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Sample records for actual patient care

  1. [Actual diet of patients with gastrointestinal diseases].

    PubMed

    Loranskaia, T I; Shakhovskaia, A K; Pavliuchkova, M S

    2000-01-01

    The study of actual nutrition of patients with erosive-ulcerative lesions in the gastroduodenal zone and of patients with operated ulcer has revealed defects in intake of essential nutrients by these patients: overeating of animal fat and refined carbohydrates, deficiency of oil, vitamins A, B2, C, D and food fibers.

  2. Patients' perception and actual practice of informed consent, privacy and confidentiality in general medical outpatient departments of two tertiary care hospitals of Lahore

    PubMed Central

    Humayun, Ayesha; Fatima, Noor; Naqqash, Shahid; Hussain, Salwa; Rasheed, Almas; Imtiaz, Huma; Imam, Sardar Zakariya

    2008-01-01

    Background The principles of informed consent, confidentiality and privacy are often neglected during patient care in developing countries. We assessed the degree to which doctors in Lahore adhere to these principles during outpatient consultations. Material & Method The study was conducted at medical out-patient departments (OPDs) of two tertiary care hospitals (one public and one private hospital) of Lahore, selected using multi-stage sampling. 93 patients were selected from each hospital. Doctors' adherence to the principles of informed consent, privacy and confidentiality was observed through client flow analysis performed by trained personnel. Overall patient perception was also assessed regarding these practices and was compared with the assessment made by our data collectors. Results Some degree of informed consent was obtained from only 9.7% patients in the public hospital and 47.8% in the private hospital. 81.4% of patients in the public hospital and 88.4% in the private hospital were accorded at least some degree of privacy. Complete informational confidentiality was maintained only in 10.8% and 35.5% of cases in public & private hospitals respectively. Informed consent and confidentiality were better practiced in the private compared to the public hospital (two-sample t-test > 2, p value < 0.05). There was marked disparity between the patients' perspective of these ethical practices and the assessment of our trained data collectors. Conclusion Observance of medical ethics is inadequate in hospitals of Lahore. Doctors should be imparted formal training in medical ethics and national legislation on medical ethics is needed. Patients should be made aware of their rights to medical ethics. PMID:18816413

  3. Reconfiguring health workforce policy so that education, training, and actual delivery of care are closely connected.

    PubMed

    Ricketts, Thomas C; Fraher, Erin P

    2013-11-01

    There is growing consensus that the health care workforce in the United States needs to be reconfigured to meet the needs of a health care system that is being rapidly and permanently redesigned. Accountable care organizations and patient-centered medical homes, for instance, will greatly alter the mix of caregivers needed and create new roles for existing health care workers. The focus of health system innovation, however, has largely been on reorganizing care delivery processes, reengineering workflows, and adopting electronic technology to improve outcomes. Little attention has been paid to training workers to adapt to these systems and deliver patient care in ever more coordinated systems, such as integrated health care networks that harmonize primary care with acute inpatient and postacute long-term care. This article highlights how neither regulatory policies nor market forces are keeping up with a rapidly changing delivery system and argues that training and education should be connected more closely to the actual delivery of care.

  4. [The information of the schizophrenic patient: actuality].

    PubMed

    Palazzolo, J; Brousse, G; Favre, P; Llorca, P-M

    2005-01-01

    Social isolation has got to be one of the greatest losses in schizophrenia. For many authors, people with schizophrenia can have no friends, no spouse, and sometimes no family. Two thirds of patients with schizophrenia return to their parents' house after discharge from a hospital for the first psychosi episode. Family members generally receive very little education as to what they can expect. They may not know the importance of medication compliance. Family members are the primary victims of violence from psychotic individuals, usually their own son or daughter, and most families cannot believe their own son or daughter would be capable of such a thing. Although families are usually the main care givers at the beginning of schizophrenia they often find their experience very frustrating for a number of reasons, and relationships suffer. Family education and support have been shown to improve outcomes considerably and family education is the second strongest factor in relapse prevention. Without education and good relapse prevention families often burst out. Most of the homeless mentally ill in downtown city cores have lost their family relationships. It is not a reflection on their families so much as the lack of adequate treatment and support. The families tried and tried and lost their ill relative. A patient writes: "My father lives just outside of Monaco. My mother developed Alzheimer's a couple of years ago or so and with a series of mild strokes died recently. I haven't seen either of them very much in the last fifteen years. I have a sister, Nicole, who also lives in Paris. I lost those relationships to some degree over the years. I am rebuilding them now. Enter the professional friend, the case manager, usually in cases where the individual is quite disabled by schizophrenia and/or at considerable risk of relapse, and usually when the individual has lost their family relationships to some degree. I had a case manager for several years and always looked

  5. Does Simulator-Based Clinical Performance Correlate with Actual Hospital Behavior? The Effect of Extended Work Hours on Patient Care Provided by Medical Interns

    PubMed Central

    Gordon, James A.; Alexander, Erik K.; Lockley, Steven W.; Flynn-Evans, Erin; Venkatan, Suresh K.; Landrigan, Christopher P.; Czeisler, Charles A.

    2013-01-01

    Purpose The correlation between simulator-based medical performance and real-world behavior remains unclear. The authors conducted this study to explore whether the effects of extended work hours on clinical performance, as reported in prior hospital-based studies, could be observed in a simulator-based testing environment. Method Intern volunteers reported to the simulator laboratory in a rested state and again in a sleep-deprived state (after a traditional 24–30 hour overnight shift [n=17]). A subset also presented after a shortened overnight shift (maximum of 16 scheduled hours [n=8]). During each laboratory visit, participants managed two critically ill patients. An on-site physician scored each case, as did a blinded rater later watching videotapes of the performances (score=1 [worst] to 8 [best]; average of both cases = session score). Results Among all participants, the average simulator session score was 6.0 (95% CI: 5.6–6.4) in the rested state, and declined to 5.0 (95% CI: 4.6–5.4) after the traditional overnight shift (P<0.001). Among those who completed the shortened overnight shift, the average post-shift simulator session score was 5.8 (95% CI: 5.0–6.6) compared to 4.3 [95%CI: 3.8–4.9]) after a traditional extended shift (P<0.001). Conclusions In a clinical simulation test, medical interns performed significantly better after working a shortened overnight shift compared to a traditional extended shift. These findings are consistent with real-time hospital studies using the same shift schedule. Such an independent correlation not only confirms the detrimental impact of extended work hours on medical performance, but also supports the validity of simulation as a clinical performance assessment tool. PMID:20881679

  6. Reconfiguring health workforce policy so that education, training, and actual delivery of care are closely connected.

    PubMed

    Ricketts, Thomas C; Fraher, Erin P

    2013-11-01

    There is growing consensus that the health care workforce in the United States needs to be reconfigured to meet the needs of a health care system that is being rapidly and permanently redesigned. Accountable care organizations and patient-centered medical homes, for instance, will greatly alter the mix of caregivers needed and create new roles for existing health care workers. The focus of health system innovation, however, has largely been on reorganizing care delivery processes, reengineering workflows, and adopting electronic technology to improve outcomes. Little attention has been paid to training workers to adapt to these systems and deliver patient care in ever more coordinated systems, such as integrated health care networks that harmonize primary care with acute inpatient and postacute long-term care. This article highlights how neither regulatory policies nor market forces are keeping up with a rapidly changing delivery system and argues that training and education should be connected more closely to the actual delivery of care. PMID:24191074

  7. Safety of patients--actual problem of modern medicine (review).

    PubMed

    Tsintsadze, Neriman; Samnidze, L; Beridze, T; Tsintsadze, M; Tsintsadze, Nino

    2011-09-01

    Safety of patients is actual problem of up-to-date medicine. The current successful treatment of various sicknesses is achieved by implementation in clinical practice such medical preparations (medications), which are characterized with the high therapeutic activity, low toxicity and prolonged effects. In spite of evidence of the pharmacotherapeutical advances, the frequency of complications after medication has grown - that is why the safety of patients is the acute actual problem of medicine and ecological state of human population today. PMID:22156680

  8. Student Exposure to Actual Patients in the Classroom.

    ERIC Educational Resources Information Center

    Chisholm, Marie A.; McCall, Charles Y.; Francisco, George E., Jr.; Poirier, Sylvie

    1997-01-01

    Two clinical courses for first-year dental students were designed to develop students' interaction skills through actual patient case presentations and discussions and an interdisciplinary teaching approach. Results indicate students preferred the case presentations, with or without lecture, to the lecture-only approach and felt they learned more…

  9. Patient-centered Care.

    PubMed

    Reynolds, April

    2009-01-01

    Patient-centered care focuses on the patient and the individual's particular health care needs. The goal of patient-centered health care is to empower patients to become active participants in their care. This requires that physicians, radiologic technologists and other health care providers develop good communication skills and address patient needs effectively. Patient-centered care also requires that the health care provider become a patient advocate and strive to provide care that not only is effective but also safe. For radiologic technologists, patient-centered care encompasses principles such as the as low as reasonably achievable (ALARA) concept and contrast media safety. Patient-centered care is associated with a higher rate of patient satisfaction, adherence to suggested lifestyle changes and prescribed treatment, better outcomes and more cost-effective care. This article is a Directed Reading. Your access to Directed Reading quizzes for continuing education credit is determined by your area of interest. For access to other quizzes, go to www.asrt.org/store. According to one theory, most patients judge the quality of their healthcare much like they rate an airplane flight. They assume that the airplane is technically viable and is being piloted by competent people. Criteria for judging a particular airline are personal and include aspects like comfort, friendly service and on-time schedules. Similarly, patients judge the standard of their healthcare on nontechnical aspects, such as a healthcare practitioner's communication and "soft skills." Most are unable to evaluate a practitioner's level of technical skill or training, so the qualities they can assess become of the utmost importance in satisfying patients and providing patient-centered care.(1). PMID:19901351

  10. Periprocedural Patient Care.

    PubMed

    Kohi, Maureen P; Fidelman, Nicholas; Behr, Spencer; Taylor, Andrew G; Kolli, Kanti; Conrad, Miles; Hwang, Gloria; Weinstein, Stefanie

    2015-10-01

    Periprocedural care of patients who undergo image-guided interventions is a task of monumental importance. As physicians who perform procedures, radiologists rely on their noninterpretive skills to optimize patient care. At the center of periprocedural care is proper patient identification. It is imperative to perform the indicated procedure for the correct patient. It is also of great importance to discuss with the patient the nature of the procedure. This conversation should include the indications, risks, benefits, alternatives, and potential complications of the procedure. Once the patient agrees to the procedure and grants informed consent, it is imperative to stop and confirm that the correct procedure is being performed on the correct patient. This universal time-out policy helps decrease errors and improves patient care. To optimize our interpretative and procedural skills, it may be necessary to provide the patient with sedation or anesthesia. However, it is important to understand the continuum of sedation and be able to appropriately monitor the patient and manage the sedation in these patients. To minimize the risks of infection, periprocedural care of patients relies on aseptic or, at times, sterile techniques. Before the procedure, it is important to evaluate the patient's coagulation parameters and bleeding risks and correct the coagulopathy, if needed. During the procedure, the patient's blood pressure and at times the patient's glucose levels will also require monitoring and management. After the procedure, patients must be observed in a recovery unit and deemed safe for discharge. The fundamental components of periprocedural care necessary to enhance patient safety, satisfaction, and care are reviewed to familiarize the reader with the important noninterpretive skills necessary to optimize periprocedural care. PMID:26466184

  11. [Actual problems of inpatient psychiatric care in Russia].

    PubMed

    Iastrebov, V S; Mitikhin, V G; Solokhina, T A; Shevchenko, L S; Tvorogova, N A

    2013-01-01

    A comparative evaluation of inpatient psychiatric care in Russia and some other countries is presented. A systematic analysis of the performance of psychiatric hospitals is conducted. The process of the deinstitutionalization in Russian psychiatry is highlighted. A range of problems hindering a reform of inpatient psychiatric service of the country is singled out. PMID:24300798

  12. Patient care in radiography

    SciTech Connect

    Ehrlich, R.A.; McCloskey, E.D.

    1989-01-01

    This book focuses on patient care procedures for radiographers. The authors focus on the role of the radiographer as a member of the health care team. The authors report on such topics as communication in patient care: safety, medico-legal considerations, transfer and positioning; physical needs; infection control; medication; CPR standards, acute situations; examination of the GI tract; contrast media; special imaging techniques and bedside radiography.

  13. Caring for Latino patients.

    PubMed

    Juckett, Gregory

    2013-01-01

    Latinos comprise nearly 16 percent of the U.S. population, and this proportion is anticipated to increase to 30 percent by 2050. Latinos are a diverse ethnic group that includes many different cultures, races, and nationalities. Barriers to care have resulted in striking disparities in quality of health care for these patients. These barriers include language, lack of insurance, different cultural beliefs, and in some cases, illegal immigration status, mistrust, and illiteracy. The National Standards for Culturally and Linguistically Appropriate Services address these concerns with recommendations for culturally competent care, language services, and organizational support. Latinos have disproportionately higher rates of obesity and diabetes mellitus. Other health problems include stress, neurocysticercosis, and tuberculosis. It is important to explore the use of alternative therapies and belief in traditional folk illnesses, recognizing that health beliefs are dependent on education, socioeconomic status, and degree of acculturation. Many-but not all-folk and herbal treatments can be safely accommodated with conventional therapy. Physicians must be sensitive to Latino cultural values of simpatia (kindness), personalismo (relationship), respeto (respect), and modestia (modesty). The LEARN technique can facilitate cross-cultural interviews. Some cultural barriers may be overcome by using the "teach back" technique to ensure that directions are correctly understood and by creating a welcoming health care environment for Latino patients. PMID:23317025

  14. The expected and actual communication of health care workers during the management of intrapartum: An interpretive multiple case study

    PubMed Central

    Fawcus, Sue; Korpela, Mikko; De la Harpe, Retha

    2015-01-01

    Background Daily activities within a health care organisation are mediated by information communication processes (ICP) involving multiple health care professionals at different levels of care. Effective perinatal management requires critical information to be accurately communicated. If there is a breakdown in this communication patient safety is at risk for various reasons such as: inadequate critical information, misconception of information and uninformed decisions being made. The purpose of this study was to interpret the complexities around ICP in order to contribute to the effective management of the intrapartum period. Methods Multi method, multiple case study approach was used to understand the ICP during the management of the intrapartum period. During the study, the expected ICP, the actual ICP, the challenges involved and the desired ICP were analysed. Twenty-four in-depth interviews with skilled birth attendants (SBAs) employing observer-as-participant roles, field notes, and document review methods were utilised to gather the data. Thematic analysis was utilised to analyse the data using Atlas TI software. Results The study revealed three subthemes which emerged from the expected ICP, whilst three others that emerged formed the theme actual ICP. The subthemes from the expected ICP included: accessibility of obstetric services, expected referral, recommended tools, expected communication and expected documentation. The theme actual ICP held three emerging subthemes: the handover processes, collaborative information seeking, information communicated and referral processes. Conclusion This study showed that what was expected was not what was actually happening. The requirements of the policies and protocols need to be effectively implemented to improve practice building these into current biomedical guidelines. PMID:26842518

  15. What It Means to Care: How Educators Conceptualize and Actualize Caring

    ERIC Educational Resources Information Center

    McBee, Robin Haskell

    2007-01-01

    Seeking to put a face on educators' conceptualizations of caring, this study examines findings from open-ended surveys of 144 teacher candidates, classroom teachers, and college faculty associated with a mid-Atlantic university's teacher education program. Reflecting theoretical constructs described in the literature on resilience,…

  16. [Team Care and Patient Safety].

    PubMed

    Hashimoto, Michio

    2015-07-01

    The purpose of patient safety management is to nurture an environment which provides optimal care for each patient through the cooperation of each healthcare staff member based on the idea of team care. This is based on the safety culture of an organization that places value on sharing information. Laboratory medicine is expected to become more important in the areas of staff, patient, and community education.

  17. Education and Decision Making at the Time of Triptan Prescribing: Patient Expectations vs Actual Practice

    PubMed Central

    Mathew, Paul G.; Pavlovic, Jelena M.; Lettich, Alyssa; Wells, Rebecca E.; Robertson, Carrie E.; Mullin, Kathleen; Charleston, Larry; Dodick, David W.; Schwedt, Todd J.

    2014-01-01

    Background Optimizing patient satisfaction with their medical care and maximizing patient adherence with treatment plans requires an understanding of patient preferences regarding education and their role in decision making when treatments are prescribed. Objective To assess the congruence between patient expectations and actual practice regarding education and decision making at the time a triptan is prescribed. Methods This multicenter cross-sectional survey was performed by headache fellow members of the American Headache Society Headache Fellows Research Consortium at their respective tertiary care headache clinics. Migraine patients who were new patients to the headache clinic and who were current triptan users (use within prior 3 months and for ≥1 year) or past triptan users (no use within 6 months; prior use within 2 years) completed questionnaires that assessed the education they received and their role in decision making at the time a triptan was first prescribed as well as their desire for education and participation in decision making when a triptan is prescribed. Results Consistent with patient preference, most participants received the majority of their education about the triptan from the prescriber's office (70.2%). In descending rank order, participants most desired to be informed about how to decide if a triptan should be taken, when during the course of migraine a triptan should be taken, possible side effects, cost, and how to obtain refills. Regarding side effects, most participants preferred to receive education about the most common side effects of a triptan rather than addressing all possible side effects. Regarding triptan dosing, participants desired to be informed in descending order of importance about taking other medications with triptans, how many doses can be taken for each migraine, how many doses can be taken each week/month, what to do if the triptan does not work, and the triptan mechanism of action. The vast majority of

  18. The transition from 'informed patient' care to 'patient informed' care.

    PubMed

    Gardiner, Ruth

    2008-01-01

    We are in the midst of a real change in the application of information technology to support the delivery of healthcare. We are seeing a shift from the 'informed patient' which has resulted from improved access to healthcare information, primarily from the Web, to the 'participative patient' as we move into Web 2.0 territory. The last decade has seen significant strides in the application of healthcare information to support patient care including: Increased access to healthcare related information by the patient through access to healthcare information on the Web (1.0). The development of electronic patient/health records. Improved access to knowledge for care professionals has enabled the dissipation of professional clinical skills with the introduction of nurse practitioners and increased use of therapies. Improved access to patient related information across disciplines is beginning to enable the shift from acute based to community based care. The introduction of home care technologies has enabled self monitoring in supporting self care. There are also developments in the way care is provided with an increasing diversity of healthcare providers with the challenges this has presented in exchanging patient related information to support continuity of care. We are now at another major turning point that could present greater challenges for healthcare professionals, organisations and the patient or client. These developments include: The application of information sharing services commonly referred to as Web 2.0. As a result we are seeing a transition from the 'informed patient' to the 'participative patient' that will present increasing challenges for healthcare professionals and healthcare organisations in adapting care to embrace this evolution. New entrants to the ehealth market are now emerging such as Google and Microsoft who are competing to 'own' the 'healthcare consumer'. Open source solutions for EPR/EHRs are now emerging that will challenge the

  19. Percentage of Surgical Patients Receiving Recommended Care

    MedlinePlus

    ... Recommended Care Percentage of Surgical Patients Receiving Recommended Care This is a composite measure based on individual ... Age Group Percentage of Surgical Patients Receiving Recommended Care by Age Group uzrc-9bvr Download these data » ...

  20. Information retrieval for patient care.

    PubMed Central

    Gardner, M.

    1997-01-01

    Doctors need clinical information during most consultations with patients, and much of this need could be satisfied by material from online sources. Advances in data communication technologies mean that multimedia information can be transported rapidly to various clinical care locations. However, selecting the few items of information likely to be useful in a particular clinical situation from the mass of information available is a major problem. Current information retrieval systems are designed primarily for use in research rather than clinical care. The design, implementation, and critical evaluation of new information retrieval systems for clinical care should be guided by knowledgeable clinical users. PMID:9099122

  1. [Contradiction and intention of actual situation and statistical observation on home custody of mental patients].

    PubMed

    Kanekawa, Hideo

    2012-01-01

    Actual Situation and Statistical Observation on Home Custody of Mental Patients (1918) by Kure and Kashida has diverse content but contains many contradictions. This book is a record of investigations performed by 15 psychiatrists regarding home custody of mental patients in 15 prefectures between 1910 and 1916. The book is written in archaic Japanese and contains a mixture of old Kanji characters and Katakana, so few people have read the entire book in recent years. We thoroughly read the book over 2 years, and presented the results of our investigation and analysis. The contents were initially published in Tokyo Journal of Medical Sciences as a series of 4 articles, and published as a book in 1918. The Department of the Interior distributed 100 copies of the book to relevant personnel. Until its dissolution in 1947, the Department of the Interior included the Police Department and had a great deal of authority. The Health and Welfare Ministry became independent from the Department of the Interior in 1938. Therefore, mental institutions were under the supervision of the police force for many years. At the time, an important task for police officers was to search for infectious disease patients and to seclude and restrain them. Thus, home custody for mental patients was also supervised under the direction of the Police Department. This book is a record of an external investigation performed by psychiatrists on home custody supervised by the police. When investigating the conditions, one of the psychiatrists obtained a copy of "Documents for mental patients under confinement" at the local police station. The contents of these documents included records of hearings by the police, as well as applications for confinement submitted by family members, as well as detailed specifications and drawings of the confinement room. With a local photographer, they traveled deep into the mountains to investigate the conditions under which mental patients were living. The book

  2. Orthogeriatric care: improving patient outcomes

    PubMed Central

    Tarazona-Santabalbina, Francisco José; Belenguer-Varea, Ángel; Rovira, Eduardo; Cuesta-Peredó, David

    2016-01-01

    Hip fractures are a very serious socio-economic problem in western countries. Since the 1950s, orthogeriatric units have introduced improvements in the care of geriatric patients admitted to hospital because of hip fractures. During this period, these units have reduced mean hospital stays, number of complications, and both in-hospital mortality and mortality over the middle term after hospital discharge, along with improvements in the quality of care and a reduction in costs. Likewise, a recent clinical trial has reported greater functional gains among the affected patients. Studies in this field have identified the prognostic factors present upon admission or manifesting themselves during admission and that increase the risk of patient mortality or disability. In addition, improved care afforded by orthogeriatric units has proved to reduce costs. Nevertheless, a number of management issues remain to be clarified, such as the optimum anesthetic, analgesic, and thromboprophylactic protocols; the type of diagnostic and therapeutic approach best suited to patients with cognitive problems; or the efficiency of the programs used in convalescence units or in home rehabilitation care. Randomized clinical trials are needed to consolidate the evidence in this regard. PMID:27445466

  3. The association between foot-care self efficacy beliefs and actual foot-care behaviour in people with peripheral neuropathy: a cross-sectional study

    PubMed Central

    Perrin, Byron M; Swerissen, Hal; Payne, Craig

    2009-01-01

    Background People with diabetes and peripheral neuropathy often do not implement the foot-care behavioural strategies that are suggested by many health professionals. The concept of self-efficacy has been shown to be an effective predictor of behaviour in many areas of health. This study investigated the relationships between foot-care self-efficacy beliefs, self-reported foot-care behaviour and history of diabetes-related foot pathology in people with diabetes and loss of protective sensation in their feet. Methods Ninety-six participants were included in this cross-sectional study undertaken in a regional city of Australia. All participants had diabetes and clinically diagnosed loss of protective sensation in their feet. The participants completed a self-report pen-paper questionnaire regarding foot-care self efficacy beliefs (the "Foot Care Confidence Scale") and two aspects of actual foot-care behaviour-preventative behaviour and potentially damaging behaviour. Pearson correlation coefficients were then calculated to determine the association between foot-care self-efficacy beliefs and actual reported foot-care behaviour. Multiple analysis of variance was undertaken to compare mean self-efficacy and behaviour subscale scores for those with a history of foot pathology, and those that did not. Results A small positive correlation (r = 0.2, p = 0.05) was found between self-efficacy beliefs and preventative behaviour. There was no association between self-efficacy beliefs and potentially damaging behaviour. There was no difference in self-efficacy beliefs in people that had a history of foot pathology compared to those that did not. Conclusion There is little association between foot-care self-efficacy beliefs and actual foot-care behaviour. The usefulness of measuring foot-care self-efficacy beliefs to assess actual self foot-care behaviour using currently available instruments is limited in people with diabetes and loss of protective sensation. PMID:19192309

  4. Paying pharmacists for patient care

    PubMed Central

    Houle, Sherilyn K. D.; Grindrod, Kelly A.; Chatterley, Trish; Tsuyuki, Ross T.

    2014-01-01

    Background: Expansion of scope of practice and diminishing revenues from dispensing are requiring pharmacists to increasingly adopt clinical care services into their practices. Pharmacists must be able to receive payment in order for provision of clinical care to be sustainable. The objective of this study is to update a previous systematic review by identifying remunerated pharmacist clinical care programs worldwide and reporting on uptake and patient care outcomes observed as a result. Methods: Literature searches were performed in several databases, including MEDLINE, Embase and International Pharmaceutical Abstracts, for papers referencing remuneration, pharmacy and cognitive services. Searches of the grey literature and Internet were also conducted. Papers and programs were identified up to December 2012 and were included if they were not reported in our previous review. One author performed data abstraction, which was independently reviewed by a second author. All results are presented descriptively. Results: Sixty new remunerated programs were identified across Canada, the United States, Europe, Australia and New Zealand, ranging in complexity from emergency contraception counseling to minor ailments schemes and comprehensive medication management. In North America, the average fee provided for a medication review is $68.86 (all figures are given in Canadian dollars), with $23.37 offered for a follow-up visit and $15.16 for prescription adaptations. Time-dependent fees were reimbursed at $93.60 per hour on average. Few programs evaluated uptake and outcomes of these services but, when available, indicated slow uptake but improved chronic disease markers and cost savings. Discussion: Remuneration for pharmacists’ clinical care services is highly variable, with few programs reporting program outcomes. Programs and pharmacists are encouraged to examine the time required to perform these activities and the outcomes achieved to ensure that fees are adequate to

  5. Gay patients. Context for care.

    PubMed Central

    Gibson, G.; Saunders, D. E.

    1994-01-01

    Gays and lesbians are a part of our society and our practices: real people with real lives, not stereotypes. Understanding their inner world and their social milieu is the first step to providing care that is holistic and appropriate. The "coming out" process and other unique health issues are described. Guidance is provided on how to identify and relate to gay and lesbian patients. PMID:8199524

  6. CMS emphasizes quality patient care.

    PubMed

    2014-07-01

    The Inpatient Prospective Payment System proposed rule for fiscal 2015 continues the Centers for Medicare & Medicaid Services' move toward basing reimbursement on quality of care, not quantity. The rule also asks for public input on the two-midnight rule and a policy to address short-stay patients. CMS is implementing the Hospital-Acquired Condition Reduction Program, which penalizes hospitals that perform poorly. The agency proposes to add two safety measures to value-based purchasing in the future. PMID:24946382

  7. [The actual issues of private health care and voluntary medical insurance in foreign countries].

    PubMed

    Kasimovskiy, K K; Jhiliyayeva, Ye P; Zaika, N M

    2014-01-01

    The article demonstrates the issues private health care and voluntary medical insurance are facing nowadays in Australia, Great Britain, Ireland and the USA. The possible directions of overcoming these problems are discussed.

  8. Supporting patient autonomy: decision making in home care.

    PubMed

    Davitt, J K; Kaye, L W

    1996-01-01

    This study examines the policies and procedures that home health care agencies have developed to handle the incapacitated patient and life-sustaining treatment decisions. Data collected from a survey of 154 home health care agency directors and interviews with 92 local agency staff (including nurses and social workers) and 67 patients confirmed that directors, staff, and patients agree that patients are informed about their legal rights. When asked about specific rights, fewer patients were aware of their right to execute an advance directive, and even fewer patients had actually executed one. Only 67 percent of agencies reported having existing policies on advance directives and life-sustaining treatment decisions, whereas 41.5 percent had policies on how to handle the patient with questionable decision-making capacity. Consistent policies are needed for social workers, nurses, and other staff to handle such difficult ethical dilemmas. A review of specific agency policies is presented with recommendations for future policy changes and development.

  9. Strategies for safe care of critical care perinatal patients.

    PubMed

    Olson, Barbara L

    2010-06-01

    In most inpatient settings, the complexity of care required by individual patients coupled with the wide range of services provided within a single institution mean patients are routinely cared for in highly specialized units. Service lines, such as surgical services; intensive care; emergency services; and maternity, typically operate cooperatively, but independently, within larger facilities. Units are distinguished from one another, not only by their mission, geographic location, and work processes, but by the expertise and specialty knowledge of clinicians who practice there. From a patient safety perspective, specialty care is advantageous because it promotes clinical benchmarking, standardization of practice norms, acquisition and maintenance of specialty knowledge and skills, and interdisciplinary teamwork.

  10. Perceived and actual risk of cardiovascular disease in patients with rheumatoid arthritis in Korea

    PubMed Central

    Boo, Sunjoo; Froelicher, Erika S.; Yun, Ju-Hui; Kim, Ye-Won; Jung, Ju-Yang; Suh, Chang-Hee

    2016-01-01

    Abstract The purposes of this study were to compare the perceived and actual 10-year risk for cardiovascular disease (CVD) and to evaluate the influence of cardiovascular risk factors on perceived CVD risk in patients with rheumatoid arthritis (RA) in Korea. Additionally, the attainment of CVD prevention guideline goals by 3 levels of CVD risk (low, moderate, and high) was presented. For this cross-sectional study, data were collected from 208 patients with RA. Actual CVD risk was estimated with the Systematic Coronary Risk Evaluation (SCORE), and goal attainment was assessed based on the European League Against Rheumatism guidelines. Actual CVD risk and perceived risk were compared with cross-tabulation. Chi-square tests were used to evaluate differences in cardiovascular risk factors by perceived risk. Levels of goal attainment were presented in percentages. Among patients with RA, 13.9% were identified as being at high risk for CVD, whereas 39.9% were at moderate risk, and 46.2% were at low risk. The majority of those at high risk (96.6%) underestimated their risk for CVD. The use of antihypertensive or lipid-lowering medications and having a parental history of CVD significantly increased the likelihood that subjects with RA would perceive themselves as being at high risk for CVD. Diabetes, smoking, physical inactivity, and obesity did not affect perceived risk. A substantial proportion of the subjects with RA did not meet the prevention guideline goals. Patients with RA who are at increased risk of developing CVD must be managed as soon as possible to attain the guideline goals and, accordingly, lower their risk of future CVD. PMID:27749595

  11. Care management: agreement between nursing prescriptions and patients' care needs

    PubMed Central

    Faeda, Marília Silveira; Perroca, Márcia Galan

    2016-01-01

    ABSTRACT Objectives: analyze agreement between nursing prescriptions recorded in medical files and patients' care needs; investigate the correlation between the nurses' professional background and agreement of prescriptions. Method: descriptive study with quantitative and documentary approach conducted in the medical clinic, surgical, and specialized units of a university hospital in the interior of São Paulo, Brazil. The new validated version of a Patient Classification Instrument was used and 380 nursing prescriptions written at the times of hospital admission and discharge were assessed. Results: 75% of the nursing prescriptions items were compatible with the patients' care needs. Only low correlation between nursing prescription agreement and professional background was found. Conclusion: the nursing prescriptions did not fully meet the care needs of patients. The care context and work process should be analyzed to enable more effective prescriptions, while strategies to assess the care needs of patients are recommended. PMID:27508902

  12. Low Quality of Basic Caregiving Environments in Child Care: Actual Reality or Artifact of Scoring?

    ERIC Educational Resources Information Center

    Norris, Deborah J.; Guss, Shannon

    2016-01-01

    Quality Rating Improvement Systems (QRIS) frequently include the Infant-Toddler Environment Rating Scale-Revised (ITERS-R) as part of rating and improving child care quality. However, studies utilizing the ITERS-R consistently report low quality, especially for basic caregiving items. This research examined whether the low scores reflected the…

  13. Outcomes for newly diagnosed patients with acute myeloid leukemia dosed on actual or adjusted body weight

    PubMed Central

    Bivona, Cory; Rockey, Michelle; Henry, Dave; Grauer, Dennis; Abhyankar, Sunil; Aljitawi, Omar; Ganguly, Siddhartha; McGuirk, Joseph; Singh, Anurag; Lin, Tara L.

    2015-01-01

    Purpose Data from solid tumor malignancies suggest that actual body weight (ABW) dosing improves overall outcomes. There is the potential to compromise efficacy when chemotherapy dosages are reduced, but the impact of dose adjustment on clinical response and toxicity in hematologic malignancies is unknown. The purpose of this study was to evaluate the outcomes of utilizing a percent of ABW for acute myeloid leukemia (AML) induction chemotherapy dosing. Methods This retrospective, single-center study included 146 patients who received 7 + 3 induction (cytarabine and anthracycline) for treatment of AML. Study design evaluated the relationship between percentage of ABW dosing and complete response (CR) rates in patients newly diagnosed with AML. Results Percentage of ABW dosing did not influence CR rates in patients undergoing induction chemotherapy for AML (p = 0.83); nor did it influence rate of death at 30 days or relapse at 6 months (p = 0.94). When comparing patients dosed at 90–100 % of ABW compared to <90 % ABW, CR rates were not significantly different in patients classified as poor risk (p = 0.907). All favorable risk category patients obtained CR. Conclusions Preemptive dose reductions for obesity did not influence CR rates for patients with AML undergoing induction chemotherapy and did not influence the composite endpoint of death at 30 days or disease relapse at 6 months. PMID:26231954

  14. [Nursing care for tracheotomy and tracheostomy patients].

    PubMed

    Nicouleau, Laurence; Cotto, Claude

    2015-09-01

    Nursing care is specific in otorhinolaryngology, particularly in oncology. The three dimensions of the care, technical, relational and educational, are essential and reflect the quality of the patient management which must be multi-disciplinary. PMID:26369746

  15. Actual Dose Variation of Parotid Glands and Spinal Cord for Nasopharyngeal Cancer Patients During Radiotherapy

    SciTech Connect

    Han Chunhui Chen Yijen; Liu An; Schultheiss, Timothy E.; Wong, Jeffrey Y.C.

    2008-03-15

    Purpose: For intensity-modulated radiotherapy of nasopharyngeal cancer, accurate dose delivery is crucial to the success of treatment. This study aimed to evaluate the significance of daily image-guided patient setup corrections and to quantify the parotid gland volume and dose variations for nasopharyngeal cancer patients using helical tomotherapy megavoltage computed tomography (CT). Methods and Materials: Five nasopharyngeal cancer patients who underwent helical tomotherapy were selected retrospectively. Each patient had received 70 Gy in 35 fractions. Daily megavoltage CT scans were registered with the planning CT images to correct the patient setup errors. Contours of the spinal cord and parotid glands were drawn on the megavoltage CT images at fixed treatment intervals. The actual doses delivered to the critical structures were calculated using the helical tomotherapy Planned Adaptive application. Results: The maximal dose to the spinal cord showed a significant increase and greater variation without daily setup corrections. The significant decrease in the parotid gland volume led to a greater median dose in the later phase of treatment. The average parotid gland volume had decreased from 20.5 to 13.2 cm{sup 3} by the end of treatment. On average, the median dose to the parotid glands was 83 cGy and 145 cGy for the first and the last treatment fractions, respectively. Conclusions: Daily image-guided setup corrections can eliminate significant dose variations to critical structures. Constant monitoring of patient anatomic changes and selective replanning should be used during radiotherapy to avoid critical structure complications.

  16. Care of patients with permanent tracheostomy.

    PubMed

    Everitt, Erica

    The third article in our series on tracheostomy care discusses the care of patients with a permanent tracheostomy. While these patients make up a small proportion of all patients who have a tracheostomy inserted, they have complex needs. This means they require practitioners in both acute and community settings, who have time, support and competent tracheostomy-care skills, to achieve a successful discharge and ongoing management of their tracheostomy. PMID:27396099

  17. Delirium in Prolonged Hospitalized Patients in the Intensive Care Unit

    PubMed Central

    Vahedian Azimi, Amir; Ebadi, Abbas; Ahmadi, Fazlollah; Saadat, Soheil

    2015-01-01

    Background: Prolonged hospitalization in the intensive care unit (ICU) can impose long-term psychological effects on patients. One of the most significant psychological effects from prolonged hospitalization is delirium. Objectives: The aim of this study was to assess the effect of prolonged hospitalization of patients and subsequent delirium in the intensive care unit. Patients and Methods: This conventional content analysis study was conducted in the General Intensive Care Unit of the Shariati Hospital of Tehran University of Medical Sciences, from the beginning of 2013 to 2014. All prolonged hospitalized patients and their families were eligible participants. From the 34 eligible patients and 63 family members, the final numbers of actual patients and family members were 9 and 16, respectively. Several semi-structured interviews were conducted face-to-face with patients and their families in a private room and data were gathered. Results: Two main themes from two different perspectives emerged, 'patients' perspectives' (experiences during ICU hospitalization) and 'family members' perspectives' (supportive-communicational experiences). The main results of this study focused on delirium, Patients' findings were described as pleasant and unpleasant, factual and delusional experiences. Conclusions: Family members are valuable components in the therapeutic process of delirium. Effective use of family members in the delirium caring process can be considered to be one of the key non-medical nursing components in the therapeutic process. PMID:26290854

  18. Caring for patients with melanoma in the primary care setting.

    PubMed

    Rea, Mary; Perrino, Laura; Sheets, Victoria; McDaniel, M Jane

    2014-07-01

    The incidence of melanoma is steadily rising and mortality continues to increase. This article describes types of melanoma and the role of primary care providers in the long-term management and follow-up of patients diagnosed with melanoma.

  19. Promoting better care for stigmatised patients.

    PubMed

    Pottle, Jessica; Marotta, Jill

    2014-12-31

    This article discusses the role of nurses and nurse leaders in the prevention and resolution of patient stigmatisation. The multiple nurse, patient and environmental factors that contribute to difficulties in nurse-patient interactions are outlined. The antecedents and consequences of patient stigmatisation are discussed and leadership strategies for counteracting and preventing patient stigmatisation are explored. The reader is encouraged to reflect on the role of patient stigmatisation in nursing practice and consider ways to promote better care of stigmatised patients. PMID:25515484

  20. Uptake of Depression Treatment Recommendations among Latino Primary Care Patients

    PubMed Central

    Ishikawa, Rachel Zack; Cardemil, Esteban V.; Alegría, Margarita; Schuman, Catherine C.; Joseph, Robert C.; Bauer, Amy M.

    2014-01-01

    Background Primary care providers (PCP) are the entry point for public sector depression treatment for many Latino patients. However, many Latino patients do not initiate their PCPs’ recommended treatment, which likely contributes to ethnic disparities in depression treatment. This study examined factors related to Latino patients’ uptake of their PCPs’ recommendations for depression treatment. Method Ninety Latino primary care patients who received a depression treatment recommendation from their PCP participated in a telephone interview. Patients rated their working alliance with their PCPs and their PCPs’ cultural competence. They also reported their treatment preference, the type of recommendation, and their intended and actual uptake of the recommendation. Patients were contacted at two time points (Time 1: M = 14 days after PCP appointment; Time 2: M = 84 days after PCP appointment) to report their uptake status. Results At Time 1, 23% of patients had initiated uptake of the treatment recommendation, increasing to 53% at Time 2. Patients who received a medication recommendation were more likely to have followed though on the recommendation, compared to patients who received a psychotherapy recommendation. The working alliance was positively associated with intention to follow up on a treatment recommendation, and also mediated the relationship between cultural competence and intention of following up on the recommendation. Conclusion PCP’s treatment recommendation and the PCP – patient alliance play a role in Latino primary care patients intention to follow a treatment recommendation for depression. An improved understanding of this role could enhance efforts to improve depression treatment uptake. PMID:24512538

  1. Patients' perspectives on dying and on the care of dying patients.

    PubMed

    McCormick, T R; Conley, B J

    1995-09-01

    Dying patients have much to teach us about their preferences for care. Although caring for dying patients is a major responsibility of physicians, the current curriculum in medical education emphasizes the pathophysiology and treatment of disease, with scarce time and emphasis for developing attitudes and skills essential to caring for persons in the final stage of life. Barriers to satisfactory communication may arise from either the physician or the patient, or both. Patients and physicians sometimes attach different meanings to words that are commonly used in discussing treatment. Barriers can be diminished or resolved by applying good communication skills, including attending to both verbal and nonverbal signals, exploring incongruent affect, and empathically eliciting patients' perspectives about illness, treatment plans, and end-of-life issues. The competent care of dying patients must extent beyond the management of physical symptoms because patients may experience their gravest suffering from fears and anxieties that go unaddressed in conversations with their physician. Conflicts arise when the disease progresses and the end of life approaches if the physician and patient have not reached agreement on their expectations. Physicians may initiate life-prolonging mechanisms when patients actually prefer palliative care. Patients experience a reduction in both physical and psychological aspects of suffering when physicians use good communication skills, are sensitive to patients' perspectives, and actively work to reduce barriers to mutual understanding.

  2. Caring for patients with lower limb amputation.

    PubMed

    Ruff, Deborah

    In 2014 a National Confidential Enquiry into Patient Outcome and Death report examined the care of people requiring lower limb amputation as a consequence of complications associated with vascular disease or diabetes. It suggests that less than half of patients who undergo surgery receive good care. This article summarises the key findings of the report and the implications for nursing practice.

  3. On Strengthening Compassionate Care for Muslim Patients.

    PubMed

    Zaidi, Danish

    2015-09-01

    In this piece, I contribute to an ongoing conversation on compassionate care for Muslim patients. I address the various barriers hindering such care and ways in which to work around them. In providing an introductory understanding of general Islamic beliefs on the definition of life, the use of palliative care, etc., I hope this reflection can offer insight into the general background of Muslim patients and spark interest in further reading and research. PMID:26463856

  4. Quality of Care in the Cirrhotic Patient

    PubMed Central

    Volk, Michael L; Kanwal, Fasiha

    2016-01-01

    Cirrhosis is a common, complex, chronic condition requiring care by multiple specialists in different locations. Emerging data demonstrates limitations in the quality of care these patients receive—in large part due to the problems with care coordination rather than failures of individual providers. This article will discuss approaches for measuring quality, and provide a step-by-step guide for developing quality improvement programs for this patient population. PMID:27101005

  5. [Guidelines for psychosocial care of cancer patients].

    PubMed

    Caminiti, Caterina

    2013-01-01

    Guidelines for psychosocial care of cancer patients. The Italian Association of Medical Oncologists published in 2013 the update of the first edition of the Psychosocial Guidelines for the care of cancer patients. The guidelines, produced by a multidisciplinary group (medical doctors, nurses, oncologists, psychologists and patients) aim at recognizing the importance of psychosocial care in helping the patients and their relatives to overcome the effects of the diagnosis and the treatments on mental health and emotional wellbeing. In some cases the evidences available are not as hard as those supporting drug treatments: many outcomes such as the effectiveness of educational interventions, the patients' wellbeing, thrust, perception of support, for their nature and complexity require both quantitative and qualitative measurements. Lack of robust evidences such as those obtained from clinical trials, does not necessarily correspond to lack of effectiveness of the intervention nor should make us forget that patients' rights (to good care, information and support) should be guaranteed. PMID:24441468

  6. Unmet patient need in home care under managed care.

    PubMed

    Kadushin, Goldie; Egan, Marcia

    2006-01-01

    Social workers in home care agencies obtained through a national random sample responded to a mail questionnaire that examined the relationship between the frequency of discharge with unmet patient need and patient/family characteristics, agency auspice, and practice activities when social workers' assessment of patient needs and managed care payment limits conflict. Regression analysis found that the importance of social work financial planning with clients and intra-agency advocacy were significant negative contributors, and patient cognitive impairment, inadequate family care, and agency auspice were significant positive contributors to a regression model explaining 31 percent of the variance in the frequency of discharge with unmet need. Implications for practice, education, and research are discussed. PMID:17062525

  7. Providing Palliative Care to LGBTQ Patients.

    PubMed

    Barrett, Nina; Wholihan, Dorothy

    2016-09-01

    Nurses should be familiar with and equipped to address the challenges that arise when caring for lesbian, gay, bisexual, transgender, or queer-identified (LGBTQ) patients. LGBTQ individuals have increased rates of certain physical diseases and are at greater risk of suffering from stress-sensitive mental health issues. Negative social attitudes, widespread discrimination and stigma, physical and psychological victimization, and less social support with aging contribute to the complexity of care for these individuals. Open communication, welcoming and accepting attitudes and environments, and sensitivity to unique multidimensional issues improve care to LGBTQ patients with serious advanced illness. Nursing can reach this vulnerable minority and positively impact the quality of care. PMID:27497022

  8. Experiences of critical care nurses caring for unresponsive patients.

    PubMed

    Villanueva, N E

    1999-08-01

    Grounded theory methodology was utilized to explore the experiences of critical care nurses caring for patients who were unable to respond due to a traumatic brain injury or receiving neuromuscular blocking agents. The registered nurses participating in the study worked in a neuroscience intensive care unit. Saturation of the categories was achieved with 16 interviews. The core category that emerged from the study is Giving the Patient a Chance. The subcategories of Learning about My Patient, Maintaining and Monitoring, Talking to My Patient, Working with Families, Struggling with Dilemmas and Personalizing the Experience all centered upon the focus of doing everything to help the patient attain the best possible outcome. Factors influencing each of the subcategories were identified such as the acuity of the patient, experience level of the nurse and the presence or absence of family members or significant others. These factors accounted for the variations in the nurses' experience. Several reasons accounting for the variations were determined. The study identified areas that need to be addressed in both general nursing education and nursing practice, such as instruction on talking to comatose patients, working with families and orientation information for nurses new to caring for these populations. Recommendations for improvement in these areas, as well as for future studies are discussed. PMID:10553569

  9. Randomized Comparison of Actual and Ideal Body Weight for Size Selection of the Laryngeal Mask Airway Classic in Overweight Patients.

    PubMed

    Kim, Min-Soo; Lee, Jong Seok; Nam, Sang Beom; Kang, Hyo Jong; Kim, Ji Eun

    2015-08-01

    Size selection of the laryngeal mask airway (LMA) Classic based on actual body weight remains a common practice. However, ideal body weight might allow for a better size selection in obese patients. The purpose of our study was to compare the utility of ideal body weight and actual body weight when choosing the appropriate size of the LMA Classic by a randomized clinical trial. One hundred patients with age 20 to 70 yr, body mass index ≥25 kg/m(2), and the difference between LMA sizes based on actual weight and ideal weight were allocated to insert the LMA Classic using either actual body weight or ideal body weight in a weight-based formula for size selection. After insertion of the device, several variables including insertion parameters, sealing function, fiberoptic imaging, and complications were investigated. The insertion success rate at the first attempt was lower in the actual weight group (82%) than in the ideal weight group (96%), even it did not show significant difference. The ideal weight group had significantly shorter insertion time and easier placement. However, fiberoptic views were significantly better in the actual weight group. Intraoperative complications, sore throat in the recovery room, and dysphonia at postoperative 24 hr occurred significantly less often in the ideal weight group than in the actual weight group. It is suggested that the ideal body weight may be beneficial to the size selection of the LMA Classic in overweight patients (Clinical Trial Registry, NCT 01843270).

  10. Alzheimer's disease care management plan: maximizing patient care.

    PubMed

    Treinkman, Anna

    2005-03-01

    Nurse practitioners have the potential to significantly impact the care of patients with dementia. Healthcare providers can now offer patients medications that will control symptoms and prolong functioning. As a result of ongoing contact with patients, NPs play an important role in assessing and screening patients for AD and educating the patients, families, and caregivers about the disease. Alzheimer's disease is a chronic, progressive illness that requires long-term management. Nurse practitioners should be familiar with available medications and appreciate the need to individualize therapy to maximize efficacy and minimize potential adverse drug reactions.

  11. Standards of care for patients with spondyloarthritis.

    PubMed

    Abad, Miguel Ángel; Ariza, Rafael Ariza; Aznar, Juan José; Batlle, Enrique; Beltrán, Emma; de Dios Cañete, Juan; de Miguel, Eugenio; Escudero, Alejandro; Fernández-Carballido, Cristina; Gratacós, Jordi; Loza, Estíbaliz; Linares, Luis Francisco; Montilla, Carlos; Ramos, Manuel Moreno; Mulero, Juan; Queiro, Rubén; Raya, Enrique; Lozano, Carlos Rodríguez; Moreno, Jesús Rodríguez; Sanz, Jesús; Silva-Fernández, Lucía; Torre Alonso, Juan Carlos; Zarco, Pedro; Fernández-Sueiro, José Luis; Juanola, Xavier

    2014-02-01

    To define and give priory to standards of care in patients with spondyloarthritis (SpA). A systematic literature review on SpA standards of care and a specific search in relevant and related sources was performed. An expert panel was established who developed the standards of care and graded their priority (high, mild, low, or no priority) following qualitative methodology and Delphi process. An electronic survey was sent to a representative sample of 167 rheumatologists all around the country, who also gave priority to the standards of care (same scale). A descriptive analysis is presented. The systematic literature review retrieved no article specifically related to SpA patients. A total of 38 standards of care were obtained-12 related to structure, 20 to process, and 6 to result. Access to care, treatment, and safety standards of care were given a high priority by most of rheumatologists. Standards not directly connected to daily practice were not given such priority, as standards which included a time framework. The standards generated for the performance evaluation (including patient and professionals satisfaction) were not considered especially important in general. This set of standards of care should help improve the quality of care in SpA patients.

  12. Standards of care for patients with spondyloarthritis.

    PubMed

    Abad, Miguel Ángel; Ariza, Rafael Ariza; Aznar, Juan José; Batlle, Enrique; Beltrán, Emma; de Dios Cañete, Juan; de Miguel, Eugenio; Escudero, Alejandro; Fernández-Carballido, Cristina; Gratacós, Jordi; Loza, Estíbaliz; Linares, Luis Francisco; Montilla, Carlos; Ramos, Manuel Moreno; Mulero, Juan; Queiro, Rubén; Raya, Enrique; Lozano, Carlos Rodríguez; Moreno, Jesús Rodríguez; Sanz, Jesús; Silva-Fernández, Lucía; Torre Alonso, Juan Carlos; Zarco, Pedro; Fernández-Sueiro, José Luis; Juanola, Xavier

    2014-02-01

    To define and give priory to standards of care in patients with spondyloarthritis (SpA). A systematic literature review on SpA standards of care and a specific search in relevant and related sources was performed. An expert panel was established who developed the standards of care and graded their priority (high, mild, low, or no priority) following qualitative methodology and Delphi process. An electronic survey was sent to a representative sample of 167 rheumatologists all around the country, who also gave priority to the standards of care (same scale). A descriptive analysis is presented. The systematic literature review retrieved no article specifically related to SpA patients. A total of 38 standards of care were obtained-12 related to structure, 20 to process, and 6 to result. Access to care, treatment, and safety standards of care were given a high priority by most of rheumatologists. Standards not directly connected to daily practice were not given such priority, as standards which included a time framework. The standards generated for the performance evaluation (including patient and professionals satisfaction) were not considered especially important in general. This set of standards of care should help improve the quality of care in SpA patients. PMID:24390635

  13. Comprehensive care of amyotrophic lateral sclerosis patients: a care model.

    PubMed

    Güell, Maria Rosa; Antón, Antonio; Rojas-García, Ricardo; Puy, Carmen; Pradas, Jesus

    2013-12-01

    Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disease that presents with muscle weakness, causing progressive difficulty in movement, communication, eating and ultimately, breathing, creating a growing dependence on family members and other carers. The ideal way to address the problems associated with the disease, and the decisions that must be taken, is through multidisciplinary teams. The key objectives of these teams are to optimise medical care, facilitate communication between team members, and thus to improve the quality of care. In our centre, we have extensive experience in the care of patients with ALS through an interdisciplinary team whose aim is to ensure proper patient care from the hospital to the home setting. In this article, we describe the components of the team, their roles and our way of working.

  14. Comprehensive care of amyotrophic lateral sclerosis patients: a care model.

    PubMed

    Güell, Maria Rosa; Antón, Antonio; Rojas-García, Ricardo; Puy, Carmen; Pradas, Jesus

    2013-12-01

    Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disease that presents with muscle weakness, causing progressive difficulty in movement, communication, eating and ultimately, breathing, creating a growing dependence on family members and other carers. The ideal way to address the problems associated with the disease, and the decisions that must be taken, is through multidisciplinary teams. The key objectives of these teams are to optimise medical care, facilitate communication between team members, and thus to improve the quality of care. In our centre, we have extensive experience in the care of patients with ALS through an interdisciplinary team whose aim is to ensure proper patient care from the hospital to the home setting. In this article, we describe the components of the team, their roles and our way of working. PMID:23540596

  15. Care-related pain in critically ill mechanically ventilated patients.

    PubMed

    Ayasrah, S

    2016-07-01

    Despite advances in pain management, critically ill patients continue to have unacceptably high rates of uncontrolled pain. Using the Behavioural Pain Scale and physiological indicators of pain, this study examines pain levels in mechanically ventilated patients prior to and during routine nursing procedures. A prospective descriptive design was used to assess and describe care-related pain associated with nociceptive procedures (repositioning, endotracheal suctioning, and vascular punctures) and non-nociceptive procedures (mouth care, eye care and dressing change). A sample of 247 mechanically ventilated Jordanian patients was recruited from intensive care units in a military hospital. The overall mean procedural pain score of 6.34 (standard deviation [SD] 2.36) was significantly higher than the mean preprocedural pain score of 3.43 (SD 0.67, t[246]=20.82, P<0.001). The highest mean procedural pain scores were observed during repositioning (9.25, SD 1.29). Few patients received analgesics and/or sedatives in the hour prior to the procedures. The mean Ramsay Scale score was 2.49 (SD 0.95), indicating that patients were either anxious or responsive to command only. The mean physiological indicators of pain increased during repositioning and endotracheal suctioning and decreased during the rest of the procedures. Mechanically ventilated patients experience pain prior to and during routine nursing procedures. Harmless and comfort procedures are actually painful. When caring for nonverbal critically ill patients, clinicians need to consider care-related pain associated with their interventions. Relying on changes in vital signs as a primary indicator of pain can be misleading. PMID:27456175

  16. Sexuality in palliative care: patient perspectives.

    PubMed

    Lemieux, Laurie; Kaiser, Stefanie; Pereira, Jose; Meadows, Lynn M

    2004-10-01

    This qualitative study investigated the meaning of sexuality to palliative patients. Face-to-face interviews were conducted with ten patients receiving care in a tertiary palliative care unit, a hospice or by palliative home care services in their homes. Several themes emerged. Emotional connection to others was an integral component of sexuality, taking precedence over physical expressions. Sexuality continues to be important at the end of life. Lack of privacy, shared rooms, staff intrusion and single beds were considered barriers to expressing sexuality in the hospital and hospice settings. Only one subject had previously been asked about sexuality as part of their clinical care, yet all felt that it should have been brought up, especially after the initial cancer treatments were completed. Home care nurses and physicians were seen as the appropriate caregivers to address this issue. Subjects unanimously mentioned that a holistic approach to palliative care would include opportunities to discuss the impact of their illness on their sexuality.

  17. Oncology nurse communication barriers to patient-centered care.

    PubMed

    Wittenberg-Lyles, Elaine; Goldsmith, Joy; Ferrell, Betty

    2013-04-01

    Although quality communication has been identified as a necessary component to cancer care, communication skills training programs have yet to focus on the unique role of nurses. This study explored communication barriers as reported by seven nurse managers to better identify communication skills needed for oncology nurses to practice patient-centered care. Thematic analysis of transcripts was used to identify barriers to patient and family communication and desirable patient-centered nursing communication skills. Overall, the nurse managers reported that nurses experience patient and family communication difficulties as a result of inconsistent messages to patients and family from other healthcare staff. Physician assumptions about nursing left nurses feeling uncomfortable asking for clarification, creating a barrier to team communication processes. Patient-centered communication and care cannot be actualized for nurses unless team roles are clarified and nurses receive training in how to communicate with physicians, patients, and family. Therefore, the authors of this article created the COMFORT communication training protocol, and key concepts and resources for nurse communication training through COMFORT are detailed in this article.

  18. Patient care in a technological age.

    PubMed

    Dragon, Natalie

    2006-07-01

    In this electronically wired world of the 21 st century, the health care system has tapped into technology available at the touch of a button. Scientific discoveries, high-tech equipment, electronic medical records, Smarticards, and long distance diagnosis using telehealth technology have all been embraced. But Natalie Dragon asks, what are the implications for nurses and the outcomes on patient care?

  19. Caring for patients with a tracheostomy.

    PubMed

    Everitt, Erica

    The National Confidential Enquiry into Patient Outcome and Death in 2014 concluded that tracheostomy care fell below what is safe and reasonable to expect, and that staff needed training in this essential skill. This article, the first of a four-part series on all aspects of tracheostomy management, discusses the principles of tracheostomy care. PMID:27328597

  20. ‘I am actually doing something to keep well. That feels really good’: Experiences of exercise within hospice care

    PubMed Central

    Turner, Karen; Tookman, Adrian; Bristowe, Katherine; Maddocks, Matthew

    2016-01-01

    Background: Patients with advanced cancer frequently experience functional impairment and reduced quality of life. Therapeutic exercise can provide benefit and be made accessible through the use of tailored programmes. Most studies examining exercise programmes for people with advanced cancer have used quantitative outcome measures and focussed on objective physical function, therefore offer a limited perspective on the experience of exercise participation. Methods: This qualitative study explored patients' experiences of an exercise programme within a palliative care setting. The interviews focussed on the perceived impact on all aspects of quality of life. Results: Nine people with advanced cancer, attending a hospice-based exercise programme, completed a one-to-one interview with a senior physiotherapist to explore the physical, emotional, and social impacts of their participation. Interviews were audiotaped, transcribed verbatim and analysed using interpretive phenomenological analysis. Patients reported an awareness of the positive physical, psychological, and social consequences of exercising. Their experiences reflected on all dimensions of quality of life, the impact of others and the sense of meaning gained through participation in exercise. Conclusion: Our findings highlight that exercise in palliative care should not be viewed solely a physical intervention, but one that has potential to enhance many aspects of patients' quality of life. PMID:27453639

  1. Assessing patient care in palliative care using the healthcare matrix.

    PubMed

    Arthur, Joseph; Kwon, Jung Hye; Reddy, Suresh; Quinn, Doris C; Bruera, Eduardo; Hui, David

    2013-08-01

    The healthcare matrix is a novel assessment tool that facilitates systematic examination of patient cases using criteria established by the Accreditation Council for Graduate Medical Education and the Institute of Medicine. It is particularly useful for analyzing complex cases, although its use in the palliative care setting has not been documented. We describe here the use of the healthcare matrix to examine the healthcare encounters of a 63 year-old patient with advanced cancer. The healthcare matrix helped us to dissect the physical, psychosocial, logistical, professional, and ethical aspects of care, and to highlight multiple opportunities for quality improvement. In addition to the case example we will be discussing the advantages and disadvantages for using the healthcare matrix and its potential utility in palliative care.

  2. Patient care: past, present, and future.

    PubMed

    Twycross, Robert

    The 40 years since St Christopher's Hospice opened has witnessed a burgeoning international interest in palliative care. Its key characteristics comprise a focus on the whole-person (physical, psychological, social, and spiritual), patient-centeredness (partnership with and empowerment of the patient and family), openness and honesty in communication, an acceptance of the inevitability of death coupled with improvement in the quality of life, multi-professional teamwork integrated with community (volunteer) involvement. Although much has been achieved, much remains to be done. Both in resource-poor countries and in more wealthy ones, the scope of palliative care has changed. Initially in the United Kingdom, palliative care was mostly limited to cancer patients but now strenuous efforts are being made to extend coverage to other patient groups, e.g., those with end-stage heart disease or renal failure. In India, with a dearth of chronic care facilities, palliative care services increasingly embrace those with chronic disability as well as progressive end-stage disease. In Sub-Saharan Africa, the devastating impact of AIDS is having a major impact on the development and delivery of palliative care. To maximize the benefits of limited financial and other resources, a strategic approach is necessary. The World Health Organization emphasizes three essential foundation measures: health service policy, public awareness and professional education, and drug availability. However, at the end of the day, if we are truly to honor Cicely Saunders, palliative care must remain a movement with momentum, combining creative charisma with inevitable bureaucratic routinization.

  3. Parkinson patients as partners in care.

    PubMed

    Hirsch, Mark A; Sanjak, Mohammed; Englert, Danielle; Iyer, Sanjay; Quinlan, Margaret M

    2014-01-01

    Increasing physical activity, as part of an active lifestyle, is an important health goal for individuals with Parkinson's disease (PD). Exercise can positively impact health related quality of life. Given this, how can we promote physically active lifestyles among PD patients (most of whom are sedentary)? Here we suggest that health care professionals could significantly expand their impact by collaborating with PD patients and their spouses (or caregivers) as partners-in-care. We outline reasons why partners-in-care approaches are important in PD, including the need to increase social capital, which deals with issues of trust and the value of social networks in linking members of a community. We then present results of a qualitative study involving partners-in-care exercise beliefs among 19 PD patients and spouses, and conclude with our perspective on future benefits of this approach. PMID:24262175

  4. Critical paths: maximizing patient care coordination.

    PubMed

    Spath, P L

    1995-01-01

    1. With today's emphasis on horizontal and vertical integration of patient care services and the new initiatives prompted by these challenges, OR nurses are considering new methods for managing the perioperative period. One such method is the critical path. 2. A critical path defines an optimal sequencing and timing of interventions by physicians, nurses, and other staff members for a particular diagnosis or procedure, designed to better use resources, maximize quality of care, and minimize delays. 3. Hospitals implementing path-based patient care have reported cost reductions and improved team-work. Critical paths have been shown to reduce patient care costs by improving hospital efficiency, not merely by reducing physician practice variations.

  5. Introducing Optometry Students to Clinical Patient Care.

    ERIC Educational Resources Information Center

    Gable, Eileen M.

    2001-01-01

    Describes the innovative content and structure of an introductory course on clinical patient care at the Illinois College of Optometry. Critiques its success based on student grades and feedback, concluding that it was successful in imparting skills of data analysis but had minimal impact on students' ability to empathize with patients. (EV)

  6. Digital subtraction angiography: patient preparation and care.

    PubMed

    Hunt, A H

    1987-08-01

    The use of digital subtraction angiography (DSA) is increasing. Nurses must be prepared to provide quality care to patients who have this relatively new method for radiographically studying the blood vessels. A description of DSA and its applications is provided. Patient preparation, assessment, teaching, and management are described. Complications of the procedure and their management are presented. PMID:2958568

  7. Health Care Communication with Low Literate Patients.

    ERIC Educational Resources Information Center

    McKeon, Christine A.

    Low literate patients face difficulties when they read health care information. The complex process of reading can be summarized in five steps: input, decoding, encoding, output, and feedback. Each occurs automatically for the fluent reader; the low literate reader might encounter stumbling blocks in one or more of the steps. Once the patient has…

  8. Postoperative Care of the Transplanted Patient

    PubMed Central

    Schumacher, Kurt R; Gajarski, Robert J

    2011-01-01

    The successful delivery of optimal peri-operative care to pediatric heart transplant recipients is a vital determinant of their overall outcomes. The practitioner caring for these patients must be familiar with and treat multiple simultaneous issues in a patient who may have been critically ill preoperatively. In addition to the complexities involved in treating any child following cardiac surgery, caretakers of newly transplanted patients encounter multiple transplant-specific issues. This chapter details peri-operative management strategies, frequently encountered early morbidities, initiation of immunosuppression including induction, and short-term outcomes. PMID:22548034

  9. Cultural competent patient-centered nursing care.

    PubMed

    Darnell, Linda K; Hickson, Shondell V

    2015-03-01

    This article provides a theoretic framework for culturally diverse practice, provides a model for developing cultural competency, and provides best-practice guidelines for conducting a cultural assessment on patients to identify their diverse needs to integrate into a patient-centered plan of care. The role of ethics is discussed to empower mutual respect, equality, and trust building in patients to promote positive health care outcomes. Cultural diversity tool kits from the National League for Nursing and the American Association of Colleges of Nursing are reviewed to provide educational resources to the front line nurse.

  10. [Institutional psychotherapy, caring for patients and the place of care].

    PubMed

    Drogoul, Frank

    2013-01-01

    Institutional psychotherapy was developed in the specific context of the "assassination" of the Spanish revolution. There are two distinct movements or two periods. The first, based around Georges Daumézon and Henri Ey gave birth to the sector. The second, around FrançoisTosquelles and Jean Oury emphasised the asylum as the place of care. The function of institutional psychotherapy is to care not only for the patients but also the place of treatment. To fulfil this function, it has a tool box: transfer, the fight against the overvaluation of hierarchy as well as the function of the therapeutic club.

  11. Medical futility and care of dying patients.

    PubMed Central

    Jecker, N S

    1995-01-01

    In this article, I address ethical concerns related to forgoing futile medical treatment in terminally ill and dying patients. Any discussion of medical futility should emphasize that health professionals and health care institutions have ethical responsibilities regarding medical futility. Among the topics I address are communicating with patients and families, resolving possible conflicts, and developing professional standards. Finally, I explore why acknowledging the futility of life-prolonging medical interventions can be so difficult for patients, families, and health professionals. PMID:7571593

  12. Research sensitivities to palliative care patients.

    PubMed

    Addington-Hall, J

    2002-09-01

    This paper considers the methodological challenges of researching the health care experiences of palliative care patients and their families. Difficulties in defining a 'palliative care patient' are highlighted, and the question of whether there are specific ethical issues when researching palliative care explored. Methodological issues are discussed, including the negotiation of access via health professionals, the choice of appropriate data collection methods and tools, the consequences of high attrition rates and the use of retrospective surveys of bereaved relatives. Key areas for research are identified. These include patients' and families' experiences of research participation, the impact of being approached on those who decline, how the characteristics of those who participate differ from those who do not and the likely impact of this on findings. Research is also needed into patient and family motivations for participation, and whether and how these change as the disease progresses. To ensure that the voices of palliative care patients and their families are heard by both service providers and policy-makers, research in this area needs to address the methodological challenges raised in this paper, as well as continuing to explore users' views. PMID:12296842

  13. Trauma-Informed Medical Care: Patient Response to a Primary Care Provider Communication Training

    PubMed Central

    Green, Bonnie L.; Saunders, Pamela A.; Power, Elizabeth; Dass-Brailsford, Priscilla; Schelbert, Kavitha Bhat; Giller, Esther; Wissow, Larry; Hurtado de Mendoza, Alejandra; Mete, Mihriye

    2016-01-01

    Trauma exposure predicts mental disorders and health outcomes; yet there is little training of primary care providers about trauma’s effects, and how to better interact with trauma survivors. This study adapted a theory-based approach to working with trauma survivors, Risking Connection, into a 6-hour CME course, Trauma-Informed Medical Care (TI-Med), to evaluate its feasibility and preliminary efficacy. We randomized four primary care sites to training or wait-list conditions; PCPs at wait-list sites were trained after reassessment. Primary care providers (PCPs) were Family Medicine residents (n = 17; 2 sites) or community physicians (n = 13; 2 sites). Outcomes reported here comprised a survey of 400 actual patients seen by the PCPs in the study. Patients, mostly minority, completed surveys before or after their provider received training. Patients rated PCPs significantly higher after training on a scale encompassing partnership issues. Breakdowns showed lower partnership scores for those with trauma or posttraumatic stress symptoms. Future studies will need to include more specific trauma-related outcomes. Nevertheless, this training is a promising initial approach to teaching trauma-informed communication skills to PCPs.

  14. [Enriching patient care with aromatherapy].

    PubMed

    Sogno-Lalloz, Isabelle

    2014-01-01

    There are increasing numbers of initiatives in healthcare institutions focusing on the benefits of essential oils. Received positively by patients who appreciate the resulting wellbeing, these innovative approaches around aromatherapy are based on the initiative of pioneering caregivers. Following on from an international congress held each year in Grasse, this article presents some example schemes. PMID:25065196

  15. Decision support for patient care: implementing cybernetics.

    PubMed

    Ozbolt, Judy; Ozdas, Asli; Waitman, Lemuel R; Smith, Janis B; Brennan, Grace V; Miller, Randolph A

    2004-01-01

    The application of principles and methods of cybernetics permits clinicians and managers to use feedback about care effectiveness and resource expenditure to improve quality and to control costs. Keys to the process are the specification of therapeutic goals and the creation of an organizational culture that supports the use of feedback to improve care. Daily feedback on the achievement of each patient's therapeutic goals provides tactical decision support, enabling clinicians to adjust care as needed. Monthly or quarterly feedback on aggregated goal achievement for all patients on a clinical pathway provides strategic decision support, enabling clinicians and managers to identify problems with supposed "best practices" and to test hypotheses about solutions. Work is underway at Vanderbilt University Medical Center to implement feedback loops in care and management processes and to evaluate the effects.

  16. Palliative care concept gives patients another option.

    PubMed

    Sansovich, D

    1998-01-01

    New drug treatments with protease inhibitors and total parenteral nutrition are changing long-term care strategies. Case studies are presented of two patients with end-stage AIDS, both of whom would have been expected to die shortly. One made a strong recovery with drugs, although his prognosis had been so poor that hospice was under consideration. The other, in hospice care, was being given nutrients intravenously. Ethical concerns exist with both approaches to AIDS treatment.

  17. Patient Care Partnership: Understanding Expectations, Rights and Responsibilities

    MedlinePlus

    ` e Patient Care Partnership Understanding Expectations, Rights and Responsibilities What to expect during your hospital stay: • High ... e Patient Care Partnership Understanding Expectations, Rights and Responsibilities W hen you need hospital care, your doctor ...

  18. Right Care for the Right Patient Each and Every Time

    PubMed Central

    Fret, Jose; Lukaj, Alex; Kuo, Hsiang; Yaparpalvi, Ravindra; Tome, Wolfgang A; Kalnicki, Shalom

    2016-01-01

    Purpose To implement a biometric patient identification system in the field of radiation oncology. Materials and Methods A biometric system using palm vein scanning technology has been implemented to ensure the delivery of treatment to the correct patient each and every time. By interfacing a palm vein biometrics system (PVBS) (PatientSecure®, Imprivata, Lexington, Massachusetts) with the radiation oncology patient management system (ROPMS) (ARIA®, Varian Medical Systems, Palo Alto, California) one can integrate patient check-in at the front desk and identify and open the correct treatment record of the patient at the point of care prior to the initiation of the radiation therapy treatment. Results The learning time for the use of the software and palm scanner was extremely short. The staff at the front desk and treatment machines learned the procedures to use, clean, and care for the device in one hour’s time. The first key to the success of the system is to have a policy and procedure in place; such a procedure was created and put in place in the department from the first day. The second key to the success is the actual hand placement on the scanner. Learning the proper placement and gently reminding patients from time to time was found to be efficient and to work well.  Conclusion The use of a biometric patient identification system employing palm vein technology allows one to ensure that the right care is delivered to the right patient each and every time. Documentation through the PVBS database now exists to show that this has taken place. PMID:27014526

  19. Patient Perceptions of Mistakes in Ambulatory Care

    PubMed Central

    Kistler, Christine E.; Walter, Louise C.; Mitchell, C. Madeline; Sloane, Philip D.

    2011-01-01

    CONTEXT Little information exists about current patient perceptions of medical mistakes in ambulatory care within a diverse population. OBJECTIVES To learn about adults’ perceptions of mistakes in ambulatory care, what factors were associated with perceived mistakes, and whether or not the respondents changed physicians because of these perceived mistakes DESIGN Cross-sectional survey conducted in 2008 SETTING Seven primary care medical practices in North Carolina PARTICIPANTS One thousand six hundred ninety-seven English or Spanish speaking adults, aged 18 and older, who presented to a medical provider during the data collection period. MAIN OUTCOME MEASURES 1) Has a doctor in a doctor’s office ever made a mistake in your care? 2) In the past 10 years, has a doctor in a doctor’s office made a wrong diagnosis or misdiagnosed you? (If yes, how much harm did this cause you?) 3) In the last 10 years, has a doctor in a doctor’s office given you the wrong medical treatment or delayed treatment? (If yes, how much harm did this cause you?) 4) Have you ever changed doctors because of either a wrong diagnosis or a wrong treatment of a medical condition? RESULTS Two hundred sixty-five participants (15.6%) responded that a doctor had ever made a mistake, 13.4% reported a wrong diagnosis, 12.4% reported a wrong treatment, and 14.1% reported having changed doctors because of a mistake. Participants perceived mistakes and harm in both diagnostic care and medical treatment. Patients with chronic low back pain, higher levels of education, and poor physical health were at increased odds of perceiving harm, whereas African-Americans were less likely to perceive mistakes. CONCLUSIONS Patients perceived mistakes in their diagnostic and treatment care in the ambulatory setting. These perceptions had a concrete impact on the patient-physician relationship, often leading patients to seek another health care provider. PMID:20837835

  20. Collaborative patient care protocols: a development process.

    PubMed

    Blaufuss, J; Wynn, J; Hujcs, M

    1993-01-01

    Computerization of these protocols is in progress. This project is funded for one year with projected completion in January 1994. This study will form a framework in which further research can be completed. Utilizing protocols will allow the measurement of nursing decision making by testing relationships between parameters and interventions and by identifying rules for decision making. For example, questions that may be answered include which physiologic parameters do clinicians treat and in what order or priority, as well as what is the impact on patient outcomes in regard to cost of care and complications. Computerized patient care protocols can be further developed to meet patient-specific needs. A computerized data base will facilitate managing large amounts of patient data and tailoring instructions to these patients. One of the goals of this project was to measure the feasibility of developing computerized patient care protocols and implementing them in a critical care setting. Eventually, this experience will facilitate implementing computerized protocols at other sites. An additional benefit is the ability to implement continuous quality improvement strategies in a prospective manner rather than by retrospective review. PMID:10171735

  1. Protocol Directed Patient Care using a Computer

    PubMed Central

    Blum, B.; Lenhard, R.; McColligan, E.

    1980-01-01

    The Johns Hopkins Oncology Center has developed a clinical information system which assists in the care of the 2,000 patients currently under treatment at the Center. The system maintains a data base containing a summary diagnostic and treatment history plus complete tabulations of laboratory results, therapies, and other clinical findings. These data are organized and displayed in formats which aid decision-making. For the past year the Center has been working with an extension to the data system which produces daily care plans for each inpatient and outpatient treated at the Center. These plans are a function of the disease, treatment protocol, and current clinical status of each patient. This paper describes the objectives, organization, and experience to date with the use of computer generated plans for protocol directed patient care.

  2. Medical education and indigent patient care.

    PubMed

    Lyon, Deborah S

    2003-12-01

    The 20th century model of medical education has focused on a network of urban medical centers serving primarily indigent patients in an unspoken contract of medical services in exchange for student and resident education. The improvement in federal and state reimbursement for indigent care services, along with the decline in reimbursement rates from the private sector, has led to competition for these patients from nonacademic providers. As numbers of patients seeking care at urban teaching centers have steadily declined, concerns about adequate teaching volume and revenue generation have led to very creative problem-solving. Bringing marketing concerns into the indigent care environment is not a straightforward undertaking, but the rewards might far exceed the simple goal of "getting our numbers back up." PMID:14613672

  3. Patient autonomy in chronic care: solving a paradox

    PubMed Central

    Reach, Gérard

    2014-01-01

    The application of the principle of autonomy, which is considered a cornerstone of contemporary bioethics, is sometimes in obvious contradiction with the principle of beneficence. Indeed, it may happen in chronic care that the preferences of the health care provider (HCP), who is largely focused on the prevention of long term complications of diseases, differ from those, more present oriented, preferences of the patient. The aims of this narrative review are as follows: 1) to show that the exercise of autonomy by the patient is not always possible; 2) where the latter is not possible, to examine how, in the context of the autonomy principle, someone (a HCP) can decide what is good (a treatment) for someone else (a patient) without falling into paternalism. Actually this analysis leads to a paradox: not only is the principle of beneficence sometimes conflicting with the principle of autonomy, but physician’s beneficence may enter into conflict with the mere respect of the patient; and 3) to propose a solution to this paradox by revisiting the very concepts of the autonomous person, patient education, and trust in the patient–physician relationship: this article provides an ethical definition of patient education. PMID:24376345

  4. Reconciling evidence-based medicine and patient-centred care: defining evidence-based inputs to patient-centred decisions.

    PubMed

    Weaver, Robert R

    2015-12-01

    Evidence-based and patient-centred health care movements have each enhanced the discussion of how health care might best be delivered, yet the two have evolved separately and, in some views, remain at odds with each other. No clear model has emerged to enable practitioners to capitalize on the advantages of each so actual practice often becomes, to varying degrees, an undefined mishmash of each. When faced with clinical uncertainty, it becomes easy for practitioners to rely on formulas for care developed explicitly by expert panels, or on the tacit ones developed from experience or habit. Either way, these tendencies towards 'cookbook' medicine undermine the view of patients as unique particulars, and diminish what might be considered patient-centred care. The sequence in which evidence is applied in the care process, however, is critical for developing a model of care that is both evidence based and patient centred. This notion derives from a paradigm for knowledge delivery and patient care developed over decades by Dr. Lawrence Weed. Weed's vision enables us to view evidence-based and person-centred medicine as wholly complementary, using computer tools to more fully and reliably exploit the vast body of collective knowledge available to define patients' uniqueness and identify the options to guide patients. The transparency of the approach to knowledge delivery facilitates meaningful practitioner-patient dialogue in determining the appropriate course of action. Such a model for knowledge delivery and care is essential for integrating evidence-based and patient-centred approaches.

  5. Patient care: past, present, and future.

    PubMed

    Twycross, Robert

    The 40 years since St Christopher's Hospice opened has witnessed a burgeoning international interest in palliative care. Its key characteristics comprise a focus on the whole-person (physical, psychological, social, and spiritual), patient-centeredness (partnership with and empowerment of the patient and family), openness and honesty in communication, an acceptance of the inevitability of death coupled with improvement in the quality of life, multi-professional teamwork integrated with community (volunteer) involvement. Although much has been achieved, much remains to be done. Both in resource-poor countries and in more wealthy ones, the scope of palliative care has changed. Initially in the United Kingdom, palliative care was mostly limited to cancer patients but now strenuous efforts are being made to extend coverage to other patient groups, e.g., those with end-stage heart disease or renal failure. In India, with a dearth of chronic care facilities, palliative care services increasingly embrace those with chronic disability as well as progressive end-stage disease. In Sub-Saharan Africa, the devastating impact of AIDS is having a major impact on the development and delivery of palliative care. To maximize the benefits of limited financial and other resources, a strategic approach is necessary. The World Health Organization emphasizes three essential foundation measures: health service policy, public awareness and professional education, and drug availability. However, at the end of the day, if we are truly to honor Cicely Saunders, palliative care must remain a movement with momentum, combining creative charisma with inevitable bureaucratic routinization. PMID:18051016

  6. Rhetoric and reality in stroke patient care.

    PubMed

    Pound, P; Ebrahim, S

    2000-11-01

    The aim of this study was to identify aspects of the process of care that might help explain the improved outcomes associated with stroke units. Three different care settings for stroke patients, an elderly care unit and general medical ward in an inner-city teaching hospital and a stroke unit in another teaching hospital in the same city, were compared using non-participant observational methods. Nurses on the stroke unit and general medical ward usually engaged in standardised and functional interaction with patients, while nurses on the elderly care unit were observed to adopt a more personal and attentive approach with patients. Rehabilitation nursing was rarely observed on the stroke unit, never on the general medical ward but always on the elderly care unit. There was evidence of effective communication between nurses and therapists on the elderly care unit but this was not observed on the stroke unit. On the elderly care unit the team appeared divided, with therapists and nurses on one side and medicine on the other, while on the stroke unit the divide was between doctors and therapists on one hand and nurses the other. On the general medical ward there was no team working. The observed lack of rehabilitation nursing, nurses' disengagement from the team and nurses' observed lack of warmth towards patients on the stroke unit were all surprising findings. Further research needs to examine whether such findings would be reproduced in stroke units elsewhere. If so, it might be that the better outcomes achieved on stroke units are despite rather than because of the nursing they receive there. PMID:11077948

  7. [Palliative Care for Non-cancer Patients].

    PubMed

    Ikegaki, Junichi

    2016-03-01

    Although palliative care has been developed and implemented as care for cancer pain, it is holistic care for suffering that includes physical, psychosocial and spiritual pain of life-threatening illness. It turned out that non-cancer patients in the end-stage are also suffering from various pain that should be treated as cancer patients. Trajectories of illness in non-cancer patients are with more gradual decline than those of cancer patients with steady progression and it is often difficult to make decision about end-of-life. The purpose of advance care planning was originally to help describe legal documents. This process is proved to contribute to improving QOL of patients and their families to discuss preference, hope, economic problems, spiritual question as well as medical treatment In Japan guideline of decision making process in end-of-life stage has been established. A program of communication training in end-of-life discussion has been made. Under current situation some comments on the role of anesthesiologists are also mentioned. PMID:27097506

  8. Discharging patients from acute care hospitals.

    PubMed

    Goodman, Helen

    2016-02-10

    Planning for patient discharge is an essential element of any admission to an acute setting, but may often be left until the patient is almost ready to leave hospital. This article emphasises why discharge planning is important and lists the essential principles that should be addressed to ensure that patients leave at an optimum time, feeling confident and safe to do so. Early assessment, early planning and co-ordination of all the teams involved in the patient's care are essential. Effective communication between the various teams and with the patient and their family or carer(s) is necessary. Patients should leave hospital with all the information, medications and equipment they require. Appropriate plans should have been developed and communicated to the receiving community or non-acute team. When patient discharge is effective, complications as a result of extended lengths of hospital stay are prevented, hospital beds are used efficiently and readmissions are reduced.

  9. Classification of Patient Care Complexity: Cloud Technology.

    PubMed

    de Oliveira Riboldi, Caren; Macedo, Andrea Barcellos Teixeira; Mergen, Thiane; Dias, Vera Lúcia Mendes; da Costa, Diovane Ghignatti; Malvezzi, Maria Luiza Falsarella; Magalhães, Ana Maria Muller; Silveira, Denise Tolfo

    2016-01-01

    Presentation of the computerized structure to implement, in a university hospital in the South of Brazil, the Patients Classification System of Perroca, which categorizes patients according to the care complexity. This solution also aims to corroborate a recent study at the hospital, which evidenced that the increasing workload presents a direct relation with the institutional quality indicators. The tools used were the Google applications with high productivity interconnecting the topic knowledge on behalf of the nursing professionals and information technology professionals. PMID:27332366

  10. Managing the Patient with Pulmonary Hypertension: Specialty Care Centers, Coordinated Care, and Patient Support.

    PubMed

    Chakinala, Murali M; Duncan, Maribeth; Wirth, Joel

    2016-08-01

    Pulmonary hypertension remains a challenging condition to diagnose and manage. Decentralized care for pulmonary arterial hypertension (PAH) has led to shortcomings in the diagnosis and management of PAH. The Pulmonary Hypertension Association-sponsored Pulmonary Hypertension Care Center program is designed to recognize specialty centers capable of providing multidisciplinary and comprehensive care of PAH. Ideally, Pulmonary Hypertension Care Centers will comanage PAH patients with community-based practitioners and address the growing needs of this emerging population of long-term PAH patients. PMID:27443143

  11. Dilemmas in providing patient-focused care.

    PubMed

    Drayton, Shirley; Canter, Amy; Allen, Cynthia

    2003-01-01

    The provision of patient-focused care to the elderly is often fraught with many ethical and challenging dilemmas. However, for health care professionals, these dilemmas can be magnified when the chronic disease is accompanied by dementia. Such was the case of Mrs. A. The multidisciplinary team of a 36-bed acute care unit identified the challenges they experienced while caring for a 65-year-old female with multiple medical problems: diabetes; hypertension; cardiovascular disease; end stage renal disease and dementia probably due to cardiovascular and metabolic causes. Mrs. A. was admitted to start hemodialysis treatments. Her care was complicated by frequent outbursts of verbal and physical aggression towards staff. Mrs. A. was deemed incapable with regard to personal care and property. Her son believed she required long-term placement, and control of her property was assumed by the Public Guardian and Trustee. Mrs. A. vehemently objected to this total loss of control. This paper will describe how the multidisciplinary team implemented a variety of strategies to help staff intervene more effectively in meeting the care needs of Mrs. A. PMID:14753100

  12. Patient Care Assistant. Florida Vocational Program Guide.

    ERIC Educational Resources Information Center

    Florida State Univ., Tallahassee. Center for Instructional Development and Services.

    This program guide identifies primary considerations in the organization, operation, and evaluation of a patient care assistant program. An occupational description and program content are presented. A curriculum framework specifies the exact course title, course number, levels of instruction, major course content, laboratory activities, special…

  13. Modelling patient flows as an aid to decision making for critical care capacities and organisation.

    PubMed

    Shahani, A K; Ridley, S A; Nielsen, M S

    2008-10-01

    Using real data from a number of hospitals, we predicted the patient flows following a capacity or organisational change. Clinically recognisable patient groups obtained through classification and regression tree analysis were used to tune a simulation model for the flow of patients in critical care units. A tuned model which accurately reflected the base case of the flow of patients was used to predict alterations in service provision in a number of scenarios which included increases in bed numbers, alterations in patients' lengths of stay, fewer delayed discharges, caring for long stay patients outside the formal intensive care unit and amalgamating small units. Where available the predictions' accuracy was checked by comparison with real hospital data collected after an actual capacity change. The model takes variability and uncertainty properly into account and it provides the necessary information for making better decisions about critical care capacity and organisation.

  14. Patient's sexual health: do we care enough?

    PubMed

    Ho, Tai Mooi; Fernández, M

    2006-01-01

    It is well documented that sexual problems often accompany chronic health conditions, for example: chronic renal failure, hypertension and diabetes mellitus. One of the responsibilities of a nurse is to provide patients with information concerning their health and treatment to achieve optimum outcomes, thus enhancing patients' quality of life. However, the authors observed that the nursing clinical pathways in their practice seldom reflect the attention given to patient's sexuality. This paper aims to confirm the hypothesis that health professionals do not give sufficient care to patient's sexual health and to define the causes. A descriptive study consisted of close-ended questionnaire was employed. The medical and nursing staff of a Nephrology Department were included in the study (92.6% response rate). Professionals' opinions on the importance of patient's sexual health, difficulty in addressing this issue and attitude were explored. Staff's opinion on the importance of patient's sexual health is moderately high. However, 86% admit that they do not give sufficient attention and 92% never initiate to address sexual issues to patients. The results reveal the impediment being in relation to awkwardness and deficient sex education in dealing with this subject. Some staff have expressed other deterring factors. This study confirms that professionals do not render sufficient care to patient's sexual health due to their conservative attitude and lack of skill in addressing sexuality. The authors therefore suggest some ways in helping to bridge this gap. PMID:17345975

  15. Caring for Surgical Patients With Piercings.

    PubMed

    Smith, Francis Duval

    2016-06-01

    Body piercing, a type of body modification that is practiced in many cultures, creates an unnatural tract through tissue that is then held open by artificial means. Today, professional body piercing is often performed in piercing establishments that are subject to dissimilar forms of regulation. The most frequently reported medical complication of body piercing and similar body modifications, such as dermal implantation, is infection. Patients with piercings who undergo surgery may have additional risks for infection, electrical burns, trauma, or airway obstruction. The published research literature on piercing prevalence, complications, regulations, education, and nursing care is outdated. The purpose of this article is to educate nurses on topics related to nursing care for patients with piercings and similar body modifications, including the history, prevalence, motivations for, and perceptions of body piercings as well as possible complications, devices used, locations, healing times, regulations, patient education, and other health concerns. PMID:27234793

  16. Factors Related to Perceived Diabetes Control Are Not Related to Actual Glucose Control for Minority Patients With Diabetes

    PubMed Central

    McAndrew, Lisa M.; Horowitz, Carol R.; Lancaster, Kristie J.; Leventhal, Howard

    2010-01-01

    OBJECTIVE To examine variables associated with perceived diabetes control compared with an objective measure of glucose control (A1C). RESEARCH DESIGN AND METHODS Beliefs about diabetes were assessed among 334 individuals with diabetes living in a primarily low-income, minority, urban neighborhood. Regression analyses tested associations between disease beliefs and both participants' perceptions of control and actual control (A1C). RESULTS Poorer perceived diabetes control was associated with perceiving a greater impact of diabetes, greater depressive symptoms, not following a diabetic diet, A1C, and a trend toward less exercise. Variables associated with better actual control (A1C) included higher BMI, older age, and not using insulin. CONCLUSIONS Patients' perceptions of their diabetes control are informed by subjective diabetes cues (e.g., perceived impact of diabetes and adherence to a diabetic diet), which are not related to A1C. Clinicians should take into account what cues patients are using to assess their diabetes control. PMID:20067972

  17. The Patient Protection and Affordable Care Act - The Role of the School Nurse: Position Statement.

    PubMed

    2015-07-01

    It is the position of the National Association of School Nurses that the registered professional school nurse (hereinafter referred to as the school nurse) serves a vital role in the delivery of health care to our nation’s students within the health care system reshaped by the Patient Protection and Affordable Care Act of 2010, commonly known as the Affordable Care Act (ACA). This law presents an opportunity to transform the health care system through three primary goals: expanding access, improving quality, and reducing cost (U.S. Government Printing Office, 2010). School nurses stand at the forefront of this system change and continue to provide evidence-based, quality interventions and preventive care that, according to recent studies, actually save health care dollars (Wang et al., 2014). NASN supports the concept that school nursing services receive the same financial parity as other health care providers to improve overall health outcomes, including insurance reimbursement for services provided to students. PMID:25926418

  18. [Semiotic Studies Lab for Patient Care Interactions].

    PubMed

    Nunes, Dulce Maria; Portella, Jean Cristtus; Bianchi e Silva, Laura

    2011-12-01

    The aim of this experience report is to present the Semiotic Studies Lab for Patient Care Interactions (Laboratório de Estudos Semióticos nas Interações de Cuidado - LESIC). The lab was set up at the Nursing School of the Federal University of Rio Grande do Sul (UFRGS), Brazil in 2010. It has the purpose of providing didactic and pedagogical updates, based on the Theory developed by the Paris School of Semiotics, that enable the increase of knowledge and interactive/observational skills regarding the nature and mastery of human care.

  19. Promoting Patient- and Family-Centered Care Through Personal Stories.

    PubMed

    Johnson, Beverley H

    2016-03-01

    Patient- and family-centered care is an approach to the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among patients, their families, and health care professionals. It redefines the relationships in health care by placing an emphasis on collaborating with patients of all ages, and their families, at all levels of care, in all health care settings, and in organizational change and improvement. This collaboration ensures that health care is responsive to an individual's priorities, preferences, and values. In patient- and family-centered care, patients define their "family" and determine how they and their family will participate in care and decision making. While patient- and family-centered care can improve the experience of care, safety, and quality, it also can improve the learning environment for students and trainees. The author shares personal stories to illustrate the core concepts of patient- and family-centered care, when they are present in health care interactions, and when they are not. Drawing from these stories and the author's experience in working with academic medical centers and other health care organizations over many decades, recommendations for changes in medical education are suggested that can contribute to the development of a health care workforce with the skills and commitment to partner respectfully, effectively, and authentically with patients and families. The implementation of the Affordable Care Act gives new impetus for building a health care delivery system and related educational programs to support patient- and family-centered practice. PMID:26796094

  20. Video capture of clinical care to enhance patient safety.

    PubMed

    Weinger, M B; Gonzales, D C; Slagle, J; Syeed, M

    2004-04-01

    Experience from other domains suggests that videotaping and analyzing actual clinical care can provide valuable insights for enhancing patient safety through improvements in the process of care. Methods are described for the videotaping and analysis of clinical care using a high quality portable multi-angle digital video system that enables simultaneous capture of vital signs and time code synchronization of all data streams. An observer can conduct clinician performance assessment (such as workload measurements or behavioral task analysis) either in real time (during videotaping) or while viewing previously recorded videotapes. Supplemental data are synchronized with the video record and stored electronically in a hierarchical database. The video records are transferred to DVD, resulting in a small, cheap, and accessible archive. A number of technical and logistical issues are discussed, including consent of patients and clinicians, maintaining subject privacy and confidentiality, and data security. Using anesthesiology as a test environment, over 270 clinical cases (872 hours) have been successfully videotaped and processed using the system.

  1. [The sociological evaluation of quality of medical care rendered to the patients with body overweight and obesity].

    PubMed

    Alekseeva, N S; Lobykina, E N; Salmina-Khvostova, O I

    2009-01-01

    The evaluation of quality of medical care rendered to the patients with body overweight and obesity was carried out in the conditions of curative preventive institution and private medical clinics on the municipal level. The study revealed the problems related to the organization of medical care provision to this category of patients addressing to the public medical institutions. The conclusion is made about the need of enhancing the actual system of medical care of patients with body overweight and obesity. It is rational to consider patients' opinion during the optimization of the available high quality medical care.

  2. A nurse practitioner patient care team: implications for pediatric oncology.

    PubMed

    Golden, Julia Rose

    2014-01-01

    The role of the pediatric advanced practice registered nurse continues to evolve within the ever-changing field of health care. In response to increased demand for health care services and because of a variety of changes in the health care delivery system, nurse practitioner patient care teams are an emerging trend in acute care settings. Care provided by nurse practitioner teams has been shown to be effective, efficient, and comprehensive. In addition to shorter hospital stays and reduced costs, nurse practitioner teams offer increased quality and continuity of care, and improved patient satisfaction. Nurse practitioner patient care teams are well suited to the field of pediatric oncology, as patients would benefit from care provided by specialized clinicians with a holistic focus. This article provides health care professionals with information about the use of nurse practitioner patient care teams and implications for use in pediatric oncology.

  3. [Day care, the day care patient and his partner].

    PubMed

    van Woerkom, E M

    1981-02-01

    The aim of this contribution is to examine what the consequences are of an admission to a psychogeriatric dayhospital for a patient and his partner. In the first place attention has been payed to some complicating factors: on the one side the organization and function of daycare among other institutions, on the other side, at greater length, the direct care to a patient and his partner. Then, an account has been given of a pilotstudy regarding the experience of a patient and his partner in case of an admission to a psychogeriatric dayhospital. By way of literature research, information from family- and patient-meetings and Grid-data, it has been found that it is significant to involve the family in an over-all treatment, in the first place because family can give relevant supplying information; in the second place because an admission can be problematic to such an extent that a partner needs support too. Besides, the carrying-capacity of the family is of crucial importance in case of a daycare-situation. It was further put that more research has to be done into the psychological processes of an admission.

  4. [Actual questions about the prevention of venous thromboembolism in cancer patients receiving chemotherapy].

    PubMed

    Losonczy, Hajna; Nagy, Ágnes; Tar, Attila

    2016-02-01

    Cancer patients have a 2-7 fold increased risk of venous thromboembolism compared with the general population and, since 1990, this is associated with significant morbidity and mortality. This review summarizes the current knowledge on venous thromboembolism and cancer. Notably, the risk of venous thromboembolism varies depending on the type and stage of cancer. For instance, pancreatic and brain cancer patients have a higher risk of venous thromboembolism than breast and prostate cancer patients. Moreover, patients with metastatic disease have a higher risk than those with localized tumors. Tumor-derived procoagulant factors, cytokines and growth factors may directly and indirectly enhance venous thromboembolism. Chemotherapy produces ~6,5 fold increase in venous thromboembolism incidence in cancer patients compared to the general population. Prevention of this complication is challenging. The authors review the development of guidelines concerning venous thromboembolism prevention in hospitalized and also in ambulatory cancer patients treated with chemotherapy. Current guidelines recommend the use of low-molecular-weight heparin. Understanding the underlying mechanisms may allow the development of new therapies to safely prevent venous thromboembolism in cancer patients. PMID:27120721

  5. Giving health care to minority patients.

    PubMed

    White, E H

    1977-03-01

    Health care is usually thought of as a basic right of each individual. This so-called basic right is denied to many mainly because of their economic situation and the color of their skin. There is a need for more blacks, Indians, Mexican-Americans, Puerto Ricans, and Asians in the health care field. The numbers are low and the training process slow. Time is needed to prepare ethnic people of color. Since most of the deliveries of health care are white, these white workers must become sensitive to the traditions, values and attitudes of the ethnic groups of color. Schools of nursing are beginning to include cultural differences in nursing curriculums, but the majority of the nurses who practice are not aware of and are not sensitive to the needs of nonwhite patients. Nursing must help solve problems of the ethnic groups of color. Nurses must become personally involved in the injustices of health care. As Marie Branch states, there must be "personal reeducation." When this occurs, health care to the minority client will improve.

  6. Crew Management Processes Revitalize Patient Care

    NASA Technical Reports Server (NTRS)

    2009-01-01

    In 2005, two physicians, former NASA astronauts, created LifeWings Partners LLC in Memphis, Tennessee and began using Crew Resource Management (CRM) techniques developed at Ames Research Center in the 1970s to help improve safety and efficiency at hospitals. According to the company, when hospitals follow LifeWings? training, they can see major improvements in a number of areas, including efficiency, employee satisfaction, operating room turnaround, patient advocacy, and overall patient outcomes. LifeWings has brought its CRM training to over 90 health care organizations and annual sales have remained close to $3 million since 2007.

  7. Care of the liver transplant patient

    PubMed Central

    Bhat, Mamatha; Al-Busafi, Said A; Deschênes, Marc; Ghali, Peter

    2014-01-01

    OBJECTIVE: To provide an approach to the care of liver transplant (LT) patients, a growing patient population with unique needs. METHODS: A literature search of PubMed for guidelines and review articles using the keywords “liver transplantation”, “long term complications” and “medical management” was conducted, resulting in 77 articles. RESULTS: As a result of being on immunosuppression, LT recipients are at increased risk of infections and must be screened regularly for metabolic complications and malignancies. DISCUSSION: Although immunosuppression is key to maintaining allograft health after transplantation, it comes with its own set of medical issues to follow. Physicians following LT recipients must be aware of the greater risk for hypertension, diabetes, dyslipidemia, renal failure, metabolic bone disease and malignancies in these patients, all of whom require regular monitoring and screening. Vaccination, quality of life, sexual function and pregnancy must be specifically addressed in transplant patients. PMID:24729996

  8. Effect of Organizational Culture on Patient Access, Care Continuity, and Experience of Primary Care.

    PubMed

    Hung, Dorothy; Chung, Sukyung; Martinez, Meghan; Tai-Seale, Ming

    2016-01-01

    This study examined relationships between organizational culture and patient-centered outcomes in primary care. Generalized least squares regression was used to analyze patient access, care continuity, and reported experiences of care among 357 physicians in 41 primary care departments. Compared with a "Group-oriented" culture, a "Rational" culture type was associated with longer appointment wait times, and both "Hierarchical" and "Developmental" culture types were associated with less care continuity, but better patient experiences with care. Understanding the unique effects of organizational culture can enhance the delivery of more patient-centered care.

  9. Effect of Organizational Culture on Patient Access, Care Continuity, and Experience of Primary Care.

    PubMed

    Hung, Dorothy; Chung, Sukyung; Martinez, Meghan; Tai-Seale, Ming

    2016-01-01

    This study examined relationships between organizational culture and patient-centered outcomes in primary care. Generalized least squares regression was used to analyze patient access, care continuity, and reported experiences of care among 357 physicians in 41 primary care departments. Compared with a "Group-oriented" culture, a "Rational" culture type was associated with longer appointment wait times, and both "Hierarchical" and "Developmental" culture types were associated with less care continuity, but better patient experiences with care. Understanding the unique effects of organizational culture can enhance the delivery of more patient-centered care. PMID:27232685

  10. Propensity-matched analysis of the gap between capacity and actual performance of dressing in patients with stroke.

    PubMed

    Fujita, Takaaki; Sato, Atsushi; Yamamoto, Yuichi; Otsuki, Koji; Iokawa, Kazuaki; Sone, Toshimasa; Midorikawa, Manabu; Tsuchiya, Kenji; Bumsuk, Lee; Tozato, Fusae

    2016-06-01

    [Purpose] Dressing is an activity of daily living for which stroke patients often show discrepancies between capacity and actual performance. The aim of this study was to elucidate the physical function and unilateral spatial neglect in stroke patients that reduce their level of actual performance despite having the capacity for dressing independently. [Subjects and Methods] This retrospective study included 60 first-time stroke patients judged by occupational therapists as able to dress independently. The patients were divided into two groups according to their FIM(®) instrument scores for dressing the upper and lower body: an independent group with both scores ≥6 and an assistance group with one or both scores ≤5. After adjusting for confounding factors through propensity score matching, the groups were compared by using Stroke Impairment Assessment Set items, the Simple Test for Evaluating Hand Function of both upper limbs, and the Berg balance scale. [Results] The assistance group had a significantly lower score for the Berg balance scale than the independent dressing group (31.0 ± 12.3 vs. 47.8 ± 7.4). [Conclusion] The results of the present study suggested that the balance function has an effect on the discrepancy between dressing capacity and performance.

  11. Propensity-matched analysis of the gap between capacity and actual performance of dressing in patients with stroke.

    PubMed

    Fujita, Takaaki; Sato, Atsushi; Yamamoto, Yuichi; Otsuki, Koji; Iokawa, Kazuaki; Sone, Toshimasa; Midorikawa, Manabu; Tsuchiya, Kenji; Bumsuk, Lee; Tozato, Fusae

    2016-06-01

    [Purpose] Dressing is an activity of daily living for which stroke patients often show discrepancies between capacity and actual performance. The aim of this study was to elucidate the physical function and unilateral spatial neglect in stroke patients that reduce their level of actual performance despite having the capacity for dressing independently. [Subjects and Methods] This retrospective study included 60 first-time stroke patients judged by occupational therapists as able to dress independently. The patients were divided into two groups according to their FIM(®) instrument scores for dressing the upper and lower body: an independent group with both scores ≥6 and an assistance group with one or both scores ≤5. After adjusting for confounding factors through propensity score matching, the groups were compared by using Stroke Impairment Assessment Set items, the Simple Test for Evaluating Hand Function of both upper limbs, and the Berg balance scale. [Results] The assistance group had a significantly lower score for the Berg balance scale than the independent dressing group (31.0 ± 12.3 vs. 47.8 ± 7.4). [Conclusion] The results of the present study suggested that the balance function has an effect on the discrepancy between dressing capacity and performance. PMID:27390439

  12. Five Policies to Promote Palliative Care for Patients with ESRD

    PubMed Central

    Meier, Diane E.

    2013-01-01

    Summary Patients with ESRD experience complex and costly care that does not always meet their needs. Palliative care, which focuses on improving quality of life and relieving suffering for patients with serious illnesses, could address a large unmet need among patients with ESRD. Strengthening palliative care is a top policy priority for health reform efforts based on strong evidence that palliative care improves value. This commentary outlines palliative care policies for patients with ESRD and is directed at policymakers, dialysis providers, nephrology professional societies, accreditation organizations, and funding agencies who play a key role in the delivery and determination of quality of ESRD care. Herein we suggest policies to promote palliative care for patients with ESRD by addressing key barriers, including the lack of access to palliative care, lack of capacity to deliver palliative care, and a limited evidence base. We also provide examples of how these policies could be implemented within the existing ESRD care infrastructure. PMID:23744000

  13. Five policies to promote palliative care for patients with ESRD.

    PubMed

    Tamura, Manjula Kurella; Meier, Diane E

    2013-10-01

    Patients with ESRD experience complex and costly care that does not always meet their needs. Palliative care, which focuses on improving quality of life and relieving suffering for patients with serious illnesses, could address a large unmet need among patients with ESRD. Strengthening palliative care is a top policy priority for health reform efforts based on strong evidence that palliative care improves value. This commentary outlines palliative care policies for patients with ESRD and is directed at policymakers, dialysis providers, nephrology professional societies, accreditation organizations, and funding agencies who play a key role in the delivery and determination of quality of ESRD care. Herein we suggest policies to promote palliative care for patients with ESRD by addressing key barriers, including the lack of access to palliative care, lack of capacity to deliver palliative care, and a limited evidence base. We also provide examples of how these policies could be implemented within the existing ESRD care infrastructure. PMID:23744000

  14. Perioperative Smartphone Apps and Devices for Patient-Centered Care.

    PubMed

    Simpao, Allan F; Lingappan, Arul M; Ahumada, Luis M; Rehman, Mohamed A; Gálvez, Jorge A

    2015-09-01

    Smartphones have grown in ubiquity and computing power, and they play an ever-increasing role in patient-centered health care. The "medicalized smartphone" not only enables web-based access to patient health resources, but also can run patient-oriented software applications and be connected to health-related peripheral devices. A variety of patient-oriented smartphone apps and devices are available for use to facilitate patient-centered care throughout the continuum of perioperative care. Ongoing advances in smartphone technology and health care apps and devices should expand their utility for enhancing patient-centered care in the future. PMID:26265239

  15. Perioperative Smartphone Apps and Devices for Patient-Centered Care.

    PubMed

    Simpao, Allan F; Lingappan, Arul M; Ahumada, Luis M; Rehman, Mohamed A; Gálvez, Jorge A

    2015-09-01

    Smartphones have grown in ubiquity and computing power, and they play an ever-increasing role in patient-centered health care. The "medicalized smartphone" not only enables web-based access to patient health resources, but also can run patient-oriented software applications and be connected to health-related peripheral devices. A variety of patient-oriented smartphone apps and devices are available for use to facilitate patient-centered care throughout the continuum of perioperative care. Ongoing advances in smartphone technology and health care apps and devices should expand their utility for enhancing patient-centered care in the future.

  16. Palliative care in patients with lung cancer

    PubMed Central

    Farbicka, Paulina

    2013-01-01

    Lung cancer accounts for 12% of all cancers and has the highest annual rate of mortality in men and women. The overall aim is cure or prolongation of life without evidence of disease. Almost 60% of patients at the moment of diagnosis are not eligible for radical treatment. Therefore soothing and supportive treatment is the only treatment of choice. Patients with lung cancer who have symptoms of dyspnea, chronic cough, severe pain, exhaustion and cachexia syndrome, fear and depression and significantly reduced physical and intellectual activities are qualified for inpatient or home palliative care. Knowledge about various methods used in palliative treatment allows one to alleviate symptoms that occur in an advanced stage of disease with an expected short survival period. Methods of oncological treatment that are often used in patients with advanced lung cancer include radiotherapy and chemotherapy. Drawing attention to the earlier implementation of palliative care is an objective of research carried out during recent years. Advances in surgical and conservative treatment of these patients have contributed to better outcomes and longer survival time. PMID:24596508

  17. Patient-Centered Care: Depends on the Point of View

    ERIC Educational Resources Information Center

    Lorig, Kate

    2012-01-01

    Patient-centered care is now front-and-center in health care reform. The federal government has established the Patient-Centered Outcomes Research Institute to study this new phenomenon and health care delivery systems such as patient-centered medical homes. Where is the health education profession in all of this? Despite what it has to offer, to…

  18. Sepsis: From Pathophysiology to Individualized Patient Care

    PubMed Central

    László, Ildikó; Trásy, Domonkos; Molnár, Zsolt; Fazakas, János

    2015-01-01

    Sepsis has become a major health economic issue, with more patients dying in hospitals due to sepsis related complications compared to breast and colorectal cancer together. Despite extensive research in order to improve outcome in sepsis over the last few decades, results of large multicenter studies were by-and-large very disappointing. This fiasco can be explained by several factors, but one of the most important reasons is the uncertain definition of sepsis resulting in very heterogeneous patient populations, and the lack of understanding of pathophysiology, which is mainly based on the imbalance in the host-immune response. However, this heroic research work has not been in vain. Putting the results of positive and negative studies into context, we can now approach sepsis in a different concept, which may lead us to new perspectives in diagnostics and treatment. While decision making based on conventional sepsis definitions can inevitably lead to false judgment due to the heterogeneity of patients, new concepts based on currently gained knowledge in immunology may help to tailor assessment and treatment of these patients to their actual needs. Summarizing where we stand at present and what the future may hold are the purpose of this review. PMID:26258150

  19. Modeling Safety Outcomes on Patient Care Units

    NASA Astrophysics Data System (ADS)

    Patil, Anita; Effken, Judith; Carley, Kathleen; Lee, Ju-Sung

    In its groundbreaking report, "To Err is Human," the Institute of Medicine reported that as many as 98,000 hospitalized patients die each year due to medical errors (IOM, 2001). Although not all errors are attributable to nurses, nursing staff (registered nurses, licensed practical nurses, and technicians) comprise 54% of the caregivers. Therefore, it is not surprising, that AHRQ commissioned the Institute of Medicine to do a follow-up study on nursing, particularly focusing on the context in which care is provided. The intent was to identify characteristics of the workplace, such as staff per patient ratios, hours on duty, education, and other environmental characteristics. That report, "Keeping Patients Safe: Transforming the Work Environment of Nurses" was published this spring (IOM, 2004).

  20. Caring for the elderly female psychiatric patient.

    PubMed

    Bashir, Mudhasir; Holroyd, Suzanne

    2010-06-01

    With the growth of the elderly population, and the female elderly population in particular, healthcare providers will see increasing numbers of elderly women with psychiatric disorders. To properly care for this group of patients, better understanding is needed not only of group differences in this patient population but also of the differences in each individual, as they age, given their unique life experiences, cohort effects, medical comorbidity, social situation, and personality traits. Understandably, these characteristics will interact with psychiatric disorders in ways that may increase the challenge to correctly diagnose and treat these patients. In addition, understanding late life changes, the prevalence of various mental disorders and the sometimes unique presentation of mental disorders in this age group is required to better diagnose and treat this population.

  1. A patient-centered pharmacy services model of HIV patient care in community pharmacy settings: a theoretical and empirical framework.

    PubMed

    Kibicho, Jennifer; Owczarzak, Jill

    2012-01-01

    Reflecting trends in health care delivery, pharmacy practice has shifted from a drug-specific to a patient-centered model of care, aimed at improving the quality of patient care and reducing health care costs. In this article, we outline a theoretical model of patient-centered pharmacy services (PCPS), based on in-depth, qualitative interviews with a purposive sample of 28 pharmacists providing care to HIV-infected patients in specialty, semispecialty, and nonspecialty pharmacy settings. Data analysis was an interactive process informed by pharmacists' interviews and a review of the general literature on patient centered care, including Medication Therapy Management (MTM) services. Our main finding was that the current models of pharmacy services, including MTM, do not capture the range of pharmacy services in excess of mandated drug dispensing services. In this article, we propose a theoretical PCPS model that reflects the actual services pharmacists provide. The model includes five elements: (1) addressing patients as whole, contextualized persons; (2) customizing interventions to unique patient circumstances; (3) empowering patients to take responsibility for their own health care; (4) collaborating with clinical and nonclinical providers to address patient needs; and (5) developing sustained relationships with patients. The overarching goal of PCPS is to empower patients' to take responsibility for their own health care and self-manage their HIV-infection. Our findings provide the foundation for future studies regarding how widespread these practices are in diverse community settings, the validity of the proposed PCPS model, the potential for standardizing pharmacist practices, and the feasibility of a PCPS framework to reimburse pharmacists services.

  2. Satisfaction with Care of Patients on Hemodialysis

    PubMed Central

    Paine, Susan S.; Grobert, Megan E.; Stidley, Christine A.; Gabbay, Ezra; Harford, Antonia M.; Zager, Philip G.; Miskulin, Dana C.; Meyer, Klemens B.

    2015-01-01

    Background and objectives Little is known about patients receiving dialysis who respond to satisfaction and experience of care surveys and those who do not respond, nor is much known about the corollaries of satisfaction. This study examined factors predicting response to Dialysis Clinic, Inc. (DCI)’s patient satisfaction survey and factors associated with higher satisfaction among responders. Design, setting, participants, & measurement A total of 10,628 patients receiving in-center hemodialysis care at 201 DCI facilities between January 1, 2011, and December 31, 2011, aged ≥18 years, treated during the survey administration window, and at the facility for ≥3 months before survey administration. Primary outcome was response to at least one of the nine survey questions; secondary outcome was overall satisfaction with care. Results Response rate was 77.3%. In adjusted logistic regression (odds ratios with 95% confidence intervals), race other than black (white race, 1.23 [1.10 to 1.37]), missed treatments (1.16 [1.02 to 1.32]) or shortened treatments (≥5 treatments, 1.40 [1.22 to 1.60]), more hospital days (>3 days in the last 3 months, 1.89 [1.66 to 2.15]), and lower serum albumin (albumin level <3.5 g/dl, 1.4 [1.28 to 1.73]) all independently predicted nonresponse. In adjusted linear regression, the following were more satisfied with care: older patients (age ≥63 years, 1.84 [1.78 to 1.90]; age <63 years, 1.91 [1.86 to 1.97]; P<0.001), white patients (1.76 [1.71 to 1.81]) versus black patients (1.93 [1.88 to 1.99]) or those of other race (1.93 [1.83 to 2.03]) (P<0.001), patients with shorter duration of dialysis (≤2.5 years, 1.79 [1.73 to 1.84]; >2.5 years, 1.96 [1.91 to 2.02]; P<0.001), patients who had missed one or fewer treatments (1.83 [1.78 to 1.88]) versus those who had missed more than one treatment (1.92 [1.85 to 1.98]; P=0.002) and those who had shortened treatment (for one treatment or less, 1.84 [1.77 to 1.90]; for two to four treatments, 1

  3. Predicting which patients actually receive radiation following breast conserving therapy in Canadian populations

    PubMed Central

    Guidolin, Keegan; Lock, Michael; Richard, Lucie; Boldt, Gabriel; Brackstone, Muriel

    2016-01-01

    Summary Canadian women with breast cancer may choose breast conserving therapy as their course of treatment, requiring both breast conserving surgery and adjuvant radiation therapy. However, more than 15% of Canadian women fail to receive the appropriate radiation therapy, putting them at increased risk for recurrence. Age, distance from their radiation therapy centre and stage of disease affect patients’ likelihood of receiving prescribed radiation therapy. We propose a nomogram that allows physicians to predict which patients will and will not receive radiation. This nomogram, once validated, could be used to guide decision making when choosing between breast conserving therapy and mastectomy as the treatment course and thereby change the practice of breast cancer management. PMID:27438052

  4. Future care planning: a first step to palliative care for all patients with advanced heart disease.

    PubMed

    Denvir, M A; Murray, S A; Boyd, K J

    2015-07-01

    Palliative care is recommended for patients with end-stage heart failure with several recent, randomised trials showing improvements in symptoms and quality of life and more studies underway. Future care planning provides a framework for discussing a range of palliative care problems with patients and their families. This approach can be introduced at any time during the patient's journey of care and ideally well in advance of end-of-life care. Future care planning is applicable to a wide range of patients with advanced heart disease and could be delivered systematically by cardiology teams at the time of an unplanned hospital admission, akin to cardiac rehabilitation for myocardial infarction. Integrating cardiology care and palliative care can benefit many patients with advanced heart disease at increased risk of death or hospitalisation. Larger, randomised trials are needed to assess the impact on patient outcomes and experiences.

  5. Re-engineering pharmaceutical care: towards a patient-focused care approach.

    PubMed

    al-Shaqha, W M; Zairi, M

    2000-01-01

    As healthcare reform takes shape, many challenges face hospital pharmacists. An opportunity exists to combine the principles of patient-focused care and pharmaceutical care to redesign the role of pharmacy. To achieve this objective, pharmacy departments should adopt business concepts such as process re-engineering. Process re-engineering is a change management tool which aims to produce dramatic improvement in performance measures by re-designing the process. The goal of restructuring is to increase the amount of time pharmacists spend providing pharmaceutical care to patients. The pharmaceutical care concept is a method of delivering pharmaceutical care services that match individual patient needs with the services provided. This article describes many hospital pharmacy department transitions to a patient focused care environment by adopting the patient focused care concept and the process re-engineering to improve the quality of patient care through systems improvement.

  6. "Drop-Outs" and "Push-Outs": Finding Hope at a School that Actualizes the Ethic of Care

    ERIC Educational Resources Information Center

    Cassidy, Wanda; Bates, Anita

    2005-01-01

    This study profiles a school that is committed to enacting the ethic of care with a population of underserved "at-risk" adolescents students with a history of criminal activity and dropping out or being expelled from school due to troublesome and troubled behavior. This article gives voice to the narratives of administrators, teachers, and…

  7. Less Is More: Low-dose Prothrombin Complex Concentrate Effective in Acute Care Surgery Patients.

    PubMed

    Quick, Jacob A; Meyer, Jennifer M; Coughenour, Jeffrey P; Barnes, Stephen L

    2015-06-01

    Optimal dosing of prothrombin complex concentrate (PCC) has yet to be defined and varies widely due to concerns of efficacy and thrombosis. We hypothesized a dose of 15 IU/kg actual body weight of a three-factor PCC would effectively correct coagulopathy in acute care surgery patients. Retrospective review of 41 acute care surgery patients who received 15 IU/kg (± 10%) actual body weight PCC for correction of coagulopathy. Demographics, laboratory results, PCC dose, blood and plasma transfusions, and thrombotic complications were analyzed. We performed subset analyses of trauma patients and those taking warfarin. Mean age was 69 years (18-94 years). Thirty (73%) trauma patients, 8 (20%) emergency surgery patients, 2 (5%) burns, and 1 (2%) nontrauma neurosurgical patient were included. Mean PCC dose was 1305.4 IU (14.2 IU/kg actual body weight). Mean change in INR was 2.52 to 1.42 (p 0.00004). Successful correction (INR <1.5) was seen in 78 per cent. Treatment failures had a higher initial INR (4.3 vs 2.03, p 0.01). Mean plasma transfusion was 1.46 units. Mean blood transfusion was 1.61 units. Patients taking prehospital warfarin (n = 29, 71%) had higher initial INR (2.78 vs 1.92, p 0.05) and received more units of plasma (1.93 vs 0.33, p 0.01) than those not taking warfarin. No statistical differences were seen between trauma and nontrauma patients. One thrombotic event occurred. Administration of low-dose PCC, 15 IU/kg actual body weight, effectively corrects coagulopathy in acute care surgery patients regardless of warfarin use, diagnosis or plasma transfusion. PMID:26031281

  8. Caring for patients with limb amputation.

    PubMed

    Virani, Anila; Werunga, Jane; Ewashen, Carol; Green, Theresa

    2015-10-01

    This article provides an overview of the care of patients undergoing limb amputation. Absence of a limb can be congenital or the result of trauma or complications of chronic diseases. While the economic burden of limb amputation is significant, nurses have an important role in limiting other losses attributable to limb loss, such as long-term disability leading to loss of employment and delayed return to work or school. Comprehensive nursing assessments and appropriate interventions, pre and post-operatively, as well as early discharge planning and community reintegration can help avoid some of these losses. Nurses should be aware of the resources available in communities and work in multidisciplinary teams to ensure optimal outcomes for patients following limb amputation and their families.

  9. Discordance between presumed standard of care and actual clinical practice: the example of rubber dam use during root canal treatment in the National Dental Practice-Based Research Network

    PubMed Central

    Gilbert, Gregg H; Riley, Joseph L; Eleazer, Paul D; Benjamin, Paul L; Funkhouser, Ellen

    2015-01-01

    Objectives Use of a rubber dam during root canal treatment is considered the standard of care because it enhances patient safety and optimises the odds of successful treatment. Nonetheless, not all dentists use a rubber dam, creating disconnect between presumed standard of care and what is actually done in clinical practice. Little is known about dentists’ attitudes towards use of the rubber dam in their practices. The objectives were to: (1) quantify these attitudes and (2) test the hypothesis that specific attitudes are significantly associated with rubber dam use. Setting National Dental Practice-Based Research Network (NationalDentalPBRN.org). Participants 1490 network dentists. Outcome measures Dentists completed a questionnaire about their attitudes towards rubber dam use during root canal treatment. Three attitude scales comprised 33 items that used a 5-point ordinal scale to measure beliefs about effectiveness, inconvenience, ease of placement, comparison to other isolation techniques and patient factors. Factor analysis, cluster analysis and multivariable logistic regression analysed the relationship between attitudes and rubber dam use. Results All items had responses at each point on the 5-point scale, with an overall pattern of substantial variation across dentists. Five attitudinal factors (rubber dam effectiveness; inconvenient/time-consuming; ease of placement; effectiveness compared to Isolite; patient factors) and 4 clusters of practitioners were identified. Each factor and cluster was independently and strongly associated with rubber dam use. Conclusions General dentists have substantial variation in attitudes about rubber dam use. Beliefs that rubber dam use is not effective, inconvenient, time-consuming, not easy to place or affected by patient factors, were independently and significantly associated with lower rubber dam use. These attitudes explain why there is substantial discordance between presumed standard of care and actual practice

  10. Glutamine Supplementation in Intensive Care Patients

    PubMed Central

    Oldani, Massimo; Sandini, Marta; Nespoli, Luca; Coppola, Sara; Bernasconi, Davide Paolo; Gianotti, Luca

    2015-01-01

    Abstract The role of glutamine (GLN) supplementation in critically ill patients is controversial. Our aim was to analyze its potential effect in patients admitted to intensive care unit (ICU). We performed a systematic literature review through Medline, Embase, Pubmed, Scopus, Ovid, ISI Web of Science, and the Cochrane-Controlled Trials Register searching for randomized clinical trials (RCTs) published from 1983 to 2014 and comparing GLN supplementation to no supplementation in patients admitted to ICU. A random-effect meta-analysis for each outcome (hospital and ICU mortality and rate of infections) of interest was carried out. The effect size was estimated by the risk ratio (RR). Thirty RCTs were analyzed with a total of 3696 patients, 1825 (49.4%) receiving GLN and 1859 (50.6%) no GLN (control groups). Hospital mortality rate was 27.6% in the GLN patients and 28.6% in controls with an RR of 0.93 (95% CI = 0.81–1.07; P = 0.325, I2 = 10.7%). ICU mortality was 18.0 % in the patients receiving GLN and 17.6% in controls with an RR of 1.01 (95% CI = 0.86–1.19; P = 0.932, I2 = 0%). The incidence of infections was 39.7% in GLN group versus 41.7% in controls. The effect of GLN was not significant (RR = 0.88; 95% CI = 0.76–1.03; P = 0.108, I2 = 56.1%). These results do not allow to recommend GLN supplementation in a generic population of critically ills. Further RCTs are needed to explore the effect of GLN in more specific cohort of patients. PMID:26252319

  11. Stakeholder Perspectives on Changes in Hypertension Care Under the Patient-Centered Medical Home

    PubMed Central

    O’Donnell, Alison J.; Kellom, Katherine; Miller-Day, Michelle; McClintock, Heather F. de Vries; Kaye, Elise M.; Gabbay, Robert; Cronholm, Peter F.

    2016-01-01

    Introduction Hypertension is a major modifiable risk factor for cardiovascular and kidney disease, yet the proportion of adults whose hypertension is controlled is low. The patient-centered medical home (PCMH) is a model for care delivery that emphasizes patient-centered and team-based care and focuses on quality and safety. Our goal was to investigate changes in hypertension care under PCMH implementation in a large multipayer PCMH demonstration project that may have led to improvements in hypertension control. Methods The PCMH transformation initiative conducted 118 semistructured interviews at 17 primary care practices in southeastern Pennsylvania between January 2011 and January 2012. Clinicians (n = 47), medical assistants (n = 26), office administrators (n = 12), care managers (n = 11), front office staff (n = 7), patient educators (n = 4), nurses (n = 4), social workers (n = 4), and other administrators (n = 3) participated in interviews. Study personnel used thematic analysis to identify themes related to hypertension care. Results Clinicians described difficulties in expanding services under PCMH to meet the needs of the growing number of patients with hypertension as well as how perceptions of hypertension control differed from actual performance. Staff and office administrators discussed achieving patient-centered hypertension care through patient education and self-management support with personalized care plans. They indicated that patient report cards were helpful tools. Participants across all groups discussed a team- and systems-based approach to hypertension care. Conclusion Practices undergoing PCMH transformation may consider stakeholder perspectives about patient-centered, team-based, and systems-based approaches as they work to optimize hypertension care. PMID:26916899

  12. Reconciling evidence-based medicine and patient-centred care: defining evidence-based inputs to patient-centred decisions.

    PubMed

    Weaver, Robert R

    2015-12-01

    Evidence-based and patient-centred health care movements have each enhanced the discussion of how health care might best be delivered, yet the two have evolved separately and, in some views, remain at odds with each other. No clear model has emerged to enable practitioners to capitalize on the advantages of each so actual practice often becomes, to varying degrees, an undefined mishmash of each. When faced with clinical uncertainty, it becomes easy for practitioners to rely on formulas for care developed explicitly by expert panels, or on the tacit ones developed from experience or habit. Either way, these tendencies towards 'cookbook' medicine undermine the view of patients as unique particulars, and diminish what might be considered patient-centred care. The sequence in which evidence is applied in the care process, however, is critical for developing a model of care that is both evidence based and patient centred. This notion derives from a paradigm for knowledge delivery and patient care developed over decades by Dr. Lawrence Weed. Weed's vision enables us to view evidence-based and person-centred medicine as wholly complementary, using computer tools to more fully and reliably exploit the vast body of collective knowledge available to define patients' uniqueness and identify the options to guide patients. The transparency of the approach to knowledge delivery facilitates meaningful practitioner-patient dialogue in determining the appropriate course of action. Such a model for knowledge delivery and care is essential for integrating evidence-based and patient-centred approaches. PMID:26456314

  13. Primary Care of the Renal Transplant Patient

    PubMed Central

    Unruh, Mark L.; Nolin, Thomas D.; Hasley, Peggy B.

    2010-01-01

    There has been a remarkable rise in the number of kidney transplant recipients (KTR) in the US over the last decade. Increasing use of potent immunosuppressants, which are also potentially diabetogenic and atherogenic, can result in worsening of pre-existing medical conditions as well as development of post-transplant disease. This, coupled with improving long-term survival, is putting tremendous pressure on transplant centers that were not designed to deliver primary care to KTR. Thus, increasing numbers of KTR will present to their primary care physicians (PCP) post-transplant for routine medical care. Similar to native chronic kidney disease patients, KTRs are vulnerable to cardiovascular disease as well as a host of other problems including bone disease, infections and malignancies. Deaths related to complications of cardiovascular disease and malignancies account for 60–65% of long-term mortality among KTRs. Guidelines from the National Kidney Foundation and the European Best Practice Guidelines Expert Group on the management of hypertension, dyslipidemia, smoking, diabetes and bone disease should be incorporated into the long-term care plan of the KTR to improve outcomes. A number of transplant centers do not supply PCPs with protocols and guidelines, making the task of the PCP more difficult. Despite this, PCPs are expected to continue to provide general preventive medicine, vaccinations and management of chronic medical problems. In this narrative review, we examine the common medical problems seen in KTR from the PCP’s perspective. Medical management issues related to immunosuppressive medications are also briefly discussed. PMID:20422302

  14. Improving Depression Care in Patients with Diabetes and Multiple Complications

    PubMed Central

    Kinder, Leslie S; Katon, Wayne J; Ludman, Evette; Russo, Joan; Simon, Greg; Lin, Elizabeth HB; Ciechanowski, Paul; Von Korff, Michael; Young, Bessie

    2006-01-01

    BACKGROUND Depression is common in patients with diabetes, but it is often inadequately treated within primary care. Competing clinical demands and treatment resistance may make it especially difficult to improve depressive symptoms in patients with diabetes who have multiple complications. OBJECTIVE To determine whether a collaborative care intervention for depression would be as effective in patients with diabetes who had 2 or more complications as in patients with diabetes who had fewer complications. DESIGN The Pathways Study was a randomized control trial comparing collaborative care case management for depression and usual primary care. This secondary analysis compared outcomes in patients with 2 or more complications to patients with fewer complications. PATIENTS Three hundred and twenty-nine patients with diabetes and comorbid depression were recruited through primary care clinics of a large prepaid health plan. MEASUREMENTS Depression was assessed at baseline, 3, 6, and 12 months with the 20-item depression scale from the Hopkins Symptom Checklist. Diabetes complications were determined from automated patient records. RESULTS The Pathways collaborative care intervention was significantly more successful at reducing depressive symptoms than usual primary care in patients with diabetes who had 2 or more complications. Patients with fewer than 2 complications experienced similar reductions in depressive symptoms in both intervention and usual care. CONCLUSION Patients with depression and diabetes who have multiple complications may benefit most from collaborative care for depression. These findings suggest that with appropriate intervention depression can be successfully treated in patients with diabetes who have the highest severity of medical problems. PMID:16836628

  15. Education in stroke: strategies to improve stroke patient care.

    PubMed

    Gompertz, Patrick; Slack, Andrew; Vogel, Mira; Burrows, Sharon; Clark, Philippa

    2002-07-01

    'Stroke units save lives', but organized care requires expert staff and regular training to be effective. However, the quality of inpatient care for stroke remains poor, and stroke education is often fragmented between the health-care professions. This review describes some national and local strategies aimed at ensuring that all patients are cared for by expert staff.

  16. Barriers to Quality Care for Dying Patients in Rural Communities

    ERIC Educational Resources Information Center

    Van Vorst, Rebecca F.; Crane, Lori A.; Barton, Phoebe Lindsey; Kutner, Jean S.; Kallail, K. James; Westfall, John M.

    2006-01-01

    Context: Barriers to providing optimal palliative care in rural communities are not well understood. Purpose: To identify health care personnel's perceptions of the care provided to dying patients in rural Kansas and Colorado and to identify barriers to providing optimal care. Methods: An anonymous self-administered survey was sent to health care…

  17. [The patient pathway, an essential element of the care project].

    PubMed

    Despiau, Frédéric; Bombail, Marie; Le Duff, Gérard; Peoc'h, Nadia; Labatut, Raymonde; Ceaux, Christine

    2015-05-01

    Constructing an innovative care project in oncology, common to two healthcare institutions with different statuses, was a challenge for the directors of nursing of the Claudius-Regaud Institute and Toulouse university hospital. The patient care pathway was a major organisational element of the project, keyto ensuring high quality patient care, from the diagnosis through to the personalised post-cancer plan. PMID:26126375

  18. Patient Activation and Mental Health Care Experiences Among Women Veterans

    PubMed Central

    Pavao, Joanne; Wong, Ava

    2016-01-01

    We utilized a nationally representative survey of women veteran primary care users to examine associations between patient activation and mental health care experiences. A dose–response relationship was observed, with odds of high quality ratings significantly greater at each successive level of patient activation. Higher activation levels were also significantly associated with preference concordant care for gender-related preferences (use of female providers, women-only settings, and women-only groups as often as desired). Results add to the growing literature documenting better health care experiences among more activated patients, and suggest that patient activation may play an important role in promoting engagement with mental health care. PMID:25917224

  19. End of life care services for patients with heart failure.

    PubMed

    Charnock, Louise A

    2014-08-26

    Heart failure has high incidence and prevalence in the UK. However, access to palliative care services for patients with heart failure is inequitable. Patients with heart failure often do not receive specialist palliative care at the end of life, or referral is made only in the last days of life. This results in lost opportunities for advance care planning, psychological support for patients and families and symptom management. Prognostic tools are useful in ensuring appropriate referral. However, the controversy regarding the Liverpool Care Pathway has created uncertainty for healthcare professionals, patients and families. This article examines palliative care and end of life care services for patients with heart failure. It presents the case for service development and examines the benefits for patients who traditionally may not have had access to this care. PMID:25138875

  20. Patients' perceptions of care are associated with quality of hospital care: a survey of 4605 hospitals.

    PubMed

    Stein, Spencer M; Day, Michael; Karia, Raj; Hutzler, Lorraine; Bosco, Joseph A

    2015-01-01

    Favorable patient experience and low complication rates have been proposed as essential components of patient-centered medical care. Patients' perception of care is a key performance metric and is used to determine payments to hospitals. It is unclear if there is a correlation between technical quality of care and patient satisfaction. The study authors correlated patient perceptions of care measured by the Hospital Consumer Assessment of Healthcare Providers and Systems scores with accepted quality of care indicators. The Hospital Compare database (4605 hospitals) was used to examine complication rates and patient-reported experience for hospitals across the nation in 2011. The majority of the correlations demonstrated an inverse relationship between patient experience and complication rates. This negative correlation suggests that reducing these complications can lead to a better hospital experience. Overall, these results suggest that patient experience is generally correlated with the quality of care provided.

  1. Evaluating palliative care: bereaved family members' evaluations of patients' pain, anxiety and depression.

    PubMed

    McPherson, Christine J; Addington-Hall, Julia M

    2004-08-01

    Palliative care surveys often rely on bereaved family members to act as proxies to provide information on patient care at the end of life, after the patient's death. However, when comparing bereaved family members' assessments with those of the patients, agreement is found to be better for symptoms that are more concrete and observable than subjective aspects such as psychological symptoms and pain. To date, little is known about how proxies actually evaluate these types of symptoms. The present study used retrospective verbal protocol analysis to elucidate the thought processes of 30 bereaved relatives during their evaluations of patients' pain, anxiety and depression. The qualitative analysis raised awareness of the difficulties experienced by proxies when discerning the presence of symptoms. It also provided insights into the cues and strategies used when making decisions, contributing to a fuller understanding of how proxies distinguish symptoms. Recommendations are made to improve the design of retrospective palliative care surveys. PMID:15276191

  2. How 3 Rural Safety Net Clinics Integrate Care for Patients

    PubMed Central

    Derrett, Sarah; Gunter, Kathryn E.; Nocon, Robert S.; Quinn, Michael T.; Coleman, Katie; Daniel, Donna M.; Wagner, Edward H.; Chin, Marshall H.

    2016-01-01

    Background Integrated care focuses on care coordination and patient centeredness. Integrated care supports continuity of care over time, with care that is coordinated within and between settings and is responsive to patients’ needs. Currently, little is known about care integration for rural patients. Objective To examine challenges to care integration in rural safety net clinics and strategies to address these challenges. Research Design Qualitative case study. Participants Thirty-six providers and staff from 3 rural clinics in the Safety Net Medical Home Initiative. Methods Interviews were analyzed using the framework method with themes organized within 3 constructs: Team Coordination and Empanelment, External Coordination and Partnerships, and Patient-centered and Community-centered Care. Results Participants described challenges common to safety net clinics, including limited access to specialists for Medicaid and uninsured patients, difficulty communicating with external providers, and payment models with limited support for care integration activities. Rurality compounded these challenges. Respondents reported benefits of empanelment and team-based care, and leveraged local resources to support care for patients. Rural clinics diversified roles within teams, shared responsibility for patient care, and colocated providers, as strategies to support care integration. Conclusions Care integration was supported by 2 fundamental changes to organize and deliver care to patients—(1) empanelment with a designated group of patients being cared for by a provider; and (2) a multidisciplinary team able to address rural issues. New funding and organizational initiatives of the Affordable Care Act may help to further improve care integration, although additional solutions may be necessary to address particular needs of rural communities. PMID:25310637

  3. Care at home of the patient with advanced multiple sclerosis--part 2.

    PubMed

    Reitman, Nancy Clayton

    2010-05-01

    Clinicians caring for patients with advanced MS have choices of different options and approaches. Whatever path is chosen, interventions must incorporate the wishes and capabilities of the patient and be supported by the care team, usually led by the nurse. As the work of the great psychologist Abraham Maslow has shown, in his famous "hierarchy of needs," the basic levels of needs must be met before the highest self-actualization can be accomplished (Maslow, 1943). This is equally true in the nursing care of very ill patients, as authors Zalenski and Raspa write: "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) self-actualization 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."(Zalenski & Raspa, 2006, p.1120). PMID:20463509

  4. Care at home of the patient with advanced multiple sclerosis--part 2.

    PubMed

    Reitman, Nancy Clayton

    2010-05-01

    Clinicians caring for patients with advanced MS have choices of different options and approaches. Whatever path is chosen, interventions must incorporate the wishes and capabilities of the patient and be supported by the care team, usually led by the nurse. As the work of the great psychologist Abraham Maslow has shown, in his famous "hierarchy of needs," the basic levels of needs must be met before the highest self-actualization can be accomplished (Maslow, 1943). This is equally true in the nursing care of very ill patients, as authors Zalenski and Raspa write: "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) self-actualization 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."(Zalenski & Raspa, 2006, p.1120).

  5. Prehospital Management of Gunshot Patients at Major Trauma Care Centers: Exploring the Gaps in Patient Care

    PubMed Central

    Norouzpour, Amir; Khoshdel, Ali Reza; Modaghegh, Mohammad-Hadi; Kazemzadeh, Gholam-Hossein

    2013-01-01

    Background Prehospital management of gunshot-wounded (GW) patients influences injury-induced morbidity and mortality. Objectives To evaluate prehospital management to GW patients emphasizing the protocol of patient transfer to appropriate centers. Patients and Methods This prospective study, included all GW patients referred to four major, level-I hospitals in Mashhad, Iran. We evaluated demographic data, triage, transport vehicles of patients, hospitalization time and the outcome. Results There were 66 GW patients. The most affected body parts were extremities (60.6%, n = 40); 59% of cases (n = 39) were transferred to the hospitals with vehicles other than an ambulance. Furthermore, 77.3% of patients came to the hospitals directly from the site of event, and 22.7% of patients were referred from other medical centers. EMS action intervals from dispatchers to scene departure was not significantly different from established standards; however, arrival to hospital took longer than optimal standards. Additionally, time spent at emergency wards to stabilize vital signs was significantly less in patients who were transported by EMS ambulances (P = 0.01), but not with private ambulances (P = 0.47). However, ambulance pre-hospital care was not associated with a shorter hospital stay. Injury Severity was the only determinant of hospital stay duration (β = 0.36, P = 0.01) in multivariate analysis. Conclusions GW was more frequent in extremities and the most patients were directly transferred from the accident site. EMS (but not private) ambulance transport improved patients' emergency care and standard time intervals were achieved by EMS; however more than a half of the cases were transferred by vehicles other than an ambulance. Nevertheless, ambulance transportation (either by EMS or by private ambulance) was not associated with a shorter hospital stay. This showed that upgrade of ambulance equipment and training of private ambulance personnel may be needed. PMID:24350154

  6. Transforming care for patients with spinal cord injury in Haiti.

    PubMed

    Stephenson, Fiona

    Patients with spinal cord injury in Haiti previously had a poor prognosis. This article features a case study showing how care was transformed after the earthquake in 2010 by providing simple bladder care.

  7. Patient involvement in diabetes care: experiences in nine diabetes care groups

    PubMed Central

    de Bruin, Simone R.; Struijs, Jeroen N.; Rijken, Mieke; Nijpels, Giel; Baan, Caroline A.

    2015-01-01

    Introduction Despite the expected beneficial effects on quality of care, patient involvement in diabetes care groups, which deliver a bundled paid integrated care programme for diabetes type 2, seems to be limited. The aim of this study was to gain insight into levels and methods of patient involvement, into facilitators and barriers, and into the future preferences of care groups and patient representatives. Theory and methods Semi-structured interviews were held with 10 representatives of care groups and 11 representatives of patient advocacy groups. An adapted version of Arnstein's ladder of citizen participation was used to define five levels of patient involvement. Results Patient involvement in care groups was mostly limited to informing and consulting patients. Higher levels, i.e., advising, co-producing and decision-making, were less frequently observed. Care groups and patient representatives perceived largely the same barriers and facilitators and had similar preferences regarding future themes and design of patient involvement. Conclusion Constructive collaboration between diabetes care groups and patient representatives to enhance patient involvement in the future seems viable. Several issues such as the lack of evidence for effectiveness of patient involvement, differences in viewpoints on the role and responsibilities of care groups and perceived barriers need to be addressed. PMID:27118961

  8. Muscle Atrophy in Intensive Care Unit Patients

    PubMed Central

    Koukourikos, Konstantinos; Tsaloglidou, Areti; Kourkouta, Labrini

    2014-01-01

    Introduction: The muscle atrophy is one of the most important and frequent problems observed in patients in Intensive Care Units. The term describes the disorder in the structure and in the function of the muscle while incidence rates range from 25-90 % in patients with prolonged hospitalization. Purpose: This is a review containing all data related to the issue of muscle atrophy and is especially referred to its causes and risk factors. The importance of early diagnosis and early mobilization are also highlighted in the study. Material and methods: a literature review was performed on valid databases such as Scopus, PubMed, Cinhal for the period 2000-2013 in English language. The following keywords were used: loss of muscle mass, ICU patients, immobilization, bed rest. Results: From the review is concluded that bed rest and immobilization in order to reduce total energy costs, are the main causes for the appearance of the problem. The results of the reduction of the muscle mass mainly affect the musculoskeletal, cardiovascular and respiratory system. The administration of the cortisone, the immobility, the sepsis and hyperglycemia are included in the risk factors. The prevention is the primary therapeutic agent and this is achieved due to the early mobilization of the patients, the use of neuromuscular electrical stimulation and the avoidance of exposure to risk factors. Conclusions: The prevention of muscle atrophy is a primary goal of treatment for the patients in the ICU, because it reduces the incidence of the disease, reduces the time spent in ICU and finally improves the quality of patients’ life. PMID:25684851

  9. [Breast cancer: patient care, rehabilitation, psychooncology].

    PubMed

    Kahán, Zsuzsanna; Szántó, István; Molnár, Mária; Rohánszky, Magda; Koncz, Zsuzsa; Mailáth, Mónika; Kapitány, Zsuzsanna; Dudás, Rita

    2016-09-01

    The development of a recommendation was intended for the follow-up of breast cancer patients treated with curative intent in Hungary. Follow-up includes the permanent contact with and health education of the patient, the surveillance and control of the adverse effects of oncological therapies or radiotherapy, the screening of metachron cancers, and the comprehensive (physical, psychological and social) rehabilitation of the patient. The early detection of local/regional tumor relapse is essential with careful follow-up, but there is no need for screening of distant metastases by means of imaging studies or tumor marker tests. If adjuvant endocrine therapy is needed, optimal adherence should be ensured with supportive therapy. In rare cases, special issues such as breast cancer risk/genetic mutation, pregnancy are raised, which should be thoughtfully discussed in view of recent advances in oncology. Follow-up is generally practised by the oncologist, however, in some cases the social worker, the physiotherapist, the psychooncologist, or in special cases, the lymphoedema expert is to be involved. The follow-up approach should be comprehensive and holistic. PMID:27579724

  10. Drinking Motives Among HIV Primary Care Patients

    PubMed Central

    Elliott, Jennifer C.; Aharonovich, Efrat; O’Leary, Ann; Wainberg, Milton; Hasin, Deborah

    2013-01-01

    Heavy drinking among individuals with HIV is associated with poor medication adherence and other health problems. Understanding reasons for drinking (drinking motives) in this population is therefore important and could inform intervention. Using concepts of drinking motives from previous alcohol research, we assessed these motives and drinking in 254 HIV-positive primary care patients (78.0% male; 94.5% African American or Hispanic) prior to their participation in an alcohol intervention trial. Three motives had good factor structure and internal consistency: “drinking to cope with negative affect”, “drinking for social facilitation” (both associated with heavier drinking), and “drinking due to social pressure” (associated with less drinking). Drinking motives may provide important content for alcohol intervention; clinical trials could indicate whether inclusion of such content improves intervention efficacy. Discussing motives in session could help providers assist clients in better managing psychological and social aspects of their lives without reliance on alcohol. PMID:24165984

  11. Patient Stratification for Preventive Care in Dentistry

    PubMed Central

    Giannobile, W.V.; Braun, T.M.; Caplis, A.K.; Doucette-Stamm, L.; Duff, G.W.; Kornman, K.S.

    2013-01-01

    Prevention reduces tooth loss, but little evidence supports biannual preventive care for all adults. We used risk-based approaches to test tooth loss association with 1 vs. 2 annual preventive visits in high-risk (HiR) and low-risk (LoR) patients. Insurance claims for 16 years for 5,117 adults were evaluated retrospectively for tooth extraction events. Patients were classified as HiR for progressive periodontitis if they had ≥ 1 of the risk factors (RFs) smoking, diabetes, interleukin-1 genotype; or as LoR if no RFs. LoR event rates were 13.8% and 16.4% for 2 or 1 annual preventive visits (absolute risk reduction, 2.6%; 95%CI, 0.5% to 5.8%; p = .092). HiR event rates were 16.9% and 22.1% for 2 and 1 preventive visits (absolute risk reduction, 5.2%; 95%CI, 1.8% to 8.4%; p = .002). Increasing RFs increased events (p < .001). Oral health care costs were not increased by any single RF, regardless of prevention frequency (p > .41), but multiple RFs increased costs vs. no (p < .001) or 1 RF (p = .001). For LoR individuals, the association between preventive dental visits and tooth loss was not significantly different whether the frequency was once or twice annually. A personalized medicine approach combining gene biomarkers with conventional risk factors to stratify populations may be useful in resource allocation for preventive dentistry (ClinicalTrials.gov, NCT01584479). PMID:23752171

  12. The value of a progressive care environment for neurosurgical patients.

    PubMed

    Schneider, Melissa A; Pomidor, Michelle A

    2014-10-01

    Intensive care is expensive and stressful for patients and families. With rising healthcare costs, hospitals need other options. This retrospective, descriptive study explored the efficacy of using a progressive care environment to manage stable, complex patients out of the intensive care unit. Data were collected on 114 neurosurgical patients using specific inclusion and exclusion criteria before and after implementation of progressive care beds within a standard medical-surgical unit. Patients in the "after" group had a statistically significant decrease in the number of intensive care unit days and overall hospital length of stay. The results suggest that it is possible for positive patient outcomes using this model if these patients are carefully selected, nurses are appropriately educated, and a collaborative approach is used.

  13. Goals of care among hospitalized patients: a validation study.

    PubMed

    Haberle, Tyler H; Shinkunas, Laura A; Erekson, Zachary D; Kaldjian, Lauris C

    2011-08-01

    Our objective was to validate 6 literature-derived goals of care by analyzing open-ended and closed-ended responses about goals of care from a previous study of hospitalized patients. Eight clinicians categorized patients' open-ended articulations of their goals of care using a literature-derived framework and then compared those categorizations to patients' own closed-ended selections of their most important goal of care. Clinicians successfully categorized patients' open-ended responses using the literature-derived framework 83.5% of the time, and their categorizations matched patients' closed-ended most important goal of care 87.8% of the time. Goals that did not fit within the literature-derived framework all pertained to the goal of understanding a patient's diagnosis or prognosis; this seventh potential goal can be added to the literature-derived framework of 6 goals of care.

  14. Patient Satisfaction With Breast and Colorectal Cancer Survivorship Care Plans

    PubMed Central

    Sprague, Brian L.; Dittus, Kim L.; Pace, Claire M.; Dulko, Dorothy; Pollack, Lori A.; Hawkins, Nikki A.; Geller, Berta M.

    2015-01-01

    Cancer survivors face several challenges following the completion of active treatment, including uncertainty about late effects of treatment and confusion about coordination of follow-up care. The authors evaluated patient satisfaction with personalized survivorship care plans designed to clarify those issues. The authors enrolled 48 patients with breast cancer and 10 patients with colorectal cancer who had completed treatment in the previous two months from an urban academic medical center and a rural community hospital. Patient satisfaction with the care plan was assessed by telephone interview. Overall, about 80% of patients were very or completely satisfied with the care plan, and 90% or more agreed that it was useful, it was easy to understand, and the length was appropriate. Most patients reported that the care plan was very or critically important to understanding an array of survivorship issues. However, only about half felt that it helped them better understand the roles of primary care providers and oncologists in survivorship care. The results provide evidence that patients with cancer find high value in personalized survivorship care plans, but the plans do not eliminate confusion regarding the coordination of follow-up care. Future efforts to improve care plans should focus on better descriptions of how survivorship care will be coordinated. PMID:23722604

  15. Curing and Caring: The Work of Primary Care Physicians With Dementia Patients

    PubMed Central

    CarolinaApesoa-Varano, Ester; Barker, Judith C.; Hinton, Ladson

    2013-01-01

    The symbolic framework guiding primary care physicians’ (PCPs) practice is crucial in shaping the quality of care for those with degenerative dementia. Examining the relationship between the cure and care models in primary care offers a unique opportunity for exploring change toward a more holistic approach to health care. The aims of this study were to (a) explore how PCPs approach the care of patients with Alzheimer’s disease (AD), and (b) describe how this care unfolds from the physicians’ perspectives. This was a cross-sectional study of 40 PCPs who completed semistructured interviews as part of a dementia caregiving study. Findings show that PCPs recognize the limits of the cure paradigm and articulate a caring, more holistic model that addresses the psychosocial needs of dementia patients. However, caring is difficult to uphold because of time constraints, emotional burden, and jurisdictional issues. Thus, the care model remains secondary and temporary. PMID:21685311

  16. A primer to natural hair care practices in black patients.

    PubMed

    Bosley, Rawn E; Daveluy, Steven

    2015-02-01

    Natural hairstyles have increased in popularity in the United States among individuals of African and Afro-Caribbean descent. Dermatologists should be aware of general principles of natural hair care in this patient population, including basic hair care terminology, types of natural hairstyles, methods of washing, and product selection. A basic knowledge of natural hair care practices in black patients will assist dermatologists in the management and treatment of many conditions associated with traumatic hairstyling in this patient population.

  17. Value Based Care and Patient-Centered Care: Divergent or Complementary?

    PubMed

    Tseng, Eric K; Hicks, Lisa K

    2016-08-01

    Two distinct but overlapping care philosophies have emerged in cancer care: patient-centered care (PCC) and value-based care (VBC). Value in healthcare has been defined as the quality of care (measured typically by healthcare outcomes) modified by cost. In this conception of value, patient-centeredness is one important but not necessarily dominant quality measure. In contrast, PCC includes multiple domains of patient-centeredness and places the patient and family central to all decisions and evaluations of quality. The alignment of PCC and VBC is complicated by several tensions, including a relative lack of patient experience and preference measures, and conceptions of cost that are payer-focused instead of patient-focused. Several strategies may help to align these two philosophies, including the use of patient-reported outcomes in clinical trials and value determinations, and the purposeful integration of patient preference in clinical decisions and guidelines. Innovative models of care, including accountable care organizations and oncology patient-centered medical homes, may also facilitate alignment through improved care coordination and quality-based payment incentives. Ultimately, VBC and PCC will only be aligned if patient-centered outcomes, perspectives, and preferences are explicitly incorporated into the definitions and metrics of quality, cost, and value that will increasingly influence the delivery of cancer care.

  18. Transforming care teams to provide the best possible patient-centered, collaborative care.

    PubMed

    Sevin, Cory; Moore, Gordon; Shepherd, John; Jacobs, Tracy; Hupke, Cindy

    2009-01-01

    Patient experience of care is now a crucial parameter in assessing the quality of healthcare delivered in the United States. Continuity, patient-driven access to care, and being "known" by a provider or practice, particularly for patients with chronic diseases, have been shown to enhance patient satisfaction with care and health outcomes. Healthcare systems are challenged to effectively meet the wants and needs of patients by tailoring interventions based on each person's unique set factors-his or her strengths, preferences, and personal and social context. Creating care teams, a coordinated multidisciplinary group of healthcare professionals, enables a practice to take advantage of the skill sets represented and redesign care delivery with the patient and community as the focal point. This article describes the attributes of highly functioning care teams, how to measure them, and guidance on creating them. A case example illustrates how these ideas work in practice.

  19. 21 CFR 870.5050 - Patient care suction apparatus.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Therapeutic Devices § 870.5050 Patient care... intrathoracic catheter to withdraw fluid from the chest during the recovery period following surgery....

  20. 21 CFR 870.5050 - Patient care suction apparatus.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Therapeutic Devices § 870.5050 Patient care... intrathoracic catheter to withdraw fluid from the chest during the recovery period following surgery....

  1. 21 CFR 870.5050 - Patient care suction apparatus.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Therapeutic Devices § 870.5050 Patient care... intrathoracic catheter to withdraw fluid from the chest during the recovery period following surgery....

  2. Care of Patients with Diabetic Foot Disease in Oman

    PubMed Central

    Al-Busaidi, Ibrahim S.; Abdulhadi, Nadia N.; Coppell, Kirsten J.

    2016-01-01

    Diabetes mellitus is a major public health challenge and causes substantial morbidity and mortality worldwide. Diabetic foot disease is one of the most debilitating and costly complications of diabetes. While simple preventative foot care measures can reduce the risk of lower limb ulcerations and subsequent amputations by up to 85%, they are not always implemented. In Oman, foot care for patients with diabetes is mainly provided in primary and secondary care settings. Among all lower limb amputations performed in public hospitals in Oman between 2002–2013, 47.3% were performed on patients with diabetes. The quality of foot care among patients with diabetes in Oman has not been evaluated and unidentified gaps in care may exist. This article highlights challenges in the provision of adequate foot care to Omani patients with diabetes. It concludes with suggested strategies for an integrated national diabetic foot care programme in Oman. PMID:27606104

  3. Care of Patients with Diabetic Foot Disease in Oman.

    PubMed

    Al-Busaidi, Ibrahim S; Abdulhadi, Nadia N; Coppell, Kirsten J

    2016-08-01

    Diabetes mellitus is a major public health challenge and causes substantial morbidity and mortality worldwide. Diabetic foot disease is one of the most debilitating and costly complications of diabetes. While simple preventative foot care measures can reduce the risk of lower limb ulcerations and subsequent amputations by up to 85%, they are not always implemented. In Oman, foot care for patients with diabetes is mainly provided in primary and secondary care settings. Among all lower limb amputations performed in public hospitals in Oman between 2002-2013, 47.3% were performed on patients with diabetes. The quality of foot care among patients with diabetes in Oman has not been evaluated and unidentified gaps in care may exist. This article highlights challenges in the provision of adequate foot care to Omani patients with diabetes. It concludes with suggested strategies for an integrated national diabetic foot care programme in Oman. PMID:27606104

  4. Care of Patients with Diabetic Foot Disease in Oman

    PubMed Central

    Al-Busaidi, Ibrahim S.; Abdulhadi, Nadia N.; Coppell, Kirsten J.

    2016-01-01

    Diabetes mellitus is a major public health challenge and causes substantial morbidity and mortality worldwide. Diabetic foot disease is one of the most debilitating and costly complications of diabetes. While simple preventative foot care measures can reduce the risk of lower limb ulcerations and subsequent amputations by up to 85%, they are not always implemented. In Oman, foot care for patients with diabetes is mainly provided in primary and secondary care settings. Among all lower limb amputations performed in public hospitals in Oman between 2002–2013, 47.3% were performed on patients with diabetes. The quality of foot care among patients with diabetes in Oman has not been evaluated and unidentified gaps in care may exist. This article highlights challenges in the provision of adequate foot care to Omani patients with diabetes. It concludes with suggested strategies for an integrated national diabetic foot care programme in Oman.

  5. Impacts of social networking sites on patient care in the emergency department.

    PubMed

    Bennett, Anne; Pourmand, Ali; Shokoohi, Hamid; Shesser, Robert; Sanchez, Jesus; Joyce, Joseph

    2014-01-01

    The use of Facebook is ubiquitous among both patients and physicians. Often Facebook intrudes into medical practice, thereby highlighting its potential to be either a positive or negative factor in a patient's medical care. Despite being a "hot topic" in the medical literature, very few real world examples exist of physicians actually using information obtained from Facebook to reach a diagnosis or otherwise affect patient care. We present a case involving a 13-year-old girl who posted photographs and captions on Facebook demonstrating suicidal ideation. The patient's parents were alerted to the girl's statements in her Facebook profile and brought her to the emergency department. The girl's statements and photographs, as reported by her parents, were used by an emergency physician to make a diagnosis of suicidal risk and to disposition of the patient to an inpatient psychiatric ward. We discuss the potential diagnostic utility of information posted on Facebook and briefly discuss the ethical questions surrounding this situation. PMID:24160899

  6. Ethical and Practical Considerations in Providing Critical Care to Patients With Ebola Virus Disease

    PubMed Central

    Davey, Richard T.; Suffredini, Anthony F.; Chertow, Daniel S.

    2015-01-01

    Infectious disease epidemics in the past have given rise to psychologic and emotional responses among health-care workers (HCWs), stemming from fear of infection during patient care. Early experiences in the AIDS epidemic provide an example where fear of contagion resulted in differential treatment of patients infected with HIV. However, with a deeper understanding of AIDS pathogenesis and treatment, fear and discrimination diminished. Parallels exist between early experiences with AIDS and the present outbreak of Ebola virus disease in West Africa, particularly regarding discussions of medical futility in seriously ill patients. We provide a historical perspective on HCWs’ risk of infection during the provision of CPR, discuss physicians’ duty to treat in the face of perceived or actual HCW risk, and, finally, present the protocols implemented at the National Institutes of Health to reduce HCW risk while providing lifesaving and life-sustaining care. PMID:25764372

  7. Using the Pharmacist Interaction Tracking Tool for Capturing Student-Patient Interactions in Direct and Simulated Patient Care Activities

    PubMed Central

    Schonder, Kristine S.; Pater, Karen S.; McGivney, Melissa S.; Meyer, Susan M.

    2016-01-01

    Objective. To create and implement a standardized data collection tool for capturing student-patient interactions in direct and simulated patient care activities. Design. Faculty members and students determined key elements, design, and an implementation plan for the tool, which was to be used by students across professional years to quantify numbers and types of interactions with patients for tracking student progression toward achievement of curricular outcomes. Assessment. During the 2013-2014 academic year, 27 778 entries were completed, with 17 767 (64%) advanced pharmacy practice experiences, 7272 (26%) introductory pharmacy practice experiences, and 2739 (10%) simulation. Direct patient care interactions occurred with 11 090 patients and 10 983 providers, with 14 252 drug-related problems identified. Data was used by students for their professional portfolios, by administrators for curricular assessment, and to student impact on patient care. Conclusion. The PITT Form enabled the collection of data from actual and simulated patient care activities, allowed for curricular assessment of activities across years, and was used by individual students. PMID:27667842

  8. Using the Pharmacist Interaction Tracking Tool for Capturing Student-Patient Interactions in Direct and Simulated Patient Care Activities.

    PubMed

    Hall, Deanne L; Schonder, Kristine S; Pater, Karen S; McGivney, Melissa S; Meyer, Susan M

    2016-08-25

    Objective. To create and implement a standardized data collection tool for capturing student-patient interactions in direct and simulated patient care activities. Design. Faculty members and students determined key elements, design, and an implementation plan for the tool, which was to be used by students across professional years to quantify numbers and types of interactions with patients for tracking student progression toward achievement of curricular outcomes. Assessment. During the 2013-2014 academic year, 27 778 entries were completed, with 17 767 (64%) advanced pharmacy practice experiences, 7272 (26%) introductory pharmacy practice experiences, and 2739 (10%) simulation. Direct patient care interactions occurred with 11 090 patients and 10 983 providers, with 14 252 drug-related problems identified. Data was used by students for their professional portfolios, by administrators for curricular assessment, and to student impact on patient care. Conclusion. The PITT Form enabled the collection of data from actual and simulated patient care activities, allowed for curricular assessment of activities across years, and was used by individual students. PMID:27667842

  9. Patient-centered care for people living with multimorbidity

    PubMed Central

    Boyd, Cynthia M.; Lucas, Gregory M.

    2014-01-01

    Purpose of review The purpose of this review is to consider a patient-centred approach to the care of people living with HIV (PLWH) who have multimorbidity, irrespective of the specific conditions. Recent findings Interdisciplinary care to achieve patient-centred care for people with multimorbidity is recognized as important, but the evaluation of models designed to achieve this goal are needed. Key elements of such approaches include patient preferences, interpretation of the evidence, prognosis as a tool to inform patient-centred care, clinical feasibility and optimization of treatment regimens. Summary Developing and evaluating the best models of patient-centred care for PLWH who also have multimorbidity is essential. This challenge represents an opportunity to leverage the lessons learned from the care of people with multimorbidity in general, and vice versa. PMID:24871089

  10. A patient perspective in research on intercultural caring in maternity care: A meta-ethnography.

    PubMed

    Wikberg, Anita; Bondas, Terese

    2010-01-01

    The aim of this study is to explore and describe a patient perspective in research on intercultural caring in maternity care. In total, 40 studies are synthesized using Noblit and Hare's meta-ethnography method. The following opposite metaphors were found: caring versus non-caring; language and communication problems versus information and choice; access to medical and technological care versus incompetence; acculturation: preserving the original culture versus adapting to a new culture; professional caring relationship versus family and community involvement; caring is important for well-being and health versus conflicts cause interrupted care; vulnerable women with painful memories versus racism. Alice in Wonderland emerged as an overarching metaphor to describe intercultural caring in maternity care. Furthermore, intercultural caring is seen in different dimensions of uniqueness, context, culture, and universality. There are specific cultural and maternity care features in intercultural caring. There is an inner core of caring consisting of respect, presence, and listening as well as external factors such as economy and organization that impact on intercultural caring. Moreover, legal status of the patient, as well as power relationships and racism, influences intercultural caring. Further meta-syntheses about well-documented intercultural phenomena and ethnic groups, as well as empirical studies about current phenomena, are suggested. PMID:20640028

  11. A patient perspective in research on intercultural caring in maternity care: A meta-ethnography

    PubMed Central

    Wikberg, Anita; Bondas, Terese

    2010-01-01

    The aim of this study is to explore and describe a patient perspective in research on intercultural caring in maternity care. In total, 40 studies are synthesized using Noblit and Hare's meta-ethnography method. The following opposite metaphors were found: caring versus non-caring; language and communication problems versus information and choice; access to medical and technological care versus incompetence; acculturation: preserving the original culture versus adapting to a new culture; professional caring relationship versus family and community involvement; caring is important for well-being and health versus conflicts cause interrupted care; vulnerable women with painful memories versus racism. Alice in Wonderland emerged as an overarching metaphor to describe intercultural caring in maternity care. Furthermore, intercultural caring is seen in different dimensions of uniqueness, context, culture, and universality. There are specific cultural and maternity care features in intercultural caring. There is an inner core of caring consisting of respect, presence, and listening as well as external factors such as economy and organization that impact on intercultural caring. Moreover, legal status of the patient, as well as power relationships and racism, influences intercultural caring. Further meta-syntheses about well-documented intercultural phenomena and ethnic groups, as well as empirical studies about current phenomena, are suggested. PMID:20640028

  12. A patient perspective in research on intercultural caring in maternity care: A meta-ethnography.

    PubMed

    Wikberg, Anita; Bondas, Terese

    2010-01-01

    The aim of this study is to explore and describe a patient perspective in research on intercultural caring in maternity care. In total, 40 studies are synthesized using Noblit and Hare's meta-ethnography method. The following opposite metaphors were found: caring versus non-caring; language and communication problems versus information and choice; access to medical and technological care versus incompetence; acculturation: preserving the original culture versus adapting to a new culture; professional caring relationship versus family and community involvement; caring is important for well-being and health versus conflicts cause interrupted care; vulnerable women with painful memories versus racism. Alice in Wonderland emerged as an overarching metaphor to describe intercultural caring in maternity care. Furthermore, intercultural caring is seen in different dimensions of uniqueness, context, culture, and universality. There are specific cultural and maternity care features in intercultural caring. There is an inner core of caring consisting of respect, presence, and listening as well as external factors such as economy and organization that impact on intercultural caring. Moreover, legal status of the patient, as well as power relationships and racism, influences intercultural caring. Further meta-syntheses about well-documented intercultural phenomena and ethnic groups, as well as empirical studies about current phenomena, are suggested.

  13. Towards better patient care: drugs to avoid.

    PubMed

    2013-04-01

    Common sense dictates that one should choose tried and tested drugs with proven, concrete benefits that outweigh their adverse effects. Many new drugs are approved each year, often despite a lack of solid evidence that they are any better than existing treatments. Worse, some are approved despite being less effective or more harmful than current options. Massive promotion is used to ensure that such drugs achieve a positive image in the eyes of healthcare professionals and patients. Renowned "opinion leaders" intervene in their favour at conferences and in specialist media, and their opinions are further propagated by specialists in the field. Finally, campaigns in the lay media are used to highlight the target illness, encouraging patients to request a prescription. New data sometimes show that older, initially promising drugs are less effective or more harmful than first thought. For all these reasons, many drugs that are now present on the market are more harmful than beneficial and should be avoided. Unfortunately, negative assessment data and warnings are often drowned in the flood of promotion and advertising. Front-line healthcare professionals who are determined to act in their patients' best interests can find themselves swimming against a tide of specialist opinion, marketing authorisation, and reimbursement decisions. By leaving drugs that are more harmful than beneficial on the market and contenting themselves with simple half-measures, healthcare authorities are failing in their duty to protect patients. Prescrire, a journal funded solely by its subscribers, does not seek to do the work of health authorities, and does not have the means to do so. Prescrire's goal is simply to help healthcare professionals provide better care. The following text lists the principal drugs that we consider more harmful than beneficial, based on our reviews published between 2010 and 2012 in our French edition. These drugs should not be used. Patients and healthcare

  14. Towards better patient care: drugs to avoid.

    PubMed

    2013-04-01

    Common sense dictates that one should choose tried and tested drugs with proven, concrete benefits that outweigh their adverse effects. Many new drugs are approved each year, often despite a lack of solid evidence that they are any better than existing treatments. Worse, some are approved despite being less effective or more harmful than current options. Massive promotion is used to ensure that such drugs achieve a positive image in the eyes of healthcare professionals and patients. Renowned "opinion leaders" intervene in their favour at conferences and in specialist media, and their opinions are further propagated by specialists in the field. Finally, campaigns in the lay media are used to highlight the target illness, encouraging patients to request a prescription. New data sometimes show that older, initially promising drugs are less effective or more harmful than first thought. For all these reasons, many drugs that are now present on the market are more harmful than beneficial and should be avoided. Unfortunately, negative assessment data and warnings are often drowned in the flood of promotion and advertising. Front-line healthcare professionals who are determined to act in their patients' best interests can find themselves swimming against a tide of specialist opinion, marketing authorisation, and reimbursement decisions. By leaving drugs that are more harmful than beneficial on the market and contenting themselves with simple half-measures, healthcare authorities are failing in their duty to protect patients. Prescrire, a journal funded solely by its subscribers, does not seek to do the work of health authorities, and does not have the means to do so. Prescrire's goal is simply to help healthcare professionals provide better care. The following text lists the principal drugs that we consider more harmful than beneficial, based on our reviews published between 2010 and 2012 in our French edition. These drugs should not be used. Patients and healthcare

  15. Sex differences in health care provider communication during genital herpes care and patients' health outcomes.

    PubMed

    Ports, Katie A; Reddy, Diane M; Barnack-Tavlaris, Jessica L

    2013-01-01

    Research in primary care medicine demonstrates that health care providers' communication varies depending on their sex, and that these sex differences in communication can influence patients' health outcomes. The present study aimed to examine the extent to which sex differences in primary care providers' communication extend to the sensitive context of gynecological care for genital herpes and whether these potential sex differences in communication influence patients' herpes transmission prevention behaviors and herpes-related quality of life. Women (N = 123) from the United States recently diagnosed with genital herpes anonymously completed established measures in which they rated (a) their health care providers' communication, (b) their herpes transmission prevention behaviors, and (c) their herpes-related quality of life. The authors found significant sex differences in health care providers' communication; this finding supports that sex differences in primary care providers' communication extend to gynecological care for herpes. Specifically, patients with female health care providers indicated that their providers engaged in more patient-centered communication and were more satisfied with their providers' communication. However, health care providers' sex did not predict women's quality of life, a finding that suggests that health care providers' sex alone is of little importance in patients' health outcomes. Patient-centered communication was significantly associated with greater quality-of-life scores and may provide a promising avenue for intervention.

  16. Nurses' experiences of caring for culturally diverse patients in an acute care setting.

    PubMed

    Cioffi, Jane

    2005-09-01

    Identification of nurses' experiences of caring for culturally diverse patients in acute care settings contributes to transcultural nursing knowledge. This qualitative study aims to describe nurses' experiences of caring for culturally diverse adult patients on medical and surgical wards in an acute care setting. These experiences identify current practice and associated issues for nurses caring for culturally diverse clients. A purposive sample of ten registered nurses was interviewed and transcripts analysed. Main findings were acquiring cultural knowledge, committing to and engaging with culturally diverse patients. Strategies for change developed from these findings focus on increasing cultural competency of nurses by: implementing a formal education program; developing partnerships with patients and their families to increase cultural comfort; and increasing organisational accommodation of the culturally diverse with policy review and extension of resources. Further research to explore issues for bilingual nurses and to describe the experiences of culturally diverse patients and their families in general acute care settings is recommended. PMID:16295344

  17. Patient Education and Self-Care: How Do They Differ?

    ERIC Educational Resources Information Center

    Levin, Lowell S.

    1978-01-01

    The author discusses health education for the patient and the differences between patient education and the concept of self-care. Both types of programs may contribute to the public's health at different points on the same continuum. (MF)

  18. Early Palliative Care Improves Patients' Quality of Life

    MedlinePlus

    ... fullstory_160885.html Early Palliative Care Improves Patients' Quality of Life Also increases chances of having end-of-life ... incurable cancer helps patients cope and improves their quality of life, a new study shows. It also leads to ...

  19. Impact of Physician Asthma Care Education on Patient Outcomes

    ERIC Educational Resources Information Center

    Cabana, Michael D.; Slish, Kathryn K.; Evans, David; Mellins, Robert B.; Brown, Randall W.; Lin, Xihong; Kaciroti, Niko; Clark, Noreen M.

    2014-01-01

    Objective: We evaluated the effectiveness of a continuing medical education program, Physician Asthma Care Education, in improving pediatricians' asthma therapeutic and communication skills and patients' health care utilization for asthma. Methods: We conducted a randomized trial in 10 regions in the United States. Primary care providers…

  20. Computerized patient care documentation. Educational applications in the baccalaureate curriculum.

    PubMed

    Strength, D E; Keen-Payne, R

    1991-01-01

    This baccalaureate program integrated computerized patient care documentation with courses in nursing fundamentals and health assessment. Using an information system designed for acute care settings, students become familiar with computer use while learning documentation of care and other nursing skills. Computer literacy may be enhanced with integration of content and increased exposure to different information systems.

  1. Obstetrics Patients' Assessment of Medical Students' Role in Their Care.

    ERIC Educational Resources Information Center

    Magrane, Diane

    1988-01-01

    Obstetric patients rated the skills and assessed the roles of students caring for them during a clinical clerkship. They rated skills and attitudes high, generally, with lower ratings for their ability to answer questions and preparation to participate in care. Most felt students improved their care, primarily in supportive ways. (Author/MSE)

  2. 42 CFR 494.90 - Condition: Patient plan of care.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... personal care, home dialysis and self-care, quality of life, rehabilitation, transplantation, and the... 42 Public Health 5 2011-10-01 2011-10-01 false Condition: Patient plan of care. 494.90 Section 494.90 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN...

  3. 42 CFR 494.90 - Condition: Patient plan of care.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... personal care, home dialysis and self-care, quality of life, rehabilitation, transplantation, and the... 42 Public Health 5 2012-10-01 2012-10-01 false Condition: Patient plan of care. 494.90 Section 494.90 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN...

  4. 42 CFR 494.90 - Condition: Patient plan of care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... personal care, home dialysis and self-care, quality of life, rehabilitation, transplantation, and the... 42 Public Health 5 2010-10-01 2010-10-01 false Condition: Patient plan of care. 494.90 Section 494.90 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN...

  5. 42 CFR 494.90 - Condition: Patient plan of care.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... personal care, home dialysis and self-care, quality of life, rehabilitation, transplantation, and the... 42 Public Health 5 2013-10-01 2013-10-01 false Condition: Patient plan of care. 494.90 Section 494.90 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN...

  6. 42 CFR 494.90 - Condition: Patient plan of care.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... personal care, home dialysis and self-care, quality of life, rehabilitation, transplantation, and the... 42 Public Health 5 2014-10-01 2014-10-01 false Condition: Patient plan of care. 494.90 Section 494.90 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN...

  7. Intraoperative positioning and care of the obese patient.

    PubMed

    Dybec, Robert B

    2004-01-01

    The perioperative nurse involved in the intraoperative care of the obese patient is faced with numerous issues and challenges. As a growing number of these patients present for medical care, the nurse must consider the special positioning needs for surgery and the equipment needed to promote the safest environment for the patient. This article addresses positioning considerations for the obese patient and special equipment needs and selection in the operating room.

  8. Dialysis patients' utilization of health care services covered by long-term care insurance in Japan.

    PubMed

    Shimizu, Utako; Mitadera, Yuji; Aoki, Hagiko; Akazawa, Kouhei

    2015-01-01

    Hemodialysis patients in Japan are aging and thus more patients need support for attending hemodialysis facilities. This study aimed to clarify how dialysis patients utilize the services covered by Japan's public long-term care insurance (LTCI) system. This cross-sectional study was based on LTCI data of March 31, 2009, the latest available data provided by Niigata City, located on the northwest coast of Honshu. Among 30,349 LTCI users in Niigata City, there were 234 dialysis patients. To clarify the characteristics of the dialysis patients, we compared the utilization of LTCI services between the dialysis patients (234 users) and randomly selected 765 non-dialysis users. We also calculated the annual transportation service costs per patient for dialysis patients who continued home care (home care group) and those who switched to long-term hospital care at LTCI care levels 4 and 5 (hospital admission group). These care levels indicate difficulty in walking or maintaining a sitting posture without assistance. The dialysis group more frequently utilized home care and equipment services, such as renting or purchasing care-support products and support for home equipment repair, and utilized facility services and short-stay services (respite care) less frequently (both p < 0.001). Cost per patient was higher in the home care group than in the hospital admission group, because the transportation services for dialysis patients at care levels 4 and 5 involve higher costs. These findings indicate that LTCI services usable for dialysis patients were limited. Therefore, instead of merely subsidizing transportation expenses, transportation services must be improved. PMID:25891160

  9. The Integrated Patient's Self-Care Process Model.

    PubMed

    Milavec Kapun, Marija; Šusteršič, Olga; Rajkovič, Vladislav

    2016-01-01

    Long-term care is more efficient and effective when it involves the active participation of the empowered patient and informal caregivers. To achieve this, it is necessary to guide the patient and informal caregivers through the systematic process of self-care. Well-documented observations and assessments are fundamental to plan further interventions of the interdisciplinary team. A systematic literature review revealed that the self-care process and the support of information technology are focused on just one chronic disease. Defined self-care process has a positive impact on the functionality and satisfaction of patients with comorbidity and on their caregivers. The model of the patient's self-care process should be an integral part of the long-term care. PMID:27332172

  10. Exploring the practice of patient centered care: The role of ethnography and reflexivity.

    PubMed

    Liberati, Elisa Giulia; Gorli, Mara; Moja, Lorenzo; Galuppo, Laura; Ripamonti, Silvio; Scaratti, Giuseppe

    2015-05-01

    Patient centered care (PCC) is an essential dimension of healthcare systems' mission worldwide and is recognized as an important condition for ensuring the quality of care. Nonetheless, it is also acknowledged that various care providers perceive patient centeredness differently and that there remain several unanswered questions about the aspects of healthcare delivery that are linked to an actual achievement of PCC. In the paper, we categorize the current research on PCC into two streams ("dyadic" and "organizational") and we discuss the strengths and weaknesses of each. Despite their important contributions to healthcare services research, these approaches to PCC do not fully capture the network of practices and relationships constituting patients and providers' experiences within healthcare contexts. Therefore, we propose an alternative interpretation of PCC that integrates insights from "practice theories" and emphasizes the negotiated and local nature of patient centeredness, which is accomplished through the engagement of providers and patients in everyday care practices. To develop such interpretation, we propose a research approach combining ethnographic and reflexive methods. Ethnography can help achieve more nuanced descriptions of what PCC truly encapsulates in the care process by drawing attention to the social and material reality of healthcare contexts. Reflexivity can help disentangle and bring to surface the tacit knowledge spread in everyday care practices and transform it into actionable knowledge, a type of knowledge that may support services improvement toward PCC. We anticipate that such improvement is far from straightforward: an actual achievement of PCC may challenge the interests of different stakeholders and unsettle consolidated habits, hierarchies and power dynamics. This unsettlement, however, can also serve as a necessary condition for engaging in a participative process of internal development. We discuss the outcomes, limitations and

  11. Exploring the practice of patient centered care: The role of ethnography and reflexivity.

    PubMed

    Liberati, Elisa Giulia; Gorli, Mara; Moja, Lorenzo; Galuppo, Laura; Ripamonti, Silvio; Scaratti, Giuseppe

    2015-05-01

    Patient centered care (PCC) is an essential dimension of healthcare systems' mission worldwide and is recognized as an important condition for ensuring the quality of care. Nonetheless, it is also acknowledged that various care providers perceive patient centeredness differently and that there remain several unanswered questions about the aspects of healthcare delivery that are linked to an actual achievement of PCC. In the paper, we categorize the current research on PCC into two streams ("dyadic" and "organizational") and we discuss the strengths and weaknesses of each. Despite their important contributions to healthcare services research, these approaches to PCC do not fully capture the network of practices and relationships constituting patients and providers' experiences within healthcare contexts. Therefore, we propose an alternative interpretation of PCC that integrates insights from "practice theories" and emphasizes the negotiated and local nature of patient centeredness, which is accomplished through the engagement of providers and patients in everyday care practices. To develop such interpretation, we propose a research approach combining ethnographic and reflexive methods. Ethnography can help achieve more nuanced descriptions of what PCC truly encapsulates in the care process by drawing attention to the social and material reality of healthcare contexts. Reflexivity can help disentangle and bring to surface the tacit knowledge spread in everyday care practices and transform it into actionable knowledge, a type of knowledge that may support services improvement toward PCC. We anticipate that such improvement is far from straightforward: an actual achievement of PCC may challenge the interests of different stakeholders and unsettle consolidated habits, hierarchies and power dynamics. This unsettlement, however, can also serve as a necessary condition for engaging in a participative process of internal development. We discuss the outcomes, limitations and

  12. 21 CFR 870.5050 - Patient care suction apparatus.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Patient care suction apparatus. 870.5050 Section 870.5050 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... suction apparatus. (a) Identification. A patient care suction apparatus is a device used with...

  13. 21 CFR 870.5050 - Patient care suction apparatus.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Patient care suction apparatus. 870.5050 Section 870.5050 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... suction apparatus. (a) Identification. A patient care suction apparatus is a device used with...

  14. Use of Care Paths to Improve Patient Management

    ERIC Educational Resources Information Center

    Campbell, Suzann K.

    2013-01-01

    The purpose of this special issue of Physical & Occupational Therapy in Pediatrics is to present an evidence-based system to guide the physical therapy management of patients in the Neonatal Intensive Care Unit (NICU). Two systematic guides to patient management will be presented. The first is a care path intended primarily for use by physical…

  15. 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.

  16. Perioperative Care Coordination Measurement: A Tool to Support Care Integration of Pediatric Surgical Patients.

    PubMed

    Ferrari, Lynne R; Ziniel, Sonja I; Antonelli, Richard C

    2016-03-01

    The relationship of care coordination activities and outcomes to resource utilization and personnel costs has been evaluated for a number of pediatric medical home practices. One of the first tools designed to evaluate the activities and outcomes for pediatric care coordination is the Care Coordination Measurement Tool (CCMT). It has become widely used as an instrument for health care providers in both primary and subspecialty care settings. This tool enables the user to stratify patients based on acuity and complexity while documenting the activities and outcomes of care coordination. We tested the feasibility of adapting the CCMT to a pediatric surgical population at Boston Children's Hospital. The tool was used to assess the preoperative care coordination activities. Care coordination activities were tracked during the interval from the date the patient was scheduled for a surgical or interventional procedure through the day of the procedure. A care coordination encounter was defined as any task, whether face to face or not, supporting the development or implementation of a plan of care. Data were collected to enable analysis of 5675 care coordination encounters supporting the care provided to 3406 individual surgical cases (patients). The outcomes of care coordination, as documented by the preoperative nursing staff, included the elaboration of the care plan through patient-focused communication among specialist, facilities, perioperative team, and primary care physicians in 80.5% of cases. The average time spent on care coordination activities increased incrementally by 30 minutes with each additional care coordination encounter for a surgical case. Surgical cases with 1 care coordination encounter took an average of 35.7 minutes of preoperative care coordination, whereas those with ≥4 care coordination encounters reported an average of 121.6 minutes. We successfully adapted and implemented the CCMT for a pediatric surgical population and measured nonface

  17. Improving organizational climate for excellence in patient care.

    PubMed

    Arnold, Edwin

    2013-01-01

    Managers in health care organizations today are expected to achieve higher-quality patient care at a lower cost. Developing and maintaining a positive organizational climate can help improve motivation and foster higher employee performance. In turn, this will help the organization deliver better patient care at a lower cost. This article offers metrics for assessing organizational climate, analyzes barriers to a positive climate, and explores strategies that managers can use to build the type of climate that fosters high performance. PMID:23903945

  18. Where Are Patients Positioned in Your Seamless Care Strategies?

    PubMed

    Fox, Brent I; Felkey, Bill G

    2015-03-01

    In our earliest thoughts of how to engage patients in self-care management, we found online banking and finance to be the best model for health care to follow. This model is still right for today. Although no digital approach will apply to 100% of any population, there is evidence that older patient populations see the benefit of being able to access their health care providers online and on mobile devices. It's all about the data, the systems, and the people.

  19. Improving organizational climate for excellence in patient care.

    PubMed

    Arnold, Edwin

    2013-01-01

    Managers in health care organizations today are expected to achieve higher-quality patient care at a lower cost. Developing and maintaining a positive organizational climate can help improve motivation and foster higher employee performance. In turn, this will help the organization deliver better patient care at a lower cost. This article offers metrics for assessing organizational climate, analyzes barriers to a positive climate, and explores strategies that managers can use to build the type of climate that fosters high performance.

  20. Palliative care for patients with non-malignant respiratory disease.

    PubMed

    McVeigh, Clare

    2015-05-01

    Non-malignant respiratory disease is a chronic life-limiting condition that requires holistic palliative care. Patients with non-malignant respiratory disease have a range of biopsychosocial and spiritual needs, which healthcare professionals should recognise and manage effectively. Healthcare professionals have an important role in enabling the delivery of effective palliative care to this group of patients and their carers, and in recognising the many factors that may impede delivery of palliative care. PMID:25942985

  1. The influence of "quiet time" for patients in critical care.

    PubMed

    Maidl, Carolyn A; Leske, Jane S; Garcia, Annette E

    2014-10-01

    The primary aim was to examine the influence of "quiet time" in critical care. A dual-unit, nonrandomized, uncontrolled trial of a quiet time (QT) protocol was completed. A sample of adult patients from the Neurosciences Intensive Care Unit (NICU) and Cardiovascular Intensive Care Unit (CVICU) participated. Environmental stressors were reduced and patient rest promoted prior to QT. One hundred twenty-nine patients participated in 205 QTs. A one-way, repeated measure analysis of covariance (ANCOVA) was calculated comparing Richards-Campbell Sleep Questionnaire scores, pain and anxiety over three consecutive QTs. No significant statistical effect was found. However, patients rated sleep higher and anxiety levels decreased over consecutive QTs. Ninety-three percent of patients reported QT mattered to them. The combined efforts of nursing, medicine, and ancillary staff are necessary to foster periods of uninterrupted rest, thereby optimizing patient care. Further research is needed to determine if successive QTs positively influence patient outcomes. PMID:23847172

  2. Health care professional development: Working as a team to improve patient care.

    PubMed

    Babiker, Amir; El Husseini, Maha; Al Nemri, Abdurrahman; Al Frayh, Abdurrahman; Al Juryyan, Nasir; Faki, Mohamed O; Assiri, Asaad; Al Saadi, Muslim; Shaikh, Farheen; Al Zamil, Fahad

    2014-01-01

    In delivering health care, an effective teamwork can immediately and positively affect patient safety and outcome. The need for effective teams is increasing due to increasing co-morbidities and increasing complexity of specialization of care. Time has gone when a doctor or a dentist or any other health practitioner in whatsoever health organization would be able to solely deliver a quality care that satisfies his or her patients. The evolution in health care and a global demand for quality patient care necessitate a parallel health care professional development with a great focus on patient centred teamwork approach. This can only be achieved by placing the patient in the centre of care and through sharing a wide based culture of values and principles. This will help forming and developing an effective team able to deliver exceptional care to the patients. Aiming towards this goal, motivation of team members should be backed by strategies and practical skills in order to achieve goals and overcome challenges. This article highlights values and principles of working as a team and principles and provides team players with a practical approach to deliver quality patient care.

  3. Health care professional development: Working as a team to improve patient care

    PubMed Central

    El Husseini, Maha; Al Nemri, Abdurrahman; Al Frayh, Abdurrahman; Al Juryyan, Nasir; Faki, Mohamed O; Assiri, Asaad; Al Saadi, Muslim; Shaikh, Farheen; Al Zamil, Fahad

    2014-01-01

    In delivering health care, an effective teamwork can immediately and positively affect patient safety and outcome. The need for effective teams is increasing due to increasing co-morbidities and increasing complexity of specialization of care. Time has gone when a doctor or a dentist or any other health practitioner in whatsoever health organization would be able to solely deliver a quality care that satisfies his or her patients. The evolution in health care and a global demand for quality patient care necessitate a parallel health care professional development with a great focus on patient centred teamwork approach. This can only be achieved by placing the patient in the centre of care and through sharing a wide based culture of values and principles. This will help forming and developing an effective team able to deliver exceptional care to the patients. Aiming towards this goal, motivation of team members should be backed by strategies and practical skills in order to achieve goals and overcome challenges. This article highlights values and principles of working as a team and principles and provides team players with a practical approach to deliver quality patient care. PMID:27493399

  4. Hypertensive patients in primary health care: access, connection and care involved in spontaneous demands.

    PubMed

    Girão, Ana Lívia Araújo; Freitas, Consuelo Helena Aires de

    2016-06-01

    Objective To assess the impacts of inclusion of care for spontaneous demands in the treatment of hypertensive patients in primary health care. Methods Third generation qualitative assessment survey conducted with 16 workers in a Primary Care Health Unit (PHCU) of the city of Fortaleza, state of Ceara, in the period between July and September of 2015. To collect data, systematic field observation and semi-structured interviews were used, and the stages of thematic content analysis were adopted for data analysis. Results Participants revealed that access, connection and care are fundamental to the treatment of hypertension. However, they said that the introduction of free access for spontaneous demands compromised the flow of care in the hypertension programs. Conclusion A dichotomy between the practice of care recommended by health policies and the one existing in the reality of PHCUs was shown, causing evident losses to the care of hypertensive patients in primary care. PMID:27253602

  5. Self-Care Among Patients With Inflammatory Bowel Disease

    PubMed Central

    Yngman-Uhlin, Pia; Hjortswang, Henrik; Riegel, Barbara; Stjernman, Henrik; Hollman Frisman, Gunilla

    2016-01-01

    Inflammatory bowel disease (IBD) is a chronic disease of unknown etiology. The disease occurs early in life and the burden of symptoms is significant. Patients need to perform self-care to handle their symptoms, but knowledge about what kind of self-care patients do is limited and these individuals need to learn how to manage the symptoms that arise. The aim of this study was to explore self-care among patients with IBD. Twenty adult patients with IBD, 25–66 years of age, were interviewed. Data were analyzed by performing a qualitative content analysis. Four categories with 10 subcategories emerged from the analysis of the interviews. The self-care patients perform consists of symptom recognition (subcategories: physiological sensations and psychological sensations), handling of symptoms (subcategories: adapting the diet, using medical treatment, stress management, and using complementary alternative medicine), planning life (subcategories: planning for when to do activities and when to refrain from activities), and seeking new options (subcategories: seeking knowledge and personal contacts). Self-care consists of symptom recognition, handling life through planning, and accommodating the existing situation with the ultimate goal of maintaining well-being. Being one step ahead facilitates living with IBD. A decision to actively participate in care of a chronic illness is a prerequisite for self-care. Healthcare professionals must consider patients' potential for and desire for self-care when giving advice on self-care activities. Doing so may help people better cope with IBD. PMID:26166423

  6. Health Care Providers and Dying Patients: Critical Issues in Terminal Care.

    ERIC Educational Resources Information Center

    Benoliel, Jeanne Quint

    1988-01-01

    Identifies three major areas of concern in relationship between health care providers and dying patients: (1) nature of difficulties and stresses associated with terminal care; (2) education of providers for work; and (3) influence of organizational structure and institutionalized values on services for dying patients and families. Reviews…

  7. The emotional experience of patient care: a case for innovation in health care design.

    PubMed

    Altringer, Beth

    2010-07-01

    This paper considers recent developments in health care facility design and in the psychology literature that support a case for increased design sensitivity to the emotional experience of patient care. The author discusses several examples of innovative patient-centred health care design interventions. These generally resulted in improvements in the patient and staff experience of care, at less cost than major infrastructural interventions. The paper relates these developments in practice with recent neuroscience research, illustrating that the design of the built environment influences patient emotional stress. In turn, patient emotional stress appears to influence patient satisfaction, and in some instances, patient outcomes. This paper highlights the need for further research in this area.

  8. Impact of Patient Empathy Modeling on Pharmacy Students Caring for the Underserved

    PubMed Central

    Chen, Judy T.; LaLopa, Joseph

    2008-01-01

    Objective To determine the impact of the Patient Empathy Modeling pedagogy on students' empathy towards caring for the underserved during an advanced pharmacy practice experience (APPE). Design Pharmacy students completing an APPE at 2 primary care clinics participated in a Patient Empathy Modeling assignment for 10 days. Each student “became the patient,” simulating the life of an actual patient with multiple chronic diseases who was coping with an economic, cultural, or communication barrier to optimal healthcare. Students completed the Jefferson Scale of Physician Empathy (JSPE) before and after completing the assignment, and wrote daily journal entries and a reflection paper. Assessment Twenty-six students completed the PEM exercises from 2005-2006. Scores on the JSPE improved. Students' comments in journals and reflection papers revealed 3 major themes: greater appreciation of the difficulty patients have with adherence to medication and treatment regimens, increased empathy for patients from different backgrounds and patients with medical and psychosocial challenges, and improved ability to apply the lessons learned in the course to their patient care roles. Conclusion A Patient Empathy Modeling assignment improved pharmacy students' empathy toward underserved populations. Integrating the assignment within an APPE allowed students to immediately begin applying the knowledge and insight gained from the exercise. PMID:18483606

  9. Improving the care of cancer patients: holistic needs assessment.

    PubMed

    Young, Jenny; Cund, Audrey; Renshaw, Marian; Quigley, Angela; Snowden, Austyn

    This discussion paper presents a review of holistic needs assessments (HNAs) in the care of patients with cancer. HNAs entail a structured review of patient needs as articulated by the patient. This discussion then leads to a care plan grounded in issues pertinent to that patient. Despite policy guidance advocating its use, there are barriers to overcome in order to integrate HNAs into routine care. This article discusses what role communication skills and clinician confidence may have on the use of HNAs in practice, and suggests a strategy to support HNAs becoming the norm. PMID:25723367

  10. Improving the care of cancer patients: holistic needs assessment.

    PubMed

    Young, Jenny; Cund, Audrey; Renshaw, Marian; Quigley, Angela; Snowden, Austyn

    This discussion paper presents a review of holistic needs assessments (HNAs) in the care of patients with cancer. HNAs entail a structured review of patient needs as articulated by the patient. This discussion then leads to a care plan grounded in issues pertinent to that patient. Despite policy guidance advocating its use, there are barriers to overcome in order to integrate HNAs into routine care. This article discusses what role communication skills and clinician confidence may have on the use of HNAs in practice, and suggests a strategy to support HNAs becoming the norm.

  11. Wound care issues in the patient with cancer.

    PubMed

    Gerlach, Mary A

    2005-06-01

    As cancer continues to represent a major health problem in the United States and in other developed countries, MCWs will continue to represent a complex problem for patients and health care professionals alike. Goals of care may range from healing to palliation, depending on the underlying pathology and patient preferences regarding their personal goals of wound or disease management. Palliative wound care should focus on patient comfort and quality of life as the goals, instead of wound. As evidence related to wound healing, products, and technology continues to increase,nurses can be at the forefront of putting into practice the science of wound healing for the benefit of patients.

  12. Patient satisfaction surveys and quality of care: an information paper.

    PubMed

    Farley, Heather; Enguidanos, Enrique R; Coletti, Christian M; Honigman, Leah; Mazzeo, Anthony; Pinson, Thomas B; Reed, Kevin; Wiler, Jennifer L

    2014-10-01

    With passage of the Patient Protection and Affordable Care Act of 2010, payment incentives were created to improve the "value" of health care delivery. Because physicians and physician practices aim to deliver care that is both clinically effective and patient centered, it is important to understand the association between the patient experience and quality health outcomes. Surveys have become a tool with which to quantify the consumer experience. In addition, results of these surveys are playing an increasingly important role in determining hospital payment. Given that the patient experience is being used as a surrogate marker for quality and value of health care delivery, we will review the patient experience-related pay-for-performance programs and effect on emergency medicine, discuss the literature describing the association between quality and the patient-reported experience, and discuss future opportunities for emergency medicine. PMID:24656761

  13. [Strategies for improving care of oncologic patients: SHARE Project results].

    PubMed

    Reñones Crego, María de la Concepción; Fernández Pérez, Dolores; Vena Fernández, Carmen; Zamudio Sánchez, Antonio

    2016-01-01

    Cancer treatment is a major burden for the patient and its family that requires an individualized management by healthcare professionals. Nurses are in charge of coordinating care and are the closest healthcare professionals to patient and family; however, in Spain, there are not standard protocols yet for the management of oncology patients. The Spanish Oncology Nursing Society developed between 2012 and 2014 the SHARE project, with the aim of establishing strategies to improve quality of life and nursing care in oncology patients. It was developed in 3 phases. First, a literature search and review was performed to identify nursing strategies, interventions and tools to improve cancer patients' care. At the second stage, these interventions were agreed within a group of oncology nursing experts; and at the third phase, a different group of experts in oncology care categorized the interventions to identify the ones with highest priority and most feasible to be implemented. As a result, 3 strategic actions were identified to improve nursing care during cancer treatment: To provide a named nurse to carry out the follow up process by attending to the clinic or telephonic consultation, develop therapeutic education with adapted protocols for each tumor type and treatment and ensure specific training for nurses on the management of the cancer patients. Strategic actions proposed in this paper aim to improve cancer patients' healthcare and quality of life through the development of advanced nursing roles based on a higher level of autonomy, situating nurses as care coordinators to assure an holistic care in oncology patients.

  14. Patient stress in intensive care: comparison between a coronary care unit and a general postoperative unit

    PubMed Central

    Dias, Douglas de Sá; Resende, Mariane Vanessa; Diniz, Gisele do Carmo Leite Machado

    2015-01-01

    Objective To evaluate and compare stressors identified by patients of a coronary intensive care unit with those perceived by patients of a general postoperative intensive care unit. Methods This cross-sectional and descriptive study was conducted in the coronary intensive care and general postoperative intensive care units of a private hospital. In total, 60 patients participated in the study, 30 in each intensive care unit. The stressor scale was used in the intensive care units to identify the stressors. The mean score of each item of the scale was calculated followed by the total stress score. The differences between groups were considered significant when p < 0.05. Results The mean ages of patients were 55.63 ± 13.58 years in the coronary intensive care unit and 53.60 ± 17.47 years in the general postoperative intensive care unit. For patients in the coronary intensive care unit, the main stressors were “being in pain”, “being unable to fulfill family roles” and “being bored”. For patients in the general postoperative intensive care unit, the main stressors were “being in pain”, “being unable to fulfill family roles” and “not being able to communicate”. The mean total stress scores were 104.20 ± 30.95 in the coronary intensive care unit and 116.66 ± 23.72 (p = 0.085) in the general postoperative intensive care unit. When each stressor was compared separately, significant differences were noted only between three items. “Having nurses constantly doing things around your bed” was more stressful to the patients in the general postoperative intensive care unit than to those in the coronary intensive care unit (p = 0.013). Conversely, “hearing unfamiliar sounds and noises” and “hearing people talk about you” were the most stressful items for the patients in the coronary intensive care unit (p = 0.046 and 0.005, respectively). Conclusion The perception of major stressors and the total stress score were similar between patients

  15. Mexican patient satisfaction in a rural Minnesota primary care clinic.

    PubMed

    Rogers, Katelyn

    2008-08-01

    The Latino population in rural Minnesota has grown significantly in recent years. Despite the increase, few studies have considered whether these newcomers are satisfied with the care they receive from local medical clinics. This article describes the results of a pilot study that assessed 20 Mexican patients' satisfaction with care they received in a primary care clinic in rural central Minnesota. Participants were interviewed using questions from Stewart's Interpersonal Care Survey and open-ended questions. Results showed the patients were generally satisfied with their health care. However, they suggested improvements in the areas of communication and involvement in decisions. Answers to the open-ended questions suggested that even though patients seemed satisfied with their care, they still strongly desired a bilingual physician.

  16. Oral care of elderly patients: nurses' knowledge and views

    PubMed Central

    Preston, A; Punekar, S; Gosney, M

    2000-01-01

    It is important that healthcare professionals caring for the elderly in hospitals have a core knowledge of the orodental care requirements of their patients. The aim of this study was to determine the knowledge and views of nurses working on acute and rehabilitation care of the elderly wards about orodental care. One hundred nurses and healthcare assistants took part in this questionnaire study of which 58 were qualified nurses and 70 had been employed on care of the elderly wards for two or more years. Although the majority of the respondents were registered with a dentist and attended regularly, 40 did have `some anxiety' about visiting their dentist. Approximately half of the study population regularly gave advice to their patients about dental care but their knowledge of and reasons for providing oral care and advice was often incorrect. The group's understanding of the availability of dental treatment provided by the National Health Service was also often inaccurate. It was concluded that a better core knowledge of the orodental care of older patients is required by all healthcare professionals who care for this group. It is also important that individuals in whom anxiety is associated with their own dental experience do not neglect to give orodental health advice to their patients.


Keywords: oral care; elderly; nurses' knowledge PMID:10644385

  17. Maternal critical care: what can we learn from patient experience? A qualitative study

    PubMed Central

    Hinton, Lisa; Locock, Louise; Knight, Marian

    2015-01-01

    Objective For every maternal death, nine women develop severe maternal morbidity. Many of those women will need care in an intensive care unit (ICU) or high dependency unit (HDU). Critical care in the context of pregnancy poses distinct issues for staff and patients, for example, with breastfeeding support and separation from the newborn. This study aimed to understand the experiences of women who experience a maternal near miss and require critical care after childbirth. Setting Women and some partners from across the UK were interviewed as part of a study of experiences of near-miss maternal morbidity. Design A qualitative study, using semistructured interviews. Participants A maximum variation sample was recruited of 35 women and 11 partners of women who had experienced a severe maternal illness, which without urgent medical attention would have led to her death. 18 of the women were admitted to ICU or HDU. Results The findings are presented in three themes: being in critical care; being a new mother in critical care; transfer and follow-up after critical care. The study highlights the shock of requiring critical care for new mothers and the gulf between their expectations of birth and what actually happened; the devastation of being separated from their baby, how valuable access to their newborn was, if possible, and the importance of breast feeding; the difficulties of transfer and the need for more support; the value of follow-up and outreach to this population of critical care patients. Conclusions While uncommon, critical illness in pregnancy can be devastating for new mothers and presents a challenge for critical care and maternity staff. This study provides insights into these challenges and recommendations for overcoming them drawn from patient experiences. PMID:25916486

  18. Patient Care, Communication, and Safety in the Mammography Suite.

    PubMed

    Arnold, Leisa

    2016-09-01

    Producing high-quality mammograms requires excellent technical skills along with exemplary communication. Mammographers must be able to address differences in patients' mental states, body habitus, and physical ability to obtain an optimal examination. In addition, every mammographer must practice consistently with patient safety, care, and satisfaction in mind. This article discusses verbal and nonverbal communication strategies, barriers to communication, and the care and safety of patients in the mammography suite who present special challenges. PMID:27601710

  19. Exemplary care of the palliative patient: the journey shared.

    PubMed

    Perry, Beth

    2005-01-01

    Critical care involves caring for complex and acute needs of patients with life-threatening conditions. Despite skilful interventions, there are times when the care needed by patients and their families is primarily palliative. In this article, the author focuses on examples of ways nurses can make the palliative care they provide exemplary. Based on findings of a research study of outstanding palliative care nurses, the researcher describes the possible effect providing excellent palliative care may have on both the patient and the caregiver. Critical care nurses are often called to stand in the shadow of grief that accompanies death. Yet in doing so, these caregivers can be molded into more caring and compassionate people, and more exemplary nurses. Nurses in critical care are challenged daily to meet the multiple needs of patients and their families. Though state of the art technology, medications and advanced skills may save many lives, there are times when the care that is required is palliative. It is in these instances that a nurse 's strength and courage may be tested. By taking up this challenge, and sharing the final journey with patients, a nurse may learn many lessons. In part, caregivers may come to see that sometimes death is neither an enemy, nor a failure. Rather, sometimes death can lead to a more joyous embracing of life. Sometimes death is the only way that suffering can be erased. This article includes a description of key ways critical care nurses may address the needs of patients who are palliative. Specifically, the themes of helping people live on, individualizing care, defending human dignity, sensitive listening, sharing hope, and keeping the promise to never abandon are described. These themes all fall under the overarching theme of simple gestures, which is also described in this report. PMID:17725264

  20. Caring for Southeast Asian refugee patients in the USA.

    PubMed Central

    Muecke, M A

    1983-01-01

    This paper concerns care of refugees from Southeast Asia who speak little English and are relatively unfamiliar with the formal health care system in the United States. It aims to demystify the behaviors of refugee patients and to support health practitioners who are attempting to care for them. Western medicine is discussed in terms of the expectations that refugees tend to hold of it, and of the conflicts with Southeast Asian beliefs and practices which it presents. Despite language differences, health care agents can increase the effectiveness of their communication with persons from Southeast Asia, primarily by allowing for their viewpoints. Topics discussed are: the first encounter with a refugee patient; use of interpreters; obtaining informed consent; "the passive obedient" patient; the "non-compliant" patient; body image; sources of social support for healing; use of medications; traditional self-care practices; and death and depression. PMID:6829826

  1. When patients are stressed, in pain, suggest palliative care.

    PubMed

    2016-06-01

    Case managers are in a good position to recognize patients who have serious medical problems that are causing them and their family members stress, and refer them for a palliative care consultation, experts say. The palliative care team coordinates with the team providing medical care and helps control pain and other physical symptoms, relieves depression and anxiety, and provides support and spiritual help for the patient and family. The core palliative care team typically includes a medical specialist, a nurse who also acts as a case manager, a social worker, and a spiritual counselor. Palliative care improves outcomes and patient satisfaction when patients have a consultation early in the stay or even in the emergency department. PMID:27323510

  2. The Cancer Experience Map: An Approach to Including the Patient Voice in Supportive Care Solutions

    PubMed Central

    2015-01-01

    The perspective of the patient, also called the “patient voice”, is an essential element in materials created for cancer supportive care. Identifying that voice, however, can be a challenge for researchers and developers. A multidisciplinary team at a health information company tasked with addressing this issue created a representational model they call the “cancer experience map”. This map, designed as a tool for content developers, offers a window into the complex perspectives inside the cancer experience. Informed by actual patient quotes, the map shows common overall themes for cancer patients, concerns at key treatment points, strategies for patient engagement, and targeted behavioral goals. In this article, the team members share the process by which they created the map as well as its first use as a resource for cancer support videos. The article also addresses the broader policy implications of including the patient voice in supportive cancer content, particularly with regard to mHealth apps. PMID:26022846

  3. The cancer experience map: an approach to including the patient voice in supportive care solutions.

    PubMed

    Hall, Leslie Kelly; Kunz, Breanne F; Davis, Elizabeth V; Dawson, Rose I; Powers, Ryan S

    2015-05-28

    The perspective of the patient, also called the "patient voice", is an essential element in materials created for cancer supportive care. Identifying that voice, however, can be a challenge for researchers and developers. A multidisciplinary team at a health information company tasked with addressing this issue created a representational model they call the "cancer experience map". This map, designed as a tool for content developers, offers a window into the complex perspectives inside the cancer experience. Informed by actual patient quotes, the map shows common overall themes for cancer patients, concerns at key treatment points, strategies for patient engagement, and targeted behavioral goals. In this article, the team members share the process by which they created the map as well as its first use as a resource for cancer support videos. The article also addresses the broader policy implications of including the patient voice in supportive cancer content, particularly with regard to mHealth apps.

  4. Case management in an acute-care hospital: collaborating for quality, cost-effective patient care.

    PubMed

    Grootveld, Kim; Wen, Victoria; Bather, Michelle; Park, Joan

    2014-01-01

    Case management has recently been advanced as a valuable component in achieving quality patient care that is also cost-effective. At St. Michael's Hospital, in Toronto, Ontario, case managers from a variety of professional backgrounds are central to a new care initiative--Rapid Assessment and Planning to Inform Disposition (RAPID)--in the General Internal Medicine (GIM) Unit that is designed to improve patient care and reconcile high emergency department volumes through "smart bed spacing." Involved in both planning and RAPID, GIM's case managers are the link between patient care and utilization management. These stewards of finite resources strive to make the best use of dollars spent while maintaining a commitment to quality care. Collaborating closely with physicians and others across the hospital, GIM's case managers have been instrumental in bringing about significant improvements in care coordination, utilization management and process redesign. PMID:24844723

  5. Communicating with Patients with Special Health Care Needs.

    PubMed

    Espinoza, Kimberly M; Heaton, Lisa J

    2016-07-01

    People with special health care needs (PSHCN) often have difficulty communicating with providers in health care settings, including dental practices. This difficulty can affect access to care as well as the quality of care received. This article provides practical tips and tools dental professionals can use to facilitate communication for a diverse population of PSHCNs. The article discusses communication needs of patients with communication disorders; augmentative and alternative communication; and communication for patients with intellectual disability, psychiatric conditions; and dental fears. Examples are given of communication breakdowns, and descriptions of how communication challenges can be resolved. PMID:27264858

  6. MASSIVE TRANSFUSION PROTOCOL: STANDARDIZING CARE TO IMPROVE PATIENT OUTCOMES.

    PubMed

    Porteous, Joan

    2015-06-01

    Providing rapid response is a primary goal when caring for surgical patients with injuries involving massive blood loss. Massive transfusion protocols have been developed in some tertiary care health care facilities to ensure a rapid and efficient response in the provision of care to patients with a massive and uncontrolled hemorrhage. The purpose of this article is to discuss a massive transfusion protocol and to describe the process used to implement a massive transfusion protocol at Winnipeg's Health Sciences Centre (the site) as well as to describe its impact in the operating room department. PMID:26310036

  7. Evaluation of a Collaborative Care Model for Hospitalized Patients.

    PubMed

    McKay, Cheryl; Wieck, K Lynn

    2014-01-01

    The current lack of collaborative care is contributing to higher mortality rates and longer hospital stays in the United States. A method for improving collaboration among health professionals for patients with congestive heart failure, the Clinical Integration Model (CIM), was implemented. The CIM utilized a process tool called the CareGraph to prioritize care for the interdisciplinary team. The CareGraph was used to focus communication and treatment strategies of health professionals on the patient rather than the discipline or specific task. Hospitals who used the collaborative model demonstrated shorter lengths of stay and cost per case.

  8. MASSIVE TRANSFUSION PROTOCOL: STANDARDIZING CARE TO IMPROVE PATIENT OUTCOMES.

    PubMed

    Porteous, Joan

    2015-06-01

    Providing rapid response is a primary goal when caring for surgical patients with injuries involving massive blood loss. Massive transfusion protocols have been developed in some tertiary care health care facilities to ensure a rapid and efficient response in the provision of care to patients with a massive and uncontrolled hemorrhage. The purpose of this article is to discuss a massive transfusion protocol and to describe the process used to implement a massive transfusion protocol at Winnipeg's Health Sciences Centre (the site) as well as to describe its impact in the operating room department.

  9. Teaching in crisis. Patient and family education in critical care.

    PubMed

    Palazzo, M O

    2001-03-01

    Although the critical care setting is not always a positive teaching environment, it is possible to achieve the goal of optimal patient and family education. The critical care nurse must understand the unique learning needs of patients and families who are experiencing a life crisis a recognize that there are substantial obstacles to overcome to educate in this setting. In addition, it takes experience and resources to develop the teaching skills of the bedside nurse, so that those teachable moments are easily recognized and suitably used to give patients and family members valuable information in small doses. The advanced practice nurse is an essential nursing resource who can spearhead the development of teaching skills for all members of the health care team. In addition, the advanced practice nurse is a clinical expert who can assess the educational needs of patients and their families and provide more detailed and individualized health information from a different perspective. Achieving good patient and family education outcomes is possible when patient care continuity is a priority and the advanced practice nurse is an active part of the nursing team. Exploring the use of new technologies and resources to meet patient and family education needs is absolutely necessary. As hospitals continue to evolve and react to the financial demands placed on them, nursing leadership and critical care nurses will need to articulate clearly all of the essential components of patient care, including patient and family education. In keeping with the rich nursing tradition of patient and family education, critical care nurses and advanced practice nurses have the opportunity to demonstrate their unique teaching skills and continue to promote health education as a priority of patient care.

  10. Meeting patients' needs: quality care in a changing environment.

    PubMed

    Rogut, L; Hudson, A

    1995-11-01

    Recent surveys of patients in New York and Cleveland, among other cities, indicate that there is substantial room for improvement in meeting patients' needs and preferences, particularly in the areas of emotional support, coordination of care, discharge preparation, and the involvement of family and friends. Hospitals are using a variety of techniques to improve patient care and organizational efficiency in this challenging environment. One prominent approach, reengineering, offers a means by which hospitals can integrate highly specialized departmental structures and functions by focusing on interdisciplinary teamwork and organizing the delivery of care around patients. Key elements of successful hospital reengineering efforts have included: - the involvement and commitment of senior management and other key stakeholders, particularly physicians, nurses, and union representatives; - investment in staff training and retraining, and the redesign of staff evaluation and compensation systems; - timely, unit-specific measures of patient satisfaction and the clinical quality of care; - consistent and frequent internal communication between staff and leadership; and - treatment that emphasizes communication among caregivers, patients, and their family members. Several basic issues need to be addressed if hospitals are to offer technically sophisticated medical care that is also responsive to their patients' personal needs, including: - variations among patients regarding the amount of information they want and need, and the amount of involvement they want in their care; - the means by which patients will get information about their medical care, and who will provide any additional support that may be needed by non-English-speaking or socioeconomically disadvantaged patients; and - the specific changes in medical practice and hospital processes that will promote the involvement of patients in their care. PMID:10164376

  11. Evaluating the care of patients with long term conditions

    PubMed Central

    Ahluwalia, Sanjiv

    2014-01-01

    Approaches to evaluating the care of patients with long-term conditions first need to be framed around defining outcomes that ‘matter to people’, rather than those that are focused on disease and easily measurable. Secondly, approaches to evaluating such care should be organised with the ability to ‘deliver what matters to people’ – such models of care must allow for the opportunity to maximise the impact of primary care. Finally, any approach to evaluation must also ‘enable the delivery of what matters to people’, including approaches to promote self-care, well-being and interprofessional workforce development organised around educational networks. PMID:25949734

  12. Developing patient-centered teams: The role of sharing stories about patients and patient care.

    PubMed

    Bennett, Ariana H; Hassinger, Jane A; Martin, Lisa A; Harris, Lisa H; Gold, Marji

    2015-09-01

    Research indicates that health care teams are good for staff, patients, and organizations. The characteristics that make teams effective include shared objectives, mutual respect, clarity of roles, communication, trust, and collaboration. We were interested in examining how teams develop these positive characteristics. This paper explores the role of sharing stories about patients in developing patient-centered teams. Data for this paper came from 1 primary care clinic as part of a larger Providers Share Workshop study conducted by the University of Michigan. Each workshop included 5 facilitated group sessions in which staff met to talk about their work. This paper analyzes qualitative data from the workshops. Through an iterative process, research team members identified major themes, developed a coding scheme, and coded transcripts for qualitative data analysis. One of the most powerful ways group members connected was through sharing stories about their patients. Sharing clinical cases and stories helped participants bond around their shared mission of patient-centered care, build supportive relationships, enhance compassion for patients, communicate and resolve conflict, better understand workflows and job roles, develop trust, and increase morale. These attributes highlighted by participants correspond to those documented in the literature as important elements of teambuilding and key indicators of team effectiveness. The sharing of stories about patients seems to be a promising tool for positive team development in a primary care clinical setting and should be investigated further. PMID:26348238

  13. Developing patient-centered teams: The role of sharing stories about patients and patient care.

    PubMed

    Bennett, Ariana H; Hassinger, Jane A; Martin, Lisa A; Harris, Lisa H; Gold, Marji

    2015-09-01

    Research indicates that health care teams are good for staff, patients, and organizations. The characteristics that make teams effective include shared objectives, mutual respect, clarity of roles, communication, trust, and collaboration. We were interested in examining how teams develop these positive characteristics. This paper explores the role of sharing stories about patients in developing patient-centered teams. Data for this paper came from 1 primary care clinic as part of a larger Providers Share Workshop study conducted by the University of Michigan. Each workshop included 5 facilitated group sessions in which staff met to talk about their work. This paper analyzes qualitative data from the workshops. Through an iterative process, research team members identified major themes, developed a coding scheme, and coded transcripts for qualitative data analysis. One of the most powerful ways group members connected was through sharing stories about their patients. Sharing clinical cases and stories helped participants bond around their shared mission of patient-centered care, build supportive relationships, enhance compassion for patients, communicate and resolve conflict, better understand workflows and job roles, develop trust, and increase morale. These attributes highlighted by participants correspond to those documented in the literature as important elements of teambuilding and key indicators of team effectiveness. The sharing of stories about patients seems to be a promising tool for positive team development in a primary care clinical setting and should be investigated further.

  14. Intensive care patients' evaluations of the informed consent process.

    PubMed

    Clark, Paul Alexander

    2007-01-01

    This study examines the informed consent process from the perspective of intensive care patients. Using the largest single-method database of patient-derived information in the United States, we systematically outlined and tested several key factors that influence patient evaluations of the intensive care unit (ICU) informed consent process. Measures of information, understanding, and decision-making involvement were found to predict overall patient satisfaction and patient loyalty intentions. Specific actions supportive of ICU informed consent, such as giving patients information on advance directives, patient's rights, and organ donation, resulted in significantly higher patient evaluation scores with large effect sizes. This research suggests that the effectiveness of the informed consent process in the ICU from the patient's perspective can be measured and evaluated and that ICU patients place a high value on the elements of the informed consent process. PMID:17704678

  15. [Nursing care systematization for outpatient treatment care of patients with multiple sclerosis].

    PubMed

    Corso, Nair Assunta Antônia; Gondim, Ana Paula Soares; Dalmeida, Patrícia Chagas Rocha; Albuquerque, Maria Girlene de Freitas

    2013-06-01

    An experience report of nurses in the implementation of care systematization in ambulatory care in an interdisciplinary care center for patients with multiple sclerosis of a public hospital in Fortaleza, Ceará, Brazil. This implementation is based on the NANDA International, Inc., Nursing Interventions Classification, and Nursing Outcomes Classifications. One of the results concerns systemized nursing care, which has enabled the identification and understanding of the responses of MS patients to potential and current health problems. Systematization entails expanding knowledge through a practice based on approach and encourage further research scientific evidence, in addition to promoting the role of the nurse in acomprehensive approachand encourage further research.

  16. Point of care and patient privacy: who is in control?

    PubMed

    Morgan, J D

    1994-05-01

    Public and patient access to medical records has been severely limited through policies limiting physical and timely access and intellectual understanding of content. New expectations of patient/public access and control have arisen accompanying the new paradigms of health care delivery and health information (computer-based patient records). Examples from these new paradigms are personalized and presented in information system contexts from bedside to community settings. Patient and family involvement in care delivery, education, assessment, and control of privacy are explored. A personalized confidentiality/security/privacy module of the computer-based patient record is suggested.

  17. Look Through Patients' Eyes to Improve the Delivery of Care.

    PubMed

    2016-07-01

    By developing and implementing a method for seeing the healthcare experience from the standpoint of patients and family members, the University of Pittsburgh Medical Center has improved care delivery, lowered costs, and improved patient satisfaction. Cross-functional, multidisciplinary teams use a six-step patient and family-centered care methodology to identify gaps and develop changes that will improve the patient experience and clinical outcomes. Committee members shadow patients and family members to get firsthand knowledge about what they are going through and what goes wrong and what goes right. The teams proposed minor and major changes, but none involve adding more staff and few involve more expenditures. PMID:27434940

  18. Commercial filming of patient care activities in hospitals.

    PubMed

    Geiderman, Joel M; Larkin, Gregory L

    2002-07-17

    Commercial filming of patient care activities is common in hospital settings. This article reviews common circumstances in which patients are commercially filmed, explores the potential positive and negative aspects of filming, and considers the ethical and legal issues associated with commercial filming of patients in hospital settings. We examine the competing goals of commercial filming and the duties of journalists vs the rights of patients to privacy. Current standards and recommendations for commercial filming of patient care activities are reviewed and additional recommendations are offered.

  19. Integration and Task Allocation: Evidence from Patient Care*

    PubMed Central

    David, Guy; Rawley, Evan; Polsky, Daniel

    2013-01-01

    Using the universe of patient transitions from inpatient hospital care to skilled nursing facilities and home health care in 2005, we show how integration eliminates task misallocation problems between organizations. We find that vertical integration allows hospitals to shift patient recovery tasks downstream to lower-cost organizations by discharging patients earlier (and in poorer health) and increasing post-hospitalization service intensity. While integration facilitates a shift in the allocation of tasks and resources, health outcomes either improved or were unaffected by integration on average. The evidence suggests that integration solves coordination problems that arise in market exchange through improvements in the allocation of tasks across care settings. PMID:24415893

  20. Nurses' Knowledge About Transgender Patient Care: A Qualitative Study.

    PubMed

    Carabez, Rebecca M; Eliason, Michele J; Martinson, Marty

    2016-01-01

    This study explored practicing nurses' knowledge of the needs of transgender patients. Structured interviews were conducted with 268 nurses in the San Francisco Bay Area. This study focused on the responses to 1 item in the 16-item interview, "Describe health care issues that are particular to transgender patients." Three themes emerged from the data: discomfort, transition, and harsh consequences of being transgender. These findings revealed nurses' discomfort and lack of knowledge about transgender people and their health care needs. Nursing curricula must challenge the gender binary to better prepare nurses to provide quality care for patients of all genders. PMID:27490881

  1. [Music therapy, a partner in patient care].

    PubMed

    Métayer, Sabine

    2012-10-01

    Long time the preserve of psychiatry, music therapy is today used in general care. At Necker University Children's Hospital in Paris, it forms part of the treatment of multifactorial pain, with the collaboration of nursing teams. PMID:23092083

  2. Ensuring optimal health care for LGBT patients.

    PubMed

    Glasper, Alan

    2016-07-14

    Emeritus Professor Alan Glasper, from the University of Southampton, discusses a Royal College of Nursing policy that highlights the complexities of providing high-quality and non-discriminatory health care. PMID:27409790

  3. [Teaching patient-centered holistic care].

    PubMed

    Wung, Hwang-Ling; Chen, Huei-Ling; Hwu, Yueh-Juen

    2007-06-01

    Nursing education aims to help students understand concepts and gain competencies in holistic care. The purpose of this paper was to present a nursing curriculum that adapted and introduced holistic care into an adult nursing curriculum taught at a university of science and technology. The course framework included both holistic and nursing domains. The holistic aspect addressed client physical psychological-spiritual needs and related factors, health related factors, and the status of Maslow's hierarchy of needs and related factors. The nursing aspect addressed the way in which nursing was applied to identify client problems and provide individualized, integrated and continuous care in hospital, family or community based settings employing primary, secondary, or tertiary prevention. Scenario with problem based learning and concept mapping were used in class to guide students to consider in depth the concepts that underpin holistic care.

  4. Emergency Care for Homeless Patients: A French Multicenter Cohort Study

    PubMed Central

    Feral-Pierssens, Anne-Laure; Aubry, Adeline; Truchot, Jennifer; Raynal, Pierre-Alexis; Boiffier, Mathieu; Hutin, Alice; Leleu, Agathe; Debruyne, Geraud; Joly, Luc-Marie; Juvin, Philippe; Riou, Bruno

    2016-01-01

    Objectives. To determine whether homeless patients experience suboptimal care in the emergency department (ED) by the provision of fewer health care resources. Methods. We conducted a prospective multicenter cohort study in 30 EDs in France. During 72 hours in March 2015, all homeless patients that visited the participating EDs were included in the study. The primary health care service measure was the order by the physician of a diagnostic investigation or provision of a treatment in the ED. Secondary measures of health care services included ED waiting time, number and type of investigations per patient, treatment in the ED, and discharge disposition. Results. A total of 254 homeless patients and 254 nonhomeless patients were included. After excluding homeless patients that attended the ED for the sole purpose of housing, we analyzed 214 homeless and 214 nonhomeless. We found no significant difference between the 2 groups in terms of health care resource consumption, and for our secondary endpoints. Conclusions. We did not find significant differences in the level of medical care delivered in French EDs to homeless patients compared with matched nonhomeless patients. PMID:26985613

  5. How do patients with exacerbated chronic obstructive pulmonary disease experience care in the intensive care unit?

    PubMed Central

    Torheim, Henny; Kvangarsnes, Marit

    2014-01-01

    The aim was to gain insight into how patients with advanced chronic obstructive pulmonary disease (COPD) experience care in the acute phase. The study has a qualitative design with a phenomenological approach. The empirics consist of qualitative in-depth interviews with ten patients admitted to the intensive care units in two Norwegian hospitals. The interviews were carried out from November 2009 to June 2011. The data have been analysed through meaning condensation, in accordance with Amadeo Giorgi's four-step method. Kari Martinsen's phenomenological philosophy of nursing has inspired the study. An essential structure of the patients' experiences of care in the intensive care unit by acute COPD-exacerbation may be described as: Feelings of being trapped in a life-threatening situation in which the care system assumes control over their lives. This experience is conditioned not only by the medical treatment, but also by the entire interaction with the caregivers. The essence of the phenomenon is presented through three themes which describe the patient's lived experience: preserving the breath of life, vulnerable interactions and opportunities for better health. Acute COPD-exacerbation is a traumatic experience and the patients become particularly vulnerable when they depend on others for breathing support. The phenomenological analysis shows that the patients experience good care during breath of life preservation when the care is performed in a way that gives patients more insight into their illness and gives new opportunities for the future. PMID:24313779

  6. The Patient Protection and Affordable Care Act: what every provider of gynecologic oncology care should know.

    PubMed

    Duska, Linda R; Engelhard, Carolyn L

    2013-06-01

    The Patient Protection and Affordable Care Act (ACA) was signed into law by President Barack Obama in 2010. While initial implementation of the law began shortly thereafter, the full implementation will take place over the next few years. With respect to cancer care, the act was intended to make care more accessible, affordable, and comprehensive across different parts of the country. For our cancer patients and our practices, the ACA has implications that are both positive and negative. The Medicaid expansion and access to insurance exchanges are intended to increase the number of insured patients and thus improve access to care, but many states have decided to opt out of the Medicaid program and in these states access problems will persist. Screening programs will be put in place for insured patients but may supplant federally funded programs that are currently in place for uninsured patients and may not follow current screening guidelines. Both hospice and home health providers will be asked to provide more services with less funding, and quality measures, including readmission rates, will factor into reimbursement. Insured patients will have access to all phases of clinical trial research. There is a need for us as providers of Gynecologic Oncology care to be active in the implementation of the ACA in order to ensure that our patients and our practices can survive and benefit from the changes in health care reimbursement, with the ultimate goals of improving access to care and quality while reducing unsustainable costs. PMID:23500090

  7. Listening to patients changes clinicians' perspectives and improves care.

    PubMed

    Vidal, Kathleen

    2014-01-01

    This article shares strategies of an academic medical center and its system of hospitals in partnering with patients and families to create a climate in which patients, families, and clinicians are comfortable enough to ask questions, suggest alternatives, and even choose to disagree. Relationship-Based Care: A Model for Transforming Practice (Koloroutis, 2004) was instrumental in developing an interdisciplinary relationship-based model of care supported by 4 key processes (admission interview, daily rounds, discharge planning, and follow-up phone calls). These processes-along with patient/ family councils, patient/family/staff retreats, patient/family representation on hospital committees, and a patient experience bundle-have proven successful in aligning patient and family expectations with clinicians' care delivery, as reflected in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. A study suggesting the nature of caring as a nurse-driven activity may vary from caring as a patient-driven activity. Inspired engagement with Koloroutis and Trout (2012) See Me as A Person: Creating Therapeutic Relationships with Patients and Their Families; attunement, wondering, following, and holding build bridges between clinicians perceptions and knowledge, and patients knowledge and expectations.

  8. Patient Protection and Affordable Care Act

    THOMAS, 111th Congress

    Rep. Rangel, Charles B. [D-NY-15

    2009-09-17

    03/23/2010 Became Public Law No: 111-148. (TXT | PDF) (All Actions) Notes: H.R.4872 makes a number of health-related financing and revenue changes to this bill. Read together, this bill and the health care-related provisions of H.R.4872 are commonly referred to as the Affordable Care Act (ACA). Tracker: This bill has the status Became LawHere are the steps for Status of Legislation:

  9. [Interventional Patient Hygiene Model. A critical reflection on basic nursing care in intensive care units].

    PubMed

    Bambi, Stefano; Lucchini, Alberto; Solaro, Massimo; Lumini, Enrico; Rasero, Laura

    2014-01-01

    Interventional Patient Hygiene Model. A critical reflection on basic nursing care in intensive care units. Over the past 15 years, the model of medical and nursing care changed from being exclusively oriented to the diagnosis and treatment of acute illness, to the achievement of outcomes by preventing iatrogenic complications (Hospital Acquired Conditions). Nursing Sensitive Outcomes show as nursing is directly involved in the development and prevention of these complications. Many of these complications, including falls from the bed, use of restraints, urinary catheter associated urinary infections and intravascular catheter related sepsis, are related to basic nursing care. Ten years ago in critical care, a school of thought called get back to the basics, was started for the prevention of errors and risks associated with nursing. Most of these nursing practices involve hygiene and mobilization. On the basis of these reflections, Kathleen Vollman developed a model of nursing care in critical care area, defined Interventional Patient Hygiene (IPH). The IPH model provides a proactive plan of nursing interventions to strengthen the patients' through the Evidence-Based Nursing Care. The components of the model include interventions of oral hygiene, mobilization, dressing changes, urinary catheter care, management of incontinence and bed bath, hand hygiene and skin antisepsis. The implementation of IPH model follows the steps of Deming cycle, and requires a deep reflection on the priorities of nursing care in ICU, as well as the effective teaching of the importance of the basic nursing to new generations of nurses.

  10. A research agenda on patient safety in primary care. Recommendations by the LINNEAUS collaboration on patient safety in primary care

    PubMed Central

    Verstappen, Wim; Gaal, Sander; Bowie, Paul; Parker, Diane; Lainer, Miriam; Valderas, Jose M.; Wensing, Michel; Esmail, Aneez

    2015-01-01

    ABSTRACT Background: Healthcare can cause avoidable serious harm to patients. Primary care is not an exception, and the relative lack of research in this area lends urgency to a better understanding of patient safety, the future research agenda and the development of primary care oriented safety programmes. Objective: To outline a research agenda for patient safety improvement in primary care in Europe and beyond. Methods: The LINNEAUS collaboration partners analysed existing research on epidemiology and classification of errors, diagnostic and medication errors, safety culture, and learning for and improving patient safety. We discussed ideas for future research in several meetings, workshops and congresses with LINNEAUS collaboration partners, practising GPs, researchers in this field, and policy makers. Results: This paper summarizes and integrates the outcomes of the LINNEAUS collaboration on patient safety in primary care. It proposes a research agenda on improvement strategies for patient safety in primary care. In addition, it provides background information to help to connect research in this field with practicing GPs and other healthcare workers in primary care. Conclusion: Future research studies should target specific primary care domains, using prospective methods and innovative methods such as patient involvement. PMID:26339841

  11. Continuity of care for patients on a waiting list for institutional long-term care.

    PubMed

    Caris-Verhallen, W M; Kerkstra, A

    2001-01-01

    The aim of this study was to examine patients' satisfaction with continuity of care while on a waiting list for residential care or nursing home care. Two hundred and seventy-eight patients participated in the study, all living in the community setting of two cities in the Netherlands. These patients were positively assessed and on a waiting list for admission in a nursing home or a residential home. The respondents were interviewed by telephone, using a structured questionnaire. From the results, it appeared that people waiting for residential care are in general over 80 years of age and dependent on help for their daily activities. They used several types of home care facility, such as home help services, home nursing and meals on wheels. Patient satisfaction was moderately high as regards the supply of substitute care and the length of time it took to receive a home care package. There was dissatisfaction, however, with the coordination of care and the amount of information on procedures regarding the waiting list. Patients on the waiting list also reported a lack of guidance in case of problems and would not know where to turn to if their situation became more severe. The establishment of a service desk to provide information or real help in these circumstances is recommended.

  12. Clinician styles of care: transforming patient care at the intersection of leadership and medicine.

    PubMed

    Huynh, Ho P; Sweeny, Kate

    2014-11-01

    A key role of clinicians is to motivate their patients to initiate and maintain beneficial health behaviors. This article integrates research on transformational leadership, clinician-patient communication, and health behavior to introduce a novel approach to understanding and improving clinicians' effectiveness as motivators. We describe three dominant clinician styles or patterned approaches to patient care that derive from leadership theory (in order of least to most effective): laissez-faire, transactional, and transformational. Additionally, we suggest potential mediators and effects of the transformational style of care. Finally, we discuss future research directions for the study of clinician styles of care.

  13. Clinician styles of care: transforming patient care at the intersection of leadership and medicine.

    PubMed

    Huynh, Ho P; Sweeny, Kate

    2014-11-01

    A key role of clinicians is to motivate their patients to initiate and maintain beneficial health behaviors. This article integrates research on transformational leadership, clinician-patient communication, and health behavior to introduce a novel approach to understanding and improving clinicians' effectiveness as motivators. We describe three dominant clinician styles or patterned approaches to patient care that derive from leadership theory (in order of least to most effective): laissez-faire, transactional, and transformational. Additionally, we suggest potential mediators and effects of the transformational style of care. Finally, we discuss future research directions for the study of clinician styles of care. PMID:23864074

  14. Care of Patients at the End of Life: Advance Care Planning.

    PubMed

    Ackermann, Richard J

    2016-08-01

    Advance directives are legal documents that give instructions about how to provide care when patients develop life-threatening illnesses and can no longer communicate their wishes. Two types of documents are widely used-a living will and a durable power of attorney for health care. Most states also authorize physician orders for life-sustaining treatment. Physicians should encourage patients, particularly those with severe chronic or terminal conditions, to prepare advance directives. Medicare now reimburses billing codes for advance care consultations. Directions regarding cardiopulmonary resuscitation and artificial ventilation often are included in advance care plans, and use of artificial nutrition and hydration (ANH) also should be addressed, particularly for patients with advanced dementia. Evidence shows that in such patients, ANH does not prolong survival, increase comfort, or improve quality of life. Given the lack of benefit, physicians should recommend against use of ANH for patients with dementia. Finally, physicians should encourage use of hospice services by patients whose life expectancy is 6 months or less. Although Medicare and most other health care insurers cover hospice care, and despite evidence that patient and family satisfaction increase when hospice services are used, many patients do not use these services. PMID:27490070

  15. 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

  16. Taiwanese nurses' appraisal of a lecture on spiritual care for patients in critical care units.

    PubMed

    Shih, F J; Gau, M L; Mao, H C; Chen, C H

    1999-04-01

    The purpose of this study is to develop a lecture on spiritual care for adult critical care trainees, and to evaluate the trainees' appraisal of the effectiveness of this lecture in preparing them to provide spiritual care for their clients in a critical care setting. A between-method triangulation research design encompassing a questionnaire and descriptive qualitative content analysis was used. A convenience sample consisting of 64 registered nurses who attended an adult critical care nurse training programme in a leading medical centre in northern Taiwan were invited to participate in this study. A total of 64 female participants completed the questionnaire. Ninety-two per cent (59) of the subjects considered the lecture on spiritual care to be helpful in assisting them to provide holistic care for critically ill patients in the Intensive Care Unit (ICU). Three types of help were identified by the subjects: (1) help in clarifying the abstract concepts related to spiritual care (86%); (2) help in self-disclosing the nurses' personal beliefs and values regarding life goals, nursing, and spiritual needs (67%); (3) help in learning how to provide spiritual care to patients in a critical care setting (34%). Twenty per cent of the subjects thought that inclusion of the following content in the lecture would have been helpful to provide a more comprehensive picture of spiritual care: religious practices and rituals (11%); the culturally bonded nursing care plan (9%); the development of human spirituality (3%); patients' families' spiritual needs in the ICU (3%); and resources for nurses in providing spiritual care (2%). Thirteen per cent of the subjects suggested that the instructor might employ the following strategies to improve the quality of teaching: providing more empirical examples (5%); discussion with the students in classes of smaller size following the lecture or extending the instruction time (5%); and providing a syllabus with detailed information (3%).

  17. A new patient registration method for intensive care department management.

    PubMed

    Van Aken, P; Bossaert, L; Gilot, C; Tielemans, L

    1987-01-01

    A new method to describe intensive care department performance is presented. The method is a complication of available administrative and medical data, completed with a severity of illness measure (Acute Physiology And Chronic Health Evaluation, APACHE) and the registration of nursing care intensity. The development of this latter patient stratification system (Intensive Care Activity Score, INCAS) is described. The performance of the method is demonstrated by a study of 200 consecutive admissions.

  18. Improving haemophilia patient care through sharing best practice.

    PubMed

    de Moerloose, Philippe; Arnberg, Daniel; O'Mahony, Brian; Colvin, Brian

    2015-10-01

    At the 2014 Annual Congress of the European Haemophilia Consortium (EHC) held in Belfast, Northern Ireland, Pfizer initiated and funded a satellite symposium entitled: 'Improving Patient Care Through Sharing Best Practice'. Co-chaired by Brian Colvin (Pfizer Global Innovative Pharma Business, Rome, Italy) and Brian O'Mahony [President of the EHC, Brussels, Belgium], the symposium provided an opportunity to consider patient care across borders, to review how patient advocacy groups can successfully engage with policymakers in healthcare decision-making and to discuss the importance of patient involvement in data collection to help shape the future environment for people with haemophilia. Professor Philippe de Moerloose (University Hospitals and Faculty of Medicine of Geneva, Switzerland) opened the session by discussing the gap between the haemophilia management guidelines and the reality of care for many patients living in Europe, highlighting the importance of sharing of best practice and building a network of treaters and patient organisations to support the improvement of care across Europe. Daniel Arnberg (SCISS AB, Hägersten, Sweden) reviewed the health technology assessment process conducted in Sweden, the first for haemophilia products, as a case study, focusing on the role of the patient organisation. Finally, Brian O'Mahony reflected on the central role of patients as individuals and also within patient organisations in shaping the future of haemophilia care. PMID:26338268

  19. Improving haemophilia patient care through sharing best practice.

    PubMed

    de Moerloose, Philippe; Arnberg, Daniel; O'Mahony, Brian; Colvin, Brian

    2015-10-01

    At the 2014 Annual Congress of the European Haemophilia Consortium (EHC) held in Belfast, Northern Ireland, Pfizer initiated and funded a satellite symposium entitled: 'Improving Patient Care Through Sharing Best Practice'. Co-chaired by Brian Colvin (Pfizer Global Innovative Pharma Business, Rome, Italy) and Brian O'Mahony [President of the EHC, Brussels, Belgium], the symposium provided an opportunity to consider patient care across borders, to review how patient advocacy groups can successfully engage with policymakers in healthcare decision-making and to discuss the importance of patient involvement in data collection to help shape the future environment for people with haemophilia. Professor Philippe de Moerloose (University Hospitals and Faculty of Medicine of Geneva, Switzerland) opened the session by discussing the gap between the haemophilia management guidelines and the reality of care for many patients living in Europe, highlighting the importance of sharing of best practice and building a network of treaters and patient organisations to support the improvement of care across Europe. Daniel Arnberg (SCISS AB, Hägersten, Sweden) reviewed the health technology assessment process conducted in Sweden, the first for haemophilia products, as a case study, focusing on the role of the patient organisation. Finally, Brian O'Mahony reflected on the central role of patients as individuals and also within patient organisations in shaping the future of haemophilia care.

  20. Modalities of palliative care in hospitalized patients with advanced AIDS.

    PubMed

    Vincent, I; D'Hérouville, D; Moulin, P; Bugler, C; Fraval, J; Mallet, D; Salamagne, M H; Vildé, J L; Jodelet, D; Leport, C

    2000-04-01

    This prospective multidisciplinary survey started in October 1994. The survey assessed the modalities of care of hospitalized patients with advanced AIDS in an Infectious and Tropical Diseases Unit with regards to the practices of palliative care in a Palliative Care Unit. Seventy-eight (78) AIDS patients with CD4 < or = 30/mm3 who had 102 consecutive hospitalizations were recruited. Types (symptomatic or curative) and number of drugs administered to the patients, as well as biological and radiological investigations performed were recorded. Symptoms were concomitantly assessed on a weekly basis by self-evaluation of the patients themselves and by physicians. The results showed that the practices of care were different in the two units according to the specific goals and norms of each unit. A higher density of care was delivered at the Infectious and Tropical Diseases Unit. Symptoms assessed by both patients and physicians were underestimated by physicians in frequency and in intensity. In conclusion, an integrated approach including objective and subjective criteria should enable a better adjustment of the palliative and curative therapeutic strategies in advanced AIDS. These would concomitantly take into account the wishes of the patient and the goals regarding care in the unit where the patient is hospitalized.

  1. Overlap between empathy, teamwork and integrative approach to patient care.

    PubMed

    Hojat, Mohammadreza; Bianco, Joseph A; Mann, Douglas; Massello, David; Calabrese, Leonard H

    2014-10-14

    Abstract Background: Empathy, teamwork and an integrative approach to patient care share common denominators such as interpersonal skills and understanding patients' concerns. Thus, a significant overlap among measures of empathy, teamwork and integrative approach to patient care is expected. Aim: This study examined the magnitude of overlap (shared variance) among three measures of empathy, teamwork and an integrative approach to patient care. Methods: Three-hundred seventy-three medical students completed the Jefferson Scale of Empathy (JSE), the Jefferson Scale of Attitudes toward Physician-Nurse Collaboration (JSAPNC) and Integrative Patient Care (IPC). Results: Significant overlaps were found among the three measures (p < 0.01), ranging from 13% (r = 0.36), between JSAPNC and IPC, to 18% (r = 0.42), between JSE and JSAPNC, and 30% (r = 0.55) between JSE and IPC for the total sample. Pattern of findings was similar for men and women. In a multiple regression model, a significant multiple correlation (R = 0.60, p < 0.01) was obtained in correlating scores on the JSE with the JSAPNC, and IPC scores, controlling for gender effect (men = 0 and women = 1). Conclusions: The significant links between empathy, teamwork and IPC support the common denominator assumption. The findings that IPC shares common variance with empathy and teamwork have implications for medical education curriculum, suggesting that implementation of integrative patient care can improve empathic engagement in patient care and orientation toward teamwork.

  2. Relational sustainability: environments for long-term critical care patients.

    PubMed

    Mammen, Jens; Laude, Cum; Costello, Brenna

    2014-01-01

    Patients undergoing bone marrow transplant, using spinal cord services, and with traumatic brain injury represent a relatively new patient type, requiring both intense care and long-term care in the same facility. As medical advances allow these patients the opportunity to recover from their critical illnesses or injuries, designers and caregivers must give increased attention to the long-term critical care environment. Designing for this type of care requires an understanding of new technologies and the potential for the built environment to address the wide range of physical, sensory, and psychological issues long-term inpatients face. Recent work by SmithGroupJJR has provided valuable insights into the ways in which lighting, patient room and unit layouts, spatial volumes, and other design elements can contribute to the recovery of patients who must spend weeks or months in a critical care environment. This knowledge was gained through an approach that allows design professionals to immerse themselves in a health care institution's values, culture, and work processes. By mapping both operational flow and patients' experiences, project teams can develop design solutions that sustain the well-being of higher-acuity patients and their family members and caregivers.

  3. The care and feeding of your high-profile patients.

    PubMed

    Baum, Neil

    2013-01-01

    Doctors and practices enjoy, for the most part, taking care of a high-profile patient. However, with the gratification and ego boost that come from being "chosen" to care for these individuals, there are potential risks and decision-making principles that must not be compromised. As a physician, a high-profile patient is a patient and an individual in need of care and expertise, and medically is no different than any other patient who seeks evaluation and treatment. As a practice, there is a need to understand how to interact and manage the expectations of the high-profile patient. This article will discuss the advantages, risks, and obstacles of and staff preparation for managing such patients.

  4. Survey of home hemodialysis patients and nursing staff regarding vascular access use and care

    PubMed Central

    Spry, Leslie A; Burkart, John M; Holcroft, Christina; Mortier, Leigh; Glickman, Joel D

    2015-01-01

    Vascular access infections are of concern to hemodialysis patients and nurses. Best demonstrated practices (BDPs) have not been developed for home hemodialysis (HHD) access use, but there have been generally accepted practices (GAPs) endorsed by dialysis professionals. We developed a survey to gather information about training provided and actual practices of HHD patients using the NxStage System One HHD machine. We used GAP to assess training used by nurses to teach HHD access care and then assess actual practice (adherence) by HHD patients. We also assessed training and adherence where GAPs do not exist. We received a 43% response rate from patients and 76% response from nurses representing 19 randomly selected HHD training centers. We found that nurses were not uniformly instructing HHD patients according to GAP, patients were not performing access cannulation according to GAP, nor were they adherent to their training procedures. Identification of signs and symptoms of infection was commonly trained appropriately, but we observed a reluctance to report some signs and symptoms of infection by patients. Of particular concern, when aggregating all steps surveyed, not a single nurse or patient reported training or performing all steps in accordance with GAP. We also identified practices for which there are no GAPs that require further study and may or may not impact outcomes such as infection. Further research is needed to develop strategies to implement and expand GAP, measure outcomes, and ultimately develop BDP for HHD to improve infectious complications. PMID:25154423

  5. Receiving family of a patient in intensive care.

    PubMed

    Clavagnier, Isabelle

    2012-10-01

    Pierre is currently working in the intensive care unit (ICU). The rules for visitors are strict. Visiting time is short and only two persons are allowed at a time, in the patient's ward. Standards of hygiene have to be respected carefully. This evening Pierre accompanies the husband of a Japanese tourist whose health is in a critical condition. PMID:23092085

  6. Self-care behaviour of patients with heart failure.

    PubMed

    Jaarsma, T; Abu-Saad, H H; Dracup, K; Halfens, R

    2000-01-01

    Heart failure-related self-care behaviour is important to optimize outcomes for patients with heart failure. Such behaviours include adherence to medication, diet and exercise, but self-care also refers to such things as seeking assistance when symptoms occur, and daily weighing. The study aim was to describe heart failure-related self-care behaviour, to test the effect of education and support on self-care behaviour and to discuss limitations. Data were collected from 128 heart failure patients during their hospital stay and at 1-, 3-, and 9-month follow-ups. Concepts from Orem's general theory of nursing were used to describe heart failure-related self-care behaviour and its limitations. The effects of intensive systematized and planned education from a nurse in hospital and at home were evaluated in an experimental design. Results showed that education enhanced self-care behaviour significantly at 1 and 3 months after discharge. Despite intensive education and support, patients did not manifest all self-care behaviours that might be expected. Patients in both the intervention and control groups described limitations in knowledge, judgement/decision-making and skills. It can be concluded that supportive-educative intervention is effective in enhancing heart failure-related self-care behaviour early after discharge. To optimize such intervention, more emphasis must be placed on behavioural strategies (e.g. self-medication), social support (e.g. from family members) and reinforcement (e.g. home visits).

  7. When Residents Need Health Care: Stigma of the Patient Role

    ERIC Educational Resources Information Center

    Moutier, Christine; Cornette, Michelle; Lehrmann, Jon; Geppert, Cynthia; Tsao, Carol; DeBoard, Renee; Hammond, Katherine Green; Roberts, Laura Weiss

    2009-01-01

    Objective: Whether and under what circumstances medical residents seek personal health care is a growing concern that has important implications for medical education and patient welfare, but has not been thoroughly investigated. Barriers to obtaining care have been previously documented, but very little empirical work has focused on trainees who…

  8. [Measuring the sources of discomfort in patients in intensive care].

    PubMed

    Haubertin, Carole; Crozes, Fanny; Le Page, Melody; Seailles, Severine

    2016-05-01

    A study carried out in 2014 in a hospital focused on the sources of discomfort of patients in intensive care. Resulting in raised awareness across all disciplines, it has enabled the actions to be undertaken to improve professional practices to be prioritised, in a culture of compassionate care. PMID:27157560

  9. Self-care behaviour of patients with heart failure.

    PubMed

    Jaarsma, T; Abu-Saad, H H; Dracup, K; Halfens, R

    2000-01-01

    Heart failure-related self-care behaviour is important to optimize outcomes for patients with heart failure. Such behaviours include adherence to medication, diet and exercise, but self-care also refers to such things as seeking assistance when symptoms occur, and daily weighing. The study aim was to describe heart failure-related self-care behaviour, to test the effect of education and support on self-care behaviour and to discuss limitations. Data were collected from 128 heart failure patients during their hospital stay and at 1-, 3-, and 9-month follow-ups. Concepts from Orem's general theory of nursing were used to describe heart failure-related self-care behaviour and its limitations. The effects of intensive systematized and planned education from a nurse in hospital and at home were evaluated in an experimental design. Results showed that education enhanced self-care behaviour significantly at 1 and 3 months after discharge. Despite intensive education and support, patients did not manifest all self-care behaviours that might be expected. Patients in both the intervention and control groups described limitations in knowledge, judgement/decision-making and skills. It can be concluded that supportive-educative intervention is effective in enhancing heart failure-related self-care behaviour early after discharge. To optimize such intervention, more emphasis must be placed on behavioural strategies (e.g. self-medication), social support (e.g. from family members) and reinforcement (e.g. home visits). PMID:12035274

  10. Problems in Financing the Care of AIDS Patients.

    ERIC Educational Resources Information Center

    Ozawa, Martha N.; And Others

    1993-01-01

    Notes that financing care of patients with Acquired Immune Deficiency Syndrome (AIDS) has reached crisis proportions. Discusses how components of U.S. health care financing system attempt to minimize their financial exposure to AIDS. Presents remedies that have been suggested in literature. Points out flaws in current system for dealing with…

  11. An Integrated Care Initiative to Improve Patient Outcome in Schizophrenia

    PubMed Central

    Mayer-Amberg, Norbert; Woltmann, Rainer; Walther, Stefanie

    2016-01-01

    The optimal treatment of schizophrenia patients requires integration of medical and psychosocial inputs. In Germany, various health-care service providers and institutions are involved in the treatment process. Early and continuous treatment is important but often not possible because of the fragmented medical care system in Germany. The Integrated Care Initiative Schizophrenia has implemented a networked care concept in the German federal state of Lower Saxony that integrates various stakeholders of the health care system. In this initiative, office-based psychiatrists, specialized nursing staff, psychologists, social workers, hospitals, psychiatric institutional outpatient’s departments, and other community-based mental health services work together in an interdisciplinary approach. Much emphasis is placed on psychoeducation. Additional efforts cover socio-therapy, visiting care, and family support. During the period from October 2010 (start of the initiative) to December 2012, first experiences and results of quality indicators were collected of 713 registered patients and summarized in a quality monitoring report. In addition, standardized patient interviews were conducted, and duration of hospital days was recorded in 2013. By the end of 2012, patients had been enrolled for an average of 18.7 months. The overall patient satisfaction measured in a patient survey in June 2013 was high and the duration of hospital days measured in a pre–post analysis in July 2013 was reduced by 44%. Two years earlier than planned, the insurance fund will continue the successfully implemented Integrated Care Initiative and adopt it in the regular care setting. This initiative can serve as a learning case for how to set up and measure integrated care systems that may improve outcomes for patients suffering from schizophrenia. PMID:26779043

  12. An Integrated Care Initiative to Improve Patient Outcome in Schizophrenia.

    PubMed

    Mayer-Amberg, Norbert; Woltmann, Rainer; Walther, Stefanie

    2015-01-01

    The optimal treatment of schizophrenia patients requires integration of medical and psychosocial inputs. In Germany, various health-care service providers and institutions are involved in the treatment process. Early and continuous treatment is important but often not possible because of the fragmented medical care system in Germany. The Integrated Care Initiative Schizophrenia has implemented a networked care concept in the German federal state of Lower Saxony that integrates various stakeholders of the health care system. In this initiative, office-based psychiatrists, specialized nursing staff, psychologists, social workers, hospitals, psychiatric institutional outpatient's departments, and other community-based mental health services work together in an interdisciplinary approach. Much emphasis is placed on psychoeducation. Additional efforts cover socio-therapy, visiting care, and family support. During the period from October 2010 (start of the initiative) to December 2012, first experiences and results of quality indicators were collected of 713 registered patients and summarized in a quality monitoring report. In addition, standardized patient interviews were conducted, and duration of hospital days was recorded in 2013. By the end of 2012, patients had been enrolled for an average of 18.7 months. The overall patient satisfaction measured in a patient survey in June 2013 was high and the duration of hospital days measured in a pre-post analysis in July 2013 was reduced by 44%. Two years earlier than planned, the insurance fund will continue the successfully implemented Integrated Care Initiative and adopt it in the regular care setting. This initiative can serve as a learning case for how to set up and measure integrated care systems that may improve outcomes for patients suffering from schizophrenia. PMID:26779043

  13. An instrument assessing patient satisfaction with day care in hospitals

    PubMed Central

    2012-01-01

    Background Patient satisfaction is an important indicator of quality of care in hospitals. Reliable and valid instruments to measure clinical and outpatient satisfaction already exist. Recently hospitals have increasingly provided day care, i.e., admitting patients for one day without an overnight stay. This article describes the adaption of the ‘Core questionnaire for the assessment of Patient Satisfaction’ (COPS) for general Day care (COPS-D), and the subsequent validation of the COPS-D. Methods The clinical COPS was supplemented with items to cover two new dimensions: Pre-admission visit and Operation Room. It was sent to a sample of day care patients of five general Dutch hospitals to investigate dimensionality, acceptability, reliability, construct and external validity. Construct validity was established by correlating the dimensions of the COPS-D with patients’ overall satisfaction. Results The COPS-D was returned by 3802 patients (response 46%). Factor analysis confirmed its’ structure: Pre-intake visit, Admission, Operation room, Nursing care, Medical care, Information, Autonomy and Discharge and aftercare (extraction communality 0.63-0.90). The internal consistency of the eight dimensions was good (α = 0.82-0.90); the item internal consistency corrected for overlap was satisfactory (>0.40); all inter-item correlations were higher than 0.45 but not too high (<0.90). The construct validity of all dimensions was good (r from 0.52-0.62, p < 0.01). The Information dimension had the strongest correlation with overall day care satisfaction. Conclusions The COPS-D is a reliable and valid instrument for measuring satisfaction with day care. It complements the model of measuring patient satisfaction with clinical and outpatient care given in hospitals. It also fulfils the conditions made while developing the clinical and outpatient COPS: a short, core instrument to screen patient satisfaction. PMID:22624677

  14. Patient Education and Involvement in Care

    ERIC Educational Resources Information Center

    Andiric, Linda Reynolds

    2010-01-01

    A study conducted on patients who underwent total knee arthroplasty indicated that participants who were offered preadmission education for their procedure had statistically better outcomes than patients who had not attended an educational class. The study further focused on patients' confidence in their ability to take control of their health…

  15. The impact of managed care on patients' trust in medical care and their physicians.

    PubMed

    Mechanic, D; Schlesinger, M

    1996-06-01

    Social trust in health care organizations and interpersonal trust in physicians may be mutually supportive, but they also diverge in important ways. The success of medical care depends most importantly on patients' trust that their physicians are competent, take appropriate responsibility and control, and give their patients' welfare the highest priority. Utilization review and structural arrangements in managed care potentially challenge trust in physicians by restricting choice, contradicting medical decisions and control, and restricting open communication with patients. Gatekeeping and incentives to limit care also raise serious trust issues. We argue that managed care plans rather than physicians should be required to disclose financial arrangements, that limits be placed on incentives that put physicians at financial risk, and that professional norms and public policies should encourage clear separation of interests of physicians from health plan organization and finance. PMID:8637148

  16. The Caring Connections Project: Providing palliative care to Medicaid patients with advanced cancer.

    PubMed

    Pfeifer, Mark P; Ritchie, Christine; Scharfenberger, Jennifer; Keeney, Cynthia; Hermann, Carla; Berwick, Marilyn; Head, Barbara

    2006-01-01

    Palliative care, with its focus on symptom management, patient-centered goals, preparation for life's end, and preservation of quality of life in the face of advancing illness, is a rapidly advancing component of mainstream American medicine. Yet, access to palliative care is often lacking in the community setting and may be further hindered by the presence of healthcare disparities that impact the poor. This article presents a unique approach to assuring the availability of palliative care to Medicaid patients receiving case management services. This descriptive article describes the evolution of a palliative care management pilot program, the Caring Connections Program, beginning with the initial planning and progressing through implementation and provision of services to 56 persons. "Lessons learned" are shared to enable other providers to develop similar programs with success. Patient profiles and intervention strategies are offered to illustrate the work accomplished.

  17. The use of flange extenders to support patient care.

    PubMed

    Black, Pat

    Pat Black, Senior Lecturer, St Mark's Institute of GI Nursing, St Mark's Hospital, explores one option for stoma care nurses to consider that could help improve patient confidence and comfort. PMID:26973006

  18. The Impact of Technology on Patients, Providers, and Care Patterns.

    ERIC Educational Resources Information Center

    Fagerhaugh, Shizuko; And Others

    1980-01-01

    Examines the problems technical innovation has brought to health care professionals, administrators, and patients from the standpoints of increased specialization, equipment obsolescence, bureaucracy, retraining, regulations, high costs of services, depersonalization, and ethical dilemmas. (CT)

  19. [Sometimes We Should Maintain a Mental Distance from a Patient--Relevance to Caring for Cancer Patients in Denial].

    PubMed

    Akechi, Tatsuo

    2015-01-01

    In Japan, cancer has been the leading cause of death since 1981 and is the most common and representative life-threatening disease. Cancer treatment has markedly progressed, and so the development of cancer is now not necessarily a death sentence. Nevertheless, approximately half of cancer patients actually die as a result of the disease even today. Cancer causes marked suffering of patients. Patients with advanced and/or terminal cancer suffer from various physical symptoms and are forced to face a continuous decline in their physical function, and previous studies reported that psychological distress is frequently observed in cancer patients, especially in advanced and/or terminally ill patients. Several types of psychological defense mechanism, especially denial, are frequently observed in these patients. There are multiple levels of denial For example, a patient with true denial denies the presence of cancer itself, although true denial is quite rare. A patient with moderate denial is likely to deny an association between distressing symptoms and disease, while one with mild denial denies the life-threatening nature of disease. Denial is a psychological defense mechanism that often helps advanced cancer patients to manage their anxiety and depression. It allows such patients to continue living while facing the painfulness of their situation. In this situation, it is important for therapists to note the patient's denial. Simply being aware of the denial can, in itself, be supportive for the patient. However, when denial does not work adaptively, such as it prohibiting adherence to necessary treatment and not being useful for ameliorating psychological distress and improving the quality of life, medical staff may consider confronting a patient with the reality of the situation carefully. This paper discusses the relevance of acknowledging denial and caring for patients with denial from the point of view of psycho-oncology.

  20. [Sometimes We Should Maintain a Mental Distance from a Patient--Relevance to Caring for Cancer Patients in Denial].

    PubMed

    Akechi, Tatsuo

    2015-01-01

    In Japan, cancer has been the leading cause of death since 1981 and is the most common and representative life-threatening disease. Cancer treatment has markedly progressed, and so the development of cancer is now not necessarily a death sentence. Nevertheless, approximately half of cancer patients actually die as a result of the disease even today. Cancer causes marked suffering of patients. Patients with advanced and/or terminal cancer suffer from various physical symptoms and are forced to face a continuous decline in their physical function, and previous studies reported that psychological distress is frequently observed in cancer patients, especially in advanced and/or terminally ill patients. Several types of psychological defense mechanism, especially denial, are frequently observed in these patients. There are multiple levels of denial For example, a patient with true denial denies the presence of cancer itself, although true denial is quite rare. A patient with moderate denial is likely to deny an association between distressing symptoms and disease, while one with mild denial denies the life-threatening nature of disease. Denial is a psychological defense mechanism that often helps advanced cancer patients to manage their anxiety and depression. It allows such patients to continue living while facing the painfulness of their situation. In this situation, it is important for therapists to note the patient's denial. Simply being aware of the denial can, in itself, be supportive for the patient. However, when denial does not work adaptively, such as it prohibiting adherence to necessary treatment and not being useful for ameliorating psychological distress and improving the quality of life, medical staff may consider confronting a patient with the reality of the situation carefully. This paper discusses the relevance of acknowledging denial and caring for patients with denial from the point of view of psycho-oncology. PMID:27044140

  1. Design as a Critical Tool in Bariatric Patient Care

    PubMed Central

    Wignall, Doug

    2008-01-01

    Both men and women in the United States are roughly an inch taller and 25 pounds heavier than they were in 1960, says the National Center for Health Statistics at the Centers for Disease Control and Prevention. An increasing number are also overweight or obese. In fact, obesity has become an alarming epidemic with enormous implications for our health care system. A critical concern is the ability to care physically and emotionally for this segment of the patient population. Respecting patient dignity and delivering optimum clinical care are primary issues, as are establishing procedures for safeguarding the health and well-being of these patients and their caregivers. Design is a critical tool in the care of and the improved long-term clinical outcomes for bariatric patients; success mandates a three-prong approach to the design process: appropriate facilities and space, proper equipment and furnishings, and training and standardized care protocols. Together, these components ensure the ability of a health care provider to adequately care for all patients—including this newest and rapidly growing patient segment—with equality and dignity. PMID:19885353

  2. Compassionate care: enhancing physician-patient communication and education in dermatology: Part II: Patient education.

    PubMed

    Hong, Judith; Nguyen, Tien V; Prose, Neil S

    2013-03-01

    Patient education is a fundamental part of caring for patients. A practice gap exists, where patients want more information, while health care providers are limited by time constraints or difficulty helping patients understand or remember. To provide patient-centered care, it is important to assess the needs and goals, health beliefs, and health literacy of each patient. This allows health care providers to individualize education for patients. The use of techniques, such as gaining attention, providing clear and memorable explanations, and assessing understanding through "teach-back," can improve patient education. Verbal education during the office visit is considered the criterion standard. However, handouts, visual aids, audiovisual media, and Internet websites are examples of teaching aids that can be used as an adjunct to verbal instruction. Part II of this 2-part series on patient-physician interaction reviews the importance and need for patient education along with specific guidelines and techniques that can be used.

  3. Self-care in heart failure patients 1

    PubMed Central

    da Conceição, Ana Paula; dos Santos, Mariana Alvina; dos Santos, Bernardo; da Cruz, Diná de Almeida Lopes Monteiro

    2015-01-01

    Abstract Objective: to describe self-care behavior and its associated factors in a sample of heart failure Brazilian patients. Method: descriptive cross-sectional study with non-probabilistic sample of 116 ambulatory patients undergoing heart failure treatment. Self-care was evaluated using the Self-Care of Heart Failure Index, (scores ≥70 points=appropriate self-care). Association tests were applied, considering a descriptive level of 0.05. Results: the mean age of participants was 57.7 (SD =11.3) years; 54.3% were male; the mean schooling was 5.5 (SD = 4.0) years; and 74.1% had functional class II-III. The mean scores on the subscales of the Self-Care of Heart Failure Index indicated inappropriate self-care (self-care maintenance: 53.2 (SD =14.3), selfcare management: 50.0 (SD = 20.3) and self-care confidence: 52.6 (SD=22.7)) and it was found low frequencies of participants with appropriate self-care (self-care maintenance, 6.9%), self-care management (14.7%) and self-care confidence (19%). Higher scores of the Self-Care of Heart Failure Index were associated with: reduced left ventricular ejection fraction (p=0.001), longer time of experience with the disease (p=0.05) and joint monitoring by physician and nurse (p=0.007). Conclusion: investments are needed to improve the self-care behavior and the nursing can play a relevant role in this improvement. PMID:26444158

  4. Caring for class III obese patients.

    PubMed

    Gardner, Lea Anne

    2013-11-01

    The Pennsylvania Patient Safety Reporting System is a confidential, statewide Internet reporting system to which all Pennsylvania hospitals, outpatient-surgery facilities, and birthing centers, as well as some abortion facilities, must file information on medical errors.Safety Monitor is a column from Pennsylvania's Patient Safety Authority, the authority that informs nurses on issues that can affect patient safety and presents strategies they can easily integrate into practice. For more information on the authority, visit www.patientsafetyauthority.org. For the original article discussed in this column or for other articles on patient safety, click on "Patient Safety Advisories" and then "Advisory Library" in the left-hand navigation menu. PMID:24149276

  5. Patient education preferences in ophthalmic care

    PubMed Central

    Rosdahl, Jullia A; Swamy, Lakshmi; Stinnett, Sandra; Muir, Kelly W

    2014-01-01

    Background The learning preferences of ophthalmology patients were examined. Methods Results from a voluntary survey of ophthalmology patients were analyzed for education preferences and for correlation with race, age, and ophthalmic topic. Results To learn about eye disease, patients preferred one-on-one sessions with providers as well as printed materials and websites recommended by providers. Patients currently learning from the provider were older (average age 59 years), and patients learning from the Internet (average age 49 years) and family and friends (average age 51 years) were younger. Patients interested in cataracts, glaucoma, macular degeneration, and dry eye were older; patients interested in double vision and glasses were younger. There were racial differences regarding topic preferences, with Black patients most interested in glaucoma (46%), diabetic retinopathy (31%), and cataracts (28%) and White patients most interested in cataracts (22%), glaucoma (22%), and macular degeneration (19%). Conclusion Most ophthalmology patients preferred personalized education: one-on-one with their provider or a health educator and materials (printed and electronic) recommended by their provider. Age-related topics were more popular with older patients, and diseases with racial risk factors were more popular with high risk racial groups. PMID:24812493

  6. Accelerating patient-care improvement in the ED.

    PubMed

    Forrester, Nancy E

    2003-08-01

    Quality improvement is always in the best interest of healthcare providers. One hospital examined the patient-care delivery process used in its emergency department to determine ways to improve patient satisfaction while increasing the effectiveness and efficiency of healthcare delivery. The hospital used activity-based costing (ABC) plus additional data related to rework, information opportunity costs, and other effectiveness measures to create a process map that helped it accelerate diagnosis and improve redesign of the care process. PMID:12938618

  7. Managing the care of patients who have visual impairment.

    PubMed

    Watkinson, Sue; Scott, Eileen

    An ageing population means that the incidence of people who are visually impaired will increase. However, extending the role of ophthalmic nurses will promote delivery of a more effective health service for these patients. Using Maslow's hierarchy of needs as a basis for addressing the care of patients with visual impairment is a means of ensuring that they receive high quality, appropriate care at the right time.

  8. Intensive care unit research ethics and trials on unconscious patients.

    PubMed

    Gillett, G R

    2015-05-01

    There are widely acknowledged ethical issues in enrolling unconscious patients in research trials, particularly in intensive care unit (ICU) settings. An analysis of those issues shows that, by and large, patients are better served in units where research is actively taking place for several reasons: i) they do not fall prey to therapeutic prejudices without clear evidential support, ii) they get a chance of accessing new and potentially beneficial treatments, iii) a climate of careful monitoring of patients and their clinical progress is necessary for good clinical research and affects the care of all patients and iv) even those not in the treatment arm of a trial of a new intervention must receive best current standard care (according to international evidence-based treatment guidelines). Given that we have discovered a number of 'best practice' regimens of care that do not optimise outcomes in ICU settings, it is of great benefit to all patients (including those participating in research) that we are constantly updating and evaluating what we do. Therefore, the practice of ICU-based clinical research on patients, many of whom cannot give prospective informed consent, ticks all the ethical boxes and ought to be encouraged in our health system. It is very important that the evaluation of protocols for ICU research should not overlook obvious (albeit probabilistic) benefits to patients and the acceptability of responsible clinicians entering patients into well-designed trials, even though the ICU setting does not and cannot conform to typical informed consent procedures and requirements.

  9. Cost-benefit analysis: patient care at neurological intensive care unit.

    PubMed

    Kopacević, Lenka; Strapac, Marija; Mihelcić, Vesna Bozan

    2013-09-01

    Modern quality definition relies on patient centeredness and on patient needs for particular services, continuous control of the service provided, complete service quality management, and setting quality indicators as the health service endpoints. The health service provided to the patient has certain costs. Thus, one can ask the following: "To what extent does the increasing cost of patient care with changes in elimination improve the quality of health care and what costs are justifiable?" As stroke is the third leading cause of morbidity and mortality in Europe and worldwide, attention has been increasingly focused on stroke prevention and providing quality care for stroke patients. One of the most common medical/nursing problems in these patients is change in elimination, which additionally affects their mental health.

  10. Sedation options for intubated intensive care unit patients.

    PubMed

    Lacoske, Jennifer

    2015-03-01

    A common requirement for intubated patients in the intensive care unit (ICU) is sedation and pain management to facilitate patient safety and timely, atraumatic healing. The Society of Critical Care Medicine guidelines for management of pain, sedation, and delirium in adult ICU patients provide assessment scales for pain, sedation, and delirium; medications for sedation and pain management, and protocols for weaning sedation, are discussed. Proficient assessment skills, pharmacologic knowledge of medications administered to provide sedation, and an understanding of the importance of nonpharmacologic interventions can help the registered nurse provide patient advocacy, safety, and improved outcomes.

  11. Caring for alcoholic patients with dissociative identity disorder.

    PubMed

    Wing, D M

    1997-01-01

    Nursing care of the alcoholic patient becomes multifaceted and complex with the presence of a psychiatric-mental health disorder. Although issues surrounding dual-diagnosis patients have been addressed in the literature, there is a paucity of research and theory regarding care of the patient who has both alcoholism and dissociative identity disorder. This article presents a synthesis of the nursing literature with the author's experience to elucidate factors that enhance healing. Nursing interventions that are unique and sensitive for the alcoholic patient with dissociative identity disorder are discussed.

  12. [Free will and patient consent during care].

    PubMed

    Bréhaux, Karine

    2016-09-01

    Raising the question of a person's free will means questioning their freedom and capacity to make choices. Therefore, being free, means being able to judge between the possibilities which are offered to us, and deciding of our own accord what is acceptable to us. The concept of free will is associated with the notion of consent, in particular during care. PMID:27596494

  13. Use of dental care by HIV-infected medical patients.

    PubMed

    Coulter, I D; Marcus, M; Freed, J R; Der-Martirosian, C; Cunningham, W E; Andersen, R M; Maas, W R; Garcia, I; Schneider, D A; Genovese, B; Shapiro, M F; Bozzette, S A

    2000-06-01

    Although increasing attention has been paid to the use of dental care by HIV patients, the existing studies do not use probability samples, and no accurate population estimates of use can be made from this work. The intent of the present study was to establish accurate population estimates of the use of dental services by patients under medical care. The study, part of the HIV Cost and Services Utilization Study (HCSUS), created a representative national probability sample, the first of its kind, of HIV-infected adults in medical care. Both bivariate and logistic regressions were conducted, with use of dental care in the preceding 6 months as the dependent variable and demographic, social, behavioral, and disease characteristics as independent variables. Forty-two percent of the sample had seen a dental health professional in the preceding 6 months. The bivariate logits for use of dental care show that African-Americans, those whose exposure to HIV was caused by hemophilia or blood transfusions, persons with less education, and those who were employed were less likely to use dental care (p < 0.05). Sixty-five percent of those with a usual source of care had used dental care in the preceding 6 months. Use was greatest among those obtaining dental care from an AIDS clinic (74%) and lowest among those without a usual source of dental care (12%). We conclude that, in spite of the high rate of oral disease in persons with HIV, many do not use dental care regularly, and that use varies by patient characteristics and availability of a regular source of dental care. PMID:10890713

  14. Educational inequalities in patient-centred care: patients' preferences and experiences

    PubMed Central

    2012-01-01

    Background Educational attainment is strongly related to specific health outcomes. The pathway in which individual patient-provider interactions contribute to (re)producing these inequalities has yet to be studied. In this article, the focus is on differences between less and more highly educated patients in their preferences for and experiences with patient-centred care., e.g. shared decision making, receiving understandable explanations and being able to ask questions. Methods Data are derived from several Consumer Quality-index (CQ-index) studies. The CQ-index is a family of standardized instruments which are used in the Netherlands to measure quality of care from the patient’s perspective. Results The educational level of patients is directly related to the degree of importance patients attribute to specific aspects of patient-centred care. It has a minor influence on the experienced level of shared decision making, but not on experiences regarding other aspects of patient-centred care. Conclusions All patients regard patient-centred care as important and report positive experiences. However, there is a discrepancy between patient preferences for patient-centred care on one hand and the care received on the other. Less educated patients might receive ‘too much’, and more highly educated patients ‘too little’ in the domains of communication, information and shared decision making. PMID:22900589

  15. Patient-Centered Care and Patient-Reported Measures: Let's Look Before We Leap.

    PubMed

    Miller, Daniel; Steele Gray, Carolyn; Kuluski, Kerry; Cott, Cheryl

    2015-08-01

    This commentary focuses on patient-reported measures as tools to support patient-centered care for patients with multiple chronic conditions (MCCs). We argue that those using patient-reported measures in care management or evaluation of services for MCC patients should do so in recognition of the challenges involved in treating them. MCC patient care is challenging because (1) it is difficult to specify the causes of particular symptoms; (2) assessment of many important symptoms relies on subjective report; and (3) patients require care from a variety of providers. Due to the multiple domains of health affected in single individuals, and the large variation in needs, care that is holistic and individualized (i.e. patient-centered) is appropriate for MCC patients. However, due to the afore-mentioned challenges, it is important to carefully consider what this care entails and how practical contexts shape it. Patient-centered care for MCC patients implies continuous, dialogic patient-provider relationships, and the formulation of coherent and adaptive multi-disciplinary care protocols. We identify two broadly defined contextual influences on the nature and quality of these processes and their outputs: (1) busy practice settings and (2) fragmented information technology. We then identify several consequences that may result from inattention to these contextual influences upon introduction of patient-reported measure applications. To maximize the benefits, and minimize the harms of patient-reported measure use, we encourage policy makers and providers to attend carefully to these and other important contextual factors before, during and after the introduction of patient-reported measure initiatives.

  16. Health System Quality Improvement: Impact of Prompt Nutrition Care on Patient Outcomes and Health Care Costs.

    PubMed

    Meehan, Anita; Loose, Claire; Bell, Jvawnna; Partridge, Jamie; Nelson, Jeffrey; Goates, Scott

    2016-01-01

    Among hospitalized patients, malnutrition is prevalent yet often overlooked and undertreated. We implemented a quality improvement program that positioned early nutritional care into the nursing workflow. Nurses screened for malnutrition risk at patient admission and then immediately ordered oral nutritional supplements for those at risk. Supplements were given as regular medications, guided and monitored by medication administration records. Post-quality improvement program, pressure ulcer incidence, length of stay, 30-day readmissions, and costs of care were reduced.

  17. Palliative care for patients with HIV/AIDS admitted to intensive care units

    PubMed Central

    Souza, Paola Nóbrega; de Miranda, Erique José Peixoto; Cruz, Ronaldo; Forte, Daniel Neves

    2016-01-01

    Objective To describe the characteristics of patients with HIV/AIDS and to compare the therapeutic interventions and end-of-life care before and after evaluation by the palliative care team. Methods This retrospective cohort study included all patients with HIV/AIDS admitted to the intensive care unit of the Instituto de Infectologia Emílio Ribas who were evaluated by a palliative care team between January 2006 and December 2012. Results Of the 109 patients evaluated, 89% acquired opportunistic infections, 70% had CD4 counts lower than 100 cells/mm3, and only 19% adhered to treatment. The overall mortality rate was 88%. Among patients predicted with a terminally ill (68%), the use of highly active antiretroviral therapy decreased from 50.0% to 23.1% (p = 0.02), the use of antibiotics decreased from 100% to 63.6% (p < 0.001), the use of vasoactive drugs decreased from 62.1% to 37.8% (p = 0.009), the use of renal replacement therapy decreased from 34.8% to 23.0% (p < 0.0001), and the number of blood product transfusions decreased from 74.2% to 19.7% (p < 0.0001). Meetings with the family were held in 48 cases, and 23% of the terminally ill patients were discharged from the intensive care unit. Conclusion Palliative care was required in patients with severe illnesses and high mortality. The number of potentially inappropriate interventions in terminally ill patients monitored by the palliative care team significantly decreased, and 26% of the patients were discharged from the intensive care unit. PMID:27737420

  18. Human rights in patient care: a theoretical and practical framework.

    PubMed

    Cohen, Jonathan; Ezer, Tamar

    2013-01-01

    The concept of "human rights in patient care" refers to the application of human rights principles to the context of patient care. It provides a principled alternative to the growing discourse of "patients' rights" that has evolved in response to widespread and severe human rights violations in health settings. Unlike "patients' rights," which is rooted in a consumer framework, this concept derives from inherent human dignity and neutrally applies universal, legally recognized human rights principles, protecting both patients and providers and admitting of limitations that can be justified by human rights norms. It recognizes the interrelation between patient and provider rights, particularly in contexts where providers face simultaneous obligations to patients and the state ("dual loyalty") and may be pressured to abet human rights violations. The human rights lens provides a means to examine systemic issues and state responsibility. Human rights principles that apply to patient care include both the right to the highest attainable standard of health, which covers both positive and negative guarantees in respect of health, as well as civil and political rights ranging from the patient's right to be free from torture and inhumane treatment to liberty and security of person. They also focus attention on the right of socially excluded groups to be free from discrimination in the delivery of health care. Critical rights relevant to providers include freedom of association and the enjoyment of decent work conditions. Some, but not all, of these human rights correspond to rights that have been articulated in "patients' rights" charters. Complementary to—but distinct from—bioethics, human rights in patient care carry legal force and can be applied through judicial action. They also provide a powerful language to articulate and mobilize around justice concerns, and to engage in advocacy through the media and political negotiation. As "patients' rights" movements and

  19. Human rights in patient care: a theoretical and practical framework.

    PubMed

    Cohen, Jonathan; Ezer, Tamar

    2013-12-12

    The concept of "human rights in patient care" refers to the application of human rights principles to the context of patient care. It provides a principled alternative to the growing discourse of "patients' rights" that has evolved in response to widespread and severe human rights violations in health settings. Unlike "patients' rights," which is rooted in a consumer framework, this concept derives from inherent human dignity and neutrally applies universal, legally recognized human rights principles, protecting both patients and providers and admitting of limitations that can be justified by human rights norms. It recognizes the interrelation between patient and provider rights, particularly in contexts where providers face simultaneous obligations to patients and the state ("dual loyalty") and may be pressured to abet human rights violations. The human rights lens provides a means to examine systemic issues and state responsibility. Human rights principles that apply to patient care include both the right to the highest attainable standard of health, which covers both positive and negative guarantees in respect of health, as well as civil and political rights ranging from the patient's right to be free from torture and inhumane treatment to liberty and security of person. They also focus attention on the right of socially excluded groups to be free from discrimination in the delivery of health care. Critical rights relevant to providers include freedom of association and the enjoyment of decent work conditions. Some, but not all, of these human rights correspond to rights that have been articulated in "patients' rights" charters. Complementary to—but distinct from—bioethics, human rights in patient care carry legal force and can be applied through judicial action. They also provide a powerful language to articulate and mobilize around justice concerns, and to engage in advocacy through the media and political negotiation. As "patients' rights" movements and

  20. Tying supply chain costs to patient care.

    PubMed

    Parkinson, Rosalind C

    2014-05-01

    In September 2014, the FDA will establish a unique device identification (UDI) system to aid hospitals in better tracking and managing medical devices and analyzing their effectiveness. When these identifiers become part of patient medical records, the UDI system will provide a much-needed link between supply cost and patient outcomes. Hospitals should invest in technology and processes that can enable them to trace supply usage patterns directly to patients and analyze how these usage patterns affect cost and quality.

  1. Tying supply chain costs to patient care.

    PubMed

    Parkinson, Rosalind C

    2014-05-01

    In September 2014, the FDA will establish a unique device identification (UDI) system to aid hospitals in better tracking and managing medical devices and analyzing their effectiveness. When these identifiers become part of patient medical records, the UDI system will provide a much-needed link between supply cost and patient outcomes. Hospitals should invest in technology and processes that can enable them to trace supply usage patterns directly to patients and analyze how these usage patterns affect cost and quality. PMID:24851451

  2. Care of the AIDS patient with Pneumocystis pneumonia.

    PubMed

    Carr, Rebecca Lamb; Dodge, Robert

    2009-01-01

    Pneumocystis pneumonia and AIDS have been linked together for many years. In the 1980s and 1990s, these diseases often resulted in admission to the critical care unit for many patients. Since the discovery of antiretroviral therapy and Pneumocystis prophylaxis, this has been a less frequent occurrence. Knowledge about caring for this patient in the critical care unit is often not available. Psychological and physiological needs common to this population are different from other populations and must be addressed. Pharmacological challenges are common and may go unrecognized until complications ensue. This article seeks to alleviate some of the mystery associated with these issues. PMID:19855202

  3. Ongoing patient randomization: an innovation in medical care research.

    PubMed Central

    Cargill, V; Cohen, D; Kroenke, K; Neuhauser, D

    1986-01-01

    Hospitals often have rotational assignment of patients to one of several similar provider care teams. The research potential of these arrangements has gone unnoticed. By changing to random assignment of patients and physicians to provider care teams (firms) this kind of organization can be used for sequential, randomized clinical trials which are ethical and efficient. The paper describes such arrangements at three different hospitals: Cleveland Metropolitan General Hospital, Brooke Army Medical Center, and University Hospitals of Cleveland. Associated methodologic issues are discussed. This is a new, more widely applicable method for medical care research. PMID:3546202

  4. Multidisciplinary Care of the Patient with Chronic Obstructive Pulmonary Disease

    PubMed Central

    Kuzma, Anne Marie; Meli, Yvonne; Meldrum, Catherine; Jellen, Patricia; Butler-Lebair, Marianne; Koczen-Doyle, Debra; Rising, Peter; Stavrolakes, Kim; Brogan, Frances

    2008-01-01

    The National Emphysema Treatment Trial used a multidisciplinary team approach to implement the maximum medical care protocol, including adjustment of medications and outpatient pulmonary rehabilitation for all patients and nutritional and psychological counseling as needed. This article discusses the benefits of such an approach in the care of the patient with chronic obstructive pulmonary disease. Team member roles complement each other and contribute to the goal of providing the highest-quality medical care. The primary focus of the team is to reinforce the medical plan and to provide patient education and support. This article reviews the elements of the initial patient assessment and the functional and nutritional assessment. Patient education focuses on medication use, recognition and management of chronic obstructive pulmonary disease exacerbation symptoms, smoking cessation, advance directives, and travel. PMID:18453373

  5. Consumerism: forcing medical practices toward patient-centered care.

    PubMed

    Ozmon, Jeff

    2007-01-01

    Consumerism has been apart of many industries over the years; now consumerism may change the way many medical practices deliver healthcare. With the advent of consumer-driven healthcare, employers are shifting the decision-making power to their employees. Benefits strategies like health savings accounts and high-deductible insurance plans now allow the patients to control how and where they spend their money on medical care. Practices that seek to attract the more affluent and informed consumers are beginning to institute patient-centered systems designs that invite patients to actively participate in their healthcare. This article will outline the changes in the healthcare delivery system facing medical practices, the importance of patient-centered care, and six strategies to implement to change toward more patient-centered care.

  6. Limitation to Advanced Life Support in patients admitted to intensive care unit with integrated palliative care

    PubMed Central

    Mazutti, Sandra Regina Gonzaga; Nascimento, Andréia de Fátima; Fumis, Renata Rego Lins

    2016-01-01

    Objective To estimate the incidence of limitations to Advanced Life Support in critically ill patients admitted to an intensive care unit with integrated palliative care. Methods This retrospective cohort study included patients in the palliative care program of the intensive care unit of Hospital Paulistano over 18 years of age from May 1, 2011, to January 31, 2014. The limitations to Advanced Life Support that were analyzed included do-not-resuscitate orders, mechanical ventilation, dialysis and vasoactive drugs. Central tendency measures were calculated for quantitative variables. The chi-squared test was used to compare the characteristics of patients with or without limits to Advanced Life Support, and the Wilcoxon test was used to compare length of stay after Advanced Life Support. Confidence intervals reflecting p ≤ 0.05 were considered for statistical significance. Results A total of 3,487 patients were admitted to the intensive care unit, of whom 342 were included in the palliative care program. It was observed that after entering the palliative care program, it took a median of 2 (1 - 4) days for death to occur in the intensive care unit and 4 (2 - 11) days for hospital death to occur. Many of the limitations to Advanced Life Support (42.7%) took place on the first day of hospitalization. Cardiopulmonary resuscitation (96.8%) and ventilatory support (73.6%) were the most adopted limitations. Conclusion The contribution of palliative care integrated into the intensive care unit was important for the practice of orthothanasia, i.e., the non-extension of the life of a critically ill patient by artificial means. PMID:27626949

  7. Issues in health care of Middle Eastern patients.

    PubMed

    Lipson, J G; Meleis, A I

    1983-12-01

    Relationships between Middle Eastern patients and Western health care professionals are often troubled by mutual misunderstanding of culturally influenced values and communication styles. Although Middle Easterners vary ethnically, they do share a core of common values and behavior that include the importance of affiliation and family, time and space orientations, interactional style and attitudes toward health and illness. Problems in providing health care involve obtaining adequate information, "demanding behavior" by a patient's family, conflicting beliefs about planning ahead and differing patterns of communicating grave diagnoses or "bad news." There are guidelines that will provide an understanding of the cultural characteristics of Middle Easterners and, therefore, will improve rather than impede their health care. A personal approach and continuity of care by the same health care professional help to bridge the gap between Middle Eastern cultures and Western medical culture. In addition, periodic use of cultural interpreters helps ameliorate the intensity of some cultural issues. PMID:6364575

  8. Communication Needs of Critical Care Patients Who Are Voiceless.

    PubMed

    Koszalinski, Rebecca S; Tappen, Ruth M; Hickman, Candice; Melhuish, Tracey

    2016-08-01

    Voice is crucial for communication in all healthcare settings. Evidence-based care highlights the need for clear communication. Clear communication methods must be applied when caring for special populations in order to assess pain effectively. Communication efforts also should be offered to patients who are in end-of-life care and would like to make independent decisions. A computer communication application was offered to patients in intensive care/critical care units in three hospitals in South Florida. Inclusion criteria included the age of 18 years or older, Richmond Agitation Sedation Scale between -1 and +1, ability to read and write English, and willingness to use the computer application. Exclusion criteria included inability to read and write English, agitation as defined by the Richmond Agitation Sedation Scale, and any patient on infection isolation protocol. Four qualitative themes were revealed, which directly relate to two published evidence-based guidelines. These are the End of Life Care and Decision Making Evidence-Based Care Guidelines and the Pain Assessment in Special Populations Guidelines. This knowledge is important for developing effective patient-healthcare provider communication. PMID:27315366

  9. Iranian nursing students' perspectives regarding caring for elderly patients.

    PubMed

    Rejeh, Nahid; Heravi-Karimooi, Majideh; Vaismoradi, Mojtaba

    2011-06-01

    The purpose of this study was to explore Iranian nursing students' perspectives regarding caring for elderly patients. A qualitative design, based on the content analysis approach, was used to collect and analyze the perspectives of 25 senior nursing students who were providing care for elderly patients in the medical and surgical wards of two teaching hospitals in Tehran, Iran. After using purposeful sampling to select the participants, semistructured interviews were held in order to collect the data. During the data analysis, two main themes and six subthemes emerged. The first theme was "the barriers to caring for elderly patients", with the subthemes of "policies and rules of the organization", "a lack of educational preparation", and "an inappropriate physical environment", and the second theme was "the facilitators to caring for elderly patients", with the subthemes of "religion and cultural norms", "role modeling", and "previous exposure to elderly patients". This study informs international audiences of the factors that influence the quality of care of elderly patients so that strategies can be devised in order to prepare nursing students to meet the physical and psychological needs of elderly patients.

  10. Starting treatment: caring for patients and their families.

    PubMed

    Williams, G; Alarcon, E; Jittimanee, S; Walusimbi, M; Sebek, M; Berga, E; Villa, T S

    2008-05-01

    The standards presented in this section focus on providing physical, social and psychological care for the patient at the point he or she is diagnosed with tuberculosis (TB) and starts treatment. Detailed guidance is included with regard to organising directly observed treatment (DOT) safely and acceptably for both the patient and the management unit. The aim is to give the patient the best possible chance of successfully completing treatment according to a regimen recommended by the World Health Organization. If the health service where the patient is diagnosed cannot offer ongoing treatment and care due to a lack of facilities, overcrowding or inaccessibility, the patient needs to be referred to a designated TB management unit (BMU) elsewhere. The patient may also receive treatment from a facility outside a BMU. However care is organised, it is essential for all patients who are diagnosed with TB to be registered at an appropriate BMU so that their progress can be routinely monitored and programme performance can be assessed. To avoid the risk of losing contact with the patient at any stage of their care, good communication is essential between all parties involved, from the patient him/herself to the person supervising their DOT to the BMU.

  11. [Strategies for improving care of oncologic patients: SHARE Project results].

    PubMed

    Reñones Crego, María de la Concepción; Fernández Pérez, Dolores; Vena Fernández, Carmen; Zamudio Sánchez, Antonio

    2016-01-01

    Cancer treatment is a major burden for the patient and its family that requires an individualized management by healthcare professionals. Nurses are in charge of coordinating care and are the closest healthcare professionals to patient and family; however, in Spain, there are not standard protocols yet for the management of oncology patients. The Spanish Oncology Nursing Society developed between 2012 and 2014 the SHARE project, with the aim of establishing strategies to improve quality of life and nursing care in oncology patients. It was developed in 3 phases. First, a literature search and review was performed to identify nursing strategies, interventions and tools to improve cancer patients' care. At the second stage, these interventions were agreed within a group of oncology nursing experts; and at the third phase, a different group of experts in oncology care categorized the interventions to identify the ones with highest priority and most feasible to be implemented. As a result, 3 strategic actions were identified to improve nursing care during cancer treatment: To provide a named nurse to carry out the follow up process by attending to the clinic or telephonic consultation, develop therapeutic education with adapted protocols for each tumor type and treatment and ensure specific training for nurses on the management of the cancer patients. Strategic actions proposed in this paper aim to improve cancer patients' healthcare and quality of life through the development of advanced nursing roles based on a higher level of autonomy, situating nurses as care coordinators to assure an holistic care in oncology patients. PMID:27237729

  12. Identifying and managing patients with delirium in acute care settings.

    PubMed

    Bond, Penny; Goudie, Karen

    2015-11-01

    Delirium is an acute medical emergency affecting about one in eight acute hospital inpatients. It is associated with poor outcomes, is more prevalent in older people and it is estimated that half of all patients receiving intensive care or surgery for a hip fracture will be affected. Despite its prevalence and impact, delirium is not reliably identified or well managed. Improving the identification and management of patients with delirium has been a focus for the national improving older people's acute care work programme in NHS Scotland. A delirium toolkit has been developed, which includes the 4AT rapid assessment test, information for patients and carers and a care bundle for managing delirium based on existing guidance. This toolkit has been tested and implemented by teams from a range of acute care settings to support improvements in the identification and immediate management of delirium.

  13. [Ethical challenge in palliative support of intensive care patients].

    PubMed

    Salomon, Fred

    2015-01-01

    Intensive care medicine and palliative care medicine were considered for a long time to be contrasting concepts in therapy. While intensive care medicine is directed towards prolonging life and tries to stabilize disordered body functions, palliative care medicine is focused upon the relief of disturbances to help patients in the face of death. Today both views have become congruent. Palliative aspects are equally important in curative therapy. In the course of illness or in respect of the patient's will, the aim of therapy may change from curative to palliative. Two examples are presented to illustrate the ethical challenges in this process. They follow from the medical indication, attention to the patient's will, different opinions in the team, truth at the bedside and from what must be done in the process of withdrawing therapy.

  14. Translating technology into patient care: Smartphone applications in pediatric health care.

    PubMed

    Sondhi, Vishal; Devgan, Amit

    2013-04-01

    The latest generations of smartphones are increasingly viewed as handheld computers rather than as phones and the applications on these phones are becoming increasingly popular among the medical professionals. A large number of health care applications are available across various smartphone platforms. At times it may be difficult to identify most appropriate and reliable application for use at the point of care. In this review, we have tried to identify the applications relevant to Pediatrics and Childcare which when used at the point of care might be helpful in improving patient care.

  15. Prediction of Dementia in Primary Care Patients

    PubMed Central

    Jessen, Frank; Wiese, Birgitt; Bickel, Horst; Eiffländer-Gorfer, Sandra; Fuchs, Angela; Kaduszkiewicz, Hanna; Köhler, Mirjam; Luck, Tobias; Mösch, Edelgard; Pentzek, Michael; Riedel-Heller, Steffi G.; Wagner, Michael; Weyerer, Siegfried; Maier, Wolfgang; van den Bussche, Hendrik

    2011-01-01

    Background Current approaches for AD prediction are based on biomarkers, which are however of restricted availability in primary care. AD prediction tools for primary care are therefore needed. We present a prediction score based on information that can be obtained in the primary care setting. Methodology/Principal Findings We performed a longitudinal cohort study in 3.055 non-demented individuals above 75 years recruited via primary care chart registries (Study on Aging, Cognition and Dementia, AgeCoDe). After the baseline investigation we performed three follow-up investigations at 18 months intervals with incident dementia as the primary outcome. The best set of predictors was extracted from the baseline variables in one randomly selected half of the sample. This set included age, subjective memory impairment, performance on delayed verbal recall and verbal fluency, on the Mini-Mental-State-Examination, and on an instrumental activities of daily living scale. These variables were aggregated to a prediction score, which achieved a prediction accuracy of 0.84 for AD. The score was applied to the second half of the sample (test cohort). Here, the prediction accuracy was 0.79. With a cut-off of at least 80% sensitivity in the first cohort, 79.6% sensitivity, 66.4% specificity, 14.7% positive predictive value (PPV) and 97.8% negative predictive value of (NPV) for AD were achieved in the test cohort. At a cut-off for a high risk population (5% of individuals with the highest risk score in the first cohort) the PPV for AD was 39.1% (52% for any dementia) in the test cohort. Conclusions The prediction score has useful prediction accuracy. It can define individuals (1) sensitively for low cost-low risk interventions, or (2) more specific and with increased PPV for measures of prevention with greater costs or risks. As it is independent of technical aids, it may be used within large scale prevention programs. PMID:21364746

  16. Cancer patients with oral mucositis: challenges for nursing care1

    PubMed Central

    Araújo, Sarah Nilkece Mesquita; Luz, Maria Helena Barros Araújo; da Silva, Grazielle Roberta Freitas; Andrade, Elaine Maria Leite Rangel; Nunes, Lívio César Cunha; Moura, Renata Oliveira

    2015-01-01

    OBJECTIVE: to analyze nursing care provided to cancer patients with oral mucositis based on the Nursing Process (NP). METHOD: this exploratory, descriptive, cross-sectional and quantitative study was conducted with 213 patients undergoing chemotherapy and/or radiotherapy in two cancer facilities: one philanthropic and one private service. RESULTS: the participants were mainly female, aged 45.8 years old on average, with up to 11 years of schooling and income of up to one times the minimum wage. Severe mucositis was related to chemotherapy associated with radiotherapy. Only 25.3% of the patients reported having received guidance from nurses during their treatment concerning self-care. The perceptions of patients regarding quality of care did not significantly differ between the private and public facilities. The basic human needs mainly affected were comfort, eating, and hygiene. Based on this finding, one NP was established listing the diagnoses, interventions and expected results to establish an ideal, though individualized, standard of nursing care to be provided to these patients. CONCLUSION: to understand oral mucositis is crucial to establish nursing care that includes prevention based on the implementation of an oral care plan. PMID:26039297

  17. [NURSING ACTION BEFORE THE TERMINAL PATIENT PHYSICAL CARE].

    PubMed

    Delgado Sevilla, David; Juarez Vela, Raúl; Pellicer García, Begoña; Redondo Castán, Luis Carlos; Ramón Arbués, Enrique; López Martín, Inmaculada; De Blas Gómez, Irene; Alburquerque Medina, Eulalia

    2014-11-01

    Palliative care is a group of actions performed by nurses in order to increase the comfort and well-being of patients with terminal illnesses. The World Health Organization (WHO) defines this term as: An approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual [1]. Cicely Mary Strode Saunders is considered as the precursor of the palliative care, who explained the need to change the Palliative Care Units in order to improve the quality of life of patients with terminal illnesses. Palliative care is necessary for patients with a terminal illness. In such cases, the life expectancy is less than six months. Human being is considered a biopsychosocial model. For this reason, the nurse must take into account all the requirements arising from these three dimensions of the human being. In this essay, we deal with palliative care in patients with terminal illnesses, considering the role of the nurse as an important reference when teaching palliative care to the main carer. PMID:26118206

  18. Value-Based Health Care for Chronic Care: Aligning Outcomes Measurement with the Patient Perspective

    PubMed Central

    Forsberg, Helena Hvitfeldt; Essén, Anna; Ernestam, Sofia

    2016-01-01

    Background: Value-based health care is increasingly used for developing health care services by relating patient outcomes to costs. A hierarchical value scorecard for creating outcome measurements has been suggested: the 3-tier model. The objective of this study was to test the model against the patient's view of value in a chronic care setting. Methods: Semistructured interviews with 22 persons with rheumatoid arthritis were conducted, transcribed, and analyzed using qualitative content analysis. Themes were extracted, and the model was critically applied and revised. Results: The study validates existing dimensions in the model but suggests adding information, social health, predictability, and continuity to make it more useful and representative of patients' preferences. Conclusion: Although the model aims to focus on outcomes relevant to patients, it lacks dimensions important to individuals with rheumatoid arthritis. The data illustrate difficulties in finding patients' preferred outcomes and imply tactics for arriving at meaningful measurements. PMID:27749717

  19. Patient Navigators: Agents of Creating Community-Nested Patient-Centered Medical Homes for Cancer Care.

    PubMed

    Simon, Melissa A; Samaras, Athena T; Nonzee, Narissa J; Hajjar, Nadia; Frankovich, Carmi; Bularzik, Charito; Murphy, Kara; Endress, Richard; Tom, Laura S; Dong, XinQi

    2016-01-01

    Patient navigation is an internationally utilized, culturally grounded, and multifaceted strategy to optimize patients' interface with the health-care team and system. The DuPage County Patient Navigation Collaborative (DPNC) is a campus-community partnership designed to improve access to care among uninsured breast and cervical cancer patients in DuPage County, IL. Importantly, the DPNC connects community-based social service delivery with the patient-centered medical home to achieve a community-nested patient-centered medical home model for cancer care. While the patient navigator experience has been qualitatively documented, the literature pertaining to patient navigation has largely focused on efficacy outcomes and program cost effectiveness. Here, we uniquely highlight stories of women enrolled in the DPNC, told from the perspective of patient navigators, to shed light on the myriad barriers that DPNC patients faced and document the strategies DPNC patient navigators implemented. PMID:27594792

  20. Electronic Nursing Documentation: Patient Care Continuity Using the Clinical Care Classification System (CCC).

    PubMed

    Whittenburg, Luann; Meetim, Aunchisa

    2016-01-01

    An innovative nursing documentation project conducted at Bumrungrad International Hospital in Bangkok, Thailand demonstrated patient care continuity between nursing patient assessments and nursing Plans of Care using the Clinical Care Classification System (CCC). The project developed a new generation of interactive nursing Plans of Care using the six steps of the American Nurses Association (ANA) Nursing process and the MEDCIN® clinical knowledgebase to present CCC coded concepts as a natural by-product of a nurse's documentation process. The MEDCIN® clinical knowledgebase is a standardized point-of-care terminology intended for use in electronic health record systems. The CCC is an ANA recognized nursing terminology. PMID:27332153

  1. Pharmacist-initiated prior authorization process to improve patient care in a psychiatric acute care hospital.

    PubMed

    Allen, Shari N; Ojong-Salako, Mebanga

    2015-02-01

    A prior authorization (PA) is a requirement implemented by managed care organizations to help provide medications to consumers in a cost-effective manner. The PA process may be seen as a barrier by prescribers, pharmacists, pharmaceutical companies, and consumers. The lack of a standardized PA process, implemented prior to a patient's discharge from a health care facility, may increase nonadherence to inpatient prescribed medications. Pharmacists and other health care professionals can implement a PA process specific to their institution. This article describes a pharmacist-initiated PA process implemented at an acute care psychiatric hospital. This process was initiated secondary to a need for a standardized process at the facility. To date, the process has been seen as a valuable aspect to patient care. Plans to expand this process include collecting data with regards to adherence and readmissions as well as applying for a grant to help develop a program to automate the PA program at this facility.

  2. Availability of ambulance patient care reports in the emergency department.

    PubMed

    Shelton, Dominick; Sinclair, Paul

    2016-01-01

    Clinical handovers of patient care among healthcare professionals is vulnerable to the loss of important clinical information. A verbal report is typically provided by paramedics and documented by emergency department (ED) triage nurses. Paramedics subsequently complete a patient care report which is submitted electronically. This emergency medical system (EMS) patient care report often contains details of paramedic assessment and management that is not all captured in the nursing triage note. EMS patient care reports are often unavailable for review by emergency physicians and nurses. Two processes occur in the distribution of EMS patient care reports. The first is an external process to the ED that is influenced by the prehospital emergency medical system and results in the report being faxed to the ED. The second process is internal to the ED that requires clerical staff to distribute the fax report to accompany patient charts. A baseline audit measured the percentage of EMS patient care reports that were available to emergency physicians at the time of initial patient assessments and showed a wide variation in the availability of EMS reports. Also measured were the time intervals from patient transfer from EMS to ED stretcher until the EMS report was received by fax (external process measure) and the time from receiving the EMS fax report until distribution to patient chart (internal process measure). These baseline measures showed a wide variation in the time it takes to receive the EMS reports by fax and to distribute reports. Improvement strategies consisted of: 1. Educating ED clerical staff about the importance of EMS reports 2. Implementing a new process to minimize ED clerical staff handling of EMS reports for nonactive ED patients 3. Elimination of the automatic retrieval of old hospital charts and their distribution for ED patients 4. Introduction of an electronic dashboard for patients arriving by ambulance to facilitate more efficient distribution of

  3. Availability of ambulance patient care reports in the emergency department

    PubMed Central

    Shelton, Dominick; Sinclair, Paul

    2016-01-01

    Clinical handovers of patient care among healthcare professionals is vulnerable to the loss of important clinical information. A verbal report is typically provided by paramedics and documented by emergency department (ED) triage nurses. Paramedics subsequently complete a patient care report which is submitted electronically. This emergency medical system (EMS) patient care report often contains details of paramedic assessment and management that is not all captured in the nursing triage note. EMS patient care reports are often unavailable for review by emergency physicians and nurses. Two processes occur in the distribution of EMS patient care reports. The first is an external process to the ED that is influenced by the prehospital emergency medical system and results in the report being faxed to the ED. The second process is internal to the ED that requires clerical staff to distribute the fax report to accompany patient charts. A baseline audit measured the percentage of EMS patient care reports that were available to emergency physicians at the time of initial patient assessments and showed a wide variation in the availability of EMS reports. Also measured were the time intervals from patient transfer from EMS to ED stretcher until the EMS report was received by fax (external process measure) and the time from receiving the EMS fax report until distribution to patient chart (internal process measure). These baseline measures showed a wide variation in the time it takes to receive the EMS reports by fax and to distribute reports. Improvement strategies consisted of: 1. Educating ED clerical staff about the importance of EMS reports 2. Implementing a new process to minimize ED clerical staff handling of EMS reports for nonactive ED patients 3. Elimination of the automatic retrieval of old hospital charts and their distribution for ED patients 4. Introduction of an electronic dashboard for patients arriving by ambulance to facilitate more efficient distribution of

  4. Midwifery care and patient-provider communication in maternity decisions

    PubMed Central

    Kozhimannil, Katy B.; Attanasio, Laura B.; Yang, Tony; Avery, Melissa; Declercq, Eugene

    2015-01-01

    Objective To characterize reasons women chose midwives as prenatal care providers and to measure the relationship between midwifery care and patient-provider communication in the U.S. context. Methods Retrospective analysis of data from a nationally-representative survey of women who gave birth in 2011–2012 to a single newborn in a U.S. hospital (n=2400). We used multivariate logistic regression models to characterize women who received prenatal care from a midwife, to describe the reasons for this choice, and to examine the association between midwife-led prenatal care and women’s reports about communication. Results Preference for a female clinician and having a particular clinician assigned was associated with higher odds of midwifery care (AOR=2.65, 95% CI=1.70, 4.14 and AOR=1.63, 95% CI=1.04, 2.58). A woman with midwifery care had lower odds of reporting that she held back questions because her preference for care was different from her provider’s recommendation (AOR=0.46, 95% CI=0.23, 0.89) or because she did not want to be perceived as difficult (AOR=0.48, 95% CI=0.28, 0.81). Women receiving midwifery care also had lower odds of reporting that the provider used medical words were hard for them to understand (AOR=0.58, 95% CI=0.37, 0.91) and not feeling encouraged to discuss all their concerns (AOR=0.54, 95% CI=0.34, 0.89). Conclusions Women whose prenatal care was provided by midwives report better communication compared with those cared for by other types of clinicians. Systems-level interventions, such as assigning a clinician, may improve access to midwifery care and the associated improvements in patient-provider communication in maternity care. PMID:25874874

  5. Unannounced standardized patients: a promising method of assessing patient-centered care in your health care system

    PubMed Central

    2014-01-01

    Background While unannounced standardized patients (USPs) have been used to assess physicians’ clinical skills in the ambulatory setting, they can also provide valuable information on patients’ experience of the health care setting beyond the physician encounter. This paper explores the use of USPs as a methodology for evaluating patient-centered care in the health care system. Methods USPs were trained to complete a behaviorally-anchored assessment of core dimensions of patient-centered care delivered within the clinical microsystem, including: 1) Medical assistants’ safe practices, quality of care, and responsiveness to patients; 2) ease of clinic navigation; and 3) the patient-centeredness of care provided by the physician. Descriptive data is provided on these three levels of patient-centeredness within the targeted clinical microsystem. Chi-square analyses were used to signal whether variations by teams within the clinical microsystem were likely to be due to chance or might reflect true differences in patient-centeredness of specific teams. Results Sixty USP visits to 11 Primary Care teams were performed over an eight-month period (mean 5 visits/team; range 2–8). No medical assistants reported detecting an USP during the study period. USPs found the clinic easy to navigate and that teams were functioning well in 60% of visits. In 30% to 47% of visits, the physicians could have been more patient-centered. Medical assistants’ patient safety measures were poor: patient identity was confirmed in only 5% of visits and no USPs observed medical assistants wash their hands. Quality of care was relatively high for vital signs (e.g. blood pressure, weight and height), but low for depression screening, occurring in only 15% of visits. In most visits, medical assistants greeted the patient in a timely fashion but took time to fully explain matters in less than half of the visits and rarely introduced themselves. Physicians tried to help patients navigate the

  6. Family Participation in the Nursing Care of the Hospitalized Patients

    PubMed Central

    Khosravan, Shahla; Mazlom, Behnam; Abdollahzade, Naiemeh; Jamali, Zeinab; Mansoorian, Mohammad Reza

    2014-01-01

    Background: Few studies, especially in Iran, have assessed the status of family participation in the care of the hospitalized patients. Objectives: This study was conducted to assess why family members partake in caregiving of their patients in hospitals, the type of care that family provide, and the outcomes of the participation in the opinions of nurses and family members. Patients and Methods: In this comparative-descriptive study, data was collected by a two- version researcher-developed questionnaire, from 253 family members of patients by quota sampling method and 83 nurses by census sampling method from wards which had licensed for entering the families. Each questionnaire has three sections: the care needs of the patients which family participated to provide, the reasons to take part, and the outcomes of this collaborative care. The data was analyzed using descriptive statistics and also chi-squared test through SPSS software version 11.5. Results: The patients received more unskilled and non- professional nursing care from their family members. Most of the nurses and families believed that family participation is both voluntary and compulsory. The shortage of personnel in different categories of nursing and speeding up the patient-related affairs were the most important outcome of the participation, from the nurses’ viewpoint was speeding up the patient-related affairs and from the side of the family members, it was the patients’ feeling of satisfaction from the presence of one of their relatives beside them. Conclusions: Co understanding, skillfulness and competence of families and nurses in collaboration with each other were not good enough.Few studies, especially in Iran, have assessed the status of family participation in the care of the hospitalized patients. PMID:24719705

  7. Alternate Level of Care Patients in Public General Hospital Psychiatry.

    ERIC Educational Resources Information Center

    Marcos, Luis R.; Gil, Rosa M.

    1984-01-01

    Analyzes the interaction between psychiatric services in public general hospitals and in other institutional settings. A one-day census of patients in a New York general hospital showed the hospital was providing care to a large number of patients in need of other, less intensive institutional settings. (BH)

  8. Prioritizing Threats to Patient Safety in Rural Primary Care

    ERIC Educational Resources Information Center

    Singh, Ranjit; Singh, Ashok; Servoss, Timothy J.; Singh, Gurdev

    2007-01-01

    Context: Rural primary care is a complex environment in which multiple patient safety challenges can arise. To make progress in improving safety with limited resources, each practice needs to identify those safety problems that pose the greatest threat to patients and focus efforts on these. Purpose: To describe and field-test a novel approach to…

  9. Health Care Professionals' Views about Supporting Patients' Self-Management

    ERIC Educational Resources Information Center

    Mikkonen, Irma; Hynynen, Marja-Anneli

    2012-01-01

    Purpose: The aim of this study was to describe nurses' and other health care professionals' views about their patient education skills and how to develop them. Design/methodology/approach: The data for the study were collected from the participants of the online education course on patient education. The data were analyzed using qualitative…

  10. [Integrated care for patients with advanced chronic obstructive pulmonary disease].

    PubMed

    Jassem, Ewa; Górecka, Dorota; Krakowiak, Piotr; Kozielski, Jerzy; Słomiński, J Marek; Krajnik, Małgorzata; Fal, Andrzej M

    2010-01-01

    Chronic obstructive pulmonary disease (COPD) is the third cause of mortality and disability (assessed by DALY) among patients above 60 year old. Severe and very severe COPD (FEV(1) = equal or less than 50% and 30% of expected value, respectively) is estimated at 20% of all COPD patients. Advanced COPD usually leads to physical and mental deterioration, the patients often manage with the problems caused by the disease and other comorbidities poorly. This leads to increased risk of COPD exacerbations and further deterioration of the patient's status, increased costs of medical care and eventually increased risk of death. Current organization of medical care for those patients does not provide adequate health and social support for them. However, it seems that introducing an integrated approach proposed by World Health Organization, could improve the situation of advanced COPD patients. In Poland, this kind of care has been provided in advanced cancer patients throughout stationary palliative care units and hospices during the last several years. This experience should be helpful in integrating actions of general practitioners and specialized nurses, as well as providing access for the specialists' consultations according to the individual needs of the patients. It should also allow for broad cooperation with auxiliary staff, such as social workers, medical assistants and volunteers, as well as psychologists and clergymen (especially in the terminal phase of the disease).

  11. Nurse case managers: patient care implications at a Pakistani university.

    PubMed

    Walani, Laila

    The role of the nurse in hospital is varied and some are choosing to incorporate more managerial and administrative skills into their clinical role. One such role is that of the nurse case manager (NCM). This particular role concentrates on involving the family and the patient in his or her own care, facilitation of the care plan, and open discussions between the patient, medics and nursing staff. NCMs in the author's hospital have made a remarkable contribution to patient care. It is a challenging and exceedingly demanding role in both developing and developed countries, but one that is increasingly important. The NCMs are involved in coordination, facilitation of core process and mobilization of resources, not only in hospital but at the patient's home. In this short introductory article the role of NCM is highlighted and the author discusses how this diverse role is concerned with patient care. NCMs work with multidisciplinary teams to enhance the patient's care process. Their attention is also given to cost reduction and clinical pathway management.

  12. Caring for LGBTQ patients: Methods for improving physician cultural competence.

    PubMed

    Klein, Elizabeth W; Nakhai, Maliheh

    2016-05-01

    This article summarizes the components of a curriculum used to teach family medicine residents and faculty about LGBTQ patients' needs in a family medicine residency program in the Pacific Northwest region of the United States. This curriculum was developed to provide primary care physicians and physicians-in-training with skills to provide better health care for LGBTQ-identified patients. The curriculum covers topics that range from implicit and explicit bias and appropriate terminology to techniques for crafting patient-centered treatment plans. Additionally, focus is placed on improving the understanding of specific and unique barriers to competent health care encountered by LGBTQ patients. Through facilitated discussion, learners explore the health disparities that disproportionately affect LGBTQ individuals and develop skills that will improve their ability to care for LGBTQ patients. The goal of the curriculum is to teach family medicine faculty and physicians in training how to more effectively communicate with and treat LGBTQ patients in a safe, non-judgmental, and welcoming primary care environment. PMID:27497452

  13. Relationship centred outcomes focused on compassionate care for older people within in-patient care settings.

    PubMed

    Smith, Stephen; Dewar, Belinda; Pullin, Simon; Tocher, Ria

    2010-06-01

    This paper describes outcomes from research titled Leadership in Compassionate Care. The research adopts a participatory action research approach, utilizing appreciative inquiry and relationship centred care. Outcomes of the research are based upon relationships between patients, families and staff. This paper focuses on in-patient care for older people. A range of data generation activities were undertaken including: observation, interviews using emotional touch points and reflective accounts. To highlight outcomes in compassionate care, this paper uses case studies from two participating services. Principles of compassionate care were derived from understanding experiences of patients, relatives and staff and initiating responsive action projects. The aim was to enhance the experience of relationship centred, compassionate care. The process of emotional touch points enabled a richer understanding of experience. In terms of outcomes for patients this involved, enhanced quality of time spent with family and opening up conversations between families and staff. Outcomes for families involved enhanced access to relevant information and the opportunity to make sense of their situation. Staff outcomes were gaining experience in working alongside family to co-create the service, enhanced understanding of the experiences of patients and relatives led to direct changes in individual and team practices.

  14. Practical Implementation of a Large Primary Care Pediatric Practice Patient Care Information System

    PubMed Central

    Mize, Susan G.; Kramer, Robert I.

    1987-01-01

    THIS PAPER PRESENTS THE USE OF A PATIENT CARE INFORMATION PORTION OF A COMPUTERIZED OFFICE PRACTICE MANAGEMENT SYSTEM. THE KEY TO IMPLEMENTING THIS SYSTEM IN A COST EFFECTIVE MANNER WAS THE ABILITY TO AUTOMATICALLY ABSTRACT MEDICAL INFORMATION FROM THE ACCOUNTING PROGRAMS WITHOUT HAVING TO REKEY THE DESIGNATED PATIENT MEDICAL INFORMATION ITEMS. THE PATIENT MANAGEMENT FUNCTIONS SPECIFICALLY INCLUDE: (1) A MINIMAL PATIENT MEDICAL INFORMATION SET WHICH IS PRINTED ON THE PATIENTCARE SLIP” OR “SUPERBILL”; (2) CLINICAL NOTES WHICH ALLOW NURSES AND PHYSICIANS TO DOCUMENT PATIENT PHONE CALLS; (3) A THERAPEUTIC GUIDE WHICH GIVES ACCESS TO NURSES TO READ ON THE TERMINAL SCREEN STANDARD RECOMMENDATIONS BY THEIR PHYSICIANS FOR THE MORE COMMON PROBLEMS AND QUESTIONS ENCOUNTERED WHILE HANDLING PATIENT PHONE CALLS; AND (4) A NURSE TELEPHONE MESSAGE SYSTEM.

  15. Housestaff activism: the emergence of patient-care demands.

    PubMed

    Hoffman, L M

    1982-01-01

    There have been two trends within the physician housestaff movement: increased acceptance of collective bargaining and unions, and a shift from narrower economic to broader political demands, including some involving patient care. Case studies of politically active housestaff associations in New York, Chicago, and Los Angeles are used to examine the emergence of "patient-care" demands and their compatibility with collective bargaining frameworks. As house-staff have become principal providers of care to indigent populations in public hospitals, and economic cutbacks have endangered service as well as the positions of physicians, patient-care demands arise and become infused with demands for participation and control in decision-making. Common factors in the politicization of housestaff have been the contribution of activists of the sixties as leaders, and the impact of fiscal crisis and economic retrenchment in the seventies. However, the emergence and resolution of these issues has differed depending upon legal, political, historical, and organizational variations. In general, patient-care issues are supported by housestaff when they dovetail with housestaff interests. However, physician interests can diverge from those of patients, as in the case of manpower redistribution. On the whole, wages and benefits have done better than educational or patient-care demands. Educational demands have met with counterattack, and patient care, limited by the traditional scope of collective bargaining, has had to evolve indirectly, and has been hurt by long-term economic trends. Finally, national housestaff organization is limited by the wide-ranging politics and ideas of diverse regional organizations which represent different types of training institutions and career orientations.

  16. Neurologic Diseases in Special Care Patients.

    PubMed

    Robbins, Miriam R

    2016-07-01

    Neurologic diseases can have a major impact on functional capacity. Patients with neurologic disease require individualized management considerations depending on the extent of impairment and impact on functional capacity. This article reviews 4 of the more common and significant neurologic diseases (Alzheimer disease, cerebrovascular accident/stroke, multiple sclerosis, and Parkinson disease) that are likely to present to a dental office and provides suggestions on the dental management of patients with these conditions.

  17. The bariatric patient: an overview of perioperative care.

    PubMed

    Fencl, Jennifer L; Walsh, Angela; Vocke, Dawn

    2015-08-01

    Obesity (ie, a body mass index of ≥30 kg/m(2)) is increasing in the United States. As a result, more overweight individuals are being surgically treated for weight loss, thus making it imperative for perioperative RNs to understand obesity's effects on patients' health, its contribution to significant comorbidities (eg, diabetes, cardiovascular disease, hypertension, sleep apnea, musculoskeletal issues, stroke), the perioperative care requirements (eg, specialized instruments and equipment, positioning and lifting aids), and unique needs of these patients (eg, diet, counseling). It is vital that the perioperative nurse accurately assesses the patient undergoing bariatric surgery to provide safe and appropriate nursing interventions during the perioperative continuum of care. PMID:26227516

  18. Exploring the Pathogens Present at the Patient Care Equipments & Supplies to Sensitise the Health Care Workers for Preventing Health Care-Associated Infections among In-Patients.

    PubMed

    Dadhich, Amit; Arya, Sanjay; Kapil, Arti

    2014-01-01

    Health care-associated infection (HCAI) is an infection that a person acquires in hospital after 24 hours of his/her admission. A health care worker (HCW) does not have any right to provide another infection to in-patients. While caring the patients, HCW innocently or otherwise can transmit various pathogens to the patient. It is both ethically and legally wrong and HCW is answerable for it. The current study was conducted with the objectives to find out the rate of presence of pathogens at the patient care equipments & supplies, to identify the most common pathogens present at the patient care equipments & supplies and to identify such equipments & supplies that are at high risk of contamination. Investigator collected 1,145 samples of different equipments & supplies used for patient care from operation theaters, labour room & medical wards of a tertiary care hospital in New Delhi. The sample was collected from April 2012 to April 2013 by random sampling. Out of 1,145 samples, 112 were positive or contaminated with certain kind of pathogen. The finding revealed that the contamination rate of patient care equipments & supplies is 9.78 percent. The most common and frequent pathogen present at the equipments & supplies is Pseudomonas (39.29%) and water of oxygen humidifier is most commonly and frequently infected (47.32%). Nurses as the backbone of hospital should strictly adhere to the policies and protocols of the institution. She/he must update the knowledge of infection control practices and various methods of controlling HCAI including hand hygiene, disinfection of patient care equipments & supplies and cleanliness of environment. A Nurse should also transmit this knowledge to other team members so as to minimise the health care-associated infection rate.

  19. Integrated care prevents hospitalisations for exacerbations in COPD patients.

    PubMed

    Casas, A; Troosters, T; Garcia-Aymerich, J; Roca, J; Hernández, C; Alonso, A; del Pozo, F; de Toledo, P; Antó, J M; Rodríguez-Roisín, R; Decramer, M

    2006-07-01

    Hospital admissions due to chronic obstructive pulmonary disease (COPD) exacerbations have a major impact on the disease evolution and costs. The current authors postulated that a simple and well-standardised, low-intensity integrated care intervention can be effective to prevent such hospitalisations. Therefore, 155 exacerbated COPD patients (17% females) were recruited after hospital discharge from centres in Barcelona (Spain) and Leuven (Belgium). They were randomly assigned to either integrated care (IC; n = 65; age mean+/-sd 70+/-9 yrs; forced expiratory volume in one second (FEV(1)) 1.1+/-0.5 L, 43% predicted) or usual care (UC; n = 90; age 72+/-9 yrs; FEV(1) 1.1+/-0.05 L, 41% pred). The IC intervention consisted of an individually tailored care plan upon discharge shared with the primary care team, as well as accessibility to a specialised nurse case manager through a web-based call centre. After 12 months' follow-up, IC showed a lower hospitalisation rate (1.5+/-2.6 versus 2.1+/-3.1) and a higher percentage of patients without re-admissions (49 versus 31%) than UC without differences in mortality (19 versus 16%, respectively). In conclusion, this trial demonstrates that a standardised integrated care intervention, based on shared care arrangements among different levels of the system with support of information technologies, effectively prevents hospitalisations for exacerbations in chronic obstructive pulmonary disease patients.

  20. Primary Care of the Patient with Asthma.

    PubMed

    Lenaeus, Michael J; Hirschmann, Jan

    2015-09-01

    Obstructive lung disease includes asthma and chronic obstructive pulmonary disease (COPD). Because a previous issue of Medical Clinics of North America (2012;96[4]) was devoted to COPD, this article focuses on asthma in adults, and addresses some topics about COPD not addressed previously. Asthma is a heterogeneous disease marked by variable airflow obstruction and bronchial hyperreactivity. Onset is most common in early childhood, although many people develop asthma later in life. Adult-onset asthma presents a particular challenge in the primary care clinic because of incomplete understanding of the disorder, underreporting of symptoms, underdiagnosis, inadequate treatment, and high rate of comorbidity.

  1. Patient Navigators: Agents of Creating Community-Nested Patient-Centered Medical Homes for Cancer Care

    PubMed Central

    Simon, Melissa A.; Samaras, Athena T.; Nonzee, Narissa J.; Hajjar, Nadia; Frankovich, Carmi; Bularzik, Charito; Murphy, Kara; Endress, Richard; Tom, Laura S.; Dong, XinQi

    2016-01-01

    Patient navigation is an internationally utilized, culturally grounded, and multifaceted strategy to optimize patients’ interface with the health-care team and system. The DuPage County Patient Navigation Collaborative (DPNC) is a campus–community partnership designed to improve access to care among uninsured breast and cervical cancer patients in DuPage County, IL. Importantly, the DPNC connects community-based social service delivery with the patient-centered medical home to achieve a community-nested patient-centered medical home model for cancer care. While the patient navigator experience has been qualitatively documented, the literature pertaining to patient navigation has largely focused on efficacy outcomes and program cost effectiveness. Here, we uniquely highlight stories of women enrolled in the DPNC, told from the perspective of patient navigators, to shed light on the myriad barriers that DPNC patients faced and document the strategies DPNC patient navigators implemented.

  2. Patient Navigators: Agents of Creating Community-Nested Patient-Centered Medical Homes for Cancer Care

    PubMed Central

    Simon, Melissa A.; Samaras, Athena T.; Nonzee, Narissa J.; Hajjar, Nadia; Frankovich, Carmi; Bularzik, Charito; Murphy, Kara; Endress, Richard; Tom, Laura S.; Dong, XinQi

    2016-01-01

    Patient navigation is an internationally utilized, culturally grounded, and multifaceted strategy to optimize patients’ interface with the health-care team and system. The DuPage County Patient Navigation Collaborative (DPNC) is a campus–community partnership designed to improve access to care among uninsured breast and cervical cancer patients in DuPage County, IL. Importantly, the DPNC connects community-based social service delivery with the patient-centered medical home to achieve a community-nested patient-centered medical home model for cancer care. While the patient navigator experience has been qualitatively documented, the literature pertaining to patient navigation has largely focused on efficacy outcomes and program cost effectiveness. Here, we uniquely highlight stories of women enrolled in the DPNC, told from the perspective of patient navigators, to shed light on the myriad barriers that DPNC patients faced and document the strategies DPNC patient navigators implemented. PMID:27594792

  3. Ethical and legal issues in special patient care.

    PubMed

    Shuman, S K; Bebeau, M J

    1994-07-01

    Dental professionals encounter a number of challenging ethical and legal dilemmas when caring for special patients. Questions may arise in securing consent for treatment; using restraints; overcoming economic, social, and physical barriers to care; and dealing with patient abuse. These concerns generally stem from underlying conflicts between any of the fundamental ethical principles of autonomy, nonmaleficence, beneficence, justice, veracity, and fidelity. When securing consent for treatment, practitioners must consider both legal competence and decision-making capacity. If decision-making is impaired, input should be solicited from others to arrive at treatment decisions in keeping with the patient's values concerning dental care. To guard against the inappropriate use of restraints, 10 guidelines are presented for consideration. Providers should strive not to allow economic considerations to influence their care unduly either by failing to offer a full range of options or by providing care that is below usual standards. Services must be made available to disabled individuals on the same basis that they are available to others without disability. This principle forms the basis of the Americans with Disabilities Act, which stipulates what accommodations must be made to ensure that physical and social barriers do not impede access to dental care. Finally, special patients, particularly the frail elderly, are at increased risk to become victims of abuse. Dental professionals should be familiar with the warning signs and symptoms of such abuse and their obligation to take actions to end it.

  4. Bridging the "system's" gap between interprofessional care and patient safety: sociological insights.

    PubMed

    Infante, Claudia

    2006-10-01

    This paper is based on the premise that a systemic approach is the crucial link between patient safety and interprofessional care. It is argued that there has been little concern with regard to the need for a critical assessment and development of a systems' theoretical model able to envisage the broad approach of delivery of health care that patient safety initiatives require. Based on a medical sociology approach, the paper analyzes four forces that threaten a well sustained development of research and problem-solving strategic proposals that are to be derived from the intersection of patient safety and interprofessional care, namely: (i) the absence of explicit theoretical models in empirical research work in both fields; (ii) the a-critical acceptance of an ideologically limited biomedical paradigm in the actual systemic definitions of the clinical model; (iii) a fragmentation of the underlying system concept that is unable to include all of the actors of the system; and, (iv) the need to go beyond the non-maleficence principle and include the remaining three bioethical principles in medical care. The paper concludes with the proposal of developing theoretically grounded empirical interprofessional research that allows the crucial inclusion of social sciences in the systemic approach. PMID:17000477

  5. Bridging the "system's" gap between interprofessional care and patient safety: sociological insights.

    PubMed

    Infante, Claudia

    2006-10-01

    This paper is based on the premise that a systemic approach is the crucial link between patient safety and interprofessional care. It is argued that there has been little concern with regard to the need for a critical assessment and development of a systems' theoretical model able to envisage the broad approach of delivery of health care that patient safety initiatives require. Based on a medical sociology approach, the paper analyzes four forces that threaten a well sustained development of research and problem-solving strategic proposals that are to be derived from the intersection of patient safety and interprofessional care, namely: (i) the absence of explicit theoretical models in empirical research work in both fields; (ii) the a-critical acceptance of an ideologically limited biomedical paradigm in the actual systemic definitions of the clinical model; (iii) a fragmentation of the underlying system concept that is unable to include all of the actors of the system; and, (iv) the need to go beyond the non-maleficence principle and include the remaining three bioethical principles in medical care. The paper concludes with the proposal of developing theoretically grounded empirical interprofessional research that allows the crucial inclusion of social sciences in the systemic approach.

  6. Psychiatric Diagnostic Uncertainty: Challenges to Patient-Centered Care.

    PubMed

    Aultman, Julie M

    2016-01-01

    In this case and commentary, a patient's request to be treated for depression without a stigmatizing diagnostic label of bipolar II disorder challenges a clinician's obligation to provide a clinically and ethically appropriate diagnosis and safe treatment consistent with the patient's family medical history. Sensitively recognizing and responding to patients' concerns and values, even when they might conflict with the delivery of reasonable psychiatric care, is essential when gauging the appropriateness of such therapeutic practices. Furthermore, developing honest and open communication; recognizing that patients, like some psychiatric diagnoses, do not fit into discrete boundaries or cannot be categorized by a single label; and placing the patient at the center of care can all serve to resolve value conflicts, protect patient privacy, and promote accurate diagnostic and treatment practices. PMID:27322991

  7. Nutrition Care for Patients with Weight Regain after Bariatric Surgery

    PubMed Central

    Johnson Stoklossa, Carlene; Atwal, Suneet

    2013-01-01

    Achieving optimal weight outcomes for patients with obesity is important to the management of their chronic disease. All interventions present risks for weight regain. Bariatric surgery is the most efficacious treatment, producing greater weight losses that are sustained over more time compared to lifestyle interventions. However, approximately 20–30% of patients do not achieve successful weight outcomes, and patients may experience a regain of 20–25% of their lost weight. This paper reviews several factors that influence weight regain after bariatric surgery, including type of surgery, food tolerance, energy requirements, drivers to eat, errors in estimating intake, adherence, food and beverage choices, and patient knowledge. A comprehensive multidisciplinary approach can provide the best care for patients with weight regain. Nutrition care by a registered dietitian is recommended for all bariatric surgery patients. Nutrition diagnoses and interventions are discussed. Regular monitoring of weight status and early intervention may help prevent significant weight regain. PMID:24348530

  8. Nutrition care for patients with weight regain after bariatric surgery.

    PubMed

    Johnson Stoklossa, Carlene; Atwal, Suneet

    2013-01-01

    Achieving optimal weight outcomes for patients with obesity is important to the management of their chronic disease. All interventions present risks for weight regain. Bariatric surgery is the most efficacious treatment, producing greater weight losses that are sustained over more time compared to lifestyle interventions. However, approximately 20-30% of patients do not achieve successful weight outcomes, and patients may experience a regain of 20-25% of their lost weight. This paper reviews several factors that influence weight regain after bariatric surgery, including type of surgery, food tolerance, energy requirements, drivers to eat, errors in estimating intake, adherence, food and beverage choices, and patient knowledge. A comprehensive multidisciplinary approach can provide the best care for patients with weight regain. Nutrition care by a registered dietitian is recommended for all bariatric surgery patients. Nutrition diagnoses and interventions are discussed. Regular monitoring of weight status and early intervention may help prevent significant weight regain.

  9. Patient-Centered Care and the Mediator's Skills.

    PubMed

    Walton, Mary K

    2015-01-01

    Bioethics mediation training offers knowledge and skills valuable for clinical ethics consultants who are engaged in high conflict situations. Furthermore, clinicians with this training can support organizational efforts to create a culture that is centered on the values, needs, and care preferences of patients and their families, rather than on those of the clinician or organization. Patient-centeredness is a hallmark of quality and an essential component for patients' safety. Clinicians with mediation training have the communication skills to address the myriad needs of patients and their loved ones, needs that are challenging to meet in inpatient hospital settings. The author illustrates principles of mediation such as validating patients' emotions, revealing the interests of all stakeholders, and shaping a shared solution to demonstrate how these skills have broad applicability in patient care settings.

  10. [Patient safety in primary care: PREFASEG project].

    PubMed

    Catalán, Arantxa; Borrell, Francesc; Pons, Angels; Amado, Ester; Baena, José Miguel; Morales, Vicente

    2014-07-01

    The Institut Català de la Salut (ICS) has designed and integrated in electronic clinical station of primary care a new software tool to support the prescription of drugs, which can detect on-line certain medication errors. The software called PREFASEG (stands for Secure drug prescriptions) aims to prevent adverse events related to medication use in the field of primary health care (PHC). This study was made on the computerized medical record called CPT, which is used by all PHC physicians in our institution -3,750- and prescribing physicians through it. PREFASEG integrated in eCAP in July 2010 and six months later we performed a cross-sectional study to evaluate their usefulness and refine their design. The software alerts on-line in 5 dimensions: drug interactions, redundant treatments, allergies, contraindications of drugs with disease, and advises against drugs in over 75 years. PREFASEG generated 1,162,765 alerts (1 per 10 high treatment), with the detection of therapeutic duplication (62%) the most alerted. The overall acceptance rate is 35%, redundancies pharmacological (43%) and allergies (26%) are the most accepted. A total of 10,808 professionals (doctors and nurses) have accepted some of the recommendations of the program. PREFASEG is a feasible and highly efficient strategy to achieve an objective of Quality Plan for the NHS.

  11. 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.

  12. Improving personal health records for patient-centered care

    PubMed Central

    Feldman, Henry J; Ross, Stephen E; Safran, Charles

    2010-01-01

    Objective To assess the patient-centeredness of personal health records (PHR) and offer recommendations for best practice guidelines. Design Semi-structured interviews were conducted in seven large early PHR adopter organizations in 2007. Organizations were purposively selected to represent a variety of US settings, including medium and large hospitals, ambulatory care facilities, insurers and health plans, government departments, and commercial sectors. Measurements Patient-centeredness was assessed against a framework of care that includes: (1) respect for patient values, preferences, and expressed needs; (2) information and education; (3) access to care; (4) emotional support to relieve fear and anxiety; (5) involvement of family and friends; (6) continuity and secure transition between healthcare providers; (7) physical comfort; (8) coordination of care. Within this framework we used evidence for patient preferences (where it exists) to compare existing PHR policies, and propose a best practice model. Results Most organizations enable many patient-centered functions such as data access for proxies and minors. No organization allows patient views of clinical progress notes, and turnaround times for PHR reporting of normal laboratory results can be up to 7 days. Conclusion Findings suggest patient-centeredness for personal health records can be improved, and recommendations are made for best practice guidelines. PMID:20190063

  13. Diabetes Stories: Use of Patient Narratives of Diabetes to Teach Patient-Centered Care

    ERIC Educational Resources Information Center

    Kumagai, Arno K.; Murphy, Elizabeth A.; Ross, Paula T.

    2009-01-01

    A critical component to instituting compassionate, patient-centered diabetes care is the training of health care providers. Our institution developed the Family Centered Experience (FCE), a comprehensive 2-year preclinical program based on longitudinal conversations with patients about living with chronic illness. The goal of the FCE is to explore…

  14. A Patient-Held Medical Record Integrating Depression Care into Diabetes Care

    PubMed Central

    Satoh-Asahara, Noriko; Ito, Hiroto; Akashi, Tomoyuki; Yamakage, Hajime; Kotani, Kazuhiko; Nagata, Daisuke; Nakagome, Kazuyuki; Noda, Mitsuhiko

    2016-01-01

    PURPOSE Depression is frequently observed in people with diabetes. The purpose of this study is to develop a tool for individuals with diabetes and depression to communicate their comorbid conditions to health-care providers. METHOD We searched the Internet to review patient-held medical records (PHRs) of patients with diabetes and examine current levels of integration of diabetes and depression care in Japan. RESULTS Eight sets of PHRs were found for people with diabetes. All PHRs included clinical follow-up of diabetes and multidisciplinary clinical pathways for diabetes care. No PHRs included depression monitoring and/or treatment. In terms of an integrated PHR for a patient comorbid with diabetes and depression, necessary components include hopes/preferences, educational information on diabetes complications and treatment, medical history, stress and coping, resources, and monitoring diabetes and depression. CONCLUSION A new PHR may be suitable for comorbid patients with diabetes and depression. PMID:27478395

  15. Mental Health Issues and Special Care Patients.

    PubMed

    Clark, David B

    2016-07-01

    Mental illness is a major health issue in the world today, yet often remains misunderstood, unrecognized, and undertreated. Patients suffering from severe psychiatric disorders generally display poor oral health, often as a consequence of both lifestyle and avoidant-type behaviors that become exacerbated by their illness. Individuals with severe mental illness display a greater incidence of oral disease compared with a similar demographic not dealing with these particular disorders. Efforts to enhance the oral health of these vulnerable patients will play a significant role in the overall rebuilding of their self-esteem and contribute positively to their journey toward stability and recovery. PMID:27264850

  16. Courtesy in caring. The patient as customer.

    PubMed

    DeBaca, V

    1990-01-01

    If you were paying $500 a night for a hotel room,. would you be happy if you were told you would be sharing it with a stranger? While such a question cannot be literally asked about a hospital experience, metaphorically it can be--and is--asked every time a patient enters a hospital. The idea of patient-as-consumer is not longer just another trendy concept but an integral part of the way many hospitals do business, and it's the hospital manager's responsibility to ensure the customer's satisfaction. PMID:10105899

  17. Mental Health Issues and Special Care Patients.

    PubMed

    Clark, David B

    2016-07-01

    Mental illness is a major health issue in the world today, yet often remains misunderstood, unrecognized, and undertreated. Patients suffering from severe psychiatric disorders generally display poor oral health, often as a consequence of both lifestyle and avoidant-type behaviors that become exacerbated by their illness. Individuals with severe mental illness display a greater incidence of oral disease compared with a similar demographic not dealing with these particular disorders. Efforts to enhance the oral health of these vulnerable patients will play a significant role in the overall rebuilding of their self-esteem and contribute positively to their journey toward stability and recovery.

  18. Patient participation in health care: an underused resource.

    PubMed

    Lott, T F; Blazey, M E; West, M G

    1992-03-01

    The CCM has been in development for more than 3 years and in operation for more than 2 years. According to Peters, "Developing a vision is a messy, artistic process. Living it convincingly is a passionate one beyond any doubt." This statement expresses our personal experience in development of the CCM in terms of time, effort, hurdles, growth, and satisfaction. An environment has been created that strengthens the nurse's role as clinical educator, advocate, and coordinator. Capable patients and families on pilot units express satisfaction because they have learned to participate actively in their care during hospitalization, to better understand their disease, and to better manage their care at home. The time saved for nurses allows them to be engaged in activities of health promotion and education, deliver selected aspects of care, and consult with other team members on issues of problematic patient management. In this environment, professional nursing practice has been enhanced and nurses are influencing positive patient outcomes. In addition, our nurse recruiter reports that it is easier to recruit nurses for CCM pilot units than for nonpilot units with similar patient populations. This project has tapped an often underused resource, the patient's self-care ability, and created an environment that benefits not only the care recipients but also the caregivers. PMID:1545996

  19. Understanding cultural difference in caring for dying patients.

    PubMed Central

    Koenig, B A; Gates-Williams, J

    1995-01-01

    Experiences of illness and death, as well as beliefs about the appropriate role of healers, are profoundly influenced by patients' cultural background. As the United States becomes increasingly diverse, cultural difference is a central feature of many clinical interactions. Knowledge about how patients experience and express pain, maintain hope in the face of a poor prognosis, and respond to grief and loss will aid health care professionals. Many patients' or families' beliefs about appropriate end-of-life care are easily accommodated in routine clinical practice. Desires about the care of the body after death, for example, generally do not threaten deeply held values of medical science. Because expected deaths are increasingly the result of explicit negotiation about limiting or discontinuing therapies, however, the likelihood of serious moral disputes and overt conflict increases. We suggest a way to assess cultural variation in end-of-life care, arguing that culture is only meaningful when interpreted in the context of a patient's unique history, family constellation, and socioeconomic status. Efforts to use racial or ethnic background as simplistic, straightforward predictors of beliefs or behavior will lead to harmful stereotyping of patients and culturally insensitive care for the dying. PMID:7571587

  20. Care of the transgender patient: the role of the gynecologist.

    PubMed

    Unger, Cécile A

    2014-01-01

    Gender dysphoria refers to distress that is caused by a sense of incongruity between an individual's self-identified gender and natal sex. Diagnosis is made in accordance with the Diagnostic and Statistical Manual of Mental Disorders and treatment first involves psychiatric therapy, which can help determine a patient's true goals in regards to achieving gender identity. Patients who wish to transition to the opposite sex must undergo a supervised real-life test and often are treated with hormonal therapy to develop physical characteristics consistent with their gender identity. Sex reassignment surgery is an option for patients who wish to transition completely. Transpatients face many barriers when it comes to basic health needs including education, housing, and health care. This is a result of long-standing marginalization and discrimination against this community. Because of these barriers, many patients do not receive the proper health care that they need. Additionally, because of certain high-risk behaviors as well as long-term hormonal therapy, transpatients have different routine health care needs that should be addressed in the primary care setting. Gynecologists play an important role in caring for transgender patients and should be knowledgeable about the general principles of transgender health.

  1. Redesigning care for patients at increased hospitalization risk: the Comprehensive Care Physician model.

    PubMed

    Meltzer, David O; Ruhnke, Gregory W

    2014-05-01

    Patients who have been hospitalized often experience care coordination problems that worsen outcomes and increase costs. One reason is that hospital care and ambulatory care are often provided by different physicians. However, interventions to improve care coordination for hospitalized patients have not consistently improved outcomes and generally have not reduced costs. We describe the rationale for the Comprehensive Care Physician model, in which physicians focus their practice on patients at increased risk of hospitalization so that they can provide both inpatient and outpatient care to their patients. We also describe the design and implementation of a study supported by the Center for Medicare and Medicaid Innovation to assess the model's effects on costs and outcomes. Evidence concerning the effectiveness of the program is expected by 2016. If the program is found to be effective, the next steps will be to assess the durability of its benefits and the model's potential for dissemination; evidence to the contrary will provide insights into how to alter the program to address sources of failure. PMID:24799573

  2. Redesigning Care For Patients At Increased Hospitalization Risk: The Comprehensive Care Physician Model

    PubMed Central

    Meltzer, David O.; Ruhnke, Gregory W.

    2015-01-01

    Patients who have been hospitalized often experience care coordination problems that worsen outcomes and increase costs. One reason is that hospital care and ambulatory care are often provided by different physicians. However, interventions to improve care coordination for hospitalized patients have not consistently improved outcomes and generally have not reduced costs. We describe the rationale for the Comprehensive Care Physician model, in which physicians focus their practice on patients at increased risk of hospitalization so that they can provide both inpatient and outpatient care to their patients. We also describe the design and implementation of a study supported by the Center for Medicare and Medicaid Innovation to assess the model’s effects on costs and outcomes. Evidence concerning the effectiveness of the program is expected by 2016. If the program is found to be effective, the next steps will be to assess the durability of its benefits and the model’s potential for dissemination; evidence to the contrary will provide insights into how to alter the program to address sources of failure. PMID:24799573

  3. Redesigning care for patients at increased hospitalization risk: the Comprehensive Care Physician model.

    PubMed

    Meltzer, David O; Ruhnke, Gregory W

    2014-05-01

    Patients who have been hospitalized often experience care coordination problems that worsen outcomes and increase costs. One reason is that hospital care and ambulatory care are often provided by different physicians. However, interventions to improve care coordination for hospitalized patients have not consistently improved outcomes and generally have not reduced costs. We describe the rationale for the Comprehensive Care Physician model, in which physicians focus their practice on patients at increased risk of hospitalization so that they can provide both inpatient and outpatient care to their patients. We also describe the design and implementation of a study supported by the Center for Medicare and Medicaid Innovation to assess the model's effects on costs and outcomes. Evidence concerning the effectiveness of the program is expected by 2016. If the program is found to be effective, the next steps will be to assess the durability of its benefits and the model's potential for dissemination; evidence to the contrary will provide insights into how to alter the program to address sources of failure.

  4. Early mobility and walking program for patients in intensive care units: creating a standard of care.

    PubMed

    Perme, Christiane; Chandrashekar, Rohini

    2009-05-01

    New technologies in critical care and mechanical ventilation have led to long-term survival of critically ill patients. An early mobility and walking program was developed to provide guidelines for early mobility that would assist clinicians working in intensive care units, especially clinicians working with patients who are receiving mechanical ventilation. Prolonged stays in the intensive care unit and mechanical ventilation are associated with functional decline and increased morbidity, mortality, cost of care, and length of hospital stay. Implementation of an early mobility and walking program could have a beneficial effect on all of these factors. The program encompasses progressive mobilization and walking, with the progression based on a patient's functional capability and ability to tolerate the prescribed activity. The program is divided into 4 phases. Each phase includes guidelines on positioning, therapeutic exercises, transfers, walking reeducation, and duration and frequency of mobility sessions. Additionally, the criteria for progressing to the next phase are provided. Use of this program demands a collaborative effort among members of the multidisciplinary team in order to coordinate care for and provide safe mobilization of patients in the intensive care unit.

  5. Benchmarking HIV health care: from individual patient care to health care evaluation. An example from the EuroSIDA study

    PubMed Central

    2012-01-01

    Background State-of-the-art care involving the utilisation of multiple health care interventions is the basis for an optimal long-term clinical prognosis for HIV-patients. We evaluated health care for HIV patients based on four key indicators. Methods Four indicators of health care were assessed: Compliance with current guidelines on initiation of: 1) combination antiretroviral therapy (cART); 2) chemoprophylaxis; 3) frequency of laboratory monitoring; and 4) virological response to cART (proportion of patients with HIV-RNA < 500copies/ml for >90% of time on cART). Results 7097 EuroSIDA patients were included from Northern (n = 923), Southern (n = 1059), West Central (n = 1290) East Central (n = 1366), Eastern (n = 1964) Europe, and Argentina (n = 495). Patients in Eastern Europe with a CD4 < 200cells/mm3 were less likely to initiate cART and Pneumocystis jiroveci-chemoprophylaxis compared to patients from all other regions, and less frequently had a laboratory assessment of their disease status. The proportion of patients with virological response was highest in Northern, 89% vs. 84%, 78%, 78%, 61%, 55% in West Central, Southern, East Central Europe, Argentina and Eastern Europe, respectively (p < 0.0001). Compared to Northern, patients from other regions had significantly lower odds of virological response; the difference was most pronounced for Eastern Europe and Argentina (adjusted OR 0.16 [95%CI 0.11-0.23, p < 0.0001]; 0.20[0.14-0.28, p < 0.0001] respectively). Conclusions This assessment of HIV health care utilization revealed pronounced regional differences in adherence to guidelines and can help to identify gaps and direct target interventions. It may serve as a tool for the assessment and benchmarking of the clinical management of HIV patients in any setting worldwide. PMID:23009317

  6. Diabetes care quality is highly correlated with patient panel characteristics

    PubMed Central

    Bailey, Steffani; O’Malley, Jean P.; Gold, Rachel; Heintzman, John; Likumahuwa, Sonja; DeVoe, Jennifer E.

    2014-01-01

    Introduction Health care reimbursement is increasingly based on quality. Little is known about how clinic-level patient characteristics affect quality performance, particularly in community health centers (CHCs). Methods Using electronic health record data for 4,019 diabetic patients from 23 CHC primary care clinics in the OCHIN practice-based research network, we calculated correlations between a clinic’s patient panel characteristics and delivery rates of diabetes preventive services in 2007. Using regression models, we estimated the proportion of clinic variability in clinics’ preventive services rates associated with the variability in the clinics’ patient panel characteristics. We also explored whether clinics’ performance rates were affected by how patient panel denominators were defined. Results Clinic rates of glycosylated hemoglobin testing, influenza immunizations, and lipid screening were positively associated with the percentage of patients with continuous health insurance coverage, and negatively associated with the percentage uninsured. Microalbumin screening rates were positively associated with the percentage of racial minorities in a clinic’s panel. Associations remained consistent with different panel denominators. Conclusions Clinic variability in delivery rates of preventive services correlates with differences in clinics’ patient panel characteristics, particularly the percentage of patients with continuous insurance coverage. Quality scores that do not account for these differences could create disincentives to diabetes care for vulnerable patients. PMID:24204063

  7. [Treatment of constipation in palliative care patients is a challenge].

    PubMed

    Jarlbæk, Lene; Johnsen, Berit; Hansen, Ole Bo; Hedal, Birte

    2016-08-15

    The evidence for treatment of constipation in palliative care patients is poor. The condition of these patients is often complex, and results from studies performed in other patient groups cannot be extrapolated unconditionally. However, macrogol (polyethylene glycol), lactulose and sodium picosulphate seem to be well tolerated, and methylnaltrexone could be used in opioid-induced constipation, if the patients are not at risk from gastrointestinal perforation. The patients should be offered quiet and private surroundings, and attention should be payed to securing an optimal body position for defecation. PMID:27550785

  8. Patient Satisfaction with Hospital Inpatient Care: Effects of Trust, Medical Insurance and Perceived Quality of Care

    PubMed Central

    Wu, Qunhong; Liu, Chaojie; Jiao, Mingli; Hao, Yanhua; Han, Yuzhen; Gao, Lijun; Hao, Jiejing; Wang, Lan; Xu, Weilan; Ren, Jiaojiao

    2016-01-01

    Objective Deteriorations in the patient-provider relationship in China have attracted increasing attention in the international community. This study aims to explore the role of trust in patient satisfaction with hospital inpatient care, and how patient-provider trust is shaped from the perspectives of both patients and providers. Methods We adopted a mixed methods approach comprising a multivariate logistic regression model using secondary data (1200 people with inpatient experiences over the past year) from the fifth National Health Service Survey (NHSS, 2013) in Heilongjiang Province to determine the associations between patient satisfaction and trust, financial burden and perceived quality of care, followed by in-depth interviews with 62 conveniently selected key informants (27 from health and 35 from non-health sectors). A thematic analysis established a conceptual framework to explain deteriorating patient-provider relationships. Findings About 24% of respondents reported being dissatisfied with hospital inpatient care. The logistic regression model indicated that patient satisfaction was positively associated with higher level of trust (OR = 14.995), lower levels of hospital medical expenditure (OR = 5.736–1.829 as compared with the highest quintile of hospital expenditure), good staff attitude (OR = 3.155) as well as good ward environment (OR = 2.361). But patient satisfaction was negatively associated with medical insurance for urban residents and other insurance status (OR = 0.215–0.357 as compared with medical insurance for urban employees). The qualitative analysis showed that patient trust—the most significant predictor of patient satisfaction—is shaped by perceived high quality of service delivery, empathic and caring interpersonal interactions, and a better designed medical insurance that provides stronger financial protection and enables more equitable access to health care. Conclusion At the core of high levels of patient dissatisfaction

  9. Patients' substantialization of disease, the hybrid symptom and metaphysical care.

    PubMed

    Pârvan, Alexandra

    2015-06-01

    In the context of current scholarship concerned with facilitating integration between the biomedical and the patient-centred models of care, the article suggests that disease brings about an ontological disruption in patients, which is not directly addressed in either model, and may interfere with treatment and therapy outcomes if not met with a type of care termed here as 'metaphysical'. The receipt of diagnosis and medical care can give patients the sense that they are ontologically diminished, or less of a human, and along with physicians' approaches to and discourses about disease, may prompt them to seek ontological restoration or security in the same way as psychologically traumatized patients sometimes do: by treating the disease and/or the experience of harm associated with it as a thing that exists per se. I call this 'substantialization' of disease (or harm) and draw on Augustine's theory of non-substantial deficiencies (physiological and moral) and on Plato's and Plotinus's different takes on such defects in order to discuss what substantialization can do for patients. Based on literature that examines patients' ways of talking about and living with their disease, I speculate that substantialization can generate a 'hybrid symptom', consisting in patterns of exercising agency which may predispose to non-adherence. Ways in which physicians could provide metaphysical care are proposed, along with an understanding of chronic patients as hybrid ontological and agentic units, which draws on theories of enactive cognition. I opine that metaphysical care may facilitate integration between the depersonalized and personalized models of care. PMID:25312387

  10. A Method to Determine the Impact of Patient-Centered Care Interventions in Primary Care

    PubMed Central

    Daaleman, Timothy P.; Shea, Christopher M.; Halladay, Jacqueline; Reed, David

    2014-01-01

    INTRODUCTION The implementation of patient-centered care (PCC) innovations continues to be poorly understood. We used the implementation effectiveness framework to pilot a method for measuring the impact of a PCC innovation in primary care practices. METHODS We analyzed data from a prior study that assessed the implementation of an electronic geriatric quality-of-life (QOL) module in 3 primary care practices in central North Carolina in 2011–12. Patients responded to the items and the subsequent patient-provider encounter was coded using the Roter Interaction Analysis System (RIAS) system. We developed an implementation effectiveness measure specific to the QOL module (i.e., frequency of usage during the encounter) using RIAS and then tested if there were differences with RIAS codes using analysis of variance. RESULTS A total of 60 patient-provider encounters examined differences in the uptake of the QOL module (i.e., implementation-effectiveness measure) with the frequency of RIAS codes during the encounter (i.e., patient-centeredness measure). There was a significant association between the effectiveness measure and patient-centered RIAS codes. CONCLUSION The concept of implementation effectiveness provided a useful framework determine the impact of a PCC innovation. PRACTICE IMPLICATIONS A method that captures real-time interactions between patients and care staff over time can meaningfully evaluate PCC innovations. PMID:25269410

  11. Predictors of mortality among elderly dependent home care patients

    PubMed Central

    2013-01-01

    Background The purpose of this study is to identify which variables –among those commonly available and used in the primary care setting– best predict mortality in a cohort of elderly dependent patients living at home (EDPLH) that were included in a home care program provided by Primary Care Teams (PCT). Additionally, we explored the risk of death among a sub-group of these patients that were admitted to hospital the year before they entered the home care program. Methods A one-year longitudinal cohort study of a sample of EDPLH patients included in a home care programme provided by 72 PCTs. Variables collected from each individual patient included health and social status, carer’s characteristics, carer’s burden of care, health and social services received. Results 1,001 patients completed the study (91.5%), 226 were admitted to hospital the year before inclusion. 290 (28.9%) died during the one-year follow-up period. In the logistic regression analysis women show a lower risk of death [OR= 0.67 (0.50-0.91)]. The risk of death increases with comorbidity [Charlson index OR= 1.14 (1,06-1.23)], the number of previous hospital admissions [OR= 1,16 (1.03-1.33)], and with the degree of pressure ulcers [ulcers degree 1–2 OR = 2.94 (1.92-4.52); ulcers degree 3–4 OR = 4.45 (1.90-10.92)]. The logistic predictive model of mortality for patients previously admitted to hospital identified male sex, comorbidity, degree of pressure ulcers, and having received home care rehabilitation as independent variables that predict death. Conclusions Comorbidity, hospital admissions and pressure ulcers predict mortality in the following year in EDPLH patients. The subgroup of patients that entered home care programs with a previous record of hospital admission and a high score in our predictive model might be considered as candidates for palliative care. PMID:23947599

  12. Patient engagement: an investigation at a primary care clinic

    PubMed Central

    Gill, Preetinder Singh

    2013-01-01

    Background Engaged employees are an asset to any organization. They are instrumental in ensuring good commercial outcomes through continuous innovation and incremental improvement. A health care facility is similar to a regular work setting in many ways. A health care provider and a patient have roles akin to a team leader and a team member/stakeholder, respectively. Hence it can be argued that the concept of employee engagement can be applied to patients in health care settings in order to improve health outcomes. Methods Patient engagement data were collected using a survey instrument from a primary care clinic in the northern Indian state of Punjab. Canonical correlation equations were formulated to identify combinations which were strongly related to each other. In addition, the cause-effect relationship between patient engagement and patient-perceived health outcomes was described using structural equation modeling. Results Canonical correlation analysis showed that the first set of canonical variables had a fairly strong relationship, ie, a magnitude > 0.80 at the 95% confidence interval, for five dimensions of patient engagement. Structural equation modeling analysis yielded a β ≥ 0.10 and a Student’s t statistic ≥ 2.96 for these five dimensions. The threshold Student’s t statistic was 1.99. Hence it was found the β values were significant at the 95% confidence interval for all census regions. Conclusion A scaled reliable survey instrument was developed to measured patient engagement. Better patient engagement is associated with better patient-perceived health outcomes. This study provides preliminary evidence that patient engagement has a causal relationship with patient-perceived health outcomes. PMID:23515133

  13. Clinical Workflow Observations to Identify Opportunities for Nurse, Physicians and Patients to Share a Patient-centered Plan of Care

    PubMed Central

    Collins, Sarah A.; Gazarian, Priscilla; Stade, Diana; McNally, Kelly; Morrison, Conny; Ohashi, Kumiko; Lehmann, Lisa; Dalal, Anuj; Bates, David W.; Dykes, Patricia C.

    2014-01-01

    Patient- and Family-Centered Care (PFCC) is essential for high quality care in the critical and acute-specialty care hospital setting. Effective PFCC requires clinicians to form an integrated interprofessional team to collaboratively engage with the patient/family and contribute to a shared patient-centered plan of care. We conducted observations on a critical care and specialty unit to understand the plan of care activities and workflow documentation requirements for nurses and physicians to inform the development of a shared patient-centered plan of care to support patient engagement. We identified siloed plan of care documentation, with workflow opportunities to converge the nurses plan of care with the physician planned To-do lists and quality and safety checklists. Integration of nurses and physicians plan of care activities into a shared plan of care is a feasible and valuable step toward interprofessional teams that effectively engage patients in plan of care activities. PMID:25954345

  14. The wireless Web and patient care.

    PubMed

    Bergeron, B P

    2001-01-01

    Wireless computing, when integrated with the Web, is poised to revolutionize the practice and teaching of medicine. As vendors introduce wireless Web technologies in the medical community that have been used successfully in the business and consumer markets, clinicians can expect profound increases in the amount of patient data, as well as the ease with which those data are acquired, analyzed, and disseminated. The enabling technologies involved in this transformation to the wireless Web range from the new generation of wireless PDAs, eBooks, and wireless data acquisition peripherals to new wireless network protocols. The rate-limiting step in the application of this technology in medicine is not technology per se but rather how quickly clinicians and their patients come to accept and appreciate the benefits and limitations of the application of wireless Web technology.

  15. [Nutritional care for patients with liver cirrhosis].

    PubMed

    Aceves-Martins, Magaly

    2014-02-01

    The liver is an important organ with specific functions that influence directly on the nutritional and physiological status of every person. At the presence of any illness or injury in this organ, liver cirrhosis is always its final phase. In this pathology, patients present carbohydrate utilization and storage diminishment, as well as protein and fat catabolism increase. This situation, plus a low ingest and a bad nutrient absorption, results in a high prevalence of malnutrition. Many studies prove the importance of an opportune nutritional treatment in these patients, bringing general benefits and improving their quality of life. It's important to considerate the possible nutritional risks and deficiencies that could appear in the course of the cirrhosis to take opportune actions. The nutritional assessment and treatment is transcendental both in compensated phase (without complications) and in decompensated phase (with complications) of the illness.

  16. A patient-centered longitudinal care plan: vision versus reality

    PubMed Central

    Dykes, Patricia C; Samal, Lipika; Donahue, Moreen; Greenberg, Jeffrey O; Hurley, Ann C; Hasan, Omar; O'Malley, Terrance A; Venkatesh, Arjun K; Volk, Lynn A; Bates, David W

    2014-01-01

    Objective As healthcare systems and providers move toward meaningful use of electronic health records, longitudinal care plans (LCPs) may provide a means to improve communication and coordination as patients transition across settings. The objective of this study was to determine the current state of communication of LCPs across settings and levels of care. Materials and methods We conducted surveys and interviews with professionals from emergency departments, acute care hospitals, skilled nursing facilities, and home health agency settings in six regions in the USA. We coded the transcripts according to the Agency for Healthcare Research and Quality (AHRQ) ‘Broad Approaches’ to care coordination to understand the degree to which current practice meets the definition of an LCP. Results Participants (n=22) from all settings reported that LCPs do not exist in their current state. We found LCPs in practice, and none of these were shared or reconciled across settings. Moreover, we found wide variation in the types and formats of care plan information that was communicated as patients transitioned. The most common formats, even when care plan information was communicated within the same healthcare system, were paper and fax. Discussion These findings have implications for data reuse, interoperability, and achieving widespread adoption of LCPs. Conclusions The use of LCPs to support care transitions is suboptimal. Strategies are needed to transform the LCP from vision to reality. PMID:24996874

  17. Colorectal cancer care in elderly patients: Unsolved issues.

    PubMed

    Aparicio, Thomas; Pamoukdjian, Frederic; Quero, Laurent; Manfredi, Sylvain; Wind, Philippe; Paillaud, Elena

    2016-10-01

    Colorectal cancers are common in elderly patients. However, cancer screening is poorly used after 75. Elderly patients form a heterogeneous population with specific characteristics. Standards of care cannot therefore be transposed from young to elderly patients. Tumour resection is frequently performed but adjuvant chemotherapy is rarely prescribed as there are no clearly established standards of care. In a metastatic setting, recent phase III studies have demonstrated that doublet front-line chemotherapy provided no survival benefit. Moreover, several studies have established the benefit of bevacizumab in association with chemotherapy. There is a lack of evidence for the efficacy of anti-epidermal growth factor antibodies in elderly patients. Geriatric assessments could help to select the adequate treatment strategy for individual patients. Geriatric oncology is now the challenge we have to face, and more specific trials are needed.

  18. Spiritual Care For Jewish Patients Facing A Life Threatening Illness

    PubMed Central

    Bluman, Rabbi Olga F.; Klein, Linda; Thomas, Jay; Ferrell, Betty

    2013-01-01

    Providing biopsychosocial/spiritual care for patients facing a life threatening illness can be complex, and this complexity can be amplified when a patient identifies as Jewish. A common but incorrect assumption is that a person who identifies him or herself as Jewish abides by the tenets of the Jewish religion. However, many Jews consider themselves Jewish in an ethnic or cultural sense rather than connected to a religion or belief in God. This case report presents an ethnic/cultural Jew with a life threatening illness of advanced lung cancer. Despite evidence of spiritual/existential suffering, this patient declined spiritual care. From an analysis of this case and clinical experience, we suggest exploratory questions that clinicians can use in response to common questions or statements made by such patients. This exploration may lead to a chaplain referral and we highlight interventions that chaplains and clinicians may find helpful as they come alongside Jewish patients. PMID:23614173

  19. Utilizing patient satisfaction surveys to prepare for Medicaid managed care.

    PubMed

    Fields, T T; Gomez, P S

    2001-02-01

    To prepare for Medicaid managed care, a community health center incorporated the business principle of continuous quality improvement, often used in the private sector to improve customer service, into its planning process. The initial endeavor was to create a patient satisfaction survey that was appropriate for the uniqueness of the community. The survey, taken monthly, resulted in both staff and patients making active improvements in the clinic environment. Staff showed more enthusiasm, and patients were more assertive in their attitudes toward the clinic. The empowerment of the patient to take ownership in the clinic will be coupled with the next step of the formalized plan, that of educating patients on the steps necessary to ensure that their Medicaid managed care facility will be the local community health center. PMID:11217229

  20. Updated care guidelines for patients with automatic implantable cardioverter defibrillators.

    PubMed

    Moser, S A; Crawford, D; Thomas, A

    1993-04-01

    Since its clinical introduction, AICD therapy has gained significant acceptance. Some physicians consider it the "gold standard" in treating malignant tachyarrhythmias associated with sudden cardiac death. As the technology and therapy application have grown, nursing responsibilities have evolved as well. And, with the forthcoming combinations of technology such as AICDs with antitachycardia pacing and bradycardia pacing, the sophistication of the therapy is expected to increase. However, the most critical role for nurses in AICD patient care remains education. Increased utilization has made AICD implants more common, but many patients still lack the initial information and acceptance needed for therapeutic success. Health-care professionals who continue to update and share their understanding of this life-saving technology make invaluable contributions to the care of these patients who have received a second chance at life.

  1. Severe hypernatremia associated catheter malposition in an intensive care patient.

    PubMed

    Silahli, Musa; Gökdemir, Mahmut; Duman, Enes; Gökmen, Zeynel

    2016-09-01

    We present a catheter related severe hypernatremia in a 2-month-old baby who was admitted to the pediatric intensive care. Imbalance of plasma sodium is commonly seen in pediatric intensive care patients. The water and sodium balance is a complex process. Especially, brain and kidneys are the most important organs that affect the water and sodium balance. Other mechanisms of the cellular structure include osmoreceptors, Na-K ATPase systems, and vasopressin. Hypernatremia is usually an iatrogenic condition in hospitalized patients due to mismanagement of water electrolyte imbalance. Central venous catheterization is frequently used in pediatric intensive care patients. Complications of central venous catheter placement still continue despite the usage of ultrasound guidance. Malposition of central venous catheter in the brain veins should be kept in mind as a rare cause of iatrogenic hypernatremia. PMID:27555161

  2. Patient-focused care: what managers should know.

    PubMed

    Myers, S M

    1998-01-01

    Implementation of PFC is considered a "rational" strategic choice in that it is thought to decrease the cost of providing health care while increasing the quality of services. Published research and evaluation studies that describe PFC are analyzed and the information is synthesized in hopes of discovering and describing commonalties among definitions, goals, and principles underlying PFC. The commonly accepted description of PFC is a model which "seeks to integrate the organization's values and culture with the operational excellence vision and processes to transform the institution into a customer-focused organization." Staff satisfaction is addressed by encouraging staff to plan and execute their clinical work in ways that are most responsive to patient needs. Grouping similar patients, bringing services closer to these patients, and appropriate cross-training of multidisciplinary care providers to enhance continuity of care are seen as the four most common elements described in most of the literature. PMID:9748983

  3. Meeting the needs of patients' families in intensive care units.

    PubMed

    Khalaila, Rabia

    2014-07-01

    A review of articles published between 2000 and 2013, retrieved from several databases, was conducted to identify research findings regarding nursing interventions intended to meet the needs of the family members of patients in the intensive care unit. The dimensions of need identified were support, comfort, reassurance, information and closeness, with reassurance, information and closeness being the most important. Overall, the needs of patients' family members were unmet. The results of studies revealed that providing families with proactive communication strategies and information via brochures or leaflets, developing education programmes and establishing family-centred care may be effective in increasing family members' satisfaction, improving their understanding of the patient's condition and decreasing anxiety and depression, and post-traumatic stress disorder. Consequently, nurses should promote comprehensive family-centred care by using the best evidence to meet families' needs. However, more experimental studies are required to determine the effectiveness of specific interventions. PMID:25159786

  4. Impact of patient satisfaction ratings on physicians and clinical care

    PubMed Central

    Zgierska, Aleksandra; Rabago, David; Miller, Michael M

    2014-01-01

    Background Although patient satisfaction ratings often drive positive changes, they may have unintended consequences. Objective The study reported here aimed to evaluate the clinician-perceived effects of patient satisfaction ratings on job satisfaction and clinical care. Methods A 26-item survey, developed by a state medical society in 2012 to assess the effects of patient satisfaction surveys, was administered online to physician members of a state-level medical society. Respondents remained anonymous. Results One hundred fifty five physicians provided responses (3.9% of the estimated 4,000 physician members of the state-level medical society, or approximately 16% of the state’s emergency department [ED] physicians). The respondents were predominantly male (85%) and practicing in solo or private practice (45%), hospital (43%), or academia (15%). The majority were ED (57%), followed by primary care (16%) physicians. Fifty-nine percent reported that their compensation was linked to patient satisfaction ratings. Seventy-eight percent reported that patient satisfaction surveys moderately or severely affected their job satisfaction; 28% had considered quitting their job or leaving the medical profession. Twenty percent reported their employment being threatened because of patient satisfaction data. Almost half believed that pressure to obtain better scores promoted inappropriate care, including unnecessary antibiotic and opioid prescriptions, tests, procedures, and hospital admissions. Among 52 qualitative responses, only three were positive. Conclusion These pilot-level data suggest that patient satisfaction survey utilization may promote, under certain circumstances, job dissatisfaction, attrition, and inappropriate clinical care among some physicians. This is concerning, especially in the context of the progressive incorporation of patient satisfaction ratings as a quality-of-care metric, and highlights the need for a rigorous evaluation of the optimal methods

  5. Palliative care for patients with advance chronic kidney disease.

    PubMed

    Douglas, C A

    2014-01-01

    Over the past three decades there has been a dramatic rise in the number of patients with advanced chronic kidney disease. The fastest expanding group receiving dialysis has been the elderly. However, for those patients who are very elderly with co-morbidity, dialysis may not offer a survival advantage. Therefore, active conservative management is a growing service offered by many renal units in the UK and focuses on non-dialytic correction of fluid and electrolyes, management of renal anaemia, and assessment and management of symptoms. The five-year survival of a patient over 75 years of age starting dialysis is 20% and if a patient is over 75 years, has co-morbidity, or a poor performance status, dialysis may not offer any survival advantage. Whether a patient is managed by dialysis or by conservative management the symptom burden suffered is high. These symptoms are under-recognised and often managed poorly because of increased drug toxicity in renal failure. This complex group of patients require close working between renal, palliative care, medicine for the elderly, and community teams, to allow best quality of life and end of life care. This review describes some of the challenges in providing Advanced Care Planning for dialysis and conservatively managed patients, highlights the symptom burden of patients with advanced chronic kidney disease, and offers guidance in how to manage the symptoms effectively.

  6. Call 4 Concern: patient and relative activated critical care outreach.

    PubMed

    Odell, Mandy; Gerber, Karin; Gager, Melanie

    Patients can experience unexpected deterioration in their physiological condition that can lead to critical illness, cardiac arrest, admission to the intensive care unit and death. While ward staff can identify deterioration through monitoring physiological signs, these signs can be missed, interpreted incorrectly or mismanaged. Rapid response systems using early warning scores can fail if staff do not follow protocols or do not notice or manage deterioration adequately. Nurses often notice deterioration intuitively because of their knowledge of individual patients. Patients and their relatives have the greatest knowledge of patients, and can often pick up subtle signs physiological deterioration before this is identified by staff or monitoring systems. However, this ability has been largely overlooked. Call 4 Concern (C4C) is a scheme where patients and relatives can call critical care teams directly if they are concerned about a patient's condition- it is believed to be the first of its kind in the UK. A C4C feasibility project ran for six months, covering patients being transferred from the intensive care unit to general wards. C4C has the potential to prevent clinical deterioration and is valued by patients and relatives. Concerns of ward staff could be managed through project management. As it is relatively new, this field offers further opportunities for research. PMID:21139519

  7. The Patient's View of Nursing Care after Hip Fracture

    PubMed Central

    Hommel, Ami; Kock, Marie-Louise; Persson, Jeanette; Werntoft, Elisabeth

    2012-01-01

    Background. The pathway for patients with a hip fracture described in this study is a fast track. Many studies have focused on prevention of various complications but, so far, the patient's view of nursing care has not been highlighted. Aim. The aim of the study is to illuminate the patient's view on nursing care when treated for a hip fracture. Method. Ten patients were interviewed. A content analysis design was conducted. Findings. From the analysis, four main categories emerged: waiting times; pain/pain relief and mobilisation; attitude/information and sense of security; complications. Conclusion. Patients generally felt satisfied with the nursing provided. The staff created a feeling of security and showed interest and empathy for the patient. However, patients experienced a stressful waiting for surgery, and patients who developed confusion waited more than 24 hours for surgery. Therefore, waiting time must be decreased. Furthermore, patients' descriptions of a variety of pain problem show, for example, that good collaboration between the nurse and physiotherapist is critical for achieving good pain relief before mobilisation. Nursing staff need to be attentive and should elicit the patient's feelings through patient-focused communication in order to relieve anxiety about going home. PMID:22811933

  8. Spiritual coping and anxiety in palliative care patients: a pilot study.

    PubMed

    Gaudette, Holly; Jankowski, Katherine R B

    2013-01-01

    Patients often rely on spirituality to cope with anxiety, yet it is not known if spiritual coping actually helps patients deal with anxiety. The present study was designed, therefore, to examine this relationship. A series of patients who were referred to the palliative care team at New York University, Langone Medical Center (N = 44) were interviewed about their spiritual coping and anxiety. Anxiety was measured using the first three items of the GAD-7. Fourteen items, which were adapted from existing scales, were used to create the "Beliefs and Activities Spirituality Scale" (BASS), having two subscales: Activities (α = .79) and Beliefs (α = .82). Anxiety had a significant negative correlations with the total BASS (r = -.56), and the Activities (r = -.52) and Beliefs (r = -.42) subscales. The salubrious association of spiritual coping and anxiety remained for the BASS and the Activities subscale, after controlling for demographic variables. PMID:24070434

  9. Post-acute care and vertical integration after the Patient Protection and Affordable Care Act.

    PubMed

    Shay, Patrick D; Mick, Stephen S

    2013-01-01

    The anticipated changes resulting from the passage of the Patient Protection and Affordable Care Act-including the proposed adoption of bundled payment systems and the promotion of accountable care organizations-have generated considerable controversy as U.S. healthcare industry observers debate whether such changes will motivate vertical integration activity. Using examples of accountable care organizations and bundled payment systems in the American post-acute healthcare sector, this article applies economic and sociological perspectives from organization theory to predict that as acute care organizations vary in the degree to which they experience environmental uncertainty, asset specificity, and network embeddedness, their motivation to integrate post-acute care services will also vary, resulting in a spectrum of integrative behavior.

  10. Improving perioperative care for adolescent idiopathic scoliosis patients: the impact of a multidisciplinary care approach

    PubMed Central

    Borden, Timothy C; Bellaire, Laura L; Fletcher, Nicholas D

    2016-01-01

    The complex nature of the surgical treatment of adolescent idiopathic scoliosis (AIS) requires a wide variety of health care providers. A well-coordinated, multidisciplinary team approach to the care of these patients is essential for providing high-quality care. This review offers an up-to-date overview of the numerous interventions and safety measures for improving outcomes after AIS surgery throughout the perioperative phases of care. Reducing the risk of potentially devastating and costly complications after AIS surgery is the responsibility of every single member of the health care team. Specifically, this review will focus on the perioperative measures for preventing surgical site infections, reducing the risk of neurologic injury, minimizing surgical blood loss, and preventing postoperative complications. Also, the review will highlight the postoperative protocols that emphasize early mobilization and accelerated discharge.

  11. Improving perioperative care for adolescent idiopathic scoliosis patients: the impact of a multidisciplinary care approach

    PubMed Central

    Borden, Timothy C; Bellaire, Laura L; Fletcher, Nicholas D

    2016-01-01

    The complex nature of the surgical treatment of adolescent idiopathic scoliosis (AIS) requires a wide variety of health care providers. A well-coordinated, multidisciplinary team approach to the care of these patients is essential for providing high-quality care. This review offers an up-to-date overview of the numerous interventions and safety measures for improving outcomes after AIS surgery throughout the perioperative phases of care. Reducing the risk of potentially devastating and costly complications after AIS surgery is the responsibility of every single member of the health care team. Specifically, this review will focus on the perioperative measures for preventing surgical site infections, reducing the risk of neurologic injury, minimizing surgical blood loss, and preventing postoperative complications. Also, the review will highlight the postoperative protocols that emphasize early mobilization and accelerated discharge. PMID:27695340

  12. Patient centered primary care is associated with patient hypertension medication adherence.

    PubMed

    Roumie, Christianne L; Greevy, Robert; Wallston, Kenneth A; Elasy, Tom A; Kaltenbach, Lisa; Kotter, Kristen; Dittus, Robert S; Speroff, Theodore

    2011-08-01

    There is increasing evidence that patient centered care, including communication skills, is an essential component to chronic illness care. Our aim was to evaluate patient centered primary care as a determinant of medication adherence. We mailed 1,341 veterans with hypertension the Short Form Primary Care Assessment Survey (PCAS) which measures elements of patient centered primary care. We prospectively collected each patient's antihypertensive medication adherence for 6 months. Patients were characterized as adherent if they had medication for >80%. 654 surveys were returned (50.7%); and 499 patients with complete data were analyzed. Antihypertensive adherence increased as scores in patient centered care increased [RR 3.18 (95% CI 1.44, 16.23) bootstrap 5000 resamples] for PCAS score of 4.5 (highest quartile) versus 1.5 (lowest quartile). Future research is needed to determine if improving patient centered care, particularly communication skills, could lead to improvements in health related behaviors such as medication adherence and health outcomes.

  13. Role of relatives of ethnic minority patients in patient safety in hospital care: a qualitative study

    PubMed Central

    van Rosse, Floor; Suurmond, Jeanine; Wagner, Cordula; de Bruijne, Martine; Essink-Bot, Marie-Louise

    2016-01-01

    Objective Relatives of ethnic minority patients often play an important role in the care process during hospitalisation. Our objective was to analyse the role of these relatives in relation to the safety of patients during hospital care. Setting Four large urban hospitals with an ethnic diverse patient population. Participants On hospital admission of ethnic minority patients, 20 cases were purposively sampled in which relatives were observed to play a role in the care process. Outcome measures We used documents (patient records) and added eight cases with qualitative interviews with healthcare providers, patients and/or their relatives to investigate the relation between the role of relatives and patient safety. An inductive approach followed by selective coding was used to analyse the data. Results Besides giving social support, family members took on themselves the role of the interpreter, the role of substitutes of the patient and the role of care provider. The taking over of these roles can have positive and negative effects on patient safety. Conclusions When family members take over various roles during hospitalisation of a relative, this can lead to a safety risk and a safety protection for the patient involved. Although healthcare providers should not hand over their responsibilities to the relatives of patients, optimising collaboration with relatives who are willing to take part in the care process may improve patient safety. PMID:27056588

  14. Attitudes and Perceptions of Patients, Caregivers, and Health Care Providers toward Background Music in Patient Care Areas: An Exploratory Study

    PubMed Central

    Perez-Cruz, Pedro; Nguyen, Linh; Rhondali, Wadih; Hui, David; Palmer, J. Lynn; Sevy, Ingrid; Richardson, Michael

    2012-01-01

    Abstract Background Background music can be used to distract from ordinary sounds and improve wellbeing in patient care areas. Little is known about individuals' attitudes and beliefs about music versus ordinary sound in this setting. Objectives To assess the preferences of patients, caregivers and healthcare providers regarding background music or ordinary sound in outpatient and inpatient care areas, and to explore their attitudes and perceptions towards music in general. Methods All participants were exposed to background music in outpatient or inpatient clinical settings. 99 consecutive patients, 101 caregivers and 65 out of 70 eligible healthcare providers (93%) completed a survey about music attitudes and preferences. The primary outcome was a preference for background music over ordinary sound in patient care areas. Results Preference for background music was high and similar across groups (70 patients (71%), 71 caregivers (71%) and 46 providers (71%), p=0.58). The three groups had very low disapproval for background music in patient care areas (10%, 9% and 12%, respectively; p=0.91). Black ethnicity independently predicted lower preference for background music (OR: 0.47, 95%CI: 0.23, 0.98). Patients, caregivers and providers reported recent use of music for themselves for the purpose of enjoyment (69%, 80% and 86% respectively p=0.02). Age, gender, religion and education level significantly predicted preferences for specific music styles. Conclusion Background music in patient care areas was preferred to ordinary sound by patients, caregivers and providers. Demographics of the population are strong determinants of music style preferences. PMID:22957677

  15. Commercial filming of prehospital patient care

    PubMed Central

    Godfrey, P D; Henning, J D

    2007-01-01

    Commercial filming of patients in the hospital and now the prehospital environment is becoming increasingly common. Television programmes that focus on medical emergencies with real footage of events remain highly successful and can make compelling viewing for both medical professionals and the general public alike. Recently several commentators have questioned the ethical aspects of filming in hospital emergency departments, and noted the lack of available evidence. This article reviews commercial filming and its impact in the prehospital environment and examines the ethical implications and current guidance in this unique setting. PMID:18029523

  16. [Specifics of Analgesia in Palliative Care Patients at Home].

    PubMed

    Pautex, Sophie

    2015-02-25

    Pain management at home for a patient, suffering from one or more advanced progressive diseases, goes beyond the prescription of an opioid. Apart from the importance of finding the most suitable analgesic drug (controlled pain with least possible adverse effects), three important dimensions will be addressed: interprofessionnal care (shared care goals, evaluation, monitoring of pain and other symptoms; physiotherapy, etc.) information, education and support for patients and relatives in particular on the use of opioids, and finally the importance of anticipation. This includes for example the requirement of breakthrough pain treatment in case of pain exacerbation or the definition of the place of hospitalization in case of worsening general condition or of death.

  17. Trauma-Informed Care: Helping Patients with a Painful Past.

    PubMed

    Koetting, Cathy

    2016-01-01

    Life trauma is highly correlated with an increased risk of mortality from chronic disease. Trauma-informed care (TIC) is an evidence-based approach to deliver healthcare in a way that recognizes and responds to the long-term health effects of the experience of trauma in patients' lives. Four essential features and six defining concepts delineate a TIC approach to healthcare. Nurses can realize the benefits and learn the tenets of TIC to deliver superior care to patients with chronic illness. PMID:27610903

  18. [Quality of care in intensive care units. Retrospective study on long-term patients].

    PubMed

    García, M P; López, P; Eseverri, C; Zazpe, C; Asiain, M C

    1998-01-01

    Nursing care must be evaluated in order to determine its effectiveness and identify deficiencies, which makes it possible to introduce corrective measures to optimize quality. The quality of care given to patients in our unit was evaluated with a retrospective analysis of 915 records in the Nursing Care Plan corresponding to 59 patients with a mean ICU stay of 15.5 days. Six areas of care and indicators of deficient practice were identified: orotracheal intubation: accidental disconnection, displacement, obstruction, and pressure sores on lips; arterial catheterization: accidental disconnection and obstruction; central venous catheterization: accidental disconnection and contamination; urinary catheterization: accidental disconnection and urinary bacteriology; nasogastric intubation: accidental disconnection, obstruction, and nasal pressure sores; conservation of skin integrity: presence of pressure sores, and prevention of falls from the bed or chair. The reference standards were taken from the published literature. The results show that airway care was adequate, although the frequency of pressure sores on the lip produced by orotracheal tubes was high. The indicators for following up the care of vascular and urinary catheters showed results similar to established standards. There was a high rate of nasogastric tube obstruction due to the administration of medication. Finally, the frequency of pressure sores was well below established standards and there were no accidental falls. It is concluded that the detection of areas in which care is deficient requires an analysis of relevant nursing activities so that corrective measures can be taken. This study is a useful baseline for future quality control.

  19. Self-care of patients with diabetes mellitus cared for at an emergency service in Mexico.

    PubMed

    Baquedano, Irasema Romero; dos Santos, Manoel Antônio; Martins, Tatiane Aparecida; Zanetti, Maria Lúcia

    2010-01-01

    This study examines the self-care ability of type 2 diabetes mellitus patients and relates it to sociodemographic and clinical variables. The study included 251 patients who were cared for by an emergency service in Mexico, in 2007. Data were obtained through structured interviews held at participants' households, through a form, a questionnaire and the Self-Care Ability Scale. Descriptive and correlation statistics were used for data analysis. The results show that 83 (33.5%) individuals displayed good self-care ability and 168 (66.5%) individuals displayed regular ability. A directly proportional correlation was found between self-care ability and schooling (r=0.124; p<0.05), as well as a negative correlation for religion (rs=-0.435; p<0.05) and duration of disease evolution (r=-0.667; p<0.05). The conclusion is that most of the individuals with type 2 diabetes mellitus displayed regular ability for self-care. Self-care ability is related to multiple variables that should be taken into account by health professionals when suggesting educational programs.

  20. The UNICANCER Patient Expectations Observatory: A new role for patients in health care institutions.

    PubMed

    Espérou, Hélène

    2014-01-01

    Recognizing the role played by patients in their own management, UNICANCER set up in November 2011 a unique initiative in France: the Patient Expectations Observatory. This was designed to reorient and improve the quality of care provided by comprehensive cancer centres in the UNICANCER group based on a better knowledge and understanding of patient perceptions and preferences. An innovative internet-based consultation process enabled us to record and prioritize patient expectations. Patient management improvement actions for cancer centres were then used to equitably satisfy the identified patient expectations. By using patients' own expectations of their health care, cancer centres can therefore provide an example of the new modalities of patient participation in health care institutions, in line with the changes proposed by public authorities.

  1. [UNICANCER patient expectations observatory: a new role for patients in health care institutions].

    PubMed

    Espérou, Hélène; Emery, Grégory

    2014-01-01

    UNICANCER, recognizing the role played by patients in their own management, set up a unique initiative in France in November 2011: the patient expectations observatory, which is designed to reorient and improve the quality of care provided by comprehensive cancer centers of the UNICANCER group based on a better knowledge and understanding of patient perceptions and preferences. An innovative internet-based participative consultation recorded and prioritized patient expectations. Patient management improvement actions in cancer centres were then generalized to equitably satisfy the identified patient expectations. By using patient expectations concerning organization of health care, cancer cancers therefore provide an example of the new modalities of patient participation in health care institutions, in line with the changes proposed by public authorities.

  2. Caring for patients with rabies in developing countries - the neglected importance of palliative care.

    PubMed

    Tarantola, Arnaud; Crabol, Yoann; Mahendra, Bangalore Jayakrishnappa; In, Sotheary; Barennes, Hubert; Bourhy, Hervé; Peng, Yiksing; Ly, Sowath; Buchy, Philippe

    2016-04-01

    Although limited publications address clinical management of symptomatic patients with rabies in intensive care units, the overwhelming majority of human rabies cases occur in the rural setting of developing countries where healthcare workers are few, lack training and drugs. Based on our experience, we suggest how clinicians in resource-limited settings can make best use of essential drugs to provide assistance to patients with rabies and their families, at no risk to themselves. Comprehensive and compassionate patient management of furious rabies should aim to alleviate thirst, anxiety and epileptic fits using infusions, diazepam or midazolam and antipyretic drugs via intravenous or intrarectal routes. Although the patient is dying, respiratory failure must be avoided especially if the family, after being informed, wish to take the patient home alive for funereal rites to be observed. Healthcare staff should be trained and clinical guidelines should be updated to include palliative care for rabies in endemic countries.

  3. Caring for patients with rabies in developing countries - the neglected importance of palliative care.

    PubMed

    Tarantola, Arnaud; Crabol, Yoann; Mahendra, Bangalore Jayakrishnappa; In, Sotheary; Barennes, Hubert; Bourhy, Hervé; Peng, Yiksing; Ly, Sowath; Buchy, Philippe

    2016-04-01

    Although limited publications address clinical management of symptomatic patients with rabies in intensive care units, the overwhelming majority of human rabies cases occur in the rural setting of developing countries where healthcare workers are few, lack training and drugs. Based on our experience, we suggest how clinicians in resource-limited settings can make best use of essential drugs to provide assistance to patients with rabies and their families, at no risk to themselves. Comprehensive and compassionate patient management of furious rabies should aim to alleviate thirst, anxiety and epileptic fits using infusions, diazepam or midazolam and antipyretic drugs via intravenous or intrarectal routes. Although the patient is dying, respiratory failure must be avoided especially if the family, after being informed, wish to take the patient home alive for funereal rites to be observed. Healthcare staff should be trained and clinical guidelines should be updated to include palliative care for rabies in endemic countries. PMID:26806229

  4. The role of the primary care physician in caring for patients with type-1 diabetes.

    PubMed

    Van Meter, Q L

    1998-02-01

    The management of type-1 diabetic patients is a challenge. Given the natural frequency of this medical problem, most primary care providers will have such patients in their office-based practice. The push for tighter control in order to lessen long-term complications is a sensible move, but it does not inherently require that you absent yourself from the loop. Most of the hoopla from the DCCT study has been used to justify the role of the endocrine sub-specialty team in the "primary care" management of all diabetic patients so that third-party payers will continue to fund such care as routine. While such team management has clear benefits, it should not preclude your active involvement in day-to-day management for fear that you do not have the proper credentials. Hopefully, this overview will give you the confidence to jump back in the ring. PMID:9533990

  5. Patient Education Leads to Better Care for Heart Patients.

    ERIC Educational Resources Information Center

    Rosenberg, Stanley G.

    The staff of a heart and circulatory disease program of a State department of health conducted a special project at a city hospital which showed that a well-organized treatment and education program for patients with congestive heart failure increased the patient's knowledge of his disease, medication, and diet as well as his adherence to a…

  6. Impact of Burnout on Self-Reported Patient Care Among Emergency Physicians

    PubMed Central

    Lu, Dave W.; Dresden, Scott; McCloskey, Colin; Branzetti, Jeremy; Gisondi, Michael A.

    2015-01-01

    Introduction Burnout is a syndrome of depersonalization, emotional exhaustion and sense of low personal accomplishment. Emergency physicians (EPs) experience the highest levels of burnout among all physicians. Burnout is associated with greater rates of self-reported suboptimal care among surgeons and internists. The association between burnout and suboptimal care among EPs is unknown. The objective of the study was to evaluate burnout rates among attending and resident EPs and examine their relationship with self-reported patient care practices. Methods In this cross-sectional study burnout was measured at two university-based emergency medicine residency programs with the Maslach Burnout Inventory. We also measured depression, quality of life (QOL) and career satisfaction using validated questionnaires. Six items assessed suboptimal care and the frequency with which they were performed. Results We included 77 out of 155 (49.7%) responses. The EP burnout rate was 57.1%, with no difference between attending and resident physicians. Residents were more likely to screen positive for depression (47.8% vs 18.5%, p=0.012) and report lower QOL scores (6.7 vs 7.4 out of 10, p=0.036) than attendings. Attendings and residents reported similar rates of career satisfaction (85.2% vs 87.0%, p=0.744). Burnout was associated with a positive screen for depression (38.6% vs 12.1%, p=0.011) and lower career satisfaction (77.3% vs 97.0%, p=0.02). EPs with high burnout were significantly more likely to report performing all six acts of suboptimal care. Conclusion A majority of EPs demonstrated high burnout. EP burnout was significantly associated with higher frequencies of self-reported suboptimal care. Future efforts to determine if provider burnout is associated with negative changes in actual patient care are necessary. PMID:26759643

  7. RENEW—a renal redesign project in predialysis patient care

    PubMed Central

    Sau Fan Chow, Josephine; Jobburn, Kim; Chapman, Margaret; Suranyi, Michael

    2016-01-01

    Background An ageing population and geographical growth, along with an increase in the number of people that reside in specific location, are increasing the demand for renal replacement therapies. Hospital-based haemodialysis units are struggling to cope with the associated physical, staffing and cost demands. Home-based dialysis therapies are known to be more cost effective with superior social, physical health and survival outcomes. Methods ‘RENEW, a renal redesign project, examined the pre-dialysis health care experience of renal patients to find opportunities to improve patient care outcomes and increase the uptake of home-based dialysis therapies. This article details two crucial parts of the approach to change management: (i) diagnostics—an inclusive, client focused, multidisciplinary approach to identify issues relating to the pre-dialysis journey—and (ii) solution design—an inclusive problem-solving approach to identify and marry solutions to the issues identified during diagnostics. Results Based on feedback from patients/caregivers and staff interviews, utilizing a clinical redesign methodology, a new model of care was developed, implemented and subsequently embedded into clinical practice. The results have been evident via improved care coordination, enhanced patient preparation for dialysis, improved patient psychosocial welfare and, importantly, an increased number of patients planned for and commencing home dialysis. This has empowered patients by giving them the confidence, knowledge and skills to be actively engaged in their own care. The project resulted in significant expenditure avoidance. Conclusion Change management strategies with successful implementation are vital components of evolving clinical practice to achieve both clinical and organizational goals.

  8. RENEW—a renal redesign project in predialysis patient care

    PubMed Central

    Sau Fan Chow, Josephine; Jobburn, Kim; Chapman, Margaret; Suranyi, Michael

    2016-01-01

    Background An ageing population and geographical growth, along with an increase in the number of people that reside in specific location, are increasing the demand for renal replacement therapies. Hospital-based haemodialysis units are struggling to cope with the associated physical, staffing and cost demands. Home-based dialysis therapies are known to be more cost effective with superior social, physical health and survival outcomes. Methods ‘RENEW, a renal redesign project, examined the pre-dialysis health care experience of renal patients to find opportunities to improve patient care outcomes and increase the uptake of home-based dialysis therapies. This article details two crucial parts of the approach to change management: (i) diagnostics—an inclusive, client focused, multidisciplinary approach to identify issues relating to the pre-dialysis journey—and (ii) solution design—an inclusive problem-solving approach to identify and marry solutions to the issues identified during diagnostics. Results Based on feedback from patients/caregivers and staff interviews, utilizing a clinical redesign methodology, a new model of care was developed, implemented and subsequently embedded into clinical practice. The results have been evident via improved care coordination, enhanced patient preparation for dialysis, improved patient psychosocial welfare and, importantly, an increased number of patients planned for and commencing home dialysis. This has empowered patients by giving them the confidence, knowledge and skills to be actively engaged in their own care. The project resulted in significant expenditure avoidance. Conclusion Change management strategies with successful implementation are vital components of evolving clinical practice to achieve both clinical and organizational goals. PMID:27679723

  9. Integrating spirituality into patient care: an essential element of person‑centered care.

    PubMed

    Puchalski, Christina M

    2013-01-01

    Spirituality and health is a growing field of healthcare. It grew out of courses in spirituality and health developed for medical students in the United States. Research in this area over the last 30 years has also formed an evidence base for spirituality and health. Studies have demonstrated an association between spiritual beliefs and values and a variety of healthcare outcomes. More recent research has also shown a strong desire on the part of patients to have their spirituality addressed as part of their care. Studies also show that spiritual care has an impact on patient decision making, particularly in end-of-life care. The Association of American Medical Colleges developed a broad definition of spirituality as well as learning objectives and guidelines for teaching. Standards in organizations such as the American College of Physicians support physicians treating the whole person, that is, the body, mind, and spirit. In 2009, National Competencies in Spirituality and Health education were developed in the United States with schools currently working on curriculum projects based on these competencies. Models are being developed for all members of the healthcare team to address patient distress, in cooperation with chaplains as spiritual care experts. The goals are to develop a biopsychosocial and spiritual assessment and treatment as part of compassionate whole-person care of all patients. PMID:24084250

  10. On-line documentation of patient care orders.

    PubMed

    Prophet, C M

    1995-01-01

    The INFORMM NIS (Information Network For Online Retrieval & Medical Management Nursing Information System) provides on-line documentation of patient care orders. These orders, generated by the nurse or the physician, prescribe direct patient care and do not include interdepartmental orders such as laboratory, radiology, or pharmacy. The order charting functions support charting efficiency by defaulting previous responses so that the user enters only updates to earlier findings or new data. Available in tables maintained by NIS staff, charting responses provide decision support by suggesting valid results for each order. Using point-of-care devices, nursing staff chart patient data that are immediately available for review by all authorized members of the health care team. These data are printed automatically on computer-generated chart forms every twenty-four hours, but may be printed also on demand. Additionally, the patient data report, containing patient data entered on-line in the sixteen or twenty-four hours immediately preceding the print request, provides a summary that is useful for nurses' report and physicians' rounds.

  11. Why Patient Centered Care Coordination Is Important in Developing Countries?

    PubMed Central

    Luna, D.; Marcelo, A.; Househ, M.; Mandirola, H.; Curioso, W.; Pazos, P.; Villalba, C.

    2015-01-01

    Summary Patient Centered Care Coordination (PCCC) focuses on the patient health care needs. PCCC involves the organization, the patients and their families, that must coordinate resources in order to accomplish the goals of PCCC. In developing countries, where disparities are frequent, PCCC could improve clinical outcomes, costs and patients satisfaction. Objective the IMIA working group Health Informatics for Development analyzes the benefits, identifies the barriers and proposes strategies to reach PCCC. Methods Discussions about PCCC emerged from a brief guide that posed questions about what is PCCC, why consider PCCC important, barriers to grow in this direction and ask about resources considered relevant in the topic. Results PCCC encompasses a broad definition, includes physical, mental, socio-environmental and self care. Even benefits are proved, in developing countries the lack of a comprehensive and integrated healthcare network is one of the main barriers to reach this objective. Working hard to reach strong health policies, focus on patients, and optimizing the use of resources could improve the performance in the devolvement of PCCC programs. International collaboration could bring benefits. We believe information IT, and education in this field will play an important role in PCCC. Conclusion PCCC in developing countries has the potential to improve quality of care. Education, IT, policies and cultural issues must be addressed in an international collaborative context in order to reach this goal. PMID:26123907

  12. Propensity of HIV Patients to Seek Urgent and Emergent Care

    PubMed Central

    Gifford, Allen L; Collins, Rebecca; Timberlake, David; Schuster, Mark A; Shapiro, Martin F; Bozzette, Samuel A; Kanouse, David E

    2000-01-01

    OBJECTIVE To assess the propensity of HIV-infected adults to seek care for common symptoms, and to determine whether they would seek care in the emergency department (ED) or with their primary care provider. DESIGN Cross-sectional interview study. SETTING Patients in care in the 48 contiguous United States. PARTICIPANTS A nationally representative group of HIV- infected adults selected using multistage probability sampling. MEASUREMENTS Subjects were interviewed between January 1996 and April 1997. Patients with advanced disease (past AIDS diagnosis and/or CD4 cell count <200/μL) and early disease were asked how they would seek care for key HIV-associated symptom complexes. Three advanced disease and 3 early disease symptom scenarios were used. MAIN RESULTS Most advanced disease patients (78% to 87%) would seek care right away from the ED or primary care provider for the symptoms asked. Most early disease patients (82%) would seek care right away for new respiratory symptoms; fewer would do so for headache (46%) or oral white patches (62%). In a multivariate model, independent predictors of propensity to use the ED for advanced disease symptoms included African-American ethnicity (adjusted odds ratio [OR], 2.5; 95% confidence interval [95% CI], 1.8 to 3.4); less education (adjusted OR, 1.4; 95% CI, 1.1 to 1.7); drug dependence (adjusted OR, 1.4; 95% CI, 1.1 to 1.7); annual income less than $5,000 (adjusted OR, 1.5; 95% CI, 1.0 to 2.3); and lower psychological well-being (adjusted OR, 0.9; 95% CI, 0.9 to 1.0). In early disease, the following independently predicted ED use: African American (adjusted OR, 4.7; 95% CI, 3.1 to 7.1) or Hispanic ethnicity (adjusted OR 2.4; 95% CI, 1.4 to 4.3), female gender (adjusted OR, 1.6; 95% CI, 1.2 to 2.2), annual income less than $5,000 (adjusted OR, 1.8; 95% CI, 1.1 to 3.0), and lower psychological well-being (adjusted OR, 0.9; 95% CI, 0.8 to 1.0). CONCLUSIONS Many patients would use the ED instead of same-day primary care for

  13. Heart failure care for patients who do not speak English.

    PubMed

    Brennan, Emma Jane

    Heart failure affects 1-2% of the UK population with prevalence rates predicted to rise over the next decade. Ineffective education for patients with heart failure can lead to a failure to adhere to guidance, reduced self-care and increased hospital readmissions. The National Institute for Health and Care Excellence (NICE) and the World Health Organization (WHO) have issued clear guidelines on patient-centred care in heart failure, particularly in relation to patients' cultural and linguistic needs. Patients with heart failure should have access to an interpreter or advocate if needed. Furthermore, heart failure educational materials should be tailored to suit the individual and be accessible to people who do not speak or read English. This article explores the practice recommendations for these patients with heart failure and provides an overview of current guidelines associated with optimal patient outcomes. It also includes practical advice on translation services, and information and educational materials available for patients with heart failure who do not speak English.

  14. The patient care component: patient-centered horizontal integration in a vertical world.

    PubMed

    Curtis, A C

    1994-01-01

    This paper describes the structure and operational properties of the Patient Care Component, a patient care data system developed by the Indian Health Service to support primary care in a multi-site, decentralized, health care organization. Sharing the same technology base as the Department of Veterans Affairs Distributed Hospital Computer Program, the system requires a minimal level of investment in technology compared to alternative approaches and is in operation at 140 sites. The Indian Health Service and historical aspects of the system are described briefly; the paper focuses on the design objectives for the system and lessons learned from development and several years of operational experience.

  15. Survivorship Care Guidelines for Patients Living With Multiple Myeloma: Consensus Statements of the International Myeloma Foundation Nurse Leadership Board

    PubMed Central

    Bilotti, Elizabeth; Faiman, Beth M.; Richards, Tiffany A.; Tariman, Joseph D.; Miceli, Teresa S.; Rome, Sandra I.

    2012-01-01

    Novel therapies approved over the past decade for the management of multiple myeloma have contributed to improved overall survival in patients with newly diagnosed and relapsed disease. Nurses play a key role in educating, advocating for, and supporting patients throughout the continuum of care. Identifying potential and actual comorbid conditions associated directly with multiple myeloma and its treatment is important, as is confirming those that are patient specific so that prompt intervention can take place; therefore, the International Myeloma Foundation Nurse Leadership Board identified the most significant needs of patients diagnosed with multiple myeloma as bone health, health maintenance, mobility and safety, sexual dysfunction, and renal health. The Nurse Leadership Board then developed a survivorship care plan to assist healthcare providers and patients with multiple myeloma, their partners, and their caregivers to identify these needs. PMID:21816706

  16. Patient care information systems and physicians: the transition from technology icon to health care instrument.

    PubMed

    Bria, W F

    1993-11-01

    We have discussed several important transitions now occurring in PCIS that promise to improve the utility and availability of these systems for the average physician. Charles Babbage developed the first computers as "thinking machines" so that we may extend our ability to grapple with more and more complex problems. If current trends continue, we will finally witness the evolution of patient care computing from information icons of the few to clinical instruments improving the quality of medical decision making and care for all patients.

  17. Advance care planning for cancer patients in primary care: a feasibility study

    PubMed Central

    Boyd, Kirsty; Mason, Bruce; Kendall, Marilyn; Barclay, Stephen; Chinn, David; Thomas, Keri; Sheikh, Aziz; Murray, Scott A

    2010-01-01

    Background Advance care planning is being promoted as a central component of end-of-life policies in many developed countries, but there is concern that professionals find its implementation challenging. Aim To assess the feasibility of implementing advance care planning in UK primary care. Design of study Mixed methods evaluation of a pilot educational intervention. Setting Four general practices in south-east Scotland. Method Interviews with 20 GPs and eight community nurses before and after a practice-based workshop; this was followed by telephone interviews with nine other GPs with a special interest in palliative care from across the UK. Results End-of-life care planning for patients typically starts as an urgent response to clear evidence of a short prognosis, and aims to achieve a ‘good death’. Findings suggest that there were multiple barriers to earlier planning: prognostic uncertainty; limited collaboration with secondary care; a desire to maintain hope; and resistance to any kind of ‘tick-box’ approach. Following the workshop, participants' knowledge and skills were enhanced but there was little evidence of more proactive planning. GPs from other parts of the UK described confusion over terminology and were concerned about the difficulties of implementing inflexible, policy-driven care. Conclusion A clear divide was found between UK policy directives and delivery of end-of-life care in the community that educational interventions targeting primary care professionals are unlikely to address. Advance care planning has the potential to promote autonomy and shared decision making about end-of-life care, but this will require a significant shift in attitudes. PMID:21144189

  18. Deprivation of liberty in psychiatric hospital care: the patient's perspective.

    PubMed

    Kuosmanen, Lauri; Hätönen, Heli; Malkavaara, Heikki; Kylmä, Jari; Välimäki, Maritta

    2007-09-01

    Deprivation of liberty in psychiatric hospitals is common world-wide. The aim of this study was to find out whether patients had experienced deprivation of their liberty during psychiatric hospitalization and to explore their views about it. Patients (n = 51) in two acute psychiatric inpatient wards were interviewed in 2001. They were asked to describe in their own words their experiences of being deprived of their liberty. The data were analysed by inductive content analysis. The types of deprivation of liberty in psychiatric hospital care reported by these patients were: restrictions on leaving the ward and on communication, confiscation of property, and various coercive measures. The patients' experiences of being deprived of their liberty were negative, although some saw the rationale for using these interventions, considering them as part of hospital care.

  19. Patient safety and hydration in the care of older people.

    PubMed

    Burns, Julie

    2016-05-01

    Ensuring patients are adequately hydrated is a fundamental part of nursing care, however, it is clear from the literature that dehydration remains a significant problem in the NHS with implications for patient safety. The development of dehydration is often multifactorial and older age is an independent risk factor for the condition. However, the media often blame nursing staff for simply not giving patients enough to drink. This article discusses the scale of the problem in acute care settings and aims to raise awareness of the importance of hydration management and accurate documentation in nursing practice. It suggests that intentional hourly rounding may provide an opportunity for nurses to ensure older patients are prompted or assisted to take a drink. PMID:27125939

  20. Teamwork: building healthier workplaces and providing safer patient care.

    PubMed

    Clark, Paul R

    2009-01-01

    A changing healthcare landscape requires nurses to care for more patients with higher acuity during their shift than ever before. These more austere working conditions are leading to increased burnout. In addition, patient safety is not of the quality or level that is required. To build healthier workplaces where safe care is provided, formal teamwork training is recommended. Formal teamwork training programs, such as that provided by the MedTeams group, TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety), or participatory action research programs such as the Healthy Workplace Intervention, have decreased errors in the workplace, increased nurse satisfaction and retention rates, and decreased staff turnover. This article includes necessary determinants of teamwork, brief overviews of team-building programs, and examples of research programs that demonstrate how teamwork brings about healthier workplaces that are safer for patients. Teamwork programs can bring about these positive results when implemented and supported by the hospital system.

  1. Oral care practices for patients in Intensive Care Units: A pilot survey

    PubMed Central

    Miranda, Alexandre Franco; de Paula, Renata Monteiro; de Castro Piau, Cinthia Gonçalves Barbosa; Costa, Priscila Paganini; Bezerra, Ana Cristina Barreto

    2016-01-01

    Objective: To assess the level of knowledge and difficulties concerning hospitalized patients regarding preventive oral health measures among professionals working in Intensive Care Units (ICUs). Study Population and Methods: A cross-sectional survey was conducted among 71 health professionals working in the ICU. A self-administered questionnaire was used to determine the methods used, frequency, and attitude toward oral care provided to patients in Brazilian ICUs. The variables were analyzed using descriptive statistics (percentages). A one-sample t-test between proportions was used to assess significant differences between percentages. t-statistics were considered statistically significant for P < 0.05. Bonferroni correction was applied to account for multiple testing. Results: Most participants were nursing professionals (80.3%) working 12-h shifts in the ICU (70.4%); about 87.3% and 66.2% reported having knowledge about coated tongue and nosocomial pneumonia, respectively (P < 0.05). Most reported using spatulas, gauze, and toothbrushes (49.3%) or only toothbrushes (28.2%) with 0.12% chlorhexidine (49.3%) to sanitize the oral cavity of ICU patients (P < 0.01). Most professionals felt that adequate time was available to provide oral care to ICU patients and that oral care was a priority for mechanically ventilated patients (80.3% and 83.1%, respectively, P < 0.05). However, most professionals (56.4%) reported feeling that the oral cavity was difficult to clean (P < 0.05). Conclusion: The survey results suggest that additional education is necessary to increase awareness among ICU professionals of the association between dental plaque and systemic conditions of patients, to standardize oral care protocols, and to promote the oral health of patients in ICUs. PMID:27275074

  2. Patient involvement in education for enhanced quality of care.

    PubMed

    Le Var, R M H

    2002-12-01

    Government policies in the UK are promoting health care practitioners working in partnership with patients and clients as an important constituent of quality in health care delivery. However, for practitioners to work in this way requires experience of such partnerships in the educational preparation. The involvement of patients and clients (i.e. service users) and their carers in the curriculum has been encouraged and supported in England since the early 1990s. From 1998, the comprehensive involvement in all phases of programme provision has been a requirement, ensuring that service users have a real 'voice' in influencing the direction of programmes. Examples of good practice are provided, demonstrating a range of approaches in the different stages of the educational process. Issues to be considered for successful implementation are included. Benefits to education and patient/client care are identified on the basis of literature and recent experience. They are strongly associated with enhanced quality of care. The article argues for a need to continue to broaden implementation for the major benefits of influencing the attitudes and approaches of students, and empowering users, with the end result of enhancing the quality of care. A strategic approach is needed to make user involvement an effective and workable reality. The need for systematic evaluation of the outcomes and for publications is highlighted. The principle of service user involvement in educational preparation is deemed to be equally relevant in other countries.

  3. Patient involvement in education for enhanced quality of care.

    PubMed

    Le Var, R M H

    2002-12-01

    Government policies in the UK are promoting health care practitioners working in partnership with patients and clients as an important constituent of quality in health care delivery. However, for practitioners to work in this way requires experience of such partnerships in the educational preparation. The involvement of patients and clients (i.e. service users) and their carers in the curriculum has been encouraged and supported in England since the early 1990s. From 1998, the comprehensive involvement in all phases of programme provision has been a requirement, ensuring that service users have a real 'voice' in influencing the direction of programmes. Examples of good practice are provided, demonstrating a range of approaches in the different stages of the educational process. Issues to be considered for successful implementation are included. Benefits to education and patient/client care are identified on the basis of literature and recent experience. They are strongly associated with enhanced quality of care. The article argues for a need to continue to broaden implementation for the major benefits of influencing the attitudes and approaches of students, and empowering users, with the end result of enhancing the quality of care. A strategic approach is needed to make user involvement an effective and workable reality. The need for systematic evaluation of the outcomes and for publications is highlighted. The principle of service user involvement in educational preparation is deemed to be equally relevant in other countries. PMID:12492943

  4. Analysis of early accountable care organizations defines patient, structural, cost, and quality-of-care characteristics.

    PubMed

    Epstein, Arnold M; Jha, Ashish K; Orav, E John; Liebman, Daniel L; Audet, Anne-Marie J; Zezza, Mark A; Guterman, Stuart

    2014-01-01

    Accountable care organizations (ACOs) have attracted interest from many policy makers and clinical leaders because of their potential to improve the quality of care and reduce costs. Federal ACO programs for Medicare beneficiaries are now up and running, but little information is available about the baseline characteristics of early entrants. In this descriptive study we present data on the structural and market characteristics of these early ACOs and compare ACOs' patient populations, costs, and quality with those of their non-ACO counterparts at baseline. We found that ACO patients were more likely than non-ACO patients to be older than age eighty and had higher incomes. ACO patients were less likely than non-ACO patients to be black, covered by Medicaid, or disabled. The cost of care for ACO patients was slightly lower than that for non-ACO patients. Slightly fewer than half of the ACOs had a participating hospital. Hospitals that were in ACOs were more likely than non-ACO hospitals to be large, teaching, and not-for-profit, although there was little difference in their performance on quality metrics. Our findings can be useful in interpreting the early results from the federal ACO programs and in establishing a baseline to assess the programs' development.

  5. Caring for adult patients who require nasogastric feeding tubes.

    PubMed

    Curtis, Kristine

    Nasogastric tubes provide a safe means of delivering nutrition support to many patients in hospital and the community. Insertion and care of these tubes will be familiar to many nurses. Evidence has shown that misplaced tubes, either on insertion or during use, can cause serious harm or even death to patients. This article explores the safety challenges posed during the insertion and maintenance of nasogastric tubes. Guidance and evidence should provide nurses with the knowledge, skills and reassurance to manage these tubes safely.

  6. Differential Patient-Caregiver Opinions of Treatment and Care For Advanced Lung Cancer Patients

    PubMed Central

    Zyzanski, Stephen J; Siminoff, Laura A

    2010-01-01

    This study examined the differences of opinion between cancer patients and caregivers with regard to treatment and care decisions. 184 advanced lung cancer patients and 171 primary caregivers were recruited as a convenience sample from clinics in Cleveland, Ohio. A telephone interview was conducted to collect data using a semi-structured questionnaire. Nonparametric tests and regression analysis were performed. The findings showed that patients and caregivers reported significant disagreement on three main issues: trade-off between treatment side effects and benefits; reporting treatment side effects to physicians, and hospice care. Caregivers were more concerned about patient’s quality of life and more willing to discuss hospice issues than were patients. Perceived family disagreement is associated with depression in both patients and caregivers. The study provided empirical evidence for patient-caregiver disagreement about treatment and care decisions and its significant adverse impact on both patients and caregivers. PMID:20137849

  7. Patient experience of computerised therapy for depression in primary care

    PubMed Central

    Knowles, Sarah E; Lovell, Karina; Bower, Peter; Gilbody, Simon; Littlewood, Elizabeth; Lester, Helen

    2015-01-01

    Objective To explore patient experience of computerised cognitive behaviour therapy (cCBT) for depression in a pragmatic randomised controlled trial (Randomised Evaluation of the Effectiveness and Acceptability of Computerised Therapy, REEACT). Design Qualitative semistructured interviews with 36 participants. Participants Depressed patients with a Patient Health Questionnaire 9 of 10 or above recruited into the REEACT randomised controlled trial. Setting Primary care settings in England. Results Participant experience was on a continuum, with some patients unable or unwilling to accept psychological therapy without interpersonal contact while others appreciated the enhanced anonymity and flexibility of cCBT. The majority of patients were ambivalent, recognising the potential benefits offered by cCBT but struggling with challenges posed by the severity of their illness, lack of support and limited personalisation of programme content. Low completion rates were commonly reported, although more positive patients reported greater engagement. Both positive and ambivalent patients perceived a need for monitoring or follow-up to support completion, while negative patients reported deliberate non-adherence due to dissatisfaction with the programme. Patients also reported that severity of depression impacted on engagement, and viewed cCBT as unsuitable for patients undergoing more severe depressive episodes. Conclusions The study demonstrates both the unique demands and benefits of computerised therapy. cCBT was preferred by some patients and rejected by others, but the majority of patients were ambivalent about the therapy. cCBT could be offered within a menu of options in stepped care if matched appropriately to individual patients or could be offered with enhanced support to appeal to a greater number of patients. Trial registration number ISRCTN91947481. PMID:26621513

  8. Confronting Disparities in Diabetes Care: The Clinical Effectiveness of Redesigning Care Management for Minority Patients in Rural Primary Care Practices

    ERIC Educational Resources Information Center

    Bray, Paul; Thompson, Debra; Wynn, Joan D.; Cummings, Doyle M.; Whetstone, Lauren

    2005-01-01

    Context: Diabetes mellitus and its complications disproportionately affect minority citizens in rural communities, many of whom have limited access to comprehensive diabetes management services. Purpose: To explore the efficacy of combining care management and interdisciplinary group visits for rural African American patients with diabetes…

  9. Futility and the care of surgical patients: ethical dilemmas.

    PubMed

    Grant, Scott B; Modi, Parth K; Singer, Eric A

    2014-07-01

    Futility has been a contentious topic in medicine for several decades. Surgery in critical or end-of-life situations often raises difficult questions about futility. In this article, we discuss the definition of futility, methods for resolving futility disputes, and some ways to reframe the futility debate to a more fruitful discussion about the goals of care, better communication between surgeon and patient/surrogate, and palliative surgical care. Many definitions of futile therapy have been discussed. The most controversial of these is "qualitative futility" which describes a situation in which the treatment provided is likely to result in an unacceptable quality of life. This is an area of continued controversy because it has been impossible to identify universally held beliefs about acceptable quality of life. Many authors have described methods for resolving futility disputes, including community standards and legalistic multi-step due process protocols. Others, however, have abandoned the concept of futility altogether as an unhelpful term. Reframing the issue of futility as one of inadequate physician-patient communication, these authors have advocated for methods of improving communication and strengthening the patient-physician relationship. Finally, we discuss the utilization of consultants who may be of use in resolving futility disputes: ethics committees, palliative care specialists, pastoral care teams, and dedicated patient advocates. Involving these specialists in a futility conflict can help improve communication and provide invaluable assistance in arriving at the appropriate treatment decision.

  10. En route care patient safety: thoughts from the field.

    PubMed

    McNeill, Margaret M; Pierce, Penny; Dukes, Susan; Bridges, Elizabeth J

    2014-08-01

    The purpose of this study was to describe the patient safety culture of en route care in the United States Air Force aeromedical evacuation system. Almost 100,000 patients have been transported since 2001. Safety concerns in this unique environment are complex because of the extraordinary demands of multitasking, time urgency, long duty hours, complex handoffs, and multiple stressors of flight. An internet-based survey explored the perceptions and experiences of safety issues among nursing personnel involved throughout the continuum of aeromedical evacuation care. A convenience sample of 236 nurses and medical technicians from settings representing the continuum was studied. Descriptive and nonparametric statistics were used to analyze the quantitative data, and thematic analysis was applied to the qualitative data. Results indicate that over 90% of respondents agree or strongly agree safety is a priority in their unit and that their unit is responsive to patient safety initiatives. Many respondents described safety incidents or near misses, and these have been categorized as personnel physical capability limitations, environmental threats, medication and equipment issues, and care process problems. Results suggest the care of patients during transport is influenced by the safety culture, human factors, training, experience, and communication. Suggestions to address safety issues emerged from the survey data.

  11. Depression Treatment Preferences in Older Primary Care Patients

    ERIC Educational Resources Information Center

    Gum, Amber M.; Arean, Patricia A.; Hunkeler, Enid; Tang, Lingqi; Katon, Wayne; Hitchcock, Polly; Steffens, David C.; Dickens, Jeanne; Unutzer, Jurgen

    2006-01-01

    Purpose: For depressed older primary care patients, this study aimed to examine (a) characteristics associated with depression treatment preferences; (b) predictors of receiving preferred treatment; and (c) whether receiving preferred treatment predicted satisfaction and depression outcomes. Design and Methods: Data are from 1,602 depressed older…

  12. 42 CFR 413.9 - Cost related to patient care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Cost related to patient care. 413.9 Section 413.9 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE...

  13. 21 CFR 880.5450 - Patient care reverse isolation chamber.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Patient care reverse isolation chamber. 880.5450 Section 880.5450 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... lacking a normal immunosuppressive defense due to therapy or congenital abnormality. The device...

  14. The Impact of Management on Knowledge and Patient Care

    ERIC Educational Resources Information Center

    Iversen, Hans Petter

    2011-01-01

    How do approaches to management affect knowledge and patient care? In this paper, the establishment and dismantling of an organisational unit for research and development (R&D) in a mental health department of a Norwegian health enterprise are analysed. The characteristics of two adverse treatment ideologies and their coherence with approaches to…

  15. Patients' Anticipation of Stress in Nursing Home Care.

    ERIC Educational Resources Information Center

    Stein, Shayna; And Others

    1985-01-01

    Examined anticipation of stresses in 223 patients recently admitted to nursing homes, who completed the stresses in Institutional Care Scale (SIC). Factor analysis revealed five factors significantly related to psychological and physical variables. Suggests using SIC for admission screening in nursing homes. Appendix contains the SIC. (NRB)

  16. Standardizing the care of detox patients to achieve quality outcomes.

    PubMed

    Becker, Kathy; Semrow, Sue

    2006-03-01

    Providing appropriate treatment for detoxification patients is both challenging and difficult because alcohol abuse and dependence are largely underestimated in the acute hospital setting. Alcohol withdrawal syndrome is treated not only by addictionologists on chemical dependency units, but also by primary care physicians in acute inpatient settings. The need for consistent inpatient treatment through the use of identified protocols can help provide safe and effective care. The need for consistent, inpatient medical-surgical detoxification treatment in our organization became apparent with the staff's identification of patient care concerns. Using an organizational approach, a multidisciplinary team was created to standardize the care of detoxification patients, beginning with patient admission and ending with discharge and referral for outpatient management. Standardization would ensure consistent assessment and intervention, and improve communication among the clinical team members. A protocol was developed for both the emergency department and the inpatient units. The goals of the team were to decrease the adverse events related to detoxification, such as seizures and aggression, and provide a consistent method of treatment for staff to follow.

  17. [Refractory cardiac arrest patients in prehospital care, potential organ donors].

    PubMed

    Le Jan, Arnaud; Dupin, Aurélie; Garrigue, Bruno; Sapir, David

    2016-09-01

    Under the authority of the French Biomedicine Agency, a new care pathway integrates refractory cardiac arrest patients into a process of organ donation. It is a medical, logistical and ethical challenge for the staff of the mobile emergency services. PMID:27596502

  18. Measuring Family System Characteristics in Families Caring for Dementia Patients.

    ERIC Educational Resources Information Center

    Niederehe, George; And Others

    This paper describes an ongoing study evaluating families that provide in-home care to elderly relatives wth dementia. Characteristics of the study, which include a focus on progressive senile dementia, use of a clinical approach, longitudinal design, descriptive nature, focus on the dyad of patient and primary caregiver, and use of videotaping…

  19. Enabling patient-centered care through health information technology.

    PubMed Central

    Finkelstein, Joseph; Knight, Amy; Marinopoulos, Spyridon; Gibbons, M Christopher; Berger, Zackary; Aboumatar, Hanan; Wilson, Renee F; Lau, Brandyn D; Sharma, Ritu; Bass, Eric B

    2012-01-01

    OBJECTIVES The main objective of the report is to review the evidence on the impact of health information technology (IT) that supports patient-centered care (PCC) on: health care processes; clinical outcomes; intermediate outcomes (patient or provider satisfaction, health knowledge and behavior, and cost); responsiveness to needs and preferences of patients; shared decisionmaking and patient-clinician communication; and access to information. Additional objectives were to identify barriers and facilitators for using health IT to deliver PCC, and to identify gaps in evidence and information needed by patients, providers, payers, and policymakers. DATA SOURCES MEDLINE®, Embase®, Cochrane Library, Scopus, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, INSPEC, and Compendex databases through July 31, 2010. METHODS Paired members of our team reviewed citations to identify randomized controlled trials of PCC-related health IT interventions and studies that addressed barriers and facilitators for health IT for delivery of PCC. Independent assessors rated studies for quality. Paired reviewers abstracted data. RESULTS The search identified 327 eligible articles, including 184 articles on the impact of health IT applications implemented to support PCC and 206 articles addressing barriers or facilitators for such health IT applications. Sixty-three articles addressed both questions. The study results suggested positive effects of PCC-related health IT interventions on health care process outcomes, disease-specific clinical outcomes (for diabetes mellitus, heart disease, cancer, and other health conditions), intermediate outcomes, responsiveness to the needs and preferences of patients, shared decisionmaking, patient-clinician communication, and access to medical information. Studies reported a number of barriers and facilitators for using health IT applications to enable PCC. Barriers included: lack of usability; problems with access to the health IT

  20. [Care as a cross-cutting element in the health care of complex chronic patients].

    PubMed

    Rico-Blázquez, Milagros; Sánchez Gómez, Sheila; Fuentelsaz Gallego, Carmen

    2014-01-01

    The care of people who live with chronic diseases is currently a priority on the roadmaps of all health care services. Within these strategies, there needs to be a specific approach required for a population group that is defined by having multiple diseases and the associated comorbidity. This group is especially vulnerable, fragile, and require very complex care, which uses up a high quantity of social health resources. The estimated prevalence in Spain is 1.4% in the general population, and approximately 5% in people over 64 years. The social and healthcare of this population requires a person-centered approach, as a paradigm of caring for the patients and not of the diseases. The models must leap from the segmented approach to diseases to a holistic and integrated vision, taking into account the social and psycho-affective situation, the experience of the patient, the family context, and the approach of human experience/response that these processes produce. The health professionals need support tools that can guide them and help in making clinical decisions in this population group. The clinical practice guidelines for the approach of patients with co-morbidity and multiple diseases have numerous limitations. Expert recommendations in this sense, lead us to a multidisciplinary approach, with self-care and self-health management as a cross-cutting element of healthcare.

  1. [Care as a cross-cutting element in the health care of complex chronic patients].

    PubMed

    Rico-Blázquez, Milagros; Sánchez Gómez, Sheila; Fuentelsaz Gallego, Carmen

    2014-01-01

    The care of people who live with chronic diseases is currently a priority on the roadmaps of all health care services. Within these strategies, there needs to be a specific approach required for a population group that is defined by having multiple diseases and the associated comorbidity. This group is especially vulnerable, fragile, and require very complex care, which uses up a high quantity of social health resources. The estimated prevalence in Spain is 1.4% in the general population, and approximately 5% in people over 64 years. The social and healthcare of this population requires a person-centered approach, as a paradigm of caring for the patients and not of the diseases. The models must leap from the segmented approach to diseases to a holistic and integrated vision, taking into account the social and psycho-affective situation, the experience of the patient, the family context, and the approach of human experience/response that these processes produce. The health professionals need support tools that can guide them and help in making clinical decisions in this population group. The clinical practice guidelines for the approach of patients with co-morbidity and multiple diseases have numerous limitations. Expert recommendations in this sense, lead us to a multidisciplinary approach, with self-care and self-health management as a cross-cutting element of healthcare. PMID:24440550

  2. Tuberculosis pharmacotherapy: strategies to optimize patient care

    PubMed Central

    Mitnick, Carole D.; McGee, Bryan; Peloquin, Charles A.

    2009-01-01

    opportunities for improving treatment of drug-resistant TB and/or shortening treatment of drug-susceptible TB. More potential options for improved TB treatment currently exist than at any other time in the last 30 years. The challenge in TB pharmacotherapy is to devise well-tolerated, efficacious, short-duration regimens that can be used successfully against drug-resistant and drug-resistant TB in a heterogeneous population of patients. PMID:19191677

  3. [Behavior profile of psychogeriatric patients in substitute care projects: nursing home care and home for the aged].

    PubMed

    Boom-Poels, P G

    1994-03-01

    This article describes behaviour profiles of psychogeriatric patients participating in some substitute care projects. The behaviour of 55 patients from five residential homes participating in these projects were rated on the Behaviour Rating Scale for Psychogeriatric Inpatients (GIP). These data were compared with GIP-data of two reference groups: elderly people in residential homes and patients in psychogeriatric nursing homes (supervision, intensive care and nursing care requiring patients). Patients in the projects have, compared to the other people in residential homes, more cognitive and social disabilities. Compared to the patients in nursing homes, the patients in the projects have less social, cognitive and psychomotor disabilities, but more emotional problems, like suspicious, melancholic and dependent behaviour. These results show that patients in substitute care projects have a specific behaviour profile. The profile can be used for careful selection of patients in these projects.

  4. The identification of family members' contribution to patients' care in the intensive care unit: a naturalistic inquiry.

    PubMed

    Williams, Caroline M A

    2005-01-01

    The admission of a patient to an intensive care unit (ICU) is recognized as being a stressful experience for their families. Many studies have focused on the needs of families within ICU, but few have highlighted the unique contribution that family members make towards patient care and recovery. Using a naturalistic approach, data were collected through observation, video recording, in-depth interviewing and reflective video analysis to explore the processes and factors underpinning families' contribution to patient care. The findings can be grouped into three themes: getting to know the patient through the family, family contribution to care and the nurses' role in supporting families of ICU patients. Families can have a very positive influence on the patient's care and recovery from ICU, but both the family members, and in turn the nursing staff, need to be supported appropriately if this valuable contribution to patient care is to be maximized and maintained.

  5. Participatory Design and Development of a Patient-centered Toolkit to Engage Hospitalized Patients and Care Partners in their Plan of Care.

    PubMed

    Dykes, Patricia C; Stade, Diana; Chang, Frank; Dalal, Anuj; Getty, George; Kandala, Ravali; Lee, Jaeho; Lehman, Lisa; Leone, Kathleen; Massaro, Anthony F; Milone, Marsha; McNally, Kelly; Ohashi, Kumiko; Robbins, Katherine; Bates, David W; Collins, Sarah

    2014-01-01

    Patient engagement has been identified as a key strategy for improving patient outcomes. In this paper, we describe the development and pilot testing of a web-based patient centered toolkit (PCTK) prototype to improve access to health information and to engage hospitalized patients and caregivers in the plan of care. Individual and group interviews were used to identify plan of care functional and workflow requirements and user interface design enhancements. Qualitative methods within a participatory design approach supported the development of a PCTK prototype that will be implemented on intensive care and oncology units to engage patients and professional care team members developing their plan of care during an acute hospitalization.

  6. Drinking patterns, health care utilization, and costs among HMO primary care patients.

    PubMed

    Polen, M R; Green, C A; Freeborn, D K; Mullooly, J P; Lynch, F

    2001-11-01

    A survey of 8,034 primary care patients in a health maintenance organization examined the relationship between alcohol consumption and health care costs and service use. Costs were estimated from service use data for 1 year before and 2 years after study enrollment. No strong, consistent relationships were identified between multiple indicators of drinking patterns and either health care costs or service use. Compared with total costs among very light drinkers, former drinkers were higher, lifetime abstainers were similar, and persons in the higher drinking levels tended to have lower but not significantly different costs. Drinking patterns did not appear to be an important predictor of short-term health care costs or service use in this setting. Further study of former drinkers is warranted to examine the role of alcohol-related illnesses in the decision to quit drinking. PMID:11732242

  7. Copy number variants in a sample of patients with psychotic disorders: is standard screening relevant for actual clinical practice?

    PubMed Central

    Van de Kerkhof, Noortje WA; Feenstra, Ilse; van der Heijden, Frank MMA; de Leeuw, Nicole; Pfundt, Rolph; Stöber, Gerald; Egger, Jos IM; Verhoeven, Willem MA

    2012-01-01

    With the introduction of new genetic techniques such as genome-wide array comparative genomic hybridization, studies on the putative genetic etiology of schizophrenia have focused on the detection of copy number variants (CNVs), ie, microdeletions and/or microduplications, that are estimated to be present in up to 3% of patients with schizophrenia. In this study, out of a sample of 100 patients with psychotic disorders, 80 were investigated by array for the presence of CNVs. The assessment of the severity of psychiatric symptoms was performed using standardized instruments and ICD-10 was applied for diagnostic classification. In three patients, a submicroscopic CNV was demonstrated, one with a loss in 1q21.1 and two with a gain in 1p13.3 and 7q11.2, respectively. The association between these or other CNVs and schizophrenia or schizophrenia-like psychoses and their clinical implications still remain equivocal. While the CNV affected genes may enhance the vulnerability for psychiatric disorders via effects on neuronal architecture, these insights have not resulted in major changes in clinical practice as yet. Therefore, genome-wide array analysis should presently be restricted to those patients in whom psychotic symptoms are paired with other signs, particularly dysmorphisms and intellectual impairment. PMID:22848183

  8. Patient-Centered Culturally Sensitive Health Care: Trend or Major Thrust in Health Care Delivery?

    ERIC Educational Resources Information Center

    Killion, Cheryl M.

    2007-01-01

    In this reaction article to the Major Contribution, the merits and challenges of implementing patient-centered culturally sensitive health care, or cultural competence plus, are explicated. Three themes are addressed: separate but equal?, factoring in mental health, and sharing the load. The need to refine the conceptualization of the two…

  9. Health System Performance for the High-Need Patient: A Look at Access to Care and Patient Care Experiences.

    PubMed

    Salzberg, Claudia A; Hayes, Susan L; McCarthy, Douglas; Radley, David C; Abrams, Melina K; Shah, Tanya; Anderson, Gerard F

    2016-08-01

    Issue: Achieving a high-performing health system will require improving outcomes and reducing costs for high-need, high-cost patients--those who use the most health care services and account for a disproportionately large share of health care spending. Goal: To compare the health care experiences of adults with high needs--those with three or more chronic diseases and a functional limitation in the ability to care for themselves or perform routine daily tasks--to all adults and to those with multiple chronic diseases but no functional limitations. Methods: Analysis of data from the 2009--2011 Medical Expenditure Panel Survey. Key findings: High-need adults were more likely to report having an unmet medical need and less likely to report having good patient-provider communication. High-need adults reported roughly similar ease of obtaining specialist referrals as other adults and greater likelihood of having a medical home. While adults with private health insurance reported the fewest unmet needs overall, privately insured high-need adults reported the greatest difficulties having their needs met. Conclusion: The health care system needs to work better for the highest-need, most-complex patients. This study's findings highlight the importance of tailoring interventions to address their needs. PMID:27571600

  10. Patient Centered Communication During Primary Care Visits for Depressive Symptoms

    PubMed Central

    Chapman, Benjamin P.; Duberstein, Paul R.; Epstein, Ron; Fiscella, Kevin; Kravitz, Richard L.

    2009-01-01

    Background Patient Centered Communication (PCC) is associated with more appropriate treatment of depression in primary care. In part a function of patient presentation, little is known about other influences on PCC. We investigated whether PCC was also influenced by personality dispositions of primary care providers (PCPs), independent of patient presentation. Methods 46 PCPs completed personality scales from the NEO-Personality Inventory, Revised and provided care to 88 Standardized Patients (SPs) presenting with either major depression or adjustment disorder with comorbid musculoskeletal symptoms, either making or not making a medication request. Coders scored each visit using the Measure of Patient Centered Communication, assessing physicians’ ability to explore the patient’s illness experience (component 1), understand the patient’s psychosocial context (component 2), and involve the patient in collaborative discussions of treatment (component 3). Results Adjusting for physician demographics, training, and patient presentation, physicians who were more open to feelings explored the patient’s experience of illness more (p = .05). More dutiful, or rule-bound physicians engaged in greater exploration of the patient’s psychosocial and life circumstances (p = .04), but involved the patient less in treatment discussions (p = .03), as did physicians reporting more anxious vulnerability (p = .03). Physician demographics, training, and patient presentation explained 4-7% of variance in MPCC components, with personality explaining an additional 4-7% of the variance. Conclusion Understanding of personality dispositions which promote or detract from PCC may help medical educators better identify trainees of varying aptitude, addressing individual training needs in a tailored fashion. PMID:18665060

  11. Loss of relational continuity of care in schizophrenia: associations with patient satisfaction and quality of care

    PubMed Central

    Sanatinia, Rahil; Cowan, Violet; Barnicot, Kirsten; Zalewska, Krysia; Shiers, David; Cooper, Stephen J.

    2016-01-01

    Background Users of mental health service are concerned about changes in clinicians providing their care, but little is known about their impact. Aims To examine associations between changes in staff, and patient satisfaction and quality of care. Method A national cross-sectional survey of 3379 people aged 18 or over treated in secondary care for schizophrenia or schizoaffective disorder. Results Nearly 41.9% reported at least one change in their key worker during the previous 12 months and 10.5% reported multiple changes. Those reporting multiple changes were less satisfied with their treatment and less likely to report having a care plan, knowing how to obtain help when in a crisis or to have had recommended physical health assessments. Conclusions Frequent changes in staff providing care for people with psychosis are associated with poorer quality of care. Greater efforts need to be made to protect relational continuity of care for such patients. Declaration of interest M.J.C. was co-chair of the expert advisory group on the NICE quality standard on Service User Experience in Adult Mental Health. S.J.C. has previously been a member of the Health and Social Care Board Northern Ireland Formulary Committee. D.S. received a speaker’s fee from Janssen Cilag in 2011. He is a topic expert on NICE guideline for psychosis and schizophrenia in children and young people and a board member of National Collaborating Centre for Mental Health. Copyright and usage © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license. PMID:27713834

  12. Multiple Victims: The Result of Caring Patients in Vegetative State

    PubMed Central

    Goudarzi, Fateme; Abedi, Heidarali; Zarea, Kourosh; Ahmadi, Fazlollah

    2015-01-01

    Background: Having a patient in a vegetative state in the family is a complicated and stressful experience. Caring for such patients with complete disability at home is very challenging. Objectives: The present study aimed to explore the outcomes of caring for patients in a vegetative state for families and caregivers at home. Patients and Methods: In this qualitative study, 16 vegetative patients’ caregivers were selected through purposive sampling. Unstructured interviews and observations were used for data gathering. Data collection was continued until saturation of data and emergence of the main themes. Data analysis was performed by the content analysis method. Results: The analysis of the gathered data led to three themes: “lost main caregiver”, “affected caring partner” and “affected family”. Each theme had some subthemes and subcategories. Conclusions: The three emerged themes in this study showed that all the family members of vegetative patients, depending on their responsibilities, were affected by physical, mental, social and economic issues. PMID:26328066

  13. Interventional pain management in the palliative care patient.

    PubMed

    McHugh, Marlene E; Miller-Saultz, Debbie; Wuhrman, Elsa; Kosharskyy, Boleslav

    2012-09-01

    For the majority of patients, cancer pain can be treated using the World Health Organization cancer pain guidelines; however, for 10-20% of patients with advanced cancer, adequate pain control cannot be achieved using these methods owing to disease pathophysiology preventing administration/absorption of pain medications or intolerance due to opioid toxicities. The need to expand analgesic treatment when oral, transdermal, and intravenous therapies fail requires exploration of interventional pain management techniques such as neuraxial (e.g. epidural and intrathecal) infusion therapies and neurolytic interventions. Nurses caring for patients with cancer pain should develop their knowledge of these multimodal approaches to cancer pain management.

  14. Management plan and delivery of care in Graves' ophthalmopathy patients.

    PubMed

    Yang, Morgan; Perros, Petros

    2012-06-01

    Most patients with Graves' orbitopathy have mild disease that requires no or minimal intervention. For the minority of patients with moderate or severe disease, multiple medical and surgical treatments may be required at different stages. It is crucial that such patients are monitored closely and treatments applied with care in the right sequence. Medical treatments should be used as early as possible and only during the active phase of the disease. Rehabilitative surgery is indicated in the inactive phase of the disease and should follow the sequence: surgical decompression followed by eye muscle surgery, followed by lid surgery. Delivery of care in a coordinated fashion that makes use of best available expertise is important and best implemented through a Combined Thyroid Eye clinic. PMID:22632367

  15. Reducing CBC Clotting Rates in the Neonatal Patient Care Areas.

    PubMed

    McCoy, Jennifer; Tichon, Tanya; Narvey, Michael

    2016-01-01

    Performing a complete blood count (CBC) is a common test performed in neonatal intensive care. Samples reported as "clotted" are not able to be analyzed and require redraw. A perceived "high" clotting rate elicits frustration among team members and has negative effects on patient flow and patient satisfaction. Process mapping and a root cause analysis determined that an educational intervention was required to optimize blood collection skills of front-line nurses. Through four rapid PDSA cycles over a three year period, the neonatal patient care areas were able to decrease their CBC clotting rates from 30% (monthly rate when the problem was identified) to 16% (yearly average at the end of the project). The CBC clotting rates continue to decease over time due to the integration of a multi-faceted educational plan into biannual education days designed for current staff nurses, as well as into the orientation plan for newly hired and student nurses. PMID:27493749

  16. Reducing CBC Clotting Rates in the Neonatal Patient Care Areas

    PubMed Central

    McCoy, Jennifer; Tichon, Tanya; Narvey, Michael

    2016-01-01

    Performing a complete blood count (CBC) is a common test performed in neonatal intensive care. Samples reported as “clotted” are not able to be analyzed and require redraw. A perceived “high” clotting rate elicits frustration among team members and has negative effects on patient flow and patient satisfaction. Process mapping and a root cause analysis determined that an educational intervention was required to optimize blood collection skills of front-line nurses. Through four rapid PDSA cycles over a three year period, the neonatal patient care areas were able to decrease their CBC clotting rates from 30% (monthly rate when the problem was identified) to 16% (yearly average at the end of the project). The CBC clotting rates continue to decease over time due to the integration of a multi-faceted educational plan into biannual education days designed for current staff nurses, as well as into the orientation plan for newly hired and student nurses. PMID:27493749

  17. Care of the patient with chronic pain: part II.

    PubMed

    Wells-Federman, C L

    2000-01-01

    Chronic nonmalignant pain frequently results in significant physical, behavioral, psychological, social, and spiritual issues for patients and their families. It is often misunderstood and unsuccessfully managed. Advanced practice nurses who are knowledgeable about chronic pain and the complex biopsychosocial-spiritual needs of this patient population serve an important role in recognizing these patients and intervening appropriately in their care. The purpose of this two-part article is to provide that information. Part I [Clinical Excellence for Nurse Practitioners, 3 (4), 192-204] outlined the pathophysiology, assessment, biopsychosocial-spiritual aspects, and pharmacologic treatment of chronic pain. In Part II, a variety of nonpharmacologic and self-management interventions one can use in the primary care setting to treat these difficult health problems are introduced. PMID:11858295

  18. Care of the patient with chronic pain: Part I.

    PubMed

    Wells-Federman, C L

    1999-07-01

    Chronic nonmalignant pain is estimated to affect over 50 million Americans. It frequently results in significant physical, behavioral, psychological, social, and spiritual problems for patients and their families. In spite of its prevalence and consequences, chronic pain is often misunderstood and inadequately managed by healthcare professionals. Advanced practice nurses who are knowledgeable about chronic pain and the complex biopsychosocial-spiritual needs of this patient population serve an important role in recognizing these patients and intervening appropriately in their care. The purpose of this two-part article is to provide that information. Part I outlines the pathophysiology, assessment, biopsychosocial-spiritual aspects, and pharmacological treatment of chronic pain. Part II addresses a variety of nonpharmacologic and self-management interventions one can use in the primary care setting to treat these difficult health problems. PMID:10711057

  19. What is patient-centered care really? Voices of Hispanic prenatal patients.

    PubMed

    Bergman, Alicia A; Connaughton, Stacey L

    2013-01-01

    Variations in patient-centered care (PCC) models and approaches contribute to ambiguity in how PCC is understood and defined, especially with regard to meeting the needs of diverse patient populations. One of the biggest challenges of putting PCC into practice is knowing what elements are the most important to patients. This qualitative study privileges patients' voices and adds a cultural dimension to existing health communication research on PCC through an empirical investigation of 48 Hispanic prenatal care patients' understandings and expectations of PCC. Semistructured interviews with 48 patients revealed five key themes in order of frequency: (a) una relación amable (a friendly relationship), (b) la atencion médica efectiva (effective medical care), (c) Español hablado (the Spanish language spoken), (d) comprensión de la información (understanding of information), and (e) eliminación del racismo (elimination of racism). The themes reflected several different assumptions and expectations with regard to PCC as compared to those espoused in many of the existing models and frameworks, such as the extent to which friendly interpersonal behaviors (e.g., smiling, making eye contact, displaying patience, and engaging in formal greetings, introductions, and farewells) were critical to patient satisfaction with the health care experience. Not only did patients feel better understood, but accompanied by friendly behaviors, information was viewed as more believable and accurate, and thus more patient-centered. The findings suggest that implementing culturally sensitive PCC approaches to caring for Hispanic prenatal care patients can include training health care staff on the importance of displaying friendly communicative behaviors such as smiling. PMID:23421385

  20. What is patient-centered care really? Voices of Hispanic prenatal patients.

    PubMed

    Bergman, Alicia A; Connaughton, Stacey L

    2013-01-01

    Variations in patient-centered care (PCC) models and approaches contribute to ambiguity in how PCC is understood and defined, especially with regard to meeting the needs of diverse patient populations. One of the biggest challenges of putting PCC into practice is knowing what elements are the most important to patients. This qualitative study privileges patients' voices and adds a cultural dimension to existing health communication research on PCC through an empirical investigation of 48 Hispanic prenatal care patients' understandings and expectations of PCC. Semistructured interviews with 48 patients revealed five key themes in order of frequency: (a) una relación amable (a friendly relationship), (b) la atencion médica efectiva (effective medical care), (c) Español hablado (the Spanish language spoken), (d) comprensión de la información (understanding of information), and (e) eliminación del racismo (elimination of racism). The themes reflected several different assumptions and expectations with regard to PCC as compared to those espoused in many of the existing models and frameworks, such as the extent to which friendly interpersonal behaviors (e.g., smiling, making eye contact, displaying patience, and engaging in formal greetings, introductions, and farewells) were critical to patient satisfaction with the health care experience. Not only did patients feel better understood, but accompanied by friendly behaviors, information was viewed as more believable and accurate, and thus more patient-centered. The findings suggest that implementing culturally sensitive PCC approaches to caring for Hispanic prenatal care patients can include training health care staff on the importance of displaying friendly communicative behaviors such as smiling.

  1. Quality Measures for the Care of Patients with Narcolepsy

    PubMed Central

    Krahn, Lois E.; Hershner, Shelley; Loeding, Lauren D.; Maski, Kiran P.; Rifkin, Daniel I.; Selim, Bernardo; Watson, Nathaniel F.

    2015-01-01

    The American Academy of Sleep Medicine (AASM) commissioned a Workgroup to develop quality measures for the care of patients with narcolepsy. Following a comprehensive literature search, 306 publications were found addressing quality care or measures. Strength of association was graded between proposed process measures and desired outcomes. Following the AASM process for quality measure development, we identified three outcomes (including one outcome measure) and seven process measures. The first desired outcome was to reduce excessive daytime sleepiness by employing two process measures: quantifying sleepiness and initiating treatment. The second outcome was to improve the accuracy of diagnosis by employing the two process measures: completing both a comprehensive sleep history and an objective sleep assessment. The third outcome was to reduce adverse events through three steps: ensuring treatment follow-up, documenting medical comorbidities, and documenting safety measures counseling. All narcolepsy measures described in this report were developed by the Narcolepsy Quality Measures Work-group and approved by the AASM Quality Measures Task Force and the AASM Board of Directors. The AASM recommends the use of these measures as part of quality improvement programs that will enhance the ability to improve care for patients with narcolepsy. Citation: Krahn LE, Hershner S, Loeding LD, Maski KP, Rifkin DI, Selim B, Watson NF. Quality measures for the care of patients with narcolepsy. J Clin Sleep Med 2015;11(3):335–355. PMID:25700880

  2. Interventions to Improve Care for Patients with Limited Health Literacy

    PubMed Central

    Sudore, Rebecca L.; Schillinger, Dean

    2009-01-01

    Objective To propose a framework and describe best practices for improving care for patients with limited health literacy (LHL). Methods Review of the literature. Results Approximately half of the U.S. adult population has LHL. Because LHL is associated with poor health outcomes and contributes to health disparities, the adoption of evidence-based best practices is imperative. Feasible interventions at the clinician-patient level (eg, patient-centered communication, clear communication techniques, teach-to-goal methods, and reinforcement), at the system-patient level (eg, clear health education materials, visual aids, clear medication labeling, self-management support programs, and shame-free clinical environments), and at the community-patient level (eg, adult education referrals, lay health educators, and harnessing the mass media) can improve health outcomes for patients with LHL. Conclusion Because LHL is prevalent, and because the recommended communication strategies can benefit patients of all literacy levels, clinicians, health system planners, and health policy leaders should promote the uptake of these strategies into routine care. PMID:20046798

  3. Detailed Dietary Assessment in Patients with Inoperable Tumors: Potential Deficits for Nutrition Care Plans.

    PubMed

    Vidra, Nikoletta; Kontogianni, Meropi D; Schina, Evaggelia; Gioulbasanis, Ioannis

    2016-10-01

    Advanced cancer often results in reduced dietary intake; however, data on actual intake at the time of diagnosis are limited. In the present study, a detailed dietary intake assessment was performed in patients with metastatic lung and upper gastrointestinal cancer, before initiation of systemic therapy. Basic demographics and performance status (PS) were recorded. Nutritional status was evaluated through anthropometry, Mini Nutritional Assessment (MNA), and 3 nonconsecutive 24-hour dietary recalls. Of the 84 patients enrolled, 61.4% were protein, energy, or protein-energy undernourished, regardless of body mass index (BMI) or MNA category. No differences in energy, macronutrients, and micronutrients intakes across BMI categories were recorded. Very low consumption of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), irrespective of energy intake, tumor site, BMI category, or PS was found. Suboptimal micronutrients intakes were recorded even in well-nourished and overweight/obese patients. Patients with adequate PS and better MNA score reported significantly higher intake of certain macro- and micronutrients (all P < 0.05). Most patients exhibited reduced dietary intake in terms of energy, macronutrient, and micronutrient. Very low EPA and DHA intake was recorded for the whole sample, whereas micronutrient suboptimal intakes were also prevalent in well-nourished or overweight patients. All the above should be taken into account during patients' nutritional care. PMID:27552101

  4. Integrating patient teaching into bedside patient care: a participant-observation study of hospital nurses.

    PubMed

    Barber-Parker, Elaine D

    Today's patients are quickly discharged from hospitals and often continue complex treatments at home. Patient teaching is critical and hospital nurses are encouraged to use "every teachable moment." This study explored and described the nature of integrating patient teaching into daily patient care and the factors influencing the delivery of teaching. A fieldwork method, conducted over 12 months, used participant-observation (PO) and a focus group session to answer the research questions. Three experienced registered nurses working on the oncology unit of an acute care community hospital served as informants. Critical attributes and patterns of observed teaching events were described.

  5. In their own words: Patients and families define high-quality palliative care in the intensive care unit*

    PubMed Central

    Nelson, Judith E.; Puntillo, Kathleen A.; Pronovost, Peter J.; Walker, Amy S.; McAdam, Jennifer L.; Ilaoa, Debra; Penrod, Joan

    2011-01-01

    Objective Although the majority of hospital deaths occur in the intensive care unit and virtually all critically ill patients and their families have palliative needs, we know little about how patients and families, the most important “stakeholders,” define high-quality intensive care unit palliative care. We conducted this study to obtain their views on important domains of this care. Design Qualitative study using focus groups facilitated by a single physician. Setting A 20-bed general intensive care unit in a 382-bed community hospital in Oklahoma; 24-bed medical–surgical intensive care unit in a 377-bed tertiary, university hospital in urban California; and eight-bed medical intensive care unit in a 311-bed Veterans’ Affairs hospital in a northeastern city. Patients Randomly-selected patients with intensive care unit length of stay ≥5 days in 2007 to 2008 who survived the intensive care unit, families of survivors, and families of patients who died in the intensive care unit. Interventions None. Measurements and Main Results Focus group facilitator used open-ended questions and scripted probes from a written guide. Three investigators independently coded meeting transcripts, achieving consensus on themes. From 48 subjects (15 patients, 33 family members) in nine focus groups across three sites, a shared definition of high-quality intensive care unit palliative care emerged: timely, clear, and compassionate communication by clinicians; clinical decision-making focused on patients’ preferences, goals, and values; patient care maintaining comfort, dignity, and personhood; and family care with open access and proximity to patients, interdisciplinary support in the intensive care unit, and bereavement care for families of patients who died. Participants also endorsed specific processes to operationalize the care they considered important. Conclusions Efforts to improve intensive care unit palliative care quality should focus on domains and processes that

  6. Health service utilization patterns of primary care patients with osteoarthritis

    PubMed Central

    Rosemann, Thomas; Joos, Stefanie; Szecsenyi, Joachim; Laux, Gunter; Wensing, Michel

    2007-01-01

    Background To assess factors associated with visits to GPs, orthopaedists, and non-physician practitioners of complementary medicine (alternative practitioners) by primary care patients with osteoarthritis (OA). Methods Cross-sectional survey among 1250 consecutively addressed patients from 75 primary care practices in Germany. All patients suffered from OA of the knee or hip according to ACR criteria. They received questionnaires collecting sociodemographic data, data about health service utilisation, prescriptions, comorbidities. They also included established instruments as the Arthritis Impact Measurement Scale (AIMS2-SF) to assess disease-specific quality of life and the Patient Health Questionnaire (PHQ-9) to assess depression. Hierarchical stepwise multiple linear regression models were used to reveal significant factors influencing health service utilization. Results 1021 of 1250 (81.6%) questionnaires were returned. Nonrespondents did not differ from participants. Factors associated with health service use (HSU) varied between providers of care. Not being in a partnership, achieving a high score on the PHQ-9, increased pain severity reflected in the “symptom” scale of the AIMS2-SF, and an increased number of drug prescriptions predicted a high frequency of GP visits. The PHQ-9 score was also a predictor for visits to orthopaedists, as were previous GP contacts, a high score in the "symptom" scale as well as a high score in the "lower limb scale" of the AIMS2-SF. Regarding visits to alternative practitioners, a high score in the AIMS -"social" scale was a positive predictor as older people were less likely to visit them. Conclusion Our results emphasize the need for awareness of psychological factors contributing to the use of health care providers. Addressing the revealed factors associated with HSU appropriately may lead to decreased health care utilization. But further research is needed to assess how this can be done successfully. PMID:17956605

  7. Point-of-Care Blood Glucose Testing for Diabetes Care in Hospitalized Patients

    PubMed Central

    Rajendran, Rajesh

    2014-01-01

    Glycemic control in hospitalized patients with diabetes requires accurate near-patient glucose monitoring systems. In the past decade, point-of-care blood glucose monitoring devices have become the mainstay of near-patient glucose monitoring in hospitals across the world. In this article, we focus on its history, accuracy, clinical use, and cost-effectiveness. Point-of-care devices have evolved from 1.2 kg instruments with no informatics to handheld lightweight portable devices with advanced connectivity features. Their accuracy however remains a subject of debate, and new standards for their approval have now been issued by both the International Organization for Standardization and the Clinical and Laboratory Standards Institute. While their cost-effectiveness remains to be proved, their clinical value for managing inpatients with diabetes remains unchallenged. This evidence-based review provides an overall view of its use in the hospital setting. PMID:25355711

  8. Medical Student Volunteerism Addresses Patients' Social Needs: A Novel Approach to Patient-Centered Care

    PubMed Central

    Onyekere, Chinwe; Ross, Sandra; Namba, Alexa; Ross, Justin C.; Mann, Barry D.

    2016-01-01

    Background: Healthcare providers must be equipped to recognize and address patients' psychosocial needs to improve overall health outcomes. To give future healthcare providers the tools and training necessary to identify and address psychosocial issues, Lankenau Medical Center in partnership with the Philadelphia College of Osteopathic Medicine designed the Medical Student Advocate (MSA) program. Methods: The MSA program places volunteer second-year osteopathic medical students in care coordination teams at Lankenau Medical Associates, a primary care practice serving a diverse patient population in the Philadelphia, PA, region. As active members of the team, MSAs are referred high-risk patients who have resource needs such as food, employment, child care, and transportation. MSAs work collaboratively with patients and the multidisciplinary team to address patients' nonmedical needs. Results: From August 2013 to August 2015, 31 osteopathic medical students volunteered for the MSA program and served 369 patients with 720 identified needs. Faculty and participating medical students report that the MSA program provided an enhanced understanding of the holistic nature of patient care and a comprehensive view of patient needs. Conclusion: The MSA program provides students with a unique educational opportunity that encompasses early exposure to patient interaction, social determinants of health, population health, and interdisciplinary collaboration. Students develop skills to help them build patient relationships, understand the psychosocial factors shaping health outcomes, and engage with other healthcare professionals. This work in the preclinical years provides students with the knowledge to help them perform more effectively in the changing healthcare environment. PMID:27046404

  9. Substance use disorder patient privacy and comprehensive care in integrated health care settings.

    PubMed

    Schaper, Elizabeth; Padwa, Howard; Urada, Darren; Shoptaw, Steven

    2016-02-01

    The Affordable Care Act (ACA) expands health insurance coverage for substance use disorder (SUD) treatment, underscoring the value of improving SUD service integration in primarily physical health care settings. It is not yet known to what degree specialized privacy regulations-Code of Federal Regulations Title 42, Part 2 (42 CFR Part 2), in particular-will affect access to or the utilization and delivery of SUD treatment in primary care. In addition to exploring the emerging benefits and barriers that specialized confidentiality regulations pose to treatment in early adopting integrated health care settings, this article introduces and explicates 42 CFR Part 2 to support provider and administrator implementation of SUD privacy regulations in integrated settings. The authors also argue that, although intended to protect patients with SUD, special SUD information protection may inadvertently reinforce stigma against patients by purporting the belief that SUD is different from other health problems and must be kept private. In turn, this stigma may inhibit the delivery of comprehensive integrated care. PMID:26845493

  10. Perceived Impact of Care Managers’ Work on Patient and Clinician Outcomes

    PubMed Central

    Carayon, Pascale; Hundt, Ann Schoofs; Hoonakker, Peter; Kianfar, Sarah; Alyousef, Bashar; Salek, Doreen; Cartmill, Randi; Walker, James M.; Tomcavage, Janet

    2015-01-01

    Objectives The aim of this study is to assess the contributions of care management as perceived by care managers themselves. Study Design Focus groups and interviews with care managers who coordinate care for chronic obstructive pulmonary disease and congestive heart failure patients, as well as patients undergoing major surgery. Methods We collected data in focus groups and interviews with 12 care managers working in the Keystone Beacon Community project, including 5 care managers working in hospitals, 2 employed in outpatient clinics and 4 telephoning discharged patients from a Transitions of Care (TOC) call center. Results Inpatient care managers believe that (1) ensuring primary care provider follow-up, (2) coordinating appropriate services, (3) providing patient education, and (4) ensuring accurate medication reconciliation have the greatest impact on patient clinical outcomes. In contrast, outpatient and TOC care managers believe that (1) teaching patients the signs and symptoms of acute exacerbations and (2) building effective relationships with patients improve patient outcomes most. Some care management activities were perceived to have greater impact on patients with certain conditions (e.g., outpatient and TOC care managers saw effective relationships as having more impact on patients with COPD). All care managers believed that relationships with patients have the greatest impact on patient satisfaction, while the support they provide clinicians has the greatest impact on clinician satisfaction. Conclusions These findings may improve best practice for care managers by focusing interventions on the most effective activities for patients with specific medical conditions. PMID:26273476

  11. Collaborating With Music Therapists to Improve Patient Care.

    PubMed

    Palmer, Jaclyn Bradley; Lane, Deforia; Mayo, Diane

    2016-09-01

    Collaboration between perioperative nurses and music therapists can be beneficial in providing a safe, cost-effective means of managing patients' anxiety and pain and reducing the need for pharmacologic intervention in the perioperative setting. The use of a board-certified music therapist may help to improve patient outcomes, ease nurse workload, and serve as an adjunct therapeutic modality that is enjoyable for both patients and staff members. We conducted a two-year, randomized controlled trial to determine how to best implement a music therapy program, navigate its challenges, and collaborate with nurse colleagues to bring its benefits to surgical patients. This article offers suggestions for alliances between perioperative nursing and music therapy staff members and describes the potential of music therapists to help provide optimal patient care. PMID:27568531

  12. Patients' assessment of out of hours care in general practice

    PubMed Central

    Bollam, Mary J; McCarthy, Mark; Modell, Michael

    1988-01-01

    A sample of 177 patients drawn from 13 north London practices were interviewed shortly after they had sought help from their practice outside normal surgery hours. Patients were asked to describe the process and outcome of their out of hours call, to comment on specific aspects of the consultation, and to access their overall satisfaction with the encounter. Parents seeking consultations for children were least satisfied with the consultation; those aged over 60 responded most positively. Visits from general practitioners were more acceptable than visits from deputising doctors for patients aged under 60, but for patients aged over 60 visits from general practitioners and deputising doctors were equally acceptable. Monitoring of patients' views of out of hours consultations is feasible, and the findings of this study suggest that practices should regularly review the organisation of their out of hours care and discuss strategies for minimising conflict in out of hours calls—particularly those concerning children. PMID:3130934

  13. Do patients "like" good care? measuring hospital quality via Facebook.

    PubMed

    Timian, Alex; Rupcic, Sonia; Kachnowski, Stan; Luisi, Paloma

    2013-01-01

    With the growth of Facebook, public health researchers are exploring the platform's uses in health care. However, little research has examined the relationship between Facebook and traditional hospital quality measures. The authors conducted an exploratory quantitative analysis of hospitals' Facebook pages to assess whether Facebook "Likes" were associated with hospital quality and patient satisfaction. The 30-day mortality rates and patient recommendation rates were used to quantify hospital quality and patient satisfaction; these variables were correlated with Facebook data for 40 hospitals near New York, NY. The results showed that Facebook "Likes" have a strong negative association with 30-day mortality rates and are positively associated with patient recommendation. These exploratory findings suggest that the number of Facebook "Likes" for a hospital may serve as an indicator of hospital quality and patient satisfaction. These findings have implications for researchers and hospitals looking for a quick and widely available measure of these traditional indicators.

  14. Nutritional care of the patient: nurses' knowledge and attitudes in an acute care setting.

    PubMed

    Kowanko, I; Simon, S; Wood, J

    1999-03-01

    Concern is growing about the occurrence of malnutrition in hospitals throughout the developed world. Reduced involvement of nurses in patients' nutritional care may be one of the contributing factors. This study explored nurses' attitudes and knowledge about nutrition and food service in hospital. Semi-structured interviews were conducted with seven nurses from the internal medical service of a large Australian acute care hospital. Analysis of the interview transcripts revealed that many nurses lacked the in-depth knowledge needed to give proper nutritional care to their patients. Although nurses considered nutritional care to be important many had difficulty in raising its priority above other nursing activities, as a result of time constraints and multitasking issues. Several problems relating to food service arrangements were also highlighted. The findings suggest a need to raise nurses' awareness of the importance of nutrition in patient outcome. This study provides information which will guide in-service nurse education programs about nutrition, and suggests strategies for practice and organizational change.

  15. [Prescribing drugs to patients receiving out-patient care].

    PubMed

    Garjón Parra, F J

    2009-01-01

    Drug prescription has evolved to deal mainly with chronic diseases. Nowadays, repeating prescriptions using computers results in problems if this is not done with adequate control. Steps proposed for appropriate prescription are: defining the problem; specifying the objective; selecting the drug; initiating therapy with appropriate details; giving information; regular evaluation; considering cost; and using tools to reduce errors. Published recommendations for prescription, which have focused on elderly patients, include: avoiding polypharmacy; carrying out a regular medication review; stopping any current drugs that are not indicated and prescribing new drugs that have a clear indication; avoiding drugs that have deleterious effects; using dosages that are suitable for the age and renal function; using simple drug regimes and appropriate administration systems; considering non-pharmacological treatments; limiting the number of practitioners prescribing for each patient; and avoiding treating adverse drug reactions with further drugs. Examples of compliance with those recommendations in the Navarre Health Service, extracted from the prescription information system, are provided. The measures for improving prescription are: education, auditing, collaboration between health professionals and use of electronic tools.

  16. Quality of care: compared perceptions of patient and prosthodontist.

    PubMed

    Chamberlain, B B; Razzoog, M E; Robinson, E

    1984-11-01

    The results suggest that, with the exception of retention, differences between patients' and prosthodontists' perceptions of treatment with complete dentures display greater variability with regard to function than to either esthetics or comfort. Although the literature has suggested that satisfying the esthetic concerns of the patient is likely to be a major hurdle in denture treatment success, this study suggests that occlusion, retention, and vertical dimension may be of more importance to effective communication. Misconceptions and unreal expectations should be dealt with early in the treatment program to avoid patient dissatisfaction. During the 1972 International Prosthodontic Workshop held in Ann Arbor, Michigan, the statement was made that patients were generally an unreliable guide as to the adequacy of their dentures, especially after wearing them for a period of time, and that further research to document the patient's reliability seemed unnecessary. This study has demonstrated that patients are quite reliable judges of many criteria related to dentures, provided channels for two-way communication are opened. With the ever greater economic stresses that force dentists to consider patients' concerns, perhaps it is increasingly the dentist's responsibility to better educate patients to evaluate all aspects of the quality of care they receive and encourage extensive two-way communication early in the treatment process. The adjusted quality assessment criteria used in the present study may be a useful instrument to use with patients prior to the initial interview in an effort to establish a better dentist-patient relationship.

  17. Care and prejudice: moving beyond mistrust in the care relationship with addicted patients.

    PubMed

    Reyre, Aymeric; Jeannin, Raphaël; Larguèche, Myriam; Hirsch, Emmanuel; Baubet, Thierry; Moro, Marie Rose; Taïeb, Olivier

    2014-05-01

    Social representations of addiction and the resulting stigmatization have been widely described and studied in the literature, but their effects are no less problematic. These representations, which also occur in care settings, generate a climate of distrust which damages the therapeutic relationship, and its ethical quality. This article, combining clinical experience and an ethical stance, offers an original, innovating approach to the existence of distrust in care relationships in the area of addiction. Pragmatic approaches deriving from the human sciences and analytical philosophy provide an invitation to escape from the demanding climate of mistrust, and to take the gamble on trust so as to improve the quality of interactions between protagonists in care. In complementary fashion, a sociology of action can combat the disquiet generated by distrust through a new commitment to innovating forms of action. This "poetic" mode of action is legitimized by the reflection that backs it up, and by its presentation to peers qualified to approve it. Finally, continental moral philosophy underlines the importance of a carefully weighed commitment on the part of caregivers and addicted patients towards promises aiming to support a sincere care relationship, without damaging the therapeutic dynamic or the ethical quality by providing too many safety nets. This reflection is intended to achieve better identification of the clinical and ethical issues raised by mistrust, and inclusion of these aspects in the training of personnel and in care provision planning.

  18. Automated key process monitors for patient care documentation.

    PubMed Central

    Heermann, L. K.; East, T. D.; Lugo, A.; Bradshaw, R. L.

    1998-01-01

    Complete, accurate and timely patient care documentation is an essential part of the practice of medicine. As with any other process in medicine or industry, continuous quality improvement (CQI) is essential to assure the highest quality at the lowest cost. CQI requires objective key process measures that can be assessed routinely. A set of key process monitors designed to assess completeness, accuracy and timeliness were created based on local, regional and national standards. Feasibility was assessed in the LDS Hospital Emergency Department using 31,429 patient visits in the 18 months from June 1995 to November 1996. The logic of the score was programmed into SQL scripts and run against an Oracle database containing the patient care documentation. The results indicate that the chosen key process monitors can be used to provide real time assessment of the patient care documentation process. The general concepts of the key process measures of completeness, accuracy and timeliness are generalizable to many areas of medicine. The overall score provides one method of easily tracking departmental performance while the overall process monitoring database allows powerful, in-depth analysis of individual components of the process. It is recommended that such automated process monitoring tools be integrated into future clinical information systems. PMID:9929223

  19. Influence of patient characteristics on care time in patients hospitalized with schizophrenia

    PubMed Central

    Sugibayashi, Yukiko; Yoshimura, Kimio; Yamauchi, Keita; Inagaki, Ataru; Ikegami, Naoki

    2014-01-01

    Background In the current Japanese payment system for the treatment of psychiatric inpatients, the length of hospital stay and nurse staffing levels are key determinants of the amount of payment. These factors do not fully reflect the costs of care for each patient. The objective of this study was to clarify the relationship between patient characteristics and their care costs as measured by “care time” for patients with schizophrenia. Methods Patient characteristics and care time were investigated in 14,557 inpatients in 102 psychiatric hospitals in Japan. Of these 14,557 inpatients, data for 8,379 with schizophrenia were analyzed using a tree-based model. Results The factor exerting the greatest influence on care time was ”length of stay”, so subjects were divided into 2 groups, a “short stay group” with length of stay ≦104 days, and “long stay group” ≧105 days. Each group was further subdivided according to dependence with regard to “activities of daily living”, “psychomotor agitation”, “verbal abuse”, and “frequent demands/repetitive complaints”, which were critical variables affecting care time. The mean care time was shorter in the long-stay group; however, in some long-stay patients, the mean care time was considerably longer than that in patients in the short-stay group. Conclusion The results of this study suggest that it is necessary to construct a new payment system reflecting not only length of stay and nurse staffing levels, but also individual patient characteristics. PMID:25187720

  20. Prognosis of CKD Patients Receiving Outpatient Nephrology Care in Italy

    PubMed Central

    Chiodini, Paolo; Zoccali, Carmine; Borrelli, Silvio; Cianciaruso, Bruno; Di Iorio, Biagio; Santoro, Domenico; Giancaspro, Vincenzo; Abaterusso, Cataldo; Gallo, Ciro; Conte, Giuseppe; Minutolo, Roberto

    2011-01-01

    Summary Background and objectives Prognosis in nondialysis chronic kidney disease (CKD) patients under regular nephrology care is rarely investigated. Design, setting, participants, & measurements We prospectively followed from 2003 to death or June 2010 a cohort of 1248 patients with CKD stages 3 to 5 and previous nephrology care ≥1 year in 25 Italian outpatient nephrology clinics. Cumulative incidence of ESRD or death before ESRD were estimated using the competing-risk approach. Results Estimated rates (per 100 patient-years) of ESRD and death 8.3 (95% confidence interval [CI], 7.4 to 9.2) and 5.9 (95% CI 5.2 to 6.6), respectively. Risk of ESRD and death increased progressively from stages 3 to 5. ESRD was more frequent than death in stage 4 and 5 CKD, whereas the opposite was true in stage 3 CKD. Younger age, lower body mass index, proteinuria, and high phosphate predicted ESRD, whereas older age, diabetes, previous cardiovascular disease, ESRD, proteinuria, high uric acid, and anemia predicted death (P < 0.05 for all). Among modifiable risk factors, proteinuria accounted for the greatest contribution to the model fit for either outcome. Conclusions In patients receiving continuity of care in Italian nephrology clinics, ESRD was a more frequent outcome than death in stage 4 and 5 CKD, but the opposite was true in stage 3. Outcomes were predicted by modifiable risk factors specific to CKD. Proteinuria used in conjunction with estimated GFR refined risk stratification. These findings provide information, specific to CKD patients under regular outpatient nephrology care, for risk stratification that complement recent observations in the general population. PMID:21817127

  1. Mobility decline in patients hospitalized in an intensive care unit

    PubMed Central

    de Jesus, Fábio Santos; Paim, Daniel de Macedo; Brito, Juliana de Oliveira; Barros, Idiel de Araujo; Nogueira, Thiago Barbosa; Martinez, Bruno Prata; Pires, Thiago Queiroz

    2016-01-01

    Objective To evaluate the variation in mobility during hospitalization in an intensive care unit and its association with hospital mortality. Methods This prospective study was conducted in an intensive care unit. The inclusion criteria included patients admitted with an independence score of ≥ 4 for both bed-chair transfer and locomotion, with the score based on the Functional Independence Measure. Patients with cardiac arrest and/or those who died during hospitalization were excluded. To measure the loss of mobility, the value obtained at discharge was calculated and subtracted from the value obtained on admission, which was then divided by the admission score and recorded as a percentage. Results The comparison of these two variables indicated that the loss of mobility during hospitalization was 14.3% (p < 0.001). Loss of mobility was greater in patients hospitalized for more than 48 hours in the intensive care unit (p < 0.02) and in patients who used vasopressor drugs (p = 0.041). However, the comparison between subjects aged 60 years or older and those younger than 60 years indicated no significant differences in the loss of mobility (p = 0.332), reason for hospitalization (p = 0.265), SAPS 3 score (p = 0.224), use of mechanical ventilation (p = 0.117), or hospital mortality (p = 0.063). Conclusion There was loss of mobility during hospitalization in the intensive care unit. This loss was greater in patients who were hospitalized for more than 48 hours and in those who used vasopressors; however, the causal and prognostic factors associated with this decline need to be elucidated. PMID:27410406

  2. Outcomes of Subsyndromal Depression in Older Primary Care Patients

    PubMed Central

    Grabovich, Andrew; Lu, Naiji; Tang, Wan; Tu, Xin; Lyness, Jeffrey M.

    2010-01-01

    Objectives Most older persons in primary care suffering clinically significant depressive symptoms do not meet criteria for major or minor depression. We tested the hypothesis that patients with subsyndromal depression (SSD) would have poorer psychiatric, medical, and functional outcomes at follow-up than non-depressed patients, but not as poor as those with minor or major depression. We also explored the relative outcomes of three definitions of SSD to determine their relative prognostic value. Design Prospective observational cohort study. Setting Primary care practices in Monroe County, NY. Participants 481 primary care patients age ≥65 years who completed research assessments at intake and at least one year of follow-up evaluation. Measurements Depression diagnoses and three definitions of SSD were determined by the Structured Clinical Interview for DSM-IV and the 24-item Hamilton Depression Rating Scale. Other validated measures assessed anxiety, cognition, medical burden, and functional status. Results Patients with SSD had poorer 1-year lagged outcomes than non-depressed subjects in terms of psychiatric symptoms and functional status, often not significantly different than major or minor depression. Two of the SSD definitions identified subjects with poorer psychiatric and functional outcomes than the third SSD definition. Conclusions Clinicians should be vigilant in caring for patients with SSD, monitoring for persistent or worsening depressive symptoms including suicidality, anxiety, cognitive impairment, and functional decline. Researchers may use particular SSD definitions to identify individuals at higher risk of poor outcomes, to better understand the relationships of SSD to functional disability and to test innovative preventive and therapeutic interventions. PMID:20173424

  3. The Impact of an eHealth Portal on Health Care Professionals’ Interaction with Patients: Qualitative Study

    PubMed Central

    Faxvaag, Arild; Svanæs, Dag

    2015-01-01

    Background People who undergo weight loss surgery require a comprehensive treatment program to achieve successful outcomes. eHealth solutions, such as secure online portals, create new opportunities for improved health care delivery and care, but depend on the organizational delivery systems and on the health care professionals providing it. So far, these have received limited attention and the overall adoption of eHealth solutions remains low. In this study, a secure eHealth portal was implemented in a bariatric surgery clinic and offered to their patients. During the study period of 6 months, 60 patients and 5 health care professionals had access. The portal included patient information, self-management tools, and communication features for online dialog with peers and health care providers at the bariatric surgery clinic. Objective The aim of this study was to characterize and assess the impact of an eHealth portal on health care professionals’ interaction with patients in bariatric surgery. Methods This qualitative case study involved a field study consisting of contextual interviews at the clinic involving observing and speaking with personnel in their actual work environment. Semi-structured in-depth interviews were conducted with health care professionals who interacted with patients through the portal. Analysis of the collected material was done inductively using thematic analysis. Results The analysis revealed two main dimensions of using an eHealth portal in bariatric surgery: the transparency it represents and the responsibility that follows by providing it. The professionals reported the eHealth portal as (1) a source of information, (2) a gateway to approach and facilitate the patients, (3) a medium for irrevocable postings, (4) a channel that exposes responsibility and competence, and (5) a tool in the clinic. Conclusions By providing an eHealth portal to patients in a bariatric surgery program, health care professionals can observe patients

  4. A patient-centered research agenda for the care of the acutely ill older patient

    PubMed Central

    Wald, Heidi L.; Leykum, Luci K.; Mattison, Melissa L. P.; Vasilevskis, Eduard E.; Meltzer, David O.

    2015-01-01

    Hospitalists and others acute care providers are limited by gaps in evidence addressing the needs of the acutely ill older adult population. The Society of Hospital Medicine (SHM) sponsored the Acute Care of Older Patients (ACOP) Priority Setting Partnership to develop a research agenda focused on bridging this gap. Informed by the Patient-Centered Outcomes Research Institute (PCORI) framework for identification and prioritization of research areas, we adapted a methodology developed by the James Lind Alliance to engage diverse stakeholders in the research agenda setting process. The work of the Partnership proceeded through four steps: convening, consulting, collating, and prioritizing. First, the steering committee convened a Partnership of 18 stakeholder organizations in May 2013. Next, stakeholder organizations surveyed members to identify important unanswered questions in the acute care of older persons, receiving 1299 responses from 580 individuals. Finally, an extensive and structured process of collation and prioritization resulted in a final list of ten research questions in the following areas: advanced care planning, care transitions, delirium, dementia, depression, medications, models of care, physical function, surgery, and training. With the changing demographics of the hospitalized population, a workforce with limited geriatrics training, and gaps in evidence to inform clinical decision-making for acutely ill older patients, the identified research questions deserve the highest priority in directing future research efforts to improve care for the older hospitalized patient and enrich training. PMID:25877486

  5. Palliative care for patients with end-stage liver disease.

    PubMed

    Larson, Anne M

    2015-05-01

    Liver disease results in over four million physician visits and over 750,000 hospitalizations per year in the USA. Those with chronic liver disease frequently progress to cirrhosis, end-stage liver disease (ESLD), and death. Patients with ESLD experience numerous complications, including muscle cramps, confusion (hepatic encephalopathy), protein calorie malnutrition, muscle wasting, fluid overload (ascites, edema), bleeding (esophagogastric variceal hemorrhage), infection (spontaneous bacterial peritonitis), fatigue, anxiety, and depression. Despite significant improvements in palliation of these complications, patients still suffer reduced quality of life and must confront the fact that their disease will often inexorably progress to death. Liver transplantation is a valid option in this setting, increasing the duration of survival and palliating many of the symptoms. However, many patients die waiting for an organ or are not candidates for transplantation due to comorbid illness. Others receive a transplant but succumb to complications of the transplant itself. Patients and families must struggle with simultaneously hoping for a cure while facing a life-threatening illness. Ideally, the combination of palliative care with life-sustaining therapy can maximize the patients' quality and quantity of life. If it becomes clear that life-sustaining therapy is no longer an option, these patients are then already in a system to help them with end-of-life care.

  6. Is Patient Choice the Future of Health Care Systems?

    PubMed Central

    Fotaki, Marianna

    2013-01-01

    Patient and user choice are at the forefront of the debate on the future direction of health and public services provision in many industrialized countries in Europe and elsewhere. It is used both, as a means to achieve desired policy goals in public health care systems such as greater efficiency and improved quality of care, and as a good with its own intrinsic value. However, the evidence suggests that its impact on efficiency and quality is at best a very limited while it might have negative consequences on equity because the pre-existing inequalities of income and education could influence patients’ access to information and, consequently, choices. The paper attempts to introduce multidisciplinary frameworks to account for the social and cultural factors guiding patients’ choices and to explain the rationale, processes and outcomes of decision making in health care. PMID:24596850

  7. Care of patients with haemoglobin abnormalities: nursing management.

    PubMed

    Khattab, Ahmed D; Rawlings, Barry; Ali, Ibtisam S

    This second of two articles on sickle cell disease (SCD) aims to provide advice on nursing care for patients. All health professionals should be aware of the various manifestations of the disease, the life-threatening complications and their optimal management. Prophylactic strategy is of paramount importance as it may avert many possible adverse outcomes. Recurrent episodes of acute, severe pain require frequent hospital admissions. The care of individuals with SCD must extend into the community and take account of domestic, employment and educational issues. Affected pregnant women should be looked after by units experienced in the care of women with this condition. The diagnosis of haemoglobin type is simple and inexpensive and a comprehensive national screening programme to detect SCD in pregnant women and newborn babies was started in April 2002 as part of the Government's broader aims to tackle inequalities in health and community.

  8. Cost reduction using patient-focused care concepts.

    PubMed

    Snyder, G H; Lathrop, J P

    1995-01-01

    The latest wave of hospital reengineering has been based on the concepts of patient-focused care (PFC). PFC concepts include decentralizing low-scale activities to the point-of-care, cross-training employees to minimize hand-offs, simplifying processes to eliminate unnecessary complexity, redesigning the organization structure to focus on the care continuum, and adopting empowerment and teamwork to change individual behavior. Three innovative health systems have begun to reap the benefits of their PFC implementation efforts. Based on these three case study organizations, PFC is not only cost-justified, but also drives increases in quality and service levels. Each of the three case study organizations chose significantly different routes to implement these concepts due to various internal and external factors. Size of cost savings was the result of three main factors: level of change implemented, size of investment required to effect change, and time frame for implementation. Article includes results of economic analysis.

  9. [Terminal care for elderly patients with dementia in two long-term care hospitals].

    PubMed

    Hirakawa, Yoshihisa; Masuda, Yuichiro; Kimata, Takaya; Uemura, Kazumasa; Kuzuya, Masafumi; Iguchi, Akihisa

    2004-01-01

    A byproduct of the aging of the population has been a dramatic rise in patients with dementia. The aim of the present study is to clarify the use of aggressive and palliative treatments, artificial nutrition and sedation in long-term care hospitals in Japan. We assessed 123 deaths in people aged 65 and older who died in two long-term care hospitals in and around Nagoya from January 2001 to December 2002. All deceased were divided into two groups according to their diagnosis of dementia. Data on the particular characteristics of the deceased, diagnosis of dementia, aggressive treatments (including CPR, intubation, mechanical ventilation, the use of systemic antibiotics and blood transfusion), palliative treatments (including oxygen, narcotic and nonnarcotic pain medication) artificial nutrition (including hyperalimentation and tube feeding) and sedation during the last six months of their lives were collected from medical charts. The prevalence of aggressive and palliative interventions did not vary significantly with the diagnosis of dementia except for the use of vasopressors. Artificial nutrition was prevalent and few patients received sedatives in either group. Patients with and without dementia received similar treatments in the end-stage. A greater understanding of the course of dementia is needed to further discussions on the terminal care of people with dementia. A national consensus on how to treat end-stage demented patients is also needed.

  10. Care Transitions: Using Narratives to Assess Continuity of Care Provided to Older Patients after Hospital Discharge

    PubMed Central

    Wong, Carolyn; Hogan, David B.

    2016-01-01

    Background A common scenario that may pose challenges to primary care providers is when an older patient has been discharged from hospital. The aim of this pilot project is to examine the experiences of patients’ admission to hospital through to discharge back home, using analysis of patient narratives to inform the strengths and weaknesses of the process. Methods For this qualitative study, we interviewed eight subjects from the Sheldon M. Chumir Central Teaching Clinic (CTC). Interviews were analyzed for recurring themes and phenomena. Two physicians and two resident learners employed at the CTC were recruited as a focus group to review the narrative transcripts. Results Narratives generally demonstrated moderate satisfaction among interviewees with respect to their hospitalization and follow-up care in the community. However, the residual effects of their hospitalization surprised five patients, and five were uncertain about their post-discharge management plan. Conclusion Both secondary and primary care providers can improve on communicating the likely course of recovery and follow-up plans to patients at the time of hospital discharge. Our findings add to the growing body of research advocating for the implementation of quality improvement measures to standardize the discharge process. PMID:27729948

  11. Caring for patients receiving therapeutic hypothermia post cardiac arrest in the intensive care unit.

    PubMed

    Gardner, Glen; MacDonald, Sandra

    2013-01-01

    Survivors of ventricular fibrillation cardiac arrest have poor and often devastating neurological outcomes despite advances in resuscitation techniques and services (Bernard et al., 2002; Collins & Samworth, 2008). In an effort to increase survival rates, improve neurological outcomes and reduce mortality for surviving patients, clinical trials have shown that a mild state of therapeutic hypothermia (32 degrees C to 34 degrees C) has been linked to improved patient outcomes post cardiac arrest (Koran, 2008; Lee & Asare, 2010). Many hospitals in Canada currently use therapeutic hypothermia (TH), but the nursing care requires advanced nursing knowledge and skills. In an effort to prepare registered nurses to care for patients receiving TH, a specially designed education program was implemented at the Rouge Valley Health System Hospital (RVHS) in Ontario. Busy nurses need flexibility in the delivery of programs in the clinical setting, and this program was designed to meet that need with a combination of self-paced modules, lectures, discussions and a return demonstration. In this article, the authors discuss the nursing care of post cardiac arrest patients receiving TH, and the design and implementation of the education program.

  12. Prepaid coordinated care for patients with diabetes: practices and patients bear the risks.

    PubMed

    Pritchard, Douglas A

    2011-06-01

    The Australian Government is planning to pilot a model of prepaid funding for coordinated care of patients with diabetes in general practice. Patients will register with a practice that undertakes to coordinate their care, and practices will manage pre-allocated funds to provide services instead of billing Medicare. Systems to manage prepaid funds in Australian general practice have not yet been developed. In the model that has been proposed, practices with a small register of patients will be at risk of overspending, which may threaten practice viability and patient services. If the initiative is to have integrity, all patient services should be paid from the prepaid funds and patients should only attend the practice with which they have registered. Risks should be delineated and contingency plans made explicit before practices and patients commit to the initiative. PMID:21644876

  13. Self-Care Behaviors and Related Factors in Hypertensive Patients

    PubMed Central

    Zinat Motlagh, Sayed Fazel; Chaman, Reza; Sadeghi, Erfan; Eslami, Ahmad Ali

    2016-01-01

    Background An assessment of an individual’s hypertension self-care behavior may provide clinicians and practitioners with important information regarding how to better control hypertension. Objectives The objective of this study was to investigate the self-care behaviors of hypertensive patients. Patients and Methods This cross-sectional study was conducted in 2014 in a sample of 1836 patients of both genders who had been diagnosed with hypertension in urban and rural health centers in the Kohgiluyeh Boyerahmad Province in southern Iran. They were randomly selected and were invited to participate in the study. Self-care activities were measured using the H-hypertension self-care activity level effects. Results The mean age of the respondents was 63 (range: 30 - 92), and 36.1% reported adherence to the recommended levels of medication; 24.5% followed the physical activity level guidelines. Less than half (39.2%) met the criteria for practices related to weight management, and adherence to low-salt diet recommendations was also low (12.3%). Overall, 86.7% were nonsmokers, and 100% abstained from alcohol. The results of a logistic regression indicated that gender was significantly associated with adherence to physical activity (OR = 0.716) and non-smoking (OR = 1.503) recommendations; that is, women were more likely to take part in physical activity than men. There was also a significant association between age and adherence to both a low-salt diet (OR = 1.497) and medication (OR = 1.435). Conclusions Based on our findings, it is crucial to implement well-designed educational programs to improve hypertension self-care behaviors.

  14. Self-Care Behaviors and Related Factors in Hypertensive Patients

    PubMed Central

    Zinat Motlagh, Sayed Fazel; Chaman, Reza; Sadeghi, Erfan; Eslami, Ahmad Ali

    2016-01-01

    Background An assessment of an individual’s hypertension self-care behavior may provide clinicians and practitioners with important information regarding how to better control hypertension. Objectives The objective of this study was to investigate the self-care behaviors of hypertensive patients. Patients and Methods This cross-sectional study was conducted in 2014 in a sample of 1836 patients of both genders who had been diagnosed with hypertension in urban and rural health centers in the Kohgiluyeh Boyerahmad Province in southern Iran. They were randomly selected and were invited to participate in the study. Self-care activities were measured using the H-hypertension self-care activity level effects. Results The mean age of the respondents was 63 (range: 30 - 92), and 36.1% reported adherence to the recommended levels of medication; 24.5% followed the physical activity level guidelines. Less than half (39.2%) met the criteria for practices related to weight management, and adherence to low-salt diet recommendations was also low (12.3%). Overall, 86.7% were nonsmokers, and 100% abstained from alcohol. The results of a logistic regression indicated that gender was significantly associated with adherence to physical activity (OR = 0.716) and non-smoking (OR = 1.503) recommendations; that is, women were more likely to take part in physical activity than men. There was also a significant association between age and adherence to both a low-salt diet (OR = 1.497) and medication (OR = 1.435). Conclusions Based on our findings, it is crucial to implement well-designed educational programs to improve hypertension self-care behaviors. PMID:27621938

  15. Waiting to see the specialist: patient and provider characteristics of wait times from primary to specialty care

    PubMed Central

    2014-01-01

    Background Wait times are an important measure of access to various health care sectors and from a patient’s perspective include several stages in their care. While mechanisms to improve wait times from specialty care have been developed across Canada, little is known about wait times from primary to specialty care. Our objectives were to calculate the wait times from when a referral is made by a family physician (FP) to when a patient sees a specialist physician and examine patient and provider factors related to these wait times. Methods Our study used the Electronic Medical Record Administrative data Linked Database (EMRALD) which is a linkage of FP electronic medical record (EMR) data to the Ontario, Canada administrative data. The EMR referral date was linked to the administrative physician claims date to calculate the wait times. Patient age, sex, socioeconomic status, comorbidity and FP continuity of care and physician age, sex, practice location, practice size and participation in a primary care delivery model were examined with respect to wait times. Results The median waits from medical specialists ranged from 39 to 76 days and for surgical specialists from 33 days to 66 days. With a few exceptions, patient factors were not associated with wait times from primary care to specialty care. Similarly physician factors were not consistently associated with wait times, except for FP practice location and size. Conclusions Actual wait times for a referral from a FP to seeing a specialist physician are longer than those reported by physician surveys. Wait times from primary to specialty care need to be included in the calculation of surgical and diagnostic wait time benchmarks in Canada. PMID:24460619

  16. [A Study on problems associated with a patient's death during home care, based on the duration of home care and patient's age-why terminal home care is difficult for a patient's family].

    PubMed

    Ohara, Hiroo; Okabe, Hiromi; Tsuchiya, Kumiko; Kikuchi, Kana

    2012-12-01

    When a patient receives home care, an important factor is how the family accepts the patient's death. In this study, we observed that the number of long-term in-home terminal care cases increased, as well as the number of short-term in-home care cases. Moreover, the number of cancer cases among the young population is also increasing. Consequently, how to acceptance of a patient's death varies among their family. When tending to patients, suitable support from the medical staff is required. Additionally, various options need to be provided for terminal care. PMID:23268913

  17. Brief intervention for anxiety in primary care patients

    PubMed Central

    Roy-Byrne, Peter; Veitengruber, Jason P.; Bystritsky, Alexander; Edlund, Mark J.; Sullivan, Greer; Craske, Michelle G.; Welch, Stacy Shaw; Stein, Murray B.

    2010-01-01

    In order to address the difficulty of assessing and managing multiple anxiety disorders in the primary care setting, this paper provides a simple, easy to learn, unified approach to the diagnosis, care management and pharmacotherapy of the four most common anxiety disorders (panic, generalized, and social anxiety disorders, and PTSD) in primary care. This evidence-based approach was developed for an ongoing NIMH-funded study designed to improve the delivery of evidence-based medication and psychotherapy treatment to primary care patients with these anxiety disorders. The paper presents a simple, validated method to screen for the four major disorders, which emphasizes identifying other medical or psychiatric comorbidities which can complicate treatment; an approach for initial education of the patient and discussion about treatment, including provision of some simple CBT skills, based on motivational interviewing/brief intervention approaches previously used for substance use disorders; a validated method for monitoring treatment outcome; an algorithmic approach for selection of initial medication treatment, selection of alternative or adjunctive treatments when the initial approach has not produced optimal results, and indications for mental health referral. PMID:19264941

  18. Architecture of a prehospital emergency patient care report system (PEPRS).

    PubMed

    Majeed, Raphael W; Stöhr, Mark R; Röhrig, Rainer

    2013-01-01

    In recent years, prehospital emergency care adapted to the technology shift towards tablet computers and mobile computing. In particular, electronic patient care report (e-PCR) systems gained considerable attention and adoption in prehospital emergency medicine [1]. On the other hand, hospital information systems are already widely adopted. Yet, there is no universal solution for integrating prehospital emergency reports into electronic medical records of hospital information systems. Previous projects either relied on proprietary viewing workstations or examined and transferred only data for specific diseases (e.g. stroke patients[2]). Using requirements engineering and a three step software engineering approach, this project presents a generic architecture for integrating prehospital emergency care reports into hospital information systems. Aim of this project is to describe a generic architecture which can be used to implement data transfer and integration of pre hospital emergency care reports to hospital information systems. In summary, the prototype was able to integrate data in a standardized manner. The devised methods can be used design generic software for prehospital to hospital data integration. PMID:23920925

  19. Professionalism: good for patients and health care organizations.

    PubMed

    Brennan, Michael D; Monson, Verna

    2014-05-01

    Professionalism is an indispensable element in the compact between the medical profession and society that is based on trust and putting the needs of patients above all other considerations. The resurgence of interest in professionalism dates back to the 1980s when health maintenance organizations were formed and proprietary influences in health care increased. Since then, a rich and comprehensive literature has emerged in defining professionalism, including desirable individual attributes and behaviors and how they may be taught, promoted, and assessed. More recently, scholarship has shifted from individual to organizational professionalism. This literature addresses the role that health care organizations can play to establish environments that are conducive to the consistent expression of professionalism by individuals and health care teams. We reviewed interdisciplinary empirical studies from health care effectiveness and outcomes, organizational sciences, positive psychology, and social psychology, finding evidence that organizational and individual professionalism is associated with a wide range of benefits to patients and the organization. We identify actionable organizational strategies and approaches that, if adopted, can foster and promote combined organizational and individual professionalism. In doing so, trust in the medical profession and its institutions can be enhanced, which in turn will reconfirm a commitment to the social compact. PMID:24797645

  20. Professionalism: good for patients and health care organizations.

    PubMed

    Brennan, Michael D; Monson, Verna

    2014-05-01

    Professionalism is an indispensable element in the compact between the medical profession and society that is based on trust and putting the needs of patients above all other considerations. The resurgence of interest in professionalism dates back to the 1980s when health maintenance organizations were formed and proprietary influences in health care increased. Since then, a rich and comprehensive literature has emerged in defining professionalism, including desirable individual attributes and behaviors and how they may be taught, promoted, and assessed. More recently, scholarship has shifted from individual to organizational professionalism. This literature addresses the role that health care organizations can play to establish environments that are conducive to the consistent expression of professionalism by individuals and health care teams. We reviewed interdisciplinary empirical studies from health care effectiveness and outcomes, organizational sciences, positive psychology, and social psychology, finding evidence that organizational and individual professionalism is associated with a wide range of benefits to patients and the organization. We identify actionable organizational strategies and approaches that, if adopted, can foster and promote combined organizational and individual professionalism. In doing so, trust in the medical profession and its institutions can be enhanced, which in turn will reconfirm a commitment to the social compact.