rural and low-income urban areas. PMID:23264662

  18. Straddling the fence: ICU nurses advocating for hospice care.

    PubMed

    Borowske, Deborah

    2012-03-01

    A key factor in nurses' experiencing moral distress is their feeling of powerlessness to initiate discussions about code status, EOL issues, or patients' preferences. Moreover, nurses encounter physicians who give patients and their families a false picture of recovery or, worse, block EOL discussions from occurring. Since its release in 1995, the landmark study of almost 10,000 patients in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT) reported a widespread gap with physicians' discussions in honest prognosis and EOL issues. Since the SUPPORT report, other studies have validated patients' and their families' preference for realistic discussions of disease trajectory and life expectancy. Unfortunately, the phenomenon of physicians failing to discuss bad news or terminal disease trajectory persists. Moreover, with a burgeoning geriatric population, coupled with advances in medical treatments, a growing segment of chronically ill patients are admitted to the ICU. With these communication shortcomings, it becomes an essential element of practice for the ICU nurse to initiate discussions about healthcare goals, preferences, and choices. The ICU nurse must be integral in fostering those discussions, particularly in cases where the family asks if hospice should be considered. Nurses have a long history of patient advocacy, with both the American Nurses Association and the American Association of Critical-Care Nurses stating that nurses have a duty to educate and promote dialogue about patients' preferences, goals, and EOL issues. With these tenets in the forefront, the ICU nurse is an integral member of the healthcare team, working with patients and their families to distinguish between what can be done and what should be done. Too often, hospice is thought of as a last resort. Rather, it is a model of care that centers on the belief that each of us has the right to die pain free and with dignity, and that our families

  19. The association between hospice use and depressive symptoms in surviving spouses

    PubMed Central

    Ornstein, Katherine A.; Aldridge, Melissa D.; Garrido, Melissa M.; Gorges, Rebecca; Meier, Diane E.; Kelley, Amy S.

    2015-01-01

    Importance Family caregivers of individuals with serious illness are at risk for depressive symptoms and depression. Hospice includes the provision of support services for family caregivers, yet evidence is limited regarding the impact of hospice use on depressive symptoms among surviving caregivers. Objective To determine the association between hospice use and depressive symptoms in surviving spouses. Design We linked data from the Health and Retirement Study (HRS), a nationally representative longitudinal survey of community dwelling U.S. adults 50 years of age and older to Medicare claims. With propensity score matching on both decedent and spousal characteristics, we compared the spouses of individuals enrolled in hospice prior to death to the spouses of individuals who did not use hospice. Setting National study of decedents and surviving spouses. Participants Propensity score matched sample of 1016 HRS decedents with at least one serious illness and their surviving spouses interviewed 2002–2010. Exposure(s) for observational studies Hospice enrollment for at least 3 days in the year prior to death. Main Outcome(s) and Measure(s) Spousal depressive symptom scores measured 0–2 years post-death with the Center for Epidemiologic Studies Depression Scale (CES-D), which is scored 0 (no symptoms) to 8 (severe symptoms). Results Of the decedents in the matched sample, 305 (30.0%) used hospice services for >= 3 days in the year prior to death. Of the spouses, 52% had more depressive symptoms over time (mean change = 2.56; S.D = 1.65), with no difference related to hospice use. A minority, (28.2%) of spouses of hospice users had improved CES-D scores, compared to 21.7% of spouses of decedents who did not use hospice (p=0.06). Among the spouses who were the primary caregivers (n-662), 27.3% of spouses of hospice users had improved CES-D scores, compared to 20.7% of spouses of decedents who did not use hospice (p=0.10); in multivariate analysis, the odds ratio for

  20. The impact of prison hospice: collaboration among social workers and other professionals in a criminal justice setting that promotes care for the dying.

    PubMed

    Bronstein, Laura R; Wright, Kevin

    2006-01-01

    This study reports on a qualitative national telephone survey with coordinators of 14 prison hospice programs in 11 states. The rationale behind the survey was to learn about interdisciplinary collaboration between social work and criminal justice, using prison hospice as an exemplar of this collaboration. In addition to learning that all prison hospices in the study operate using an interdisciplinary team model and that most report high quality collaboration on the hospice team, the following additional five themes emerged: administrators and wardens are very supportive while correctional staff provides mixed support to team and program; greater collaboration with those outside prison hospice is critical; collaboration through prison hospice has a positive impact on dying prisoners; collaboration through prison hospice has a positive impact on prisoner volunteers; and, collaboration through prison hospice has a positive impact on the entire culture of the prison. PMID:17387096

  1. 42 CFR 418.309 - Hospice cap amount.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Hospice cap amount. 418.309 Section 418.309 Public...) MEDICARE PROGRAM HOSPICE CARE Payment for Hospice Care § 418.309 Hospice cap amount. The hospice cap amount... until October 31 of the following year. (b) Each hospice's cap amount is calculated by the...

  2. Continuum of care comes full circle. Adding hospice care allows a Denver system to better meet patient needs.

    PubMed

    Rockers, T H; Hoagland, B

    1994-09-01

    In November 1993 Hospice of Peace, a home hospice program in Denver, was reorganized under a new joint sponsorship of Provenant Health Partners and Catholic Charities and Community Services. Home hospice completes Provenant's continuum of healthcare. Based on the campus of Provenant Senior Life Center, Hospice of Peace employs multidisciplinary professionals who care for patients and their family care givers in their homes. Each hospice team works with a patient's physician and comes from a pool of primary care nurses, certified nurse assistants, social workers, counselors, pastoral care counselors, and specially trained volunteers and bereavement counselors. Respect for human life at all stages is the ethic behind the organizations' hospice efforts. Even at life's end, when aggressive medical treatment is no longer appropriate, healthcare professionals can enhance patients' quality of life and provide bereavement support to their loved ones. Just as Catholic healthcare addresses the spiritual component of healing, so it addresses the spiritual component of dying. PMID:10136079

  3. 42 CFR 418.26 - Discharge from hospice care.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Discharge from hospice care. 418.26 Section 418.26 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...) behavior is disruptive, abusive, or uncooperative to the extent that delivery of care to the patient or...

  4. 42 CFR 422.320 - Special rules for hospice care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Special rules for hospice care. 422.320 Section 422.320 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Payments to Medicare Advantage Organizations §...

  5. Rehospitalization of Older Adults Discharged to Home Hospice Care

    PubMed Central

    Goldenheim, Anna; Oates, Daniel; Parker, Victoria; Russell, Matthew; Winter, Michael

    2014-01-01

    Abstract Background: Acute hospital readmission of older adults receiving hospice care is not aligned with hospice goals. Objective: To identify factors associated with 30-day readmission among older adults newly discharged to hospice. Design/Subjects: Medical record review of 59 patients, 19 readmitted within 30 days and 40 randomly selected controls not readmitted, from 206 patients newly discharged to home hospice care between February 1, 2005 and January 31, 2010. Measures/Analysis: Information was collected about hospital course, end-of-life planning, and posthospitalization follow-up. We calculated bivariate associations and developed a Cox Proportional Hazards model examining the relation between index admission characteristics and readmission. Results: Patients' mean age was 79.7±8.4; 74.6% were female; 52.5% were black. Among those readmitted, 25% had received a palliative care consultation, compared to 47.1% of those not readmitted (p=0.06). Patients without a participating decision-maker involved in their hospice decision had 3.5 times the risk of readmission within 30 days, compared to those with (hazard ratio [HR] 3.53, confidence interval [CI] 0.97, 12.82). Patients who had one or more telephone contacts with their primary care physician (PCP) during week 1 after discharge had 2.4 times the readmission risk within 30 days, compared to patients with no such contacts during this period (HR 2.35, CI 0.9, 6.1). Conclusions: Readmission within 30 days of initial discharge to hospice is associated with several measures of care and care planning. Further study of these measures may identify opportunities for interventions to improve the hospital-to-hospice transition and to decrease hospital readmissions. PMID:24708490

  6. Relationships between Social Work Involvement and Hospice Outcomes: Results of the National Hospice Social Work Survey

    ERIC Educational Resources Information Center

    Reese, Dona J.; Raymer, Mary

    2004-01-01

    In a struggle to balance fiscal realities with hospice philosophy, some hospices have attempted to cut costs by reducing social work involvement. This cross-sectional survey of 66 hospices found, however, increased social work involvement was significantly associated with lower hospice costs. Additional benefits included better team functioning,…

  7. Discussions with Physicians about Hospice among Patients with Metastatic Lung Cancer

    PubMed Central

    Huskamp, Haiden A.; Keating, Nancy L.; Malin, Jennifer L.; Zaslavsky, Alan M.; Weeks, Jane C.; Earle, Craig C.; Teno, Joan M.; Virnig, Beth A.; Kahn, Katherine L.; He, Yulei; Ayanian, John Z.

    2009-01-01

    Context Many terminally-ill patients enroll in hospice only in the final days before death or not at all. Discussing hospice with a provider could increase awareness of hospice and possibly result in earlier use. Methods We used data on 1517 patients diagnosed with stage IV lung cancer from a multi-regional study. We estimated logistic regression models for the probability that a patient discussed hospice with a physician or other health-care provider before an interview 4−7 months after diagnosis as reported by either the patient or surrogate or documented in the medical record. Results Half (53%) of patients had discussed hospice with a provider. Patients who were black, Hispanic, non-English speaking, married or living with a partner, Medicaid beneficiaries, or had received chemotherapy were less likely to have discussed hospice. Only 53% of individuals who died within two months after the interview had discussed hospice, and rates were lower among those who lived longer. Patients who reported that they expected to live less than two years had much higher rates of discussion than those expecting to live longer. Patients reporting the most severe pain or dyspnea were no more likely to have discussed hospice than those reporting less severe or no symptoms. A third of patients who reported discussing do-not-resuscitate (DNR) preferences with a doctor had also discussed hospice. Conclusions Many patients diagnosed with metastatic lung cancer had not discussed hospice with a provider within 4−7 months of diagnosis. Increased communication with physicians could address patients’ lack of awareness about hospice and misunderstandings about prognosis. PMID:19468089

  8. The Need for Quality Hospice Care.

    ERIC Educational Resources Information Center

    Butler, Robert N.

    1979-01-01

    There has been little comment in the hospice literature about the special problems of the elderly. Promotes the continued refinement of hospice concepts and practices in relation to both disease and age. (Author/CMG)

  9. National Hospice and Palliative Care Organization

    MedlinePlus

    ... Strategic Planning for Hospice Hospice Policy and Advocacy Healthcare Reform and Innovation Inspirational Address Booking Policies Contact NHPCO ... Webinar Registration MP4 Recordings Pay for CE/CME Online Learning E-OL Courses Interdisciplinary Team Palliative Care ...

  10. Psychological Consultation in an HMO Hospice.

    ERIC Educational Resources Information Center

    Gould, Warren

    Hospice care differs from traditional medical care in that it aims to optimize the quality of the patient's remaining life rather than to maximize its duration. The Hayward Hospice project, begun in November of 1977 as a pilot project to evaluate whether hospice quality care could be provided within manageable costs and thus be included as a…

  11. Profile of an Effective Hospice Team Member.

    ERIC Educational Resources Information Center

    Basile, Joseph L.; Stone, Donald B.

    1987-01-01

    Examined competencies that hospice practitioners and experts in the field would agree upon as necessary attributes to being an effective hospice team member. Results indicated strong positive agreement between the rankings of the practitioners on emotional and interpersonal characteristics needed by hospice personnel to effectively function with…

  12. NATIONAL HOME AND HOSPICE CARE SURVEY (NHHCS)

    EPA Science Inventory

    The National Home and Hospice Care Survey is a continuing series of surveys of home and hospice care agencies in the United States. Information was collected about agencies that provide home and hospice care and about their current patients and discharges. The NHHCS is based on a...

  13. Evaluating transformational leadership skills of hospice executives.

    PubMed

    Longenecker, Paul D

    2006-01-01

    Health care is a rapidly changing environment requiring a high level of leadership skills by executive level personnel. The hospice industry is experiencing the same rapid changes; however, the changes have been experienced over the brief span of 25 years. Highly skilled hospice executives are a necessity for the growth and long-term survival of hospice care. This descriptive study was conducted to evaluate the leadership skills of hospice executives. The study population consisted of hospice executives who were members of the state hospice organization in Ohio and/or licensed by the state (88 hospice providers). Three questionnaires were utilized for collecting data. These questionnaires collected data on transformational leadership skills of participants, participants' personal demographics, and their employer's organizational demographics. Forty-seven hospice executives responded (53%). Key findings reported were high levels of transformational leadership skills (mean, 3.39), increased use of laissez-faire skills with years of hospice experience (P = .57), and positive reward being a frequent leadership technique utilized (mean, 3.29). In addition, this was the first study of leadership skills of hospice executives and the first formal collection of personal demographic data about hospice executives. PMID:17060280

  14. Conflicts and conflict regulation in hospices: nurses' perspectives. Results of a qualitative study in three German hospices.

    PubMed

    Walker, Andreas; Breitsameter, Christof

    2013-11-01

    The present article considers conflicts and conflict regulation in hospices. The authors carried out a qualitative study in three hospices in North Rhine-Westphalia, Germany, to explore how conflicts arise and how conflict regulation proceeds. Hospice nurses should act according to a set of ethical codes, to mission statements of the institution and to professional standards of care. In practice the subjective interpretations of codes and/or models concerning questions of care are causes of conflicts among nurses, with doctors, patients and family members. The management has two choices to react to these conflicts. It can either tolerate the conflicts, as long as they do not disturb the daily routine. Or it can increase the degree of organisation by integrating the different viewpoints into its own program and/or by restructuring its organisational units. PMID:23264046

  15. The Hospice: An Integrated Bibliography.

    ERIC Educational Resources Information Center

    Bodine, George E.; Sobotor, William

    This extensive bibliography of books and articles provides an interdisciplinary overview of present day terminal care and the hospice alternative. Designed to aid in the development and implementation of terminal care programs stressing palliative and supportive services for both patients and their families, the bibliography includes abstracts of…

  16. Nonverbal Communication in Hospice Care.

    ERIC Educational Resources Information Center

    Jensen, Marvin D.

    Hospice care (health care for the terminally ill that emphasizes emotional support for the patient and family) is essential to ease emotional, psychological, and social pain, and can be a factor in addressing spiritual and physical pain. Yet to ease the pain of final illness, therapeutic communication must extend beyond words. Physical contact--in…

  17. Communication Aspects of Hospice Care.

    ERIC Educational Resources Information Center

    Jensen, Marvin D.

    No theories of communication can minimize the crisis of dying. But those who study commmunication can suggest ways of offering comfort and dignity to the dying person. Many of these ways go beyond words, for death cannot be addressed with verbal cliches. The theoretical work from which a communication scholar draws can help hospice volunteers and…

  18. Motivations of German Hospice Volunteers: How Do They Compare to Nonhospice Volunteers and US Hospice Volunteers?

    PubMed

    Stelzer, Eva-Maria; Lang, Frieder R

    2016-03-01

    We examined reasons of volunteering for hospice and nonhospice organizations in a study with 125 volunteers (22-93 years) from the United States and Germany. Motives of US and German hospice volunteers revealed similarities and few differences. Hospice volunteers are involved because they seek to help others, seek new learning experiences, seek social contacts, or seek personal growth. The US hospice volunteers reported motives related to altruistic concerns, enhancement, and social influence as more influential, while German hospice volunteers rated career expectations as being more important. Comparison of German hospice with nonhospice volunteers revealed stronger differences: German hospice volunteers scored higher on altruistic motives, while German nonhospice volunteers yielded higher scores on self-serving motives. Findings contribute to improved understanding of volunteering motivation and of activating or retaining hospice volunteers. PMID:25422517

  19. The need for increased access to pediatric hospice and palliative care.

    PubMed

    Jones, Brian W

    2011-01-01

    Pediatric hospice and palliative care continue to be an underutilized model of care. There is much confusion over the differences between hospice and palliative care. Nurses and physicians continue to need specialized training regarding end-of-life care and the pediatric population. Children and their families may needlessly be suffering during the dying process. Many barriers exist that prevent its use among medical professionals. This article discusses some of these barriers and strategies to reduce them. Recent changes in health care law will allow both curative and hospice care to be provided at the same time. PMID:21841410

  20. The two-faced angel: do phase I clinical trials have a place in modern hospice?

    PubMed

    Ross, Daniel S

    2006-01-01

    Increasingly, bioethicists have been exploring the possibility of making phase I clinical trials available to hospice patients. Phase I clinical trials are designed to test a drug's safety and dosage, not its effectiveness. Participants in these studies generally do not understand that the purpose of the investigation is not to benefit them, thus challenging the notion of informed consent. But furthermore, the idea that patients believe experimental drugs will help them is contrary to the principles of hospice. Also, the very nature of the research in phase I conflicts with hospice's methods. For these reasons, this paper finds that the two models must remain distinct. PMID:17146915

  1. The routinization of hospice: charisma and bureaucratization.

    PubMed

    James, N; Field, D

    1992-06-01

    In 25 years the number of hospices in Britain has multiplied from under 15 in 1965 to over 430 in 1991. During this period, often working out with the mainstream health system, the hospices actively sought to transform terminal care. More recently a process of diversification and legitimation has meant that hospices have become increasingly subject to mainstream influence. Using Weber's concept of charisma we examine the development of the hospice movement during this period of expansion. We suggest there are a number of factors leading to the routinization of hospice care including the ways in which it was sponsored and developed at the local level, and pressures toward bureaucratization and professionalization. We make links with recent developments in the health services. Finally we consider whether it is possible for the hospice movement to sustain its founding ideals. PMID:1529374

  2. Improving Diabetes Care for Hospice Patients.

    PubMed

    Lee, Sei J; Jacobson, Margaret A; Johnston, C Bree

    2016-07-01

    Although type 2 diabetes guidelines recommend less aggressive glycemic control for patients with limited life expectancy, many hospice patients continue their glucose-lowering medications, resulting in an increased risk of hypoglycemia. Three common reasons for overly tight glycemic control in hospice patients include (1) discussions about reducing or stopping chronic medications are uncomfortable; (2) many patients and families believe that mild hyperglycemia can cause symptoms; and (3) until 2014, Healthcare Information and Data Information Set (HEDIS) quality indicators for glycemic control included hospice patients. To address these issues, we recommend (1) providers discuss with patients and families upon hospice enrollment that diabetes medications can be reduced or discontinued as their life-limiting disease progresses; (2) keeping blood glucose levels between 200 and 300 mg/dL; and (3) educate providers that HEDIS measures now exclude hospice patients. Implementing these recommendations should decrease the risk of hypoglycemia in hospice patients and improve their quality of life. PMID:25852204

  3. Hospice-Where Peace and Turmoil Coexist.

    PubMed

    Viswanath, Vidya

    2016-01-01

    It is often said that a hospice is much more than just a place providing supportive care for the terminally ill. This narrative describes Neha, a young mother who found her solace in the hospice and spent her last days there by choice. It reinforces the fact that the hospice is truly a philosophy of care where powerful and contrasting emotions do coexist. PMID:26862661

  4. Death representation of caregivers in hospice.

    PubMed

    Andruccioli, Jessica; Russo, Maria Maffia; Bruschi, Angela; Pedrabissi, Luigi; Sarti, Donatella; Monterubbianesi, Maria Cristina; Rossi, Sabina; Rocconi, Sabina; Raffaeli, William

    2012-11-01

    In this study, we investigated caregiver's death representation in hospice. The results presented here are a further analysis of the data collected in our previous study, concerning the evaluation of the caregiver in hospice. The data analysis of 24 caregivers of patients hospitalized in Rimini Hospice (Italy) underlined that caregivers avoiding death representation of the patient admitted to hospice had fewer protective factors (52.3%) and more risk factors (47.7%) than caregivers nonavoiding (66.5% and 33.5%, respectively). Caregivers avoiding death representation, moreover, experienced a greater distress (58%) than those nonavoiding (42%). PMID:22241459

  5. Telehospice: reasons for slow adoption in home hospice care.

    PubMed

    Whitten, Pamela; Holtz, Bree; Meyer, Emily; Nazione, Samantha

    2009-01-01

    We investigated why hospice nurses were slow to adopt videophones to care for their patients. We used the unified theory of acceptance and use of technology (UTAUT) model and the organizational readiness for change (ORC) assessment via interviews and focus groups with hospice staff. Twenty-five hospice employees participated. Eighteen (72%) were in clinical positions and seven were in non-clinical positions (28%). Thirty-nine percent of respondents reported no videophone training, despite the fact that every employee had received training. Only four staff members actually used a videophone with patients. The respondents overwhelmingly stated that they had the organizational resources necessary to use the videophone and that it was easy to operate. Despite initial enthusiasm, leaders in the hospice agency did not endorse the videophones for work, nor offer incentives for using the videophones or providing them to patients. It is important to note that videophone technology is not meant to replace face-to-face visits, but to supplement them and to provide an additional tool for the nurses. PMID:19471030

  6. Creative ritual in a hospice.

    PubMed

    Roche, J

    1994-12-01

    St. Peter's Hospice, Albany, NY, is dedicated to meeting the emotional needs of patients, families, and staff. Creative ritual, hospice leaders have found, is a powerful tool that can: Provide an "arena" for healing, affirmation, reconciliation, and celebration Serve as a reminder of the sacred Evoke heartfelt emotion Effect renewal and inspiration Offer an opportunity to cleanse the soul of grief, anger, frustration, or guilt Provide tangible experiences of bonding and interdependence Prevent staff burnout St. Peter's staff show a good deal of imagination and variety in creating rituals. Possible themes include patients' birthdays or wedding anniversaries, religious celebrations, national holidays, and changes of seasons. A lighted candle, bouquet of flowers, or incense burner may be used to give the ritual a focus. Music is often played to help set the tone. Rituals involve a major shift in consciousness. They often allow participants to express feelings it would otherwise be difficult for them to put into words. At St. Peter's, participants may begin to communicate by sharing favorite prayers, poems, photos, or works of art. Or they may make music--the hospice provides the instruments--or pass around a Native American "talking stick." Such methods facilitate the bonding of patients and their families. Particularly important are those rituals which allow patients and estranged family members to reconcile. Others enable patients to acknowledge God-given gifts. Still other rituals are held for staff members, who thereby deal with the anger and sadness their work inevitably brings. For all at St. Peter's Hospice ritual is a source of healing, affirmation, renewal, inspiration, and grace. PMID:10138592

  7. Factors Affecting Willingness to Use Hospice in Racially/Ethnically Diverse Older Men and Women.

    PubMed

    Park, Nan Sook; Jang, Yuri; Ko, Jung Eun; Chiriboga, David A

    2016-09-01

    Racial/ethnic minorities tend to underutilize hospice services. Guided by Andersen behavioral health model, the purpose of this study was to explore the predictors of the willingness to use hospice services in racially/ethnically diverse older men and women. Data were drawn from the Survey of Older Floridians: 504 non-Hispanic whites, 360 African Americans, 328 Cuban Americans, and 241 non-Cuban Hispanics. In each group, logistic regression models of the willingness to use hospice were estimated. A greater likelihood of willingness was observed among younger non-Hispanic whites and among African Americans with fewer functional disabilities. In non-Cuban Hispanics, English proficiency increased the willingness by 3.1 times. Findings of the study identified group-specific factors contributing to the willingness to use hospice services and hold implications for tailored intervention programs. PMID:26071499

  8. Regulating and Paying for Hospice and Palliative Care: Reflections on the Medicare Hospice Benefit.

    PubMed

    Mor, Vincent; Teno, Joan M

    2016-08-01

    Hospice began as a social movement outside of mainstream medicine with the goal of helping those dying alone and in unbearable pain in health care institutions. The National Hospice Study, undertaken to test whether hospice improved dying cancer patients' quality of life while saving Medicare money, found hospice care achieved comparable outcomes to traditional cancer care and was less costly as long as hospice lengths of stay were not too long. In 1982, before study results were final, Congress created a Medicare hospice benefit under a capitated per diem payment system restricting further treatment. In 1986 the benefit was extended to beneficiaries living in nursing homes. This change resulted in longer average lengths of stay, explosive growth in the number of hospices, particularly of the for-profit variety, and increases in total Medicare expenditures on hospice care. An increasingly high proportion of beneficiaries receive hospice care. However, over 30 percent are served fewer than seven days before they die, while very long stays are also increasingly common. These and other factors raise quality concerns about hospice being disconnected from the rest of the health care system. We offer suggestions regarding how hospice could be better integrated into the broader health care delivery system. PMID:27127256

  9. In the business of dying: questioning the commercialization of hospice.

    PubMed

    Perry, Joshua E; Stone, Robert C

    2011-01-01

    This article critically questions the commercialization of hospice care and the ethical concerns associated with the industry's movement toward "market-driven medicine" at the end of life. For example, the article examines issues raised by an influx of for-profit hospice providers whose business model appears at its core to have an ethical conflict of interest between shareholders doing well and terminal patients dying well. Yet, empirical data analyzing the experience of patients across the hospice industry are limited, and general claims that end-of-life patient care is inferior among for-profit providers or even that their business practices are somehow unseemly when compared to nonprofit providers cannot be substantiated. In fact, non-profit providers are not immune to potentially conflicting concerns regarding financial viability (i.e., "no margin, no mission"). Given the limitations of existing empirical data and contrasting ideological commitments of for-profit versus non-profit providers, the questions raised by this article highlight important areas for reflection and further study. Policymakers and regulators are cautioned to keep ethical concerns in the fore as an increasingly commercialized hospice industry continues to emerge as a dominant component of the U.S. health care system. Both practitioners and researchers are encouraged to expand their efforts to better understand how business practices and commercial interests may compromise the death process of the patient and patient's family--a process premised upon a philosophy and ethical tradition that earlier generations of hospice providers and proponents established as a trusted, end-of-life alternative. PMID:21561517

  10. 75 FR 67905 - National Hospice Month, 2010

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-04

    ... States of America the two hundred and thirty-fifth. (Presidential Sig.) [FR Doc. 2010-28082 Filed 11-3-10... Documents#0;#0; ] Proclamation 8594 of October 29, 2010 National Hospice Month, 2010 By the President of the United States of America A Proclamation During National Hospice Month, we recognize the dignity...

  11. Characterizing Hospice Services in the United States

    ERIC Educational Resources Information Center

    Smith, Maureen A.; Seplaki, Christopher; Biagtan, Mark; DuPreez, Amanda; Cleary, James

    2008-01-01

    Purpose: Although caregivers desire specific information about hospice programs, there is little descriptive information available. We characterized agencies that provide formal or informal hospice care in the United States according to four types of services considered important by caregivers: medications and treatments; rehabilitative care;…

  12. The Hospice Concept: Health Occupation 305.

    ERIC Educational Resources Information Center

    Schobel, Deborah A.

    A description is provided of "The Hospice Concept," an elective course offered as part of a two-year college health occupations curriculum. The course is designed to further the students understanding of the multiple facets of death and dying and to prepare them to be hospice volunteers. Following a course description and a glossary of terms,…

  13. The Hospice Farewell: Ideological Perspectives of Its Professional Practitioners.

    ERIC Educational Resources Information Center

    Rinaldi, Anoel; Kearl, Michael C.

    1990-01-01

    Questioned 48 hospice experts to elicit group judgments about hospice ideology, control over one's own death trajectory, and hospice's relevance for older individuals. Although high rate of consensus was obtained on many issues, little evidence of coherent ideology could be detected linking notions of hospice origins, issues of patient control,…

  14. 42 CFR 417.531 - Hospice care services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Hospice care services. 417.531 Section 417.531... PREPAYMENT PLANS Medicare Payment: Cost Basis § 417.531 Hospice care services. (a) If a Medicare enrollee of... receive hospice care services, payment for these services is made to the hospice that furnishes...

  15. 42 CFR 418.25 - Admission to hospice care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Admission to hospice care. 418.25 Section 418.25... (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.25 Admission to hospice care. (a) The hospice admits a patient only on the recommendation of the medical...

  16. The grief experience of prison inmate hospice volunteer caregivers.

    PubMed

    Supiano, Katherine P; Cloyes, Kristin G; Berry, Patricia H

    2014-01-01

    Correctional institutions are obligated to provide end-of-life care to a population with complex medical needs. Prison hospices are increasingly being formed to address this demand. Few empirical studies have examined the impact of caring for dying inmates on the hospice inmate volunteers, who, in several prison health care systems, provide direct care. In this study, experiences of the inmate hospice volunteers with death were investigated to illuminate their grief processes. Understanding the bereavement needs of hospice volunteers and how prison hospice volunteers navigate grief and remain committed to providing excellent hospice care can inform the grief processes and practices of hospice care professionals. PMID:24628143

  17. Predictors of live hospice discharge: data from the National Home and Hospice Care Survey (NHHCS).

    PubMed

    Kutner, Jean S; Blake, Marcia; Meyer, Sue A

    2002-01-01

    In the context of the current regulatory environment, patients may be discharged from hospice if their condition stabilizes or improves over time and the certifying physician is unable to provide a conscientious recertification of the six-month prognosis. Little is known about the characteristics or outcomes of patients who are determined by physicians to no longer be eligible for hospice care. This retrospective study was designed to characterize the rates and predictors of live hospice discharge using data from the 1996 and 1998. National Home and Hospice Care Survey (NHHCS). We compare records of live hospice discharge with hospice discharges due to death from the discharge patient files of the 1996 and the 1998 NHHCS. Of the 807,733 patients in the combined 1996 and 1998 NHHCS discharge patient file who met study inclusion criteria, 761,858 (94 percent) were deceased and 45,875 (6 percent) were discharged alive. Those who were discharged alive were more likely to be female, have received hospice care for more than 60 days, and to have had a noncancer diagnosis, particularly advanced cardiopulmonary or neurologic disease. Mean age and total number of assistive medical devices used did not differ significantly between patients who were discharged alive and those who died in hospice care. Factors most associated with live hospice discharge, using bivariate analyses, were length of service greater than 60 days (OR, 6.60; 95 percent CI, 6.47-6.73), cardiopulmonary diagnosis (OR, 3.24; 95 percent CI, 3.19-3.30), and neurologic diagnosis (OR, 2.73; 95 percent CI, 2.67-2.79). Multivariate logistic regression identified length of service greater than 60 days, cardiopulmonary diagnosis, neurologic diagnosis, female gender, worse functional status, and living in an institutional setting as being independently associated with live hospice discharge. We found that patients who were discharged alive from hospice care were more likely to have longer lengths of service

  18. Reciprocal Suffering: Caregiver Concerns During Hospice Care

    PubMed Central

    Wittenberg-Lyles, Elaine; Demiris, George; Oliver, Debra Parker; Burt, Stephanie

    2010-01-01

    Context For many hospice caregivers, the constancy and difficulty of caregiving impact their physical quality of life and cause depression, psychological distress, guilt, loneliness, and restrictions on social activities. Objectives Deviating from traditional unidimensional research on hospice caregivers, this study explored the transactional nature of reciprocal suffering by examining caregiver concerns through four dimensions: physical, psychological, social, and spiritual. Methods Researchers analyzed audiotapes of intervention discussions between hospice caregivers and research social workers. Results Results indicated that of the 125 pain talk utterances, the majority referenced psychological concern (49%), followed by physical (28%), social (22%), and spiritual (2%). Reflections on concerns revealed a global perspective of caregiving, which highlighted the patient’s needs juxtaposed to the caregiver’s recognized limitations. Conclusion By examining the reciprocal nature of suffering for caregivers, this study reinforced the need for assessing caregivers in hospice care, with specific emphasis on the importance of providing caregiver education on pain management. PMID:21146356

  19. Hospice: enhancing the quality of life.

    PubMed

    Lamers, W M

    1990-05-01

    Hospice care is directed at the relief of the physical, social and psychologic symptoms that often accompany advanced, incurable illness. In recent years, an increasing number of physicians has come to recognize the necessity for hospice care in the treatment of some patients with cancer, HIV infection, and a number of other (as yet) incurable illnesses. Hospice care is designed to improve the quality of life through the use of medications and treatments directed at the relief of symptoms secondary to the underlying disease and its treatment. Hospice makes use of a wide range of physical, social and psychological therapies to relieve symptoms and to provide support and information for the patient's family and caregivers. PMID:2143397

  20. American Academy of Hospice and Palliative Medicine

    MedlinePlus

    ... Getting Involved Communities Advanced Lung Disease Forum Psychiatry, Psychology, Mental Health Forum Social Work Forum SIG Instructions ... HPM Lecture Series Research Scholars Mentoring Scholarship About History Position Statements Access to Palliative Care and Hospice ...

  1. Breaking Down Barriers: Hospice Palliative Care as a Human Right in Canada

    ERIC Educational Resources Information Center

    Freeman, Shannon; Heckman, George; Naus, Peter J.; Marston, Hannah R.

    2013-01-01

    The need to attend to terminally ill persons and provide improved quality of living and dying should be a national priority in Canada. Hospice palliative care (HPC), a person-centered approach that addresses the needs of the whole person, improves the quality of living and dying of persons facing a life-threatening illness. To ensure Canadians are…

  2. 42 CFR 418.110 - Condition of participation: Hospices that provide inpatient care directly.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... inpatient care directly. 418.110 Section 418.110 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Conditions of participation... address real or potential threats to the health and safety of the patients, others, and property. (ii)...

  3. Guide for Hospices. Interdisciplinary Team Training and Humanistic Patient Care for Hospices. Monograph 1.

    ERIC Educational Resources Information Center

    English, David J.; Mortenson, Lee E.

    This monograph, the first in a series of five, provides training information for hospice staff in improving interdisciplinary team functions and humanistic care provisions. Its purpose is to assist hospice directors, educators, and other administrative staff members to understand the focus of the proposed training and its applicability to their…

  4. Hierarchical and joint site-edge methods for medicare hospice service region boundary analysis.

    PubMed

    Ma, Haijun; Carlin, Bradley P; Banerjee, Sudipto

    2010-06-01

    Hospice service offers a convenient and ethically preferable health-care option for terminally ill patients. However, this option is unavailable to patients in remote areas not served by any hospice system. In this article, we seek to determine the service areas of two particular cancer hospice systems in northeastern Minnesota based only on death counts abstracted from Medicare billing records. The problem is one of spatial boundary analysis, a field that appears statistically underdeveloped for irregular areal (lattice) data, even though most publicly available human health data are of this type. In this article, we suggest a variety of hierarchical models for areal boundary analysis that hierarchically or jointly parameterize both the areas and the edge segments. This leads to conceptually appealing solutions for our data that remain computationally feasible. While our approaches parallel similar developments in statistical image restoration using Markov random fields, important differences arise due to the irregular nature of our lattices, the sparseness and high variability of our data, the existence of important covariate information, and most importantly, our desire for full posterior inference on the boundary. Our results successfully delineate service areas for our two Minnesota hospice systems that sometimes conflict with the hospices' self-reported service areas. We also obtain boundaries for the spatial residuals from our fits, separating regions that differ for reasons yet unaccounted for by our model. PMID:19645704

  5. Hierarchical and Joint Site-Edge Methods for Medicare Hospice Service Region Boundary Analysis

    PubMed Central

    Ma, Haijun; Carlin, Bradley P.; Banerjee, Sudipto

    2011-01-01

    Summary Hospice service offers a convenient and ethically preferable health care option for terminally ill patients. However, this option is unavailable to patients in remote areas not served by any hospice system. In this paper we seek to determine the service areas of two particular cancer hospice systems in northeastern Minnesota based only on death counts abstracted from Medicare billing records. The problem is one of spatial boundary analysis, a field that appears statistically underdeveloped for irregular areal (lattice) data, even though most publicly available human health data are of this type. In this paper, we suggest a variety of hierarchical models for areal boundary analysis that hierarchically or jointly parameterize both the areas and the edge segments. This leads to conceptually appealing solutions for our data that remain computationally feasible. While our approaches parallel similar developments in statistical image restoration using Markov random fields, important differences arise due to the irregular nature of our lattices, the sparseness and high variability of our data, the existence of important covariate information, and most importantly, our desire for full posterior inference on the boundary. Our results successfully delineate service areas for our two Minnesota hospice systems that sometimes conflict with the hospices' self-reported service areas. We also obtain boundaries for the spatial residuals from our fits, separating regions that differ for reasons yet unaccounted for by our model. PMID:19645704

  6. Barriers to Hospice Use among African Americans: A Systematic Review

    ERIC Educational Resources Information Center

    Washington, Karla T.; Bickel-Swenson, Denise; Stephens, Nathan

    2008-01-01

    The present review was undertaken to explore recent evidence in the professional literature pertaining to use of hospice services by African Americans. The article addresses the research methods that have been used to study African American hospice use, obstacles to African American participation in hospice that have been identified, and…

  7. 42 CFR 418.24 - Election of hospice care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Election of hospice care. 418.24 Section 418.24... (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.24 Election of hospice care. (a) Filing an election statement. An individual who meets the eligibility requirement...

  8. 42 CFR 418.24 - Election of hospice care.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Election of hospice care. 418.24 Section 418.24... (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.24 Election of hospice care. (a) Filing an election statement. An individual who meets the...

  9. 42 CFR 418.24 - Election of hospice care.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Election of hospice care. 418.24 Section 418.24... (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.24 Election of hospice care. (a) Filing an election statement. An individual who meets the eligibility requirement...

  10. 42 CFR 418.30 - Change of the designated hospice.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Change of the designated hospice. 418.30 Section... (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.30 Change of the designated hospice. (a) An individual or representative may change, once in each election...

  11. A Comparative Study of Terminally Ill Hospice and Hospital Patients.

    ERIC Educational Resources Information Center

    Labus, Janet G.; Dambrot, Faye H.

    1986-01-01

    Investigated differences between 28 hospice and 28 hospital patients who died. Comparison found that hospice patients were younger, had more people living in the home, and had shorter disease history. Age, number of people living in the home, and primary cancer site significantly discriminated between hospice and hospital patients and predicted…

  12. 42 CFR 417.585 - Special rules: Hospice care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Special rules: Hospice care. 417.585 Section 417... PREPAYMENT PLANS Medicare Payment: Risk Basis § 417.585 Special rules: Hospice care. (a) No payment is made to an HMO or CMP on behalf of a Medicare enrollee who has elected hospice care under § 418.24 of...

  13. Hospice Education Program for Nurses. Health Manpower References.

    ERIC Educational Resources Information Center

    HCS, Inc., Potomac, MD.

    This publication contains a curriculum to prepare nurses for delivery of hospice care for the terminally ill. It provides training manuals for both participant and facilitator in a preservice or inservice Hospice Education Program. Each manual (participant and facilitator) includes nine modules: (1) Hospice Care Concept; (2) Communication Skills;…

  14. Oncology Social Workers' Attitudes toward Hospice Care and Referral Behavior

    ERIC Educational Resources Information Center

    Becker, Janet E.

    2004-01-01

    Members of the Association of Oncology Social Workers completed a survey, which included the Hospice Philosophy Scale (HPS) assessing the likelihood of the worker referring a terminally ill patient to hospice, background and experience, and demographics. The respondents held overwhelmingly favorable attitudes toward hospice philosophy and care,…

  15. Predicting patient survival before and after hospice enrollment.

    PubMed

    Christakis, N A

    1998-01-01

    Despite the apparent advantages of hospice care, several barriers exist in terms of patient referral. Physicians' prognoses play a large role in determining when hospice care should begin. Predicting patient survival is a subjective decision dependent on several factors that vary before and after hospice enrollment. Currently, the stay of patients in hospice is very short; this can be attributed to late referral by physicians. Additional research on physician behavior and prognostication could help optimize the use of hospice as a valuable health care resource, thereby improving end of life care for terminally ill patients. PMID:9644394

  16. Hospice benefits and phase I cancer trials.

    PubMed

    Byock, Ira; Miles, Steven H

    2003-02-18

    Medicare denies hospice coverage to patients with terminal illnesses who enroll as participants in phase I studies, which assess the toxicity and dosing of potential treatments for incurable diseases. Federal regulations require patients to forgo curative therapies, and they interpret phase I agents as treatment for the terminal condition for which hospice care was elected. Thus, by enrolling as a participant in a phase I trial, a patient otherwise eligible for hospice is rendered ineligible. Private insurers have similar provisions for children and adults younger than 65 years of age. Such exclusions are not defensible on ethical or clinical grounds. Policymakers, insurers, and institutional review boards all have a role in resolving this problem. PMID:12585832

  17. Ethical dilemmas faced by hospice social workers.

    PubMed

    Dennis, Mary Kate; Washington, Karla T; Koenig, Terry L

    2014-10-01

    Ethical decision making is critically important in hospice social work. Through in-depth interviews, researchers explored ethical dilemmas faced by 14 hospice social workers and the processes they used to move toward resolution. The dilemmas were integrated into a framework focused on the sources of ethical conflict: the client system, the agency, and the profession. Processes involved in resolving ethical dilemmas included consulting with other professionals, weighing the pros and cons of options, and bringing about desired outcomes. Findings suggest that hospice teams should be provided with opportunities to meaningfully discuss ethical decision making. Further, the involvement of social workers in administrative leadership is recommended to increase the likelihood that discipline-specific perspectives are incorporated into formal policies and procedures that shape practice in ethically complex situations. PMID:25397348

  18. Guest at hospice: time for consideration.

    PubMed

    Warrén Stomberg, Margareta

    2009-01-01

    This study focuses on daily life situation of terminally ill guests residing at a hospice. In the study, interviews were conducted with 9 such guests. Data were analyzed using a method similar to content analysis. Categories emerged that were related to aspects regarded as external and internal essentials for the well-being of the individual at the hospice. These essentials were as follows: encouragement from the staff, the alleviation of pain, a pleasant and calm atmosphere at the hospice, the significance of visits from relatives, the regret of not being able to take care of oneself, and time to reconcile to one's life. These results not only show the need for close community with both family and staff but also the need for privacy to reflect on life. PMID:19244475

  19. Hospice quality improvement programs: an initial examination.

    PubMed

    D'Onofrio, C N

    1998-05-01

    Recognizing that little is known about use of quality improvement (QI) processes to enhance care of the dying, 11 large hospices exchanged information about their QI programs. These hospices reported monitoring from 3 to 50 outcomes measured by various indicators and methods. Agencies that related QI to their organization's mission, goals, and strategic plan were more likely to have dedicated QI staff; a more intense, comprehensive, and participatory QI program; and more QI projects resulting in performance enhancement. Both accomplishments and difficulties were identified in several areas, including establishing benchmarks, involving staff, and using computer technology to manage and analyze QI data. PMID:10179273

  20. From hospice to hospital: short-term follow-up study of hospice patient outcomes in a US acute care hospital surveillance system

    PubMed Central

    Pathak, Elizabeth Barnett; Wieten, Sarah; Djulbegovic, Benjamin

    2014-01-01

    Objectives In the USA, there is little systematic evidence about the real-world trajectories of patient medical care after hospice enrolment. The objective of this study was to analyse predictors of the length of stay for hospice patients who were admitted to hospital in a retrospective analysis of the mandatorily reported hospital discharge data. Setting All acute-care hospitals in Florida during 1 January 2010 to 30 June 2012. Participants All patients with source of admission coded as ‘hospice’ (n=2674). Primary outcome measures The length of stay and discharge status: (1) died in hospital; (2) discharged back to hospice; (3) discharged to another healthcare facility; and (4) discharged home. Results Patients were elderly (median age=81) with a high burden of disease. Almost half died (46%), while the majority of survivors were discharged to hospice (80% of survivors, 44% of total). A minority went to a healthcare facility (5.6%) or to home (5.2%). Only 9.2% received any procedure. Respiratory services were received by 29.4% and 16.8% were admitted to the intensive care unit. The median length of stay was 1 day for those who died. In an adjusted survival model, discharge to a healthcare facility resulted in a 74% longer hospital stay compared with discharge to hospice (event time ratio (ETR)=1.74, 95% CI 1.54 to 1.97 p<0.0001), with 61% longer hospital stays among patients discharged home (ETR=1.61, 95% CI 1.39 to 1.86 p<0.0001). Total financial charges for all patients exceeded $25 million; 10% of patients who appeared to exit hospice incurred 32% of the charges. Conclusions Our results raise significant questions about the ethics and pragmatics of end-of-life medical care, and the intentions and scope of hospices in the USA. Future studies should incorporate prospective linkage of subjective patient-centred data and objective healthcare encounter data. PMID:25052170

  1. The Hospice: Advocate for the Dying.

    ERIC Educational Resources Information Center

    Anspaugh, David J.

    1978-01-01

    The hospice philosophy seeks to meet the needs of dying patients and their families. These needs include: effective control of pain; to be loved and to alleviate loneliness; to retain dignity and maintain control of as many aspects of life as possible; and to help the family be supportive and adapt to their inevitable loss. (JMF)

  2. Hospice Decision Making: Diagnosis Makes a Difference

    ERIC Educational Resources Information Center

    Waldrop, Deborah P.; Meeker, Mary Ann

    2012-01-01

    Purpose: This study explored the process of decision making about hospice enrollment and identified factors that influence the timing of that decision. Methods: This study employed an exploratory, descriptive, cross-sectional design and was conducted using qualitative methods. In-depth in-person semistructured interviews were conducted with 36…

  3. Volunteers: The Life-Line of Hospice.

    ERIC Educational Resources Information Center

    Patchner, Michael A.; Finn, Mark B.

    1988-01-01

    Survey of 68 hospice volunteers found volunteers to be relatively young, well-educated, in good health, motivated by religious beliefs and personal experience, and prepared for jobs after training and some on-the-job experience. Volunteers were most satisfied when working in direct contact with patients and families and in the hospital.…

  4. Successful Interprofessional Collaboration on the Hospice Team.

    ERIC Educational Resources Information Center

    Reese, Dona J.; Sontag, Mary-Ann

    2001-01-01

    Despite the holistic approach inherent in the hospice philosophy, social work may be viewed as ancillary to medicine. Social work, in turn, may lack sensitivity about other professions' expertise and values and therefore be unprepared to collaborate across cultural boundaries between professions. This article outlines the barriers and proposes…

  5. Utilization of Pets in a Hospice Program.

    ERIC Educational Resources Information Center

    Doyle, Kathleen; Kukowski, Thomas

    1989-01-01

    The therapeutic use of animals with specific populations has gained increased attention and interest. Pet placement in special settings such as prisons, mental institutions and hospices have shown beneficial results. Development of a pet visitation program requires specific planning and organization. (JD)

  6. Characteristics of Hospice Patients and their Caregivers.

    ERIC Educational Resources Information Center

    Bass, David M.; And Others

    1986-01-01

    Describes selected characteristics of 146 terminal patients enrolled in a home-based hospice program and similar characteristics of the patients' primary caregivers. Examines relationships between the characteristics of patients and caregivers and relationships between these characteristics and the rate at which various services were utilized.…

  7. A VNA-Organized Hospice Volunteer Program.

    ERIC Educational Resources Information Center

    Dorang, Edith S.

    1981-01-01

    Factors contributing to the success of a hospice volunteer program, organized by a visiting nurse association, include patient involvement in defining agency expectations of a volunteer, careful selection of candidates, a well-planned training program, contractual agreements, and record-keeping. (CT)

  8. A Survey of Hospices Use of Complementary Therapy

    PubMed Central

    Running, Alice; Shreffler-Grant, Jean; Andrews, Wendy

    2009-01-01

    As people live longer with chronic illnesses, the need for hospice services will increase. Complementary therapies have been shown to increase ease, relieve pain, and improve quality of life; all relevant for people with chronic illness at the end of their lives. The first aim of this study was to identify complementary therapy services available to, and provided for, clients receiving hospice care in Nevada and Montana. The second aim was to identify differences in those therapies for urban and rural hospice clients. Using a descriptive survey design, data were collected from surveys sent to all hospice administrators in Nevada and Montana (N=54). A 50% (n=27) response rate was obtained. Most (70.4%, n=19) of the participating hospices offered complementary therapy; slightly more than half (52.9%, n=9) provided the services for less than 25% of their clients. No significant differences were found between rural and urban hospices. PMID:19756253

  9. Key Results of Interaction Models with Centering

    ERIC Educational Resources Information Center

    Afshartous, David; Preston, Richard A.

    2011-01-01

    We consider the effect on estimation of simultaneous variable centering and interaction effects in linear regression. We technically define, review, and amplify many of the statistical issues for interaction models with centering in order to create a useful and compact reference for teachers, students, and applied researchers. In addition, we…

  10. EPA CENTER FOR EXPOSURE ASSESSMENT MODELING (CEAM)

    EPA Science Inventory

    The EPA Center for Exposure Assessment Modeling (CEAM) supports the Agency and professional community in environmental, risk-based decision-making by expanding their applications expertise for quantitatively assessing pollutant exposure via aquatic, terrestrial, and multimedia pa...

  11. Human Centered Hardware Modeling and Collaboration

    NASA Technical Reports Server (NTRS)

    Stambolian Damon; Lawrence, Brad; Stelges, Katrine; Henderson, Gena

    2013-01-01

    In order to collaborate engineering designs among NASA Centers and customers, to in clude hardware and human activities from multiple remote locations, live human-centered modeling and collaboration across several sites has been successfully facilitated by Kennedy Space Center. The focus of this paper includes innovative a pproaches to engineering design analyses and training, along with research being conducted to apply new technologies for tracking, immersing, and evaluating humans as well as rocket, vehic le, component, or faci lity hardware utilizing high resolution cameras, motion tracking, ergonomic analysis, biomedical monitoring, wor k instruction integration, head-mounted displays, and other innovative human-system integration modeling, simulation, and collaboration applications.

  12. Coulombic contribution and fat center vortex model

    SciTech Connect

    Rafibakhsh, Shahnoosh; Deldar, Sedigheh

    2007-02-27

    The fat (thick) center vortex model is one of the phenomenological models which is fairly successful to interpret the linear potential between static sources. However, the Coulombic part of the potential has not been investigated by the model yet. In an attempt to get the Coulombic contribution and to remove the concavity of the potentials, we are studying different vortex profiles and vortex sizes.

  13. The Community Transition Center (CTC) Model.

    ERIC Educational Resources Information Center

    Coker, Charles C.; Costello, James

    This paper describes the Community Transition Center (CTC) model, being tested in six districts in rural Wisconsin. The model is a way of conceptualizing and organizing the employment-related needs of mainstreamed mildly handicapped youths who are exiting secondary schools. The model emphasizes the role of secondary school transition programming,…

  14. Hospice in a zoologic medicine setting.

    PubMed

    Jessup, David A; Scott, Cheryl A

    2011-06-01

    Forty years ago, Dr. Elizabeth Kubler-Ross in her landmark book On death and dying observed "maybe at the end of our days, when we have worked and given, enjoyed ourselves and suffered, we are going back to the stage that we started out with and the circle of life is closed." Just as human life expectancy has steadily increased over the last 4 or 5 decades, animal life expectancy has increased, including that of zoologic species. With this has come a need for humans to openly and frankly deal with end-of-life issues for themselves and for their animals, including those in zoos. By necessity, zoos have been dealing with problems such as aggressive pain management and triage, and efforts to incorporate end-of-life care into zoologic medicine. But these efforts have yet to include formal acknowledgment that they are a basic form of hospice. Hospice for humans, and now for companion animals, includes much more than pain relief and geriatric care. This article reviews the concepts and basic practices of hospice and the closely related field of palliative care, their relatively recent application to companion animal care, potential applications to zoologic medicine, and the ways this could provide opportunities for personal growth of zoo visitors and staff, including veterinary staff. PMID:22946395

  15. Antibiotic Policies and Utilization in Oregon Hospice Programs.

    PubMed

    Novak, Rachel L; Noble, Brie N; Fromme, Erik K; Tice, Michael O; McGregor, Jessina C; Furuno, Jon P

    2016-09-01

    Antibiotics are frequently used in hospice care, despite limited data on safety and effectiveness in this patient population. We surveyed Oregon hospice programs on antibiotic policies and prescribing practices. Among 39 responding hospice programs, the median reported proportion of current census using antibiotics was 10% (interquartile range = 3.5%-20.0%). Approximately 31% of responding hospice programs had policies for antibiotic initiation, 17% of hospice programs had policies for antibiotic discontinuation, and 95% of hospice programs had policies for managing drug interactions. Diarrhea, nausea/vomiting, and yeast infections were the most frequently reported antibiotic-associated adverse events, occurring "sometimes" or "often" among 62%, 47%, and 62% of respondents, respectively. In conclusion, less than a third of participating hospice programs reported having a policy for antibiotic initiation and even less frequently a policy for discontinuation. More data are needed on the risks and benefits of antibiotic use in hospice care to inform these policies and optimize outcomes in this vulnerable patient population. PMID:26268730

  16. Examining Variables Related to Successful Collaboration on the Hospice Team

    ERIC Educational Resources Information Center

    Parker-Oliver, Debra; Bronstein, Laura R.; Kurzejeski, Lori

    2005-01-01

    Although social work participation on interdisciplinary teams is long-standing, little research has been done to examine its effectiveness. This study used the Index of Interdisciplinary Collaboration to explore relationships between selected variables and teamwork in the hospice setting. The findings indicate that hospice social workers report a…

  17. Creating Decent Prisons: A Serendipitous Finding about Prison Hospice

    ERIC Educational Resources Information Center

    Wright, Kevin N.; Bronstein, Laura

    2007-01-01

    Limited research has been conducted on the creation or impact of "decent" prisons, institutions where prisoners are treated with care and respect. This study set out to explore organizational factors associated with locating hospice programs into prison settings. Yet, the research produced unexpected findings about the contribution of hospice to…

  18. Mental Health Training and the Hospice Community: A National Survey.

    ERIC Educational Resources Information Center

    Garfield, Charles A.; And Others

    1982-01-01

    Summarizes a national survey of the hospice community. Results indicated that the hospice community is attempting to meet the mental health training needs of its paid staff members and volunteers. However, more than half expressed a need for further training and a more systematic and comprehensive curriculum. (Author)

  19. The Administrative Role in Hospice Planning and Organization.

    ERIC Educational Resources Information Center

    Sallady, Susan A.

    1982-01-01

    Addresses the specific advantages to new hospices of incorporating administrative resource people in the planning and organization phases of their programs. Describes organizational structure and the role of the interdisciplinary team. An annotated bibliography summarizes hospice adminstrative resources and research. (Author/JAC)

  20. The Viability of Pediatric Hospices: A Case Study.

    ERIC Educational Resources Information Center

    Wilson, Dottie C.

    1982-01-01

    Identifies the special characteristics needed by hospices caring for terminally ill children, based on a feasibility study for a pediatric hospital. Concludes that the needs of terminally ill children and their families are not being met currently and that the hospice is as appropriate for children as for adults. (Author)

  1. 42 CFR 418.28 - Revoking the election of hospice care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Revoking the election of hospice care. 418.28... Revoking the election of hospice care. (a) An individual or representative may revoke the individual's election of hospice care at any time during an election period. (b) To revoke the election of hospice...

  2. 42 CFR 418.308 - Limitation on the amount of hospice payments.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Limitation on the amount of hospice payments. 418... HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Payment for Hospice Care § 418.308 Limitation on the amount of hospice payments. (a) Except as specified in paragraph (b) of this section,...

  3. Hospice nurses' emotional challenges in their encounters with the dying.

    PubMed

    Ingebretsen, Lina Paola; Sagbakken, Mette

    2016-01-01

    The purpose of this study was to explore nurses' emotional challenges when caring for the dying in hospices. The study has a qualitative design, and knowledge was developed through a dialectical exchange between theory and data. Ten individual in-depth interviews were conducted with nurses recruited from two hospices in Denmark. Although all of the nurses said that they experienced emotional challenges or felt emotionally touched during their work, the study found a variety of opinions related to the extent to which their emotional reactions should be revealed in their role as a hospice professional. The participants described their emotional challenges as being simultaneously draining and enriching experiences leading to personal and professional growth and development. The study may contribute to increased awareness of emotional challenges for hospice nurses, which involve continuous reflection and balancing between meeting the dying as a human being and meeting the dying as a hospice professional. PMID:27258584

  4. Hospice nurses’ emotional challenges in their encounters with the dying

    PubMed Central

    Ingebretsen, Lina Paola; Sagbakken, Mette

    2016-01-01

    The purpose of this study was to explore nurses’ emotional challenges when caring for the dying in hospices. The study has a qualitative design, and knowledge was developed through a dialectical exchange between theory and data. Ten individual in-depth interviews were conducted with nurses recruited from two hospices in Denmark. Although all of the nurses said that they experienced emotional challenges or felt emotionally touched during their work, the study found a variety of opinions related to the extent to which their emotional reactions should be revealed in their role as a hospice professional. The participants described their emotional challenges as being simultaneously draining and enriching experiences leading to personal and professional growth and development. The study may contribute to increased awareness of emotional challenges for hospice nurses, which involve continuous reflection and balancing between meeting the dying as a human being and meeting the dying as a hospice professional. PMID:27258584

  5. 78 FR 27823 - Medicare Program; FY 2014 Hospice Wage Index and Payment Rate Update; Hospice Quality Reporting...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-10

    ... Hospice Wage Index final rule (74 FR 39384) finalized a 10 percent reduced BNAF for FY 2010 as the first... Conditions of Participation final rule (73 FR 32088), palliative care is an approach that ``optimizes quality... Hospice Conditions of Participation final rule (73 FR 32088), we stated ``the medical director...

  6. 78 FR 48233 - Medicare Program; FY 2014 Hospice Wage Index and Payment Rate Update; Hospice Quality Reporting...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-07

    ... Calendar Year DME Durable Medical Equipment FEHC Family Evaluation of Hospice Care FR Federal Register FY... described in section IV.C.3. The August 6, 2009 FY 2010 Hospice Wage Index final rule (74 FR 39384... Conditions of Participation final rule (73 FR 32088), palliative care is an approach that ``optimizes...

  7. The Use of Videophones for Patient and Family Participation in Hospice Interdisciplinary Team Meetings: A Promising Approach

    PubMed Central

    Oliver, Debra Parker; Demiris, George; Wittenberg-Lyles, Elaine; Porock, Davina

    2009-01-01

    Inclusion of patients and caregivers in decisions related to the delivery of care is inherent in the hospice philosophy. Telemedicine technologies offer a potential solution to the challenges presented by the geographic distance between team meetings and the home environment. While inclusion requires additional coordination by the hospice team, it also offers an important opportunity to improve communication between the team and the patient and family. A modified conceptual model based on two previous frameworks is outlined to support patient and family involvement in hospice team meetings. Further research is suggested to determine the structural feasibility of patient and family involvement via videophone as well as the structural and procedural changes resulting from this inclusion. Finally, clinical outcomes and family evaluation of the inclusion experience need to be thoroughly researched before final conclusions may be reached. PMID:19832889

  8. A national survey of health professionals and volunteers working in voluntary hospice services in the UK. I. Attitudes to current issues affecting hospices and palliative care.

    PubMed

    Addington-Hall, Julia M; Karlsen, Saffron

    2005-01-01

    This paper reports results from a national survey in 1999 of voluntary hospice services in the UK. It focuses on volunteer and staff views of the purposes of hospice care, and on current debates within palliative care. Twenty-five hospice services, stratified by region, services provided (inpatient care, day care and/or home care) and number of beds were randomly sampled from amongst 175 voluntary hospices in the UK. Nineteen participated. Seventy per cent of a random sample of professional and voluntary staff within these hospices returned a postal questionnaire. Both volunteers and professionals considered care of the whole person, pain and symptom control, quality of life and dying peacefully to be important aspects of hospice care. Most doctors chose care of the whole person as the most important aspect, and they were more likely to choose this option than other staff. Hospice volunteers were less positive than hospice staff (particularly doctors and nurses) in their attitudes to extending hospice care to noncancer patients (where many volunteers held no strong view), to restricting care to patients with specialist palliative care needs, and less negative about euthanasia. These findings illustrate the importance of including hospice volunteers and the general public, as well as hospice staff, in debates about the future of hospice and palliative care in the UK. Further research is needed into lay and professional views of the role of hospices and palliative care services. PMID:15690867

  9. Center for Advanced Modeling and Simulation Intern

    SciTech Connect

    Gertman, Vanessa

    2010-01-01

    Some interns just copy papers and seal envelopes. Not at INL! Check out how Vanessa Gertman, an INL intern working at the Center for Advanced Modeling and Simulation, spent her summer working with some intense visualization software. Lots more content like this is available at INL's facebook page http://www.facebook.com/idahonationallaboratory.

  10. Infiltration Model for Center Pivot Sprinkler Irrigation

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The marked reduction in infiltration rate caused by formation of a soil surface seal due to water droplet impact on bare soil is a well known phenomenon but is rarely considered in infiltration models, especially under center pivot irrigation. The objective of this study was to develop a soil infil...

  11. Center for Advanced Modeling and Simulation Intern

    ScienceCinema

    Gertman, Vanessa

    2013-05-28

    Some interns just copy papers and seal envelopes. Not at INL! Check out how Vanessa Gertman, an INL intern working at the Center for Advanced Modeling and Simulation, spent her summer working with some intense visualization software. Lots more content like this is available at INL's facebook page http://www.facebook.com/idahonationallaboratory.

  12. An Analysis Model for Center Governance.

    ERIC Educational Resources Information Center

    Priselac, Nancy J.; Priselac, Stephen M.

    This paper discusses the development and design of an analysis model for governance of teacher centers organized in consortium form. A consortium is descirbed as "an organization of autonomous bodies or individuals which bond together by some relatively formal agreement to secure some benefit." The consortium generally functions in a collaborative…

  13. Patient experience key in hospice refurb.

    PubMed

    Beach, Matt

    2015-03-01

    A major design and build scheme which has seen the inpatient unit at St. Luke's Hospice in Sheffield extended and refurbished to provide a more comfortable and homely environment, and bring the facilities up to the best 21st century standards, has benefited significantly from both high quality architecture and stakeholder commitment. The result, reports Matt Beach, associate at scheme architects, Race Cottam Associates, is an even better and 'more personal'environment for delivery of end-of-life-care at a facility that, as one patient puts it,'has something very rare and special about it'. PMID:26268027

  14. Determining Community Provider Practices in Hospices: The Challenges of Documentation

    PubMed Central

    Bergen-Jackson, Kimberly; Sanders, Sara; Herr, Keela; Fine, Perry G.; Titler, Marita; Forcucci, Chris; Reyes, Jimmy; McNichol, Patricia

    2010-01-01

    Documentation is a key factor in supporting consistency and quality of patient care in the hospice setting, however variation among program provider practices, including documentation, were observed during the initial data collection phase of our National Cancer Institute (NCI) funded study, Cancer Pain in Elders: Promoting Evidence-Based Practices (EBPs) in Hospices. The study is a randomized trial to test a multifaceted intervention to promote adoption and maintenance of EBPs for cancer pain management involving 16 Midwestern hospices of varied size and structure. In the face of such variance, and especially in the absence of uniformly adopted outcome measures and documentation standards, quality improvement initiatives in this important and growing healthcare sector will be difficult to manage. This paper provides background on the importance of documentation, quality measures, outcomes of care, and regulatory imperatives in the hospice setting with specific observations from our research study and suggestions for changes in documentation practices. From our observations, we posit the necessity of pertinent outcome measures supported by standardized documentation processes in hospice. Uniformity in key practice indicators and patient outcome measures in documentation systems would advance the movement to improve quality and consistency of care in hospices. Standardization of documentation systems and language would also facilitate the conduct of research in the hospice setting, a population for which advancing knowledge is essential to assure quality care at the end of life. PMID:20419047

  15. Hospice enrollment saves money for Medicare and improves care quality across a number of different lengths-of-stay.

    PubMed

    Kelley, Amy S; Deb, Partha; Du, Qingling; Aldridge Carlson, Melissa D; Morrison, R Sean

    2013-03-01

    Despite its demonstrated potential to both improve quality of care and lower costs, the Medicare hospice benefit has been seen as producing savings only for patients enrolled 53-105 days before death. Using data from the Health and Retirement Study, 2002-08, and individual Medicare claims, and overcoming limitations of previous work, we found $2,561 in savings to Medicare for each patient enrolled in hospice 53-105 days before death, compared to a matched, nonhospice control. Even higher savings were seen, however, with more common, shorter enrollment periods: $2,650, $5,040, and $6,430 per patient enrolled 1-7, 8-14, and 15-30 days prior to death, respectively. Within all periods examined, hospice patients also had significantly lower rates of hospital service use and in-hospital death than matched controls. Instead of attempting to limit Medicare hospice participation, the Centers for Medicare and Medicaid Services should focus on ensuring the timely enrollment of qualified patients who desire the benefit. PMID:23459735

  16. [Continuing hospice care of cancer--a three-year experience].

    PubMed

    Lai, Y L; Young, A; Lai, E Y; Yeh, C Y; Chiou, J F; Chang, K H; Chung, C H; Hsieh, A L

    1994-09-01

    The hospice at Mackay Memorial Hospital was established in February 1990. A group of team workers including physicians, nurses, social workers and the clergy were involved in this holistic care program for terminal cancer patients. Four hundred and seventy-nine patients were eligible for the program up to February 1993. Regarding duration of stay, 62.5% of patients resided for 14 days. Those surviving under 90 days constituted 75.5% of patients. Fifty-one point eight percent of patients died in the hospice and 18.2% died at home soon after being discharged from the hospice. Pain is the most common symptom among the patients. Treatment strategies vary according to the three-step-ladder protocol designed by WHO. Total pain relief was achieved in 80% of patients. Opportune private talking and family conferences formed the basis of the "peer model". Through this model, treatment decisions including physical, psychosocial and spiritual issues were made. Before the peer model, only 36 (10.3%) patients agreed with the idea of hospice care, while 257 (73.6%) patients agreed after the model was established. Awareness of dying was evident in 412 (86%) patients. Two hundred and eighty (68%) patients became aware of the prospect of death through guessing, while the other 132 (32%) patients were informed by medical staff. Problems encountered by the team workers included 1) needs in education and training, 2) psychological pressure, 3) management of loss and grief, 4) needs in supportive system and 5) troubles caused by families' lying to patients. The team workers were satisfied with the quality of care in 38.4% of patients and fairly satisfied with 30.7% of patients.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7536505

  17. Family Perspectives on the Hospice Experience in Adult Family Homes

    PubMed Central

    Washington, Karla T.; Oliver, Debra Parker; Demiris, George; Wittenberg-Lyles, Elaine; Shaunfield, Sara

    2011-01-01

    Growing numbers of terminally ill older adults receive hospice services in adult family homes (AFHs); however, little is known about the provision and receipt of end-of-life care in such environments. This paper reports findings from a qualitative exploration of family members’ perspectives of the hospice experience in AFHs. Analysis of data obtained during interviews of fifteen residents’ family members exposed significant challenges associated with transition to an AFH, highlighted the importance of AFH and hospice staff in family members’ assessment of overall quality of care, and emphasized the critical nature of communication in AFH settings. PMID:21240714

  18. Predictors of Intention to Refer to Pediatric Palliative or Hospice Care.

    PubMed

    Conner, Norma E; Uddin, Nizam

    2016-08-01

    The purpose of this descriptive correlational study was to determine whether nurse characteristics, level of comfort with care of the dying, and spirituality predict intention to refer and timing of referral to pediatric palliative/hospice care. The Behavioral Model of Health Services Use served as the framework for this study. Data were collected from 105 pediatric nurses recruited from 7 patient units of one pediatric hospital. Regression analysis revealed several nurse factors (practice unit, years of experience, age, race/ethnicity) that predicted intent to refer and timing of referral to pediatric palliative/hospice care. The relationship between nurse characteristics and intent to refer was specific to certain medical conditions (HIV, extreme prematurity, brain injuries). Healthcare providers can use these findings to improve care for children with life-limiting illnesses. PMID:26150677

  19. Hospice and palliative care development in India: a multimethod review of services and experiences.

    PubMed

    McDermott, Elizabeth; Selman, Lucy; Wright, Michael; Clark, David

    2008-06-01

    Palliative care has been developing in India since the mid-1980s, but there is a dearth of evidence about service provision on which to base national policy and practice. The aim of this study was to assess the current state of palliative care in India, mapping the existence of services state by state, and documenting the perspectives and experiences of those involved. A multimethod review was used, which included synthesis of evidence from published and grey literature, ethnographic field visits, qualitative interviews with 87 individuals from 12 states, and collation of existing public health data. The review identified 138 hospice and palliative care services in 16 states and union territories. These are mostly concentrated in large cities, with the exception of Kerala, where they are much more widespread. Nongovernmental organizations, public and private hospitals, and hospices are the predominant sources of provision. We were unable to identify palliative care services in 19 states/union territories. Development of services is uneven, with greater provision evident in the south than the north, but for the majority of states, coverage is poor. Barriers to the development of palliative care include: poverty, population density, geography, opioid availability, workforce development, and limited national palliative care policy. Successful models exist for the development of affordable, sustainable community-based palliative care services. These have arisen from adapting Western models of hospice and palliative care for implementation in the Indian cultural context. Further work is required to ensure that the growing interest in hospice and palliative care in India is used to increase the momentum of progress. PMID:18395401

  20. Medicare program; FY 2015 hospice wage index and payment rate update; hospice quality reporting requirements and process and appeals for Part D payment for drugs for beneficiaries enrolled in hospice. Final rule.

    PubMed

    2014-08-22

    This final rule will update the hospice payment rates and the wage index for fiscal year (FY) 2015 and continue the phase-out of the wage index budget neutrality adjustment factor (BNAF). This rule provides an update on hospice payment reform analyses, potential definitions of "terminal illness'' and "related conditions,'' and information on potential processes and appeals for Part D payment for drugs while beneficiaries are under a hospice election. This rule will specify timeframes for filing the notice of election and the notice of termination/revocation; add the attending physician to the hospice election form, and require hospices to document changes to the attending physician; require hospices to complete their hospice aggregate cap determinations within 5 months after the cap year ends, and remit any overpayments; and update the hospice quality reporting program. In addition, this rule will provide guidance on determining hospice eligibility; information on the delay in the implementation of the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM); and will further clarify how hospices are to report diagnoses on hospice claims. Finally, the rule will make a technical regulations text change. PMID:25167592

  1. Stress and Burnout: Concerns for the Hospice Volunteer.

    ERIC Educational Resources Information Center

    Glass, J. Conrad, Jr.; Hastings, Janice L.

    1992-01-01

    Sources of stress for hospice volunteers are environmental, ideological, and personal. Attention to volunteer stress and burnout involves defining job requirements and responsibilities, frequent communication and feedback, stress management techniques, flexibility in assignments, and opportunities to verbalize emotions. (SK)

  2. 42 CFR 418.302 - Payment procedures for hospice care.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... individual who has elected hospice care receives general inpatient care in an inpatient facility for pain control or acute or chronic symptom management which cannot be managed in other settings. (c) The...

  3. 42 CFR 418.302 - Payment procedures for hospice care.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... individual who has elected hospice care receives general inpatient care in an inpatient facility for pain control or acute or chronic symptom management which cannot be managed in other settings. (c) The...

  4. 42 CFR 418.302 - Payment procedures for hospice care.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... individual who has elected hospice care receives general inpatient care in an inpatient facility for pain control or acute or chronic symptom management which cannot be managed in other settings. (c) The...

  5. 42 CFR 418.302 - Payment procedures for hospice care.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... individual who has elected hospice care receives general inpatient care in an inpatient facility for pain control or acute or chronic symptom management which cannot be managed in other settings. (c) The...

  6. The benefits of expanded physician assistant practice in hospice and palliative medicine.

    PubMed

    Boucher, Nathan A; Nix, Harvey

    2016-09-01

    Patients with advanced or terminal illness, especially racial and ethnic minorities, would benefit from greater access to hospice and palliative care. Expanding the PA role in these areas would help fill gaps in both access and patients' understanding of what hospice and palliative care can offer. This article describes why hospice and palliative care are needed, what PAs can and do offer hospice and palliative care delivery, and what challenges should be overcome to expand PA practice in hospice and palliative care. The article also reviews the legislative outlook for PA practice in hospice care. PMID:27575903

  7. Hospice clinical experiences for nursing students: living to the fullest.

    PubMed

    Spicer, Sherri; Heller, Rebecca; Troth, Sarah

    2015-01-01

    Preparing future nurses to provide appropriate care for patients and their families at the end of life can be a formidable challenge for nurse educators. Most nursing schools thread end-of-life concepts throughout the curriculum. Grand Canyon University includes a 40-hour hospice clinical as a component of a home healthcare practicum. Students' weekly written reflections reveal the depth of affective learning that occurs during this experience. Article includes hospice materials and resources. PMID:25585469

  8. Validation of Space Weather Models at Community Coordinated Modeling Center

    NASA Technical Reports Server (NTRS)

    Kuznetsova, M. M.; Pulkkinen, A.; Rastaetter, L.; Hesse, M.; Chulaki, A.; Maddox, M.

    2011-01-01

    The Community Coordinated Modeling Center (CCMC) is a multiagency partnership, which aims at the creation of next generation space weather modes. CCMC goal is to support the research and developmental work necessary to substantially increase space weather modeling capabilities and to facilitate advanced models deployment in forecasting operations. The CCMC conducts unbiased model testing and validation and evaluates model readiness for operational environment. The presentation will demonstrate the recent progress in CCMC metrics and validation activities.

  9. External validation of a web-based prognostic tool for predicting survival for patients in hospice care.

    PubMed

    Miladinovic, Branko; Mhaskar, Rahul; Kumar, Ambuj; Kim, Sehwan; Schonwetter, Ronald; Djulbegovic, Benjamin

    2013-01-01

    Prognostat is an interactive Web-based prognostic tool for estimating hospice patient survival based on a patient's Palliative Performance Scale (PPS) score, age, gender, and cancer status. The tool was developed using data from 5,893 palliative care patients, which was collected at the Victoria Hospice in Victoria, British Columbia, Canada, beginning in 1994. This study externally validates Prognostat with a retrospective cohort of 590 hospice patients at LifePath Hospice and Palliative Care in Florida, USA. The criteria used to evaluate the prognostic performance were the Brier score, area under the receiver operating curve, discrimination slope, and Hosmer-Lemeshow goodness-of-fit test. Though the Kaplan-Meier curves show each PPS level to be distinct and significantly different, the findings reveal low agreement between observed survival in our cohort of patients and survival predicted by the prognostic tool. Before developing a new prognostic model, researchers are encouraged to update survival estimates obtained using Prognostat with the information from their cohort of patients. If it is to be useful to patients and clinicians, Prognostat needs to explicitly report patient risk scores and estimates of baseline survival. PMID:24380212

  10. Energy Modeling for the Artisan Food Center

    SciTech Connect

    Goel, Supriya

    2013-05-01

    The Artisan Food Center is a 6912 sq.ft food processing plant located in Dayton, Washington. PNNL was contacted by Strecker Engineering to assist with the building’s energy analysis as a part of the project’s U.S. Green Building Council’s Leadership in Energy and Environmental Design (LEED) submittal requirements. The project is aiming for LEED Silver certification, one of the prerequisites to which is a whole building energy model to demonstrate compliance with American Society of Heating Refrigeration and Air Conditioning Engineers (ASHRAE) 90.1 2007 Appendix G, Performance Rating Method. The building incorporates a number of energy efficiency measures as part of its design and the energy analysis aimed at providing Strecker Engineering with the know-how of developing an energy model for the project as well as an estimate of energy savings of the proposed design over the baseline design, which could be used to document points in the LEED documentation. This report documents the ASHRAE 90.1 2007 baseline model design, the proposed model design, the modeling assumptions and procedures as well as the energy savings results in order to inform the Strecker Engineering team on a possible whole building energy model.

  11. The Hospice Environmental Survey (HES): Pilot Test of a New Measurement Instrument.

    ERIC Educational Resources Information Center

    Taylor, Jean H.; Perrill, Norman K.

    1988-01-01

    Describes development of the Hospice Environmental Survey (HES) to measure user's perception of the homelike atmosphere provided by a hospital inpatient unit called Hospice House. Presents the HES instrument, methodology, and pilot study data. (Author/NB)

  12. Space Weather Modeling Services at the Community Coordinated Modeling Center

    NASA Technical Reports Server (NTRS)

    Hesse, Michael

    2006-01-01

    The Community Coordinated Modeling Center (CCMC) is a multi-agency partnership, which aims at the creation of next generation space weather models. The goal of the CCMC is to support the research and developmental work necessary to substantially increase the present-day modeling capability for space weather purposes, and to provide models for transition to the Rapid Prototyping Centers at the space weather forecast centers. This goal requires close collaborations with and substantial involvement of the research community. The physical regions to be addressed by CCMC-related activities range from the solar atmosphere to the Earth's upper atmosphere. The CCMC is an integral part of the National Space Weather Program Implementation Plan, of NASA's Living With a Star (LWS) initiative, and of the Department of Defense Space Weather Transition Plan. CCMC includes a facility at NASA Goddard Space Flight Center. CCMC also provides, to the research community, access to state-of-the-art space research models. In this paper we will provide a description of the current CCMC status, discuss current plans, research and development accomplishments and goals, and describe the model testing and validation process undertaken as part of the CCMC mandate. Special emphasis will be on solar and heliospheric models currently residing at CCMC, and on plans for validation and verification.

  13. Costs and implications of discarded medication in hospice.

    PubMed

    Speer, Nathan D; Dioso, Jhanina; Casner, Paul R

    2013-08-01

    Symptom control for hospice patients frequently involves the use of pharmacologic agents for control of pain, dyspnea, and anxiety. Other troubling symptoms that will often require pharmacologic agents include nausea, vomiting, constipation, and delirium. While the Medicare requirement for hospice is a prognosis of six months or less, accurately predicting prognosis is very difficult. Because of this, medications for symptom control will often have to be prescribed and refilled without knowing exactly how much the hospice patient may require. The objective of the current study was to determine the amount of medication discarded at death. Additionally we wanted to estimate the cost related to discarded medication. We reviewed the records of 296 patients over a three-year period in a community hospice to characterize the medications that were discarded at death. Seventeen patients were not eligible for evaluation because of lack of complete information, leaving 279 study subjects. Cost calculations were used using a website cost calculator (HealthTrans.com). Fifty-six percent of the decedents were female and the majority were Hispanic (62%). The five most common diagnoses were cancer (36%); dementia (22%); and COPD, CVA, and congestive heart failure (CHF) (8%). The median length of stay in hospice was 16 days. The most frequent medication unused at the time of death was morphine solution followed by lorazepam. The cost of discarded morphine including tablets as well as solution totaled over $6,000 for the study period. The next highest medication cost was lorazepam for both solution and tablets, which came to over $1,600. The total estimated cost for all medications for the study period amounted to $14,980. The results of this study indicate that hospice patients have variable amounts of discarded medication at the time of death and that the cost involved of these unused medications can be significant. Hospice organizations should investigate creative ways to reduce

  14. Massage, Music and Art Therapy in Hospice: Results of a National Survey

    PubMed Central

    Dain, Aleksandra S.; Bradley, Elizabeth H.; Hurzeler, Rosemary; Aldridge, Melissa D.

    2015-01-01

    Context Complementary and alternative medicine (CAM) provides clinical benefits to hospice patients, including decreased pain and improved quality of life. Yet little is known about the extent to which U.S. hospices employ CAM therapists. Objectives To report the most recent national data regarding the inclusion of art, massage, and music therapists on hospice interdisciplinary teams and how CAM therapist staffing varies by hospice characteristics. Methods A national cross-sectional survey of a random sample of hospices (n=591; 84% response rate) from September 2008 to November 2009. Results Twenty-nine percent of hospices (169 of 591) reported employing an art, massage, or music therapist. Of those hospices, 74% employed a massage therapist, 53% a music therapist, and 22% an art therapist, and 42% expected the therapist to attend interdisciplinary staff meetings, indicating a significant role for these therapists on the patient’s care team. In adjusted analyses, larger hospices compared with smaller hospices had significantly higher odds of employing a CAM therapist (adjusted odds ratio (AOR) = 6.38, 95% CI 3.40, 11.99) and forprofit hospices had lower odds of employing a CAM therapist compared with nonprofit hospices (AOR = 0.52, 95% CI 0.32, 0.85). Forty-four percent of hospices in the Mountain/Pacific region reported employing a CAM therapist versus 17% in the South Central region. Conclusion Less than one-third of U.S. hospices employ art, massage, or music therapists despite the benefits these services may provide to patients and families. A higher proportion of large hospices, nonprofit hospices and hospices in the Mountain/Pacific region employ CAM therapists, indicating differential access to these important services. PMID:25555445

  15. Center for Extended Magnetohydrodynamic Modeling Cooperative Agreement

    SciTech Connect

    Carl R. Sovinec

    2008-02-15

    The Center for Extended Magnetohydrodynamic Modeling (CEMM) is developing computer simulation models for predicting the behavior of magnetically confined plasmas. Over the first phase of support from the Department of Energy’s Scientific Discovery through Advanced Computing (SciDAC) initiative, the focus has been on macroscopic dynamics that alter the confinement properties of magnetic field configurations. The ultimate objective is to provide computational capabilities to predict plasma behavior—not unlike computational weather prediction—to optimize performance and to increase the reliability of magnetic confinement for fusion energy. Numerical modeling aids theoretical research by solving complicated mathematical models of plasma behavior including strong nonlinear effects and the influences of geometrical shaping of actual experiments. The numerical modeling itself remains an area of active research, due to challenges associated with simulating multiple temporal and spatial scales. The research summarized in this report spans computational and physical topics associated with state of the art simulation of magnetized plasmas. The tasks performed for this grant are categorized according to whether they are primarily computational, algorithmic, or application-oriented in nature. All involve the development and use of the Non-Ideal Magnetohydrodynamics with Rotation, Open Discussion (NIMROD) code, which is described at http://nimrodteam.org. With respect to computation, we have tested and refined methods for solving the large algebraic systems of equations that result from our numerical approximations of the physical model. Collaboration with the Terascale Optimal PDE Solvers (TOPS) SciDAC center led us to the SuperLU_DIST software library [http://crd.lbl.gov/~xiaoye/SuperLU/] for solving large sparse matrices using direct methods on parallel computers. Switching to this solver library boosted NIMROD’s performance by a factor of five in typical large

  16. Validation of Space Weather Models at Community Coordinated Modeling Center

    NASA Technical Reports Server (NTRS)

    Kuznetsova, M. M.; Hesse, M.; Pulkkinen, A.; Maddox, M.; Rastaetter, L.; Berrios, D.; Zheng, Y.; MacNeice, P. J.; Shim, J.; Taktakishvili, A.; Chulaki, A.

    2011-01-01

    The Community Coordinated Modeling Center (CCMC) is a multi-agency partnership to support the research and developmental work necessary to substantially increase space weather modeling capabilities and to facilitate advanced models deployment in forecasting operations. Space weather models and coupled model chains hosted at the CCMC range from the solar corona to the Earth's upper atmosphere. CCMC has developed a number of real-time modeling systems, as well as a large number of modeling and data products tailored to address the space weather needs of NASA's robotic missions. The CCMC conducts unbiased model testing and validation and evaluates model readiness for operational environment. CCMC has been leading recent comprehensive modeling challenges under GEM, CEDAR and SHINE programs. The presentation will focus on experience in carrying out comprehensive and systematic validation of large sets of. space weather models

  17. 3 CFR 8594 - Proclamation 8594 of October 29, 2010. National Hospice Month, 2010

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... provide tailored support to meet the needs of these heroes. The Affordable Care Act signed into law this... receive hospice care before first discontinuing treatments to cure their disease. The Affordable Care Act... Proclamation During National Hospice Month, we recognize the dignity hospice care can provide to patients...

  18. Guide for Trainers. Interdisciplinary Team Training and Humanistic Patient Care for Hospices. Monograph 2.

    ERIC Educational Resources Information Center

    Wilson, Dottie C.; Grady, Kathleen A.

    This monograph, the second in a series of five, provides information for trainers on interdisciplinary team training and humanistic patient care in hospices. Designed to help outside trainers who may be invited by a hospice to conduct its training, the materials help instructors to understand the nature of hospices, to determine whether or not the…

  19. Social Workers' Participation in the Resolution of Ethical Dilemmas in Hospice Care

    ERIC Educational Resources Information Center

    Csikai, Ellen L.

    2004-01-01

    Ethical dilemmas are inherent in every health care setting. A sample of hospice social workers with no direct access to a hospice ethics committee (N = 110) was surveyed regarding ethical issues in hospice care, how the issues were managed, and the extent to which social workers participated in resolution of ethical dilemmas. Common issues…

  20. 42 CFR 417.423 - Special rules: ESRD and hospice patients.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Special rules: ESRD and hospice patients. 417.423... Special rules: ESRD and hospice patients. (a) ESRD patients. (1) A Medicare beneficiary who has been... not disenroll the beneficiary except as provided in § 417.460. (b) Hospice patients. A...

  1. 42 CFR 418.21 - Duration of hospice care coverage-Election periods.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Duration of hospice care coverage-Election periods... HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.21 Duration of hospice care coverage—Election periods. (a) Subject to the conditions set forth...

  2. Interpersonal Communication Instruction in the Non-Traditional Context: Teaching Communication Strategies in a Hospice Setting.

    ERIC Educational Resources Information Center

    Fieweger, Margaret A.

    While many health care delivery systems are criticized for the dehumanizing way they treat patients, hospice care presents a refreshing alternative to health care for the terminally ill. Patients appropriate for hospice care are those with six months or less to live. Interpersonal communication education is an important component of hospice care…

  3. 42 CFR 418.205 - Special requirements for hospice pre-election evaluation and counseling services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    .... (ii) The physician furnishing these services must be an employee or medical director of the hospice billing for this service. (iii) The services cannot be furnished by hospice personnel other than employed... employee of the hospice. (iv) If the beneficiary's attending physician is also the medical director or...

  4. 42 CFR 418.205 - Special requirements for hospice pre-election evaluation and counseling services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    .... (ii) The physician furnishing these services must be an employee or medical director of the hospice billing for this service. (iii) The services cannot be furnished by hospice personnel other than employed... employee of the hospice. (iv) If the beneficiary's attending physician is also the medical director or...

  5. 75 FR 42943 - Medicare Program; Hospice Wage Index for Fiscal Year 2011

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-22

    ... new OMB standards that included CBSAs. In the FY 2006 hospice wage index final rule (70 FR 45130), we.... Specifically, in the Hospice Wage Index for FY 2010 Final Rule, published on August 6, 2009 (74 FR 39384), we... August 8, 1997 hospice wage index final rule (62 FR 42860), the pre-floor and pre-reclassified...

  6. Hospice management of patients receiving cytotoxic chemotherapy: problems and opportunities.

    PubMed

    Hicks, F; Corcoran, G

    1993-12-01

    In Britain, the specialty of palliative medicine continues to develop, encouraging the referral of patients early in the palliative phase of their illness. This had led to an increased number of patients receiving palliative chemotherapy and hospice care concurrently, posing special problems to the professionals involved. In this retrospective study, 52 patients were identified who received chemotherapy and hospice care simultaneously. Case notes were reviewed to reveal problems arising from sharing the duty of care. The poor quality of communication between professionals, perhaps reflecting a limited understanding of the various roles in patient care, we found to cause significant difficulties. The duration and discontinuation of cytotoxic therapy seems to be a particularly difficult matter. Hospice admission often signalled the end of this treatment. In a third of the patients, no decision was taken to stop chemotherapy despite the last dose being an average of just 1 week before death. The value of chemotherapy for patients who are too ill to return home is questioned. Seven patients were diagnosed as suffering from chemotherapy-induced sepsis and neutropenia either by hospice inpatient or home care teams, and were admitted to their acute centres accordingly. Most patients who died during the study period received terminal care in the hospice. Suggestions are made on improving professional education and communication, including the use of a 'chemotherapy card'. PMID:7505105

  7. Combining information from two data sources with misreporting and incompleteness to assess hospice-use among cancer patients: a multiple imputation approach.

    PubMed

    He, Yulei; Landrum, Mary Beth; Zaslavsky, Alan M

    2014-09-20

    Combining information from multiple data sources can enhance estimates of health-related measures by using one source to supply information that is lacking in another, assuming the former has accurate and complete data. However, there is little research conducted on combining methods when each source might be imperfect, for example, subject to measurement errors and/or missing data. In a multisite study of hospice-use by late-stage cancer patients, this variable was available from patients' abstracted medical records, which may be considerably underreported because of incomplete acquisition of these records. Therefore, data for Medicare-eligible patients were supplemented with their Medicare claims that contained information on hospice-use, which may also be subject to underreporting yet to a lesser degree. In addition, both sources suffered from missing data because of unit nonresponse from medical record abstraction and sample undercoverage for Medicare claims. We treat the true hospice-use status from these patients as a latent variable and propose to multiply impute it using information from both data sources, borrowing the strength from each. We characterize the complete-data model as a product of an 'outcome' model for the probability of hospice-use and a 'reporting' model for the probability of underreporting from both sources, adjusting for other covariates. Assuming the reports of hospice-use from both sources are missing at random and the underreporting are conditionally independent, we develop a Bayesian multiple imputation algorithm and conduct multiple imputation analyses of patient hospice-use in demographic and clinical subgroups. The proposed approach yields more sensible results than alternative methods in our example. Our model is also related to dual system estimation in population censuses and dual exposure assessment in epidemiology. PMID:24804628

  8. Combining information from two data sources with misreporting and incompleteness to assess hospice-use among cancer patients: a multiple imputation approach

    PubMed Central

    He, Yulei; Landrum, Mary Beth; Zaslavsky, Alan M.

    2014-01-01

    Combining information from multiple data sources can enhance estimates of health-related measures by using one source to supply information that is lacking in another, assuming the former has accurate and complete data. However, there is little research conducted on combining methods when each source might be imperfect, for example, subject to measurement errors and/or missing data. In a multisite study of hospice-use by late-stage cancer patients, this variable was available from patients’ abstracted medical records, which may be considerably underreported because of incomplete acquisition of these records. Therefore, data for Medicare-eligible patients were supplemented with their Medicare claims that contained information on hospice-use, which may also be subject to underreporting yet to a lesser degree. In addition, both sources suffered from missing data because of unit nonresponse from medical record abstraction and sample undercoverage for Medicare claims. We treat the true hospice-use status from these patients as a latent variable and propose to multiply impute it using information from both data sources, borrowing the strength from each. We characterize the complete-data model as a product of an ‘outcome’ model for the probability of hospice-use and a ‘reporting’ model for the probability of underreporting from both sources, adjusting for other covariates. Assuming the reports of hospice-use from both sources are missing at random and the underreporting are conditionally independent, we develop a Bayesian multiple imputation algorithm and conduct multiple imputation analyses of patient hospice-use in demographic and clinical subgroups. The proposed approach yields more sensible results than alternative methods in our example. Our model is also related to dual system estimation in population censuses and dual exposure assessment in epidemiology. PMID:24804628

  9. Medicare Program; FY 2016 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements. Final rule.

    PubMed

    2015-08-01

    This final rule will update the hospice payment rates and the wage index for fiscal year (FY) 2016 (October 1, 2015 through September 30, 2016), including implementing the last year of the phase-out of the wage index budget neutrality adjustment factor (BNAF). Effective on January 1, 2016, this rule also finalizes our proposals to differentiate payments for routine home care (RHC) based on the beneficiary's length of stay and implement a service intensity add-on (SIA) payment for services provided in the last 7 days of a beneficiary's life, if certain criteria are met. In addition, this rule will implement changes to the aggregate cap calculation mandated by the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act), align the cap accounting year for both the inpatient cap and the hospice aggregate cap with the federal fiscal year starting in FY 2017, make changes to the hospice quality reporting program, clarify a requirement for diagnosis reporting on the hospice claim, and discuss recent hospice payment reform research and analyses. PMID:26248391

  10. An examination of the effect of reimbursement and organizational structure on the allocation of hospice staff time.

    PubMed

    Mor, V; Schwartz, R; Laliberte, L; Hiris, J

    1985-01-01

    The unique needs of the terminally ill patient may require more planning and service coordination than those of the non-terminal patient. The hospice interdisciplinary team was a response to these additional needs. This paper examines the pattern of patient care and administrative activities of paid hospice staff by hospice organizational type and demonstration status in the National Hospice Study. Data gathered over a one year period revealed that demonstration hospices, in which all allowable costs were Medicare reimbursed, spent significantly more time in general and patient related administrative activities than non-demonstration hospices, which operated within existing Medicare cost limits. Staff in demonstration home care-based hospices reported significantly longer home visits than staff in non-demonstration hospices. In both groups, home care-based hospice visits were of longer duration than those home visits conducted by staff of hospital-based hospices. PMID:10300373

  11. In-patient hospice: A qualitative study with Portuguese patients, family and staff.

    PubMed

    Hilário, Ana Patrícia

    2016-05-27

    The present study aims to provide insights on the role of in-patient hospices, which are sometimes described as disconnecting spaces. Researchers complement participant observation with in-depth interviews with 10 hospice patients, 20 family members, and 20 members of hospice staff. The findings suggest that the hospice provides a space where patients could enjoy the company of their loved ones without concerns regarding the dying process. The study reveals that the hospice offers a proper alternative to the home setting even in countries characterized by a strong familialistic culture like Portugal. PMID:26765681

  12. Perceptions About Hospice From a Community-Based Pilot Study: Lessons and Findings

    PubMed Central

    Van Dussen, Daniel; Culler, Krystal L.; Cagle, John G.

    2016-01-01

    Research investigating the knowledge and attitudes of diverse older adults about hospice care and end-of-life issues is needed to expand service utilization. This pilot study explored an urban area’s perceptions and awareness of hospice through local churches. The sample consisted of 148 adults age 43 and older. Although recruitment efforts resulted in a relatively homogenous sample, findings suggest a lack of knowledge about whether hospice is covered by Medicare, Medicaid, or private insurance. Perceptions of the expense of hospice, however, were not associated with knowledge of coverage. Respondents generally agreed that hospice is important and would recommend its services for their family members. PMID:21208898

  13. Designing research with hospice and palliative care populations.

    PubMed

    Wohleber, Ashley M; McKitrick, Daniel S; Davis, Shawn E

    2012-08-01

    Research in palliative care and hospice populations is important for improving quality of care, quality of life, and provider understanding of individuals at the end of life. However, this research involves many potential challenges. This review seeks to inform and assist researchers targeting to design studies targeting hospice and palliative care patients by presenting a thorough review of the published literature. This review covers English-language articles published from 1990 through 2009 listed in the PsycInfo, Medline, or CINAHL research databases under relevant keywords. Articles on pediatric hospice were not included. Issues discussed include study design, informed consent, and recruitment for participants. Synthesized recommendations for researchers in these populations are presented. PMID:22104045

  14. Staff Efficiency Trends Among Pediatric Hospices, 2002-2011.

    PubMed

    Cozad, Melanie J; Lindley, Lisa C; Mixer, Sandra J

    2016-01-01

    This study provided the first examination of staff efficiency trends among pediatric hospices. Although pediatric staff efficiency demonstrated large variability from 2002 to 2011, the general trend in efficiency from 2003 to 2010. The decline in efficiency means, on average, pediatric hospices had higher operating expenses and used more capacity, but greater amounts of these greater outputs as measured by visits per patient. The study also highlights the crucial role pediatric hospice nurse managers play in developing effective workforce strategies that allow for responsive changes to workload fluctuations. Due to the associations between efficiency, regulation, and growth, nurse leaders' abilities to develop effective strategies are more imperative than ever to ensure quality end-of-life care for children and their families. PMID:27265950

  15. Family Members' Experience With Hospice in Nursing Homes.

    PubMed

    Gage, L Ashley; Washington, Karla; Oliver, Debra Parker; Kruse, Robin; Lewis, Alexandra; Demiris, George

    2016-05-01

    Research has documented numerous benefits and challenges associated with receipt of hospice care in nursing homes; however, study of this partnership from the perspective of residents' family members has been limited. The purpose of this qualitative investigation was to explore family members' experience with hospice services received in the nursing home setting. Researchers conducted a secondary data analysis of 175 family member interviews using a thematic analytic approach. Findings highlighted the critical role of communication in supporting residents and their family members. Care coordination, support and oversight, and role confusion also impacted family members' experience of hospice care in the nursing home. Efforts directed at enhancing communication and more clearly articulating the roles of members of the health care team are indicated. PMID:25422516

  16. Pain in Hospice Patients With Dementia: The Informal Caregiver Experience

    PubMed Central

    Tarter, Robin; Demiris, George; Pike, Kenneth; Washington, Karla; Oliver, Debra Parker

    2016-01-01

    Introduction At the end of life, patients with dementia often experience high levels of pain due to complex interplay of disease processes and numerous barriers to symptom management. In the hospice setting, informal caregivers play an essential role in pain management. This study describes their experience managing pain in hospice patients with dementia. Methods We conducted a qualitative analysis of audio-recorded interviews with informal caregivers of hospice patients with dementia who had chosen pain as the challenge they wanted to work on within a problem-solving therapy intervention. Results The thematic analysis of sessions with 51 caregivers identified 4 themes: difficulty in communicating with patients, lack of consistent guidance from health-care professionals, perceived uncertainty about the etiology of pain, and secondary suffering. Discussion Our findings indicate the possible need for increased support for caregivers, including educational interventions targeting pain etiology and assessment, and improved communication with health-care professionals. PMID:27303062

  17. CFD Modeling Activities at the NASA Stennis Space Center

    NASA Technical Reports Server (NTRS)

    Allgood, Daniel

    2007-01-01

    A viewgraph presentation on NASA Stennis Space Center's Computational Fluid Dynamics (CFD) Modeling activities is shown. The topics include: 1) Overview of NASA Stennis Space Center; 2) Role of Computational Modeling at NASA-SSC; 3) Computational Modeling Tools and Resources; and 4) CFD Modeling Applications.

  18. Heliophysical Modeling at the Community Coordinated Modeling Center

    NASA Astrophysics Data System (ADS)

    MacNeice, P. J.; Taktakishvili, A.; Mays, M. L.; Mullinix, R.; Chulaki, A.; Mendoza, A. M. M.

    2015-12-01

    The Community Coordinated Modeling Center (CCMC) at NASA/GSFC provides the heliophysics research community with access to state of the art modeling resources, and facilitates modeling challenges for model validation or for mission support. In this presentation we report on new additions to the CCMC's inventory of heliophysical models, and on a community wide modeling effort in support of the New Horizons flyby of Pluto.During the last year we have added a number of significant new models to our model inventory. In this presentation we describe these new models. These include a Non-Linear Force Free Field model of the coronal field which can use a spherical grid and so can model large surface patches containing multiple active regions, and which is configured to use HMI data.We have also installed the SRPM irradiance model.We will also discuss work being done to install an 'eruption generator' capability that operates within the SWMF coronal MHD component, and an updated version of EMMREM which can couple with the ENLIL MHD model of the inner heliosphere to model particle fluences.Shortly before the New Horizons flyby, the Planetary Division at NASA HQ requested that the CCMC provide a forecast of the state of the Solar Wind at the spacecraft.The CCMC's primary mission is to provide the research and forecasrting community with heliophysical models of relevance to Space Weather. Prior to the New Horizons flyby the CCMC's focus had been on models of the inner heliosphere. To respond to the New Horizons opportunity, modelers of the outer heliosphere were invited to contribute. As a result, by the time of closest approach six different model forecasts were posted publically at the CCMC web site dedicated to this project.In this presentation we will describe the community wide effort which the CCMC facilitated in response to this request, detailing the different models which participated and illustrating the results.

  19. National Space Science Data Center Information Model

    NASA Astrophysics Data System (ADS)

    Bell, E. V.; McCaslin, P.; Grayzeck, E.; McLaughlin, S. A.; Kodis, J. M.; Morgan, T. H.; Williams, D. R.; Russell, J. L.

    2013-12-01

    The National Space Science Data Center (NSSDC) was established by NASA in 1964 to provide for the preservation and dissemination of scientific data from NASA missions. It has evolved to support distributed, active archives that were established in the Planetary, Astrophysics, and Heliophysics disciplines through a series of Memoranda of Understanding. The disciplines took over responsibility for working with new projects to acquire and distribute data for community researchers while the NSSDC remained vital as a deep archive. Since 2000, NSSDC has been using the Archive Information Package to preserve data over the long term. As part of its effort to streamline the ingest of data into the deep archive, the NSSDC developed and implemented a data model of desired and required metadata in XML. This process, in use for roughly five years now, has been successfully used to support the identification and ingest of data into the NSSDC archive, most notably those data from the Planetary Data System (PDS) submitted under PDS3. A series of software packages (X-ware) were developed to handle the submission of data from the PDS nodes utilizing a volume structure. An XML submission manifest is generated at the PDS provider site prior to delivery to NSSDC. The manifest ensures the fidelity of PDS data delivered to NSSDC. Preservation metadata is captured in an XML object when NSSDC archives the data. With the recent adoption by the PDS of the XML-based PDS4 data model, there is an opportunity for the NSSDC to provide additional services to the PDS such as the preservation, tracking, and restoration of individual products (e.g., a specific data file or document), which was unfeasible in the previous PDS3 system. The NSSDC is modifying and further streamlining its data ingest process to take advantage of the PDS4 model, an important consideration given the ever-increasing amount of data being generated and archived by orbiting missions at the Moon and Mars, other active projects

  20. The Learning Center: A Comprehensive Model for Colleges and Universities.

    ERIC Educational Resources Information Center

    Martin, Deanna C.; And Others

    Intended for use by educators responsible for developing post-secondary learning centers, this manual emphasizes the design and administration of such centers rather than the various aspects of skill instruction. Its seven chapters discuss the concept of a learning center; the components of the model, including a supplemental course, recruitment…

  1. Security at a "model" psychiatric center.

    PubMed

    Camacho, H S; Cottrell, P A

    1997-01-01

    The security problems faced by a recently opened psychiatric center located on the campus of a hospital--including staffing, fire safety, access control, patient restraints, and budget cuts--and how they are being dealt with. PMID:10173429

  2. The Restorative Healing Model: Implementation at the Woodbourne Center

    ERIC Educational Resources Information Center

    Park, Juyoung; Carlson, George; Weinstein, Stanley; Lee, Bethany

    2008-01-01

    This study describes the Restorative Healing Model used at the Woodbourne Center (Baltimore) to improve socially adaptive functioning and behaviors among youth residing in a residential treatment center. This treatment model requires collaborative work with youth, their families, staff members, and community members. Unlike program models built on…

  3. Effectively training the hospice and palliative medicine physician workforce for improved end-of-life health care in the United States.

    PubMed

    Bui, Thomas

    2012-09-01

    The widening gap between the demand for palliative care services and the supply of trained palliative care professionals has resulted in considerable end-of-life distress for patients. Without formal training in palliative medicine and end-of-life symptom management, physicians in the United States are less equipped to competently address seriously ill and dying patients' medical, emotional, and spiritual needs. Recent attempts within graduate medical education training deliberately seek to prepare a critical mass of physicians as the new hospice and palliative medicine workforce in the United States. In addition, healthcare reform proposals may re-define the National Health Service Corps (NHSC) post-graduate training over the next five years and the Hospice Medicare Benefit altogether. Healthcare policy options include steady changes at multiple levels of medical training -namely, medical school curriculum mandates, requiring all graduate physician residency training to foster patient-centered communication skills and discussions about advanced directives, and instituting palliative medicine proficiency Continuing Medical Education (CME) requirements for all states' medical licensing boards. Attracting qualified physicians to serve patients at the end of life, innovative medical school loan repayment programs and scholarships will also foster excellence in the field of hospice and palliative medicine. Correcting our current paucity of formal training in palliative medicine better utilizes hospice and restores patients' dignity at the end of life. PMID:22174315

  4. Art Therapy in Hospice: A Catalyst for Insight and Healing

    ERIC Educational Resources Information Center

    Safrai, Mary B.

    2013-01-01

    The reach of art therapy in assisting a hospice patient in confronting existential issues at the end of life is illustrated in this article with a case that took place over the course of 22 semiweekly sessions. Painting with an art therapist allowed the patient to shift from a state of anxiety and existential dread to a more accepting, fluid…

  5. 42 CFR 418.26 - Discharge from hospice care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.26 Discharge... stabilize or otherwise change such that the patient cannot continue to be certified as terminally ill. (2... education, or other services before the patient is discharged because he or she is no longer terminally ill....

  6. Stress Management Training for Hospice Personnel: An Exploratory Study.

    ERIC Educational Resources Information Center

    Clark, Susan; And Others

    There is very little published research specifically addressing the stress management skills of hospice caregivers. In order to ascertain if breathing exercises, biofeedback training, relaxation exercises, and cognitive therapy would be beneficial, pre- and post-treatment questionnaires and six 30-minute treatment sessions were administered to…

  7. Methodological Research Priorities in Palliative Care and Hospice Quality Measurement.

    PubMed

    Dy, Sydney Morss; Herr, Keela; Bernacki, Rachelle E; Kamal, Arif H; Walling, Anne M; Ersek, Mary; Norton, Sally A

    2016-02-01

    Quality measurement is a critical tool for improving palliative care and hospice, but significant research is needed to improve the application of quality indicators. We defined methodological priorities for advancing the science of quality measurement in this field based on discussions of the Technical Advisory Panel of the Measuring What Matters consensus project of the American Academy of Hospice and Palliative Medicine and Hospice and Palliative Nurses Association and a subsequent strategy meeting to better clarify research challenges, priorities, and quality measurement implementation strategies. In this article, we describe three key priorities: 1) defining the denominator(s) (or the population of interest) for palliative care quality indicators, 2) developing methods to measure quality from different data sources, and 3) conducting research to advance the development of patient/family-reported indicators. We then apply these concepts to the key quality domain of advance care planning and address relevance to implementation of indicators in improving care. Developing the science of quality measurement in these key areas of palliative care and hospice will facilitate improved quality measurement across all populations with serious illness and care for patients and families. PMID:26596877

  8. Hospice placement reminded me that nursing is about caring.

    PubMed

    Short, Camille

    2011-08-24

    I did not expect to learn much during my two weeks in the day hospice. Indeed, I was unsure what a nurse could do in such an environment. I had a vague impression that there would be arts and crafts, and people passing the time. PMID:27317072

  9. Assessment of Need for a Children's Hospice Program.

    ERIC Educational Resources Information Center

    Davies, Betty

    1996-01-01

    Discusses the development of Canuck Place, North America's first free-standing pediatric hospice of its kind, opened in British Columbia, Canada, in 1995. Discusses the process of assessing the need for Canuck Place. Data from traditional quantitative and less-traditional qualitative sources were used to document and develop an argument in support…

  10. Factors affecting satisfaction among community-based hospice volunteer visitors.

    PubMed

    Chevrier, F; Steuer, R; MacKenzie, J

    1994-01-01

    Trained volunteers are an essential component in the delivery of care to clients and families facing a terminal and/or life-threatening illness. As the need for hospice care increases, so does the need to increase the number of volunteers available for visiting. Hospice of London, which is a community based hospice, proposed that volunteers who felt satisfied would remain with the organization longer, thereby, decreasing the costs associated with training new volunteers and enhancing the ability of the agency to provide high-quality volunteer client matches. Accordingly, a survey was conducted in August 1992 to determine which factors were related to hospice volunteer satisfaction. One hundred and five volunteer were surveyed over the telephone. Results demonstrated a positive correlation between satisfaction and feeling like a team member, receiving feedback from staff, feeling valuable and having the volunteer's expectations match the position. Differences in the factors related to satisfaction were noted when the groups were divided by age and gender. PMID:7893559

  11. At the Eleventh Hour: Psychosocial Dynamics in Short Hospice Stays

    ERIC Educational Resources Information Center

    Waldrop, Deborah P.

    2006-01-01

    Purpose: This study explored the psychosocial dynamics of short hospice stays (less than 2 weeks) of cancer patients age 65 and older. Design and Methods: In-depth interviews with 59 caregivers of 50 patients were audiotaped, transcribed, and coded by using Atlas ti software. Results: A descriptive typology is presented. A late diagnosis (n = 22…

  12. Comprehensive Career Education Center Model. Final Report.

    ERIC Educational Resources Information Center

    Stauber, Dick

    The objective of this project was to establish the Moraine Park Technical Institute as a Career Education Center to coordinate and provide a focus for the career education efforts of the public and private secondary schools in the Moraine Park Vocational, Technical and Adult Education District. The District service area covers several counties in…

  13. IHY Modeling Support at the Community Coordinated Modeling Center

    NASA Technical Reports Server (NTRS)

    Chulaki, A.; Hesse, Michael; Kuznetsova, Masha; MacNeice, P.; Rastaetter, L.

    2005-01-01

    The Community Coordinated Modeling Center (CCMC) is a US inter-agency activity aiming at research in support of the generation of advanced space weather models. As one of its main functions, the CCMC provides to researchers the use of space science models, even if they are not model owners themselves. In particular, the CCMC provides to the research community the execution of "runs-onrequest" for specific events of interest to space science researchers. Through this activity and the concurrent development of advanced visualization tools, CCMC provides, to the general science community, unprecedented access to a large number of state-of-the-art research models. CCMC houses models that cover the entire domain from the Sun to the Earth. In this presentation, we will provide an overview of CCMC modeling services that are available to support activities during the International Heliospheric Year. In order to tailor CCMC activities to IHY needs, we will also invite community input into our IHY planning activities.

  14. Exploring differences in referrals to a hospice at home service in two socio-economically distinct areas of Manchester, UK.

    PubMed

    Campbell, Malcolm; Grande, Gunn; Wilson, Charlotte; Caress, Ann-Louise; Roberts, Dai

    2010-06-01

    In order to provide equitable access to hospice at home palliative care services, it is important to identify the socio-economic factors associated with poorer access. In this population-based study we aimed to test the inverse care law by exploring how socio-economic status and other key demographic indicators were associated with referral rates in two distinct areas (Salford and Trafford) served by the same service. Secondary data from the UK National Census 2001, North West Cancer Intelligence Service (2004) and hospice at home service referral data (2004-06) was collated for both areas. Descriptive analysis profiled electoral ward characteristics whilst simple correlations and regression modelling estimated associations with referral rates. Referral rates were lower and cancer mortality higher in the most deprived areas (Salford). Referral rates were significantly associated with deprivation, particularly multiple deprivation, but not significantly associated with cancer mortality (service model and resources available were held constant). At the population level, the socio-economic characteristics of those referred to hospice at home rather than service provision strongly predicted referral rates. This has implications for the allocation and targeting of resources and contributes important findings to future work exploring equitable access at organizational and professional levels. PMID:20015917

  15. Validating a Technology Enhanced Student-Centered Learning Model

    ERIC Educational Resources Information Center

    Kang, Myunghee; Hahn, Jungsun; Chung, Warren

    2015-01-01

    The Technology Enhanced Student Centered Learning (TESCL) Model in this study presents the core factors that ensure the quality of learning in a technology-supported environment. Although the model was conceptually constructed using a student-centered learning framework and drawing upon previous studies, it should be validated through real-world…

  16. Overcoming the Obstacles in Promoting Hospice Palliative Care--Sharing Experiences of the Taiwan Changhua Christian Hospital.

    PubMed

    Tsai, Pei-Yu

    2015-01-01

    Hospice palliative care for terminal patients is necessary, yet challenges are on the way worldwide. This study demonstrated that hospice palliative care has been quickly developed in Taiwan due to the support of the National Health Insurance system, the promotion by civil societies and religious groups, patient's legal right for DNR, easier access to pain killers through medical prescription, and well-planned hospice staff training programs. This paper introduces how hospice consultation is provided by a comprehensive hospice palliative team at Changhua Christian Hospital to establish trust and cooperation with the medical team, and to improve hospice-palliative care referral and utilization rates. PMID:26867341

  17. Geographic access to hospice care for children with cancer in Tennessee, 2009 to 2011.

    PubMed

    Lindley, Lisa C; Edwards, Sheri L

    2015-12-01

    The geographic interface between the need for and the supply of pediatric hospice may be critical in whether children with cancer access care. This study sought to describe the geographic distribution of pediatric hospice need and supply and identify areas lacking pediatric hospice care in Tennessee over a 3-year time period. Using ArcGIS, a series of maps were created. There was a consistent need for care among children with cancer across the state. Most urban areas were supplied by pediatric hospices, except the Knoxville area. Areas within the state were identified where the supply of pediatric hospice care declined, while the need for hospice care was unchanging. This study has important regulatory implications for clinicians practicing in certificate of need states such as Tennessee. PMID:25028742

  18. Ethical considerations in the treatment of pain in a hospice environment.

    PubMed

    Zylicz, Z

    2000-08-01

    Most people treated in hospices suffer from pain. The hospice environment offers them a place where they may feel safe and get rest before they die. This particular environment was originally created to solve the many problems terminal patients encountered in busy modern hospitals. However, it is clear that solving some problems frequently means creating new ones. For people who are about to complete their life's journey, a hospice is a place of care and autonomy. Previous losses and severe spiritual distress complicate most of the severe pain conditions seen in hospices. In this paper, some specific ethical problems encountered in hospice practice will be discussed. Patients' autonomy with all its advantages and disadvantages will be highlighted. Acceptance of death may result in an active and creative attitude. Although scientific evidence of the processes taking place is still lacking, the modern hospice may be seen as a complementary, main-stream institution contributing to the development of whole medicine. PMID:10900366

  19. Hospice Nurse Communication with Patients with Cancer and their Family Caregivers

    PubMed Central

    Reblin, Maija; Clayton, Margaret F.; Berry, Patricia; Mooney, Kathleen

    2012-01-01

    Abstract Background Effective communication by hospice nurses enhances symptom management for the patient, reduces family caregiver burden and distress, and potentially improves bereavement adjustment. However, research has not kept pace with the rising use of hospice by patients with cancer and thus we know little about how hospice nurses communicate. Methods The overriding objective of this pilot study was to provide insight into these in-home visits. Hospice nurses audiorecorded their interactions over time with family caregivers and patients with cancer. The communication within these tapes was coded using Roter Interaction Analysis System (RIAS) and analyzed. Results We found that tape recording home hospice nurse visits was feasible. RIAS was suited to capture the general content and process of the home hospice encounter and the coded interactions show the range of topics and emotions that are evident in the dialogue. Implications and future directions for research are discussed. PMID:22339285

  20. Settings of Care within Hospice: New Options and Questions about Dying “At Home”

    PubMed Central

    Lysaght, Susan; Ersek, Mary

    2012-01-01

    Although place of death has been routinely studied in end-of-life (EOL) care, more analysis on place of death within hospice is needed because of the recent, dramatic rise in the number of hospice patients dying in inpatient settings. Using a case study to illustrate the complexity of determinants of place of death within hospice, this article highlights important known factors and elucidate gaps for further research. Individual and system level factors, sociocultural meanings, caregiving and preferences are shown to have important implications. Additionally, the unique components of home hospice, inpatient hospice and transitions between these settings may have a fundamental role in the future of quality EOL care. Further research on determinants of hospice settings of care is essential to the care of older adults at the end of life. PMID:23853526

  1. Is there congruence in hospice nurses' view of their patients' quality of life and their hospice patients' view of their own quality of life?

    PubMed

    Mueller-Marquez, B J

    1993-01-01

    Since the development of the hospice movement in the United States, care of the terminally ill has undergone vital change. This change involves the alternative of home care for the terminally ill. It allows the patients, the primary caregiver, and the rest of the family to be in control of care. As stated by Masters, hospice is unique in that the patient and family controls the environment, and lifestyle, including treatment modalities, more than in any other concept in health care. Hospice was developed to give people with a terminal illness an option to traditional medicine. Hospice is a concept of care that has been established to improve the quality of life of the terminally ill. Therefore, the ultimate goal of hospice care is to enhance the quality of life of patients with terminal illness, mainly cancer. In the hospice setting, the nurse applies a holistic approach when planning and providing primary care. The nurse becomes increasingly more knowledgeable about the problems and strengths of the patient and family to whom he/she is caring for. The nurse must make the transition in her philosophy from cure-to-care in hospice, and symptom control being the nurses' priority in order to enhance the patients quality of life. Curtis and Fernsler explain that hospice care focuses on helping patients to communicate effectively and to share life agendas with their primary caregiver and the hospice nurse. These researchers continue to state that these efforts promote congruence between patient, primary caregiver, and the hospice nurses' view of the patients quality of life.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8398476

  2. Complicated grief symptoms in caregivers of persons with lung cancer: the role of family conflict, intrapsychic strains, and hospice utilization.

    PubMed

    Kramer, Betty J; Kavanaugh, Melinda; Trentham-Dietz, Amy; Walsh, Matthew; Yonker, James A

    Guided by a stress process conceptual model, this study examines social and psychological determinants of complicated grief symptoms focusing on family conflict, intrapsychic strains, and the potential moderating effect of care quality and hospice utilization. Relying on data from 152 spouse and adult child lung cancer caregiver survey respondents, drawn from an ancillary study of the Assessment of Cancer CarE and SatiSfaction (ACCESS) in Wisconsin, hierarchical multiple regression analysis was used to examine determinants of complicated grief. After controlling for contextual factors and time since death, complicated grief symptoms were higher among caregivers with less education, among families with lower prior conflict but higher conflict at the end-of-life, who had family members who had difficulty accepting the illness, and who were caring for patients with greater fear of death. Additionally, hospice utilization moderated the effect of fear of death on complicated grief. Findings suggest that family conflict, intrapsychic strains, and hospice utilization may help to explain the variability found in complicated grief symptoms among bereaved caregivers. Implications for enhancing complicated grief assessment tools and preventative interventions across the continuum of cancer care are highlighted. PMID:21495532

  3. Hospice Use Following Implantable Cardioverter-Defibrillator Implantation in Older Patients

    PubMed Central

    Reynolds, Matthew R.; Normand, Sharon-Lise; Parzynski, Craig S.; Spertus, John A.; Mor, Vincent; Mitchell, Susan L.

    2016-01-01

    Background— Older recipients of implantable cardioverter-defibrillators (ICDs) are at increased risk for short-term mortality in comparison with younger patients. Although hospice use is common among decedents aged >65, its use among older ICD recipients is unknown. Methods and Results— Medicare patients aged >65 matched to data in the National Cardiovascular Data Registry – ICD Registry from January 1, 2006 to March 31, 2010 were eligible for analysis (N=194 969). The proportion of ICD recipients enrolled in hospice, cumulative incidence of hospice admission, and factors associated with time to hospice enrollment were evaluated. Five years after device implantation, 50.9% of patients were either deceased or in hospice. Among decedents, 36.8% received hospice services. The cumulative incidence of hospice enrollment, accounting for the competing risk of death, was 4.7% (95% confidence interval [CI], 4.6%–4.8%) within 1 year and 21.3% (95% CI, 20.7%–21.8%) at 5 years. Factors most strongly associated with shorter time to hospice enrollment were older age (adjusted hazard ratio, 1.77; 95% CI, 1.73–1.81), class IV heart failure (versus class I; adjusted hazard ratio, 1.79; 95% CI, 1.66–1.94); ejection fraction <20 (adjusted hazard ratio, 1.57; 95% CI, 1.48–1.67), and greater hospice use among decedents in the patients’ health referral region. Conclusions— More than one-third of older patients dying with ICDs receive hospice care. Five years after implantation, half of older ICD recipients are either dead or in hospice. Hospice providers should be prepared for ICD patients, whose clinical trajectories and broader palliative care needs require greater focus. PMID:27016104

  4. 76 FR 26731 - Medicare Program; Hospice Wage Index for Fiscal Year 2012

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-09

    ... methodology. In the April 24, 2009 ``Hospice Wage Index For FY 2010'' proposed rule (74 FR 18,912, 18,920-22) and in the July 22, 2010 ``Hospice Wage Index for FY 2011'' notice with comment period (75 FR 42,944... supplies. 42 U.S.C. 1395x(dd)(1); see also 48 FR 56,008, 56,008 (Dec. 16, 1983) (describing hospice...

  5. Hospice care for patients living alone: results of a demonstration program.

    PubMed

    Bly, J L; Kissick, P

    1994-01-01

    The Wissahickon Hospice initiated a demonstration program in 1988 to provide home hospice care to individuals living at home without primary care persons. This paper describes the planning process and admission requirements for the Live Alone Program and the evaluation results for 34 Live Alone patients compared to 105 regular hospice patients. Principal findings were that the hospice was able to maintain patients at home, to provide care safely to patients, and to enable home deaths for patients living alone. Patients living alone tended to require more supportive services than regular patients and to incur higher patient care costs. PMID:7829035

  6. Psychosocial and spiritual care in hospice: differences between nursing, social work, and clergy.

    PubMed

    Reese, D J; Brown, D R

    1997-01-01

    A chart review of the most recent home visits from nursing, social work, and clergy to 37 home hospice patients indicated that all but two psychosocial and spiritual issues examined were addressed by hospice staff on home visits. Spirituality and, secondly, death anxiety were the most frequently discussed variables. Clergy addressed more spiritual issues than the other two professions, and social work addressed more psychosocial issues than the other two professions. These findings underscore the important roles that clergy and social work play on the hospice team, and imply that hospice should make a renewed commitment to psychosocial and spiritual care. PMID:9248405

  7. Influence of hospice use on hospital inpatient mortality: a state-level analysis.

    PubMed

    Chang, Cyril F; Steinberg, Stephanie C

    2006-01-01

    This study tests the hypothesis that high hospice enrollment is associated with lower Medicare inpatient mortality. The results show that Medicare inpatient mortality in a state can be explained by hospice enrollment and a host of demographic and market environment variables. An increase in hospice population by 100 individuals is associated with a reduction of 28 inpatient deaths, ceteris paribus. The results suggest, among other things, that opportunities exist for greater expansion of hospice capacity in low-use states to reduce deaths in the expensive hospital setting and improve the quality of end-of-life care for terminally ill patients. PMID:16708687

  8. A needs assessment: Fellowship Directors Forum of the American Academy of Hospice and Palliative Medicine.

    PubMed

    Scott, Judy Opatik; Hughes, Lorraine

    2006-04-01

    The Fellowship Directors Forum, a special interest group of the American Academy of Hospice and Palliative Medicine (AAHPM) initiated an assessment of the needs of directors of fellowship programs in the emerging specialty of hospice and palliative care. One major finding, which may contribute to understanding the needs of other new disciplines, is that directors come into this role with clinical and teaching experience, but lacking administrative, educational, and management skills perceived as necessary to success. A study team collected data from current and former fellowship directors across the United States using an online survey and telephone interviews. The survey was sent to 60 current and former directors, with a 60% response rate, and 16 randomly selected directors were interviewed. Results showed that directors believe development of an outcome-based standardized curriculum is vitally important to advancement of the field, and that this should be developed collaboratively through the Forum. Although directors were confident of their own clinical and teaching skills, directors identified a lack of adequate training and experience in several management and educational skill areas critical to running a successful fellowship program. The study team made several recommendations: develop models from parts of existing programs that can be incorporated into a standardized curriculum to meet Accreditation Council of Graduate Medical Education (ACGME) requirements; provide workshops and toolkits for new directors to address the lack of management and educational skills; and establish new communication methods through more or longer forum meetings, a dedicated website, and an online discussion group. PMID:16629556

  9. A patient-centered care ethics analysis model for rehabilitation.

    PubMed

    Hunt, Matthew R; Ells, Carolyn

    2013-09-01

    There exists a paucity of ethics resources tailored to rehabilitation. To help fill this ethics resource gap, the authors developed an ethics analysis model specifically for use in rehabilitation care. The Patient-Centered Care Ethics Analysis Model for Rehabilitation is a process model to guide careful moral reasoning for particularly complex or challenging matters in rehabilitation. The Patient-Centered Care Ethics Analysis Model for Rehabilitation was developed over several iterations, with feedback at different stages from rehabilitation professionals and bioethics experts. Development of the model was explicitly informed by the theoretical grounding of patient-centered care and the context of rehabilitation, including the International Classification of Functioning, Disability and Health. Being patient centered, the model encourages (1) shared control of consultations, decisions about interventions, and management of the health problems with the patient and (2) understanding the patient as a whole person who has individual preferences situated within social contexts. Although the major process headings of the Patient-Centered Care Ethics Analysis Model for Rehabilitation resemble typical ethical decision-making and problem-solving models, the probes under those headings direct attention to considerations relevant to rehabilitation care. The Patient-Centered Care Ethics Analysis Model for Rehabilitation is a suitable tool for rehabilitation professionals to use (in real time, for retrospective review, and for training purposes) to help arrive at ethical outcomes. PMID:23636083

  10. Implementation of hydrologic models at Goddard Space Flight Center

    NASA Technical Reports Server (NTRS)

    1974-01-01

    Major watershed simulation models were implemented on the computer system at NASA Goddard Space Flight Center, and their operation was verified. Historical and physiographic data were acquired for two Maryland river basins (Monocasy River above Jug Bridge and Patuxent River near Laurel, Maryland) and the models were calibrated to simulate them. GSFC personnel were instructed in model operation after the models were implemented.

  11. Staff Evaluation of the JCCC Success Center Model.

    ERIC Educational Resources Information Center

    Weglarz, Shirley G.

    This report describes a survey conducted at Johnson County Community College (JCCC) (Kansas) to measure staff perceptions, attitudes, and satisfaction with a variety of aspects of the Success Center/Student Services model, upon which the college's two-year old Success Center is based. Surveys were distributed in December 2001 to 107 Student Center…

  12. Caregivers' experiences seeking hospice care for loved ones with dementia.

    PubMed

    Lewis, Laura Foran

    2014-09-01

    As the prevalence of dementia continues to grow, informal caregivers face unique challenges as they approach the end of life, and access to support and palliative care is often limited. I used a phenomenological approach to explore the experiences of caregivers actively seeking formal end-of-life care, in particular hospice care, for a loved one with dementia. In-depth interviews with 11 caregivers about 14 patients revealed five themes, including: setting the stage for heartbreak, reaching the boiling point, getting through the front lines, settling for less, and welcoming death. Nurses must recognize the complex needs of caregivers, educate caregivers on the disease process, and adjust to palliative goals sooner to meet the needs of caregivers. Prevalence of these issues must be further examined through quantitative study to evaluate the need to reconsider current hospice eligibility criteria based on prognosis. PMID:25079503

  13. Qualitative pain classification in hospice and pain therapy unit.

    PubMed

    Raffaeli, William; Andruccioli, Jessica; Florindi, Stefania; Ferioli, Isabella; Monterubbianesi, Maria Cristina; Sarti, Donatella; Castellani, Francesca; Giarelli, Guido

    2012-12-01

    In this study, we investigated patient's meaning attribution to pain in hospice and pain therapy unit, using a qualitative approach: narrative-based medicine. The data presented here were related to patients (n = 17) hospitalized in Rimini Hospice (Italy). These data were compared to those of patients (n = 21) with noncancer pain (control sample). The interviews were then analyzed according to the technique of thematic narrative analysis. The results of our research identified a differential process in pain processing in relationship to the meaning that the patient attributed to pain. The thematic analysis of the interviews allowed the inductive construction of a specific network of pain dimensions, which were summarized in "the pain chronogram." PMID:22310024

  14. A Review of Barriers to Utilization of the Medicare Hospice Benefits in Urban Populations and Strategies for Enhanced Access

    PubMed Central

    McHenry, Janet; Snow, Daniel; Cassin, Carolyn; Schumacher, Donald; Selwyn, Peter A.

    2008-01-01

    Disparities in access to health care extend to end-of-life care. Lack of access to hospice mirrors lack of access to health maintenance and primary care. Patients who are served by hospice nationally are disproportionately white and likely to reside in economically stable communities. In many urban low-income communities, less than 5% of decedents receive hospice care in the last 6 months of life. This review focuses on barriers to palliative care and hospice in urban, predominantly low-income communities, including cultural and reimbursement factors and the paucity of hospice providers, outreach projects, and in-patient hospice beds in urban communities. This review will also address some strategies that are being implemented by hospices locally and nationally to overcome demographic barriers to hospice care. PMID:18240022

  15. Two dimensional thick center vortex model

    NASA Astrophysics Data System (ADS)

    Rafibakhsh, Shahnoosh; Ahmadi, Alireza

    2016-01-01

    The potential between static color source is calculated in the SU (3) gauge group by introducing a two dimensional vortex flux. To generalize the model, the length of the Wilson loop is equal to R oriented along the x axis, and the vortex flux is considered as a function of x and y. The comparison between the generalized model and the original one shows that the intermediate linear regime is increased significantly and better agreement with Casimir scaling is achieved. Furthermore, the model is applied to calculate the potential between baryons.

  16. Dignity Therapy Implementation in a Community-Based Hospice Setting

    PubMed Central

    Montross, Lori; Winters, Kathryn D.

    2011-01-01

    Abstract Background Dignity Therapy is a brief, empirically supported, individualized psychotherapy designed to address legacy needs among patients at the end of life. To date, this psychotherapy has not been implemented in a “real-world” community-based hospice setting. This study was designed to offer information about the pragmatic aspects of implementing Dignity Therapy for patients receiving hospice care. Method Twenty-seven patients completed Dignity Therapy as part of a clinical service newly offered at a community-based hospice. Referral and enrollment procedures, as well as the logistics of therapy implementation were monitored. Patients' legacy transcripts were also qualitatively analyzed to measure emergent themes. Results Patients were most commonly referred by social workers, and on average produced Dignity Therapy legacy transcripts approximately 3000 words/8 pages in length. The mean number of sessions spent with patients was 4, equating to an average of 380 minutes of clinician time per patient. Qualitative analyses revealed the most commonly discussed topics among patients were (in rank order): autobiographical information, love, lessons learned in life, defining roles in vocations or hobbies, accomplishments, character traits, unfinished business, hopes and dreams, catalysts, overcoming challenges, and guidance for others. Discussion This was the first study to implement Dignity Therapy in a community sample, with results highlighting the practical aspects of treatment as well as the most common themes discussed by clinical patients in a hospice setting. These findings provide useful data for clinicians or organizational leaders who may consider offering Dignity Therapy in their setting, and offer general insight regarding the legacy topics most frequently discussed by patients near the end of life. PMID:21548823

  17. Informal hospice caregiver pain management concerns: A qualitative study

    PubMed Central

    Kelley, Marjorie; Demiris, George; Nguyen, Huong; Oliver, Debra P; Wittenberg-Lyles, Elaine

    2014-01-01

    Background Informal, unpaid, family caregivers provide much hospice care in the United States. These caregivers suffer physically, psychologically, emotionally, and socially from the burden of caring. The most often identified area of caregiver burden is the management of end-of-life pain. However, little empirical evidence exists of effective interventions to help caregivers manage end-of-life pain, and issues surrounding caregiver pain management remain vague and undefined. Understanding these concerns will inform the design of effective caregiver interventions. Aim The purpose of this study was to describe and organize caregiver pain management challenges faced by home hospice caregivers of cancer patients. Design A content analysis of secondary data, namely, recordings of caregiver interviews, was conducted to describe pain management issues. These interviews were part of a larger clinical trial. Setting/participants Multiple sessions with 29 informal caregivers, of patients dying of cancer, were audio-recorded. Subjects were purposively selected from two hospice programs in the Northwestern United States. Caregivers of noncancer patients were excluded from the study sample. Results A framework of six major themes with subordinate subthemes was developed through a literature review and peer review. The framework was used to organize the content of 87 caregiver interviews. The six major themes identified in the analysis included Caregiver-Centric Issues, Caregiver Medication Skills and Knowledge Issues, End-of-Life Symptom Knowledge Issues, Communication and Teamwork Issues, Organizational Skill Issues, and Patient-Centric Issues. Conclusion This analysis clearly articulated and classified caregiver issues surrounding pain management. Future hospice research may benefit from the use of this analysis and framework in the development of tools to alleviate this major cause of caregiver burden. PMID:23612959

  18. The Wisconsin Small Business Development Center Information Service: A Model.

    ERIC Educational Resources Information Center

    Awe, Susan C.

    1986-01-01

    Presents the model of the Information Service of the Wisconsin Small Business Development Center Information Service, including the objectives and tasks necessary to develop an information service, and staffing and funding guidelines for the first two years. (EJS)

  19. 72. VISITOR'S CENTER, MODEL OF BOILER CHAMBER, AUXILIARY CHAMBER, REACTOR ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    72. VISITOR'S CENTER, MODEL OF BOILER CHAMBER, AUXILIARY CHAMBER, REACTOR AND CANAL (LOCATION T) - Shippingport Atomic Power Station, On Ohio River, 25 miles Northwest of Pittsburgh, Shippingport, Beaver County, PA

  20. Supramolecular structures modeling photosynthetic reaction center function

    SciTech Connect

    Wasielewski, M.R.; Gaines, G.L. III; Gosztola, D.; Niemczyk, M.P.; Svec, W.A.

    1992-08-20

    Work in our laboratory has focused on the influence of solvent motion on the rates and energetics of photochemical charge separation in glassy solids. The efficiencies of many nonadiabatic electron transfer reactions involving photochemical electron donors with relatively low excited state energies, such as porphyrins and chlorophylls, are poor in the solid state. Recent work has shown that placing a porphyrin-acceptor system in a glassy solid at low temperature significantly raises the energy of ks ion-pair state. This destabilization can be as much as 0.8 eV relative to the ion pair state energy in a polar liquid. This contrasts sharply with photosynthetic reaction centers, which maintain medium-independent electron transfer rates with relatively small free energies of charge separation. Using this information we have set out to design photochemical systems that produce long-lived radical ion pairs in glassy solids with high quantum efficiency. These systems maintain their efficiency when placed in other glassy matrices, such as polymers. An important consequence of this effort is the design of molecules that minimize the electronic interaction between the oxidized donor and reduced acceptor. This minimization can be attained by careful design of the spacer groups linking the donor and acceptor and by using more than a single electron transfer step to increase the distance between the separated charges as is done in natural photosynthesis.

  1. The impact of volunteering in hospice palliative care.

    PubMed

    Claxton-Oldfield, Stephen; Claxton-Oldfield, Jane

    2007-01-01

    The goal of this study was to examine the impact of hospice palliative care work on volunteers' lives. In-depth interviews were conducted with 23 direct-patient care volunteers. More than half of the volunteers became involved in hospice palliative care because of their own experiences with family members and/or friends who have died. Most of the volunteers reported that they were different now or had changed in some way since they have been volunteering (e.g., they had grown in some way, have learned how to keep things in perspective). In addition, most of the volunteers felt that their outlook on life had changed since they started volunteering (e.g., they were more accepting of death, and they learned the importance of living one day at a time). Volunteers reported doing a number of different things to prevent compassion fatigue or burnout (e.g., reading a book, listening to music, talking to others, and taking time off from volunteering). Most of the volunteers said that they would tell anyone who might be thinking of volunteering in hospice palliative care that it is a very rewarding activity and/or that they should try it. Finally, many of the volunteers offered suggestions for doing things differently in their programs. PMID:17895491

  2. Research Tools Available at the Community Coordinated Modeling Center

    NASA Astrophysics Data System (ADS)

    Berrios, D. H.; Maddox, M.; Rastaetter, L.; Chulaki, A.; Hesse, M.

    2007-12-01

    The Community Coordinated Modeling Center (CCMC), located at NASA Goddard Space Flight Center, provides access to state-of-the-art space weather models to the research community. The majority of the models residing at the CCMC are comprehensive computationally intensive physics-based models. The CCMC also provides free services and tools to assist the research community in analyzing the results from the space weather model simulations. We present an overview of the available services at the CCMC: the Runs-On-Request system, the online visualizations, the Kameleon access and interpolation library, and the CCMC Space Weather Widget. Finally, we discuss the future services and tools in development.

  3. To center or not to center? Investigating inertia with a multilevel autoregressive model

    PubMed Central

    Hamaker, Ellen L.; Grasman, Raoul P. P. P.

    2015-01-01

    Whether level 1 predictors should be centered per cluster has received considerable attention in the multilevel literature. While most agree that there is no one preferred approach, it has also been argued that cluster mean centering is desirable when the within-cluster slope and the between-cluster slope are expected to deviate, and the main interest is in the within-cluster slope. However, we show in a series of simulations that if one has a multilevel autoregressive model in which the level 1 predictor is the lagged outcome variable (i.e., the outcome variable at the previous occasion), cluster mean centering will in general lead to a downward bias in the parameter estimate of the within-cluster slope (i.e., the autoregressive relationship). This is particularly relevant if the main question is whether there is on average an autoregressive effect. Nonetheless, we show that if the main interest is in estimating the effect of a level 2 predictor on the autoregressive parameter (i.e., a cross-level interaction), cluster mean centering should be preferred over other forms of centering. Hence, researchers should be clear on what is considered the main goal of their study, and base their choice of centering method on this when using a multilevel autoregressive model. PMID:25688215

  4. Discharge Hospice Referral and Lower 30-Day All-Cause Readmission in Medicare Beneficiaries Hospitalized for Heart Failure

    PubMed Central

    Kheirbek, Raya E.; Fletcher, Ross D.; Bakitas, Marie A.; Fonarow, Gregg C.; Parvataneni, Sridivya; Bearden, Donna; Bailey, F. Amos; Morgan, Charity J.; Singh, Steven; Blackman, Marc R.; Zile, Michael R.; Patel, Kanan; Ahmed, Momanna B.; Tucker, Rodney O.; Brown, Cynthia J.; Love, Thomas E.; Aronow, Wilbert S.; Roseman, Jeffrey M.; Rich, Michael W.; Allman, Richard M.; Ahmed, Ali

    2015-01-01

    Background Heart failure (HF) is the leading cause for hospital readmission. Hospice care may help palliate HF symptoms but its association with 30-day all-cause readmission remains unknown. Methods and Results Of the 8032 Medicare beneficiaries hospitalized for HF in 106 Alabama hospitals (1998–2001), 182 (2%) received discharge hospice referrals. Of the 7850 patients not receiving hospice referrals, 1608 (20%) died within 6 months post-discharge (the hospice-eligible group). Propensity scores for hospice referral were estimated for each of the 1790 (182+1608) patients and were used to match 179 hospice-referral patients with 179 hospice-eligible patients who were balanced on 28 baseline characteristics (mean age, 79 years, 58% women, 18% African American). Overall, 22% (1742/8032) died in 6 months, of whom 8% (134/1742) received hospice referrals. Among the 358 matched patients, 30-day all-cause readmission occurred in 5% and 41% of hospice-referral and hospice-eligible patients, respectively (hazard ratio {HR} associated with hospice referral, 0.12; 95% confidence interval {CI}, 0.06–0.24). HRs (95% CIs) for 30-day all-cause readmission associated with hospice referral among the 126 patients who died and 232 patients who survived 30-day post-discharge were 0.03 (0.04–0.21) and 0.17 (0.08–0.36), respectively. Although 30-day mortality was higher in the hospice referral group (43% vs. 27%), it was similar at 90 days (64% vs. 67% among hospice-eligible patients). Conclusions A discharge hospice referral was associated with lower 30-day all-cause readmission among hospitalized HF patients. However, most HF patients who died within 6 months of hospital discharge did not receive a discharge hospice referral. PMID:26019151

  5. Conducting Research: A Student-Centered Model.

    ERIC Educational Resources Information Center

    Duffield, Judith A.

    1998-01-01

    Claims that the importance of gaining information literacy skills is in the use of information rather than the finding of information but that many students undertaking research projects do not understand this. Describes a research process model developed for use in a classroom setting and gives a sample lesson using its steps: presearch, search,…

  6. Models of Urban Redevelopment: Renaissance Center or the Solidary Neighborhood.

    ERIC Educational Resources Information Center

    Bolger, Rory

    This paper examines the attempts to rebuild downtown Detroit. Two models for redevelopment are examined: (1) the use of private sector investment as exemplified by the Renaissance Center Complex; and (2) the "solidary neighborhood" model, which involves the use of community labor and participation. The "Renaissance model" of redevelopment is…

  7. Interdisciplinary Team Training: Content and Methodology. Interdisciplinary Team Training and Humanistic Patient Care for Hospices. Monograph 4.

    ERIC Educational Resources Information Center

    Wilson, Dottie C.; Grady, Kathleen A.

    This monograph, the fourth in a series of five, provides training information for hospice staff in improving interdisciplinary team functions and humanistic care provisions. Its purpose is to prepare a skilled team of trainers with information about hospices that is relevant to hospice interdisciplinary team training and to document experiences in…

  8. Development and assessment of a biotechnology workforce development center model

    NASA Astrophysics Data System (ADS)

    Huxley, Mary Pat

    Life science and biotechnology companies are the fastest growing industries in the nation, with more than 30% of these companies and close to 50% of the nation's life science workers located in California. The need for well-trained biotechnology workers continues to grow. Educational institutions and industry professionals have attempted to create the training and the workforce for the bioscience and biotechnology industry. Many have concluded that one way would be to create a multiuse training center where trainees from high school age through late adulthood could receive up-to-date training. This case study had 2 unique phases. Phase 1 consisted of examining representative stakeholder interview data for characteristics of an ideal biotechnology shared-use regional education (B-SURE) center, which served as the basis for an assessment tool, with 107 characteristics in 8 categories. This represented what an ideal center model should include. Phase 2 consisted of using this assessment tool to gather data from 6 current biotechnology regional centers to determine how these centers compared to the ideal model. Results indicated that each center was unique. Although no center met all ideal model characteristics, the 6 centers could clearly be ranked. Recommendations include refining the core characteristics, further assessing the existing and planned centers; evaluating and refining the interview instrument in Phase 1 and the assessment tool in Phase 2 by including additional stakeholders in both phases and by adding reviewers of Phase 1 transcripts; and determining a method to demonstrate a clear return on investment in a B-SURE center.

  9. In Search of Models of Care

    ERIC Educational Resources Information Center

    Davidson, Glen W.

    1978-01-01

    Without careful definition of "spiritual," hospice care will be little different in quality from that offered in acute and chronic care centers. Also discussed is the challenge to hospice care staff to defy trends in recent health care allowing staff rather than patients to determine what dignity means. (Author)

  10. 42 CFR 418.76 - Condition of participation: Hospice aide and homemaker services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... the need for respect for the patient, his or her privacy, and his or her property. (ix) Appropriate... Participation: Patient Care Non-Core Services § 418.76 Condition of participation: Hospice aide and homemaker... other hospice staff. (ii) Observation, reporting, and documentation of patient status and the care...

  11. Hospice Use among Urban Black and White U.S. Nursing Home Decedents in 2006

    ERIC Educational Resources Information Center

    Lepore, Michael J.; Miller, Susan C.; Gozalo, Pedro

    2011-01-01

    Purpose: Medicare hospice is a valuable source of quality care at the end of life, but its lower use by racial minority groups is of concern. This study identifies factors associated with hospice use among urban Black and White nursing home (NH) decedents in the United States. Design and Methods: Multiple data sources are combined and multilevel…

  12. Training Program Design. Interdisciplinary Team Training and Humanistic Patient Care for Hospices. Monograph 3.

    ERIC Educational Resources Information Center

    English, David J.; Mortenson, Lee E.

    This monograph, the third in a series of five, provides training information for hospice staff in improving interdisciplinary team functions and humanistic care provisions. Its purpose is to describe the steps in designing a training program for a particular hospice and the activities undertaken between the selection of the trainers and the…

  13. Traits of Hospice Nurses Compared with Those Who Work in Traditional Settings.

    ERIC Educational Resources Information Center

    Amenta, Madalon M.

    1984-01-01

    Compared 36 hospice nurses with 35 nurses who were working in traditional settings. Data from a battery of five tests revealed the hospice nurses to be significantly more assertive, imaginative, forthright, free-thinking and independent than their collegues, who scored lower than the norms. (LLL)

  14. Linking Family Life and Health Professionals, Volunteers, and Family Life Students in a Community Hospice Program.

    ERIC Educational Resources Information Center

    Fruit, Dorothy

    This paper describes the Portage County, Ohio community hospice program, emphasizing the linkages between family life specialists, health professionals, volunteers, and students. Hospice service is defined as a specialized, home-based program for the management of pain and other symptoms of terminal illness, with the family as the unit of care.…

  15. Hospice in Assisted Living: Promoting Good Quality Care at End of Life

    ERIC Educational Resources Information Center

    Cartwright, Juliana C.; Miller, Lois; Volpin, Miriam

    2009-01-01

    Purpose: The purpose of this study was to describe good quality care at the end of life (EOL) for hospice-enrolled residents in assisted living facilities (ALFs). Design and Methods: A qualitative descriptive design was used to obtain detailed descriptions of EOL care provided by ALF medication aides, caregivers, nurses, and hospice nurses in…

  16. The Philosophy and Practice of Patient Control in Hospice: The Dynamics of Autonomy versus Paternalism.

    ERIC Educational Resources Information Center

    Mesler, Mark A.

    1995-01-01

    Based on nearly three years of participant-observation research in hospice settings, factors that interfere with the hospice philosophy of providing patient autonomy include efforts at symptom control, patient residence, patient disease state, and staff limit setting. Discusses examples, implications, and staff attempts at solutions. (JPS)

  17. Impact of Hospice Volunteer Training on Death Anxiety and Locus of Control.

    ERIC Educational Resources Information Center

    Hayslip, Bert; Walling, Mary L.

    1986-01-01

    Examined effects of hospice volunteer training program on locus of control and death anxiety by comparing 29 hospice volunteers who underwent volunteer training course and 30 controls. Results indicated both groups decreased in generalized conscious death fear, but increased in their conscious fear of others' deaths, although experimental…

  18. Portraits of Caregivers of End-Stage Dementia Patients Receiving Hospice Care

    ERIC Educational Resources Information Center

    Sanders, Sara; Butcher, Howard K.; Swails, Peggy; Power, James

    2009-01-01

    The purpose of this study was to investigate how caregivers respond to the end stages of dementia with the assistance from hospice. Data were collected from 27 family caregivers over the course of 10 months, with each caregiver being interviewed up to 4 times during the time that the patient received hospice care. Chart review data were also…

  19. Negotiating Life for the Dying: Hospice and the Strategy of Tactical Socialization.

    ERIC Educational Resources Information Center

    Mesler, Mark A.

    1995-01-01

    Participant-observation research was conducted in the home care components of a free-standing inpatient facility associated with several hospice organizations over three years. The data are reported using negotiated order theory as a framework for understanding the hospice movement and its attempts to change the experience of dying. (JPS)

  20. 78 FR 26250 - Payment for Home Health Services and Hospice Care to Non-VA Providers

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-06

    ... November 21, 2011 (76 FR 71920), VA proposed to amend its regulations concerning the billing methodology... AFFAIRS 38 CFR Part 17 RIN 2900-AN98 Payment for Home Health Services and Hospice Care to Non-VA Providers... services and hospice care. Because the newly applicable methodology cannot supersede rates for which VA...

  1. Hospice Care in Nursing Homes: Does It Contribute to Higher Quality Pain Management?

    ERIC Educational Resources Information Center

    Kayser-Jones, Jeanie S.; Kris, Alison E.; Miaskowski, Christine A.; Lyons, William L.; Paul, Steven M.

    2006-01-01

    Purpose: The purpose of this study was to investigate pain management among 42 hospice and 65 non-hospice residents in two proprietary nursing homes. Design and Methods: In this prospective, anthropological, quantitative, and qualitative study, we used participant observation, event analysis, and chart review to obtain data. The Medication…

  2. 42 CFR 418.76 - Condition of participation: Hospice aide and homemaker services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... of hospice aide classroom and supervised practical training. (1) Hospice aide training must include classroom and supervised practical training in a practicum laboratory or other setting in which the trainee... nurse, or a licensed practical nurse, who is under the supervision of a registered nurse. Classroom...

  3. 42 CFR 418.76 - Condition of participation: Hospice aide and homemaker services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... of hospice aide classroom and supervised practical training. (1) Hospice aide training must include classroom and supervised practical training in a practicum laboratory or other setting in which the trainee... nurse, or a licensed practical nurse, who is under the supervision of a registered nurse. Classroom...

  4. 42 CFR 418.76 - Condition of participation: Hospice aide and homemaker services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... of hospice aide classroom and supervised practical training. (1) Hospice aide training must include classroom and supervised practical training in a practicum laboratory or other setting in which the trainee... nurse, or a licensed practical nurse, who is under the supervision of a registered nurse. Classroom...

  5. How they cope: a qualitative study of the coping skills of hospice volunteers.

    PubMed

    Brown, Mary V

    2011-09-01

    The purpose of this phenomenological study was to examine the coping techniques utilized by hospice volunteers. Individual semi-structured interviews were conducted with 15 hospice volunteers who had at least 1 year of experience, working as a hospice volunteer with direct patient care. The interviews were digitally recorded, transcribed, and analyzed utilizing qualitative research methods. The results indicated the volunteers used problem-focused coping (seeking advice from members of the hospice interdisciplinary team), emotion-focused coping (talking with others, going to funerals), meaning making through appraisal (religious beliefs, downward comparison), and physical techniques (walking, deep breathing). The most significant coping mechanism utilized for the volunteer was talking with the volunteer coordinator. Implications for hospice volunteer coordinators are also discussed. PMID:21262760

  6. Values important to terminally ill African American older adults in receiving hospice care.

    PubMed

    Noh, Hyunjin

    2014-01-01

    While racial disparity in the use of hospice care by older African Americans is widely acknowledged, little is known about the values that they consider as important in receiving health care services along with direct experiences with having these values respected by hospice care providers. Using individual, face-to-face interviews, data were collected directly from 28 African American hospice patients about their experiences in hospice care. Content analysis was used to identify and categorize themes from multiple readings of the qualitative data. Resulting themes included: dying at home, open communications, independent decision-making, autonomy in daily life, unwillingness to be a burden, and relationships. Through the initial assessment, value preferences can be explored and then shared with hospice team members to ensure that services are provided in such a way that their values and preferences are respected. PMID:25494930

  7. Quality improvement in hospice: adding a big job to an already big job?

    PubMed

    Durham, Danielle D; Rokoske, Franziska S; Hanson, Laura C; Cagle, John G; Schenck, Anna P

    2011-01-01

    Hospice organizations are adopting quality measurement and quality improvement (QI) practices to comply with the Medicare Conditions of Participation effective January 31, 2009. However, little is known about organizational best practices or specific needs during implementation. This study identified and described the barriers and facilitators to QI implementation in hospice. Using semistructured interviews with a national sample of key informants (n = 52) concerning facilitators and barriers to QI in hospice, 4 major themes emerged from the data regarding participants' experiences and perceptions: (1) external factors constrain QI implementation; (2) internal factors limit capacity for QI; (3) research on best practices is limited; and (4) traditional QI may not be a good fit for hospice. Though challenging, participants provided recommendations that they believed would facilitate QI in hospice. Categorizing barriers and facilitators as within or outside an organization's control may help organizations assess their capabilities and locate resources to address areas for improvement. PMID:21403176

  8. A team approach to recruitment in hospice research: engaging patients, close people and health professionals.

    PubMed

    L Campbell, Cathy; Bailey, Cara; Armour, Kathy; Perry, Rachel; Orlando, Rosanna; Kinghorn, Philip; Jones, Louise; Coast, Joanna

    2016-07-01

    Research is vital to the future development of hospice care. However, research in hospice settings is very challenging. This paper describes a case study of a successful multidisciplinary research team approach (MDRT) to the recruitment of participants (hospice patients, family members and health professionals) for a study in a hospice setting on the economic evaluation of end-of-life care. A successful recruitment plan includes three key strategies: identifying key members of the MDRT early in the research process; having a clear and constant communication stream; and creating an environment where all team members have a shared commitment to the research, all voices are heard and valued, and everyone contributes to the research aims. An MDRT approach will be helpful to guide the development of successful recruitment plans for academic-community research partnerships in the hospice setting. PMID:27444161

  9. Complementary and alternative medicine utilization in Texas hospices: prevalence, importance, and challenges.

    PubMed

    Olotu, Busuyi S; Brown, Carolyn M; Lawson, Kenneth A; Barner, Jamie C

    2014-05-01

    The purpose of this study was to describe the prevalence, importance, and challenges of complementary and alternative medicine (CAM) utilization in Texas hospices. Mail surveys were sent to 369 hospices in Texas, and 110 useful surveys were returned. Results showed that a majority (n = 62, 56.4%) of hospices offer CAM to their clients, with the most popularly offered CAMs being massage, music, and relaxation therapies. Despite the availability of CAM services in most hospices, and that the utilization of CAM has the potential to improve overall quality of life of patients, our results showed that a sizeable proportion of patients in these hospices are not utilizing the provided CAMs. Funding and personnel constraints were substantial obstacles to offering CAM. PMID:23625931

  10. New Teacher Center Induction Model. What Works Clearinghouse Intervention Report

    ERIC Educational Resources Information Center

    What Works Clearinghouse, 2015

    2015-01-01

    The "New Teacher Center (NTC) Induction Model" is a systemic approach to support beginning teachers (i.e., teachers new to the profession). Based on the research, the "NTC Induction Model" was found to have no discernible effects on teacher retention in the school district, teacher retention in the profession, or teacher…

  11. 25. CURRENT METERS: GURLEY MODEL NO. 665 AT CENTER, GURLEY ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    25. CURRENT METERS: GURLEY MODEL NO. 665 AT CENTER, GURLEY MODEL NO. 625 'PYGMY' CURRENT METER AT LEFT, AND WES MINIATURE PRICE-TYPE CURRENT METER AT RIGHT. - Waterways Experiment Station, Hydraulics Laboratory, Halls Ferry Road, 2 miles south of I-20, Vicksburg, Warren County, MS

  12. Space Weather Products at the Community Coordinated Modeling Center

    NASA Technical Reports Server (NTRS)

    Hesse, Michael; Kuznetsova, M.; Pulkkinen, A.; Maddox, M.; Rastaetter, L.; Berrios, D.; MacNeice, P.

    2010-01-01

    The Community Coordinated Modeling Center (CCMC) is a US inter-agency activity aiming at research in support of the generation of advanced space weather models. As one of its main functions, the CCMC provides to researchers the use of space science models, even if they are not model owners themselves. The second CCMC activity is to support Space Weather forecasting at national Space Weather Forecasting Centers. This second activity involves model evaluations, model transitions to operations, and the development of space weather forecasting tools. Owing to the pace of development in the science community, new model capabilities emerge frequently. Consequently, space weather products and tools involve not only increased validity, but often entirely new capabilities. This presentation will review the present state of space weather tools as well as point out emerging future capabilities.

  13. Interdisciplinary perceptions of the social work role in hospice: building upon the classic Kulys and Davis study.

    PubMed

    Reese, Dona J

    2011-01-01

    This national survey found that hospice directors (n = 43) considered social workers most qualified, and most involved, in 12 of 24 interventions considered by social workers to define their role. This is a change from Kulys and Davis' ( 1986 , 1987 ) findings of a more limited social work role in hospice. The results of the current study provide new information about director attitudes, social work involvement, and the impact of efforts to develop the hospice social work field. Social work education should incorporate more end-of-life care content to continue this progress, and hospice social workers should continue to document their effectiveness on the hospice team. PMID:22150181

  14. Customer-centered careflow modeling based on guidelines.

    PubMed

    Huang, Biqing; Zhu, Peng; Wu, Cheng

    2012-10-01

    In contemporary society, customer-centered health care, which stresses customer participation and long-term tailored care, is inevitably becoming a trend. Compared with the hospital or physician-centered healthcare process, the customer-centered healthcare process requires more knowledge and modeling such a process is extremely complex. Thus, building a care process model for a special customer is cost prohibitive. In addition, during the execution of a care process model, the information system should have flexibility to modify the model so that it adapts to changes in the healthcare process. Therefore, supporting the process in a flexible, cost-effective way is a key challenge for information technology. To meet this challenge, first, we analyze various kinds of knowledge used in process modeling, illustrate their characteristics, and detail their roles and effects in careflow modeling. Secondly, we propose a methodology to manage a lifecycle of the healthcare process modeling, with which models could be built gradually with convenience and efficiency. In this lifecycle, different levels of process models are established based on the kinds of knowledge involved, and the diffusion strategy of these process models is designed. Thirdly, architecture and prototype of the system supporting the process modeling and its lifecycle are given. This careflow system also considers the compatibility of legacy systems and authority problems. Finally, an example is provided to demonstrate implementation of the careflow system. PMID:22318459

  15. Parenteral inotropic therapy in the home: an update for home care and hospice.

    PubMed

    Lyons, Margaret G; Carey, Lawrence

    2013-04-01

    This article provides an evidence-based overview of heart failure (HF), including its pathogenesis, staging, assessment, prognosis, and treatment with intravenous inotropic medications in the home. Inotropic infusions in the home setting require advanced care planning, symptom management, and knowledge about ambulatory pumps and devices. These medications can be safely used throughout the continuum of care as pediatric/adult bridges from transplant to hospice care. Nurses who recognize advanced HF symptomatology and use prognostic/risk-stratification models will be better prepared to facilitate this advanced care planning, thus supporting optimal treatment outcomes. The ultimate goal of care for heart failure therapy in the home is to integrate pharmacotherapeutic knowledge of treatment advances with comfort measures and to provide them to patients concurrently and in a seamless process. PMID:23549250

  16. [Support of the family with schizophrenia in case of home hospice care].

    PubMed

    Hirooka, Kayo; Watanabe, Miyako; Kawagoe, Koh

    2013-08-01

    There are various types of families of terminally-ill cancer patients, and care for the family should therefore be individualized. In cases where the primary caregivers have schizophrenia, caring for the patients at home might cause a serious burden to a family. From this aspect, two patients who were cared for by family with schizophrenia were reviewed. Four important factors were obtained. First, assessment of psychiatric conditions of the family collaborating with the psychiatrist or public health nurse; second, confirmation of the patients'/family's wills concerning living through death at home; third, death education given to a family; and fourth, efficient collaboration with social services by an other organization. It was considered that these factors would constitute a model for providing home hospice care to a family with schizophrenia. PMID:23986065

  17. Hospice and palliative medicine: curriculum evaluation and learner assessment in medical education.

    PubMed

    Sanchez-Reilly, Sandra; Ross, Jeanette S

    2012-01-01

    Major efforts have been pursued to improve palliative care education for physicians at all levels of their training. Such changes include the incorporation of palliative care curriculum and guidelines, an established process for competency-based evaluation and certification, faculty development, innovative educational experiences, the improvement of textbooks, and the establishment of accredited palliative medicine fellowships. Hospice and palliative medicine (HPM) has been clearly defined as a subspecialty and a crucial area of medical education. As innovative curricular approaches have become available to educate medical and other interprofessional trainees, this article aims to describe different models and methods applied in curriculum evaluation, tailoring such approaches to the field of palliative medicine. A stepwise process of curriculum development and evaluation is described, focusing on available curriculum evaluation competency-based tools for each level of learners. As HPM evolves and its educational programs grow, curriculum evaluation will provides invaluable feedback to institutions and programs in many ways. PMID:22268408

  18. Confining bond rearrangement in the random center vortex model

    NASA Astrophysics Data System (ADS)

    Altarawneh, Derar; Höllwieser, Roman; Engelhardt, Michael

    2016-03-01

    We present static meson-meson and baryon-antibaryon potentials in Z (2 ) and Z (3 ) random center vortex models for the infrared sector of Yang-Mills theory, i.e., hypercubic lattice models of random vortex world surfaces. In particular, we calculate multiple Polyakov loop correlators corresponding to static meson-meson or baryon-antibaryon configurations in a center vortex background and observe that their expectation values follow the minimal area law, displaying bond rearrangement behavior, a characteristic expected for the confining dynamics of the strong interaction. The static meson-meson and baryon-antibaryon potentials are compared with theoretical predictions and lattice QCD simulations.

  19. Center for Modeling of Turbulence and Transition: Research Briefs, 1995

    NASA Technical Reports Server (NTRS)

    1995-01-01

    This research brief contains the progress reports of the research staff of the Center for Modeling of Turbulence and Transition (CMOTT) from July 1993 to July 1995. It also constitutes a progress report to the Institute of Computational Mechanics in Propulsion located at the Ohio Aerospace Institute and the Lewis Research Center. CMOTT has been in existence for about four years. In the first three years, its main activities were to develop and validate turbulence and combustion models for propulsion systems, in an effort to remove the deficiencies of existing models. Three workshops on computational turbulence modeling were held at LeRC (1991, 1993, 1994). At present, CMOTT is integrating the CMOTT developed/improved models into CFD tools which can be used by the propulsion systems community. This activity has resulted in an increased collaboration with the Lewis CFD researchers.

  20. Center for modeling of turbulence and transition: Research briefs, 1993

    NASA Technical Reports Server (NTRS)

    Liou, William W. (Editor)

    1994-01-01

    This research brief contains the progress reports of the research staff of the Center for Modeling of Turbulence and Transition (CMOTT) from June 1992 to July 1993. It is also an annual report to the Institute for Computational Mechanics in Propulsion located at Ohio Aerospace Institute and NASA Lewis Research Center. The main objectives of the research activities at CMOTT are to develop, validate, and implement turbulence and transition models for flows of interest in propulsion systems. Currently, our research covers eddy viscosity one- and two-equation models, Reynolds-stress algebraic equation models, Reynolds-stress transport equation models, nonequilibrium multiple-scale models, bypass transition models, joint scalar probability density function models, and Renormalization Group Theory and Direct Interaction Approximation methods. Some numerical simulations (LES and DNS) have also been carried out to support the development of turbulence modeling. Last year was CMOTT's third year in operation. During this period, in addition to the above mentioned research, CMOTT has also hosted the following programs: an eighteen-hour short course on 'Turbulence--Fundamentals and Computational Modeling (Part I)' given by CMOTT at the NASA Lewis Research Center; a productive summer visitor research program that has generated many encouraging results; collaborative programs with industry customers to help improve their turbulent flow calculations for propulsion system designs; a biweekly CMOTT seminar series with speakers from within and without the NASA Lewis Research Center including foreign speakers. In addition, CMOTT members have been actively involved in the national and international turbulence research activities. The current CMOTT roster and organization are listed in Appendix A. Listed in Appendix B are the abstracts of the biweekly CMOTT seminar. Appendix C lists the papers contributed by CMOTT members.

  1. Development of a Clinical Protocol for Home Hospice Care for Koreans

    PubMed Central

    Lee, Chang-geol

    2005-01-01

    As the Korean government's recognition of the importance of hospice service grows, the government has initiated a variety of hospice services in Korea. Each hospice organization has shown a significant difference in its health care delivery methods, constitution and care content. Developing a clinical protocol is essential for establishing standardized hospice services. A preliminary protocol was drawn up by examining the records of terminal patients (n=541) in a home hospice organization while elucidating the health problems as well as classifying them through the Home Health Care Classification (HHCC), and by reviewing the relevant nursing interventions and medical treatments in the literature concerning the clinical protocols. Korea's leading hospice specialty groups participated in four rounds of content validity verification processes in order to establish a protocol. A guideline was developed through a team approach, integrating the opinions of doctors, nurses, ministers, volunteers, patients' families, nutritionists and pharmacists. Eighteen health problems and a total of 223 interventions (173 major treatments and nursing interventions, and 50 optional interventions) were included in the final clinical protocol. This study is expected to contribute to the overall qualitative improvement of home hospice care and the subsequent shortening of documentation time. Evaluation tools and a regulatory feedback system need to be developed in order to maintain consistent evaluation procedures based on the continuous promotion and use of the protocol. PMID:15744800

  2. A comparison of hospice and hospital care for people who die: views of the surviving spouse.

    PubMed

    Seale, C; Kelly, M

    1997-03-01

    To compare the quality of inpatient care for dying people in St Christopher's Hospice, London and nearby hospitals in 1994 and make comparisons with earlier studies of the same setting, interviews were undertaken with spouses of people who had died from cancer in these settings, matched by age and sex. The subjects comprised 66 people who had died in 1994, 33 of whom had died in the hospice, 33 in local hospitals. The mean age was 70.2, 61% were male. The hospice group were more likely to know that they were dying and less likely to be admitted as emergencies. Treatment for pain, breathlessness and nausea from both sources provided relief in almost all cases. Most information about the illness was given by hospital doctors before hospice care occurred. Where it occurred, communication by hospice staff was judged better than that by hospital doctors. Staff in hospitals were more likely to be judged 'very busy'. Hospice respondents were less likely to want improvements, and more likely to judge the institution as being 'like a family'. Earlier studies had shown a trend for symptom control to have improved in hospitals but for difference in the psychosocial climate to favour the hospice, By 1994, this latter difference was still obtained. We stress the role of hospital staff and general practitioners in helping patients accept a terminal prognosis, so that better-planned care can proceed. The busy public atmosphere of some hospital wards may not be conducive to the good care of dying people. PMID:9156104

  3. Hospice Services for Complicated Grief and Depression: Results from a National Survey

    PubMed Central

    Ghesquiere, Angela R.; Aldridge, Melissa D.; Johnson-Hürzeler, Rosemary; Kaplan, Daniel; Bruce, Martha L.; Bradley, Elizabeth

    2016-01-01

    OBJECTIVES To describe the prevalence of screening for complicated grief (CG) and depression in hospice and access to bereavement therapy and to examine whether screening and access to therapy varied according to hospice organizational characteristics or staff training and involvement. DESIGN Cross-sectional national survey conducted from 2008 to 2009. SETTING United States. PARTICIPANTS Hospices (N = 591). MEASUREMENTS Whether hospices screened for depression or CG at the time of death or provided access to bereavement therapy (individual or group). Organizational characteristics included region, chain status, ownership, and patient volume. Staffing-related variables included training length and meeting attendance requirements. RESULTS Fifty-five percent of hospices provided screening for CG and depression and access to bereavement therapy, 13% provided screening but not access to bereavement therapy, 24% provided access to bereavement therapy but not screening, and 8% neither screened nor provided access to bereavement therapy. Hospices with 100 patients per day or more were significantly more likely to provide screening and access to bereavement therapy. CONCLUSION Hospices appear to have high capacity to provide screening for CG and depression and to deliver group and individual therapy, but data are needed on whether screeners are evidence based and whether therapy addresses CG or depression specifically. Future work could build upon existing infrastructure to ensure use of well-validated screeners and evidence-based therapies. PMID:26456597

  4. On euthanasia, resistance, and redemption: the moralities and politics of a hospice.

    PubMed

    Broom, Alex

    2012-02-01

    Euthanasia/assisted dying, the desire to hasten death, and religious supportive care at the end of life are controversial issues that have been heavily debated within the academic and medical communities. Little research has been done on hospice patients' views, despite hospices being political spaces, espousing a range of perspectives on assisted dying, religiosity, and "good deaths." In this article I document the presence, articulation, and significance of these issues as perceived and experienced by 20 hospice inpatients in the last 4 weeks of their lives. Key themes to emerge included polarization in desire for hastened death and assisted dying in the hospice; the hospice as a morally bound space situated within particular notions of "dying well"; and the divisive character of religion as part of formalized hospice care. Theoretically, the participants' perspectives on euthanasia/assisted dying and religiosity in the hospice provide a means of unpacking and revealing the moral economy of modern dying practices and the institutional governance and production of "timely deaths." PMID:21908705

  5. Infiltration model for center pivot irrigation on bare soil

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The marked reduction in infiltration rate caused by formation of a soil surface seal due to water droplet impact on bare soil is a well known phenomenon but is rarely considered in infiltration models, especially under center pivot irrigation. The objective of this study was to develop a soil infil...

  6. Prioritization of future research topics for children's hospice care by its key stakeholders: a Delphi study.

    PubMed

    Malcolm, C; Knighting, K; Forbat, L; Kearney, N

    2009-07-01

    The Delphi process, widely used in health research to seek consensus on key issues amongst large stakeholder groups, was adopted to allow families, hospice staff/volunteers and linked professionals to identify and prioritize future research priorities for children's hospice care. In the qualitative Round 1, interviews with families (n = 5), linked professionals (n = 18) and focus groups with hospice staff and volunteers (n = 44) led to the generation of 56 research topics categorised within 14 broad themes. To give a larger number of stakeholders (n = 621) (including families n = 293; hospice staff/volunteers n = 216 and professionals n = 112) the opportunity to rate the importance of each research topic and seek group consensus on the future research priorities for children's hospice care, subsequent Rounds 2 and 3 involved the use of postal questionnaires. Response rates to questionnaires were 44% in Round 2 (274/621) and 83% in Round 3 (204/247). Participants prioritized research topics relating to 1) hospice and respite care needs of young people (aged 16 +), 2) pain and symptom management and 3) bereavement and end-of-life care. There was wide acknowledgement by those took part in the process of the difficulty in rating the topics, and emphasis on the fact that all of the topics raised during the project are of high importance and merit further research. The current salient issues perceived by key stakeholders as being the research priorities for children's hospice care were identified. Addressing these priority topics for research would further contribute to the development of a much needed evidence base in children's hospice and palliative care research and optimise the delivery of children's hospice services that are underpinned by valid and robust research. PMID:19304805

  7. Primary thromboprophylaxis for hospice inpatients: who needs it?

    PubMed

    Gillon, Suzie; Noble, Simon; Ward, Jason; Lodge, Keri-Michele; Nunn, Anne; Koon, Sim; Johnson, Miriam J

    2011-10-01

    Primary thromboprophylaxis (PTP) is a Department of Health priority in England. The NICE guidelines agree that PTP is inappropriate in the dying patient, but should be considered for those with reversible pathology. In the light of continued variation and uncertainty in UK hospice practice, we assessed PTP prescribing in three hospices. Case notes were reviewed from consecutive patients admitted before (300 patients) and after (350 patients) implementation of the Pan Birmingham Cancer Network (PBCN) venous thromboembolism prophylaxis (VTE) prevention guidelines. Just under half (43%; 40%) of patients had a contraindication to anticoagulation and PTP. Whilst just under a tenth (8.6%; 8.7%) in each group had a temporary increased risk of VTE, considerably fewer (3.6%; 6.3%) had a temporary increased risk of VTE without contraindication to PTP. Patients receiving PTP increased slightly from 1% to 3.6% and documentation of PTP decisions increased from 5% to 81%. Whilst the PBCN VTE tool is a useful tool to tailor an approach for this complex patient group, many questions remain. Clinical trials that include patients with advanced disease with relevant outcome measures are needed to help inform the clinicians who care for them. PMID:21310773

  8. Nurses working 12-hour shifts in the hospice setting.

    PubMed

    Hodgson, L A

    1995-04-01

    A system of 12-hour nursing shifts was adopted at a newly-opened independent hospice. This paper presents the results from an exploratory, descriptive study in which nursing staff reported perceived advantages, disadvantages and satisfaction with the 12-hour shift system. A small sample (n = 11) of both qualified and unqualified nurses working the 12-hour shift completed the questionnaire. A content analysis of the qualitative data produced a number of categories relating to the perceived advantages and disadvantages of the 12-hour shift system in relation to the respondents, to the hospice and to patient and family care. The need for continuing to monitor and evaluate the shift system was demonstrated, particularly in relation to patient and family satisfaction, and the quality of care. It was concluded that examining the advantages and disadvantages of the 12-hour shift system increased awareness of the needs of staff, presented a useful way of identifying and managing potential difficulties within the workplace, and highlighted areas for future research. PMID:7606330

  9. Magma to Microbe: Modeling Hydrothermal Processes at Ocean Spreading Centers

    NASA Astrophysics Data System (ADS)

    Lowell, Robert P.; Seewald, Jeffrey S.; Metaxas, Anna; Perfit, Michael R.

    Hydrothermal systems at oceanic spreading centers reflect the complex interactions among transport, cooling and crystallization of magma, fluid circulation in the crust, tectonic processes, water-rock interaction, and the utilization of hydrothermal fluids as a metabolic energy source by microbial and macro-biological ecosystems. The development of mathematical and numerical models that address these complex linkages is a fundamental part the RIDGE 2000 program that attempts to quantify and model the transfer of heat and chemicals from "mantle to microbes" at oceanic ridges. This volume presents the first "state of the art" picture of model development in this context. The most outstanding feature of this volume is its emphasis on mathematical and numerical modeling of a broad array of hydrothermal processes associated with oceanic spreading centers. By examining the state of model development in one volume, both cross-fertilization of ideas and integration across the disparate disciplines that study seafloor hydrothermal systems is facilitated. Students and scientists with an interest in oceanic spreading centers in general and more specifically in ridge hydrothermal processes will find this volume to be an up-to-date and indispensable resource.

  10. Underuse of Hospice Care by Medicaid-Insured Patients With Stage IV Lung Cancer in New York and California

    PubMed Central

    Mack, Jennifer W.; Chen, Kun; Boscoe, Francis P.; Gesten, Foster C.; Roohan, Patrick J.; Weeks, Jane C.; Schymura, Maria J.; Schrag, Deborah

    2013-01-01

    Purpose Medicare patients with advanced cancer have low rates of hospice use. We sought to evaluate hospice use among patients in Medicaid, which insures younger and indigent patients, relative to those in Medicare. Patients and Methods Using linked patient-level data from California (CA) and New York (NY) state cancer registries, state Medicaid programs, NY Medicare, and CA Surveillance, Epidemiology, and End Results–Medicare data, we identified 4,797 CA Medicaid patients and 4,001 NY Medicaid patients ages 21 to 64 years, as well as 27,416 CA Medicare patients and 16,496 NY Medicare patients ages ≥ 65 years who were diagnosed with stage IV lung cancer between 2002 and 2006. We evaluated hospice use, timing of enrollment, and location of death (inpatient hospice; long-term care facility or skilled nursing facility; acute care facility; home with hospice; or home without hospice). We used multiple logistic regressions to evaluate clinical and sociodemographic factors associated with hospice use. Results Although 53% (CA) and 44% (NY) of Medicare patients ages ≥ 65 years used hospice, fewer than one third of Medicaid-insured patients ages 21 to 64 years enrolled in hospice after a diagnosis of stage IV lung cancer (CA, 32%; NY, 24%). A minority of Medicaid patient deaths (CA, 19%; NY, 14%) occurred at home with hospice. Most Medicaid patient deaths were either in acute-care facilities (CA, 28%; NY, 36%) or at home without hospice (CA, 39%; NY, 41%). Patient race/ethnicity was not associated with hospice use among Medicaid patients. Conclusion Given low rates of hospice use among Medicaid enrollees and considerable evidence of suffering at the end of life, opportunities to improve palliative care delivery should be prioritized. PMID:23733768

  11. Expectation in Life Review: A Term of Spiritual Needs Easily Understood by Chinese Hospice Patients.

    PubMed

    Deng, Di; Deng, Qing; Liu, Xiaofang; Xie, Cong Hua; Wu, Xin

    2015-11-01

    Terms such as spirituality and spiritual needs are abstract and difficult to understand. Realization of spirituality of hospice patients was premise in addressing expression of their spiritual needs. This study investigated expectations expressed during life review and tried to prove that the expectation was intelligible term for spiritual needs in Chinese hospice from May 2011 to June 2013. Among the 107 recruited patients, families were the most frequent emotion-expressing recipients, and 133 expectations related to patients' spiritual needs were identified. The emotion-expressing recipients and the patient's expectations were not affected by demographic characteristics. The expectations in life review with hospice patients and their families had the features of spiritual essence. The identified expectation contents could be used to address spiritual needs in hospice care in Chinese. PMID:24963084

  12. Portraits of caregivers of end-stage dementia patients receiving hospice care.

    PubMed

    Sanders, Sara; Butcher, Howard K; Swails, Peggy; Power, James

    2009-07-01

    The purpose of this study was to investigate how caregivers respond to the end stages of dementia with the assistance from hospice. Data were collected from 27 family caregivers over the course of 10 months, with each caregiver being interviewed up to 4 times during the time that the patient received hospice care. Chart review data were also collected. Four distinct caregiver portraits emerged: (a) disengaged; (b) questioning; (c) all-consumed; and (d) reconciled. Caregivers in each portrait differed in how they responded to the impending death of the care recipient, the disease progression, and hospice care. Recognizing the differences in the ways that caregivers respond to the final stages of the disease will assist hospice and other providers in best meeting the needs of the caregivers. PMID:19565686

  13. Essentials of hospice: what every Oklahoma physician needs to know, Part I.

    PubMed

    Winn, Peter; Salinas, Robert

    2004-12-01

    Every physician, regardless of specialty, must advocate and facilitate patient access to comprehensive palliative and hospice care as their patients enter the last phase of life due to advanced disease or a terminal condition. Accordingly, physicians must become familiar with both the general and the disease-specific eligibility guidelines for hospice, the different levels of hospice care, physician re-imbursement for hospice patient care, and become knowledgeable in advance healthcare planning. The latter includes an understanding of Oklahoma's DNR law and the Advance Directive for Health Care (Living Will) law. Physician proficiency in the palliation of pain and non-pain symptoms that occur in patients at end-of-life is critical to alleviate patient suffering and to ensure the patient's peaceful dying. PMID:15732883

  14. Essentials of hospice: what every Oklahoma physician needs to know, Part II.

    PubMed

    Winn, Peter; Salinas, Robert

    2005-01-01

    Every physician, regardless of specialty, must advocate and facilitate patient access to comprehensive palliative and hospice care as their patients enter the last phase of life due to advanced disease or a terminal condition. Accordingly, physicians must become familiar with both the general and the disease-specific eligibility guidelines for hospice, the different levels of hospice care, physician re-imbursement for hospice patient care, and become knowledgeable in advance health care planning. The latter includes an understanding of Oklahoma's DNR law and the Advance Directive for Health Care (Living Will) law. Physician proficiency in the palliation of pain and non-pain symptoms that occur in patients at end-of-life is critical to alleviate patient suffering and to ensure the patient's peaceful dying. PMID:15729991

  15. Seeing is believing - reducing misconceptions about children's hospice care through effective teaching with undergraduate nursing students.

    PubMed

    Price, Jayne; Dornan, Jean; Quail, Lorraine

    2013-09-01

    Children's palliative care has evolved in recent years and is now recognised as a distinct area of health and social care practice. Whilst children's hospices are viewed as central to quality care for these children and families, lack of knowledge regarding the exact nature of care they provide exists. Education can go part way to changing attitudes and knowledge about the key contribution of hospices, thus improving future care. Alternative and innovative strategies to stimulate meaningful learning are pivotal to children's nurse education and this paper examines one such innovation adopted with 2nd year children's nursing students. Aiming to help students explore the ethos of children's hospice an educational visit was arranged, followed by an on line discussion. Although some practical challenges were encountered, the visit heightened student awareness moving them from the readily held perception that children's hospices were exclusively for dying children and was viewed by students as more effective than a traditional classroom session. PMID:23111411

  16. Exploring Sensory Experiences and Personalization in an Inpatient Residential Hospice Setting.

    PubMed

    Niedzielski, Oksana K; Rodin, Gary; Emmerson, Debbie; Rutgers, Job; Sellen, Katherine M

    2016-08-01

    Residential hospices are often purpose-built to enhance the experience of patients and families. However, there has been relatively little research on ambient and sensory experiences of patients and families. This study explored the ambient and sensory experience of residents and families in a residential hospice. Hospice users participated in personalizing environments and experiences, adapting and developing rituals, and enjoying the experience (including smells and sounds) of communal spaces and private rooms. Opportunity for developing new rituals, in particular, suggests an environment supportive of sense of control, social support, and positive distractors. The design of an inpatient hospice can offer a platform through which to support the delivery of flexible care practices, providing opportunities for personal expression, shared experiences, and the maintenance or development of rituals. PMID:26809827

  17. The staging of a hospice arts and crafts exhibition in the UK.

    PubMed

    Sarginson, Andrea

    2005-09-01

    The use of arts in hospices is now well established. However, the voluntary nature of much hospice work in England encourages most regular creative activities to be provided by volunteers with minimal financial support. This article looks at how a successful arts and crafts exhibition for a hospice community was staged by a volunteer arts worker, helped by art and design students from the local university. It was not intended that the exhibition should be a research project; however, it became clear that to learn more about arts practice within a hospice environment, it would need to be appraised in some way. The project leader (and author) adopted an approach which reflected on the responses of people involved in the preparation and staging of the exhibition. PMID:16215528

  18. The Influence of Nursing Unit Characteristics on RN Vacancies in Specialized Hospice and Palliative Care.

    PubMed

    Lindley, Lisa C; Mixer, Sandra J; Cozad, Melanie J

    2016-07-01

    The nursing shortage is projected to intensify in the United States. Organizations providing specialized hospice and palliative care will be particularly hard hit. The purpose of our study was to examine the influence of the nursing unit on registered nurse (RN) vacancies and test the moderating role of recruitment strategies in perinatal hospices. We estimated the association between the nursing unit and RN vacancies and tested the interaction effects of recruitment strategies (signing bonus and recruitment bonus). Our findings showed that increasing RN unit size and nursing leadership directly affected vacancies and that recruitment bonuses had stronger influence on reducing vacancies than signing bonuses. The findings offer critical insights for hospice administrators in attracting nurses among specialized hospice and palliative care providers. PMID:25747671

  19. The Caring Coalition--An Educational Look at the Hospice Movement.

    ERIC Educational Resources Information Center

    Hiemstra, Roger

    1981-01-01

    Describes how one hospice organization is trying, through education, to change the practices, attitudes, and opinions of people such as hospital administrators, nursing home administrators, nurses, social workers, and other professionals who attend to the sick and dying. (CT)

  20. Veterinary hospice and palliative care: a comprehensive review of the literature.

    PubMed

    Goldberg, Katherine J

    2016-04-01

    The death of a pet is a universal experience for those who share their lives with animals. In parallel with a rising interest in palliative medicine, hospice care and advance-care planning within human medicine, increasing attention is currently being given to serious illness and death within veterinary medicine. Our ability to prolong life has created the need for thoughtful end of life discourse. Interest in hospice and palliative care for companion animals is on the rise, yet there has been limited scholarly research in these areas to date. This review concludes that veterinary hospice and palliative care is currently hindered by an inadequate amount of scholarly research to guide clinicians. Given a lack of prospective studies in veterinary hospice and palliative care to date, a significant opportunity exists for veterinary teaching institutions to contribute to the literature in an important and growing field. PMID:27056812

  1. Transformational leadership and the hospice R.N. case manager: a new critical pathway.

    PubMed

    Lafferty, C L

    1998-01-01

    This article asserts that in light of changing conditions in the healthcare environment, transformational leadership is the most appropriate leadership style for the hospice registered nurse case manager. The author defines transformational leadership and, tracing from early leadership theories, demonstrates how the transformational-transactional leadership paradigm emerged from preceding leadership theories. The components of transformational leadership--transformational behavior and transformational characteristics--are linked to hospice theory and hospice-specific nursing practices. The expanding role of the hospice R.N. case manager is addressed in light of transformational leadership and culture building. Specific actions are proposed in the arenas of research, education, and community, corporate, and legislative involvement. PMID:9677956

  2. Model-It: A Case Study of Learner-Centered Software Design for Supporting Model Building.

    ERIC Educational Resources Information Center

    Jackson, Shari L.; Stratford, Steven J.; Krajcik, Joseph S.; Soloway, Elliot

    Learner-centered software design (LCSD) guides the design of tasks, tools, and interfaces in order to support the unique needs of learners: growth, diversity and motivation. This paper presents a framework for LCSD and describes a case study of its application to the ScienceWare Model-It, a learner-centered tool to support scientific modeling and…

  3. The Terrible Choice: Re-Evaluating Hospice Eligibility Criteria for Cancer

    PubMed Central

    Casarett, David J.; Fishman, Jessica M.; Lu, Hien L.; O'Dwyer, Peter J.; Barg, Frances K.; Naylor, Mary D.; Asch, David A.

    2009-01-01

    Purpose To be eligible for the Medicare Hospice Benefit, cancer patients with a life expectancy of 6 months or less must give up curative treatment. Our goal was to determine whether willingness to make this choice identifies patients with greater need for hospice services. Patients and Methods Three hundred patients with cancer and 171 family members were recruited from six oncology practices. Respondents completed conjoint interviews in which their perceived need for five hospice services was calculated from the choices they made among combinations of services. Patients' preferences for treatment were measured, and patients were followed for 6 months or until death. Results Thirty-eight patients (13%) said they would not want cancer treatment even if it offered an almost 100% chance of 6-month survival. These patients, who would have been eligible for hospice, did not have greater perceived need for hospice services compared with other patients (n = 262; mean, 1.75 v 1.98; Wilcoxon rank sum test, P = .46), nor did their family members (mean, 1.95 v 2.04; Wilcoxon rank sum test, P = .80). Instead, independent predictors of patients' perceived need for hospice services included African American ethnicity, less social support, worse functional status, and a greater burden of psychological symptoms. For families, predictors included caregiver burden, worse self-reported health, working outside the home, and caring for a patient with worse functional status. Conclusion The requirement that patients forgo life-sustaining treatment does not identify patients with greater perceived need for hospice services. Other characteristics offer a better way to identify the patients who are most likely to benefit from hospice. PMID:19114698

  4. Feigning terminal illness to get narcotics: a cautionary tale for hospices.

    PubMed

    Gonzalez, Faustino; Galante, Mirta

    2012-08-01

    We present the case of a woman who enrolled in the hospice benefit in order to obtain narcotics. We believe this is a cautionary tale for hospices because of our propensity to enroll patients with minimal corroborating information, in order not to delay symptom management. Also we are philosophically predisposed to believe a patient's self-report of pain and other distressing symptoms. PMID:21868431

  5. Policy and the Re-Formation of Hospice: Lessons from the Past for the Future of Palliative Care.

    PubMed

    Buck, Joy

    2011-11-01

    During the twentieth-century, dramatic changes in the manner and location of care for the dying resulted in the conception and birth of the modern American hospice movement. Idealistic nurses, clergy, and others concerned about the plight of terminally ill cancer patients launched hospice as a necessary health care reform. As new hospice programs opened across the country, the idealism of the early leaders gave way to more pragmatic issues such as program viability. As hospice was studied and integrated into the health care system, it came to be redefined by the politics of health policy and the health care industry. As a result, there is a disarticulation between the needs of seriously ill persons and their families and the health care that is available to them. Important lessons can be learned from the history of the Medicare hospice benefit to help guide current palliative care policy initiatives. While formalized reimbursement for hospice enhanced organizational sustainability, many critical issues remain. PMID:22184500

  6. Policy and the Re-Formation of Hospice: Lessons from the Past for the Future of Palliative Care

    PubMed Central

    Buck, Joy

    2011-01-01

    During the twentieth-century, dramatic changes in the manner and location of care for the dying resulted in the conception and birth of the modern American hospice movement. Idealistic nurses, clergy, and others concerned about the plight of terminally ill cancer patients launched hospice as a necessary health care reform. As new hospice programs opened across the country, the idealism of the early leaders gave way to more pragmatic issues such as program viability. As hospice was studied and integrated into the health care system, it came to be redefined by the politics of health policy and the health care industry. As a result, there is a disarticulation between the needs of seriously ill persons and their families and the health care that is available to them. Important lessons can be learned from the history of the Medicare hospice benefit to help guide current palliative care policy initiatives. While formalized reimbursement for hospice enhanced organizational sustainability, many critical issues remain. PMID:22184500

  7. Pain Reports by Older Hospice Cancer Patients and Family Caregivers: The Role of Cognitive Functioning

    PubMed Central

    Allen, Rebecca S.; Haley, William E.; Small, Brent J.; McMillan, Susan C.

    2009-01-01

    Purpose Prior research in nursing homes has shown that cognitive impairment may reduce self-reported pain, but this relation has not been systematically explored among hospice patients. The assessment and treatment of pain is a primary goal of hospice care, and both disease processes and the use of opioid analgesics may lead to cognitive impairment among hospice patients. However, little is known about how cognitive functioning may impact the self-report of pain or the report of care recipient pain by family caregivers. Design and Methods We explored the associations between pain, cognitive functioning, and gender among cancer patients and their family caregivers (N = 176 dyads) during in-home hospice care. This was a cross-sectional, correlational study. Results Contrary to expectation, care recipients with cognitive impairment reported more intense pain than care recipients with intact cognitive functioning. However, cognitive impairment among care recipients had no impact on the pain report of family caregivers. Care recipient cognitive impairment was related to greater discrepancy in the pain reports of caregivers and care recipients. No gender differences in pain intensity report were found. Implications Measurement issues and implications for assessing self-reported pain among hospice cancer patients with impaired cognitive functioning and the report of care recipient pain by family caregivers are discussed. Specifically, hospice staff must educate family caregivers regarding the potential impact of care recipient cognitive impairment on pain reports in order to facilitate accurate pain assessment and management. PMID:12145378

  8. Exploring Factors that Influence Informal Caregiving in Medication Management for Home Hospice Patients

    PubMed Central

    Berman, Rebecca; Halpern, Leslie; Pickard, A. Simon; Schrauf, Robert; Witt, Whitney

    2010-01-01

    Abstract Objective To explore factors that influence how informal caregivers manage medications as part of caring for hospice patients. Methods : Semistructured, open-ended interviews were conducted with 23 informal caregivers and 22 hospice providers from 4 hospice programs in the Chicago metropolitan areas. Qualitative analysis was conducted consistent with the grounded theory approach. Results : In general, informal caregivers and hospice providers identified similar key factors that facilitated or impeded caregivers' process in managing medications. Caregivers' life experience and self-confidence were considered assets that facilitated medication management. Limitations impeding the process included caregivers' negative emotional states, cognitive and physical impairments, low literacy, other competing responsibilities, as well as patients' negative emotional states and complex medication needs. Furthermore, the social context of medication management emerged as a salient theme: caregivers' good interpersonal relations with patients facilitated medication management, whereas poor communication/relations among caregivers within a support network impeded the process. While both study groups discussed the positive attributes of good caregiver–patient relations and support from multiple caregivers, hospice providers were cautious about the potential adverse influence of close relations with patients on caregivers' decision making about medications and discussed poor communication/relations among informal and privately hired caregivers that often resulted from family conflicts and/or a lack of long-standing leadership. Conclusion Our findings suggest additional intervention points, beyond knowledge and skill building, that could be addressed to support caregivers in executing medication responsibilities at home for hospice patients. PMID:20836633

  9. Hospice patients' attitudes regarding spiritual discussions with their doctors.

    PubMed

    Hart, Alton; Kohlwes, R Jeff; Deyo, Rick; Rhodes, Lorna A; Bowen, Deborah J

    2003-01-01

    The purpose of this study was to assess hospice patients' attitudes regarding the discussion of spiritual issues with their physicians. We conducted in-depth interviews using open-ended questions on living with illness, spirituality and religion, and physician-patient relationships. The interviews were audiotaped, transcribed, and analyzed for dominant themes. The following dominant themes were identified: (1) treating the whole person, (2) treating with sensitivity, (3) favorable attitudes toward religious or spiritual discussions with doctors, and (4) no "preaching." Our findings suggest that patients do not expect physicians to be their primary spiritual advisors; however, physicians should be aware of and comfortable communicating with patients about religious or spiritual issues. More training in this topic may enhance the care physicians provide to patients near the end of life. PMID:12693646

  10. Evaluation of Subcutaneous Phenobarbital Administration in Hospice Patients.

    PubMed

    Hosgood, Jessica Richards; Kimbrel, Jason M; McCrate Protus, Bridget; Grauer, Phyllis A

    2016-04-01

    Phenobarbital is used in hospice and palliative care to treat refractory symptoms. In end-of-life care, Food and Drug Administration approved routes of administration may be unreasonable based on patients' status. In these cases, phenobarbital may be administered subcutaneously for symptom management. However, according to the American Hospital Formulary Service, subcutaneous administration of commercially available injectable phenobarbital is cautioned due to possible skin reactions. This study evaluates the tolerability of phenobarbital administered subcutaneously. Of 69 patients and 774 distinct subcutaneous phenobarbital injections, 2 site reactions were recorded (2.9% of patients; 0.3% of injections). Both were mild, grade 1 reactions. Each patient continued to receive subcutaneous phenobarbital via newly placed ports with no additional reactions. Based on these findings, phenobarbital appears to be well tolerated when administered subcutaneously. PMID:25473092

  11. Redefining the Poet as Healer: Valerie Gillies's Collaborative Role in the Edinburgh Marie Curie Hospice Quiet Room Project.

    PubMed

    Severin, Laura

    2015-01-01

    This article examines the poetic contribution of Valerie Gillies, Edinburgh Makar (or poet of the city) from 2005-2008, to the Edinburgh Marie Curie Hospice Quiet Room, a new contemplation space for patients, families, and staff. In collaboration with others, Gillies created a transitional space for the Quiet Room, centered on the display of her sonnet, "A Place Apart." This space functions to comfort visitors to the Quiet Room by relocating them in their surroundings and offering the solace provided by nature and history. With this project, her first as Edinburgh Makar, Gillies redefines the role of the poet as healer and advocates for newer forms of palliative care that focus on patients' spiritual and emotional, as well as physical, wellbeing. PMID:26095846

  12. Center vortex model for Sp(2) Yang-Mills theory

    SciTech Connect

    Engelhardt, M.; Sperisen, B.

    2006-12-15

    The question whether the center vortex picture of the strongly interacting vacuum can encompass the infrared dynamics of both SU(2) as well as Sp(2) Yang-Mills theory is addressed. These two theories contain the same center vortex degrees of freedom, and yet exhibit deconfinement phase transitions of different order. This is argued to be caused by the effective action governing the vortices being different in the two cases. To buttress this argument, a random vortex world-surface model is constructed which reproduces available lattice data characterizing Sp(2) Yang-Mills confinement properties. A new effective action term which can be interpreted in terms of a vortex stickiness serves to realize a first-order deconfinement phase transition, as found in Sp(2) Yang-Mills theory. Predictions are given for the behavior of the spatial string tension at finite temperatures.

  13. Nearly half of all Medicare hospice enrollees received care from agencies owned by regional or national chains.

    PubMed

    Stevenson, David G; Dalton, Jesse B; Grabowski, David C; Huskamp, Haiden A

    2015-01-01

    Analyses of ownership in the US hospice sector have focused on the growth of for-profit hospice care and on aggregate differences in patient populations and service use patterns between for-profit and not-for-profit agencies. Such comparisons, although useful, do not offer insights about the types of organizations within the hospice sector, including the emergence of multiagency chains. Using Medicare cost report data for the period 2000-11, we tracked the evolution of the US hospice industry. We not only describe the market's composition by profit status but also provide new information about the roles of regional and national chains. Almost half of all Medicare hospice enrollees in 2011 received hospice services from a multiagency chain. A handful of companies play a prominent role, although the presence of smaller for-profit and not-for-profit hospice chains also has grown in recent years. By focusing on the role of the diverse organizations that provide hospice care, our analyses can help inform efforts to monitor and assure quality of care, to assess payment adequacy and options for reform, and to facilitate greater transparency and accountability within the hospice marketplace. PMID:25561641

  14. Rapid EHR development and implementation using web and cloud-based architecture in a large home health and hospice organization.

    PubMed

    Weaver, Charlotte A; Teenier, Pamela

    2014-01-01

    Health care organizations have long been limited to a small number of major vendors in their selection of an electronic health record (EHR) system in the national and international marketplace. These major EHR vendors have in common base systems that are decades old, are built in antiquated programming languages, use outdated server architecture, and are based on inflexible data models [1,2]. The option to upgrade their technology to keep pace with the power of new web-based architecture, programming tools and cloud servers is not easily undertaken due to large client bases, development costs and risk [3]. This paper presents the decade-long efforts of a large national provider of home health and hospice care to select an EHR product, failing that to build their own and failing that initiative to go back into the market in 2012. The decade time delay had allowed new technologies and more nimble vendors to enter the market. Partnering with a new start-up company doing web and cloud based architecture for the home health and hospice market, made it possible to build, test and implement an operational and point of care system in 264 home health locations across 40 states and three time zones in the United States. This option of "starting over" with the new web and cloud technologies may be posing a next generation of new EHR vendors that retells the Blackberry replacement by iPhone story in healthcare. PMID:24943570

  15. Los Alamos Center for Computer Security formal computer security model

    SciTech Connect

    Dreicer, J.S.; Hunteman, W.J.; Markin, J.T.

    1989-01-01

    This paper provides a brief presentation of the formal computer security model currently being developed at the Los Alamos Department of Energy (DOE) Center for Computer Security (CCS). The need to test and verify DOE computer security policy implementation first motivated this effort. The actual analytical model was a result of the integration of current research in computer security and previous modeling and research experiences. The model is being developed to define a generic view of the computer and network security domains, to provide a theoretical basis for the design of a security model, and to address the limitations of present formal mathematical models for computer security. The fundamental objective of computer security is to prevent the unauthorized and unaccountable access to a system. The inherent vulnerabilities of computer systems result in various threats from unauthorized access. The foundation of the Los Alamos DOE CCS model is a series of functionally dependent probability equations, relations, and expressions. The model is undergoing continued discrimination and evolution. We expect to apply the model to the discipline of the Bell and LaPadula abstract sets of objects and subjects. 6 refs.

  16. Hospice family members’ perceptions and experiences with end-of-life care in the nursing home

    PubMed Central

    Washington, Karla; Kruse, Robin L.; Albright, David L; Lewis, Alexandria; Demiris, George

    2014-01-01

    Objective Despite the fact that more than 25% of Americans die in nursing homes, end-of-life care has consistently been found to be less than adequate in this setting. Even for those residents on hospice, end-of-life care has been found to be problematic. This study had two research questions; 1) How do family members of hospice nursing home residents differ in their anxiety, depression, quality of life, social networks, perceptions of pain medication, and health compared to family members of community dwelling hospice patients? 2) What are family members’ perceptions of and experiences with end-of-life care in the nursing home setting? Methods This study is a secondary mixed methods analysis of interviews with family members of hospice nursing home residents and a comparative statistical analysis of standard outcome measures between family members of hospice patients in the nursing home and family member of hospice patients residing in the community. Results Outcome measures for family members of nursing home residents were compared (n=176) with family members of community dwelling hospice patients (n=267). The family members of nursing home residents reported higher quality of life however, levels of anxiety, depression, perceptions of pain medicine, and health were similar for hospice family members in the nursing home and in the community. Lending an understanding to the stress for hospice family members of nursing home residents concerns were found with collaboration between the nursing home and the hospice, nursing home care that did not meet family expectations, communication problems, and resident care concerns including pain management. Some family members reported positive end-of-life care experiences in the nursing home setting. Conclusion These interviews identify a multitude of barriers to quality end-of-life care in the nursing home setting, and demonstrate that support for family members is an essential part of quality end-of-life care for

  17. CSMOS GROUNDWATER MODELING SOFTWARE (CENTER FOR SUBSURFACE MODELING SUPPORT, SUBSURFACE PROTECTION AND REMEDIATION DIVISION, NRMRL)

    EPA Science Inventory

    The Center for Subsurface Modeling Support (CSMoS), which is part of NRMRL's Subsurface Protection and Remediation Division, distributes various public domain groundwater and vadose zone models. A short decription of each model is available. You can obtain both models and manuals...

  18. Galactic Center Shells and a Recurrent Starburst Model

    NASA Astrophysics Data System (ADS)

    Sofue, Yoshiaki

    2003-04-01

    By applying filtering techniques to remove straight filaments in the 20-cm VLA radio image of the Galactic Center Arc region, we have shown that numerous concentric radio shells of radii 5 to 20pc are surrounding the Pistol and Sickle region, which we call Galactic Center Shells (GCS).Each shell has thermal energy of the order of1049-50erg.Several CO-line shells are associated, whose kinetic energies are of the order of 1049-50erg. Summing up the energies of recognized GCSs, the total energy amounts to ˜ 1051erg.The GCSs show an excellent correlation with the FIR shells observed at 16-26μm with the MSX.We propose a model in which GCSs were produced by recurrent and/or intermittent starbursts in the Pistol area during the last million years.The most recent burst occurred some 105 years ago, producing an inner round-shaped shell (GCS I);earlier ones a million years ago produced outer shells (GCS II and III), which a re more deformed by interactions with the surrounding ISM and Sgr A halo.We argue that recurrent starbursts had also occurred in the past, which produced larger scale hyper-shell structures as well.A burst some million years ago produced the Galactic Center Lobe, and a much stronger one 15 million years ago produced the North Polar Spur.

  19. How should a Catholic hospice respond to patients who choose to voluntarily stop eating and drinking in order to hasten death?

    PubMed Central

    Cavanagh, Maureen

    2014-01-01

    The practice of voluntarily stopping eating and drinking (VSED) in order to hasten death poses a unique problem for the Catholic hospice. Hospice staff may be confronted with patients already on their service who decide to pursue this option for ending their lives. Patients not on hospice service who are contemplating VSED are often advised to contact hospice for symptom palliation associated with the process of VSED. Intentionally hastening death not only violates the sanctity of human life and the Ethical and Religious Directives the Catholic hospice is bound to uphold, but it also runs counter to the general philosophy that hospice neither hastens nor postpones death. At the same time, hospice programs have a strong philosophy of nonabandonment of patients. This article will analyze the ethical issues from the perspective of the Catholic tradition and suggest strategies for the Catholic hospice to respond to this group of patients. PMID:25249707

  20. Analyst-centered models for systems design, analysis, and development

    NASA Technical Reports Server (NTRS)

    Bukley, A. P.; Pritchard, Richard H.; Burke, Steven M.; Kiss, P. A.

    1988-01-01

    Much has been written about the possible use of Expert Systems (ES) technology for strategic defense system applications, particularly for battle management algorithms and mission planning. It is proposed that ES (or more accurately, Knowledge Based System (KBS)) technology can be used in situations for which no human expert exists, namely to create design and analysis environments that allow an analyst to rapidly pose many different possible problem resolutions in game like fashion and to then work through the solution space in search of the optimal solution. Portions of such an environment exist for expensive AI hardware/software combinations such as the Xerox LOOPS and Intellicorp KEE systems. Efforts are discussed to build an analyst centered model (ACM) using an ES programming environment, ExperOPS5 for a simple missile system tradeoff study. By analyst centered, it is meant that the focus of learning is for the benefit of the analyst, not the model. The model's environment allows the analyst to pose a variety of what if questions without resorting to programming changes. Although not an ES per se, the ACM would allow for a design and analysis environment that is much superior to that of current technologies.

  1. Space Weather Products at the Community Coordinated Modeling Center

    NASA Technical Reports Server (NTRS)

    Hesse, Michael

    2010-01-01

    In addition to supporting space research in the international community, the Community Coordinated Modeling Center (CCMC) has as its second objective to bring to apply the power of modern research models toward space weather specification and forecasting. Initially motivated by the objective to test models and to ease the transition of research models to space weather forecasting organization, the CCMC has developed a number of real-time modeling systems, as well as large number of modeling and data products for space weather forecasting. Over time, these activities have evolved into tailored products for partners, as well as into a direct support of the space weather needs within NASA robotic mission community. Accessible through a customizable interface, users within the US or at partnering institutions internationally have access to space weather tools driven by the most advanced space research models. Through partnering with agencies and institutions in the US and abroad, the CCMC strives to set up further data sharing agreements to the benefit of all participating institutions. In this presentation, we provide an overview of existing CCMC space weather services and products, and we will explore additional avenues for international collaborations.

  2. Space weather products at the Community Coordinated Modeling Center

    NASA Astrophysics Data System (ADS)

    Hesse, Michael

    In addition to supporting space research in the international community, the Community Co-ordinated Modeling Center (CCMC) has as its second objective to bring to apply the power of modern research models toward space weather specification and forecasting. Initially motivated by the objective to test models and to ease the transition of research models to space weather forecasting organization, the CCMC has developed a number of real-time modeling systems, as well as large number of modeling and data products for space weather forecasting. Over time, these activities have evolved into tailored products for partners, as well as into a direct support of the space weather needs within NASA robotic mission community. Accessible through a customizable interface, users within the US or at partnering institutions internationally have access to space weather tools driven by the most advanced space research models. Through partnering with agencies and institutions in the US and abroad, the CCMC strives to set up further data sharing agreements to the benefit of all participating institutions. In this presen-tation, we provide an overview of existing CCMC space weather services and products, and we will explore additional avenues for international collaborations.

  3. 'Where do I go from here'? A cultural perspective on challenges to the use of hospice services.

    PubMed

    Frey, Rosemary; Gott, Merryn; Raphael, Deborah; Black, Stella; Teleo-Hope, Linda; Lee, Hyeonjoo; Wang, Zonghua

    2013-09-01

    Do hospice services as shaped by a western perspective adequately fulfil the needs of persons from non-Western cultures? Based on a Western view of palliative care, the vision outlined in the New Zealand Palliative Care Strategy (2001) is to deliver palliative care services, including hospice services, to all patients and their families requiring them in the context of an increasingly pluralistic and multicultural society. It is predicted that over the next two decades the proportion of people identifying as Māori, Pacific and Asian will dramatically increase within New Zealand. Ministry of Health information provided through a GAP analysis identified hospices as facing access-to-care pressures for Māori, Pacific and Asian patients. It is therefore critical to identify the challenges to hospice service access for Māori, Asian and Pacific patients. This project involved qualitative interviews with 37 cancer patients (Māori, Pacific and Asian self-identified ethnicities), whānau/family and bereaved whanua/family, as well as 15 health professionals (e.g. referring GPs, oncologists, allied health professionals) within one District Health Board. Patients and their families included both those who utilised hospice services, as well as those non-users of hospice services identified by a health professional as having palliative care needs. Challenges to hospice service utilisation reported in the findings include a lack of awareness in the communities of available services, as well as continuing misconceptions concerning the nature of hospice services. Language barriers were particularly reported for Asian patients and their families. Issues concerning the ethnic representativeness of the hospice services staff were raised. The findings highlight the importance of patient and family knowledge of hospice care for utilisation of services. This information can be used for future planning to enable hospices to both provide high quality evidence based palliative care

  4. Model-Based Systems Engineering in Concurrent Engineering Centers

    NASA Technical Reports Server (NTRS)

    Iwata, Curtis; Infeld, Samantha; Bracken, Jennifer Medlin; McGuire; McQuirk, Christina; Kisdi, Aron; Murphy, Jonathan; Cole, Bjorn; Zarifian, Pezhman

    2015-01-01

    Concurrent Engineering Centers (CECs) are specialized facilities with a goal of generating and maturing engineering designs by enabling rapid design iterations. This is accomplished by co-locating a team of experts (either physically or virtually) in a room with a focused design goal and a limited timeline of a week or less. The systems engineer uses a model of the system to capture the relevant interfaces and manage the overall architecture. A single model that integrates other design information and modeling allows the entire team to visualize the concurrent activity and identify conflicts more efficiently, potentially resulting in a systems model that will continue to be used throughout the project lifecycle. Performing systems engineering using such a system model is the definition of model-based systems engineering (MBSE); therefore, CECs evolving their approach to incorporate advances in MBSE are more successful in reducing time and cost needed to meet study goals. This paper surveys space mission CECs that are in the middle of this evolution, and the authors share their experiences in order to promote discussion within the community.

  5. Model-Based Systems Engineering in Concurrent Engineering Centers

    NASA Technical Reports Server (NTRS)

    Iwata, Curtis; Infeld, Samatha; Bracken, Jennifer Medlin; McGuire, Melissa; McQuirk, Christina; Kisdi, Aron; Murphy, Jonathan; Cole, Bjorn; Zarifian, Pezhman

    2015-01-01

    Concurrent Engineering Centers (CECs) are specialized facilities with a goal of generating and maturing engineering designs by enabling rapid design iterations. This is accomplished by co-locating a team of experts (either physically or virtually) in a room with a narrow design goal and a limited timeline of a week or less. The systems engineer uses a model of the system to capture the relevant interfaces and manage the overall architecture. A single model that integrates other design information and modeling allows the entire team to visualize the concurrent activity and identify conflicts more efficiently, potentially resulting in a systems model that will continue to be used throughout the project lifecycle. Performing systems engineering using such a system model is the definition of model-based systems engineering (MBSE); therefore, CECs evolving their approach to incorporate advances in MBSE are more successful in reducing time and cost needed to meet study goals. This paper surveys space mission CECs that are in the middle of this evolution, and the authors share their experiences in order to promote discussion within the community.

  6. Community Coordinated Modeling Center (CCMC): Providing Access to Space Weather Models and Research Support Tools

    NASA Astrophysics Data System (ADS)

    Chulaki, A.; Bakshi, S. S.; Berrios, D.; Hesse, M.; Kuznetsova, M. M.; Lee, H.; MacNeice, P. J.; Mendoza, A. M.; Mullinix, R.; Patel, K. D.; Pulkkinen, A.; Rastaetter, L.; Shim, J.; Taktakishvili, A.; Zheng, Y.

    2011-12-01

    The Community Coordinated Modeling Center at NASA, Goddard Space flight Center, provides access to state-of-the-art space weather models to the research community. The majority of the models residing at the CCMC are comprehensive computationally intensive physics-based models. The CCMC also provides free services and tools to assist the research community in analyzing the results from the space weather model simulations. We present an overview of the available tools and services at the CCMC: the Runs-On-Request system, the online visualization, the Kameleon access and interpolation library and the Metrics Challenge tools suite.

  7. Center for Programming Models for Scalable Parallel Computing

    SciTech Connect

    John Mellor-Crummey

    2008-02-29

    Rice University's achievements as part of the Center for Programming Models for Scalable Parallel Computing include: (1) design and implemention of cafc, the first multi-platform CAF compiler for distributed and shared-memory machines, (2) performance studies of the efficiency of programs written using the CAF and UPC programming models, (3) a novel technique to analyze explicitly-parallel SPMD programs that facilitates optimization, (4) design, implementation, and evaluation of new language features for CAF, including communication topologies, multi-version variables, and distributed multithreading to simplify development of high-performance codes in CAF, and (5) a synchronization strength reduction transformation for automatically replacing barrier-based synchronization with more efficient point-to-point synchronization. The prototype Co-array Fortran compiler cafc developed in this project is available as open source software from http://www.hipersoft.rice.edu/caf.

  8. Final Report: Center for Programming Models for Scalable Parallel Computing

    SciTech Connect

    Mellor-Crummey, John

    2011-09-13

    As part of the Center for Programming Models for Scalable Parallel Computing, Rice University collaborated with project partners in the design, development and deployment of language, compiler, and runtime support for parallel programming models to support application development for the “leadership-class” computer systems at DOE national laboratories. Work over the course of this project has focused on the design, implementation, and evaluation of a second-generation version of Coarray Fortran. Research and development efforts of the project have focused on the CAF 2.0 language, compiler, runtime system, and supporting infrastructure. This has involved working with the teams that provide infrastructure for CAF that we rely on, implementing new language and runtime features, producing an open source compiler that enabled us to evaluate our ideas, and evaluating our design and implementation through the use of benchmarks. The report details the research, development, findings, and conclusions from this work.

  9. "I'm Not Trying to Be Cured, so There's Not Much He Can Do for Me": Hospice Patients' Constructions of Hospice's Holistic Care Approach in a Biomedical Culture

    ERIC Educational Resources Information Center

    Nebel Pederson, Sarah; Emmers-Sommer, Tara M.

    2012-01-01

    The hospice philosophy was founded on a mission to provide comprehensive and holistic services to individuals at the end of life. Hospice interdisciplinary teams work together to offer therapies such as spiritual services, comfort care, and massage therapy to meet patients' physical, psychological, emotional, and spiritual needs. Although the…

  10. Real-time Models at the Community Coordinated Modeling Center and their Capabilities

    NASA Technical Reports Server (NTRS)

    Hesse, Michael

    2006-01-01

    Real-time models at the Community Coordinated Modeling Center and their capabilities The Community Coordinated Modeling Center serves both scientific research and space weather operations communities through access to and evaluation of modern space environment models. Critical to both objectives is an unbiased assessment of model capabilities, which includes scientific validity, performance verification, and model robustness. While all of these assessments are relevant to operational customers, the latter plays a particularly important role. For this reason, as well as for testing model validity, CCMC established a set of fully automated real-time execution systems, which are based on models provided by the research community. This presentation will provide a summary of these activities, and a report on experiences and model validity. Finally, this presentation will invite feedback from CCMC customers regarding future directions of real time modeling at CCMC.

  11. Transit Model Fitting in the Kepler Science Operations Center Pipeline

    NASA Astrophysics Data System (ADS)

    Li, Jie; Burke, C. J.; Jenkins, J. M.; Quintana, E. V.; Rowe, J. F.; Seader, S. E.; Tenenbaum, P.; Twicken, J. D.

    2012-05-01

    We describe the algorithm and performance of the transit model fitting of the Kepler Science Operations Center (SOC) Pipeline. Light curves of long cadence targets are subjected to the Transiting Planet Search (TPS) component of the Kepler SOC Pipeline. Those targets for which a Threshold Crossing Event (TCE) is generated in the transit search are subsequently processed in the Data Validation (DV) component. The light curves may span one or more Kepler observing quarters, and data may not be available for any given target in all quarters. Transit model parameters are fitted in DV to transit-like signatures in the light curves of target stars with TCEs. The fitted parameters are used to generate a predicted light curve based on the transit model. The residual flux time series of the target star, with the predicted light curve removed, is fed back to TPS to search for additional TCEs. The iterative process of transit model fitting and transiting planet search continues until no TCE is generated from the residual flux time series or a planet candidate limit is reached. The transit model includes five parameters to be fitted: transit epoch time (i.e. central time of first transit), orbital period, impact parameter, ratio of planet radius to star radius and ratio of semi-major axis to star radius. The initial values of the fit parameters are determined from the TCE values provided by TPS. A limb darkening model is included in the transit model to generate the predicted light curve. The transit model fitting results are used in the diagnostic tests in DV, such as the centroid motion test, eclipsing binary discrimination tests, etc., which helps to validate planet candidates and identify false positive detections. Funding for the Kepler Mission has been provided by the NASA Science Mission Directorate.

  12. Optimization modeling to maximize population access to comprehensive stroke centers

    PubMed Central

    Branas, Charles C.; Kasner, Scott E.; Wolff, Catherine; Williams, Justin C.; Albright, Karen C.; Carr, Brendan G.

    2015-01-01

    Objective: The location of comprehensive stroke centers (CSCs) is critical to ensuring rapid access to acute stroke therapies; we conducted a population-level virtual trial simulating change in access to CSCs using optimization modeling to selectively convert primary stroke centers (PSCs) to CSCs. Methods: Up to 20 certified PSCs per state were selected for conversion to maximize the population with 60-minute CSC access by ground and air. Access was compared across states based on region and the presence of state-level emergency medical service policies preferentially routing patients to stroke centers. Results: In 2010, there were 811 Joint Commission PSCs and 0 CSCs in the United States. Of the US population, 65.8% had 60-minute ground access to PSCs. After adding up to 20 optimally located CSCs per state, 63.1% of the US population had 60-minute ground access and 86.0% had 60-minute ground/air access to a CSC. Across states, median CSC access was 55.7% by ground (interquartile range 35.7%–71.5%) and 85.3% by ground/air (interquartile range 59.8%–92.1%). Ground access was lower in Stroke Belt states compared with non–Stroke Belt states (32.0% vs 58.6%, p = 0.02) and lower in states without emergency medical service routing policies (52.7% vs 68.3%, p = 0.04). Conclusion: Optimal system simulation can be used to develop efficient care systems that maximize accessibility. Under optimal conditions, a large proportion of the US population will be unable to access a CSC within 60 minutes. PMID:25740858

  13. Humanistic Patient Care Training: Content and Methodology. Interdisciplinary Team Training and Humanistic Patient Care for Hospices. Monograph 5.

    ERIC Educational Resources Information Center

    Grady, Kathleen A.; Wilson, Dottie C.

    This monograph, the fifth in a series of five, provides training information for hospice staff in improving interdisciplinary team functions and humanistic care provisions. Its purpose is to provide a skilled group trainer with the hospice-specific insights necessary to conduct training in humanistic patient care. Chapter 1 covers training program…

  14. Referral and Timing of Referral to Hospice Care in Nursing Homes: The Significant Role of Staff Members

    ERIC Educational Resources Information Center

    Welch, Lisa C.; Miller, Susan C.; Martin, Edward W.; Nanda, Aman

    2008-01-01

    Purpose: Given concerns about end-of-life care for many nursing home (NH) residents, this study sought to understand factors influencing hospice referral or nonreferral as well as timing of referral. Design and Methods: We conducted semistructured interviews with personnel from seven participating NHs and two hospices. We interviewed NH directors…

  15. Racial Differences in Hospice Use and In-Hospital Death among Medicare and Medicaid Dual-Eligible Nursing Home Residents

    ERIC Educational Resources Information Center

    Kwak, Jung; Haley, William E.; Chiriboga, David A.

    2008-01-01

    Purpose: We investigated the role of race in predicting the likelihood of using hospice and dying in a hospital among dual-eligible (Medicare and Medicaid) nursing home residents. Design and Methods: This follow-back cohort study examined factors associated with hospice use and in-hospital death among non-Hispanic Black and non-Hispanic White…

  16. Problems Associated with Coordination and Role Definitions in Health Care Teams: A Hospice Program Evaluation and Intervention Case Study.

    ERIC Educational Resources Information Center

    Berteotti, Carol R.; And Others

    Using an evaluation of a hospital-based hospice as a case study, this paper analyzes problematic issues surrounding health care teams (HCTs) in light of findings revealed in the literature concerning HCT structures and processes. The factors of coordination and role definitions in HCTs and their manifestations in a particular hospice HCT in terms…

  17. A multi-pathway model for photosynthetic reaction center.

    PubMed

    Qin, M; Shen, H Z; Yi, X X

    2016-03-28

    Charge separation occurs in a pair of tightly coupled chlorophylls at the heart of photosynthetic reaction centers of both plants and bacteria. Recently it has been shown that quantum coherence can, in principle, enhance the efficiency of a solar cell, working like a quantum heat engine. Here, we propose a biological quantum heat engine (BQHE) motivated by Photosystem II reaction center (PSII RC) to describe the charge separation. Our model mainly considers two charge-separation pathways which is more than that typically considered in the published literature. We explore how these cross-couplings increase the current and power of the charge separation and discuss the effects of multiple pathways in terms of current and power. The robustness of the BQHE against the charge recombination in natural PSII RC and dephasing induced by environments is also explored, and extension from two pathways to multiple pathways is made. These results suggest that noise-induced quantum coherence helps to suppress the influence of acceptor-to-donor charge recombination, and besides, nature-mimicking architectures with engineered multiple pathways for charge separations might be better for artificial solar energy devices considering the influence of environments. PMID:27036480

  18. A multi-pathway model for photosynthetic reaction center

    NASA Astrophysics Data System (ADS)

    Qin, M.; Shen, H. Z.; Yi, X. X.

    2016-03-01

    Charge separation occurs in a pair of tightly coupled chlorophylls at the heart of photosynthetic reaction centers of both plants and bacteria. Recently it has been shown that quantum coherence can, in principle, enhance the efficiency of a solar cell, working like a quantum heat engine. Here, we propose a biological quantum heat engine (BQHE) motivated by Photosystem II reaction center (PSII RC) to describe the charge separation. Our model mainly considers two charge-separation pathways which is more than that typically considered in the published literature. We explore how these cross-couplings increase the current and power of the charge separation and discuss the effects of multiple pathways in terms of current and power. The robustness of the BQHE against the charge recombination in natural PSII RC and dephasing induced by environments is also explored, and extension from two pathways to multiple pathways is made. These results suggest that noise-induced quantum coherence helps to suppress the influence of acceptor-to-donor charge recombination, and besides, nature-mimicking architectures with engineered multiple pathways for charge separations might be better for artificial solar energy devices considering the influence of environments.

  19. Gravitational model improvement at the Goddard Space Flight Center

    NASA Technical Reports Server (NTRS)

    Marsh, J. G.; Lerch, F. J.; Putney, B. H.; Felsentreger, T. L.; Sanchez, B. V.; Smith, D. E.; Klosko, S. M.; Pavlis, E. C.; Robbins, J. W.; Williamson, R. G.

    1989-01-01

    Major new computations of terrestrial gravitational field models were performed by the Geodynamics Branch of Goddard Space Flight Center (GSFC). This development has incorporated the present state of the art results in satellite geodesy and have relied upon a more consistent set of reference constants than was heretofore utilized in GSFC's GEM models. The solutions are complete in spherical harmonic coefficients out to degree 50 for the gravity field parameters. These models include adjustment for a subset of 66 ocean tidal coefficients for the long wavelength components of 12 major ocean tides. This tidal adjustment was made in the presence of 550 other fixed ocean tidal terms representing 32 major and minor ocean tides and the Wahr frequency dependent solid earth tidal model. In addition 5-day averaged values for Earth rotation and polar motion were derived for the time period of 1980 onward. Two types of models were computed. These are satellite only models relying exclusively on tracking data and combination models which have incorporated satellite altimetry and surface gravity data. The satellite observational data base consists of over 1100 orbital arcs of data on 31 satellites. A large percentage of these observations were provided by third generation laser stations (less than 5 cm). A calibration of the model accuracy of the GEM-T2 satellite only solution indicated that it was a significant improvement over previous models based solely upon tracking data. The rms geoid error for this field is 110 cm to degree and order 36. This is a major advancement over GEM-T1 whose errors were estimated to be 160 cm. An error propagation using the covariances of the GEM-T2 model for the TOPEX radial orbit component indicates that the rms radial errors are expected to be 12 cm. The combination solution, PGS-3337, is a preliminary effort leading to the development of GEM-T3. PGS-3337 has incorporated global sets of surface gravity data and the Seasat altimetry to produce a

  20. Palliative Care, Hospice, and Advance Care Planning: Views of People Living with HIV and Other Chronic Conditions.

    PubMed

    Slomka, Jacquelyn; Prince-Paul, Maryjo; Webel, Allison; Daly, Barbara J

    2016-01-01

    People living with HIV (PLWH) who survive to older adulthood risk developing multiple chronic medical conditions. Health policymakers recognize the role of early palliative care and advance care planning in improving health quality for at-risk populations, but misperceptions about palliative care, hospice, and advance care planning are common. Before testing a program of early palliative care for PLWH and other chronic conditions, we conducted focus groups to elicit perceptions of palliative care, hospice, and advance care planning in our target population. Overall, participants were unfamiliar with the term palliative care, confused concepts of palliative care and hospice, and/or associated hospice care with dying. Participants misunderstood advance care planning, but valued communication about health care preferences. Accepting palliative care was contingent on distinguishing it from hospice and historical memories of HIV and dying. Provision of high-quality, comprehensive care will require changing public perceptions and individuals' views in this high-risk population. PMID:27053406

  1. The experiences of Batswana families regarding hospice care of AIDS patients in the Bophirima district, North West province, South Africa.

    PubMed

    Makhele, M F; Mulaudzi, F M

    2012-01-01

    The HIV/AIDS pandemic put significant strain on healthcare services in the country. Hospitals were no longer coping with the escalating number of AIDS patients. This resulted in the early discharge of patients, with some patients, too ill to be nursed at home, being sent to hospices for continued care. The Batswana had mixed feelings about hospice care, because their beliefs on patient care are based on the ubuntu philosophy, which emphasises the principle of caring for one another. The purpose of this study was to explore and describe the experiences of Batswana families regarding hospice care for patients in the Thlabane township in the province of the North West as well as to make recommendations to policy-makers to ensure that hospices are accepted by community members and utilised effectively. A qualitative, explorative, descriptive research design was applied. Purposive sampling was applied to select study participants with whom in-depth unstructured interviews were conducted. A qualitative data analysis was done by categorising, ordering, and summarising the data, and describing the findings. The findings indicated that families of patients in hospice care experienced such care as foreign to their culture. These families also experienced stigmatisation, firstly owing to the stigma associated with AIDS and secondly because they opted for hospice care. However, they also observed the high quality of care provided by the hospice and understood its benefits for AIDS patients. The study concluded that hospice care relieved families of terminally ill AIDS patients of the burden of care and enabled them to keep on working and earning a living. Recommendations to policy-makers included enhancing hospice care and ensuring the provisioning of culturally safe hospice care. PMID:23237045

  2. Being a hospice volunteer influenced medical students' comfort with dying and death: a pilot study.

    PubMed

    Stecho, Will; Khalaf, Roy; Prendergast, Patrick; Geerlinks, Ashley; Lingard, Lorelei; Schulz, Valerie

    2012-01-01

    Being comfortable with death and communicating with patients near the end of life are important attributes in palliative care. We developed a hospice volunteer program to teach these attitudes and skills to preclinical medical students. Using a mixed-methods approach, validated surveys measured participants' and non-participants fear of death and communication apprehension regarding dying. Journals and focus groups examined participants' subjective experiences as their patient relationships evolved. Survey scores were significantly lower for participant hospice volunteers, indicating lower levels of death anxiety and communication apprehension regarding dying. An explanatory framework, using journals and focus groups, captured participants' sense of development over time into three categories: challenges, learning, and growth. This pilot project provides insight into the medical students' experiential learning as they participate in our hospice volunteer program. PMID:23098013

  3. A cost comparison of hospice care in amyotrophic lateral sclerosis and lung cancer.

    PubMed

    Elman, Lauren B; Stanley, Lisa; Gibbons, Patricia; McCluskey, Leo

    2006-01-01

    The authors compare the cost of hospice care provided to 25 amyotrophic lateral sclerosis (ALS) patients and 159 lung cancer patients by the Wissahickon Hospice of the University of Pennsylvania. The mean length of stay was 86.7 days for ALS patients and 35.0 days for patients with lung cancer (P = .011). The mean per patient cost was 5622.93 dollars for the ALS patients and 2658.91 dollars for patients with lung cancer (P = .057) The average operating margin excluding administrative costs was 5293.04 dollars for ALS patients and 2126.74 dollars for patients with lung cancer (P = .008). The longer length of stay (LOS) accounts for this difference. Longer LOS can be accomplished by close clinical monitoring of ALS patients for the development of life threatening respiratory and/or nutritional compromise and by liberalizing the present hospice admission guidelines. PMID:17060281

  4. Assessing governance theory and practice in health-care organizations: a survey of UK hospices.

    PubMed

    Chambers, Naomi; Benson, Lawrence; Boyd, Alan; Girling, Jeff

    2012-05-01

    This paper sets out a theoretical framework for analyzing board governance, and describes an empirical study of corporate governance practices in a subset of non-profit organizations (hospices in the UK). It examines how practices in hospice governance compare with what is known about effective board working. We found that key strengths of hospice boards included a strong focus on the mission and the finances of the organizations, and common weaknesses included a lack of involvement in strategic matters and a lack of confidence, and some nervousness about challenging the organization on the quality of clinical care. Finally, the paper offers suggestions for theoretical development particularly in relation to board governance in non-profit organizations. It develops an engagement theory for boards which comprises a triadic proposition of high challenge, high support and strong grip. PMID:22673698

  5. Access to space weather model data provided by the Community Coordinated Modeling Center

    NASA Astrophysics Data System (ADS)

    Chulaki, A.; Berrios, D.; Hesse, M.; Kuznetsova, M. M.; MacNeice, P. J.; Maddox, M.; Rastaetter, L.; Taktakishvili, A.

    2009-12-01

    The Community Coordinated Modeling Center (CCMC), located at NASA Goddard Space Flight Center, provides access to state-of-the-art space weather models to the research community. The majority of the models residing at the CCMC are comprehensive, computationally intensive physics-based models. The CCMC provides access to output of performed model runs through a searchable and sortable online database and offers services and tools to assist the research community in analyzing results from space weather model simulations. Virtual Observatories can provide access to model output for corresponding events using the CCMC run database and interface. CCMC is planning to expand its database of run information to improve the service to users as well as its connection with VOs.

  6. Soliciting an Herbal Medicine and Supplement Use History at Hospice Admission

    PubMed Central

    Kaiser, Karen; Jackson, Steve; McPherson, Mary Lynn

    2010-01-01

    Abstract Background Reconciling medication use and performing drug utilization review on admission of a patient into hospice care are essential in order to safely prescribe medications and to prevent possible adverse drug events and drug–drug interactions. As part of this process, fully assessing herbal medicine and supplement use in hospice patients is crucial, as patients in hospice may be likely to use these medications and may be more vulnerable to their potential adverse effects. Objective Our purpose was to identify herbals, vitamins, and supplements that should be routinely assessed on every hospice admission because of their higher likelihood of use or higher risk of adverse effects or drug interactions. Methods Experts in the fields of palliative medicine, pharmacy, and alternative medicine were asked to complete a Web-based survey on 37 herbals, vitamins, supplements, and natural products, rating likelihood of use, potential for harm, and recommendation to include it on the final list on a scale of 1 to 5 (least to most likely to agree). Results Twenty experts participated in the survey. Using a cutoff of 3.75 for inclusion of a medication on the final list, 12 herbal medicines were identified that should be routinely and specifically assessed on hospice admission. Conclusions Although assessing all herbal medicine use is ideal, thorough detection of herbals may be challenging. The list of herbals and supplements identified by this survey could be a useful tool for medication reconciliation in hospice and could aid in identifying potentially harmful medication use at the end of life. PMID:20557233

  7. Enhancing Web-Based Instruction Using a Person-Centered Model of Instruction

    ERIC Educational Resources Information Center

    Miller, Christopher T.

    2007-01-01

    This study compared the implementation of a person-centered model of instruction to non person-centered instruction in Web-based courses. Three questions were posed regarding the outcomes of the person-centered model of instruction: Is it possible to increase the self actualization, or striving for individual achievement from learners in a…

  8. Assessment of levels of hospice care coverage offered to commercial managed care plan members in California: implications for the California Health Insurance Exchange.

    PubMed

    Chung, Kyusuk; Jahng, Joelle; Petrosyan, Syuzanna; Kim, Soo In; Yim, Victoria

    2015-06-01

    The implementation of the Affordable Care Act that provides for the expansion of affordable insurance to uninsured individuals and small businesses, coupled with the provision of mandated hospice coverage, is expected to increase the enrollment of the terminally ill younger population in hospice care. We surveyed health insurance companies that offer managed care plans in the 2014 California health insurance exchange and large hospice agencies that provided hospice care to privately insured patients in 2011. Compared with Medicare and Medicaid hospice benefits, hospice benefits for privately insured patients, particularly those enrolled in managed care plans, varied widely. Mandating hospice care alone may not be sufficient to ensure that individuals enrolled in different managed care plans receive the same level of coverage. PMID:24619923

  9. Assessment of Levels of Hospice Care Coverage Offered to Commercial Managed Care Plan Members in California: Implications for the California Health Insurance Exchange

    PubMed Central

    Chung, Kyusuk; Jahng, Joelle; Petrosyan, Syuzanna; Yim, Victoria

    2014-01-01

    The implementation of the Affordable Care Act that provides for the expansion of affordable insurance to uninsured individuals and small businesses, coupled with the provision of mandated hospice coverage, is expected to increase the enrollment of the terminally ill younger population in hospice care. We surveyed health insurance companies that offer managed care plans in the 2014 California Health Insurance Exchange and large hospice agencies that provided hospice care to privately insured patients in 2011. Compared with Medicare and Medicaid Hospice Benefits, hospice benefits for privately insured patients, particularly those enrolled in managed care plans, varied widely. Mandating hospice care alone may not be sufficient to ensure that individuals enrolled in different managed care plans receive the same level of coverage. PMID:24619923

  10. ESTABLISHMENT OF A GROUNDWATER RESEARCH DATA CENTER FOR VALIDATION OF SUBSURFACE FLOW AND TRANSPORT MODELS

    EPA Science Inventory

    The International Ground Water Modeling Center has established a Groundwater Research Data Center that provides information on datasets resulting from publicly funded field experiments and related bench studies in soil and groundwater pollution and distributes datasets for tes...

  11. ESTABLISHMENT OF A GROUNDWATER RESEARCH DATA CENTER FOR VALIDATION OF SUBSURFACE FLOW AND TRANSPORT MODELS

    EPA Science Inventory

    The International Ground Water Modeling Center has established a Groundwater Research Data Center which provides information on research datasets resulting from publicly funded field experiments regarding soil and groundwater pollution and related laboratory bench studies, and wh...

  12. THE ESTABLISHMENT OF A GROUNDWATER RESEARCH DATA CENTER FOR VALIDATION OF SUBSURFACE FLOW AND TRANSPORT MODELS

    EPA Science Inventory

    The International Ground Water Modeling Center has established a Groundwater Research Data Center which provides information on research datasets resulting from publicly funded field experiments regarding soil and groundwater pollution and related laboratory bench studies, and wh...

  13. Transition Components of the Frost Center, a Model Program Background: The Frost Center and Its Students.

    ERIC Educational Resources Information Center

    Mosso, Janet L.

    The Frost Center (Rockville, Maryland) is a private, nonprofit school and therapeutic day program that serves adolescents with emotional, learning, and behavioral disabilities and their families. Approximately two-thirds of each student's day is spent in academic classes, acquiring the skills and behavior necessary for a return to a less…

  14. Developing competencies for pediatric hospice and palliative medicine.

    PubMed

    Klick, Jeffrey C; Friebert, Sarah; Hutton, Nancy; Osenga, Kaci; Pituch, Kenneth J; Vesel, Tamara; Weidner, Norbert; Block, Susan D; Morrison, Laura J

    2014-12-01

    In 2006, hospice and palliative medicine (HPM) became an officially recognized subspecialty. This designation helped initiate the Accreditation Council of Graduate Medical Education Outcomes Project in HPM. As part of this process, a group of expert clinician-educators in HPM defined the initial competency-based outcomes for HPM fellows (General HPM Competencies). Concurrently, these experts recognized and acknowledged that additional expertise in pediatric HPM would ensure that the competencies for pediatric HPM were optimally represented. To fill this gap, a group of pediatric HPM experts used a product development method to define specific Pediatric HPM Competencies. This article describes the development process. With the ongoing evolution of HPM, these competencies will evolve. As part of the Next Accreditation System, the Accreditation Council of Graduate Medical Education uses milestones as a framework to better define competency-based, measurable outcomes for trainees. Currently, there are no milestones specific to HPM, although the field is designing curricular milestones with multispecialty involvement, including pediatrics. These competencies are the conceptual framework for the pediatric content in the HPM milestones. They are specific to the pediatric HPM subspecialist and should be integrated into the training of pediatric HPM subspecialists. They will serve a foundational role in HPM and should inform a wide range of emerging innovations, including the next evolution of HPM Competencies, development of HPM curricular milestones, and training of adult HPM and other pediatric subspecialists. They may also inform pediatric HPM outcome measures, as well as standards of practice and performance for pediatric HPM interdisciplinary teams. PMID:25404726

  15. Marshall Space Flight Center surface modeling and grid generation applications

    NASA Technical Reports Server (NTRS)

    Williams, Robert W.; Benjamin, Theodore G.; Cornelison, Joni W.

    1995-01-01

    The Solid Rocket Motors (SRM) used by NASA to propel the Space Shuttle employ gimballing nozzles as a means for vehicular guidance during launch and ascent. Gimballing a nozzle renders the pressure field of the exhaust gases nonaxisymmetric. This has two effects: (1) it exerts a torque and side load on the nozzle; and (2) the exhaust gases flow circumferentially in the aft-dome region, thermally loading the flexible boot, case-to-nozzle joint, and casing insulation. The use of CFD models to simulate such flows is imperative in order to assess SRM design. The grids for these problems were constructed by obtaining information from drawings and tabulated coordinates. The 2D axisymmetric grids were designed and generated using the EZ-Surf and GEN2D surface and grid generation codes. These 2D grids were solved using codes such as FDNS, GASP, and MINT. These axisymmetric grids were rotated around the center-line to form 3D nongimballed grids. These were then gimballed around the pivot point and the gaps or overlaps resurfaced to obtain the final domains, which contained approximately 366,000 grid points. The 2D solutions were then rotated and manipulated as appropriate for geometry and used as initial guesses in the final solution. The analyses were used in answering questions about flight criteria.

  16. Marshall Space Flight Center surface modeling and grid generation applications

    NASA Astrophysics Data System (ADS)

    Williams, Robert W.; Benjamin, Theodore G.; Cornelison, Joni W.

    1995-03-01

    The Solid Rocket Motors (SRM) used by NASA to propel the Space Shuttle employ gimballing nozzles as a means for vehicular guidance during launch and ascent. Gimballing a nozzle renders the pressure field of the exhaust gases nonaxisymmetric. This has two effects: (1) it exerts a torque and side load on the nozzle; and (2) the exhaust gases flow circumferentially in the aft-dome region, thermally loading the flexible boot, case-to-nozzle joint, and casing insulation. The use of CFD models to simulate such flows is imperative in order to assess SRM design. The grids for these problems were constructed by obtaining information from drawings and tabulated coordinates. The 2D axisymmetric grids were designed and generated using the EZ-Surf and GEN2D surface and grid generation codes. These 2D grids were solved using codes such as FDNS, GASP, and MINT. These axisymmetric grids were rotated around the center-line to form 3D nongimballed grids. These were then gimballed around the pivot point and the gaps or overlaps resurfaced to obtain the final domains, which contained approximately 366,000 grid points. The 2D solutions were then rotated and manipulated as appropriate for geometry and used as initial guesses in the final solution. The analyses were used in answering questions about flight criteria.

  17. Perspective of patients, patients’ families, and healthcare providers towards designing and delivering hospice care services in a middle income Country

    PubMed Central

    Azami-Aghdash, Saber; Ghojazadeh, Morteza; Aghaei, Mir Hossein; Naghavi-Behzad, Mohammad; Asgarlo, Zoleikha

    2015-01-01

    Introduction: In view of the recent surge in chronic disease rates and elderly population in the developing countries, there is an urgent felt need for palliative and hospice care services. The present study investigates the views and attitudes of patients and their families, physicians, nurses, healthcare administrators, and insurers regarding designing and delivering hospice care service in a middle income country. Materials and Methods: In this qualitative study, the required data was collected using semi structured interviews and was analyzed using thematic analysis. Totally 65 participants from hospitals and Tabriz University of Medical Sciences were selected purposively to achieve data saturation. Results: Analyzing the data, five main themes (barriers, facilitators, strategies, attitudes, and service provider) were extracted. Barriers included financial issues, cultural-religious beliefs, patient and family-related obstacles, and barriers related to healthcare system. Facilitators included family-related issues, cultural-religious beliefs, as well as facilitators associated with patients, healthcare status, and benefits of hospice service. Most participants (79%) had positive attitude towards hospice care service. Participant suggested 10 ways to design and deliver effective and efficient hospice care service. They thought the presence of physicians, nurses, and psychologists and other specialists and clergy were necessary in the hospice care team. Conclusion: Due to lack of experience in hospice care in developing countries, research for identifying probable barriers and appropriate management for reducing unsuccessfulness in designing and delivering hospice care service seems necessary. Input from the facilitators and their suggested solutions can be useful in planning the policy for hospice care system. PMID:26600704

  18. Needs and experiences of non-English-speaking hospice patients and families in an English-speaking country.

    PubMed

    McGrath, P; Vun, M; McLeod, L

    2001-01-01

    There is increasing evidence that, in practice, hospice care is predominantly accessed by white, middle-class patients, who live in stable home environments with available caregivers and other supports. The present challenge for researchers, administrators, and clinicians is to identify populations of terminally ill patients most in need of hospice care and to direct services to these patients. As a contribution to the development of this area, this paper presents the findings from a recent Australian hospice study that examines the needs and experiences of families from non-English-speaking backgrounds. The findings indicate that it is as important to focus on similarities as it is to highlight differences. PMID:11565183

  19. Patterns and Meanings of Prayer in Hospice Caregivers: An Exploratory Study.

    ERIC Educational Resources Information Center

    Schneider, Susanne; Kastenbaum, Robert

    1993-01-01

    Examined role of prayer in personal and professional lives of caregivers to dying. Background questionnaires were completed by 78 counselors, doctors, nurses, and volunteers associated with hospice programs. Interviews were conducted with 24 of these subjects. Most caregivers described themselves as very religious; typical caregiver made frequent…

  20. 76 FR 26805 - Medicare Program; Hospice Wage Index for Fiscal Year 2012

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-09

    ... continue with successive 15 percent reductions from FY 2013 through FY 2016. This proposed rule would.... In the August 11, 2004 Inpatient Prospective Payment System (IPPS) final rule (69 FR 48916, 49026... standards that included CBSAs. In the FY 2006 hospice wage index final rule (70 FR 45130), we implemented...

  1. Live Discharge from Hospice and the Grief Experience of Dementia Caregivers.

    PubMed

    Wladkowski, Stephanie P

    2016-01-01

    When an individual has dementia, family members are involved in many care transitions in their roles as caregivers. One such transition is the 'live' discharge from hospice services. This occurs when an individual no longer meets eligibility criteria. This can be difficult for caregivers who have been anticipating an end to understand in the context of their grief process. This qualitative study (N = 24) explored the experience of caregivers of adults with dementia, including Alzheimer's disease, who experienced a 'live' discharge from hospice. Specifically, the experience of grief is examined. Results from this study highlight the complexity of caring for someone with a terminal disease and the grief experience in end-of-life care as caregivers struggle to understand the individual's terminal prognosis as temporary. This is further complicated for caregivers who must resume caregiving responsibilities or assume a new caregiving role after experiencing a loss of hospice services. Finally, hospice social workers are well positioned to offer emotional and other concrete support to caregivers who experience a 'live' discharge. PMID:27143573

  2. Transcultural comparison of hospital and hospice as caring environments for dying patients.

    PubMed

    Gates, M F

    1991-01-01

    Leininger's nursing Theory of Cultural Care Diversity and Universality provided the framework for this comparative study of two environments for persons who are dying; namely a hospital oncology unit and a free-standing hospice unit. Analysis of data from ethnographic and ethnonursing research methods including unstructured interviews, observation-participation, and field journal materials yielded contrasts with two settings. The presence of a caring atmosphere/ambience was apparent in both the hospital and hospice. Universal patterns common to both were: caring beliefs and practices of staff; identification of each setting as "community" or "home"; and multiple symbolic uses of humor and food. Diversities included hierarchical organizational structure and cure orientation in the hospital; interdisciplinary collaboration and care orientation in hospice; more pronounced use of touch as a caring modality; and greater evidence of symbolism and ritual related to death and dying in hospice. Adoption of the cultural care modes of accommodation, repatterning, and maintenance are suggested in promoting a caring atmosphere wherever dying patients are served. PMID:2043293

  3. 42 CFR 418.76 - Condition of participation: Hospice aide and homemaker services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... service furnished. (iii) Reading and recording temperature, pulse, and respiration. (iv) Basic infection... furnishing Medicaid personal care aide-only services under a Medicaid personal care benefit. An individual... personal care benefit may be used to the extent that the hospice would routinely use the services of...

  4. 76 FR 71920 - Payment for Home Health Services and Hospice Care by Non-VA Providers

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-21

    ... medical charges associated with non-VA outpatient care, provided under 38 CFR 17.52 or 17.120. 75 FR 78901.... See 75 FR 78901. We explained: Home Health Care and Hospice Care he pricing methodology adopted by... amended Sec. 17.56. See 75 FR 7218 (Feb. 18, 2010); 75 FR 78901. We need not repeat them here. Indeed,...

  5. [Hospice palliative care is a universal value and the essence of nursing].

    PubMed

    Chao, Co-Shi Chantal

    2015-04-01

    This article uses four examples to illustrate the recent rise of hospice palliative care as a universal value. These examples include the story of Dame Cecily Saunders, the pioneer of the palliative care movement in the U.K.; the national healthcare plan currently promoted by United States' President Obama; a survey on the topic of quality of death in 40 countries conducted by the Lien Foundation (Singapore); and the story of the Hospice Movement in Taiwan. This article further describes how hospice palliative care has changed the healthcare culture and presents the World Health Organization's definition of palliative care and the implications of this definition. Additionally, this article identifies the common palliative-care mistakes that have been made by the general public and by healthcare workers. Healthcare professionals must acquire essential relevant knowledge and skills in order to ensure that hospice palliative care addresses the needs of terminally ill patients adequately. Finally, the author describes a novel approach to instilling proper palliative-care concepts and practices that is entitled Life, Peace, Care, and Honor (LPCH or the "3344" concept). PMID:25854942

  6. Preparation for Oncology Settings: What Hospice Social Workers Say They Need.

    ERIC Educational Resources Information Center

    Kovacs, Pamela J.; Bronstein, Laura R.

    1999-01-01

    Investigates the influence of formal academic training, informal on-the-job training, and related professional and personal experiences of hospice social workers on preparation for their work. Findings suggest that social workers view both the generalist or core courses as well as specialist and elective courses as important preparation.…

  7. The Meaning of Parenteral Hydration to Family Caregivers and Patients with Advanced Cancer Receiving Hospice Care

    PubMed Central

    Cohen, Marlene Z; Torres-Vigil, Isabel; Burbach, Beth E.; de Rosa, Allison; Bruera, Eduardo

    2012-01-01

    Context In the U.S., patients with advanced cancer who are dehydrated or have decreased oral intake virtually always receive parenteral hydration in acute care facilities but rarely in the hospice setting. Objectives To describe the meaning of hydration for terminally ill cancer patients in home hospice care and for their primary caregivers. Methods Phenomenological interviews were conducted at two time points with 85 patients and 84 caregivers enrolled in a randomized, double-blind, controlled trial examining the efficacy of parenteral hydration in patients with advanced cancer receiving hospice care in the southern U.S. Transcripts were analyzed hermeneutically by the interdisciplinary research team until consensus on the theme labels was reached. Results Patients and their family caregivers both saw hydration as meaning hope and comfort. Hope was the view that hydration might prolong a life of dignity and enhance quality of life by reducing symptoms such as fatigue and increasing patients’ alertness. Patients and caregivers also described hydration as improving patients’ comfort by reducing pain, enhancing the effectiveness of pain medication, and nourishing the body, mind and spirit. Conclusion These findings differ from traditional hospice beliefs that dehydration enhances patient comfort given that patients and their families in the study viewed fluids as enhancing comfort, dignity and quality of life. Discussion with patients and families about their preferences for hydration may help tailor care plans to meet specific patient needs. PMID:22459230

  8. Affirming the Connection: Comparative Findings on Communication Issues from Hospice Patients and Hematology Survivors

    ERIC Educational Resources Information Center

    McGrath, Pam

    2004-01-01

    The following discussion presents comparative findings from hospice patients and hematology survivors on the topic of talking about dying to significant others within their network of family and friends. The insights have been gathered from an Australian research program that is exploring the notion of spirituality in relation to serious illness.…

  9. 76 FR 28195 - Medicare Program; Hospice Wage Index for Fiscal Year 2012

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-16

    ...; Hospice Wage Index for Fiscal Year 2012 Correction In proposed rule document 2011-10689 appearing on pages... Wage Index for Rural Areas Wage CBSA code Nonurban area index 1 Alabama 0.8000 2 Alaska 1.3073 3... rural areas of Massachusetts, so the wage index value used is the average of the contiguous Counties....

  10. 76 FR 44010 - Medicare Program; Hospice Wage Index for Fiscal Year 2012; Correction

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-22

    ... (76 FR 26731) was incorrectly titled as ``Hospice Wage Index for Fiscal Year 2012''. We note that the.... SUPPLEMENTARY INFORMATION: I. Background In FR Doc. 2011-10694 of May 9, 2011 (76 FR 26731), there were... FR Doc. 2011-10694 of May 9, 2011 (76 FR 26731), make the following corrections: 1. On page 26731,...

  11. 77 FR 44242 - Medicare Program; Hospice Wage Index for Fiscal Year 2013

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-27

    ... wage index final rule (70 FR 45130), we implemented a 1-year transition policy using a 50/50 blend of... index. In the August 8, 1997 Federal Register (62 FR 42860), we published a final rule implementing a... the BNAF. The FY 2010 Hospice Wage Index final rule (74 FR 39384) finalized a provision for a...

  12. A comprehensive community nursing center model: maximizing practice income--a challenge to educators.

    PubMed

    Walker, P H

    1994-01-01

    The potential role of community nursing centers to generate revenue through faculty practice is critical for the survival of nursing centers in the future. A nursing center entrepreneurial model for faculty practice within the University of Rochester School of Nursing uses sound business principles to enhance financial success and challenges current paradigms in education, practice, and research. PMID:8034852

  13. The Decker Family Development Center: Supportive Data of an Intervention Model for Multiple-Risk Families.

    ERIC Educational Resources Information Center

    Newman, Carole; And Others

    The Decker Family Development Center in Barberton (Ohio) is a holistic "one-stop shop" that provides services to families who are at multiple risk. During its 5 years of operation, this center has developed a model that goes beyond cooperation into co-construction to empower stakeholders. This paper describes the center and its successes and…

  14. A project-centered undergraduate geoscience curriculum model

    NASA Astrophysics Data System (ADS)

    Kelso, P.; Brown, L.

    2003-04-01

    Lake Superior State University, a comprehensive rural public university with approximately 10% Native-Americans enrolled, located in Michigan's eastern Upper Peninsula, U.S.A., has redesigned it's undergraduate geology major by developing an entire curriculum around a project-centered integration of geoscience sub-disciplines. Our model, adapted from modern educational theory, advocates sub-discipline integration by implementing problem-based learning through coursework that develops students' intellectual skills and engages them in using complex reasoning in real-world contexts. Students in this new curriculum will actively discover how to learn about a new geologic province, what questions to ask in approaching problems, where and how to find answers, and how to apply knowledge to solving problems. To accomplish our goals, we redesigned our pedagogy for all courses by creating active learning environments including cooperative learning, jigsaw methodologies, debates, investigation oriented laboratories, use of case studies, writing and communication intensive exercises, and research experiences. Fundamental sub-discipline concepts were identified by our national survey and are presented in the context of sequentially ordered problems that reflect increasing geological complexity. All courses above first year incorporate significant field experience. Our lower division courses include a two semester sequence of physical and historical geology in which physical processes are discussed in the context of their historical extension and one semester of structure/tectonics and mineralogy/petrology. The lower division culminates with a three week introductory field geology course. Our upper division courses include hydrologic systems, environmental systems, geochemical systems, tectonic systems, geophysical systems, clastic systems, carbonate systems, two seminar courses, and advanced field geology. The two field courses, offered in different geologic provinces, provide

  15. Assessment of hospice nurses' technique in the use of inhalers and nebulizers.

    PubMed

    Scarpaci, Laura T; Tsoukleris, Mona G; McPherson, Mary Lynn

    2007-06-01

    Dyspnea, a common distressing end-of-life symptom, is treated with oral (i.e., opioids and anxiolytics) and inhaled medications (anti-inflammatory and bronchodilator agents). Health care providers and patients have demonstrated an inability to use inhaler devices correctly, which can lead to suboptimal drug delivery and poor symptom relief. Hospice nurses are the primary health care providers educating patients, making it critical that they convey accurate device technique. This study assessed hospice nurses' ability to demonstrate proper inhaler device technique and their knowledge of agents used to treat dyspnea. Forty-seven nurses participated. Participants completed a written questionnaire, which gathered demographic data, as well as information regarding previous training with an inhaler device, administration, pharmacokinetics, mechanism of action, patient assessment, and nursing technique. Additionally, each nurse demonstrated the use of a metered dose inhaler, spacer, dry powder inhaler, and a nebulizer, while being observed by a pharmacist trained in the use of inhalers. A standardized evaluation form was used to ensure consistency between evaluators and subjects. Percentage of steps completed correctly by the study participants ranged from 34.9% with the dry powder inhaler to 67.6% with the metered dose inhaler. Years of experience, presence of hospice certification, personal use of inhaler, and nursing comfort level significantly impacted ability to use inhalation devices. This study demonstrated the existence of knowledge gaps regarding patient assessment, pharmacology and pharmacokinetics of inhaled medications, and inhalation device technique among hospice nurses. Formal education of hospice practitioners regarding inhaled medications and inhalation delivery devices is needed. PMID:17592978

  16. Underserved patients' perspectives on patient-centered primary care: does the patient-centered medical home model meet their needs?

    PubMed

    Mead, Holly; Andres, Ellie; Regenstein, Marsha

    2014-02-01

    The patient-centered medical home (PCMH) has gained significant interest as a delivery system model that can improve health care quality while reducing costs. This study uses focus groups to investigate underserved, chronically ill patients' preferences for care and develops a patient-centered framework of priorities. Seven major priorities were identified: (a) communication and partnership, (b) affordable care, (c) coordinated care, (d) personal responsibility, (e) accessible care, (f) education and support resources, and (g) the essential role of nonphysician providers in supporting their care. Using the framework, we analyzed the PCMH joint principals as developed by U.S. medical societies to identify where the PCMH model could be improved to better meet the needs of these patients. Four of the seven patient priorities were identified as not present in or supported by current PCMH joint principles. The study discusses how the PCMH model can better address the needs of low-income, disadvantaged patients. PMID:24288366

  17. A Dirichlet process mixture model for survival outcome data: assessing nationwide kidney transplant centers.

    PubMed

    Zhao, Lili; Shi, Jingchunzi; Shearon, Tempie H; Li, Yi

    2015-04-15

    Mortality rates are probably the most important indicator for the performance of kidney transplant centers. Motivated by the national evaluation of mortality rates at kidney transplant centers in the USA, we seek to categorize the transplant centers based on the mortality outcome. We describe a Dirichlet process model and a Dirichlet process mixture model with a half-cauchy prior for the estimation of the risk-adjusted effects of the transplant centers, with strategies for improving the model performance, interpretability, and classification ability. We derive statistical measures and create graphical tools to rate transplant centers and identify outlying groups of centers with exceptionally good or poor performance. The proposed method was evaluated through simulation and then applied to assess kidney transplant centers from a national organ failure registry. PMID:25620744

  18. Center of Excellence in Model-Based Human Performance

    NASA Technical Reports Server (NTRS)

    Wandell, Brian A.

    1997-01-01

    The Center of Excellence (COE) was created in 1984 to facilitate active collaboration between the scientists at Ames Research Center and the Stanford Psychology Department. As this document will review, over that period of time, the COE served its function well. Funds from the Center supported a large number of projects over the last ten years. Many of the people who were supported by the Center have gone on to distinguished research careers in government, industry and university. In fact, several of the people currently working at NASA Ames were initially funded by the Center mechanism, which served as a useful vehicle for attracting top quality candidates and supporting their research efforts. We are grateful for NASA's support over the years. As we reviewed in the reports for each year, the COE budget generally provided a portion of the true costs of the individual research projects. Hence, the funds from the COE were leveraged with funds from industry and other government agencies. In this way, we feel that all parties benefitted greatly from the collaborative spirit and interactive aspects of the COE. The portion of the support from NASA was particularly important in helping members of the COE to set aside the time to publish papers and communicate advances in our understanding of human performance in NASA-related missions.

  19. Center of Excellence in Model-Based Human Performance

    NASA Technical Reports Server (NTRS)

    Wandell, Brian A.

    1997-01-01

    The Center of Excellence (COE) was created in 1984 to facilitate active collaboration between the scientists at Ames Research Center and the Stanford Psychology Department. As this document will review, over that period of time, the COE served its function well. Funds from the Center supported a large number of projects over the last ten years. Many of the people who were supported by the Center Have gone on to distinguished research careers in government, industry and university. In fact, several of the people currently working at NASA Ames were initially funded by the Center mechanism, which served as a useful vehicle for attracting top quality candidates and supporting their research efforts. We are grateful for NASA's support over the years. As we reviewed in the reports for each year, the COE budget generally provided a portion of the true costs of the individual research project. Hence, the funds from the COE were leveraged with funds from industry and other government agencies. In this way, we feel that all parties benefitted greatly from the collaborative spirit and interactive aspects of the COE. The portion of the support from NASA was particularly important in helping members of the COE to set aside the time to publish papers and communicate advances in our understanding of human performance in NASA-related missions.

  20. National Survey of Hematopoietic Cell Transplant Center Personnel, Infrastructure and Models of Care Delivery

    PubMed Central

    Majhail, Navneet S.; Mau, Lih-Wen; Chitphakdithai, Pintip; Payton, Tammy; Eckrich, Michael; Joffe, Steven; Lee, Stephanie J.; LeMaistre, Charles F.; LeRademacher, Jennifer; Loberiza, Fausto; Logan, Brent; Parsons, Susan K.; Repaczki-Jones, Ramona; Robinett, Pam; Rizzo, J Douglas; Murphy, Elizabeth; Denzen, Ellen M.

    2015-01-01

    Hematopoietic cell transplantation (HCT) is a complex procedure that requires availability of adequate infrastructure, personnel and resources at transplant centers. We conducted a national survey of transplant centers in the United States to obtain data on their personnel, infrastructure and care delivery models. A 42-item web-based survey was administered to medical directors of transplant centers in the US that reported any allogeneic HCT to the Center for International Blood and Marrow Transplant Research (CIBMTR) in 2011. The response rate for the survey was 79% for adult programs (85/108 centers) and 82% for pediatric programs (54/66 centers). For describing results, we categorized centers into groups with similar volumes based on 2010 total HCT activity (adult centers 9 categories, pediatric centers 6 categories). We observed considerable variation in available resources, infrastructure, personnel and care delivery models among adult and pediatric transplant centers. Characteristics varied substantially among centers with comparable transplant volumes. Transplant centers may find these data helpful in assessing their present capacity and use them to evaluate potential resource needs for personnel, infrastructure and care delivery and in planning for growth. PMID:25840337

  1. National Survey of Hematopoietic Cell Transplantation Center Personnel, Infrastructure, and Models of Care Delivery.

    PubMed

    Majhail, Navneet S; Mau, Lih-Wen; Chitphakdithai, Pintip; Payton, Tammy; Eckrich, Michael; Joffe, Steven; Lee, Stephanie J; LeMaistre, Charles F; LeRademacher, Jennifer; Loberiza, Fausto; Logan, Brent; Parsons, Susan K; Repaczki-Jones, Ramona; Robinett, Pam; Rizzo, J Douglas; Murphy, Elizabeth; Denzen, Ellen M

    2015-07-01

    Hematopoietic cell transplantation (HCT) is a complex procedure that requires availability of adequate infrastructure, personnel, and resources at transplantation centers. We conducted a national survey of transplantation centers in the United States to obtain data on their personnel, infrastructure, and care delivery models. A 42-item web-based survey was administered to medical directors of transplantation centers in the United States that reported any allogeneic HCT to the Center for International Blood and Marrow Transplant Research in 2011. The response rate for the survey was 79% for adult programs (85 of 108 centers) and 82% for pediatric programs (54 of 66 centers). For describing results, we categorized centers into groups with similar volumes based on 2010 total HCT activity (adult centers, 9 categories; pediatric centers, 6 categories). We observed considerable variation in available resources, infrastructure, personnel, and care delivery models among adult and pediatric transplantation centers. Characteristics varied substantially among centers with comparable transplantation volumes. Transplantation centers may find these data helpful in assessing their present capacity and use them to evaluate potential resource needs for personnel, infrastructure, and care delivery and in planning for growth. PMID:25840337

  2. Attitudes Toward Use of Benzodiazepines among U.S. Hospice Clinicians: Survey and Review of the Literature

    PubMed Central

    Kamell, Andrew

    2016-01-01

    Abstract Background: Benzodiazepines are commonly used in inpatient hospices internationally. U.S. hospice clinician views toward benzodiazepines are unknown. Objectives: Study objectives were (1) to assess inpatient hospice clinician attitudes towards the benefits of benzodiazepines for various indications and (2) to compare these attitudes to current clinical recommendations and literature. Methods: A survey was developed and distributed to hospices with inpatient units nationwide. Results were analyzed, then compared to current clinical guidelines. Literature review was performed. U.S. hospice physicians and nurses were the study subjects. Participants were asked to indicate their level of agreement regarding benefit from benzodiazepines for various end-of-life symptoms and to answer questions regarding benzodiazepines in delirium. Results: Of 143 surveys returned, 128 surveys were completed. For anxiety, 80% of participants agreed that benzodiazepines were beneficial for restlessness, dyspnea 77%, insomnia 68%, dying process 65%, agitation 57%, nausea 54%, hyperactive delirium 42%, and severe pain 38%. Nurses found benzodiazepines beneficial for more indications than physicians. Over 50% reported benzodiazepines on their order sets for agitation, insomnia, acute anxiety, chronic anxiety, chronic panic, restlessness, seizures, and withdrawal. Among physicians, 39% believe that benzodiazepines are overused within their own hospice. A literature review found very limited evidence of overall benefit from benzodiazepines for the symptoms listed above. In addition, this revealed significant evidence for risks and harms from benzodiazepines, particularly in patients at risk for delirium. Conclusions: Benzodiazepines are viewed favorably by most hospice nurses and many hospice physicians for various indications, despite little supportive clinical evidence along with significant potential for harm. PMID:27002463

  3. Race, treatment preferences, and hospice enrollment. Eligibility criteria may exclude patients with the greatest needs for care

    PubMed Central

    Fishman, Jessica; O'Dwyer, Peter; Lu, Hien L.; Henderson, Hope; Asch, David A.; Casarett, David J.

    2009-01-01

    Background The requirement that patients give up curative treatment makes hospice enrollment unappealing for some patients, and may particularly limit use among African American patients. Objectives To determine whether African-American patients with cancer are more likely than white patients are to have preferences for cancer treatment that exclude them from hospice, and whether they are less likely to want specific hospice services. Methods 283 patients receiving treatment for cancer at six oncology clinics within the University of Pennsylvania Cancer Network completed conjoint interviews measuring their perceived need for five hospice services and their preferences for continuing cancer treatment. Patients were followed for six months or until death. Results African American patients had stronger preferences for continuing their cancer treatments on a 7-point scale even after adjusting for age, sex, finances, education, ECOG performance status, quality of life, and physical and psychological symptom burden (adjusted means 4.75 vs. 3.96; β coefficient 0.82; 95% confidence interval 0.22-1.41; p=0.007). African-American patients also had greater perceived needs for hospice services after adjusting for these characteristics (adjusted means 2.31 vs. 1.83) (β coefficient 0.51; 95% confidence interval 0.11-0.92; p=0.01). However, this effect disappeared after adjusting for household finances. Conclusions Hospice eligibility criteria may exclude African-American patients disproportionately despite greater perceived needs for hospice services in this population. The mechanisms driving this health disparity likely include both cultural differences and economic characteristics, and consideration should be given to redesigning hospice eligibility criteria. PMID:19107761

  4. Paying the Price at the End of Life: A Consideration of Factors that Affect the Profitability of Hospice

    PubMed Central

    Ettner, Susan L.; Lorenz, Karl A.

    2008-01-01

    Abstract Objective To evaluate factors that affect the financial performance of hospice. Methods Using the California Office of Statewide Health Planning and Development 2003 survey, we evaluated the organizational attributes, clinical care, and financial performance of 185 operational hospices. As outcomes, we evaluated revenues, costs, and profits per patient and per patient–day, the intensity and skill mix of care, and the provision of charitable and special palliative services. We evaluated regression-adjusted differences by profit status controlling for other organizational features and aggregate patient characteristics. Results Hospices reported median revenue of $6865 per patient and $138 per patient–day (for-profit-not-for profit [FP-NFP] difference −$20, p = 0.045), median cost of $6737 per patient, and $135 per patient–day (FP-NFP difference −$55, p = 0.002), and median pretax profit of $334 per patient and $6 per patient–day (FP-NFP difference $34, p = 0.026). Patients received a median of 29.9 total visits by all providers per patient (FP-NFP difference 8.8 visits, p = 0.010), but there was no difference in total visits per patient–day. A median of 50.8% of all nursing visits were registered nurse (RN) visits (FP-NFP difference −14.1%, p < 0.001). Few hospices provided charity care, and only 4% of hospices reported expenditures on chemotherapy and only 9% on radiation therapy. Conclusions Overall hospice profitability is low. Length of stay is strongly associated with financial performance, and greater FP profitability is related to lower costs. FP hospices also provide less RN care as a proportion of nursing care. Few hospices provide charitable care or special costly services. The relationship of service patterns to patient quality needs to be examined. PMID:18788962

  5. Models and applications for space weather forecasting and analysis at the Community Coordinated Modeling Center.

    NASA Astrophysics Data System (ADS)

    Kuznetsova, Maria

    The Community Coordinated Modeling Center (CCMC, http://ccmc.gsfc.nasa.gov) was established at the dawn of the new millennium as a long-term flexible solution to the problem of transition of progress in space environment modeling to operational space weather forecasting. CCMC hosts an expanding collection of state-of-the-art space weather models developed by the international space science community. Over the years the CCMC acquired the unique experience in preparing complex models and model chains for operational environment and developing and maintaining custom displays and powerful web-based systems and tools ready to be used by researchers, space weather service providers and decision makers. In support of space weather needs of NASA users CCMC is developing highly-tailored applications and services that target specific orbits or locations in space and partnering with NASA mission specialists on linking CCMC space environment modeling with impacts on biological and technological systems in space. Confidence assessment of model predictions is an essential element of space environment modeling. CCMC facilitates interaction between model owners and users in defining physical parameters and metrics formats relevant to specific applications and leads community efforts to quantify models ability to simulate and predict space environment events. Interactive on-line model validation systems developed at CCMC make validation a seamless part of model development circle. The talk will showcase innovative solutions for space weather research, validation, anomaly analysis and forecasting and review on-going community-wide model validation initiatives enabled by CCMC applications.

  6. User-Centered Innovation: A Model for "Early Usability Testing."

    ERIC Educational Resources Information Center

    Sugar, William A.; Boling, Elizabeth

    The goal of this study is to show how some concepts and techniques from disciplines outside Instructional Systems Development (ISD) have the potential to extend and enhance the traditional view of ISD practice when they are employed very early in the ISD process. The concepts and techniques employed were user-centered in design and usability, and…

  7. Model Program: Southern Lehigh High School, Center Valley, PA

    ERIC Educational Resources Information Center

    Colelli, Richard

    2009-01-01

    In this article, the author describes the technology education program at Southern Lehigh High School, Center Valley, Pennsylvania. The school district is presently providing an educational program known for its excellence and forward-looking perspective, which is sensitive to the changing needs of its students. Within the technology education…

  8. OFF-CENTER SPHERICAL MODEL FOR DOSIMETRY CALCULATIONS IN CHICK BRAIN TISSUE

    EPA Science Inventory

    The paper presents calculations for the electric field and absorbed power density distribution in chick brain tissue inside a test tube, using an off-center spherical model. It is shown that the off-center spherical model overcomes many of the limitations of the concentric spheri...

  9. First Medicare Demonstration of Concurrent Provision of Curative and Hospice Services for End-of-Life Care.

    PubMed

    Harrison, Krista L; Connor, Stephen R

    2016-08-01

    Hospice developed in the United States in the 1970s as a way to address unmet needs for end-of-life care: support for pain and symptom management provided in the location and manner that the patient and family prefer. In Europe and Australia, hospice is available from the time of diagnosis of an advanced life-limiting illness onward, but in the United States, the Medicare hospice benefit restricts eligibility for these services to patients who no longer receive curative treatment. We provide background and analysis of the first Medicare hospice demonstration in 35 years that will test the concurrent provision of curative and hospice services for terminally ill individuals with a life expectancy of six months or less. This demonstration is a harbinger of potential policy changes to hospice and palliative care in the United States that could reduce barriers to end-of-life care that aligns with patient and family preferences as the demand for care increases with an aging population. PMID:27310352

  10. Interactional communication challenges in end-of-life care: dialectical tensions and management strategies experienced by home hospice nurses.

    PubMed

    Gilstrap, Cristina M; White, Zachary M

    2015-01-01

    This study examines the dialectical tensions experienced by home hospice nurses in interactions with patients, families, and health care providers. In-depth, semistructured interviews were conducted with 24 home hospice nurses from a mid-size for-profit hospice organization serving approximately 230 patients on an annual basis. Interviews revealed hospice nurses experience both interpersonal and organizational dialectics during hospice interactions: authoritative-nonauthoritative, revelation-concealment, independence-collaboration, and quality of care-business of care. Dialectics often resulted as a by-product of (a) responding to expectations and care choices of patients and families particular to the emotionally charged home context, (b) obtaining authorization from health care providers who are not members of the interdisciplinary team, and (c) pressures associated with providing quality patient care while fulfilling organizational role requirements. The praxis strategies used to negotiate tensions included segmentation, balance, recalibration, and spiraling inversion. Specifically, nurses employed strategies such as ascertaining family/patient acceptance, using persuasive tactics when communicating with external health care providers, relying on effective time management, and working off the clock to provide more in-person care. Although functional for patients and hospice organizations, nurses who continually rely on these strategies may experience job stress when their interpersonal commitments repeatedly conflict with organizational role demands. PMID:24991918

  11. The Colorado State University Pet Hospice program: end-of-life care for pets and their families.

    PubMed

    Bishop, Gail A; Long, Christie C; Carlsten, Kelly S; Kennedy, Katie C; Shaw, Jane R

    2008-01-01

    While the concept of hospice care for humans has existed for decades and is an integral part of the dying process, providing hospice care for companion animals is a new and growing service. Veterinarians and pet-owners have recently recognized that there is a need and a demand to care for pets with terminal illnesses. The Colorado State University Pet Hospice program meets those needs through supporting pets, their owners, and veterinarians, and educating professional veterinary students in end-of-life care. Developed in 2003, Pet Hospice is a student-run program that trains veterinary students in animal hospice care, and matches them with the family and veterinarian of a terminally ill pet in the community. Since its inception, 101 veterinary student volunteers have been trained and provided support to 68 families. Continued expansion of the client base, enlargement of the network of veterinarians and volunteers, and positive program evaluations reflect the strong impact of Pet Hospice and its support from veterinary students, veterinarians, and the community. PMID:19228904

  12. On shrinkage and model extrapolation in the evaluation of clinical center performance

    PubMed Central

    Varewyck, Machteld; Goetghebeur, Els; Eriksson, Marie; Vansteelandt, Stijn

    2014-01-01

    We consider statistical methods for benchmarking clinical centers based on a dichotomous outcome indicator. Borrowing ideas from the causal inference literature, we aim to reveal how the entire study population would have fared under the current care level of each center. To this end, we evaluate direct standardization based on fixed versus random center effects outcome models that incorporate patient-specific baseline covariates to adjust for differential case-mix. We explore fixed effects (FE) regression with Firth correction and normal mixed effects (ME) regression to maintain convergence in the presence of very small centers. Moreover, we study doubly robust FE regression to avoid outcome model extrapolation. Simulation studies show that shrinkage following standard ME modeling can result in substantial power loss relative to the considered alternatives, especially for small centers. Results are consistent with findings in the analysis of 30-day mortality risk following acute stroke across 90 centers in the Swedish Stroke Register. PMID:24812420

  13. MiPLAN: a learner-centered model for bedside teaching in today's academic medical centers.

    PubMed

    Stickrath, Chad; Aagaard, Eva; Anderson, Mel

    2013-03-01

    Clinician educators and medical trainees face intense pressure to complete numerous patient care and teaching activities in a limited amount of time. To address the need for effective and efficient teaching methods for use in the inpatient setting, the authors used constructivist learning theory, the principles of adult learning, and their expertise as clinician educators to develop the MiPLAN model for bedside teaching. This three-part model is designed to enable clinical teachers to simultaneously provide care to patients while assessing learners, determining high-yield teaching topics, and providing feedback to learners.The "M" refers to a preparatory meeting between teacher and learners before engaging in patient care or educational activities. During this meeting, team members should become acquainted and the teacher should set goals and clarify expectations. The "i" refers to five behaviors for the teacher to adopt during learners' bedside presentations: introduction, in the moment, inspection, interruptions, and independent thought. "PLAN" is an algorithm to establish priorities for teaching subsequent to a learner's presentation: patient care, learners' questions, attending's agenda, and next steps.The authors suggest that the MiPLAN model can help clinical teachers gain more confidence in their ability to teach at the bedside and increase the frequency and quality of bedside teaching. They propose further research to assess the generalizability of this model to other institutions, settings, and specialties and to evaluate educational and patient outcomes. PMID:23348088

  14. Space Weather Models, Tools and Services at the Community Coordinated Modeling Center

    NASA Technical Reports Server (NTRS)

    Kuznetsova, M. M.; Hesse, M.; Maddox, M.; Rastaetter, L.; Berrios, D.; Pulkkinen, A.; Zheng, Y.; MacNeice, P. J.; Shim, J.; Takakishvili, A.; Chulaki, A.

    2010-01-01

    The Community Coordinated Modeling center (CCMC) is a multi-agency partnership to support the research and developmental work necessary to substantially increase space weather modeling capabilities and to facilitate advanced models deployment in forecasting operations. The CCMC conducts unbiased model testing and validation and evaluates model readiness for operational environment. Space weather models and coupled model chains hosted at the CCMC range from the solar corona to the Earth's upper atmosphere. CCMC has developed a number of real-time modeling systems, as well as a large number of modeling and data products tailored to address the space weather needs of NASA's robotic missions. The presentation will demonstrate the rapid progress towards development the system allowing using products derived from space weather models in applications associated with National Space Weather needs. The adaptable Integrated Space Weather Analysis (ISWA) System developed at CCMC for NASA-relevant space weather information combines forecasts based on advanced space weather models hosted at CCMC with concurrent space environment information. The system is also enabling post-impact analysis and flexible dissemination of space weather information.

  15. Computer Center: BASIC String Models of Genetic Information Transfer.

    ERIC Educational Resources Information Center

    Spain, James D., Ed.

    1984-01-01

    Discusses some of the major genetic information processes which may be modeled by computer program string manipulation, focusing on replication and transcription. Also discusses instructional applications of using string models. (JN)

  16. Intercept Centering and Time Coding in Latent Difference Score Models

    ERIC Educational Resources Information Center

    Grimm, Kevin J.

    2012-01-01

    Latent difference score (LDS) models combine benefits derived from autoregressive and latent growth curve models allowing for time-dependent influences and systematic change. The specification and descriptions of LDS models include an initial level of ability or trait plus an accumulation of changes. A limitation of this specification is that the…

  17. Revisiting perceptions of quality of hospice care: managing for the ultimate referral.

    PubMed

    Churchman, Richard; York, Grady S; Woodard, Beth; Wainright, Charles; Rau-Foster, Mary

    2014-08-01

    Hospice services provided in the final months of life are delivered through complex interpersonal relationships between caregivers, patients, and families. Often, service value and quality are defined by these interpersonal interactions. This understanding provides hospice leaders with an enormous opportunity to create processes that provide the optimal level of care during the last months of life. The authors argue that the ultimate referral is attained when a family member observes the care of a loved one, and the family member conveys a desire to receive the same quality of services their loved one received at that facility. The point of this article is to provide evidence that supports the methods to ultimately enhance the patient's and family's experience and increase the potential for the ultimate referral. PMID:23928074

  18. Views of hospice and palliative care among younger and older sexually diverse women.

    PubMed

    June, Andrea; Segal, Daniel L; Klebe, Kelli; Watts, Linda K

    2012-09-01

    The aim of the present study was to explore end-of-life health care attitudes among younger and older sexually diverse women. Self-identified lesbian and heterosexual older women as well as lesbian and heterosexual middle-aged women were recruited. Results indicated that lesbian women held significantly more positive beliefs about hospice services and the role of alternative medicines in health care. No differences among sexual orientation were found for comfort discussing pain management but heterosexual women reported a significantly greater desire for life-sustaining treatments in the event of an incurable disease and severe life-limiting conditions (eg, feeding tube, life support, no brain response). Additionally, as expected, older women in this study held more positive beliefs about hospice and more comfort discussing pain management than middle-aged women. PMID:22144659

  19. Gendered Processes in Hospice Palliative Home Care for Seniors With Cancer and Their Family Caregivers.

    PubMed

    Sutherland, Nisha; Ward-Griffin, Catherine; McWilliam, Carol; Stajduhar, Kelli

    2016-06-01

    There has been limited investigation into the processes that shape gender (in)equities in hospice palliative home care. As part of a larger critical ethnographic study, we examined how and why gender relations occur in this context. Using a critical feminist lens, we conducted in-depth interviews with clients living with terminal cancer, their family caregivers and primary nurses; observations of agency home visits; and review of institutional documents. A gender-based analysis revealed that gender enactments of Regulating Gender Relations were legitimized through ideological processes of Normalizing Gender Relations and Equalizing Gender Relations (Re)produced through institutional discourses of individualism and egalitarianism, these gendered processes both advantaged and disadvantaged men and women in hospice palliative home care. Findings suggest that to promote equity, health care providers and policy makers must attend to gender as a prevalent social determinant of health and health care. Implications for policy, practice, education, and research are discussed. PMID:26489710

  20. Caregiver evaluation in hospice: application of a semi-structured interview.

    PubMed

    Andruccioli, Jessica; Russo, Maria Maffia; Bruschi, Angela; Pedrabissi, Luigi; Sarti, Donatella; Monterubbianesi, Maria Cristina; Rossi, Sabina; Rocconi, Sabina; Raffaeli, William

    2011-09-01

    In this study we report the results of construction and administration of a semi-structured interview for the evaluation of caregivers in hospice. The results presented here are related to interviews (n = 25) that were administered at Rimini Hospice. According to the interview coding system, it was possible to identify thematic areas of the interviews where the caregiver's distress was mainly concentrated. As concerning the care burden, greater distress was detected in areas relating to the change in the rhythm of life (38%) and in social network (26%); whereas, as concerning the psychological burden, a greater distress was detected in the area related to the caregiver role (51%). In conclusion, a singular element identified as a source of distress in, our study, is that of social network. PMID:21190946

  1. What Is the Essence of Spiritual Care? A Danish Hospice Perspective.

    PubMed

    Steenfeldt, Vibeke Ostergaard

    2016-01-01

    This study explored patients', relatives', and healthcare professionals' experience of life and caring practice in two Danish hospice settings. Using a phenomenological approach, four caring themes emerged from data analysis: recognized as an individual human being; caring as doing and being; caring for the whole body; and spaces of caring. Spiritual care was understood as providing whole-body experiences, respecting the patient, and involving the other person. PMID:27299946

  2. 42 CFR 418.110 - Condition of participation: Hospices that provide inpatient care directly.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... U.S.C. 552(a) and 1 CFR part 51. A copy of the code is available for inspection at the CMS... incorporation by reference in accordance with 5 U.S.C. 552(a) and 1 CFR part 51. A copy of the code is available... 42 Public Health 3 2010-10-01 2010-10-01 false Condition of participation: Hospices that...

  3. Creatively caring: effects of arts-based encounters on hospice caregivers in South Africa.

    PubMed

    Repar, Patricia Ann; Reid, Steve

    2014-05-01

    International literature and experience suggest that arts-based encounters can be effective in reducing stress and burnout in health care workers. Are these principles universal? Are they as applicable and effective in resource-constrained situations in Africa as in other parts of the world? We describe the impact of creative and arts-based encounters on a group of hospice caregivers at South Coast Hospice in KwaZulu Natal. An experienced facilitator built a caring and trusting relationship with the participants over a three month period through a variety of means, including a singing and songwriting intervention specifically designed to empower and give voice to the hospice caregivers, most of whom were Zulu women. We documented the process through several rounds of interviews, extensive field notes, and audio recordings. This article is a reflection on the experience and draws from the interviews, correspondence among researchers, field notes, and a performance piece written by the facilitator one year after completion of the study. We found that the songwriting and other creative activities of the engagement provided affirmation and acknowledgment of the caregivers as well as an opportunity to release stress, grief, and pain. They experienced changes in terms of hope and freedom both for themselves and their patients. The conceptual themes that emerged from the interviews with the caregivers were interpreted in terms of their inherent cultural assets, a release of agency, a sense of revelation, and transformation. The expressive arts can have a significantly beneficial effect on hospice workers and their patients, and clinical engagement can be enhanced through creative encounters, even in resource-constrained situations. If such creative processes were to be promoted among a wider group of health workers, daily routine work in health care could be not just a repetition of well-rehearsed utilitarian rituals but rather a series of creative and transformative

  4. Pharmacovigilance in hospice/palliative care: net effect of gabapentin for neuropathic pain

    PubMed Central

    Sanderson, Christine; Quinn, Stephen J; Agar, Meera; Chye, Richard; Clark, Katherine; Doogue, Matthew; Fazekas, Belinda; Lee, Jessica; Lovell, Melanie R; Rowett, Debra; Spruyt, Odette; Currow, David C

    2015-01-01

    Objective Hospice/palliative care patients may differ from better studied populations, and data from other populations cannot necessarily be extrapolated into hospice/palliative care clinical practice. Pharmacovigilance studies provide opportunities to understand the harms and benefits of medications in routine practice. Gabapentin, a γ-amino butyric acid analogue antiepileptic drug, is commonly prescribed for neuropathic pain in hospice/palliative care. Most of the evidence however relates to non-malignant, chronic pain syndromes (diabetic neuropathy, postherpetic neuralgia, central pain syndromes, fibromyalgia). The aim of this study was to quantify the immediate and short-term clinical benefits and harms of gabapentin in routine hospice/palliative care practice. Design Multisite, prospective, consecutive cohort. Population 127 patients, 114 of whom had cancer, who started gabapentin for neuropathic pain as part of routine clinical care. Settings 42 centres from seven countries. Data were collected at three time points—at baseline, at day 7 (and at any time; immediate and short-term harms) and at day 21 (clinical benefits). Results At day 21, the average dose of gabapentin for those still using it (n=68) was 653 mg/24 h (range 0–1800 mg) and 54 (42%) reported benefits, of whom 7 (6%) experienced complete pain resolution. Harms were reported in 39/127 (30%) patients at day 7, the most frequent of which were cognitive disturbance, somnolence, nausea and dizziness. Ten patients had their medication ceased due to harms. The presence of significant comorbidities, higher dose and increasing age increased the likelihood of harm. Conclusions Overall, 42% of people experienced benefit at a level that resulted in continued use at 21 days. PMID:25324335

  5. Scientific Benefits of Space Science Models Archiving at Community Coordinated Modeling Center

    NASA Technical Reports Server (NTRS)

    Kuznetsova, Maria M.; Berrios, David; Chulaki, Anna; Hesse, Michael; MacNeice, Peter J.; Maddox, Marlo M.; Pulkkinen, Antti; Rastaetter, Lutz; Taktakishvili, Aleksandre

    2009-01-01

    The Community Coordinated Modeling Center (CCMC) hosts a set of state-of-the-art space science models ranging from the solar atmosphere to the Earth's upper atmosphere. CCMC provides a web-based Run-on-Request system, by which the interested scientist can request simulations for a broad range of space science problems. To allow the models to be driven by data relevant to particular events CCMC developed a tool that automatically downloads data from data archives and transform them to required formats. CCMC also provides a tailored web-based visualization interface for the model output, as well as the capability to download the simulation output in portable format. CCMC offers a variety of visualization and output analysis tools to aid scientists in interpretation of simulation results. During eight years since the Run-on-request system became available the CCMC archived the results of almost 3000 runs that are covering significant space weather events and time intervals of interest identified by the community. The simulation results archived at CCMC also include a library of general purpose runs with modeled conditions that are used for education and research. Archiving results of simulations performed in support of several Modeling Challenges helps to evaluate the progress in space weather modeling over time. We will highlight the scientific benefits of CCMC space science model archive and discuss plans for further development of advanced methods to interact with simulation results.

  6. Predicting hospice appropriateness for patients with dementia of the Alzheimer's type.

    PubMed

    Marsh, G W; Prochoda, K P; Pritchett, E; Vojir, C P

    2000-11-01

    The appropriateness of admitting individuals to hospice services is determined by assessing the individual's 6-month survival prognosis. Clinical parameters that guide clinicians in assessing prognosis, however, are not well defined in cases of dementia of the Alzheimer's type (DAT) when compared to other illnesses. The Alzheimer's-Hospice Placement Evaluation Scale (AHOPE) was developed to assess the 6-month prognosis of individuals with late-stage DAT. The purposes of this study were to estimate the reliability and predictive validity of AHOPE and to test additional demographic and clinical indicators to determine their added contribution to predicting 6-month survival and hospice appropriateness. Data were collected on 112 long-term care residents with DAT at enrollment and 6 months following enrollment. Initial reliability and predictive validity of AHOPE were supported. Other demographic and clinical indicators were not predictors of 6-month survival. Although additional research is indicated, nurses can use AHOPE to enhance clinical observation and decision making for implementing appropriate care strategies for patients with end-stage DAT and their families. PMID:11078784

  7. Professional and educational needs of hospice and palliative care social workers.

    PubMed

    Weisenfluh, Sherri M; Csikai, Ellen L

    2013-01-01

    In the past decade much growth has occurred in the numbers of patients and families served by hospices and palliative care services. Thus, not surprisingly, these services have also been subject to increasing regulation by governmental and accrediting entities. In order to stay up-to-date in this ever-changing environment and to continue to provide effective interventions, social workers must stay engaged in the professional community and continuing education. In this quantitative study, 1,169 practicing hospice and palliative care social workers provided information about their practice activities and agency characteristics, professional affiliations and certification, and ongoing educational needs. About one-half of respondents carried a caseload of 21-50 and were most engaged in communicating the psychosocial needs of the patient and family to other members of the team and assessing for grief and bereavement issues. The most important educational needs pertained to the psychological and social needs of patients and families and psychosocial interventions. Most were members of professional organizations and three-quarters were members of NASW. Although many were aware of the joint NASW-NHPCO social work hospice specialty certification, few held this certification yet. The results of this survey can be utilized in the design of continuing education programs and advocacy for programmatic and policy change within agencies and the industry. PMID:23438645

  8. 'Hospice' versus 'hospital' care--re-evaluation after 10 years as seen by surviving spouses.

    PubMed Central

    Parkes, C. M.; Parkes, J.

    1984-01-01

    This study compares terminal cancer care in 1967-69 with care in 1977-79 as evaluated by surviving spouses of patients who died in St Christopher's Hospice and other local hospitals. Patients and their surviving spouses reported less personal distress in both settings in 1977-79 than in 1967-69 and the patients were also thought to have suffered less pain. These differences were found before, during and, in surviving spouses, after the period of terminal care. They were confirmed in subsamples of 30-34 patients matched for age, sex, socio-economic status and duration of terminal period. Improvements may be attributable to the training in terminal care provided by staff of the Hospice since 1967 and augmented in its Study Centre which was opened in 1973. Although pain and distress in the patient is no longer a major problem in either setting, spouses in 1977-79 remain less anxious at St Christopher's Hospice than at other hospitals; they play a larger part in the care of the patient and are in closer contact with staff before and after bereavement. PMID:6709542

  9. The global change research center atmospheric chemistry model

    SciTech Connect

    Moraes, F.P. Jr.

    1995-01-01

    This work outlines the development of a new model of the chemistry of the natural atmosphere. The model is 2.5-dimensional, having spatial coordinates height, latitude, and, the half-dimension, land and ocean. The model spans both the troposphere and stratosphere, although the troposphere is emphasized and the stratosphere is simple and incomplete. The chemistry in the model includes the O{sub x}, HO{sub x}, NO{sub x}, and methane cycles in a highly modular fashion which allows model users great flexibility in selecting simulation parameters. A detailed modeled sensitivity analysis is also presented. A key aspect of the model is its inclusion of clouds. The model uses current understanding of the distribution and optical thickness of clouds to determine the true radiation distribution in the atmosphere. As a result, detailed studies of the radiative effects of clouds on the distribution of both oxidant concentrations and trace gas removal are possible. This work presents a beginning of this study with model results and discussion of cloud effects on the hydroxyl radical.

  10. Lincoln County Primary Care Center Is a Model for Good Health.

    ERIC Educational Resources Information Center

    Casto, James E.

    1992-01-01

    Describes a rural West Virginia health-care center as a successful model program for integration between the clinic and community. Describes center facilities, funding sources, community cooperation, and cooperative residency program with regional medical school. Discusses implications for other medical-education programs. Describes differences…

  11. A New Extension Model: The Memorial Middle School Agricultural Extension and Education Center

    ERIC Educational Resources Information Center

    Skelton, Peter; Seevers, Brenda

    2010-01-01

    The Memorial Middle School Agricultural Extension and Education Center is a new model for Extension. The center applies the Cooperative Extension Service System philosophy and mission to developing public education-based programs. Programming primarily serves middle school students and teachers through agricultural and natural resource science…

  12. Coding and Centering of Time in Latent Curve Models in the Presence of Interindividual Time Heterogeneity

    ERIC Educational Resources Information Center

    Blozis, Shelley A.; Cho, Young Il

    2008-01-01

    The coding of time in latent curve models has been shown to have important implications in the interpretation of growth parameters. Centering time is often done to improve interpretation but may have consequences for estimated parameters. This article studies the effects of coding and centering time when there is interindividual heterogeneity in…

  13. A Learner-Centered Molecular Modeling Exercise for Allied Health Majors in a Biochemistry Class

    ERIC Educational Resources Information Center

    Fletcher, Terace M.; Ershler, Jeff

    2014-01-01

    Learner-centered molecular modeling exercises in college science courses can be especially challenging for nonchemistry majors as students typically have a higher degree of anxiety and may not appreciate the relevance of the work. This article describes a learner-centered project given to allied health majors in a Biochemistry course. The project…

  14. Applying Forecast Models from the Center for Integrated Space Weather Modeling

    NASA Astrophysics Data System (ADS)

    Gehmeyr, M.; Baker, D. N.; Millward, G.; Odstrcil, D.

    2007-12-01

    The Center for Integrated Space Weather Modeling (CISM) has developed three forecast models (FMs) for the Sun-Earth chain. They have been matured by various degrees toward the operational stage. The Sun-Earth FM suite comprises empirical and physical models: the Planetary Equivalent Amplitude (AP-FM), the Solar Wind (SW- FM), and the Geospace (GS-FM) models. We give a brief overview of these forecast models and touch briefly on the associated validation studies. We demonstrate the utility of the models: AP-FM supporting the operations of the AIM (Aeronomy of Ice in the Mesosphere) mission soon after launch; SW-FM providing assistance with the interpretation of the STEREO beacon data; and GS-FM combining model and observed data to characterize the aurora borealis. We will then discuss space weather tools in a more general sense, point out where the current capabilities and shortcomings are, and conclude with a look forward to what areas need improvement to facilitate better real-time forecasts.

  15. Mouse Xenograft Model for Mesothelioma | NCI Technology Transfer Center | TTC

    Cancer.gov

    The National Cancer Institute is seeking parties interested in collaborative research to co-develop, evaluate, or commercialize a new mouse model for monoclonal antibodies and immunoconjugates that target malignant mesotheliomas. Applications of the technology include models for screening compounds as potential therapeutics for mesothelioma and for studying the pathology of mesothelioma.

  16. Data Format Standardization of Space Weather Model Output at the Community Coordinated Modeling Center

    NASA Technical Reports Server (NTRS)

    Maddox, M.; Rastatter, L.; Hesse, M.

    2005-01-01

    The disparate nature of space weather model output provides many challenges with regards to the portability and reuse of not only the data itself, but also any tools that are developed for analysis and visualization. We are developing and implementing a comprehensive data format standardization methodology that allows heterogeneous model output data to be stored uniformly in any common science data format. We will discuss our approach to identifying core meta-data elements that can be used to supplement raw model output data, thus creating self-descriptive files. The meta-data should also contain information describing the simulation grid. This will ultimately assists in the development of efficient data access tools capable of extracting data at any given point and time. We will also discuss our experiences standardizing the output of two global magnetospheric models, and how we plan to apply similar procedures when standardizing the output of the solar, heliospheric, and ionospheric models that are also currently hosted at the Community Coordinated Modeling Center.

  17. An Integrated Model of Care: A Visit to The SPARK Center, a Program of Boston Medical Center

    ERIC Educational Resources Information Center

    Griest, Christa

    2010-01-01

    This article features The SPARK Center, a program of Boston Medical Center, located in Mattapan, Massachusetts. The Center has pioneered a whole-child approach to address the multi-dimensional needs of Boston's most at-risk children, recognizing that vulnerable children need more than educational supports to flourish. The Center's integrated model…

  18. ENVIRONMENTAL SOFTWARE AT THE U.S. ENVIRONMENTAL PROTECTION AGENCY'S CENTER FOR EXPOSURE ASSESSMENT MODELING

    EPA Science Inventory

    The Center for Exposure Assessment Modeling (CEAM) was established to meet the scientific and technical exposure assessment needs of the United States Environmental Protection Agency's (EPA) Progrsm and Regional Offices and the various state environmental agencies. o support envi...

  19. Healthcare ethics: a patient-centered decision model.

    PubMed

    Oddo, A R

    2001-01-01

    A common financial model used in business decisions is the cost/benefit comparison. The costs of a proposed project are compared with the benefits, and if the benefits outweigh the costs, the project is accepted; if the costs exceed the benefits, the project is rejected. This model is applicable when tangible costs and benefits can be reasonably measured in monetary units. However, it is difficult to consider intangible factors in this model because intangible factors cannot be readily quantified in money. While some might argue that the financial model should not apply to healthcare decisions, the fact is that costs do enter into the picture. People may decide to forego needed healthcare because they cannot afford it. Healthcare providers may make choices based in part on the costs of diagnosis and treatment, rather than solely on medical information and what is best for the patient. Should financial issues enter into healthcare decisions--decisions about human health and well being? If so, how should the costs and benefits be measured and evaluated? What are some ethical issues and dilemmas involved in such decisions. This paper addresses ethical dilemmas and financial issues in healthcare. A healthcare decision model, which considers medical information, financial information, as well as ethical and other intangible factors, is proposed. PMID:12530441

  20. QuickStats: Percentages* of Residential Care Communities and Adult Day Services Centers That Provided(†) Selected Services - United States, 2014.

    PubMed

    2016-01-01

    In 2014, a greater percentage of residential care communities than adult day service centers provided five of seven selected services. The majority of residential care communities provided pharmacy services (82%); followed by transportation for social activities (79%); physical, occupational, or speech therapy (69%); hospice (62%); skilled nursing (59%); and mental health services (52%). Fewer than half provided social work services (48%). The majority of adult day services centers provided transportation for social activities (69%); skilled nursing (66%); and social work (52%). %). Fewer than half provided physical, occupational, or speech therapy (49%). One third or less provided mental health (33%), pharmacy (27%), and hospice services (12%). PMID:27607333

  1. The changing demographics of inpatient hospice death: Population-based cross-sectional study in England, 1993–2012

    PubMed Central

    Sleeman, Katherine E; Davies, Joanna M; Verne, Julia; Gao, Wei; Higginson, Irene J

    2016-01-01

    Background: Studies in the United Kingdom and elsewhere have suggested inequality of hospice provision with respect to factors such as age, diagnosis and socio-economic position. How this has changed over time is unknown. Aim: To describe the factors associated with inpatient hospice death in England and examine how these have changed over time. Design: Population-based study. Multivariable Poisson regression compared 1998–2002, 2003–2007 and 2008–2012, with 1993–1997. Explanatory variables included individual factors (age, gender, marital status, underlying cause of death) and area-based measures of deprivation. Setting: Adults aged 25 years and over who died in inpatient hospice units in England between 1993 and 2002 (n = 446,615). Results: The annual number of hospice deaths increased from 17,440 in 1993 to 26,032 in 2012, accounting for 3.4% of all deaths in 1993 and 6.0% in 2012. A total of 50.6% of hospice decedents were men; the mean age was 69.9 (standard deviation: 12.4) years. The likelihood of hospice decedents being in the oldest age group (>85 years) increased over time (proportion ratio: 1.43, 95% confidence interval: 1.39 to 1.48 for 2008–2012 compared to 1993–1997). Just 5.2% of all hospice decedents had non-cancer diagnoses, though the likelihood of non-cancer conditions increased over time (proportion ratio: 1.41, 95% confidence interval: 1.37 to 1.46 for 2008–2012 compared to 1993–1997). The likelihood of hospice decedents being resident in the least deprived quintile increased over time (proportion ratio: 1.25, 95% confidence interval: 1.22 to 1.29 for 2008–2012 compared to 1993–1997). Conclusion: The increase in non-cancer conditions among hospice decedents is encouraging although absolute numbers remain very small. Deprivation trends are concerning and require further exploration. PMID:25991729

  2. Absolute IGS antenna phase center model igs08.atx: status and potential improvements

    NASA Astrophysics Data System (ADS)

    Schmid, R.; Dach, R.; Collilieux, X.; Jäggi, A.; Schmitz, M.; Dilssner, F.

    2016-04-01

    On 17 April 2011, all analysis centers (ACs) of the International GNSS Service (IGS) adopted the reference frame realization IGS08 and the corresponding absolute antenna phase center model igs08.atx for their routine analyses. The latter consists of an updated set of receiver and satellite antenna phase center offsets and variations (PCOs and PCVs). An update of the model was necessary due to the difference of about 1 ppb in the terrestrial scale between two consecutive realizations of the International Terrestrial Reference Frame (ITRF2008 vs. ITRF2005), as that parameter is highly correlated with the GNSS satellite antenna PCO components in the radial direction.

  3. Center for Programming Models for Scalable Parallel Computing: Future Programming Models

    SciTech Connect

    Gao, Guang, R.

    2008-07-24

    The mission of the pmodel center project is to develop software technology to support scalable parallel programming models for terascale systems. The goal of the specific UD subproject is in the context developing an efficient and robust methodology and tools for HPC programming. More specifically, the focus is on developing new programming models which facilitate programmers in porting their application onto parallel high performance computing systems. During the course of the research in the past 5 years, the landscape of microprocessor chip architecture has witnessed a fundamental change – the emergence of multi-core/many-core chip architecture appear to become the mainstream technology and will have a major impact to for future generation parallel machines. The programming model for shared-address space machines is becoming critical to such multi-core architectures. Our research highlight is the in-depth study of proposed fine-grain parallelism/multithreading support on such future generation multi-core architectures. Our research has demonstrated the significant impact such fine-grain multithreading model can have on the productivity of parallel programming models and their efficient implementation.

  4. PACE Model Gives Advertising Campaign-Centered Curriculum (Commentary).

    ERIC Educational Resources Information Center

    Thayer, Frank

    1990-01-01

    Describes PACE (Portfolio, Assignments, Content, and Evaluation), an advertising curriculum model in which students work on real advertising campaigns. Explains that students form account groups which locate products needing promotional assistance. Identifies the goals of the curriculum to be competent writing and practical understanding of…

  5. Modeling Center Pivot Irrigated Cotton at Field Scale

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Pivot irrigation equipment may take several days to complete a cycle around a field. This long cycle magnifies the spatial and temporal variability of water and energy balance dynamics and presents some complex challenges for modeling activities at field scale, e.g., 1 km2. One such challenge is the...

  6. A Model Marine Science Laboratory, North Kitsap Marine Environmental Center.

    ERIC Educational Resources Information Center

    Driscoll, Andrew L.; And Others

    The project had two overall goals: (1) to establish and maintain a model marine science facility to be used as a teaching station and a base for research; and (2) to increase student and public awareness about the oceans and the important role they will play in man's future. The project served all the school districts in Kitsap County (Washington)…

  7. Design Model for Learner-Centered, Computer-Based Simulations.

    ERIC Educational Resources Information Center

    Hawley, Chandra L.; Duffy, Thomas M.

    This paper presents a model for designing computer-based simulation environments within a constructivist framework for the K-12 school setting. The following primary criteria for the development of simulations are proposed: (1) the problem needs to be authentic; (2) the cognitive demand in learning should be authentic; (3) scaffolding supports a…

  8. Hospice and palliative care: an expert interview with Louis W. Sullivan, MD. Interview by Perry G. Fine.

    PubMed

    Sullivan, Louis W

    2006-01-01

    At the National Hospice and Palliative Care Organization's 6th Clinical Team Conference on Hospice and Palliative Care, held April 21-23, 2005, in Atlanta, Georgia, Perry G. Fine, MD, Professor in the Department of Anesthesiology at the University of Utah in Salt Lake City and Vice President of Medical Affairs for the National Hospice and Palliative Care Organization interviewed Louis W. Sullivan, MD, former Secretary of the US Department of Health and Human Services and currently President Emeritus of Morehouse School of Medicine, Chair of the Sullivan Commission-a commission to increase diversity among health professionals, Chair of the National Health Museum, Cochair of the President's Commission on HIV/AIDS, and Chair of the President's Commission on Black Colleges and Universities, as well as Chair of Medical Education for South African Blacks. Dr. Fine and Dr. Sullivan discussed the importance of hospice and palliative care, along with some of the practical issues facing clinicians who wish to use the hospice care system. PMID:16687353

  9. The Power of Advance Care Planning in Promoting Hospice and Out-of-Hospital Death in a Dialysis Unit

    PubMed Central

    Weaner, Barbara B.; Long, Dustin

    2015-01-01

    Abstract Background: Despite mortality rates that exceed those of most cancers, hospice remains underutilized in patients with end-stage renal disease (ESRD) on dialysis and nearly half of all dialysis patients die in the hospital. Objective: To review the impact of advance care planning on withdrawal from dialysis, use of hospice, and location of death. Design: Retrospective review. Setting: A rural outpatient dialysis unit. Participants: Former dialysis patients who died over a 5-year period. Exposure: Advance care planning, the use of physician orders for life-sustaining therapy program (POLST). Main Outcome and Measure: Use of hospice among patients withdrawing from dialysis, location of death. Results: Advance care planning was associated with a low incidence of in-hospital death and among those who withdrew, a high use of hospice. Conclusions and Relevance: Comprehensive and systematic advance care planning among patients with ESRD on dialysis promotes greater hospice utilization and may facilitate the chance that death will occur out of hospital. PMID:25006866

  10. The Learner-Centered Instructional Design Model: A Modified Delphi Study

    ERIC Educational Resources Information Center

    Melsom, Duane Allan

    2010-01-01

    The learner-centered instructional design model redefines the standard linear instructional design model to form a circular model where the learner's needs are the first item considered in the development of instruction. The purpose of this modified Delphi study was to have a panel of experts in the instructional design field review the…

  11. Mentoring Resulting in a New Model: Affect-Centered Transformational Leadership

    ERIC Educational Resources Information Center

    Moffett, David W.; Tejeda, Armando R.

    2014-01-01

    The authors were professor and student, in a doctoral leadership course, during fall semester of 2013-2014. Across the term the professor mentored the mentee, guiding him to the creation of the next, needed model for leadership. The new model, known as The Affect-Centered Transformational Leadership Model, came about as the result. Becoming an…

  12. A Family-Centered Model for Sharing Genetic Risk.

    PubMed

    Daly, Mary B

    2015-01-01

    The successes of the Human Genome Project have ushered in a new era of genomic science. To effectively translate these discoveries, it will be critical to improve the communication of genetic risk within families. This will require a systematic approach that accounts for the nature of family relationships and sociocultural beliefs. This paper proposes the application of the Family Systems Illness Model, used in the setting of cancer care, to the evolving field of genomics. PMID:26479564

  13. Regional-Scale Modeling at NASA Goddard Space Flight Center

    NASA Technical Reports Server (NTRS)

    Tao, W.-K.; Adler, R.; Baker, D.; Braun, S.; Chou, M.-D.; Jasinski, M. F.; Jia, Y.; Kakar, R.; Karyampudi, M.; Lang, S.

    2003-01-01

    Over the past decade, the Goddard Mesoscale Modeling and Dynamics Group has used a popular regional scale model, MM5, to study precipitation processes. Our group is making contributions to the MM5 by incorporating the following physical and numerical packages: improved Goddard cloud processes, a land processes model (Parameterization for Land-Atmosphere-Cloud Exchange - PLACE), efficient but sophisticated radiative processes, conservation of hydrometeor mass (water budget), four-dimensional data assimilation for rainfall, and better computational methods for trace gas transport. At NASA Goddard, the MM5 has been used to study: (1) the impact of initial conditions, assimilation of satellite-derived rainfall, and cumulus parameterizations on rapidly intensifying oceanic cyclones, hurricanes and typhoons, (2) the dynamic and thermodynamic processes associated with the development of narrow cold frontal rainbands, (3) regional climate and water cycles, (4) the impact of vertical transport by clouds and lightning on trace gas distributiodproduction associated with South and North American mesoscale convective systems, (5) the development of a westerly wind burst (WWB) that occurred during the TOGA COARE and the diurnal variation of precipitation in the tropics, (6) a Florida sea breeze convective event and a Mid-US flood event using a sophisticated land surface model, (7) the influence of soil heterogeneity on land surface energy balance in the southwest GCIP region, (8) explicit simulations (with 1.33 to 4 km horizontal resolution) of hurricanes Bob (1991) and Bonnie (1998), (9) a heavy precipitation event over Taiwan, and (10) to make real time forecasts for a major NASA field program. In this paper, the modifications and simulated cases will be described and discussed.

  14. Unpacking prevention capacity: an intersection of research-to-practice models and community-centered models.

    PubMed

    Flaspohler, Paul; Duffy, Jennifer; Wandersman, Abraham; Stillman, Lindsey; Maras, Melissa A

    2008-06-01

    Capacity is a complex construct that lacks definitional clarity. Little has been done to define capacity, explicate components of capacity, or explore the development of capacity in prevention. This article represents an attempt to operationalize capacity and distinguish among types and levels of capacity as they relate to dissemination and implementation through the use of a taxonomy of capacity. The development of the taxonomy was informed by the capacity literature from two divergent models in the field: research-to-practice (RTP) models and community-centered (CC) models. While these models differ in perspective and focus, both emphasize the importance of capacity to the dissemination and sustainability of prevention innovations. Based on the review of the literature, the taxonomy differentiates the concepts of capacity among two dimensions: level (individual, organizational, and community levels) and type (general capacity and innovation-specific capacity). The proposed taxonomy can aid in understanding the concept of capacity and developing methods to support the implementation and sustainability of prevention efforts in novel settings. PMID:18307028

  15. 42 CFR 418.26 - Discharge from hospice care.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...'s home) behavior is disruptive, abusive, or uncooperative to the extent that delivery of care to the... the patient's behavior or situation; (iii) Ascertain that the patient's proposed discharge is not...

  16. 42 CFR 418.26 - Discharge from hospice care.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...'s home) behavior is disruptive, abusive, or uncooperative to the extent that delivery of care to the... the patient's behavior or situation; (iii) Ascertain that the patient's proposed discharge is not...

  17. Tropical cyclone center location based on Fisher discriminant and Chan-Vese model

    NASA Astrophysics Data System (ADS)

    Qiao, Wenfeng; Li, Yuanxiang; Wei, Xian; Shen, Ji

    2011-12-01

    TC center location is important for weather forecast and TC analysis. However the appearance of TC centers has different shapes and sizes at different time. At different stages of TC lifetime, the difficulty of locating TC center is different. In order to improve the automatism and precision, we present a TC center location scheme for eye TCs and non-eye TCs. Fisher discriminant is used to segment TC so that we can get the binary image automatically and effectively. Since the cloud wall near the non-eye TC center is homocentric circle, Chan-Vese model is used to get TC contour. Experimental results on TCs show that our scheme can achieve an average error within 0.3 degrees in longitude/latitude in comparison with the best tracks by CMA and RSMC.

  18. Tropical cyclone center location based on Fisher discriminant and Chan-Vese model

    NASA Astrophysics Data System (ADS)

    Qiao, Wenfeng; Li, Yuanxiang; Wei, Xian; Shen, Ji

    2012-01-01

    TC center location is important for weather forecast and TC analysis. However the appearance of TC centers has different shapes and sizes at different time. At different stages of TC lifetime, the difficulty of locating TC center is different. In order to improve the automatism and precision, we present a TC center location scheme for eye TCs and non-eye TCs. Fisher discriminant is used to segment TC so that we can get the binary image automatically and effectively. Since the cloud wall near the non-eye TC center is homocentric circle, Chan-Vese model is used to get TC contour. Experimental results on TCs show that our scheme can achieve an average error within 0.3 degrees in longitude/latitude in comparison with the best tracks by CMA and RSMC.

  19. Modeling crustal deformation near active faults and volcanic centers: a catalog of deformation models and modeling approaches

    USGS Publications Warehouse

    Battaglia, Maurizio; Cervelli; Peter, F.; Murray, Jessica R.

    2013-01-01

    This manual provides the physical and mathematical concepts for selected models used to interpret deformation measurements near active faults and volcanic centers. The emphasis is on analytical models of deformation that can be compared with data from the Global Positioning System (GPS) receivers, Interferometric synthetic aperture radar (InSAR), leveling surveys, tiltmeters and strainmeters. Source models include pressurized spherical, ellipsoidal, and horizontal penny-shaped geometries in an elastic, homogeneous, flat half-space. Vertical dikes and faults are described following the mathematical notation for rectangular dislocations in an elastic, homogeneous, flat half-space. All the analytical expressions were verified against numerical models developed by use of COMSOL Multyphics, a Finite Element Analysis software (http://www.comsol.com). In this way, typographical errors present were identified and corrected. Matlab scripts are also provided to facilitate the application of these models.

  20. Oscillatory Pattern Generation of the Olfactory Center Using Pulse-Type Hardware Chaotic Neuron Models

    NASA Astrophysics Data System (ADS)

    Saito, Ken; Hatano, Hirokazu; Saito, Minoru; Sekine, Yoshifumi

    Oscillatory patterns of electrical activity are a ubiquitous feature in nervous systems. Oscillatory patterns play an important role in the processing of sensory information pattern recognition. For example, earlier reports describe that the oscillatory patterns in the olfactory center of the land slug are changed by odor stimuli to the tentacles. Olfactory processing has also been studied in relation to rabbits and land slugs through the construction and use of mathematical neural network models. However, a large-scale model is necessary for the study of a model which has sensory information recognition by the oscillatory pattern. Therefore, the construction of a hardware model that can generate oscillatory patterns is desired because nonlinear operations can be processed at higher speeds than the mathematical model. We are studying about the neural network using hardware neuron models to construct the olfactory center model of the living organisms. In the present study, we discuss about the oscillatory pattern generation of the olfactory center using pulse-type hardware chaotic neuron models. Our model shows periodic, quasi-periodic and chaotic oscillations such as the olfactory center of living organisms by changing the synaptic connection weights.

  1. Partnerships for Education and Diversity in the Center for Integrated Space Weather Modeling

    NASA Astrophysics Data System (ADS)

    Lopez, R. E.

    2008-05-01

    The Center for Integrated Space Weather Modeling (CISM) is a Science and Technology Center funded by the National Science Foundation that comprises 11 institutions from Boston to Berkeley. All such centers are mandated to have extensive education and diversity programs. In this presentation I will discuss our efforts in building a partnership with a leading HBCU, Alabama A&M University. I will also discuss some of the other education efforts that rely on the partnership between CISM institutions, in particular the CISM summer school, as well as some features of undergraduate research being conducted under CISM sponsorship.

  2. Solar-terrestrial models at the National Space Science Data Center

    NASA Technical Reports Server (NTRS)

    Bilitza, D.

    1991-01-01

    The National Space Science Data Center (NSSDC) and World Data Center A for Rockets and Satellites (WDC-A-R&S) has a long record of participation in the worldwide efforts to establish and improve empirical models for the different regions of the solar-terrestrial environment. The center maintains a unique archive of solar-terrestrial models and related applications software, described in a recently published models catalog. The software packages are distributed on tape, diskette, and on-line on the Space Physics Analysis Network (SPAN). Four of the most frequently requested models (IRI, MSIS/CIRA, IGRF, AE-8/AP-8) can also be accessed and run on the NSSDC Online Documentation and Information Service (NODIS) account, which can be reached from any SPAN node.

  3. A Tutorial on Centering in Cross-Sectional Two-Level Models

    ERIC Educational Resources Information Center

    Myers, Nicholas D.; Brincks, Ahnalee M.; Beauchamp, Mark R.

    2010-01-01

    The primary purpose of this tutorial is to succinctly review some options for, and consequences of, centering Level 1 predictors in commonly applied cross-sectional two-level models. It is geared toward both practitioners and researchers. A general understanding of multilevel modeling is necessary prior to understanding the subtleties of centering…

  4. Fanon Center Restoration Model: An Emancipatory Strategy for Education of all Children. Final Report.

    ERIC Educational Resources Information Center

    King, Lewis M.; And Others

    This paper discusses the Fanon Center's Restoration Model, an "exemplary education" paradigm that seeks to institute a new educational ideology and alternative educational approach based on a "new humanism." The basis of this new humanism is the synthesis of analytic, affective, and sensate ways of discovery and knowing. The model places equal…

  5. Clinical Assessment at College Counseling Centers: The Consultant-on-Duty Model

    ERIC Educational Resources Information Center

    Schoen, Eva; McKelley, Ryan

    2012-01-01

    The consultant-on-duty (COD) clinical consultation model maximizes efficient use of services, is distinct from other university counseling center (UCC) services, and precedes therapy. This model enables clinicians to ensure optimal fit between client need and type of UCC services provided, including brief therapy. The 4 objectives of the COD model…

  6. California Geriatric Education Center Logic Model: An Evaluation and Communication Tool

    ERIC Educational Resources Information Center

    Price, Rachel M.; Alkema, Gretchen E.; Frank, Janet C.

    2009-01-01

    A logic model is a communications tool that graphically represents a program's resources, activities, priority target audiences for change, and the anticipated outcomes. This article describes the logic model development process undertaken by the California Geriatric Education Center in spring 2008. The CGEC is one of 48 Geriatric Education…

  7. Robust Optimization Model and Algorithm for Railway Freight Center Location Problem in Uncertain Environment

    PubMed Central

    He, Shi-wei; Song, Rui; Sun, Yang; Li, Hao-dong

    2014-01-01

    Railway freight center location problem is an important issue in railway freight transport programming. This paper focuses on the railway freight center location problem in uncertain environment. Seeing that the expected value model ignores the negative influence of disadvantageous scenarios, a robust optimization model was proposed. The robust optimization model takes expected cost and deviation value of the scenarios as the objective. A cloud adaptive clonal selection algorithm (C-ACSA) was presented. It combines adaptive clonal selection algorithm with Cloud Model which can improve the convergence rate. Design of the code and progress of the algorithm were proposed. Result of the example demonstrates the model and algorithm are effective. Compared with the expected value cases, the amount of disadvantageous scenarios in robust model reduces from 163 to 21, which prove the result of robust model is more reliable. PMID:25435867

  8. Model Attitude and Deformation Measurements at the NASA Glenn Research Center

    NASA Technical Reports Server (NTRS)

    Woike, Mark R.

    2008-01-01

    The NASA Glenn Research Center is currently participating in an American Institute of Aeronautics and Astronautics (AIAA) sponsored Model Attitude and Deformation Working Group. This working group is chartered to develop a best practices document dealing with the measurement of two primary areas of wind tunnel measurements, 1) model attitude including alpha, beta and roll angle, and 2) model deformation. Model attitude is a principle variable in making aerodynamic and force measurements in a wind tunnel. Model deformation affects measured forces, moments and other measured aerodynamic parameters. The working group comprises of membership from industry, academia, and the Department of Defense (DoD). Each member of the working group gave a presentation on the methods and techniques that they are using to make model attitude and deformation measurements. This presentation covers the NASA Glenn Research Center s approach in making model attitude and deformation measurements.

  9. The impact of advance care planning of place of death, a hospice retrospective cohort study

    PubMed Central

    Abel, Julian; Pring, Andy; Rich, Alison; Malik, Tariq; Verne, Julia

    2013-01-01

    Objectives There is limited evidence of the impact of advance care planning (ACP) on outcomes. We conducted a retrospective cohort study on deaths of all patients known to a hospice in a 2.5-year period to see if use of ACP affected actual place of death, hospital use and cost of hospital care in the last year. Results 969 patients were included. 550 (57%) people completed ACP. 414 (75%) achieved their choice of place of death. For those who chose home, 34 (11.3%) died in hospital; a care home 2 (1.7%) died in hospital; a hospice 14 (11.2%) died in hospital and 6 (86%) who chose to die in hospital did so. 112 (26.5%) of people without ACP died in hospital. Mean number of days in hospital in the last year of life was 18.1 in the ACP group and 26.5 in the non-ACP group(p<0.001). Mean cost of hospital treatment during the last year of life for those who died in hospital was £11,299, those dying outside of hospital £7,730 (p<0.001). Mean number of emergency admissions for those who died in hospital was 2.2 and who died elsewhere was 1.7 (p<0.001). Conclusions ACP can be used routinely in a hospice setting. Those who used ACP spent less time in hospital in their last year. ACP is associated with a reduction in the number of days in hospital in the last year of life with less hospital costs, supporting the assumptions made in the End of Life Care Strategy 2008. PMID:23626905

  10. Reflections on the history of occupational stress in hospice/palliative care.

    PubMed

    Vachon, M L

    1999-01-01

    The concept of hospice and palliative care emerged a quarter of a century ago out of recognition of the unmet needs of dying persons and the social issues of the 1960s and 1970s. The issues of the day included the sexual revolution; a questioning of social values; an increased awareness of death resulting from the murder of the Kennedy brothers and Martin Luther King and daily television exposure to deaths in the Vietnam War, feminism, consumerism, reclaiming a more humanized role in the birth process, and hence in the process of death. The history of the hospice movement and the stress experienced by staff is traced from the early developmental days through to the present. Initially there was sometimes a struggle to integrate the concepts of relief of physical symptoms with meeting the psychosocial and emotional needs of patients and families, caregivers were expected to sacrifice much of their personal life for work, emotional intensity was high and supports were developed to ease some of the stress experienced by caregivers. From the early days team stress and burnout have been issues of concern. In the 1980s issues involved establishing funding sources, dealing with the new crisis of AIDS, and dealing with the gap between the ideal and the real. In the 1990s the economic climate has escalated some of the tensions that have always existed as hospice attempts to position itself within mainstream care with diminishing fiscal resources. These are issues that confront us as we move into the next century. PMID:10839014

  11. Sedation at the end of life: a hospice's decision-making practices in the UK.

    PubMed

    Dean, Antonia; Miller, Barbara; Woodwork, Catherine

    2014-10-01

    The administration of sedative drugs at the end of life raises both clinical and ethical challenges. This article details the evolution of sedation decision-making practices at a 14-bedded UK hospice over the course of 5 years through an initial review and two follow-up audits. Key areas, such as documented consideration of hydration status and discussion with family members, have been improved following the implementation of a checklist of decision-making prompts, demonstrating how practice can be improved and sustained over time. PMID:25350213

  12. Hospice disease types which indicate a greater need for bereavement counseling.

    PubMed

    Jones, Brian W

    2010-05-01

    This article attempts to find a correlation between certain disease types and increased needs for bereavement services for survivors. Data were examined from those requesting increased bereavement services from a hospice provider in Kentucky, over a 2-year span. The survivors were then matched with the disease type of their loved one to see whether there was a connection between the two. Although limited in its scope and focus, the study revealed that patients surviving Alzheimer disease, lung cancer, and renal failure consistently (at least 50% of the time) required increased bereavement services after the death of their loved one. Other disease types indicated more erratic patterns for increased grief services. PMID:19837970

  13. Center forTelehealth and Cybermedicine Research, University of New Mexico Health Sciences Center: a model of a telehealth program within an academic medical center.

    PubMed

    Alverson, Dale C; Dion, Denise; Migliorati, Margaret; Rodriguez, Adrian; Byun, Hannah W; Effertz, Glen; Duffy, Veronica; Monge, Benjamin

    2013-05-01

    An overview of the Center for Telehealth and Cybermedicine Research at the University of New Mexico Health Sciences Center was presented along with several other national and international programs as part of the of a symposium-workshop on telehealth, "Sustaining and Realizing the Promise of Telemedicine," held at the University of Michigan Health System in Ann Arbor, MI, May 18-19, 2012 and hosted by the University of Michigan Telemedicine Resource Center and its Director, Rashid Bashshur. This article describes our Center, its business plan, and a view to the future. PMID:23317516

  14. Information System Success Model for Customer Relationship Management System in Health Promotion Centers

    PubMed Central

    Choi, Wona; Rho, Mi Jung; Park, Jiyun; Kim, Kwang-Jum; Kwon, Young Dae

    2013-01-01

    Objectives Intensified competitiveness in the healthcare industry has increased the number of healthcare centers and propelled the introduction of customer relationship management (CRM) systems to meet diverse customer demands. This study aimed to develop the information system success model of the CRM system by investigating previously proposed indicators within the model. Methods The evaluation areas of the CRM system includes three areas: the system characteristics area (system quality, information quality, and service quality), the user area (perceived usefulness and user satisfaction), and the performance area (personal performance and organizational performance). Detailed evaluation criteria of the three areas were developed, and its validity was verified by a survey administered to CRM system users in 13 nationwide health promotion centers. The survey data were analyzed by the structural equation modeling method, and the results confirmed that the model is feasible. Results Information quality and service quality showed a statistically significant relationship with perceived usefulness and user satisfaction. Consequently, the perceived usefulness and user satisfaction had significant influence on individual performance as well as an indirect influence on organizational performance. Conclusions This study extends the research area on information success from general information systems to CRM systems in health promotion centers applying a previous information success model. This lays a foundation for evaluating health promotion center systems and provides a useful guide for successful implementation of hospital CRM systems. PMID:23882416

  15. A generation/recombination model assisted with two trap centers in wide band-gap semiconductors

    NASA Astrophysics Data System (ADS)

    Yamaguchi, Ken; Kuwabara, Takuhito; Uda, Tsuyoshi

    2013-03-01

    A generation/recombination (GR) model assisted with two trap centers has been proposed for studying reverse current on pn junctions in wide band-gap semiconductors. A level (Et1) has been assumed to be located near the bottom of the conduction band and the other (Et2) to be near the top of the valence band. The GR model has been developed by assuming (1) a high-electric field; F, (2) a short distance; d, between trap centers, (3) reduction in an energy-difference; Δeff = |Et1 - Et2| - eFd, and (4) hopping or tunneling conductions between trap centers with the same energy-level (Δeff ≈ 0). The GR rate has been modeled by trap levels, capture cross-sections, trap densities, and transition rate between trap centers. The GR rate, about 1010 greater than that estimated from the single-level model, has been predicted on pn junctions in a material with band-gap of 3.1 eV. Device simulations using the proposed GR model have been demonstrated for SiC diodes with and without a guard ring. A reasonable range for reverse current at room temperature has been simulated and stable convergence has been obtained in a numerical scheme for analyzing diodes with an electrically floating region.

  16. Center for Modeling of Turbulence and Transition (CMOTT). Research briefs: 1990

    NASA Technical Reports Server (NTRS)

    Povinelli, Louis A. (Compiler); Liou, Meng-Sing (Compiler); Shih, Tsan-Hsing (Compiler)

    1991-01-01

    Brief progress reports of the Center for Modeling of Turbulence and Transition (CMOTT) research staff from May 1990 to May 1991 are given. The objectives of the CMOTT are to develop, validate, and implement the models for turbulence and boundary layer transition in the practical engineering flows. The flows of interest are three dimensional, incompressible, and compressible flows with chemistry. The schemes being studied include the two-equation and algebraic Reynolds stress models, the full Reynolds stress (or second moment closure) models, the probability density function models, the Renormalization Group Theory (RNG) and Interaction Approximation (DIA), the Large Eddy Simulation (LES) and Direct Numerical Simulation (DNS).

  17. Center for Modeling of Turbulence and Transition (CMOTT): Research Briefs, 1992

    NASA Technical Reports Server (NTRS)

    Liou, William W. (Editor)

    1992-01-01

    The progress is reported of the Center for Modeling of Turbulence and Transition (CMOTT). The main objective of the CMOTT is to develop, validate and implement the turbulence and transition models for practical engineering flows. The flows of interest are three-dimensional, incompressible and compressible flows with chemical reaction. The research covers two-equation (e.g., k-e) and algebraic Reynolds-stress models, second moment closure models, probability density function (pdf) models, Renormalization Group Theory (RNG), Large Eddy Simulation (LES) and Direct Numerical Simulation (DNS).

  18. Methodological challenges in conducting a multi-site randomized clinical trial of massage therapy in hospice.

    PubMed

    Kutner, Jean; Smith, Marlaine; Mellis, Karen; Felton, Sue; Yamashita, Traci; Corbin, Lisa

    2010-06-01

    Researchers conducting multi-site studies of interventions for end-of-life symptom management face significant challenges with respect to obtaining an adequate sample and training and retaining on-site study teams. The purpose of this paper is to describe the strategies and responses to these challenges in a multi-site randomized clinical trial (RCT) of the efficacy of massage therapy for decreasing pain among patients with advanced cancer in palliative care/hospice settings. Over a period of 36 months, we enrolled 380 participants across 15 sites; 27% of whom withdrew prior to study completion (less than the anticipated 30% rate). We saw an average of 68% turnover amongst study staff. Three key qualities characterized successful on-site study teams: (1) organizational commitment; (2) strong leadership from on-site study coordinators; and (3) effective lines of communication between the on-site study coordinators and both their teams and the university-based research team. Issues of recruitment, retention and training should be accounted for in hospice-based research study design and budgeting. PMID:20597707

  19. Dyspnea and quality of life indicators in hospice patients and their caregivers

    PubMed Central

    Moody, Linda E; McMillan, Susan

    2003-01-01

    This study describes the assessment of dyspnea, symptom distress, and quality of life measures in 163 hospice patients with cancer who reported dyspnea. Mean age of the hospice patient sample was 70.22 years and 61.86 for caregivers (65% were spouses). The majority of patients and caregivers were white: 87%, 63% of the patients were male while 78% of caregivers were female. Mean dyspnea intensity as reported by patients was 4.52 (SD 2.29) and caregivers, 4.39 (SD 2.93). Patients' and caregivers' ratings of the patient's dyspnea intensity revealed no significant differences in ratings thus verifying that caregivers can assess dyspnea severity accurately. Patients' perceived quality of life ratings were not significantly correlated with ratings of their caregivers' perceived quality of life. For patients, symptom distress and education were significant predictors of variance in quality of life (R2 = .35, p = .04). However, mastery, symptom distress, age, and education were found to be significant predictors of variance in quality of life of caregivers (R2 = .40, p = .02). PMID:12740034

  20. Prevalence and characteristics of breakthrough pain in cancer patients admitted to a hospice.

    PubMed

    Zeppetella, G; O'Doherty, C A; Collins, S

    2000-08-01

    A prospective survey was undertaken to determine the prevalence and characteristics of breakthrough pain in cancer patients admitted to a hospice. Of 414 consecutive admissions, 33 patients were confused or too unwell to take part and 136 were pain-free. The remaining 245 reported 404 pains (range 1-5 per patient); of these patients, 218 (89%) had breakthrough pain and identified 361 pains (range 1-5 per patient). Breakthrough pain was classified as somatic (46%) visceral (30%), neuropathic (10%) or mixed etiology (16%). Thirty-eight percent of pains were severe or excruciating. The average number of daily breakthrough pain episodes was 4 [corrected] (range 1-14); 49% occurred suddenly. Most (59%) were unpredictable, and 72% lasted less than 30 minutes. Seventy-five percent of patients were dissatisfied with their pain control. Breakthrough pain is common among patients admitted to our hospice. It is frequent, short lasting, often unpredictable and not necessarily related to chronic pain making treatment difficult. PMID:10989246

  1. After-hour home care service provided by a hospice in Singapore.

    PubMed

    Tay, M H; Koo, W H; Huang, D T

    2002-03-01

    A home care Hospice programme was set up to provide care to the patients with advanced diseases and their families in Singapore. After office-hour, the service is managed by a doctor on weekdays, with the assistance of a nurse during daytime on Saturdays, Sundays and public holidays. The doctor on-call made an average of 3.1 phone calls and 1.3 visits each weekday evening. Over the weekends and public holidays, there were a mean of 16.7 phone calls and 6 visits each day. More than half of the visits (50.3%) were made for certification of death. The commonest symptoms that prompted visits were dyspnoea (20%) and pain (12.2%). The busiest period during weekdays was between 6.00 pm and 11.00 pm, when our doctors did most of their visits. The workload of the hospice home care service is likely to increase and resources such as family health physicians can be explored to help to meet this increasing demand. This can be achieved through the provision of comprehensive training and easy accessibility to medical records which are kept with patients. PMID:14569717

  2. Maslow's hierarchy of needs: a framework for achieving human potential in hospice.

    PubMed

    Zalenski, Robert J; Raspa, Richard

    2006-10-01

    Although the widespread implementation of hospice in the United States has led to tremendous advances in the care of the dying, there has been no widely accepted psychological theory to drive needs assessment and intervention design for the patient and family. The humanistic psychology of Abraham Maslow, especially his theory of motivation and the hierarchy of needs, has been widely applied in business and social science, but only sparsely discussed in the palliative care literature. In this article we review Maslow's original hierarchy, adapt it to hospice and palliative care, apply the adaptation to a case example, and then discuss its implications for patient care, education, and research. The five levels of the hierarchy of needs as adapted to palliative care are: (1) distressing symptoms, such as pain or dyspnea; (2) fears for physical safety, of dying or abandonment; (3) affection, love and acceptance in the face of devastating illness; (4) esteem, respect, and appreciation for the person; (5) selfactualization and transcendence. Maslow's modified hierarchy of palliative care needs could be utilized to provide a comprehensive approach for the assessment of patients' needs and the design of interventions to achieve goals that start with comfort and potentially extend to the experience of transcendence. PMID:17040150

  3. Illness awareness in hospice: application of a semi-structured interview.

    PubMed

    Andruccioli, Jessica; Montesi, Alessandra; Di Leo, Silvia; Sarti, Donatella; Turci, Paola; Pittureri, Cristina; Monterubbianesi, Maria Cristina; Parma, Tiziana; Raffaeli, William

    2009-01-01

    This study describes the results of a semi-structured interview to assess the illness awareness of cancer patients in Hospice. The results of this study are based on the interviews made in Rimini and Savignano sul Rubicone Hospices (n = 51). Psychologists evaluated illness awareness of the participants interviewed independently from the code system that is provided for the interview. According to the psychologists, 18 patients (35%) were aware, 11 patients (22%) were unaware, and 22 patients (43%) were aware with defense mechanisms. According to the code system of the interview, the results were the following: 18 patients (35%) were aware, 2 patients (4%) were unaware, and 29 patients (57%) were aware with defense mechanisms. Two participants had to be reassessed because of inconsistency in some factors. In conclusion, the data analysis underlined that the congruence of the 2 assessment methods was found in 33 of the 51 patients examined (65%) and that the degree of concordance was rather low (kappa = .46; 95% CI = 0.24-0.68). PMID:19581384

  4. Translating Evidence into Practice at the End-of-Life: Information needs, access and usage by hospice and palliative nurses

    PubMed Central

    Klein-Fedyshin, Michele

    2014-01-01

    Information literacy is important for evidence-based nursing and quality patient care. Hospice/palliative nurses are often unaffiliated with academic institutions and may experience barriers accessing information. The project's goals were to identify their (1) access to evidence-based resources, (2) information literacy skills and (3) training needs. The research design was a descriptive assessment. Members of the Hospice & Palliative Nurses Association in 4 states received the assessment in collaboration with University of Pittsburgh. The methodology yielded statistics on information needs, access and literacy skills. Data analysis included frequency distributions, cross-tabulations, and a chi-square test. Of the respondents, 69% worked clinically. The need for drug or disease information occurred in 89% to 100% of respondents across sites. Respondents knew of PubMed in 28% to 70% of sites. Evidence databases were unavailable in 7% to 39% of settings. The most frequent source of information was colleagues (74%), followed by Internet searches (70%). About 43% of respondents felt confident using health literacy strategies. The greatest training needs were finding quality nursing information (79%), reliable patient education (65%) and evidence for practice/quality improvement (64%). There is a large need for quality nursing, patient and evidence-based information in hospice environments. Hospice nurses access the Internet, although evidence/database access is often lacking or unknown making it suboptimal. PMID:26085819

  5. Online resources for culturally and linguistically appropriate services for home healthcare and hospice, part 5: resources for African patients.

    PubMed

    Young, Judith S

    2013-05-01

    Providing culturally and linguistically appropriate home healthcare and hospice care to patients who have emigrated from the African continent can be a challenge. This article reviews Web sites that provide introductions to some of the predominant cultures in Africa. Web sites providing patient education material in 13 African languages are also discussed. PMID:23652979

  6. Engaged Scholarship in Partnership with a Local Hospice: A Qualitative Case Study in a Radiation Therapy Classroom

    ERIC Educational Resources Information Center

    Trad, Megan

    2012-01-01

    This qualitative case study focuses on providing answers to the following research questions. How do radiation therapy students respond to the implementation of an engaged scholarship partnership with the local hospice in relation to educational gains, experiential learning, transformational learning, and professional growth? This question is…

  7. Exploring Hospice Decisions: The Road from the Institute on Aging and Social Work to an ARRA Challenge Grant

    ERIC Educational Resources Information Center

    Waldrop, Deborah

    2014-01-01

    Decisions about treatment and options for care at the end stage of an advanced chronic illness are important determinants of the quality of a person's death and of how family members adapt in bereavement. This article describes the steps taken to secure federal funding to study how people make the decision to enroll in hospice. The National…

  8. Music therapy with imminently dying hospice patients and their families: facilitating release near the time of death.

    PubMed

    Krout, Robert E

    2003-01-01

    Hospice care seeks to address the diverse needs of terminally ill patients in a number of physical, psychosocial, and spiritual areas. Family members of the patient often are included in the care and services provided by the hospice team, and hospice clinicians face a special challenge when working with families of patients who are imminently dying. When loved ones are anticipating the patient's impending death, they may find it difficult to express feelings, thoughts, and last wishes. Music therapy is a service modality that can help to facilitate such communication between the family and the patient who is actively dying, while also providing a comforting presence. Music therapy as a way to ease communication and sharing between dying patients and their loved ones is discussed in this article. The ways in which music therapy can facilitate a means of release for both patients and family members in an acute care unit of a large US hospice organization are specifically described. Case descriptions illustrate how music therapy functioned to allow five patients and their families to both come together and let go near the time of death. Elements to consider when providing such services to imminently dying patients and their families are discussed. PMID:12693645

  9. The Cajon Valley Union School District/San Diego State University Model Education Center (MEC).

    ERIC Educational Resources Information Center

    Berg, Marlowe; Nagel, Thomas

    The Cajon Valley/San Diego State University Model Education Center (MEC) focuses on the training of elementary school teachers, teacher inservice, and collaborative leadership. It provides an exemplary training site for preparing elementary school teachers, and uses staff development to create a school environment/climate which will produce…

  10. A Comprehensive Community Nursing Center Model: Maximizing Practice Income--A Challenge to Educators.

    ERIC Educational Resources Information Center

    Walker, Patricia Hinton

    1994-01-01

    The University of Rochester's community nursing center is an entrepreneurial model for faculty practice based on sound business principles to enhance financial success. These principles include development and pricing of the product of nursing services, consumer dialogue instead of advertising monologue, and a diversified income base. (SK)

  11. Stimulating Healthy Aging with a Model Nurse-Managed Free Clinic in a Senior Center.

    ERIC Educational Resources Information Center

    Franklin, Ruth H.

    As part of a Geriatric Education and Health Management program, a model nurse-managed free clinic has been established at an urban senior center by faculty and students of the University of New Mexico College of Nursing. Funded by a 3-year grant from the Department of Health and Human Services, the weekly clinic is based on Orem's self-care theory…

  12. Participant-Centered Education: Building a New WIC Nutrition Education Model

    ERIC Educational Resources Information Center

    Deehy, Karen; Hoger, Fatima S.; Kallio, Jan; Klumpyan, Kay; Samoa, Siniva; Sell, Karen; Yee, Linda

    2010-01-01

    Objective: To assess the readiness of the Western Region Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) states to implement participant-centered nutrition education (PCE) and to develop a PCE model for WIC service delivery. Design: Formative research including on-line survey, qualitative in-depth interviews, focus…

  13. Model Validation at the 204 MW New Mexico Wind Energy Center: Preprint

    SciTech Connect

    Muljadi, E.; Butterfield, C. P.; Ellis, A.; Mechenbier, J.; Hochheimer, J.; Young, R.; Miller, N.; Delmerico, R.; Zavadil, R.; Smith, J. C.

    2006-06-01

    In this paper, we describe methods to derive and validate equivalent models for a large wind farm. FPL Energy's 204-MW New Mexico Wind Energy Center, which is interconnected to the Public Service Company of New Mexico (PNM) transmission system, was used as a case study. The methods described are applicable to any large wind power plant.

  14. Information Transfer with the Ohio College Library Center Program as a Model. Paper No. 4.

    ERIC Educational Resources Information Center

    Michigan Library Consortium, Detroit.

    The Michigan Library Consortium (MLC) is studying the problems and possibilities of networking, with the Ohio College Library Center (OCLC) as a model and possible data base for the MLC. Standards on an international scale must be developed, and the need for constantly improving technology, particularly computers, must be recognized. Since the…

  15. The Center of Excellence Model for Information Services. CLIR Publication No. 163

    ERIC Educational Resources Information Center

    Kirchner, Joy; Diaz, José; Henry, Geneva; Fliss, Susan; Culshaw, John; Gendron, Heather; Cawthorne, Jon E.

    2015-01-01

    In 2013, The Andrew W. Mellon Foundation awarded a group of seven librarians from the Research Library Leadership Fellows program of the Association of Research Libraries (ARL) a planning grant to examine the center of excellence (CoE) model for information services. Used in a variety of industries, CoEs are designed to attract the most talented…

  16. Promoting Cultural Relativism in Counselors through the Cultural De-Centering Model

    ERIC Educational Resources Information Center

    McAuliffe, Garrett J.; Milliken, Tammi F.

    2009-01-01

    Counselors who are culturally encapsulated are likely to create client mistrust and to misinterpret clients' cultural norms. This article presents the Cultural De-Centering Model (CDCM) as a constructive-developmental method for helping future counselors to be less ethnocentric in their work. The goal of the CDCM is to increase counselors'…

  17. CAROLINA CENTER FOR COMPUTATIONAL TOXICOLOGY: ASSAYS, MODELS AND TOOLS FOR NEXTGEN SAFETY ASSESSMENTS

    EPA Science Inventory

    The Center will develop new methods and tools, and will continue to collaborate closely with EPA, Tox21 and other environmental scientists. New in vitro populationbased assays and computer-based models that fill critical gaps in risk assessment will be developed and deliver...

  18. The Art and Process of Negotiation: An Area Health Education Center Model.

    ERIC Educational Resources Information Center

    Hassan, Umar A.

    The negotiating relationship of a medical school and a community-based organization is examined, based on the point of view of a negotiator and the California Area Health Education Center (AHEC) System model. The Health Professions Educational Assistance Act (1974) funds medical schools to negotiate the use of a portion of their educational…

  19. Investigating Models for Preservice Teachers' Use of Technology to Support Student-Centered Learning

    ERIC Educational Resources Information Center

    Chen, Rong-Ji

    2010-01-01

    The study addressed two limitations of previous research on factors related to teachers' integration of technology in their teaching. It attempted to test a structural equation model (SEM) of the relationships among a set of variables influencing preservice teachers' use of technology specifically to support student-centered learning. A review of…

  20. The Impacts of the WIA One-Stop Center Model on Local Training Services

    ERIC Educational Resources Information Center

    Cajayon, Felicito

    2012-01-01

    This study examined the Workforce Investment Act (WIA) One-Stop Center model, which is the local service mechanism for providing employment and training services. It reviewed the processes and service patterns of four program designs that offer an array of services that align with the WIA program's allowable activities. The purpose of the…

  1. Developing Student-Centered Learning Model to Improve High Order Mathematical Thinking Ability

    ERIC Educational Resources Information Center

    Saragih, Sahat; Napitupulu, Elvis

    2015-01-01

    The purpose of this research was to develop student-centered learning model aiming to improve high order mathematical thinking ability of junior high school students of based on curriculum 2013 in North Sumatera, Indonesia. The special purpose of this research was to analyze and to formulate the purpose of mathematics lesson in high order…

  2. Predictors of Intensive End-of-Life and Hospice Care in Latino and White Advanced Cancer Patients

    PubMed Central

    Maciejewski, Paul K.; Jimenez, Rachel; Nilsson, Matthew; Paulk, Elizabeth; Stieglitz, Heather; Prigerson, Holly G.

    2013-01-01

    Abstract Background The role of end-of-life (EOL) care preferences and conversations in receipt of care near death for Latinos is unclear. Objective This study examines rates and predictors of intensive EOL and hospice care among Latino and white advanced cancer patients. Design Two-hundred-and-ninety-two self-reported Latino (n=58) and white (n=234) Stage IV cancer patients participated in a U.S. multisite, prospective, cohort study from September 2002 to August 2008. The Latino and white, non-Hispanic participants were interviewed and followed until death, a median of 118.5 days from baseline. Measurements Patient-reported, baseline predictors of EOL care included EOL care preference; terminal illness acknowledgement; EOL discussion; completion of a DNR order; and religious coping. Caregiver postmortem interviews provided information regarding EOL care received. Intensive EOL care was defined as resuscitation and/or ventilation followed by death in an intensive care unit. Hospice was either in- or outpatient. Results Latino and white patients received intensive EOL and hospice care at similar rates (5.2% and 3.4% for intensive care, p=0.88; 70.7% versus 73.4% for hospice, p=0.33). No white or Latino patient who reported a DNR order or EOL discussion at baseline received intensive EOL care. Religious coping and a preference for life-extending care predicted intensive EOL care for white patients (adjusted odds ratio [aOR] 6.69 [p=0.02] and aOR 6.63 [p=0.01], respectively), but not for Latinos. No predictors were associated with Latino hospice care. Conclusions EOL discussions and DNR orders may prevent intensive EOL care among Latino cancer patients. Efforts should continue to engage Latino patients and caregivers in these activities. PMID:24053593

  3. Space Weather Data Dissemination Tools from the Community Coordinated Modeling Center

    NASA Astrophysics Data System (ADS)

    Donti, N.; Berrios, D.; Boblitt, J.; LaSota, J.; Maddox, M. M.; Mullinix, R.; Hesse, M.

    2011-12-01

    The Community Coordinated Modeling Center (CCMC) at NASA Goddard Space Flight Center has developed new space weather data dissemination products. These include a Java-based conversion software for space weather simulation data, an interactive and customizable timeline tool for time series data, and Android phone and tablet versions of the NASA Space Weather App for mobile devices. We highlight the new features of all the updated services, discuss the back-end capabilities required to realize these services, and talk about future services in development.

  4. New organizational and funds flow models for an academic cancer center.

    PubMed

    Spahlinger, David A; Pai, Chih-Wen; Waldinger, Marcy B; Billi, John E; Wicha, Max S

    2004-07-01

    The clinical impetus to develop cancer centers has been the recognition that many cancer patients require a comprehensive treatment plan coordinated across multiple specialties. Developing an effective organizational and financial structure among the multiple entities that comprise an academic cancer center has, however, been a challenge. The authors describe an effort to realize a sustainable clinical operation at the University of Michigan Comprehensive Cancer Center (UMCCC) by developing an appropriate management structure and financial model. The modified organizational structure established a clear line of administrative authority and held faculty members accountable for their effort in the UMCCC. A unified budget aligned financial incentive among all stakeholders to increase efficiency, revenue, and margin. The authors report preliminary financial evidence of the success of the new managerial structure. PMID:15234911

  5. Commentary: Change we must: putting patients first with the institute model of academic health center organization.

    PubMed

    Young, James B; Cosgrove, Delos M

    2012-05-01

    In the traditional department-based organizational structure of an academic health center, patients can be neglected as a result of fragmented systems of care. Specialty-driven, provider-oriented, economically influenced organizations dominated by research and education missions might, paradoxically, promote too little concern for the patient. All three components (education, research, and patient care) of academic health centers' tripartite mission are sacred, but times have changed. Academic health centers must rethink their traditional approach to achieving their mission. The authors describe the evolution at the Cleveland Clinic of a unique, institute-based reorganization that is focused on integrated disease- and organ-system-based patient care, research, and education. The authors argue that this model better focuses on the patient as well as on the institution's academic charge. It is a concept that should be more widely adopted with deference to individual institutional culture and history. PMID:22531586

  6. An MIP model to schedule the call center workforce and organize the breaks

    NASA Astrophysics Data System (ADS)

    Türker, Turgay; Demiriz, Ayhan

    2016-06-01

    In modern economies, companies place a premium on managing their workforce efficiently especially in labor intensive service sector, since the services have become the significant portion of the economies. Tour scheduling is an important tool to minimize the overall workforce costs while satisfying the minimum service level constraints. In this study, we consider the workforce management problem of an inbound call-center while satisfying the call demand within the short time periods with the minimum cost. We propose a mixed-integer programming model to assign workers to the daily shifts, to determine the weekly off-days, and to determine the timings of lunch and other daily breaks for each worker. The proposed model has been verified on the weekly demand data observed at a specific call center location of a satellite TV operator. The model was run on both 15 and 10 minutes demand estimation periods (planning time intervals).

  7. DUSTRAN – AN ATMOSPHERIC DISPERSION MODEL FOR CONSEQUENCE ASSESSMENT APPLICATIONS IN EMERGENCY OPERATIONS CENTERS

    SciTech Connect

    Rishel, Jeremy P.; Glantz, Clifford S.

    2008-09-30

    A new atmospheric dispersion modeling system is being tested for consequence assessment applications in emergency response operations. DUSTRAN is an operational, fully documented atmospheric dispersion modeling system designed originally to allow U.S. Department of Defense personnel to rapidly predict and assess the potential air quality impacts of military maneuvers at military training and testing ranges. This model also can be applied at emergency operations centers where it can fill the niche between on-site, plume-based modeling systems and the National Atmospheric Release Advisory Center off-site, particle-based modeling system. DUSTRAN offers a user-friendly graphical user interface based on the Environmental Systems Research Institute ArcMap geographic information system software that allows DUSTRAN to be easily customized to operate at any location in the world. DUSTRAN employs the U.S. Environmental Protection Agency regulatory CALPUFF modeling system to create a three-dimensional wind field and simulate downwind plume transport and diffusion. Other dispersion models also can be integrated into the DUSTRAN componentized architecture, allowing the user to choose the appropriate dispersion modeling engine for a given application. The DUSTRAN architecture also supports the development and integration of a variety of source-term models.

  8. Modeling hydrothermal processes at ocean spreading centers: Magma to microbe—An overview

    NASA Astrophysics Data System (ADS)

    Lowell, Robert P.; Seewald, Jeffrey S.; Metaxas, Anna; Perfit, Michael R.

    Hydrothermal processes at oceanic spreading centers encompass a number of highly interconnected processes ranging from the transport of mantle melts beneath spreading centers to the evolution of ocean chemistry and Earth's climate. This volume, which stems from a RIDGE Theoretical Institute held at Mammoth Lakes, California in June 2006, contains papers that address the complex connections among magmatic heat supply, crustal formation, seismicity, and hydrothermal circulation as well as the complex linkages among hydrothermal circulation, vent chemistry, carbon cycling, and microbial and macrofaunal ecosystems. The last paper in this volume explores the connection between hydrothermal venting and the chemical evolution of the oceans during the Phanerozoic. From reading these papers, one should recognize the wide variety of modeling approaches used and the uneven state of model development within various subdisciplines. Models of hydrothermal circulation and vent chemistry tend to be more quantitative, whereas models of carbon cycling and biological processes tend to be more conceptual. Although many of the complex linkages among the subdisciplines are understood at a conceptual level, considerable effort must be undertaken to develop integrated quantitative models of hydrothermal processes at oceanic spreading centers.

  9. Primary immunodeficiencies worldwide: an updated overview from the Jeffrey Modell Centers Global Network.

    PubMed

    Modell, Vicki; Quinn, Jessica; Orange, Jordan; Notarangelo, Luigi D; Modell, Fred

    2016-06-01

    Primary immunodeficiencies (PI) are defects of the immune system that cause severe, sometimes life-threatening, infections if not diagnosed and treated appropriately. Many patients with PI are undiagnosed, under-diagnosed, or misdiagnosed. To raise awareness and assure earliest diagnosis, appropriate treatment, and proper care management, the Jeffrey Modell Foundation (JMF) implemented a physician education and public awareness program beginning in 2003. Data are requested annually from physician experts within the Jeffrey Modell Centers Network (JMCN), consisting of 602 expert physicians, at 253 academic institutions, in 206 cities, and 84 countries spanning six continents. Center Directors reported on patients' specific PI defects and treatment modalities including immunoglobulins, transplantation, and gene therapy as well as data on gender and age. Center Directors also provided physician-reported patient outcomes as well as pre- and post-diagnosis differences. Costs were assigned to these factors. In collaboration with the Network, JMF advocated, funded, and implemented population-based newborn screening for severe combined immunodeficiency and T cell lymphopenia, covering 96.2 % of all newborns in the US. Finally, 21 JMF Centers participated in a polio surveillance study of patients with PI who either received or have been exposed to the oral polio vaccine. These initiatives have led to an overall better understanding of the immune system and will continue to improve quality of life for those with PI. PMID:26802037

  10. Using a facilitation model to achieve patient-centered medical home recognition.

    PubMed

    Lane, Sandi J; Watkins, R W Chip

    2015-01-01

    This article describes how a facilitation model that included a partnership between a Community Care of North Carolina network and undergraduates at a regional university supported rural primary care practices in transforming their practices to become National Committee for Quality Assurance-recognized patient-centered medical homes. Health care management and preprofessional undergraduate students worked with 14 rural primary care practices to redesign practice processes and complete the patient-centered medical home application. Twelve of the practices participated in the evaluation of the student contribution. A semistructured interview guide containing questions about practice characteristics, student competencies, and the value of the student's contribution to their practice's achievement of patient-centered medical home recognition was used to interview practice managers or their designee. Analysis included item-descriptive statistics and qualitative analysis of narrative content. All 12 participating practices achieved 2011 National Committee for Quality Assurance patient-centered medical home recognition, with 4 practices achieving level 3, 5 practices achieving level 2, and 3 practices achieving level 1. The facilitation model using partnerships between health care agencies and universities might be an option for enhancing a practice's internal capacity for successful transformation and should be explored further. PMID:25909396

  11. Cancer patient-centered home care: a new model for health care in oncology

    PubMed Central

    Tralongo, Paolo; Ferraù, Francesco; Borsellino, Nicolò; Verderame, Francesco; Caruso, Michele; Giuffrida, Dario; Butera, Alfredo; Gebbia, Vittorio

    2011-01-01

    Patient-centered home care is a new model of assistance, which may be integrated with more traditional hospital-centered care especially in selected groups of informed and trained patients. Patient-centered care is based on patients’ needs rather than on prognosis, and takes into account the emotional and psychosocial aspects of the disease. This model may be applied to elderly patients, who present comorbid diseases, but it also fits with the needs of younger fit patients. A specialized multidisciplinary team coordinated by experienced medical oncologists and including pharmacists, psychologists, nurses, and social assistance providers should carry out home care. Other professional figures may be required depending on patients’ needs. Every effort should be made to achieve optimal coordination between the health professionals and the reference hospital and to employ shared evidence-based guidelines, which in turn guarantee safety and efficacy. Comprehensive care has to be easily accessible and requires a high level of education and knowledge of the disease for both the patients and their caregivers. Patient-centered home care represents an important tool to improve quality of life and help cancer patients while also being cost effective. PMID:21941445

  12. CenteringParenting: an innovative dyad model for group mother-infant care.

    PubMed

    Bloomfield, Joanna; Rising, Sharon Schindler

    2013-01-01

    CenteringParenting is a group model that brings a cohort of 6 to 7 mothers and infants together for care during the first year of life. During 9 group sessions the clinician provides well-baby care and also attends to the health, development, and safety issues of the mother. Ideally, CenteringParenting provides continuity of care for a cohort of women who have received care in CenteringPregnancy, group prenatal care that is 10 sessions throughout the entire pregnancy and that leads to community building, better health outcomes, and increased satisfaction with prenatal care. The postpartum year affects the entire family, but especially the mother, who is redefining herself and her own personal goals. Issues of weight/body image, breastfeeding, depression, contraception, and relationship issues all may surface. In traditional care, health resources for support and intervention are frequently lacking or unavailable. Women's health clinicians also note the loss of contact with women they have followed during the prenatal period, often not seeing a woman again until she returns for another pregnancy. CenteringParenting recognizes that the health of the mother is tied to the health of the infant and that assessment and interventions are more appropriate and efficient when done in a dyad context. Facilitative leadership, rather than didactic education, encourages women to fully engage in their care, to raise issues of importance to them, and to discuss concerns within an atmosphere that allows for the surfacing of culturally appropriate values and beliefs. Implementing the model calls for system changes that are often significant. It also requires the building of a substantial team relationship among care providers. This overview describes the CenteringParenting mother-infant dyad care model with special focus on the mother and reviews the perspectives and experiences of staff from several practice sites. PMID:24406037

  13. Community Coordinated Modeling Center Support of Operations: Real-Time Simulations and V & V.

    NASA Technical Reports Server (NTRS)

    Kuznetsova, M.; Hesse, M.; Rastaetter, L.; Maddox, M.; Macneice, P.; Chulaki, A.; Berrios, D.

    2007-01-01

    In support of Operations Community Coordinated Modeling Center (CCMC) performing validation and verification of space weather models. To identify suitable metrics the CCMC focus on parameters most useful to operations that CCMC resident models can provide. The real time simulations carried out at CCMC are an essential tool to test model performance and stability by using input conditions that may occur in nature at any time. Since 2001, the magnetospheric MHD model BATSRUS has been run in real time using ACE real time data. CCMC staff developed an experimental real-time system that controls uploading of the real-time ACE data, monitors continuous model execution, initiates automatic recovery procedure in case of data gaps or hardware failures, synchronizes BATSRUS and FRC runs, and periodically runs IDL based visualization software.

  14. The Community Coordinated Modeling Center - An Evolving Cyberinfrastructure for the Space Science Community

    NASA Astrophysics Data System (ADS)

    Maddox, M. M.; Kuznetsova, M. M.; Pulkkinen, A. A.; Rastaetter, L.; Mays, M. L.; MacNeice, P. J.; Zheng, Y.; Chulaki, A.; Shim, J. S.; Collado-Vega, Y. M.; Mendoza, A. M. M.; Taktakishvili, A.; Mullinix, R.; Boblitt, J.; Bakshi, S. S.; Patel, K.; Pembroke, A. D.

    2015-12-01

    The Community Coordinated Modeling Center (CCMC) at NASA Goddard Space Flight Center was established in 2000 as an essential element of the National Space Weather Program and was designed to be a long-term & flexible solution to the Research-to-Operations (R2O) transition problem. Over its 15-year existence, the CCMC has changed how state-of-the-art space weather models are utilized in research, and has also facilitated the transition of many research models into operational environments. The CCMC currently hosts a large and expanding collection of physics-based space weather models that have been developed by the international research community, and has amassed a peta-byte of model simulation output that represents advances in space weather modeling and space science research for the past 15 years.The ability of the CCMC to engage the international research community and support community challenges, campaigns, studies, and general research is vital to its success - so a flexible cyberinfrastructure that facilitates data discovery and interoperability with external systems is a necessity. There are many challenges associated with supporting a large number of disparate, physics-based models and the computational infrastructure to support them. This paper will highlight the CCMC's past, present, and future computational infrastructure, and showcase several examples of how the CCMC continues to support many self-organized efforts in the space science community.

  15. The Inflammatory Bowel Disease Specialty Medical Home: A New Model of Patient-centered Care.

    PubMed

    Regueiro, Miguel D; McAnallen, Sandra E; Greer, Julia B; Perkins, Stephen E; Ramalingam, S; Szigethy, Eva

    2016-08-01

    New models of health care have emerged over the past decade. Accountable care organizations and patient-centered medical homes are designed to improve the patient experience, enhance health care quality, and decrease cost. These models have been developed in the primary care domain and have yet to be tested in specialty care. Certain chronic diseases require principal care by a specialist or health care team. The specialty medical home would provide patient-centered care for specific populations of patients whose health care derives from a single chronic disease. This article defines the parameters for a specialty medical home and provides a specific payer-provider experience for the comprehensive care of an inflammatory bowel disease population. PMID:27135486

  16. Confronting Galactic center and dwarf spheroidal gamma-ray observations with cascade annihilation models

    NASA Astrophysics Data System (ADS)

    Dutta, Bhaskar; Gao, Yu; Ghosh, Tathagata; Strigari, Louis E.

    2015-10-01

    Many particle dark matter models predict that the dark matter undergoes cascade annihilations, i.e. the annihilation products are 4-body final states. In the context of model-independent cascade annihilation processes, we study the compatibility of the dark matter interpretation of the Fermi-LAT Galactic center gamma-ray emission with null detections from dwarf spheroidal galaxies. For canonical values of the Milky Way density profile and the local dark matter density, we find that the dark matter interpretation to the Galactic center emission is strongly constrained. However, uncertainties in the dark matter distribution weaken the constraints and leave open dark matter interpretations over a wide range of mass scales.

  17. Pathology service line: a model for accountable care organizations at an academic medical center.

    PubMed

    Sussman, Ira; Prystowsky, Michael B

    2012-05-01

    Accountable care is designed to manage the health of patients using a capitated cost model rather than fee for service. Pay for performance is an attempt to use quality and not service reduction as the way to decrease costs. Pathologists will have to demonstrate value to the system. This value will include (1) working with clinical colleagues to optimize testing protocols, (2) reducing unnecessary testing in both clinical and anatomic pathology, (3) guiding treatment by helping to personalize therapy, (4) designing laboratory information technology solutions that will promote and facilitate accurate, complete data mining, and (5) administering efficient cost-effective laboratories. The pathology service line was established to improve the efficiency of delivering pathology services and to provide more effective support of medical center programs. We have used this model effectively at the Montefiore Medical Center for the past 14 years. PMID:22333926

  18. Webcasting in home and hospice care services: virtual communication in home care.

    PubMed

    Smith-Stoner, Marilyn

    2011-06-01

    The access to free live webcasting over home computers was much more available in 2007, when three military leaders from West Point, with the purpose of helping military personnel stay connected with their families when deployed, developed Ustream.tv. There are many types of Web-based video streaming applications. This article describes Ustream, a free and effective communication tool to virtually connect staff. There are many features in Ustream, but the most useful for home care and hospice service providers is its ability to broadcast sound and video to anyone with a broadband Internet connection, a chat room for users to interact during a presentation, and the ability to have a "co-host" or second person also broadcast simultaneously. Agencies that provide community-based services in the home will benefit from integration of Web-based video streaming into their communication strategy. PMID:21633224

  19. The Partners in Prevention Program: The Evaluation and Evolution of the Task-Centered Case Management Model

    ERIC Educational Resources Information Center

    Colvin, Julanne; Lee, Mingun; Magnano, Julienne; Smith, Valerie

    2008-01-01

    This article reports on the further development of the task-centered model for difficulties in school performance. We used Bailey-Dempsey and Reid's (1996) application of Rothman and Thomas's (1994) design and development framework and annual evaluations of the Partners in Prevention (PIP) Program to refine the task-centered case management model.…

  20. 76 FR 33734 - Applications for New Awards; Spinal Cord Injury Model Systems (SCIMS) Centers and SCIMS Multi...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-09

    ... Applications for New Awards; Spinal Cord Injury Model Systems (SCIMS) Centers and SCIMS Multi-Site... Rehabilitation Research Projects (DRRPs) and Special Projects and Demonstrations for Spinal Cord Injury Program--Spinal Cord Injury Model Systems (SCIMS) Centers and SCIMS Multi-Site Collaborative Research...