Science.gov

Sample records for advance patient care

  1. 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.

  2. 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.

  3. [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).

  4. 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.

  5. 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

  6. An overview of advance care planning for patients with advanced chronic kidney disease: The basics.

    PubMed

    Wasylynuk, Betty Ann; Davison, Sara N

    2016-01-01

    As the number of Canadians living with end-stage kidney disease (ESKD) continues to grow, even higher numbers are living with advanced chronic kidney disease (CKD). Many of these people will eventually require renal replacement therapy (RRT), either dialysis or transplantation. More than 50% of patients starting RRT today are aged 65 or older, with the fastest growing group being patients 75 years and older. Despite advances to dialysis technology and dialysis care, the mortality rates remain high and dialysis patients' end-of-life care may not align with their preferences or values. Advance care planning (ACP) is an essential component of quality comprehensive kidney care. Kidney care teams develop strong relationships with their patients and are well positioned to integrate ACP into routine kidney care. This article defines ACP, outlines the essential components of ACP, and discusses the benefits, challenges, and special considerations of ACP. By enhancing the kidney care team's understanding of ACP, this article aims to assist in integrating ACP into routine kidney care for patients with advanced CKD. PMID:27215058

  7. 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

  8. 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.

  9. Advance care directives

    MedlinePlus

    ... advance directive; Do-not-resuscitate - advance directive; Durable power of attorney - advance care directive; POA - advance care directive; Health care agent - advance care directive; Health care proxy - ...

  10. Advance care planning: thinking ahead to achieve our patients' goals.

    PubMed

    Cairns, Rosemary

    2011-09-01

    The End of Life Care Strategy for England describes advance care planning (ACP) as a 'voluntary process of discussion about future care...concerns and wishes...values or personal goals for care, their understanding of their illness and prognosis...wishes for types of care or treatment and the availability of these' (Department of Health (DH), 2008). In Scotland, Living and Dying Well: Building on Progress (Scottish Government (SG), 2011) referred to adopting a 'thinking ahead' philosophy.

  11. Urinary Stone Disease: Advancing Knowledge, Patient Care, and Population Health.

    PubMed

    Scales, Charles D; Tasian, Gregory E; Schwaderer, Andrew L; Goldfarb, David S; Star, Robert A; Kirkali, Ziya

    2016-07-01

    Expanding epidemiologic and physiologic data suggest that urinary stone disease is best conceptualized as a chronic metabolic condition punctuated by symptomatic, preventable stone events. These acute events herald substantial future chronic morbidity, including decreased bone mineral density, cardiovascular disease, and CKD. Urinary stone disease imposes a large and growing public health burden. In the United States, 1 in 11 individuals will experience a urinary stone in their lifetime. Given this high incidence and prevalence, urinary stone disease is one of the most expensive urologic conditions, with health care charges exceeding $10 billion annually. Patient care focuses on management of symptomatic stones rather than prevention; after three decades of innovation, procedural interventions are almost exclusively minimally invasive or noninvasive, and mortality is rare. Despite these advances, the prevalence of stone disease has nearly doubled over the past 15 years, likely secondary to dietary and health trends. The NIDDK recently convened a symposium to assess knowledge and treatment gaps to inform future urinary stone disease research. Reducing the public health burden of urinary stone disease will require key advances in understanding environmental, genetic, and other individual disease determinants; improving secondary prevention; and optimal population health strategies in an increasingly cost-conscious care environment. PMID:26964844

  12. Quality Nursing Care for Hospitalized Patients with Advanced Illness: Concept Development

    PubMed Central

    Izumi, Shigeko; Baggs, Judith G.; Knafl, Kathleen A.

    2011-01-01

    The quality of nursing care as perceived by hospitalized patients with advanced illness has not been examined. A concept of quality nursing care for this population was developed by integrating the literature on constructs defining quality nursing care with empirical findings from interviews of 16 patients with advanced illness. Quality nursing care was characterized as competence and personal caring supported by professionalism and delivered with an appropriate demeanor. Although the attributes of competence, caring, professionalism, and demeanor were identified as common components of quality care across various patient populations, the caring domain increased in importance when patients with advanced illness perceived themselves as vulnerable. Assessment of quality nursing care for patients with advanced illness needs to include measures of patient perceptions of vulnerability. PMID:20572095

  13. 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

  14. 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

  15. Advance care planning.

    PubMed

    Lo, Bernard

    2004-01-01

    Advance directives allow patients to have some control over decisions even when they are no longer able to make decisions themselves. All states authorize written advance directives, such as the appointment of a health care proxy, but commonly impose procedural requirements. Some states have restricted the use of oral advance directives, although they are frequently used in everyday practice. Advance directives are limited because they are infrequently used, may not be informed, and may conflict with the patient's current best interests. Moreover, surrogates often cannot state patients' preferences accurately. Furthermore, discussions among physicians and patients about advance directives are flawed. Physicians can improve discussions about advance directives by asking the patient who should serve as proxy and by ascertaining the patient's values and general preferences before discussing specific clinical situations. PMID:15538068

  16. Perceptions of palliative care among patients with advanced cancer and their caregivers

    PubMed Central

    Zimmermann, Camilla; Swami, Nadia; Krzyzanowska, Monika; Leighl, Natasha; Rydall, Anne; Rodin, Gary; Tannock, Ian; Hannon, Breffni

    2016-01-01

    Background: Early palliative care is increasingly recommended but seldom practised. We sought to examine perceptions of palliative care among patients with advanced cancer and their caregivers. Methods: After conducting a cluster randomized controlled trial of early palliative care versus standard care for patients with advanced cancer, we approached patients and their caregivers to participate in semistructured interviews seeking to assess, qualitatively, their attitudes and perceptions about palliative care. We used the grounded theory method for data collection and analysis. Results: A total of 48 patients (26 intervention, 22 control) and 23 caregivers (14 intervention, 9 control) completed interviews. Participants’ initial perceptions of palliative care in both trial arms were of death, hopelessness, dependency and end-of-life comfort care for inpatients. These perceptions provoked fear and avoidance, and often originated from interactions with health care professionals. During the trial, those in the intervention arm developed a broader concept of palliative care as “ongoing care” that improved their “quality of living” but still felt that the term itself carried a stigma. Participants in the intervention group emphasized the need for palliative care to be reframed and better explained by health care professionals. Participants in the control group generally considered it pointless to rename palliative care, but many in the intervention group stated emphatically that a different name was necessary in the early outpatient setting. Interpretation: There is a strong stigma attached to palliative care, which may persist even after positive experiences with an early palliative care intervention. Education of the public, patients and health care providers is paramount if early integration of palliative care is to be successful. PMID:27091801

  17. Association of Early Patient-Physician Care Planning Discussions and End-of-Life Care Intensity in Advanced Cancer

    PubMed Central

    Tisnado, Diana M.; Walling, Anne M.; Dy, Sydney M.; Asch, Steven M.; Ettner, Susan L.; Kim, Benjamin; Pantoja, Philip; Schreibeis-Baum, Hannah C.; Lorenz, Karl A.

    2015-01-01

    Abstract Background: Early patient-physician care planning discussions may influence the intensity of end-of-life (EOL) care received by veterans with advanced cancer. Objective: The study objective was to evaluate the association between medical record documentation of patient-physician care planning discussions and intensity of EOL care among veterans with advanced cancer. Methods: This was a retrospective cohort study. Subjects were 665 veteran decedents diagnosed with stage IV colorectal, lung, or pancreatic cancer in 2008, and followed till death or the end of the study period in 2011. We estimated the effect of patient-physician care planning discussions documented within one month of metastatic diagnosis on the intensity of EOL care measured by receipt of acute care, intensive interventions, chemotherapy, and hospice care, using multivariate logistic regression models. Results: Veterans in our study were predominantly male (97.1%), white (74.7%), with an average age at diagnosis of 66.4 years. Approximately 31% received some acute care, 9.3% received some intensive intervention, and 6.5% had a new chemotherapy regimen initiated in the last month of life. Approximately 41% of decedents received no hospice or were admitted within three days of death. Almost half (46.8%) had documentation of a care planning discussion within the first month after diagnosis and those who did were significantly less likely to receive acute care at EOL (OR: 0.67; p=0.025). Documented discussions were not significantly associated with intensive interventions, chemotherapy, or hospice care. Conclusion: Early care planning discussions are associated with lower rates of acute care use at the EOL in a system with already low rates of intensive EOL care. PMID:26186553

  18. Home Palliative Care for Patients with Advanced Chronic Kidney Disease: Preliminary Results

    PubMed Central

    Teruel, José L.; Rexach, Lourdes; Burguera, Victor; Gomis, Antonio; Fernandez-Lucas, Milagros; Rivera, Maite; Diaz, Alicia; Collazo, Sergio; Liaño, Fernando

    2015-01-01

    Healthcare for patients with advanced chronic kidney disease (ACKD) on conservative treatment very often poses healthcare problems that are difficult to solve. At the end of 2011, we began a program based on the care and monitoring of these patients by Primary Care Teams. ACKD patients who opted for conservative treatment were offered the chance to be cared for mainly at home by the Primary Care doctor and nurse, under the coordination of the Palliative Care Unit and the Nephrology Department. During 2012, 2013, and 2014, 76 patients received treatment in this program (mean age: 81 years; mean Charlson age-comorbidity index: 10, and mean glomerular filtration rate: 12.4 mL/min/1.73 m2). The median patient follow-up time (until death or until 31 December 2014) was 165 days. During this period, 51% of patients did not have to visit the hospital’s emergency department and 58% did not require hospitalization. Forty-eight of the 76 patients died after a median time of 135 days in the program; 24 (50%) died at home. Our experience indicates that with the support of the Palliative Care Unit and the Nephrology Department, ACKD patients who are not dialysis candidates may be monitored at home by Primary Care Teams. PMID:27417813

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

    PubMed Central

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

    2012-01-01

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

  20. Advance Care Planning

    Cancer.gov

    The thirteenth module of the EPEC-O (Education in Palliative and End-of-Life Care for Oncology) Self-Study: Cultural Considerations When Caring for African Americans explores the attitudes and practices of African Americans related to completion of advance directives, and recommends effective strategies to improve decision-making in the setting of serious, life-threatening illness, in ways that augment patient autonomy and support patient-centered goal-setting and decision-making among African American patients and their families.

  1. The Experiences of Advanced Practice Nurses Caring for Patients with Substance Use Disorder and Chronic Pain.

    PubMed

    St Marie, Barbara

    2016-10-01

    Management of chronic pain is a challenge shared by healthcare providers in various clinical settings. The epidemic of opioid misuse has escalated this challenge. A gap exists in understanding barriers and facilitators to practices of advanced practice registered nurses (APRNs) caring for patients with chronic pain and substance use disorder (SUD). The purpose of this study was to examine the APRNs' experiences while caring for patients with coexisting SUD and chronic pain to help envision better ways to manage pain and direct educational initiatives. Qualitative narrative method. Telephone interviews. Twenty APRNs caring for patients with coexisting SUD and chronic pain were recruited nationwide through the American Society for Pain Management Nursing list serve. Semistructured interviews with thematic analysis. Participants identified 1) a shift of patients from other healthcare providers into the APRNs' practices; 2) barriers to accessing nonmedical modalities for managing pain, including insurance coverage, geographic location, and the patient's desire for only medication management; 3) the role of the APRN in caring for this population contained subthemes of educating and guiding patients through a process of change, applying risk strategies to keep patients safe, and educating colleagues on implementing risk management strategies while prescribing opioids. The APRNs identified barriers to providing care for patients with coexisting SUD and chronic pain. They also described the role of APRNs in providing focused education regarding risk management strategies for assessment, prescribing opioids to manage pain, and minimizing risk. PMID:27567096

  2. End-of-life care in patients with advanced lung cancer.

    PubMed

    Lim, Richard B L

    2016-10-01

    Despite advances in the detection, pathological diagnosis and therapeutics of lung cancer, many patients still develop advanced, incurable and progressively fatal disease. As physicians, the duties to cure sometimes, relieve often and comfort always should be a constant reminder to us of the needs that must be met when caring for a patient with lung cancer. Four key areas of end-of-life care in advanced lung cancer begin with first recognizing 'when a patient is approaching the end of life'. The clinician should be able to recognize when the focus of care needs to shift from an aggressive life-sustaining approach to an approach that helps prepare and support a patient and family members through a period of progressive, inevitable decline. Once the needs are recognized, the second key area is appropriate communication, where the clinician should assist patients and family members in understanding where they are in the disease trajectory and what to expect. This involves developing rapport, breaking bad news, managing expectations and navigating care plans. Subsequently, the third key area is symptom management that focuses on the goals to first and foremost provide comfort and dignity. Symptoms that are common towards the end of life in lung cancer include pain, dyspnoea, delirium and respiratory secretions. Such symptoms need to be anticipated and addressed promptly with appropriate medications and explanations to the patient and family. Lastly, in order for physicians to provide quality end-of-life care, it is necessary to understand the ethical principles applied to end-of-life-care interventions. Misconceptions about euthanasia versus withholding or withdrawing life-sustaining treatments may lead to physician distress and inappropriate decision making. PMID:27585597

  3. Developing a Patient Care Co-ordination Centre in Trafford, England: lessons from the International Foundation for Integrated Care (IFIC)/Advancing Quality Alliance integrated care fellowship experience.

    PubMed

    Gregory, Michael

    2015-01-01

    The NHS and Social Care in England are facing one of the biggest financial challenges for a generation. Commissioners and providers need to work on collaborative schemes to manage the increasing demand on health and social care within a period of financial constraint. Different forms of care co-ordination have been developed at different levels across the world. In the north-west of England, the Trafford health and social care economy have been working through a competitive dialogue process with industry to develop an innovative and dynamic solution to deliver seamless co-ordination for all patients and service users. The strategy is to develop a new Patient Care Co-ordination Centre, which will be responsible for the delivery of co-ordinated, quality care. The Patient Care Co-ordination Centre will work at clinical, service, functional and community levels across multiple providers covering risk stratification, preventative, elective and unscheduled care. I am the clinical lead for the Patient Care Co-ordination Centre and during my year as an Advancing Quality Alliance Integrated Care Fellow, I have had the opportunity to study examples of care coordination from UK and international sites. The learning from these visits has been assimilated into the design process of the Patient Care Co-ordination Centre.

  4. Current advances in targeted therapies for metastatic gastric cancer: improving patient care.

    PubMed

    Aguiar, Pedro Nazareth; Muniz, Thiago Pimentel; Miranda, Raelson Rodrigues; Tadokoro, Hakaru; Forones, Nora Manoukian; Monteiro, Ines-de-Paula; Castelo-Branco, Pedro; Janjigian, Yelena Y; Mello, Ramon Andrade de

    2016-03-01

    In this article, we review the literature on the current advances in targeted therapies for metastatic gastric cancer aimed at improving patient care. We conclude that the key to guiding targeted therapy is individual biomarkers, which are not completely elucidated. HER2 overexpression is the only predictive biomarker currently in use. Furthermore, it is necessary to understand that gastric tumors are heterogeneous; therefore, is impossible to evaluate a novel biological compound without evaluating personal biomarkers. The selection of patients who are able to receive each treatment is paramount for improving advanced gastric cancer survival and reducing unnecessary costs.

  5. The patient perspective: arthritis care provided by Advanced Clinician Practitioner in Arthritis Care program-trained clinicians

    PubMed Central

    Warmington, Kelly; Kennedy, Carol A; Lundon, Katie; Soever, Leslie J; Brooks, Sydney C; Passalent, Laura A; Shupak, Rachel; Schneider, Rayfel

    2015-01-01

    Objective To assess patient satisfaction with the arthritis care services provided by graduates of the Advanced Clinician Practitioner in Arthritis Care (ACPAC) program. Materials and methods This was a cross-sectional evaluation using a self-report questionnaire for data collection. Participants completed the Patient–Doctor Interaction Scale, modified to capture patient–practitioner interactions. Participants completed selected items from the Group Health Association of America’s Consumer Satisfaction Survey, and items capturing quality of care, appropriateness of wait times, and a comparison of extended-role practitioner (ERP) services with previously received arthritis care. Results A total of 325 patients seen by 27 ERPs from 15 institutions completed the questionnaire. Respondents were primarily adults (85%), female (72%), and living in urban areas (79%). The mean age of participants was 54 years (range 3–92 years), and 51% were not working. Patients with inflammatory (51%) and noninflammatory conditions (31%) were represented. Mean (standard deviation) Patient–Practitioner Interaction Scale subscale scores ranged from 4.50 (0.60) to 4.63 (0.48) (1 to 5 [greater satisfaction]). Overall satisfaction with the quality of care was high (4.39 [0.77]), as was satisfaction with wait times (referral to appointment, 4.27 [0.86]; in clinic, 4.24 [0.91]). Ninety-eight percent of respondents felt the arthritis care they received was comparable to or better than that previously received from other health care professionals. Conclusion Patients were very satisfied with and amenable to arthritis care provided by graduates of the ACPAC program. Our findings provide early support for the deployment and integration of ACPAC ERPs into the Ontario health care system and should inform future evaluation at the patient level. PMID:27790044

  6. Trends in the Aggressiveness of End-of-Life Care for Advanced Stomach Cancer Patients

    PubMed Central

    Hong, Ji Hyung; Rho, Sang-Young

    2013-01-01

    Purpose It is important to balance the appropriateness of active cancer treatments and end-of-life care to improve the quality of life for terminally ill cancer patients. This study describes the treatment patterns and end-of-life care in terminal gastric cancer patients. Materials and Methods We retrospectively analyzed the records of 137 patients with advanced gastric cancer receiving chemotherapy and dying between June 1, 2006 and May 31, 2011. We recorded interval between last chemotherapy dose and death; frequency of emergency room visits or admission to the intensive care unit in the last month before death; rate of hospice referral and agreement with written do-not-resuscitate orders; and change in laboratory values in the last three months before death. Results During the last six months of life, 130 patients (94.9%) received palliative chemotherapy; 86 (62.7%) during the final two months; 41 (29.9%) during the final month. During the final month, 53 patients (38.7%) visited an emergency room more than once; 21 (15.3%) were admitted to the intensive care unit. Hospice referral occurred in 54% (74 patients) of the patients; 93.4% (128 patients) gave written do-not-resuscitate orders. Platelets, aspartate aminotransferase and creatinine changed significantly two weeks before death; total bilirubin, one month before; and C-reactive protein, between four and two weeks before death. Conclusion Our results demonstrated that a significant proportion of gastric cancer patients received palliative chemotherapy to the end of life and the patients who stopped the chemotherapy at least one month before death had a lower rate of intensive care unit admission and longer overall survival than those who sustained aggressive chemotherapy until the last months of their lives. PMID:24453999

  7. Quality of life and palliative care needs of elderly patients with advanced heart failure

    PubMed Central

    Chan, Helen YL; Yu, Doris SF; Leung, Doris YP; Chan, Aileen WK; Hui, Elsie

    2016-01-01

    Objective To examine the quality of life and palliative care needs of elderly patients with advanced heart failure (HF). Methods This was a correlation descriptive study conducted at a 650-bed sub-acute hospital. Patients who were aged 65 or over, diagnosed with HF of New York Heart Association Class III or IV symptoms, and mentally sound were eligible to the study. The Edmonton Symptom Assessment Scale, the overall quality of life single item scale, and the McQill Quality of Life Questionnaire (MQoL), were used for measurement. Multiple regression analysis was performed to determine factors for predicting quality of life. Results A convenience sample of 112 patients was recruited. Their age was 81.5 ± 8.5 years. The three most distressing symptoms reported by the patients were tiredness (5.96 ± 2.78), drowsiness (5.47 ± 2.93), and shortness of breath (5.34 ± 2.96). Their mean overall quality of life single item scale score was 4.72 ± 2.06 out of 10. The mean MQoL physical subscale score was the lowest (4.20 ± 1.767), whereas their mean psychological subscale was the highest (7.14 ± 2.39). However, in a multivariate analysis model, quality of life was significantly associated with existential wellbeing, physical wellbeing, psychological wellbeing and educational level. Conclusions The findings highlight that spiritual concerns are significant palliative care needs among elderly patients with advanced HF, in addition to symptom management. This is in line with the argument that palliative care that places great emphasis on holistic care should be integrated to the care of this group of patients. PMID:27594869

  8. 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

  9. 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).

  10. Advance care planning in nursing homes: pre- and post-Patient Self-Determination Act.

    PubMed Central

    Castle, N G; Mor, V

    1998-01-01

    OBJECTIVES: (1) To identify resident and organizational factors associated with the use of advance care plans pre- and post-implementation of the Patient Self-Determination Act (PSDA), and (2) to identify changes (pre- and post-implementation of the PSDA) in the relationship between these factors and the use of advance care plans. DESIGN: Complex, multistage cluster sampling. SETTING: Ten states were selected for variation in geographic location, Medicaid reimbursement rate, and average staffing patterns. Participants were 4,215 nursing home residents in 268 facilities. PRINCIPAL FINDINGS: Seventeen resident and organizational factors were associated with the use of do-not-resuscitate (DNR) orders in 1990, and 12 resident and organizational factors were associated with their use in 1993. Five factors showed a significant change from 1990 to 1993: activities of daily living (ADL) scores, race, cognitive performance scale (CPS) scores, full-time equivalent (FTE) nurse aides per resident, and bed size. Ten resident and organizational factors were associated with use of do-not-hospitalize (DNH) orders in 1990 and six resident and organizational factors were associated with DNH orders in 1993. Four factors showed a significant change from 1990 to 1993: legal guardian, FTE LPNs per resident, Medicaid census, and forprofit ownership. Five resident and organizational factors were associated with the use of living wills in 1990 and seven resident and organizational factors were associated with the use of living wills in 1993. Four factors showed a significant change from 1990 to 1993: ADL scores, race, length of stay, and for-profit ownership. CONCLUSION: The results indicate that the PSDA may have been successful in increasing the use of advance care plans and in changing the types of residents who use advance care plans. However, they also show that the use of advance care plans is associated with organizational characteristics, indicating that some types of facilities

  11. The Importance of Supportive Care in Optimizing Treatment Outcomes of Patients with Advanced Prostate Cancer

    PubMed Central

    2012-01-01

    Optimal oncologic care of older men with prostate cancer, including effective prevention and management of the disease and treatment side effects (so-called best supportive care measures) can prolong survival, improve quality of life, and reduce depressive symptoms. In addition, the proportion of treatment discontinuations can be reduced through early reporting and management of side effects. Pharmacologic care may be offered to manage the side effects of androgen-deprivation therapy and chemotherapy, which may include hot flashes, febrile neutropenia, fatigue, and diarrhea. Nonpharmacologic care (e.g., physical exercise, acupuncture, relaxation) has also been shown to benefit patients. At the Georges Pompidou European Hospital, the Program of Optimization of Chemotherapy Administration has demonstrated that improved outpatient follow-up by supportive care measures can reduce the occurrence of chemotherapy-related side effects, reduce cancellations and modifications of treatment, reduce chemotherapy wastage, and reduce the length of stay in the outpatient unit. The importance of supportive care measures to optimize management and outcomes of older men with advanced prostate cancer should not be overlooked. PMID:23015682

  12. Consensus statement on advancing research in emergency department operations and its impact on patient care.

    PubMed

    Yiadom, Maame Yaa A B; Ward, Michael J; Chang, Anna Marie; Pines, Jesse M; Jouriles, Nick; Yealy, Donald M

    2015-06-01

    The consensus conference on "Advancing Research in Emergency Department (ED) Operations and Its Impact on Patient Care," hosted by The ED Operations Study Group (EDOSG), convened to craft a framework for future investigations in this important but understudied area. The EDOSG is a research consortium dedicated to promoting evidence-based clinical practice in emergency medicine. The consensus process format was a modified version of the NIH Model for Consensus Conference Development. Recommendations provide an action plan for how to improve ED operations study design, create a facilitating research environment, identify data measures of value for process and outcomes research, and disseminate new knowledge in this area. Specifically, we call for eight key initiatives: 1) the development of universal measures for ED patient care processes; 2) attention to patient outcomes, in addition to process efficiency and best practice compliance; 3) the promotion of multisite clinical operations studies to create more generalizable knowledge; 4) encouraging the use of mixed methods to understand the social community and human behavior factors that influence ED operations; 5) the creation of robust ED operations research registries to drive stronger evidence-based research; 6) prioritizing key clinical questions with the input of patients, clinicians, medical leadership, emergency medicine organizations, payers, and other government stakeholders; 7) more consistently defining the functional components of the ED care system, including observation units, fast tracks, waiting rooms, laboratories, and radiology subunits; and 8) maximizing multidisciplinary knowledge dissemination via emergency medicine, public health, general medicine, operations research, and nontraditional publications.

  13. Consensus statement on advancing research in emergency department operations and its impact on patient care.

    PubMed

    Yiadom, Maame Yaa A B; Ward, Michael J; Chang, Anna Marie; Pines, Jesse M; Jouriles, Nick; Yealy, Donald M

    2015-06-01

    The consensus conference on "Advancing Research in Emergency Department (ED) Operations and Its Impact on Patient Care," hosted by The ED Operations Study Group (EDOSG), convened to craft a framework for future investigations in this important but understudied area. The EDOSG is a research consortium dedicated to promoting evidence-based clinical practice in emergency medicine. The consensus process format was a modified version of the NIH Model for Consensus Conference Development. Recommendations provide an action plan for how to improve ED operations study design, create a facilitating research environment, identify data measures of value for process and outcomes research, and disseminate new knowledge in this area. Specifically, we call for eight key initiatives: 1) the development of universal measures for ED patient care processes; 2) attention to patient outcomes, in addition to process efficiency and best practice compliance; 3) the promotion of multisite clinical operations studies to create more generalizable knowledge; 4) encouraging the use of mixed methods to understand the social community and human behavior factors that influence ED operations; 5) the creation of robust ED operations research registries to drive stronger evidence-based research; 6) prioritizing key clinical questions with the input of patients, clinicians, medical leadership, emergency medicine organizations, payers, and other government stakeholders; 7) more consistently defining the functional components of the ED care system, including observation units, fast tracks, waiting rooms, laboratories, and radiology subunits; and 8) maximizing multidisciplinary knowledge dissemination via emergency medicine, public health, general medicine, operations research, and nontraditional publications. PMID:26014365

  14. The Project ENABLE II Randomized Controlled Trial to Improve Palliative Care for Patients with Advanced Cancer

    PubMed Central

    Bakitas, Marie; Lyons, Kathleen Doyle; Hegel, Mark T.; Balan, Stefan; Brokaw, Frances C.; Seville, Janette; Hull, Jay G.; Li, Zhongze; Tosteson, Tor; Byock, Ira R.; Ahles, Tim A.

    2013-01-01

    Context There are few randomized controlled trials of the effectiveness of palliative care. Objective To determine the effect of a palliative care intervention on quality of life (QOL), symptom intensity, mood, and resource utilization. Design, Setting, and Participants Randomized controlled trial (November 2003-May 2008) of 322 patients with advanced cancer and an identified caregiver in a rural, NCI-designated comprehensive cancer center (the Norris Cotton Cancer Center, Lebanon, NH) and affiliated outreach clinics and Veteran’s Affairs Medical Center (White River Junction, VT). Intervention A multi-component, psycho-educational, palliative care intervention (Project ENABLE) conducted by an advanced practice nurse consisting of 4 weekly educational sessions and monthly follow-up until death or study completion. Main Outcome Measures (1) The Functional Assessment of Chronic Illness Therapy-Palliative (range: 0 to 184; higher scores indicate better QOL), (2) Edmonton Symptom Assessment Scale (range: 0 to 900; higher scores indicate greater symptom intensity), (3) Center for Epidemiological Studies-Depression (range: 0 to 60; higher scores indicate more depressive symptoms), completed at baseline, 1 month and every 3 months until death or study completion, (4) days in hospital, intensive care unit (ICU), and emergency department visits recorded in the medical record. Results 322 participants with gastrointestinal (41%), lung (36%), genitourinary (12%), and breast (10%) cancer were randomized. Estimated treatment effects (intervention minus usual care) for all subjects were 4.6 (P = .02) for QOL, −27.8 (P = .06) for symptom intensity, and −1.8 (P = .02) for depressed mood. Estimated average treatment effects in the sample of participants who died during the study were 8.6 (P = .02) for QOL, −24.2 (P = .24) for symptom intensity, and −2.7 (P = .03) for depressed mood. Days in hospital, intensive care unit, and emergency department visits were not different

  15. Evaluation of Spiritual Needs of Patients with Advanced Cancer in a Palliative Care Unit

    PubMed Central

    Valls, Joan; Porta, Josep; Viñas, Juan

    2014-01-01

    Abstract Introduction: Spiritual needs play an important role in palliative care as both a clinical dimension and a therapeutic strategy. However, recent studies have shown that the management of this dimension still remains a challenge at the clinical level of palliative care. Goals: Our goal was to evaluate the spiritual needs of patients diagnosed with advanced and terminal cancer by the palliative care unit of a hospital in Barcelona, Spain. Methods: An observational study was conducted that involved 50 patients who were recruited between May 2007 and January 2008. A questionnaire was used which included 28 items selected from a review of the literature; the responses were analyzed using a five-point Lickert scale. The results were grouped in 11 categories corresponding to different spiritual needs. Results: Two spiritual needs emerged as the most relevant for the patients: their need to be recognized as a person until the end of their life and their need to know the truth about their illness. The least important spiritual needs were identified as those: for continuity and an afterlife; to get rid of obsessions; to achieve freedom from blame and to be able to forgive others; and the need for reconciliation and to feel forgiven by others. Conclusions: When patients knew the truth about their illnesses and they were treated with dignity, their most important needs were likely to be covered. These results suggest that patients receiving palliative care wish to live for the present with as much normality as possible and show only minor concern for their past and future. PMID:24745870

  16. Advance Care Planning: A Qualitative Study of Dialysis Patients and Families

    PubMed Central

    Eneanya, Nwamaka D.; Feinberg, Rebecca; Germain, Michael J.; Marr, Lisa; Berzoff, Joan; Cohen, Lewis M.; Unruh, Mark

    2015-01-01

    Background and objectives More than 90,000 patients with ESRD die annually in the United States, yet advance care planning (ACP) is underutilized. Understanding patients’ and families’ diverse needs can strengthen systematic efforts to improve ACP. Design, setting, participants, & measurements In-depth interviews were conducted with a purposive sample of patients and family/friends from dialysis units at two study sites. Applying grounded theory, interviews were audiotaped, professionally transcribed, and analyzed in an iterative process. Emergent themes were identified, discussed, and organized into major themes and subthemes. Results Thirteen patients and nine family/friends participated in interviews. The mean patient age was 63 years (SD 14) and five patients were women. Participants identified as black (n=1), Hispanic (n=4), Native American (n=4), Pacific Islander (n=1), white (n=11), and mixed (n=1). Three major themes with associated subthemes were identified. The first theme, “Prior experiences with ACP,” revealed that these discussions rarely occur, yet most patients desire them. A potential role for the primary care physician was broached. The second theme, “Factors that may affect perspectives on ACP,” included a desire for more of a connection with the nephrologist, positive and negative experiences with the dialysis team, disenfranchisement, life experiences, personality traits, patient-family/friend relationships, and power differentials. The third theme, “Recommendations for discussing ACP,” included thoughts on who should lead discussions, where and when discussions should take place, what should be discussed and how. Conclusions Many participants desired better communication with their nephrologist and/or their dialysis team. A number expressed feelings of disenfranchisement that could negatively impact ACP discussions through diminished trust. Life experiences, personality traits, and relationships with family and friends may

  17. Determinants of Quality Care and Mortality for Patients With Locally Advanced Cervical Cancer in Virginia

    PubMed Central

    Showalter, Timothy N.; Camacho, Fabian; Cantrell, Leigh A.; Anderson, Roger T.

    2016-01-01

    Abstract Outcomes for patients with locally advanced cervical cancer are influenced by receipt of all indicated components of quality care: early diagnosis and receipt of external beam radiation therapy, chemotherapy, and brachytherapy. We performed an observational cohort study to evaluate receipt of quality cancer care and mortality after cancer diagnosis among patients with locally advanced cervical cancer in Virginia. We queried the Virginia state cancer registry to identify patients with International Federation of Gynecology and Obstetrics Stage IB-IVA cervical cancer who were diagnosed during 2002 to 2012. We evaluated the influence of tumor-related, demographic, and geospatial factors on the receipt of indicated therapies and mortality. Treatment quality score of 0 to 3 was defined based upon the extent of receipt of the components of indicated therapy. A total of 1048 patients were identified; 33.1% received all 3 components of treatment and only 54.0% received brachytherapy. Predictors of higher quality score included younger age group versus 66+ years at diagnosis (18–42 odds ratio [OR] = 12.3, 95% confidence interval: 6.6, 23.0; 42–53 OR = 5.6, CI: 3.3, 9.5; 53–66 OR = 5.5, CI: 3.3, 9.1), lower tumor stages versus IVA (IB2 OR = 3.3, CI: 1.8, 6.2; II OR = 2.7, CI: 1.6, 4.5; IIIx OR = 2.1, CI: 1.3, 3.6), and treatment at a high-volume facility (OR 2.2, CI: 1.2, 4.2). Predictors of increased mortality included earlier year of diagnosis, higher tumor stage, treatment at a lower volume facility, and lower treatment quality score. In a cohort of locally advanced cervical cancer patients in Virginia, we identified a low rate of receipt of complete quality care for cervical cancer and a strong effect of facility volume on quality treatment and survival. Further research is needed to develop strategies to improve access to quality treatment and outcomes for cervical cancer. PMID:26937934

  18. Self-perceived competence among medical residents in skills needed to care for patients with advanced dementia versus metastatic cancer.

    PubMed

    Manu, Erika; Marks, Adam; Berkman, Cathy S; Mullan, Patricia; Montagnini, Marcos; Vitale, Caroline A

    2012-06-01

    To examine medical residents' perceived competence in caring for patients with dementia we conducted an online survey of all 120 second, third and fourth-year residents in Internal Medicine, Medicine/Pediatrics, and Family Medicine at University of Michigan. A structured survey elicited residents' training, experience, confidence, and perceived career needs for skills in estimating prognosis, symptom management, and communication in caring for patients with dementia, compared to patients with metastatic cancer. Among the 61 (51 %) respondents, a majority report lower confidence in assessing prognosis and eliciting treatment wishes in patients with dementia (vs. metastatic cancer), and in performing skills integral to the care of patients with dementia, including the ability to assess caregiver needs, decisional capacity, advise on place of care, and manage agitation, despite viewing these skills as important to their future careers. These findings support the need for enhanced education on optimal care of patients with advanced dementia.

  19. Self-perceived competence among medical residents in skills needed to care for patients with advanced dementia versus metastatic cancer.

    PubMed

    Manu, Erika; Marks, Adam; Berkman, Cathy S; Mullan, Patricia; Montagnini, Marcos; Vitale, Caroline A

    2012-06-01

    To examine medical residents' perceived competence in caring for patients with dementia we conducted an online survey of all 120 second, third and fourth-year residents in Internal Medicine, Medicine/Pediatrics, and Family Medicine at University of Michigan. A structured survey elicited residents' training, experience, confidence, and perceived career needs for skills in estimating prognosis, symptom management, and communication in caring for patients with dementia, compared to patients with metastatic cancer. Among the 61 (51 %) respondents, a majority report lower confidence in assessing prognosis and eliciting treatment wishes in patients with dementia (vs. metastatic cancer), and in performing skills integral to the care of patients with dementia, including the ability to assess caregiver needs, decisional capacity, advise on place of care, and manage agitation, despite viewing these skills as important to their future careers. These findings support the need for enhanced education on optimal care of patients with advanced dementia. PMID:22477667

  20. Consensus Statement on Advancing Research in Emergency Department Operations and Its Impact on Patient Care

    PubMed Central

    Ward, Michael J.; Chang, Anna Marie; Pines, Jesse M.; Jouriles, Nick; Yealy, Donald M.

    2016-01-01

    The Consensus Conference on “Advancing Research in Emergency Department (ED) Operations and Its Impact on Patient Care,” hosted by The ED Operations Study Group (EDOSG), convened to craft a framework for future investigations in this important but underserved area. The EDOSG is a research consortium dedicated to promoting evidence based clinical practice in Emergency Medicine. The consensus process format was a modified version of the NIH Model for Consensus Conference Development. Recommendations provide an action plan for how to improve ED operations study design, create a facilitating research environment, identify data measures of value for process and outcomes research, and disseminate new knowledge in this area. Specifically, we called for eight key initiatives: 1) the development of universal measures for ED patient care processes; 2) attention to patient outcomes, in addition to process efficiency and best practice compliance; 3) the promotion of multi-site clinical operations studies to create more generalizable knowledge; 4) encouraging the use of mixed methods to understand the social community and human behavior factors that influence ED operations; 5) the creation of robust ED operations research registries to drive stronger evidence based research, 6) prioritizing key clinical questions with the input of patients, clinicians, medical leadership, emergency medicine organizations, payers, and other government stakeholders; 7) more consistently defining the functional components of the ED care system including observation units, fast tracks, waiting rooms, laboratories and radiology sub-units; and 8) maximizing multidisciplinary knowledge dissemination via emergency medicine, public health, general medicine, operations research and nontraditional publications. PMID:26014365

  1. Critical care research on patients with advance directives or do-not-resuscitate status: ethical challenges for clinician-investigators.

    PubMed

    Williams, Michael A; Haywood, Carlton

    2003-03-01

    Clinician-investigators face challenges in conducting research on critically ill patients when they have do-not-resuscitate orders, advance directives, or are in need of end-of-life care. Potential conflicts of interest for clinician-investigators include either financial stakes or academic and reputational stakes. The dual roles for intensive care unit physician or nurse clinician-investigators as healthcare professionals and scientists also present conflicts of interest, as does the dual purpose for the physical plant of the intensive care unit, which simultaneously serves as a site for patient care and a site for clinical research. Intensive care unit patients who become human research subjects also have dual roles that present conflict or confusion that can result in the therapeutic misconception. There are no scientifically or ethically sound reasons to exclude patients from participation in critical care research based on the presence of an advance directive or do-not-resuscitate order, as it would create a biased study sample that does not reflect the critically ill patient population, and it would treat a large group of potential research subjects differently from others without justification. There are four values in tension for critical care clinician-investigators in relation to patients/human research subjects: curative intent, palliative intent, research, and fiduciary obligations. A patient's decision to participate in research does not relieve clinician-investigators of their obligation to serve patient/human research subject's interests, even when doing so involves decisions to limit or withdraw life-sustaining interventions or withdraw the patient/human research subject from research. Critical care research involving patients with advance directives or do-not-resuscitate status is both possible and desirable because it is just, respects patient autonomy, and results in study populations that better reflect the clinical population in all respects

  2. Communication About Sexuality in Advanced Illness Aligns With a Palliative Care Approach to Patient-Centered Care.

    PubMed

    Leung, Margaret W; Goldfarb, Shari; Dizon, Don S

    2016-02-01

    Treatment-related sexual complications are common in cancer patients although rarely discussed in the palliative care setting. Sexuality is an important survivorship issue and remains relevant even in the terminal setting. There are multiple barriers in dialoguing about intimacy and sexual functioning from the patient and provider perspectives. Palliative care providers, while not expected to be sexual health experts, can provide comprehensive patient-centered care by including sexual health as part of their evaluation. They can explore how sexual dysfunction can impair functioning and utilize an interdisciplinary approach to manage symptoms. Palliative care providers can help patients identify their goals of care and explore what anticipated sexual changes and treat-related side effects are tolerable and intolerable to the patient's quality of life. Principles on addressing sexuality in the palliative setting and practical ways of incorporating sexual history into the palliative care assessment are provided.

  3. Communication About Sexuality in Advanced Illness Aligns With a Palliative Care Approach to Patient-Centered Care.

    PubMed

    Leung, Margaret W; Goldfarb, Shari; Dizon, Don S

    2016-02-01

    Treatment-related sexual complications are common in cancer patients although rarely discussed in the palliative care setting. Sexuality is an important survivorship issue and remains relevant even in the terminal setting. There are multiple barriers in dialoguing about intimacy and sexual functioning from the patient and provider perspectives. Palliative care providers, while not expected to be sexual health experts, can provide comprehensive patient-centered care by including sexual health as part of their evaluation. They can explore how sexual dysfunction can impair functioning and utilize an interdisciplinary approach to manage symptoms. Palliative care providers can help patients identify their goals of care and explore what anticipated sexual changes and treat-related side effects are tolerable and intolerable to the patient's quality of life. Principles on addressing sexuality in the palliative setting and practical ways of incorporating sexual history into the palliative care assessment are provided. PMID:26769116

  4. Advance Directives and Communication Skills of Prehospital Physicians Involved in the Care of Cardiovascular Patients.

    PubMed

    Gigon, Fabienne; Merlani, Paolo; Ricou, Bara

    2015-12-01

    Advance directives (AD) were developed to respect patient autonomy. However, very few patients have AD, even in cases when major cardiovascular surgery is to follow. To understand the reasons behind the low prevalence of AD and to help decision making when patients are incompetent, it is necessary to focus on the impact of prehospital practitioners, who may contribute to an increase in AD by discussing them with patients. The purpose of this study was to investigate self-rated communication skills and the attitudes of physicians potentially involved in the care of cardiovascular patients toward AD.Self-administered questionnaires were sent to general practitioners, cardiologists, internists, and intensivists, including the Quality of Communication Score, divided into a General Communication score (QOCgen 6 items) and an End-of-life Communication score (QOCeol 7 items), as well as questions regarding opinions and practices in terms of AD.One hundred sixty-four responses were received. QOCgen (mean (±SD)): 9.0/10 (1.0); QOCeol: 7.2/10 (1.7). General practitioners most frequently start discussions about AD (74/149 [47%]) and are more prone to designate their own specialty (30/49 [61%], P < 0.0001). Overall, only 57/159 (36%) physicians designated their own specialty; 130/158 (82%) physicians ask potential cardiovascular patients if they have AD and 61/118 (52%) physicians who care for cardiovascular patients talk about AD with some of them.The characteristics of physicians who do not talk about AD with patients were those who did not personally have AD and those who work in private practices.One hundred thirty-three (83%) physicians rated the systematic mention of patients' AD in the correspondence between physicians as good, while 114 (71%) at the patients' first registration in the private practice.Prehospital physicians rated their communication skills as good, whereas end-of-life communication was rated much lower. Only half of those surveyed speak about AD

  5. Variables Affecting Pharmacy Students’ Patient Care Interventions during Advanced Pharmacy Practice Experiences

    PubMed Central

    Patterson, Brandon J.; Sen, Sanchita; Bingham, Angela L.; Bowen, Jane F.; Ereshefsky, Benjamin; Siemianowski, Laura A.

    2016-01-01

    Objective. To identify the temporal effect and factors associated with student pharmacist self-initiation of interventions during acute patient care advanced pharmacy practice experiences (APPE). Methods. During the APPE, student pharmacists at an academic medical center recorded their therapeutic interventions and who initiated the intervention throughout clinical rotations. At the end of the APPE student pharmacists completed a demographic survey. Results. Sixty-two student pharmacists were included. Factors associated with lower rates of self-initiated interventions were infectious diseases and pediatrics APPEs and an intention to pursue a postgraduate residency. Timing of the APPE, previous specialty elective course completion, and previous hospital experience did not result in any significant difference in self-initiated recommendations. Conclusion. Preceptors should not base practice experience expectations for self-initiated interventions on previous student experience or future intentions. Additionally, factors leading to lower rates of self-initiated interventions on infectious diseases or pediatrics APPEs should be explored. PMID:27756924

  6. Significance of symptom clustering in palliative care of advanced cancer patients.

    PubMed

    Tsai, Jaw-Shiun; Wu, Chih-Hsun; Chiu, Tai-Yuan; Chen, Ching-Yu

    2010-04-01

    Patients with advanced cancer often experience multiple concurrent symptoms. To explore this symptom clustering and its associated parameters, we prospectively surveyed 427 consecutive patients on admission to the Palliative Care Unit. There were 222 males (52.0%) and 205 females (48.0%), with a median age of 66 years (range: 27-93 years). The main tumor sites were lung (19.9%), liver (18.0%), and colorectum (11.0%). The median survival was 13 days (1-418 days). Symptoms were assessed using a face-valid Symptom Reporting Form. We identified five symptom clusters by exploratory factor analysis. Clusters were named "loss of energy," "poor intake," "autonomic dysfunction," "aerodigestive impairment," and "pain complex." We used nonhierarchical cluster analysis to divide the 394 patients with complete data into six groups. Each group was characterized by a particular pattern that was composed of different symptom clusters. Survival, functional performance, bone metastasis, and fluid accumulation were significantly associated with symptom clustering in six groups of patients. The severity of psychological distress also related to their physical deterioration. These data suggest that different underlying mechanisms associate with symptom clustering. Further elucidation of these processes may assist in symptom management. PMID:20226623

  7. Privacy and confidentiality issues in primary care: views of advanced practice nurses and their patients--an APRNet study [corrected].

    PubMed

    Deshefy-Longhi, Terry; Dixon, Jane Karpe; Olsen, Douglas; Grey, Margaret

    2004-01-01

    Various aspects of the concepts of privacy and confidentiality are discussed in relation to health care information in primary health care settings. In addition, findings are presented from patient and nurse practitioner focus groups held to elicit concerns that these two groups have in relation to privacy and confidentiality in their respective primary care settings. The focus groups were held prior to the implementation of the Health Insurance Portability and Accessibility Act in the USA. Implications for advanced practice registered nurses in primary care practices are provided.

  8. Advancing educational continuity in primary care residencies: an opportunity for patient-centered medical homes.

    PubMed

    Bowen, Judith L; Hirsh, David; Aagaard, Eva; Kaminetzky, Catherine P; Smith, Marie; Hardman, Joseph; Chheda, Shobhina G

    2015-05-01

    Continuity of care is a core value of patients and primary care physicians, yet in graduate medical education (GME), creating effective clinical teaching environments that emphasize continuity poses challenges. In this Perspective, the authors review three dimensions of continuity for patient care-informational, longitudinal, and interpersonal-and propose analogous dimensions describing continuity for learning that address both residents learning from patient care and supervisors and interprofessional team members supporting residents' competency development. The authors review primary care GME reform efforts through the lens of continuity, including the growing body of evidence that highlights the importance of longitudinal continuity between learners and supervisors for making competency judgments. The authors consider the challenges that primary care residency programs face in the wake of practice transformation to patient-centered medical home models and make recommendations to maximize the opportunity that these practice models provide. First, educators, researchers, and policy makers must be more precise with terms describing various dimensions of continuity. Second, research should prioritize developing assessments that enable the study of the impact of interpersonal continuity on clinical outcomes for patients and learning outcomes for residents. Third, residency programs should establish program structures that provide informational and longitudinal continuity to enable the development of interpersonal continuity for care and learning. Fourth, these educational models and continuity assessments should extend to the level of the interprofessional team. Fifth, policy leaders should develop a meaningful recognition process that rewards academic practices for training the primary care workforce. PMID:25470307

  9. Advance Directives and Do-Not-Resuscitate Orders in Patients with Cancer with Metastatic Spinal Cord Compression: Advanced Care Planning Implications

    PubMed Central

    Palmer, J. Lynn; Bianty, Josephine; Konzen, Benedict; Shin, Ki; Bruera, Eduardo

    2010-01-01

    Abstract Objectives Communication about end-of-life decisions is crucial. Although patients with metastatic spinal cord compression (MSCC) have a median survival time of 3 to 6 months, few data are available concerning the presence of advance directives and do-not-resuscitate (DNR) orders in this population. The objective of this study was to determine presence of advance directives and DNR order among patients with MSCC. Methods We retrospectively reviewed data concerning advance directives for 88 consecutive patients with cancer who had MSCC and required rehabilitation consultation at The University of Texas M. D. Anderson Cancer Center from September 20, 2005 to August 29, 2008. We characterized the data using univariate descriptive statistics and used the Fisher exact test to find correlations. Results The mean age of this patient population was 55 years (range, 24–81). Thirty patients (33%) were female. Twenty patients (23%) had a living will, 27 patients (31%) had health care proxies, and 10 patients (11%) had either out-of-hospital DNR order and/or dictated DNR note. The median survival time for these patients was 4.3 months. Conclusion Despite strong evidence showing short survival times for MSCC patients, it seems many of these patients are not aware of the urgency to have an advance directive. This may be an indicator of delayed end-of-life palliative care and suboptimal doctor–patient communication. Using the catastrophic event of a diagnosis of MSCC to trigger communication and initiate palliative care may be beneficial to patients and their families. PMID:20192843

  10. [Palliative care for patients with advanced dementia: Evidence-based practice replaced by values-based practice].

    PubMed

    Kunz, R

    2003-10-01

    For the treatment of patients with advanced dementia, we could not find any evidence based guidelines to help in decision making. Individual values and expected quality of life must be the leading goals of any intervention. Symptom control and relieving suffering are core values of palliative care, but the recognition of discomfort needs qualified assessment skills. Pain assessment with common tools like the VAS fails in patients with cognitive impairment and inability to communicate; instruments like Doloplus and ECPA can be helpful to assess behavioral changes as expression of pain. The treatment of acute and chronic pain in advanced dementia is still not sufficient and needs improvement. Oral feeding in advanced dementia becomes more and more difficult. No randomized controlled study has found evidence that tube feeding will reduce the risk of aspiration or prolong life expectancy. Eating may be the only meaningful activity that remains for the patient; artificial feeding cannot serve the same function. All final complications, like pneumonia, call for a decision making process. Those who care for and care about these patients must make decisions. The feelings of the family have to be considered, but the probable will of the patient, his dignity and quality of life must not be overridden.

  11. Case study of a chaplain's spiritual care for a patient with advanced metastatic breast cancer.

    PubMed

    Cooper, Rhonda S

    2011-01-01

    The case study seeks to describe an oncology chaplain's pastoral relationship with a 64-year-old woman with advanced metastatic breast cancer. The patient's distress was complicated by a history of anxiety and other chronic medical conditions. Approximately 16 pastoral encounters occurred during the last year of the patient's life. The patient, chaplain, and the pastoral conversations are presented as well as a retrospective assessment of them. The chaplain's interventions were appropriate for the patient's spiritual needs, particularly in regard to her fear of death, loneliness, grief that her life was "too short" and estrangement from her inherited faith tradition, with observable benefits for the patient. The oncology chaplain has a distinctive role in the healthcare team as one who can meet the patient at the point of their spiritual need, provide appropriate interventions and, thereby, ameliorate the distress, particularly in regard to death anxiety, peace of mind, and issues of meaning.

  12. The Role of Technical Advances in the Adoption and Integration of Patient-Reported Outcomes in Clinical Care

    PubMed Central

    Jensen, Roxanne E.; Rothrock, Nan E.; DeWitt, Esi Morgan; Spiegel, Brennan; Tucker, Carole A.; Crane, Heidi M.; Forrest, Christopher B.; Patrick, Donald L.; Fredericksen, Rob; Shulman, Lisa M.; Cella, David; Crane, Paul K.

    2016-01-01

    Background Patient-reported outcomes (PROs) are gaining recognition as key measures for improving the quality of patient care in clinical care settings. Three factors have made the implementation of PROs in clinical care more feasible: increased use of modern measurement methods in PRO design and validation, rapid progression of technology (e.g., touch screen tablets, Internet accessibility, and electronic health records (EHRs)), and greater demand for measurement and monitoring of PROs by regulators, payers, accreditors, and professional organizations. As electronic PRO collection and reporting capabilities have improved, the challenges of collecting PRO data have changed. Objectives To update information on PRO adoption considerations in clinical care, highlighting electronic and technical advances with respect to measure selection, clinical workflow, data infrastructure, and outcomes reporting. Methods Five practical case studies across diverse healthcare settings and patient populations are used to explore how implementation barriers were addressed to promote the successful integration of PRO collection into the clinical workflow. The case studies address selecting and reporting of relevant content, workflow integration, pre-visit screening, effective evaluation, and EHR integration. Conclusions These case studies exemplify elements of well-designed electronic systems, including response automation, tailoring of item selection and reporting algorithms, flexibility of collection location, and integration with patient health care data elements. They also highlight emerging logistical barriers in this area, such as the need for specialized technological and methodological expertise, and design limitations of current electronic data capture systems. PMID:25588135

  13. Acute hospital care is the chief driver of regional spending variation in Medicare patients with advanced cancer.

    PubMed

    Brooks, Gabriel A; Li, Ling; Uno, Hajime; Hassett, Michael J; Landon, Bruce E; Schrag, Deborah

    2014-10-01

    The root causes of regional variation in medical spending are poorly understood and vary by clinical condition. To identify drivers of regional spending variation for Medicare patients with advanced cancer, we used linked Surveillance, Epidemiology, and End Results program (SEER)-Medicare data from the period 2004-10. We broke down Medicare spending into thirteen cancer-relevant service categories. We then calculated the contribution of each category to spending and regional spending variation. Acute hospital care was the largest component of spending and the chief driver of regional spending variation, accounting for 48 percent of spending and 67 percent of variation. In contrast, chemotherapy accounted for 16 percent of spending and 10 percent of variation. Hospice care constituted 5 percent of spending. However, variation in hospice spending was fully offset by opposing variation in other categories. Our analysis suggests that the strategy with the greatest potential to improve the value of care for patients with advanced cancer is to reduce reliance on acute hospital care for this patient population.

  14. Process and Outcome Measures among COPD Patients with a Hospitalization Cared for by an Advance Practice Provider or Primary Care Physician

    PubMed Central

    Agarwal, Amitesh; Zhang, Wei; Kuo, YongFang; Sharma, Gulshan

    2016-01-01

    Objectives To examine the process and outcomes of care of COPD patients by Advanced Practice Providers (APPs) and primary care physicians. Methods We conducted a cross sectional retrospective cohort study of Medicare beneficiaries with COPD who had at least one hospitalization in 2010. We examined the process measures of receipt of spirometry evaluation, influenza and pneumococcal vaccine, use of COPD medications, and referral to a pulmonary specialist visit. Outcome measures were emergency department (ER) visit, number of hospitalizations and 30-day readmission in 2010. Results A total of 7,257 Medicare beneficiaries with COPD were included. Of these, 1,999 and 5,258 received primary care from APPs and primary care physicians, respectively. Patients in the APP group were more likely to be white, younger, male, residing in non-metropolitan areas and have fewer comorbidities. In terms of process of care measures, APPs were more likely to prescribe short acting bronchodilators (adjusted odds ratio [aOR] = 1.18, 95%Confidence Interval [CI] 1.05–1.32), oxygen therapy (aOR = 1.25, 95% CI 1.12–1.40) and consult a pulmonary specialist (aOR = 1.39, 95% CI 1.23–1.56), but less likely to give influenza and pneumococcal vaccinations. Patients receiving care from APPs had lower rates of ER visits for COPD (aOR = 0.84, 95%CI 0.71–0.98) and had a higher follow-up rate with pulmonary specialist within 30 days of hospitalization for COPD (aOR = 1.25, 95%CI 1.07–1.48) than those cared for by physicians. Conclusions Compared to patients cared for by physicians, patients cared for by APPs were more likely to receive short acting bronchodilator, oxygen therapy and been referred to pulmonologist, however they had lower rates of vaccination probably due to lower age group. Patients cared for by APPs were less like to visit an ER for COPD compared to patients care for by physicians, conversely there was no differences in hospitalization or readmission for COPD between MDs and

  15. Pretreatment neutrophil-to-lymphocyte ratio and its dynamic changes are associated with the overall survival in advanced cancer patients undergoing palliative care

    PubMed Central

    Zhao, Weiwei; Wu, Zhenyu; Li, Yintao; Jia, Huixun; Chen, Menglei; Gu, Xiaoli; Liu, Minghui; Zhang, Zhe; Wang, Peng; Cheng, Wenwu

    2016-01-01

    The objective of this study was to investigate the prognostic value of pretreatment NLR and its dynamic changes responsive to palliative care in advanced cancer patients. The study was retrospectively assessed in 378 consecutive advanced cancer patients receiving palliative care, and in an extended follow-up study of 106 of those patients. The cutoff value of pretreatment NLR was determined to be 3.0. In the 378 advanced cancer patients, 89 had pretreatment NLR ≤ 3, and 289 had an NLR > 3. Univariate and multivariate analyses showed that tumor stage, palliative care, albumin level, and pretreatment NLR (HR: 1.514, 95% CI: 1.125~2.038, P = 0.006) were independent prognostic indicators of OS. Moreover, in the follow-up cohort of 106 readmitted patients, 43 patients achieved a decreased NLR after palliative care, while the remaining 63 patients showed an increased NLR. Univariate and multivariate analyses showed that an increase in NLR was significantly associated with a poor survival (HR: 2.506, 95% CI: 1.474~4.261, P = 0.001). In conclusion, pretreatment NLR and changes in NLR independently predicted OS in advanced cancer patients undergoing palliative care. Incorporating NLR into clinical practice may better inform the prognosis and therapy decisions of advanced cancer patients in palliative settings. PMID:27510632

  16. Effect and safety of duodenal levodopa infusion in advanced Parkinson's disease: a retrospective multicenter outcome assessment in patient routine care.

    PubMed

    Antonini, A; Odin, P; Opiano, L; Tomantschger, V; Pacchetti, C; Pickut, B; Gasser, U E; Calandrella, D; Mancini, F; Zibetti, M; Minafra, B; Bertaina, I; De Deyn, P; Cras, C; Wolf, E; Spielberger, S; Poewe, W

    2013-11-01

    Duodenal levodopa infusion represents an effective strategy to manage motor and non-motor complications in patients with advanced Parkinson's disease (PD). However, most published clinical series regard small numbers of patients and do not exceed 1 year follow-up. In this multi-national observational cohort study conducted in seven specialised PD clinics and university hospitals we assessed long-term safety and outcome of chronic treatment with intra-duodenal levodopa infusions in a large population of patients with advanced PD. The starting population consisted of 98 treated patients (safety population). We report clinical outcomes of 73 patients with subsequent efficacy assessment(s) (efficacy population) over a follow-up period up to 2 years. Follow-up periods and collection of clinical observations varied based on individual routine care program. At last follow-up there was a significant (p ≤ 0.05) reduction in duration of "Off" periods as well as dyskinesia duration and severity that was associated with an improvement of quality of life. Twenty three patients (25.3 % of the safety population) withdraw, due to adverse drug reaction (5), procedure and device related events (7), compliance (3) and lack of efficacy (8). The mean duration for last value reported after baseline (LV) was 608 ± 292 days (median: 697 days). Our results demonstrate significant and sustained benefit over a long observation period in motor complications and in quality of life following a change from oral pulsatile to continuous levodopa delivery. The relatively large number of withdrawals reflects the current use of duodenal levodopa infusion in very advanced PD patients. PMID:23595879

  17. Advancing human rights in patient care through strategic litigation: challenging medical confidentiality issues in countries in transition.

    PubMed

    Talbot, Susie

    2013-12-12

    The concept of human rights in patient care offers a framework, relevant to both patients and providers, for identifying and addressing human rights violations within a state's health system. While a range of legal and non-legal mechanisms are available to advance this concept (and, indeed, are generally used to best effect in combination as part of a wider advocacy strategy), this paper considers the use of strategic litigation to hold states to account and encourage broader systemic change. As an illustration of such an approach, this article focuses on the issue of breaches of medical confidentiality-a pervasive problem in certain countries in Eastern Europe and Central Asia, with serious implications for vulnerable or marginalized individuals. This paper presents an overview of the European Court of Human Rights' approach to this topic and discusses the potential for further strategic litigation in Eastern Europe and Central Asia.

  18. [Advances in wound care].

    PubMed

    Raffoul, Wassim

    2008-03-01

    Wound care made great progress during last years related to several factors. The first is an awakening of the importance of wounds. The progress made in the comprehension of the physiopathology of wounds led to innovations in all stages of this complex process which is the wound healing. Autologus platelet concentrate producing growth factors are in use to stimulate the first phase of the healing. The second phase which is the phase of proliferation and secretion is currently better managed with new categories of bandages which are true local treatments. The nutrition became one of the pillars of wound treatments especially among old patients. The reconstructive surgery took great steps since the physiology and the vascular anatomy of the skin and soft tissues are better known. Finally the bio-engineering has entered the treatment of the wound there is more than 20 years ago and methods have improved and become more reliable.

  19. Autonomy, liberalism and advance care planning.

    PubMed Central

    Ikonomidis, S; Singer, P A

    1999-01-01

    The justification for advance directives is grounded in the notion that they extend patient autonomy into future states of incompetency through patient participation in decision making about end-of-life care. Four objections challenge the necessity and sufficiency of individual autonomy, perceived to be a defining feature of liberal philosophical theory, as a basis of advance care planning. These objections are that the liberal concept of autonomy (i) implies a misconception of the individual self, (ii) entails the denial of values of social justice, (iii) does not account for justifiable acts of paternalism, and (iv) does not account for the importance of personal relationships in the advance care planning process. The last objection is especially pertinent in light of recent empirical research highlighting the importance of personal relationships in advance care planning. This article examines these four objections to autonomy, and the liberal theoretical framework with which it is associated, in order to re-evaluate the philosophical basis of advance care planning. We argue that liberal autonomy (i) is not a misconceived concept as critics assume, (ii) does not entail the denial of values of social justice, (iii) can account for justifiable acts of paternalism, though it (iv) is not the best account of the value of personal relationships that arise in advance care planning. In conclusion, we suggest that liberalism is a necessary component of a theoretical framework for advance care planning but that it needs to be supplemented with theories that focus explicitly on the significance of personal relationships. PMID:10635509

  20. Latest advances in confocal microscopy of skin cancers toward guiding patient care: a Mohs surgeon's review and perspective (Conference Presentation)

    NASA Astrophysics Data System (ADS)

    Nehal, Kishwer S.; Rajadhyaksha, Milind

    2016-02-01

    Latest advances in confocal microscopy of skin cancers toward guiding patient care: a Mohs surgeon's review and perspective About 350 publications worldwide have reported the ability of reflectance confocal microscopy (RCM) imaging to detect melanocytic skin lesions in vivo with specificity of 84-88% and sensitivity of 71-92%, and non-melanocytic skin lesions with specificity of 85-97% and sensitivity 100-92%. Lentigo maligna melanoma can be detected with sensitivity of 93% and specificity 82%. While the sensitivity is comparable to that of dermoscopy, the specificity is 2X superior, especially for lightly- and non-pigmented lesions. Dermoscopy combined with RCM imaging is proving to be both highly sensitive and highly specific. Recent studies have reported that the ratio of equivocal (i.e., would have been biopsied) lesions to detected melanomas dropped by ~2X when guided by dermoscopy and RCM imaging, compared to that with dermoscopy alone. Dermoscopy combined with RCM imaging is now being implemented to guide noninvasive diagnosis (to rule out malignancy and biopsy) and to also guide treatment, with promising initial impact: thus far, about 3,000 patients have been saved from biopsies of benign lesions. These are currently under follow-up monitoring. With fluorescence confocal microscopy (FCM) mosaicing, residual basal cell carcinomas can be detected in Mohs surgically excised fresh tissue ex vivo, with sensitivity of 94-97% and specificity 89-94%. FCM mosaicing is now being implemented for guiding Mohs surgery. To date, about 600 Mohs procedures have been performed, guided with mosaicing, and with pathology being performed in parallel to confirm the final outcome. These latest advances demonstrate the promising ability of RCM and FCM to guide patient care.

  1. Integrating Palliative Care into the Care of Neurocritically Ill Patients: A Report from The IPAL-ICU (Improving Palliative Care in the Intensive Care Unit) Project Advisory Board and the Center to Advance Palliative Care

    PubMed Central

    Frontera, Jennifer A.; Curtis, J. Randall; Nelson, Judith E.; Campbell, Margaret; Gabriel, Michelle; Hays, Ross M.; Mosenthal, Anne C.; Mulkerin, Colleen; Puntillo, Kathleen A.; Ray, Daniel E.; Bassett, Rick; Boss, Renee D.; Lustbader, Dana R.; Brasel, Karen J.; Weiss, Stefanie P.; Weissman, David E.

    2015-01-01

    Objectives To describe unique features of neurocritical illness that are relevant to provision of high-quality palliative care; To discuss key prognostic aids and their limitations for neurocritical illnesses; To review challenges and strategies for establishing realistic goals of care for patients in the neuro-ICU; To describe elements of best practice concerning symptom management, limitation of life support, and organ donation for the neurocritically ill. Data Sources A search of Pubmed and MEDLINE was conducted from inception through January 2015 for all English-language articles using the term “palliative care,” “supportive care,” “end-of-life care,” “withdrawal of life-sustaining therapy,” “limitation of life support,” “prognosis,” or “goals of care” together with “neurocritical care,” “neurointensive care,” “neurological,” “stroke,” “subarachnoid hemorrhage,” “intracerebral hemorrhage,” or “brain injury.” Data Extraction and Synthesis We reviewed the existing literature on delivery of palliative care in the neurointensive care unit setting, focusing on challenges and strategies for establishing realistic and appropriate goals of care, symptom management, organ donation, and other considerations related to use and limitation of life-sustaining therapies for neurocritically ill patients. Based on review of these articles and the experiences of our interdisciplinary/interprofessional expert Advisory Board, this report was prepared to guide critical care staff, palliative care specialists, and others who practice in this setting. Conclusions Most neurocritically ill patients and their families face the sudden onset of devastating cognitive and functional changes that challenge clinicians to provide patient-centered palliative care within a complex and often uncertain prognostic environment. Application of palliative care principles concerning symptom relief, goal setting, and family emotional support, will

  2. Measuring patient treatment preferences in end-of-life care research: applications for advance care planning interventions and response shift research.

    PubMed

    Schwartz, Carolyn E; Merriman, Melanie P; Reed, George W; Hammes, Bernard J

    2004-04-01

    Understanding the dynamics of patient treatment preferences can be important for end-of life are research, and has particular salience not only to guide a process of advance care planning (ACP) but also as an outcome measure. Ascertaining the reliability and responsiveness of preferences for life-sustaining treatments within and between patients is a necessary foundation for utilizing patient-agent congruence as an outcome for ACP interventions. This study validated a modified version of the Emanuel and Emanuel Medical Directive for use in both research and clinical applications. Seriously ill patients (n = 168) were asked at baseline and 21 days to consider four common end-of-life health state scenarios, to indicate their goals for treatment, and to state their preferences for six specific treatments. We investigated the reliability and validity of this tool. We found that preferences for life-sustaining treatments were highly intercorrelated, and internally consistent across treatments by scenario and across scenarios by treatment. Preferences for pain medications were, however, distinct from preferences for other treatments. Preference scores exhibited stability over follow-up, and demonstrated both concurrent and discriminant validity. We detected a small effect size for change in preferences as a function of health state change, suggesting that re-prioritization response shifts do occur but are small in magnitude in these patient samples over this time frame. We conclude that this measure is reliable and valid for use in clinical settings and for evaluating interventions designed to improve patient-agent congruence about patient preferences for life-sustaining treatments. Clinical applications of the tool are discussed. PMID:15130201

  3. A framework for the development and implementation of an advanced practice role for physiotherapists that improves access and quality of care for patients.

    PubMed

    Robarts, Susan; Kennedy, Deborah; MacLeod, Anne Marie; Findlay, Helen; Gollish, Jeffrey

    2008-01-01

    A new model of care has been implemented at the Sunnybrook Holland Orthopaedic and Arthritic Centre that expands the role of physiotherapists to improve access and quality of care for patients requiring hip and knee replacement surgery. An advanced practice physiotherapist (APP) role was created to support both referral management and post-operative care to reduce surgeon workload and better streamline services. This article describes our nine-step framework for implementing an APP role and can be used as a template for other organizations evolving similar roles. The framework was adapted from the participatory, evidence-based, patient-focused process for the development of an advanced practice nurse role. Key steps include (1) obtaining stakeholder consensus, (2) identifying barriers and facilitators and (3) developing the necessary administrative and training supports as well as clinical protocols and an evaluation framework. Approaching change in a series of small steps (plan-do-study-act [PDSA] methodology) alongside existing processes has facilitated buy-in and role acceptance. The early and continued involvement of decision-makers within the organization has been paramount to successful implementation. In addition, patient input has been central to the evolution of the role, with patient satisfaction a key indicator. The new role and model of care reconfigures traditional roles and introduces a team approach that results in timely access to care for patients. Benefits include an improved assessment process, enhanced education across the care continuum and improved coordination and delivery of services.

  4. [Advances in metabolic and nutritional management of patients in critical care].

    PubMed

    Hasebe, M; Suzuki, H; Nakatani, T; Kobayashi, K

    1999-07-01

    Nutritional management often fails in critically ill patients such as trauma and sepsis because of their acutely progressive malnutrition and metabolic derangement being characteristic of such clinical settings. Nutritional strategies for these patients have been almost established by the methods of clinical epidemiology. A considerable amount of clinical evidences suggests that the following should be of benefit for the patients, enteral delivery of nutrition, a nutrition assessment including metabolic evaluation such as liver function or energy requirements, and supplementation of specialty nutrients. Our current data suggest that the metabolic evaluation should include measurement of energy expenditure, assessment of hepatic mitochondrial function, and measurement of the magnitude of body water deviations. Energy expenditure and hepatic mitochondrial function can be observed by the methods of indirect calorimetry and arterial ketone body measurement, respectively. These parameters are helpful to prevent overfeeding from the patients. We emphasize that application of a new method, body impedance spectrum analysis, is important and useful to evaluate the change of body water distributions resulting from metabolic derangement. PMID:10481846

  5. Advances in the care of head and neck cancer patients at Baylor University Medical Center.

    PubMed

    O'Brien, John C

    2008-01-01

    Editor's note: The Society of Baylor Surgeons held a meeting on August 10 to 11, 2007: "Advances in Surgery and Surgical Education: The Past 20 Years," in honor of Dr. Ronald C. Jones' 20th year as chairman of the Department of Surgery at Baylor University Medical Center. This society was founded in 1981 by Dr. Robert Sparkman, past chief of the department, as a way to reunite former Baylor surgery residents and provide continuing surgical education for residents and members of the medical staff.Under the direction of program director John Preskitt, MD, the 2007 CME-accredited meeting included presentations from four prominent guest speakers: Edward M. Copeland, MD, president of the American College of Surgeons; R. Scott Jones, MD, professor and chairman of surgery emeritus for the University of Virginia Health System; Kirby I. Bland, MD, chairman of the Department of Surgery at the University of Alabama; and Stanley Dudrick, MD, chairman of the Department of Surgery at St. Mary's Hospital, Waterbury, Connecticut. In addition, 12 physicians from Baylor made presentations at this meeting, and some provided summaries, which are reproduced in this issue of Proceedings.

  6. Pathophysiological advances in membranous nephropathy: time for a shift in patient's care.

    PubMed

    Ronco, Pierre; Debiec, Hanna

    2015-05-16

    Membranous nephropathy is a major cause of nephrotic syndrome of non-diabetic origin in adults. It is the second or third leading cause of end-stage renal disease in patients with primary glomerulonephritis, and is the leading glomerulopathy that recurs after kidney transplantation (occurring in about 40% of patients). Treatment with costly and potentially toxic drugs remains controversial and challenging, partly because of insufficient insight into the pathogenesis of the disease and absence of sensitive biomarkers of disease activity. The disease is caused by the formation of immune deposits on the outer aspect of the glomerular basement membrane, which contain podocyte or planted antigens and circulating antibodies specific to those antigens, resulting in complement activation. In 2002, podocyte neutral endopeptidase was identified as an antigenic target of circulating antibodies in alloimmune neonatal nephropathy, and in 2009, podocyte phospholipase A2 receptor (PLA2R) was reported as an antigenic target in autoimmune adult membranous nephropathy. These major breakthroughs were translated to clinical practice very quickly. Measurement of anti-PLA2R antibodies in serum and detection of PLA2R antigen in glomerular deposits can now be done routinely. Anti-PLA2R antibodies have high specificity (close to 100%), sensitivity (70-80%), and predictive value. PLA2R detection in immune deposits allows for retrospective diagnosis of PLA2R-related membranous nephropathy in archival kidney biopsies. These tests already have a major effect on diagnosis and monitoring of treatment, including after transplantation.

  7. Collaboration and entanglement: An actor-network theory analysis of team-based intraprofessional care for patients with advanced heart failure.

    PubMed

    McDougall, A; Goldszmidt, M; Kinsella, E A; Smith, S; Lingard, L

    2016-09-01

    Despite calls for more interprofessional and intraprofessional team-based approaches in healthcare, we lack sufficient understanding of how this happens in the context of patient care teams. This multi-perspective, team-based interview study examined how medical teams negotiated collaborative tensions. From 2011 to 2013, 50 patients across five sites in three Canadian provinces were interviewed about their care experiences and were asked to identify members of their health care teams. Patient-identified team members were subsequently interviewed to form 50 "Team Sampling Units" (TSUs), consisting of 209 interviews with patients, caregivers and healthcare providers. Results are gathered from a focused analysis of 13 TSUs where intraprofessional collaborative tensions involved treating fluid overload, or edema, a common HF symptom. Drawing on actor-network theory (ANT), the analysis focused on intraprofessional collaboration between specialty care teams in cardiology and nephrology. The study found that despite a shared narrative of common purpose between cardiology teams and nephrology teams, fluid management tools and techniques formed sites of collaborative tension. In particular, care activities involved asynchronous clinical interpretations, geographically distributed specialist care, fragmented forms of communication, and uncertainty due to clinical complexity. Teams 'disentangled' fluid in order to focus on its physiological function and mobilisation. Teams also used distinct 'framings' of fluid management that created perceived collaborative tensions. This study advances collaborative entanglement as a conceptual framework for understanding, teaching, and potentially ameliorating some of the tensions that manifest during intraprofessional care for patients with complex, chronic disease. PMID:27490299

  8. The Real-World Problem of Care Coordination: A Longitudinal Qualitative Study with Patients Living with Advanced Progressive Illness and Their Unpaid Caregivers

    PubMed Central

    Daveson, Barbara A.; Harding, Richard; Shipman, Cathy; Mason, Bruce L.; Epiphaniou, Eleni; Higginson, Irene J.; Ellis-Smith, Clare; Henson, Lesley; Munday, Dan; Nanton, Veronica; Dale, Jeremy R.; Boyd, Kirsty; Worth, Allison; Barclay, Stephen; Donaldson, Anne; Murray, Scott

    2014-01-01

    Objectives To develop a model of care coordination for patients living with advanced progressive illness and their unpaid caregivers, and to understand their perspective regarding care coordination. Design A prospective longitudinal, multi-perspective qualitative study involving a case-study approach. Methods Serial in-depth interviews were conducted, transcribed verbatim and then analyzed through open and axial coding in order to construct categories for three cases (sites). This was followed by continued thematic analysis to identify underlying conceptual coherence across all cases in order to produce one coherent care coordination model. Participants Fifty-six purposively sampled patients and 27 case-linked unpaid caregivers. Settings Three cases from contrasting primary, secondary and tertiary settings within Britain. Results Coordination is a deliberate cross-cutting action that involves high-quality, caring and well-informed staff, patients and unpaid caregivers who must work in partnership together across health and social care settings. For coordination to occur, it must be adequately resourced with efficient systems and services that communicate. Patients and unpaid caregivers contribute substantially to the coordination of their care, which is sometimes volunteered at a personal cost to them. Coordination is facilitated through flexible and patient-centered care, characterized by accurate and timely information communicated in a way that considers patients’ and caregivers’ needs, preferences, circumstances and abilities. Conclusions Within the midst of advanced progressive illness, coordination is a shared and complex intervention involving relational, structural and information components. Our study is one of the first to extensively examine patients’ and caregivers’ views about coordination, thus aiding conceptual fidelity. These findings can be used to help avoid oversimplifying a real-world problem, such as care coordination. Avoiding

  9. New regulations for medical devices: Rationale, advances and impact on research and patient care.

    PubMed

    Labek, Gerold; Schöffl, Harald; Stoica, Christian Ioan

    2016-03-18

    A series of events relating to inferior medical devices has brought about changes in the legal requirements regarding quality control on the part of regulators. Apart from clinical studies, register and routine data will play an essential role in this context. To ensure adequate use of these data, adapted methodologies are required as register data in fact represent a new scientific entity. For the interpretation of register and routine data several limitations of published data should be taken into account. In many cases essential parameters of study cohorts - such as age, comorbidities, the patients' risk profiles or the hospital profile - are not presented. Required data and evaluation procedures differ significantly, for example, between hip and spine implants. A "one fits for all" methodology is quite unlikely to exist and vigorous efforts will be required to develop suitable standards in the next future. The new legislation will affect all high-risk products, besides joint implants also contact lenses, cardiac pacemakers or stents, for example, the new regulations can markedly enhance product quality monitoring. Register data and clinical studies should not be considered as competitors, they complement each other when used responsibly. In the future follow-up studies should increasingly focus on specific questions, while global follow-up investigations regarding product complication rates and surgical methods will increasingly be covered by registers.

  10. Clinical Impact of Education Provision on Determining Advance Care Planning Decisions among End Stage Renal Disease Patients Receiving Regular Hemodialysis in University Malaya Medical Centre

    PubMed Central

    Hing (Wong), Albert; Chin, Loh Ee; Ping, Tan Li; Peng, Ng Kok; Kun, Lim Soo

    2016-01-01

    Introduction: Advance care planning (ACP) is a process of shared decision-making about future health-care plans between patients, health care providers, and family members, should patients becomes incapable of participating in medical treatment decisions. ACP discussions enhance patient's autonomy, focus on patient's values and treatment preferences, and promote patient-centered care. ACP is integrated as part of clinical practice in Singapore and the United States. Aim: To assess the clinical impact of education provision on determining ACP decisions among end-stage renal disease patients on regular hemodialysis at University Malaya Medical Centre (UMMC). To study the knowledge and attitude of patients toward ACP and end-of-life issues. Materials and Methods: Fifty-six patients were recruited from UMMC. About 43 questions pretest survey adapted from Lyon's ACP survey and Moss's cardiopulmonary resuscitation (CPR) attitude survey was given to patients to answer. An educational brochure is then introduced to these patients, and a posttest survey carried out after that. The results were analyzed using SPSS version 22.0. Results: Opinion on ACP, including CPR decisions, showed an upward trend on the importance percentage after the educational brochure exposure, but this was statistically not significant. Seventy-five percent of participants had never heard of ACP before, and only 3.6% had actually prepared a written advanced directive. Conclusion: The ACP educational brochure clinically impacts patients’ preferences and decisions toward end-of-life care; however, this is statistically not significant. Majority of patients have poor knowledge on ACP. This study lays the foundation for execution of future larger scale clinical trials, and ultimately, the incorporation of ACP into clinical practice in Malaysia. PMID:27803566

  11. 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

  12. Advances in prehospital trauma care

    PubMed Central

    Williamson, Kelvin; Ramesh, Ramaiah; Grabinsky, Andreas

    2011-01-01

    Prehospital trauma care developed over the last decades parallel in many countries. Most of the prehospital emergency medical systems relied on input or experiences from military medicine and were often modeled after the existing military procedures. Some systems were initially developed with the trauma patient in mind, while other systems were tailored for medical, especially cardiovascular, emergencies. The key components to successful prehospital trauma care are the well-known ABCs of trauma care: Airway, Breathing, Circulation. Establishing and securing the airway, ventilation, fluid resuscitation, and in addition, the quick transport to the best-suited trauma center represent the pillars of trauma care in the field. While ABC in trauma care has neither been challenged nor changed, new techniques, tools and procedures have been developed to make it easier for the prehospital provider to achieve these goals in the prehospital setting and thus improve the outcome of trauma patients. PMID:22096773

  13. 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

  14. 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.

  15. 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

  16. An Online Learning Module to Increase Self-Efficacy and Involvement in Care for Patients With Advanced Lung Cancer: Research Protocol

    PubMed Central

    Nagrial, Adnan; Pene, Christopher; Rabbets, Melanie; Carlino, Matteo; Zachulski, Clare; Phillips, Jane; Birnbaum, Robert; Gandhi, Tejal; Harnett, Paul

    2016-01-01

    Background Improving patient care for individuals with lung cancer is a priority due to the increasing burden of the disease globally. One way this can be done is by improving patient self-management capabilities through increasing their self-efficacy. This can improve positive outcomes for patients with chronic conditions and increase their ability to manage the challenges of such illnesses. Unfortunately, patients with chronic conditions often struggle to travel far from home to engage with patient education events, a common means of improving self-efficacy. The development of more accessible tools for improving patient self-efficacy is required to increase quality of life for patients with chronic conditions. Objective To evaluate the feasibility of delivering symptom identification and management information to patients with advanced lung cancer using an online program. Methods This article describes a pre-post test study to evaluate a Qstream online learning platform to improve patient self-efficacy for managing advanced lung cancer symptoms. Undertaking this program should increase participant knowledge about the side-effects they may experience as a result of their treatment and in turn increase help-seeking behavior and self-efficacy for the participant cohort. Quantitative data collected by the Qstream platform on the completion rates of participants will be used as a tool to evaluate the intervention. Additionally, validated scales will be used to collect data on patient self-efficacy. Qualitative data will also be collected via an exit survey and thematic content analysis of semi-structured interviews. Results The research is in the preliminary stages but thus far a protocol has been approved in support of the project. Additionally, advisory committee members have been identified and initial meetings have been undertaken. Conclusions Development of new approaches for increasing patient understanding of their care is important to ensure high quality care

  17. Identifying patients with advanced chronic conditions for a progressive palliative care approach: a cross-sectional study of prognostic indicators related to end-of-life trajectories

    PubMed Central

    Amblàs-Novellas, J; Murray, S A; Espaulella, J; Martinez-Muñoz, M; Blay, C; Gómez-Batiste, X

    2016-01-01

    Objectives 2 innovative concepts have lately been developed to radically improve the care of patients with advanced chronic conditions (PACC): early identification of palliative care (PC) needs and the 3 end-of-life trajectories in chronic illnesses (acute, intermittent and gradual dwindling). It is not clear (1) what indicators work best for this early identification and (2) if specific clinical indicators exist for each of these trajectories. The objectives of this study are to explore these 2 issues. Setting 3 primary care services, an acute care hospital, an intermediate care centre and 4 nursing homes in a mixed urban–rural district in Barcelona, Spain. Participants 782 patients (61.5% women) with a positive NECPAL CCOMS-ICO test, indicating they might benefit from a PC approach. Outcome measures The characteristics and distribution of the indicators of the NECPAL CCOMS-ICO tool are analysed with respect to the 3 trajectories and have been arranged by domain (functional, nutritional and cognitive status, emotional problems, geriatric syndromes, social vulnerability and others) and according to their static (severity) and dynamic (progression) properties. Results The common indicators associated with early end-of-life identification are functional (44.3%) and nutritional (30.7%) progression, emotional distress (21.9%) and geriatric syndromes (15.7% delirium, 11.2% falls). The rest of the indicators showed differences in the associations per illness trajectories (p<0.05). 48.2% of the total cohort was identified as advanced frailty patients with no advanced disease criteria. Conclusions Dynamic indicators are present in the 3 trajectories and are especially useful to identify PACC for a progressive PC approach purpose. Most of the other indicators are typically associated with a specific trajectory. These findings can help clinicians improve the identification of patients for a palliative approach. PMID:27645556

  18. Being in a safe haven and struggling against alcohol dependency. The meaning of caring for male patients in advanced addiction nursing.

    PubMed

    Thurang, Anna; Rydström, Jens; Bengtsson Tops, Anita

    2011-01-01

    The aim of the present study was to explore and illuminate the meaning of advanced nursing caring for men with alcohol dependency, as narrated by the men themselves. Ten male patients were interviewed in-depth and data were subjected to a phenomenological-hermeneutic analysis. Caring meant having the opportunity to rest in a safe haven together with professional caregivers, to struggle for liberation from dependency, and to expand the life-sphere by starting to accept oneself and broaden social participation. The findings illuminate various patterns of masculinity and point to the importance for caregivers to be open to challenging stereotypical gender assumptions.

  19. Adversaries at the Bedside: Advance Care Plans and Future Welfare.

    PubMed

    Kestigian, Aidan; London, Alex John

    2016-10-01

    Advance care planning refers to the process of determining how one wants to be cared for in the event that one is no longer competent to make one's own medical decisions. Some have argued that advance care plans often fail to be normatively binding on caretakers because those plans do not reflect the interests of patients once they enter an incompetent state. In this article, we argue that when the core medical ethical principles of respect for patient autonomy, honest and adequate disclosure of information, institutional transparency, and concern for patient welfare are upheld, a policy that would allow for the disregard of advance care plans is self-defeating. This is because when the four principles are upheld, a patient's willingness to undergo treatment depends critically on the willingness of her caretakers to honor the wishes she has outlined in her advance care plan. A patient who fears that her caretakers will not honor her wishes may choose to avoid medical care so as to limit the influence of her caretakers in the future, which may lead to worse medical outcomes than if she had undergone care. In order to avoid worse medical outcomes and uphold the four core principles, caregivers who are concerned about the future welfare of their patients should focus on improving advance care planning and commit to honoring their patients' advance care plans. PMID:27212709

  20. Adversaries at the Bedside: Advance Care Plans and Future Welfare.

    PubMed

    Kestigian, Aidan; London, Alex John

    2016-10-01

    Advance care planning refers to the process of determining how one wants to be cared for in the event that one is no longer competent to make one's own medical decisions. Some have argued that advance care plans often fail to be normatively binding on caretakers because those plans do not reflect the interests of patients once they enter an incompetent state. In this article, we argue that when the core medical ethical principles of respect for patient autonomy, honest and adequate disclosure of information, institutional transparency, and concern for patient welfare are upheld, a policy that would allow for the disregard of advance care plans is self-defeating. This is because when the four principles are upheld, a patient's willingness to undergo treatment depends critically on the willingness of her caretakers to honor the wishes she has outlined in her advance care plan. A patient who fears that her caretakers will not honor her wishes may choose to avoid medical care so as to limit the influence of her caretakers in the future, which may lead to worse medical outcomes than if she had undergone care. In order to avoid worse medical outcomes and uphold the four core principles, caregivers who are concerned about the future welfare of their patients should focus on improving advance care planning and commit to honoring their patients' advance care plans.

  1. Phase 2 Randomised Controlled Trial and Feasibility Study of Future Care Planning in Patients with Advanced Heart Disease

    PubMed Central

    Denvir, Martin A.; Cudmore, Sarah; Highet, Gill; Robertson, Shirley; Donald, Lisa; Stephen, Jacqueline; Haga, Kristin; Hogg, Karen; Weir, Christopher J.; Murray, Scott A.; Boyd, Kirsty

    2016-01-01

    Future Care Planning (FCP) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost. We assessed the feasibility, acceptability and tested a design of a randomised trial evaluating the impact of FCP in patients and carers. 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of >20% were randomly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks. Quality of life, symptoms and anxiety/distress were assessed by questionnaire. Hospitalisation and mortality events were documented for 6 months post-discharge. FCP increased implementation and documentation of key decisions linked to end-of-life care. FCP did not increase anxiety/distress (Kessler score -E 16.7 (7.0) vs D 16.8 (7.3), p = 0.94). Quality of life was unchanged (EQ5D: E 0.54(0.29) vs D 0.56(0.24), p = 0.86) while unadjusted hospitalised nights was lower (E 8.6 (15.3) vs D 11.8 (17.1), p = 0.01). Qualitative interviews indicated that FCP was highly valued by patients, carers and family physicians. FCP is feasible in a randomised clinical trial in patients with acute high risk cardiac conditions. A Phase 3 trial is needed urgently. PMID:27090299

  2. Advance Care Planning for Serious Illness

    MedlinePlus

    ... conversations Caring Connections National Hospice and Palliative Care Organization Links to every state’s advance care directive forms http: / / www. caringinfo. org/ i4a/ pages/ index. cfm? ...

  3. Advanced Directives and Advanced Care Planning for Healthcare Professionals.

    PubMed

    Booth, Adam T; Lehna, Carlee

    2016-01-01

    The purposes of this study were to assess healthcare professionals' need for information on advanced directives and to implement and evaluate an educational plan for change in knowledge and behaviors related to advanced directives. End-of-life (EOL) care is an important topic for patients to discuss with their families and healthcare professionals (HP). Needs assessment data were collected from healthcare providers at an urban trauma intensive care unit (ICU) in Louisville, Kentucky on concepts related to end-of-life. Next, healthcare professionals participated in an educational intervention focused on: knowledge about advanced directives; communication techniques for healthcare professionals to use with patients and their families; awareness of the patient's level of illness in advanced care planning; and specifics about living wills in Kentucky and how to complete one. Pre- and post-test data were collected to evaluate change in knowledge, capability an average of 8.7 years (SD = 9.1; range = 1.9-35 years) in healthcare and worked an average of 8.4 years (SD = 9.3; range = 4 months to 35 years) in their respective ICUs. Eighty-seven percent did not have an AD in place even though their perceived knowledge about AD remained moderate throughout pre- and post-test scores (3.3 to 3.8 on a 5 point scale, respectively). Total post-test scores revealed a 2% improvement in correct responses. These findings point to the need for education of healthcare providers in the ICU to increase early AD and ACP discussions with patients and their families. PMID:27183766

  4. Advances in caring for the older cancer patient: a report from the 2015 conference of the International Society of Geriatric Oncology

    PubMed Central

    Stepney, Rob

    2016-01-01

    A paradox in cancer research is that the majority of patients enrolled in clinical trials are relatively young and fit while typical patients in daily practice are elderly and have comorbidities and impaired organ function. Given these differences, many major studies provide an imperfect guide to optimizing the treatment of the majority of patients. Since cancer incidence is highly correlated with age, and since the world's population is rapidly ageing, this problem can only increase. For this reason, oncologists and geriatricians need to collaborate in developing tools to systematically assess the health status of elderly patients and their fitness to receive cancer therapies of various intensity. Tailoring anti-cancer treatments and supportive care to individual needs should be seen as part of the move towards personalized medicine. Achieving this goal is as much of a challenge to developing and middle-income countries as it is to western nations. The 2015 annual conference of the International Society of Geriatric Oncology (SIOG) held in Prague, Czech Republic, November 2015 and had a global focus on advancing the science of geriatric oncology and supportive care. Central to this approach is the systematic assessment of life expectancy, independent functioning, and the physical and psychological health of older cancer patients. The assumption behind comprehensive geriatric assessment is that elderly cancer patients have complex needs. The implication is that effective intervention will require a multidisciplinary team. Examples of effective geriatric assessment, multidisciplinary working and supportive care were presented at the SIOG conference.

  5. [Physician-assisted suicide and advance care planning--ethical considerations on the autonomy of dementia patients at their end of life].

    PubMed

    Gather, Jakov; Vollmann, Jochen

    2014-10-01

    Physician-assisted suicide (PAS), which is currently the subject of intense and controversial discussion in medical ethics, is barely discussed in psychiatry, albeit there are already dementia patients in Germany and other European countries who end their own lives with the assistance of physicians. Based on the finding that patients who ask for medical assistance in suicide often have in mind the loss of their mental capacity, we submit PAS to an ethical analysis and put it into a broader context of patient autonomy at the end of life. In doing so, we point to advance care planning, through which the patient autonomy of the person concerned can be supported as well as respected in later stages of the disease. If patients adhere to their autonomous wish for PAS, physicians find themselves in an ethical dilemma. A further tabooing of the topic, however, does not provide a solution; rather, an open societal and professional ethical discussion and regulation are essential. PMID:25068685

  6. [Physician-assisted suicide and advance care planning--ethical considerations on the autonomy of dementia patients at their end of life].

    PubMed

    Gather, Jakov; Vollmann, Jochen

    2014-10-01

    Physician-assisted suicide (PAS), which is currently the subject of intense and controversial discussion in medical ethics, is barely discussed in psychiatry, albeit there are already dementia patients in Germany and other European countries who end their own lives with the assistance of physicians. Based on the finding that patients who ask for medical assistance in suicide often have in mind the loss of their mental capacity, we submit PAS to an ethical analysis and put it into a broader context of patient autonomy at the end of life. In doing so, we point to advance care planning, through which the patient autonomy of the person concerned can be supported as well as respected in later stages of the disease. If patients adhere to their autonomous wish for PAS, physicians find themselves in an ethical dilemma. A further tabooing of the topic, however, does not provide a solution; rather, an open societal and professional ethical discussion and regulation are essential.

  7. FAmily CEntered (FACE) advance care planning: Study design and methods for a patient-centered communication and decision-making intervention for patients with HIV/AIDS and their surrogate decision-makers

    PubMed Central

    Kimmel, Allison L.; Wang, Jichuan; Scott, Rachel; Briggs, Linda; Lyon, Maureen E.

    2016-01-01

    Although the Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) has become a chronic illness, disease-specific advance care planning has not yet been evaluated for the palliative care needs of adults with HIV/AIDS. This prospective, longitudinal, randomized, two-arm controlled clinical trial aims to test the efficacy of FAmily CEntered Advance Care Planning among adults living with AIDS and/or HIV with co-morbidities on congruence in treatment preferences, healthcare utilization, and quality of life. The FAmily CEntered intervention arm is two face-to-face sessions with a trained, certified facilitator: Session 1) Disease-Specific Advance Care Planning Respecting Choices Interview; Session 2) Completion of advance directive. The Healthy Living control arm is: Session 1) Developmental/Relationship History; Session 2) Nutrition. Follow-up data will be collected at 3, 6, 12, and 18-month post-intervention. A total of 288 patient/surrogate dyads will be enrolled from five hospital-based, out-patient clinics in Washington, District of Columbia. Participants will be HIV positive and ≥21 years of age; surrogates will be ≥18 years of age. Exclusion criteria are homicidality, suicidality, psychosis, and impaired cognitive functioning. We hypothesize that this intervention will enhance patient-centered communication with a surrogate decision-maker about end of life treatment preferences over time, enhance patient quality of life and decrease health care utilization. We further hypothesize that this intervention will decrease health disparities for Blacks in completion of advance directives. If proposed aims are achieved, the benefits of palliative care, particularly increased treatment preferences about end-of-life care and enhanced quality of life, will be extended to people living with AIDS. PMID:26044463

  8. FAmily CEntered (FACE) advance care planning: Study design and methods for a patient-centered communication and decision-making intervention for patients with HIV/AIDS and their surrogate decision-makers.

    PubMed

    Kimmel, Allison L; Wang, Jichuan; Scott, Rachel K; Briggs, Linda; Lyon, Maureen E

    2015-07-01

    Although the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has become a chronic illness, disease-specific advance care planning has not yet been evaluated for the palliative care needs of adults with HIV/AIDS. This prospective, longitudinal, randomized, two-arm controlled clinical trial aims to test the efficacy of FAmily CEntered advance care planning among adults living with AIDS and/or HIV with co-morbidities on congruence in treatment preferences, healthcare utilization, and quality of life. The FAmily CEntered intervention arm is two face-to-face sessions with a trained, certified facilitator: Session 1) Disease-Specific Advance Care Planning Respecting Choices Interview; Session 2) Completion of advance directive. The Healthy Living Control arm is: Session 1) Developmental/Relationship History; Session 2) Nutrition. Follow-up data will be collected at 3, 6, 12, and 18 months post-intervention. A total of 288 patient/surrogate dyads will be enrolled from five hospital-based, out-patient clinics in Washington, District of Columbia. Participants will be HIV positive and ≥ 21 years of age; surrogates will be ≥ 18 years of age. Exclusion criteria are homicidality, suicidality, psychosis, and impaired cognitive functioning. We hypothesize that this intervention will enhance patient-centered communication with a surrogate decision-maker about end of life treatment preferences over time, enhance patient quality of life and decrease health care utilization. We further hypothesize that this intervention will decrease health disparities for Blacks in completion of advance directives. If proposed aims are achieved, the benefits of palliative care, particularly increased treatment preferences about end-of-life care and enhanced quality of life, will be extended to people living with AIDS.

  9. The need for safeguards in advance care planning.

    PubMed

    Billings, J Andrew

    2012-05-01

    The recent uproar about Medicare "death panels" draws attention to public and professional concerns that advance care planning might restrict access to desired life-sustaining care. The primary goal of advance care planning is to promote the autonomy of a decisionally incapacitated patient when choices about life-sustaining treatments are encountered, but the safety of this procedure has not received deserved scrutiny. Patients often do not understand their decisions or they may change their mind without changing their advance care directives. Likewise, concordance between patients' wishes and the understanding of the physicians and surrogate decision makers who need to represent these wishes is disappointingly poor. A few recent reports show encouraging outcomes from advance care planning, but most studies indicate that the procedure is ineffective in protecting patients from unwanted treatments and may even undermine autonomy by leading to choices that do not reflect patient values, goals, and preferences. Safeguards for advance care planning should be put in place, such as encouraging physicians to err on the side of preserving life when advance care directives are unclear, requiring a trained advisor to review non-emergent patient choices to limit life-sustaining treatment, training of clinicians in conducting such conversations, and structured discussion formats that first address values and goals rather than particular life-sustaining procedures. Key targets for research include: how to improve completion rates for person wanting advance care directives, especially among minorities; more effective and standardized approaches to advance care planning discussions, including how best to present prognostic information to patients; methods for training clinicians and others to assist patients in this process; and systems for assuring that directives are available and up-to-date.

  10. Advance care planning in South Korea: Social work perspective.

    PubMed

    Kwon, Sung Ae; Kolomer, Stacey

    2016-08-01

    As ethical issues arise concerning the continuation of futile medical treatment for dying patients in Korean society, advance directive planning initiatives have been put into place to guide practice. This article describes the awareness and attitudes of social workers in Korea regarding advance care planning and related factors. A total of 246 gerontological/geriatric social workers completed a mailed or in-person survey regarding awareness and attitudes toward advance care planning. Seventy-three percent (n = 180) of the participants reported no knowledge of advance directives. Social workers who emphasized self-determination as a professional value, professed a preference for hospice care, and who were comfortable discussing death were more likely to have a positive attitudes toward advance care planning. This study reinforces the need for the infusion of advance care planning and end-of-life training in social work education in Korea. PMID:27428654

  11. [Nurses' knowledge about the health care proxy and advance directives].

    PubMed

    Georget, Jean-Philippe; Cecire-Denoyer, Catherine

    2015-06-01

    The Basse-Normandie palliative care nurses' group carried out a survey regarding nurses' knowledge of the health care proxy and advance directives. The study revealed a lack of connection between these two arrangements, poor knowledge about advance directives but an understanding of the role of the health care proxy. How, therefore, can patients be effectively informed? How should they be supported in this process of determining themselves the conditions of their end of life? PMID:26146326

  12. Values and options in cancer care (VOICE): study design and rationale for a patient-centered communication and decision-making intervention for physicians, patients with advanced cancer, and their caregivers

    PubMed Central

    2013-01-01

    Background Communication about prognosis and treatment choices is essential for informed decision making in advanced cancer. This article describes an investigation designed to facilitate communication and decision making among oncologists, patients with advanced cancer, and their caregivers. Methods/design The Values and Options in Cancer Care (VOICE) Study is a National Cancer Institute sponsored randomized controlled trial conducted in the Rochester/Buffalo, NY and Sacramento, CA regions. A total of 40 oncologists, approximately 400 patients with advanced cancer, and their family/friend caregivers (one per patient, when available) are expected to enroll in the study. Drawing upon ecological theory, the intervention uses a two-pronged approach: oncologists complete a multifaceted tailored educational intervention involving standardized patient instructors (SPIs), and patients and caregivers complete a coaching intervention to facilitate prioritizing and discussing questions and concerns. Follow-up data will be collected approximately quarterly for up to three years. Discussion The intervention is hypothesized to enhance patient-centered communication, quality of care, and patient outcomes. Analyses will examine the effects of the intervention on key elements of physician-patient-caregiver communication (primary outcomes), the physician-patient relationship, shared understanding of prognosis, patient well-being, and health service utilization (secondary outcomes). Trial registration Clinical Trials Identifier: NCT01485627 PMID:23570278

  13. Future Care Planning for patients approaching end-of-life with advanced heart disease: an interview study with patients, carers and healthcare professionals exploring the content, rationale and design of a randomised clinical trial

    PubMed Central

    Denvir, Martin A; Highet, Gill; Robertson, Shirley; Cudmore, Sarah; Reid, Janet; Ness, Andrea; Hogg, Karen; Weir, Christopher; Murray, Scott; Boyd, Kirsty

    2014-01-01

    Objective To explore the optimal content and design of a clinical trial of an end-of-life intervention for advanced heart disease with patients, carers and healthcare professionals. Design Qualitative interview and focus group study. Setting Community and hospital-based focus groups and interviews. Participants Stable community-dwelling patients, informal carers (PC, n=15) and primary and secondary care based healthcare professionals (HCP, n=11). Results PC highlighted fragmentation of services and difficulty in accessing specialist care as key barriers to good care. They felt that time for discussion with HCP was inadequate within current National Health Service (NHS) healthcare systems. HCP highlighted uncertainty of prognosis, explaining mortality risk to patients and switching from curative to palliative approaches as key challenges. Patient selection, nature of the intervention and relevance of trial outcomes were identified by HCP as key challenges in the design of a clinical trial. Conclusions PC and HCP expressed a number of concerns relevant to the nature and content of an end-of-life intervention for patients with advanced heart disease. The findings of this study are being used to support a phase II randomised clinical trial of Future Care Planning in advanced heart disease. PMID:25023130

  14. Endocrine profile of β-thalassemia major patients followed from childhood to advanced adulthood in a tertiary care center

    PubMed Central

    De Sanctis, Vincenzo; Elsedfy, Heba; Soliman, Ashraf T.; Elhakim, Ihab Zaki; Soliman, Nada A.; Elalaily, Rania; Kattamis, Christos

    2016-01-01

    Aim: Chronic iron overload resulting from frequent transfusions, poor compliance to efficient chelation therapy and chronic liver disease is basically responsible for the most severe complications of thalassemia major (TM). Before conventional treatment, TM was entirely childhood disease with a very short survival. Today, survival improved to 40–50 years and becomes a prevalent disease of adulthood and in the near future it will be one of senility. Furthermore, clinical phenotype of TM is changing with age and appearance of severe complications from the heart and endocrine glands that require special health care from well-informed specialists. Objectives: The aims of our study were to: (1) Imprint the clinical profile of long-lived TM patients; (2) evaluate retrospectively the cumulative incidence of endocrine diseases; (3) identify potential risk factors; and (4) orient the physicians in the modified clinical phenotype and the relative patients' health needs. Design: A retrospective cross-sectional study followed from childhood to adulthood by the same physician in a tertiary thalassemia clinic. Participants: Forty-three long-lived TM patients (mean age: 50.3 ± 10.8 years; range: 45.8–59.5 years; 23 females) were studied. Patients and Methods: An extensive medical history, with detailed clinical and laboratory data, endocrine complications, and current treatments, was obtained. Results: The data indicate that 88.4% of adult TM patients suffered from at least one endocrine complication. The majority of patients developed endocrine complications in the second decade of life when serum ferritin level was very high (12/23 TM female and 8/20 TM male patients, the serum ferritin levels at the diagnosis were above 5.000 ng/ml). Conclusions: These data underline that endocrine and bone complications in adult TM patients are highly prevalent and necessitate close monitoring, treatment, and follow-up. Physicians' strategies to optimize chelation therapy include

  15. Training Advanced Practice Palliative Care Nurses.

    ERIC Educational Resources Information Center

    Sherman, Deborah Witt

    1999-01-01

    Describes the role and responsibilities of advanced-practice nurses in palliative care and nursing's initiative in promoting high-quality care through the educational preparation of these nurses. (JOW)

  16. Advances in bypassing agent therapy for hemophilia patients with inhibitors to close care gaps and improve outcomes.

    PubMed

    Shapiro, Amy D; Hedner, Ulla

    2011-10-01

    In the past, patients with hemophilia and inhibitors have had less-than-optimal treatment and have experienced more orthopedic complications than patients without inhibitors. Bypassing agents offer the potential to close treatment gaps between inhibitor and noninhibitor patients by helping the former better attain key treatment goals, including: facilitating early initiation of treatment and hemostatic control in hemarthroses; providing effective treatment in serious hemorrhagic episodes; and performance of major surgery. Effective treatment with a bypassing agent minimizes joint and/or muscle damage and potentially can serve as an effective prophylactic agent to minimize the number of hemarthroses experienced per year, thereby mitigating the development of arthropathy. The reported efficacy of the currently available bypassing agents ranges from approximately 50-80% (50-64% in controlled studies) for plasma-derived activated prothrombin complex concentrate (pd-aPCC) and 81-91% (in controlled studies) for recombinant activated factor VII (rFVIIa), including use in major orthopedic surgery. Both bypassing agents have undergone key improvements in their formulation and/or properties in recent years. The nanofiltered, vapor-heated formulation of pd-aPCC has diminished the risk of acquiring blood-borne viral infections and the room temperature stable formulation of rFVIIa allows more convenient storage, increased ease to dissolve and inject, and smaller volumes, thereby increasing overall ease of administration. Use of recommended dosing has been demonstrated to provide effective hemostasis with a minimal number of injections for both agents. In this paper, we review the individual characteristics of pd-aPCC and rFVIIa and discuss clinical data from studies conducted in inhibitor patients that demonstrate the potential benefits of these bypassing agents in this difficult-to-treat population, and underscore the potential opportunities to close the gap in care between

  17. [Palliative care needs in advanced chronic illness].

    PubMed

    Tripodoro, Vilma A; Rynkiewicz, María C; Llanos, Victoria; Padova, Susana; De Lellis, Silvina; De Simone, Gustavo

    2016-01-01

    About 75% of population will die from one or more chronic progressive diseases. From this projection WHO urged countries to devise strategies for strengthening palliative treatment as part of comprehensive care. In Catalonia, Spain, direct measurement of the prevalence of these patients with NECPAL CCOMS-ICO© tool was 1.5% of the population. This tool is an indicative, not dichotomous, quali-quantitative multifactorial evaluation to be completed by the treating physician. In Argentina there is no information on these patients. Our goal was to explore and characterize the proportion of chronically ill patients in palliative care needs, by NECPAL CCOMS-ICO© tool, in an accessible population of the City of Buenos Aires. General hospitals of the Health Region 2 (Piñero, álvarez and Santojanni) and its program areas were surveyed. In Health Region 1, we surveyed the Udaondo gastroenterology hospital. A total of 53 physicians (704 patients) were interviewed. It was identified that 29.5% of these patients were affected by advanced chronic diseases; 72.1% of them were NECPAL positive, younger (median 64) than in others studies, and more than 98% presented high levels of comorbidity. Palliative care demand (31.4%) and needs (52.7%) were recorded. Specific indicators of fragility, progression, severity and kind of chronic disease were described. The main finding was to identify, with an instrument not based on mortality that, in Buenos Aires City, 1 in 3 patients with chronic diseases could die in the next year and had palliative care needs. PMID:27295702

  18. End-of-life care in advanced dementia.

    PubMed

    Heron, Christopher R; Simmons, B Brent

    2014-10-01

    In the next 30 years, the average age of the population will continue to increase, as will the prevalence of dementia. The management of advanced dementia requires the careful orchestration of communication, prognostication, patient care, and caregiver education. Understanding the specific tools available to establish prognosis and guide medical management in these complicated medical patients greatly improves patient and caregiver satisfaction at the end of the patient's life. In caring for patients with advanced-stage dementia, providers should be knowledgeable regarding the terminal nature of the condition and its common comorbid diseases, and should be prepared to educate the patients' caregivers, building a structure of support for the patient's benefit and navigating the complexities of end-of-life care. PMID:25414940

  19. Advance directives, living wills, and futility in perioperative care.

    PubMed

    Goede, Matthew; Wheeler, Matthew

    2015-04-01

    Patient autonomy is preserved through the use of advance directives. A living will defines treatment by establishing parameters under which patients want to be treated. A durable power of attorney for health care establishes a surrogate for patients if they are unable to make decisions for themselves. In the perioperative setting, advance directives are applied with significant variation between surgeons, likely due to surgeons implying from informed consent discussions that patients want to pursue aggressive treatment. Futility is a rare occurrence in patient care that is difficult to define; however, there are some classic surgical conditions in which futility is part of the decision process.

  20. Ethics and advance care planning in a culturally diverse society.

    PubMed

    Johnstone, Megan-Jane; Kanitsaki, Olga

    2009-10-01

    Emerging international research suggests that in multicultural countries, such as Australia and the United States, there are significant disparities in end-of-life care planning and decision making by people of minority ethnic backgrounds compared with members of mainstream English-speaking background populations. Despite a growing interest in the profound influence of culture and ethnicity on patient choices in end-of-life care, and the limited uptake of advance care plans and advance directives by ethnic minority groups in mainstream health care contexts, there has been curiously little attention given to cross-cultural considerations in advance care planning and end-of-life care. Also overlooked are the possible implications of cross-cultural considerations for nurses, policy makers, and others at the forefront of planning and providing end-of-life care to people of diverse cultural and language backgrounds. An important aim of this article is to redress this oversight.

  1. Advanced units: quality measures in urgency and emergency care

    PubMed Central

    Viola, Dan Carai Maia; Cordioli, Eduardo; Pedrotti, Carlos Henrique Sartorato; Iervolino, Mauro; Bastos, Antonio da Silva; de Almeida, Luis Roberto Natel; Neves, Henrique Sutton de Sousa; Lottenberg, Claudio Luiz

    2014-01-01

    Objective To evaluate, through care indicators, the quality of services rendered to patients considered urgency and emergency cases at an advanced emergency care unit. Methods We analyzed data from managerial reports of 64,891 medical visits performed in the Emergency Care Unit of the Ibirapuera Unit at Care during the period from June 1st, 2012 through May 31st, 2013. The proposed indicators for the assessment of care were rate of death in the emergency care unit; average length of stay of patients in the unit; rate of unplanned return visits; admission rate for patients screened as level 1 according to the Emergency Severity Index; rate of non-finalized medical consultations; rate of complaints; and door-to-electrocardiogram time. Results The rate of death in the emergency care unit was zero. Five of the 22 patients classified as Emergency Severity Index 1 (22.7%) arrived presenting cardiac arrest. All were treated with cardiopulmonary resuscitation and reestablishment of vital functions. The average length of stay of patients in the unit was 3 hours, 33 minutes, and 7 seconds. The rate of unscheduled return visits at the emergency care unit of the Ibirapuera unit was 13.64%. Rate of complaints was 2.8/1,000 patients seen during the period Conclusion The model of urgency and emergency care in advanced units provides an efficient and efficaious service to patients. Both critically ill patients and those considered less complex can receive proper treatment for their needs. PMID:25628203

  2. 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

  3. [Technological advances and hospital-at-home care].

    PubMed

    Tibaldi, Vittoria; Aimonino Ricauda, Nicoletta; Rocco, Maurizio; Bertone, Paola; Fanton, Giordano; Isaia, Giancarlo

    2013-05-01

    Advances in the miniaturization and portability of diagnostic technologies, information technologies, remote monitoring, and long-distance care have increased the viability of home-based care, even for patients with serious conditions. Telemedicine and teleradiology projects are active at the Hospital at Home Service of Torino. PMID:23748683

  4. [Technological advances and hospital-at-home care].

    PubMed

    Tibaldi, Vittoria; Aimonino Ricauda, Nicoletta; Rocco, Maurizio; Bertone, Paola; Fanton, Giordano; Isaia, Giancarlo

    2013-05-01

    Advances in the miniaturization and portability of diagnostic technologies, information technologies, remote monitoring, and long-distance care have increased the viability of home-based care, even for patients with serious conditions. Telemedicine and teleradiology projects are active at the Hospital at Home Service of Torino.

  5. Pediatric advance care planning from the perspective of health care professionals: A qualitative interview study

    PubMed Central

    Jox, Ralf J; Borasio, Gian Domenico; Führer, Monika

    2015-01-01

    Background: Pediatric advance care planning differs from the adult setting in several aspects, including patients’ diagnoses, minor age, and questionable capacity to consent. So far, research has largely neglected the professionals’ perspective. Aim: We aimed to investigate the attitudes and needs of health care professionals with regard to pediatric advance care planning. Design: This is a qualitative interview study with experts in pediatric end-of-life care. A qualitative content analysis was performed. Setting/participants: We conducted 17 semi-structured interviews with health care professionals caring for severely ill children/adolescents, from different professions, care settings, and institutions. Results: Perceived problems with pediatric advance care planning relate to professionals’ discomfort and uncertainty regarding end-of-life decisions and advance directives. Conflicts may arise between physicians and non-medical care providers because both avoid taking responsibility for treatment limitations according to a minor’s advance directive. Nevertheless, pediatric advance care planning is perceived as helpful by providing an action plan for everyone and ensuring that patient/parent wishes are respected. Important requirements for pediatric advance care planning were identified as follows: repeated discussions and shared decision-making with the family, a qualified facilitator who ensures continuity throughout the whole process, multi-professional conferences, as well as professional education on advance care planning. Conclusion: Despite a perceived need for pediatric advance care planning, several barriers to its implementation were identified. The results remain to be verified in a larger cohort of health care professionals. Future research should focus on developing and testing strategies for overcoming the existing barriers. PMID:25389347

  6. Advancing the role of nonprofit health care.

    PubMed

    Metcalfe, Marcia

    2002-01-01

    This article comes out of a series of discussions among a diverse group of chief executive officers (CEOs) and other leaders of nonprofit hospitals, long-term care facilities, health maintenance organizations, and other insurance providers, including several nonprofit Blue Cross Blue Shield (BCBS) plans. The group was convened as part of Howard Berman's Walter J. McNerney Fellowship project. (Berman is CEO of Excellus, Inc., a nonprofit Blue Cross Blue Shield affiliate that insures the health of more than 2.15 million people in upstate New York. He was awarded the McNerney Fellowship in April 2001 by the Health Research and Educational Trust, an American Hospital Association affiliate. The Fellowship goes annually to at least one fellow to highlight or pursue work that will provide new insights into how different sectors of the health care system can better work together for improved outcomes.) The group has met several times over the past year around a shared concern: the current challenges to nonprofit health care organizations and the future role for nonprofits in the re-visioning and creation of an American health care system that is characterized by universal access, patient-centered quality, and national affordability. Members have supported the public relations campaign of the "Alliance for Advancing Nonprofit Health Care," an effort initiated by the Caucus, an independent group of nonprofit BCBS plans. The group continues to explore the need for a broad-based coalition of providers, insurers, and other organizations to effectively protect and enhance the role of nonprofit health care.

  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. Benefits of Early Versus Delayed Palliative Care to Informal Family Caregivers of Patients With Advanced Cancer: Outcomes From the ENABLE III Randomized Controlled Trial

    PubMed Central

    Dionne-Odom, J. Nicholas; Azuero, Andres; Lyons, Kathleen D.; Hull, Jay G.; Tosteson, Tor; Li, Zhigang; Li, Zhongze; Frost, Jennifer; Dragnev, Konstantin H.; Akyar, Imatullah; Hegel, Mark T.; Bakitas, Marie A.

    2015-01-01

    Purpose To determine the effect of early versus delayed initiation of a palliative care intervention for family caregivers (CGs) of patients with advanced cancer. Patients and Methods Between October 2010 and March 2013, CGs of patients with advanced cancer were randomly assigned to receive three structured weekly telephone coaching sessions, monthly follow-up, and a bereavement call either early after enrollment or 3 months later. CGs of patients with advanced cancer were recruited from a National Cancer Institute cancer center, a Veterans Administration Medical Center, and two community outreach clinics. Outcomes were quality of life (QOL), depression, and burden (objective, stress, and demand). Results A total of 122 CGs (early, n = 61; delayed, n = 61) of 207 patients participated; average age was 60 years, and most were female (78.7%) and white (92.6%). Between-group differences in depression scores from enrollment to 3 months (before delayed group started intervention) favored the early group (mean difference, −3.4; SE, 1.5; d = −.32; P = .02). There were no differences in QOL (mean difference, −2; SE, 2.3; d = −.13; P = .39) or burden (objective: mean difference, 0.3; SE, .7; d = .09; P = .64; stress: mean difference, −.5; SE, .5; d = −.2; P = .29; demand: mean difference, 0; SE, .7; d = −.01; P = .97). In decedents' CGs, a terminal decline analysis indicated between-group differences favoring the early group for depression (mean difference, −3.8; SE, 1.5; d = −.39; P = .02) and stress burden (mean difference, −1.1; SE, .4; d = −.44; P = .01) but not for QOL (mean difference, −4.9; SE, 2.6; d = −.3; P = .07), objective burden (mean difference, −.6; SE, .6; d = −.18; P = .27), or demand burden (mean difference, −.7; SE, .6; d = −.23; P = .22). Conclusion Early-group CGs had lower depression scores at 3 months and lower depression and stress burden in the terminal decline analysis. Palliative care for CGs should be initiated

  9. Oncology Advanced Practitioners Bring Advanced Community Oncology Care.

    PubMed

    Vogel, Wendy H

    2016-01-01

    Oncology care is becoming increasingly complex. The interprofessional team concept of care is necessary to meet projected oncology professional shortages, as well as to provide superior oncology care. The oncology advanced practitioner (AP) is a licensed health care professional who has completed advanced training in nursing or pharmacy or has completed training as a physician assistant. Oncology APs increase practice productivity and efficiency. Proven to be cost effective, APs may perform varied roles in an oncology practice. Integrating an AP into an oncology practice requires forethought given to the type of collaborative model desired, role expectations, scheduling, training, and mentoring. PMID:27249776

  10. Center to Advance Palliative Care palliative care clinical care and customer satisfaction metrics consensus recommendations.

    PubMed

    Weissman, David E; Morrison, R Sean; Meier, Diane E

    2010-02-01

    Data collection and analysis are vital for strategic planning, quality improvement, and demonstration of palliative care program impact to hospital administrators, private funders and policymakers. Since 2000, the Center to Advance Palliative Care (CAPC) has provided technical assistance to hospitals, health systems and hospices working to start, sustain, and grow nonhospice palliative care programs. CAPC convened a consensus panel in 2008 to develop recommendations for specific clinical and customer metrics that programs should track. The panel agreed on four key domains of clinical metrics and two domains of customer metrics. Clinical metrics include: daily assessment of physical/psychological/spiritual symptoms by a symptom assessment tool; establishment of patient-centered goals of care; support to patient/family caregivers; and management of transitions across care sites. For customer metrics, consensus was reached on two domains that should be tracked to assess satisfaction: patient/family satisfaction, and referring clinician satisfaction. In an effort to ensure access to reliably high-quality palliative care data throughout the nation, hospital palliative care programs are encouraged to collect and report outcomes for each of the metric domains described here. PMID:19922199

  11. Technological Advances in Nursing Care Delivery.

    PubMed

    Sullivan, Debra Henline

    2015-12-01

    Technology is rapidly changing the way nurses deliver patient care. The Health Information Technology for Economic and Clinical Health Act of 2009 encourages health care providers to implement electronic health records for meaningful use of patient information. This development has opened the door to many technologies that use this information to streamline patient care. This article explores current and new technologies that nurses will be working with either now or in the near future.

  12. “EXHALE”: exercise as a strategy for rehabilitation in advanced stage lung cancer patients: a randomized clinical trial comparing the effects of 12 weeks supervised exercise intervention versus usual care for advanced stage lung cancer patients

    PubMed Central

    2013-01-01

    Background Lung cancer is the leading cause of cancer death in North America and Western Europe. Patients with lung cancer in general have reduced physical capacity, functional capacity, poor quality of life and increased levels of anxiety and depression. Intervention studies indicate that physical training can address these issues. However, there is a lack of decisive evidence regarding the effect of physical exercise in patients with advanced lung cancer. The aim of this study is to evaluate the effects of a twelve weeks, twice weekly program consisting of: supervised, structured training in a group of advanced lung cancer patients (cardiovascular and strength training, relaxation). Methods/Design A randomized controlled trial will test the effects of the exercise intervention in 216 patients with advanced lung cancer (non-small cell lung cancer (NSCLC) stage IIIb - IV and small cell lung cancer (SCLC) extensive disease (ED)). Primary outcome is maximal oxygen uptake (VO2peak). Secondary outcomes are muscle strength (1RM), functional capacity (6MWD), lung capacity (Fev1) and patient reported outcome (including anxiety, depression (HADS) and quality of life (HRQOL)). Discussion The present randomized controlled study will provide data on the effectiveness of a supervised exercise intervention in patients receiving systemic therapy for advanced lung cancer. It is hoped that the intervention can improve physical capacity and functional level, during rehabilitation of cancer patients with complex symptom burden and help them to maintain independent function for as long as possible. Trial registration http://ClinicalTrials.gov, NCT01881906 PMID:24124893

  13. Advanced Respite Care: Medically Challenged. Teacher Edition. Respite Care Series.

    ERIC Educational Resources Information Center

    Oklahoma State Dept. of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.

    This curriculum guide is designed to help teachers to provide advanced-level training for care providers who want to work with individuals who are chronically or terminally ill and require specialized care. The curriculum contains seven units. Each of the instructional units includes some or all of these basic components: performance objectives,…

  14. Center to Advance Palliative Care

    MedlinePlus

    ... Take me to the Registry Registry Jobs For Job Seekers CAPC posts positions for palliative care professionals ... field. Browse the listings , and please contact the job poster directly for further information. Browse Jobs For ...

  15. Survival analysis of platinum-refractory patients with advanced esophageal cancer treated with docetaxel or best supportive care alone: a retrospective study.

    PubMed

    Moriwaki, T; Kajiwara, T; Matsumoto, T; Suzuki, H; Hiroshima, Y; Matsuda, K; Hirai, S; Yamamoto, Y; Yamada, T; Sugaya, A; Kobayashi, M; Endo, S; Ishige, K; Nishina, T; Hyodo, I

    2014-01-01

    The survival benefit of second-line chemotherapy with docetaxel in platinum-refractory patients with advanced esophageal cancer (AEC) remains unclear. A retrospective analysis of AEC patients with Eastern Cooperative Oncology Group performance status (PS)≤2 was performed, and major organ functions were preserved, who determined to receive docetaxel or best supportive care (BSC) alone after failure of platinum-based chemotherapy. The post-progression survival (PPS), defined as survival time after disease progression following platinum-based chemotherapy, was analyzed by multivariate Cox regression analysis using factors identified as significant in univariate analysis of various 20 characteristics (age, sex, PS, primary tumor location, etc) including Glasgow prognostic score (GPS), which is a well-known prognostic factor in many malignant tumors. Sixty-six and 45 patients were determined to receive docetaxel and BSC between January 2007 and December 2011, respectively. The median PPS was 5.4 months (95% confidence interval [CI] 4.8-6.0) in the docetaxel group and 3.3 months (95% CI 2.5-4.0) in the BSC group (hazard ratio [HR] 0.56, 95% CI 0.38-0.84, P=0.005). Univariate analysis revealed six significant factors: treatment, PS, GPS, number of metastatic organs, liver metastasis, and bone metastasis. Multivariate analysis including these significant factors revealed three independent prognostic factors: docetaxel treatment (HR 0.62, 95% CI 0.39-0.99, P=0.043), better GPS (HR 0.61, 95% CI 0.46-0.81, P=0.001), and no bone metastasis (HR 0.31, 95% CI 0.15-0.68, P=0.003). There was a trend for PPS in favor of the docetaxel group compared with patients who refused docetaxel treatment in the BSC group (adjusted HR 0.61, 95% CI 0.29-1.29, P=0.20). Docetaxel treatment may have prolonged survival in platinum-refractory patients with AEC.

  16. Legal Briefing: Medicare Coverage of Advance Care Planning.

    PubMed

    Pope, Thaddeus Mason

    2015-01-01

    This issue's "Legal Briefing" column covers the recent decision by the Centers for Medicare and Medicaid Services (CMS) to expand Medicare coverage of advance care planning, beginning 1 January 2016. Since 2009, most "Legal Briefings" in this journal have covered a wide gamut of judicial, legislative, and regulatory developments concerning a particular topic in clinical ethics. In contrast, this "Legal Briefing" is more narrowly focused on one single legal development. This concentration on Medicare coverage of advance care planning seems warranted. Advance care planning is a frequent subject of articles in JCE. After all, it has long been seen as an important, albeit only partial, solution to a significant range of big problems in clinical ethics. These problems range from medical futility disputes to decision making for incapacitated patients who have no available legally authorized surrogate. Consequently, expanded Medicare coverage of advance care planning is a potentially seismic development. It may materially reduce both the frequency and severity of key problems in clinical ethics. Since the sociological, medical, and ethical literature on advance care planning is voluminous, I will not even summarize it here. Instead, I focus on Medicare coverage. I proceed, chronologically, in six stages: 1. Prior Medicare Coverage of Advance Care Planning 2. Proposed Expanded Medicare Coverage in 2015 3. Proposed Expanded Medicare Coverage in 2016 4. The Final Rule Expanding Medicare Coverage in 2016 5. Remaining Issues for CMS to Address in 2017 6. Pending Federal Legislation.

  17. Legal Briefing: Medicare Coverage of Advance Care Planning.

    PubMed

    Pope, Thaddeus Mason

    2015-01-01

    This issue's "Legal Briefing" column covers the recent decision by the Centers for Medicare and Medicaid Services (CMS) to expand Medicare coverage of advance care planning, beginning 1 January 2016. Since 2009, most "Legal Briefings" in this journal have covered a wide gamut of judicial, legislative, and regulatory developments concerning a particular topic in clinical ethics. In contrast, this "Legal Briefing" is more narrowly focused on one single legal development. This concentration on Medicare coverage of advance care planning seems warranted. Advance care planning is a frequent subject of articles in JCE. After all, it has long been seen as an important, albeit only partial, solution to a significant range of big problems in clinical ethics. These problems range from medical futility disputes to decision making for incapacitated patients who have no available legally authorized surrogate. Consequently, expanded Medicare coverage of advance care planning is a potentially seismic development. It may materially reduce both the frequency and severity of key problems in clinical ethics. Since the sociological, medical, and ethical literature on advance care planning is voluminous, I will not even summarize it here. Instead, I focus on Medicare coverage. I proceed, chronologically, in six stages: 1. Prior Medicare Coverage of Advance Care Planning 2. Proposed Expanded Medicare Coverage in 2015 3. Proposed Expanded Medicare Coverage in 2016 4. The Final Rule Expanding Medicare Coverage in 2016 5. Remaining Issues for CMS to Address in 2017 6. Pending Federal Legislation. PMID:26752396

  18. 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

  19. 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.

  20. 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.

  1. [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.

  2. 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.

  3. Natural advances in eczema care.

    PubMed

    Eichenfield, Lawrence F; Fowler, Joseph F; Rigel, Darrell S; Taylor, Susan C

    2007-12-01

    Atopic dermatitis (AD) is a chronic relapsing dermatitis characterized by increased transepidermal water loss (TEWL) and subjective symptoms of pruritus, inflammation, skin sensitivity, and dryness. AD is a frequent issue for individuals of color, though it may be underrecognized. Therapy for AD is based on reducing pruritus and inflammation, and normalizing skin surface lipids, particularly ceramides. Topical corticosteroids are the gold-standard treatment for controlling disease flares, but a variety of active natural ingredients can be used adjunctively to help control itch, inflammation, and dryness. Oatmeal, particularly avenanthramides, a newly discovered oat fraction, may be of particular value in restoring the cutaneous barrier and reducing symptoms of AD. Feverfew, licorice, and dexpanthenol also have been shown to be effective in the management of inflammation. Licorice, which has some skin-lightening activity, may be helpful in patients with postinflammatory hyperpigmentation (PIH). The compromised skin barrier in AD is especially vulnerable to UV radiation exposure. Several new long-lasting photostable sunscreen ingredients provide longer durations of protection with improved cosmetic attributes. PMID:18277662

  4. 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

  5. Advanced access: reducing waiting and delays in primary care.

    PubMed

    Murray, Mark; Berwick, Donald M

    2003-02-26

    Delay of care is a persistent and undesirable feature of current health care systems. Although delay seems to be inevitable and linked to resource limitations, it often is neither. Rather, it is usually the result of unplanned, irrational scheduling and resource allocation. Application of queuing theory and principles of industrial engineering, adapted appropriately to clinical settings, can reduce delay substantially, even in small practices, without requiring additional resources. One model, sometimes referred to as advanced access, has increasingly been shown to reduce waiting times in primary care. The core principle of advanced access is that patients calling to schedule a physician visit are offered an appointment the same day. Advanced access is not sustainable if patient demand for appointments is permanently greater than physician capacity to offer appointments. Six elements of advanced access are important in its application balancing supply and demand, reducing backlog, reducing the variety of appointment types, developing contingency plans for unusual circumstances, working to adjust demand profiles, and increasing the availability of bottleneck resources. Although these principles are powerful, they are counter to deeply held beliefs and established practices in health care organizations. Adopting these principles requires strong leadership investment and support.

  6. Advanced access: reducing waiting and delays in primary care.

    PubMed

    Murray, Mark; Berwick, Donald M

    2003-02-26

    Delay of care is a persistent and undesirable feature of current health care systems. Although delay seems to be inevitable and linked to resource limitations, it often is neither. Rather, it is usually the result of unplanned, irrational scheduling and resource allocation. Application of queuing theory and principles of industrial engineering, adapted appropriately to clinical settings, can reduce delay substantially, even in small practices, without requiring additional resources. One model, sometimes referred to as advanced access, has increasingly been shown to reduce waiting times in primary care. The core principle of advanced access is that patients calling to schedule a physician visit are offered an appointment the same day. Advanced access is not sustainable if patient demand for appointments is permanently greater than physician capacity to offer appointments. Six elements of advanced access are important in its application balancing supply and demand, reducing backlog, reducing the variety of appointment types, developing contingency plans for unusual circumstances, working to adjust demand profiles, and increasing the availability of bottleneck resources. Although these principles are powerful, they are counter to deeply held beliefs and established practices in health care organizations. Adopting these principles requires strong leadership investment and support. PMID:12597760

  7. Pain: advances and issues in critical care.

    PubMed

    Harrison, M; Cotanch, P H

    1987-09-01

    The milieu of the critical care unit is stressful for both the patient and health care professionals. As such, it has the potential to increase pain perception in patients, and decrease the nurse's awareness of pain relief needs of the patient. Several physical and pharmacologic methods of pain relief were discussed in this article. Nontechnologic analgesia such as hypnosis and relaxation were introduced as adjuncts or alternatives to more familiar methods of pain relief. Although critically ill patients are not always able to express their discomfort, it is the responsibility of the nurse to recognize the potential for pain, and plan treatment accordingly. This article suggests several strategies for dealing with pain in critically ill patients. PMID:3302958

  8. 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

  9. An Assessment of Social Diffusion in the Respecting Choices Advance Care Planning Program

    ERIC Educational Resources Information Center

    Moorman, Sara M.; Carr, Deborah; Kirchhoff, Karin T.; Hammes, Bernard J.

    2012-01-01

    This study examines the potential social diffusion effects of the Respecting Choices advance care planning program administered in La Crosse, Wisconsin, since 1991. The program produces educational materials for patients, trains facilitators to help patients prepare for end of life, and ensures that advance directives are connected to patients'…

  10. Experiences of the advanced nurse practitioner role in acute care.

    PubMed

    Cowley, Alison; Cooper, Joanne; Goldberg, Sarah

    2016-05-01

    The aim of the service evaluation presented in this article was to explore the multidisciplinary team's (MDT) experiences and perception of the advanced nurse practitioner (ANP) role on an acute health care of the older person ward. A qualitative case study was carried out comprising semi-structured interviews with members of the MDT, exploring their experiences of the ANP role. An overarching theme of 'Is it a nurse? Is it a doctor? No, it's an ANP' emerged from the data, with three subthemes: the missing link; facilitating and leading holistic care; and safe, high quality care. The ANP role is valued by the MDT working with them and provides a unique skill set that has the potential to enhance care of older patients living with frailty. While there are challenges to its introduction, it is a role worth introducing to older people's wards.

  11. Experiences of the advanced nurse practitioner role in acute care.

    PubMed

    Cowley, Alison; Cooper, Joanne; Goldberg, Sarah

    2016-05-01

    The aim of the service evaluation presented in this article was to explore the multidisciplinary team's (MDT) experiences and perception of the advanced nurse practitioner (ANP) role on an acute health care of the older person ward. A qualitative case study was carried out comprising semi-structured interviews with members of the MDT, exploring their experiences of the ANP role. An overarching theme of 'Is it a nurse? Is it a doctor? No, it's an ANP' emerged from the data, with three subthemes: the missing link; facilitating and leading holistic care; and safe, high quality care. The ANP role is valued by the MDT working with them and provides a unique skill set that has the potential to enhance care of older patients living with frailty. While there are challenges to its introduction, it is a role worth introducing to older people's wards. PMID:27125941

  12. [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

  13. 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 » ...

  14. 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

  15. Strategic targeting of advance care planning interventions: the Goldilocks phenomenon.

    PubMed

    Billings, J Andrew; Bernacki, Rachelle

    2014-04-01

    Strategically selecting patients for discussions and documentation about limiting life-sustaining treatments-choosing the right time along the end-of-life trajectory for such an intervention and identifying patients at high risk of facing end-of-life decisions-can have a profound impact on the value of advance care planning (ACP) efforts. Timing is important because the completion of an advance directive (AD) too far from or too close to the time of death can lead to end-of-life decisions that do not optimally reflect the patient's values, goals, and preferences: a poorly chosen target patient population that is unlikely to need an AD in the near future may lead to patients making unrealistic, hypothetical choices, while assessing preferences in the emergency department or hospital in the face of a calamity is notoriously inadequate. Because much of the currently studied ACP efforts have led to a disappointingly small proportion of patients eventually benefitting from an AD, careful targeting of the intervention should also improve the efficacy of such projects. A key to optimal timing and strategic selection of target patients for an ACP program is prognostication, and we briefly highlight prognostication tools and studies that may point us toward high-value AD interventions. PMID:24493203

  16. Strategic targeting of advance care planning interventions: the Goldilocks phenomenon.

    PubMed

    Billings, J Andrew; Bernacki, Rachelle

    2014-04-01

    Strategically selecting patients for discussions and documentation about limiting life-sustaining treatments-choosing the right time along the end-of-life trajectory for such an intervention and identifying patients at high risk of facing end-of-life decisions-can have a profound impact on the value of advance care planning (ACP) efforts. Timing is important because the completion of an advance directive (AD) too far from or too close to the time of death can lead to end-of-life decisions that do not optimally reflect the patient's values, goals, and preferences: a poorly chosen target patient population that is unlikely to need an AD in the near future may lead to patients making unrealistic, hypothetical choices, while assessing preferences in the emergency department or hospital in the face of a calamity is notoriously inadequate. Because much of the currently studied ACP efforts have led to a disappointingly small proportion of patients eventually benefitting from an AD, careful targeting of the intervention should also improve the efficacy of such projects. A key to optimal timing and strategic selection of target patients for an ACP program is prognostication, and we briefly highlight prognostication tools and studies that may point us toward high-value AD interventions.

  17. The ascension health experience: maximizing the chief nursing officer role in a large, multihospital system to advance patient care quality and safety.

    PubMed

    Hendrich, Ann L; Batcheller, Joyce; Ellison, Darcy A; Janik, Angela M; Jeffords, Nina B; Miller, Linda; Perlich, Gwynn L; Staffileno, Gerri; Strom, Maria; Williams, Cynthia

    2012-01-01

    Ascension Health is the largest Catholic and nonprofit health system in the United States, encompassing 70 acute care hospitals organized into 34 health ministries. Consistent with its distributed leadership model, Ascension Health has created a Chief Nursing Officer (CNO) Advisory Council to provide strategic direction and thought leadership on major system-level initiatives that impact quality, safety, operational performance, nursing leadership, and patient care delivery. The council fosters systemwide CNO engagement and dialogue through a unique structure of regional CNO work teams called "pods," each of which is chaired by a member of the council. This communication structure has facilitated consensus on major system initiatives at Ascension Health related to clinical goals, patient safety, nursing leadership, and systemwide capital investments. This article describes the history, structure, goals, processes, and successes of the CNO Advisory Council shared governance model.

  18. 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

  19. Advance Care Planning and Goals of Care Communication in Older Adults with Cardiovascular Disease and Multi-Morbidity.

    PubMed

    Lum, Hillary D; Sudore, Rebecca L

    2016-05-01

    This article provides an approach to advance care planning (ACP) and goals of care communication in older adults with cardiovascular disease and multi-morbidity. The goal of ACP is to ensure that the medical care patients receive is aligned with their values and preferences. In this article, the authors outline common benefits and challenges to ACP for older adults with cardiovascular disease and multimorbidity. Recognizing that these patients experience diverse disease trajectories and receive care in multiple health care settings, the authors provide practical steps for multidisciplinary teams to integrate ACP into brief clinic encounters.

  20. Delirium in patients with advanced cancer.

    PubMed

    Lawlor, Peter G; Bruera, Eduardo D

    2002-06-01

    Managing delirium is of major importance in end-of-life care and frequently gives rise to controversies and to clinical and ethical dilemmas. These problems arise from a number of causes, including the sometimes-poor recognition or misdiagnosis of delirium despite its frequent occurrence. Delirium generates major symptomatic of distress for the patient, consequent stress for the patient's family, the potential to misinterpret delirium symptomatology, and behavioral management challenges for health care professionals. Paradoxically, delirium is potentially reversible in some episodes, but in many patients delirium presents a nonreversible terminal episode. Greater educational efforts are required to improve the recognition of delirium and lead to a better understanding of its impact in end-of-life care. Future research might focus on phenomenology, the development of low-burden instruments for assessment, communication strategies, and the family education regarding the manifestations of delirium. Further research is needed among patients with advanced cancer to establish a predictive model for reversibility that recognizes both baseline vulnerability factors and superimposed precipitating factors. Evidence-based guidelines should be developed to assist physicians in more appropriate use of sedation in the symptomatic management of delirium.

  1. End-of-Life Decisions and Palliative Care in Advanced Heart Failure.

    PubMed

    Meyers, Deborah E; Goodlin, Sarah J

    2016-09-01

    Advanced heart failure (HF) therapies are focused on extending life and improving function. In contrast, palliative care is a holistic approach that focuses on symptom alleviation and patients' physical, psychosocial, and spiritual needs. HF clinicians can integrate palliative care strategies by incorporating several important components of planning and decision-making for HF patients. Future care planning (FCP) for HF patients should incorporate the basic tenets of shared decision-making (SDM). These include understanding the patient's perspective and care preferences, articulating what is medically feasible, and integrating these considerations into the overall care plan. Use of defined triggers for FCP can stimulate important patient-caregiver conversations. Guidelines advocate an annual review of HF status and future care preferences. Advance directives are important for any individual with a chronic, life-limiting illness and should be integrated into FCP. Nevertheless, use of advance directives by HF patients is extremely low. Consideration of illness trajectories and risk-scoring tools might facilitate prognostication and delivery of appropriate HF care. Decisions about heart transplantation or left ventricular assist device implantation should include planning for potential complications associated with these therapies. Such decisions also should include a discussion of palliative management, as an alternative to intervention and also as an option for managing symptoms or adverse events after intervention. Palliative care, including FCP and SDM, should be integrated into the course of all patients with advanced HF. Clinicians who provide HF care should acquire the skills necessary for conducting FCP and SDM discussions.

  2. End-of-Life Decisions and Palliative Care in Advanced Heart Failure.

    PubMed

    Meyers, Deborah E; Goodlin, Sarah J

    2016-09-01

    Advanced heart failure (HF) therapies are focused on extending life and improving function. In contrast, palliative care is a holistic approach that focuses on symptom alleviation and patients' physical, psychosocial, and spiritual needs. HF clinicians can integrate palliative care strategies by incorporating several important components of planning and decision-making for HF patients. Future care planning (FCP) for HF patients should incorporate the basic tenets of shared decision-making (SDM). These include understanding the patient's perspective and care preferences, articulating what is medically feasible, and integrating these considerations into the overall care plan. Use of defined triggers for FCP can stimulate important patient-caregiver conversations. Guidelines advocate an annual review of HF status and future care preferences. Advance directives are important for any individual with a chronic, life-limiting illness and should be integrated into FCP. Nevertheless, use of advance directives by HF patients is extremely low. Consideration of illness trajectories and risk-scoring tools might facilitate prognostication and delivery of appropriate HF care. Decisions about heart transplantation or left ventricular assist device implantation should include planning for potential complications associated with these therapies. Such decisions also should include a discussion of palliative management, as an alternative to intervention and also as an option for managing symptoms or adverse events after intervention. Palliative care, including FCP and SDM, should be integrated into the course of all patients with advanced HF. Clinicians who provide HF care should acquire the skills necessary for conducting FCP and SDM discussions. PMID:27568873

  3. 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.

  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. Palliative communications: addressing chemotherapy in patients with advanced cancer.

    PubMed

    Kadakia, K C; Moynihan, T J; Smith, T J; Loprinzi, C L

    2012-04-01

    Patients with advanced cancers often endure chemotherapy late in their disease course leading to unnecessary adverse effects, loss of quality of life, and delay in hospice referral. Compassionate and honest communication about the use of chemotherapy can facilitate better patient care. This manuscript will explore communication issues regarding palliative-intent chemotherapy.

  8. Advanced hemodynamic monitoring: principles and practice in neurocritical care.

    PubMed

    Lazaridis, Christos

    2012-02-01

    Advanced hemodynamic monitoring is necessary for many patients with acute brain and/or spinal cord injury. Optimizing cerebral and systemic physiology requires multi-organ system function monitoring. Hemodynamic manipulations are cardinal among interventions to regulate cerebral perfusion pressure and cerebral blood flow. The pulmonary artery catheter is not any more the sole tool available; less invasive and potentially more accurate methodologies have been developed and employed in the operating room and among diverse critically ill populations. These include transpulmonary thermodilution, arterial pressure pulse contour, and waveform analysis and bedside critical care ultrasound. A thorough understanding of hemodynamics and of the available monitoring modalities is an essential skill for the neurointensivist.

  9. Recent advance in patient monitoring

    PubMed Central

    2010-01-01

    Recent advance in technology has developed a lot of new aspects of clinical monitoring. We can monitor sedation levels during anesthesia using various electroencephalographic (EEG) indices, while it is still not useful for anesthesia depth monitoring. Some attempts are made to monitor the changes in sympathetic nerve activity as one of the indicators of stress, pain/analgesia, or anesthesia. To know the balance of sympathetic and parasympathetic activity, heart rate or blood pressure variability is investigated. For trend of cardiac output, low invasive monitors have been investigated. Improvement of ultrasound enables us to see cardiac structure and function continuously and clearer, increases success rate and decreases complication of central venous puncture and various kinds of nerve blocks. Without inserting an arterial catheter, trends of arterial oxygen tension or carbon dioxide tension can be monitored. Indirect visualization of the airway decreases difficult intubation and makes it easier to teach tracheal intubation. The changes in blood volume can be speculated non-invasively. Cerebral perfusion and metabolism are not ordinary monitored yet, but some studies show their usefulness in management of critically ill. This review introduces recent advances in various monitors used in anesthesia and critical care including some studies of the author, especially focused on EEG and cardiac output. However, the most important is that these new monitors are not almighty but should be used adequately in a limited situation where their meaning is confirmed. PMID:20877698

  10. Advanced practice nursing in performing arts health care.

    PubMed

    Weslin, Anna T; Silva-Smith, Amy

    2010-06-01

    Performing arts medicine is a growing health care profession specializing in the needs of performing artists. As part of the performing arts venue, the dancer, a combination of athlete and artist, presents with unique health care needs requiring a more collaborative and holistic health care program. Currently there are relatively few advanced practice nurses (APNs) who specialize in performing arts health care. APNs, with focus on collaborative and holistic health care, are ideally suited to join other health care professionals in developing and implementing comprehensive health care programs for the performing artist. This article focuses on the dancer as the client in an APN practice that specializes in performing arts health care.

  11. Palliative care for advanced dementia in Japan: knowledge and attitudes.

    PubMed

    Nakanishi, Miharu; Miyamoto, Yuki

    This study examined factors contributing to the knowledge and attitudes of nursing home staff regarding palliative care for advanced dementia in Japan. A cross-sectional survey of 275 nurses and other care workers from 74 long-term care facilities was conducted across three prefectures in August 2014. The Japanese versions of the Questionnaire on Palliative Care for Advanced Dementia (qPAD) and Frommelt Attitudes Toward Care of the Dying scale, Form B (FATCOD-B-J) were used. Greater knowledge was exhibited among nursing home staff in facilities that established a manual for end-of-life care. Higher levels of positive attitudes were observed among nursing home staff in facilities that had established a manual and those in facilities with a physician's written opinions on end-of-life care. An organisational effort should be explored to establish end-of-life care policies among nursing home staff for advanced dementia.

  12. Advance Care Planning in Nursing Homes: Correlates of Capacity and Possession of Advance Directives

    ERIC Educational Resources Information Center

    Allen, Rebecca S.; DeLaine, Shermetra R.; Chaplin, William F.; Marson, Daniel C.; Bourgeois, Michelle S.; Dijkstra, Katinka; Burgio, Louis D.

    2003-01-01

    Purpose: The identification of nursing home residents who can continue to participate in advance care planning about end-of-life care is a critical clinical and bioethical issue. This study uses high quality observational research to identify correlates of advance care planning in nursing homes, including objective measurement of capacity. Design…

  13. 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

  14. 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.

  15. 38 CFR 17.32 - Informed consent and advance care planning.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...) Definitions: Advance Directive. Specific written statements made by a patient who has decision-making capacity regarding future health care decisions in any of the following: (i) VA Living Will. A written statement made.... (ii) VA Durable Power of Attorney for Health Care. A written instruction on a VA form which...

  16. Improving the Care of Children With Advanced Cancer by Using an Electronic Patient-Reported Feedback Intervention: Results From the PediQUEST Randomized Controlled Trial

    PubMed Central

    Wolfe, Joanne; Orellana, Liliana; Cook, E. Francis; Ullrich, Christina; Kang, Tammy; Geyer, Jeffrey Russell; Feudtner, Chris; Weeks, Jane C.; Dussel, Veronica

    2014-01-01

    Purpose This study aimed to determine whether feeding back patient-reported outcomes (PROs) to providers and families of children with advanced cancer improves symptom distress and health-related quality of life (HRQoL). Patients and Methods This study was a parallel, multicentered pilot randomized controlled trial. At most once per week, children age ≥ 2 years old with advanced cancer or their parent completed the computer-based Pediatric Quality of Life and Evaluation of Symptoms Technology (PediQUEST) survey consisting of age- and respondent-adapted versions of the Memorial Symptom Assessment Scale (MSAS), Pediatric Quality of Life Inventory 4.0 Generic Core Scales (PedsQL4.0), and an overall Sickness question. In the intervention group (n = 51), oncologists and families received printed reports summarizing PROs; e-mails were sent to oncologists and subspecialists when predetermined scores were exceeded. No feedback was provided in the control group (n = 53). Primary outcomes included linear trends of MSAS, PedsQL4.0 total and subscale scores, and Sickness scores during 20 weeks of follow-up, along with child, parent, and provider satisfaction with PediQUEST feedback. Results Feedback did not significantly affect average MSAS, PedsQL4.0, or Sickness score trends. Post hoc subgroup analyses among children age ≥ 8 years who survived 20 weeks showed that feedback improved PedsQL4.0 emotional (+8.1; 95% CI, 1.8 to 14.4) and Sickness (−8.2; 95% CI, −14.2 to −2.2) scores. PediQUEST reports were valued by children, parents, and providers and contributed at least sometimes to physician initiation of a psychosocial consult (56%). Conclusion Although routine feedback of PROs did not significantly affect the child's symptoms or HRQoL, changes were in expected directions and improvements observed in emotional HRQoL through exploratory analyses were encouraging. Importantly, children, parents, and providers value PRO feedback. PMID:24616307

  17. 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.

  18. The Era of “E”: The Use of New Technologies in Advance Care Planning

    PubMed Central

    Green, Michael J.; Levi, Benjamin H.

    2012-01-01

    In this paper, we review developments in technology that can help patients, their loved ones, and healthcare providers engage in more effective advance care planning (ACP). We begin with a brief description of ACP and its purpose; then proceed to discuss various electronically available resources for ACP in the U.S.; and finally provide a critical assessment of the achievements, challenges, and future prospects for electronic advance care planning, or “e-planning.” PMID:23141197

  19. The era of "e": the use of new technologies in advance care planning.

    PubMed

    Green, Michael J; Levi, Benjamin H

    2012-01-01

    In this article, the authors review developments in technology that can help patients, their loved ones, and healthcare providers engage in more effective advance care planning (ACP). The article begins with a brief description of ACP and its purpose and then discusses various electronically available resources for ACP in the U.S. Finally the authors provide a critical assessment of the achievements, challenges, and future prospects for electronic advance care planning, or "e-planning."

  20. 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

  1. 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

  2. Insomnia among patients with advanced disease during admission in a Palliative Care Unit: a prospective observational study on its frequency and association with psychological, physical and environmental factors

    PubMed Central

    2014-01-01

    Background The aims of this study were: 1) to assess the frequency of insomnia among patients during admission in a Palliative Care Unit (PCU); 2) to study the association between emotional distress and insomnia, taking physical, environmental and other psychological factors into account. Methods Prospective observational study including patients consecutively admitted to a PCU during eight months, excluding those with severe cognitive problems or too low performance status. Insomnia was assessed by asking a single question and by using the Sleep Disturbance Scale (SDS), and emotional distress using the Hospital Anxiety and Depression Scale (HADS). Physical, environmental and other psychological factors potentially interfering with sleep quality were evaluated. Association between insomnia and the factors evaluated was studied using univariate and multivariate regression analyses. Results 61 patients were included (mean age 71.5 years; 95% with oncological disease); 38 (62%) answered “yes” to the insomnia single question and 29 (47%) showed moderate to severe insomnia according to the SDS. 65% showed clinically significant emotional distress and 79% had nocturnal rumination. The physical symptoms most often mentioned as interfering with sleep quality were pain (69%) and dyspnoea (36%). 77% reported at least one environmental disturbance. In the univariate analysis, answering “yes” to the insomnia single question was significantly associated with higher HADS score, anxiety, nocturnal rumination, clear knowledge of the diagnosis, higher performance status and dyspnoea; moderate to severe insomnia was significantly associated with nocturnal rumination, higher performance status, environmental disturbances and daytime sleepiness. In the multivariate regression analysis, answering “yes” to the single question was associated with dyspnoea (OR 7.2 [1.65-31.27]; p = 0.009), nocturnal rumination (OR 5.5 [1.05-28.49]; p = 0.04) and higher performance

  3. Decision aids for advance care planning: an overview of the state of the science.

    PubMed

    Butler, Mary; Ratner, Edward; McCreedy, Ellen; Shippee, Nathan; Kane, Robert L

    2014-09-16

    Advance care planning honors patients' goals and preferences for future care by creating a plan for when illness or injury impedes the ability to think or communicate about health decisions. Fewer than 50% of severely or terminally ill patients have an advance directive in their medical record, and physicians are accurate only about 65% of the time when predicting patient preferences for intensive care. Decision aids can support the advance care planning process by providing a structured approach to informing patients about care options and prompting them to document and communicate their preferences. This review, commissioned as a technical brief by the Agency for Healthcare Research and Quality Effective Health Care Program, provides a broad overview of current use of and research related to decision aids for adult advance care planning. Using interviews of key informants and a search of the gray and published literature from January 1990 to May 2014, the authors found that many decision aids are widely available but are not assessed in the empirical literature. The 16 published studies testing decision aids as interventions for adult advance care planning found that most are proprietary or not publicly available. Some are constructed for the general population, whereas others address disease-specific conditions that have more predictable end-of-life scenarios and, therefore, more discrete choices. New decision aids should be designed that are responsive to diverse philosophical perspectives and flexible enough to change as patients gain experience with their personal illness courses. Future efforts should include further research, training of advance care planning facilitators, dissemination and access, and tapping potential opportunities in social media or other technologies. PMID:25069709

  4. Fewer Advanced Alzheimer's Patients on Feeding Tubes

    MedlinePlus

    ... at someone in the advanced stages of a terminal illness, a feeding tube doesn't make a ... of palliative care (keeping a person with a terminal illness as comfortable as possible), Mitchell said. As ...

  5. [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

  6. [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.

  7. Educating advanced practice nurses in using social media in rural health care.

    PubMed

    Rutledge, Carolyn M; Renaud, Michelle; Shepherd, Laurel; Bordelon, Michele; Haney, Tina; Gregory, Donna; Ayers, Paula

    2011-01-01

    Health care in the United States is facing a crisis in providing access to quality care for those in underserved and rural regions. Advanced practice nurses are at the forefront of addressing such issues, through modalities such as health care technology. Many nursing education programs are seeking strategies for better educating students on technology utilization. Health care technology includes electronic health records, telemedicine, and clinical decision support systems. However, little focus has been placed on the role of social media in health care. This paper describes an educational workshop using standardized patients and hands-on experiences to introduce advanced practice nurses in a Doctor of Nursing Practice program to the role of social media in addressing issues inherent in the delivery of rural health care. The students explore innovative approaches for utilizing social media for patient and caregiver support as well as identify online resources that assist providers in a rural setting. PMID:22718665

  8. 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

  9. Health Care Outcomes and Advance Care Planning in Older Adults Who Receive Home-Based Palliative Care: A Pilot Cohort Study

    PubMed Central

    Thorsteinsdottir, Bjorg; Cha, Stephen S.; Hanson, Gregory J.; Peterson, Stephanie M.; Rahman, Parvez A.; Naessens, James M.; Takahashi, Paul Y.

    2015-01-01

    Abstract Background: Approximately 20% of seniors live with five or more chronic medical illnesses. Terminal stages of their lives are often characterized by repeated burdensome hospitalizations and advance care directives are insufficiently addressed. This study reports on the preliminary results of a Palliative Care Homebound Program (PCHP) at the Mayo Clinic in Rochester, Minnesota to service these vulnerable populations. Objective: The study objective was to evaluate inpatient hospital utilization and the adequacy of advance care planning in patients who receive home-based palliative care. Methods: This is a retrospective pilot cohort study of patients enrolled in the PCHP between September 2012 and March 2013. Two control patients were matched to each intervention patient by propensity scoring methods that factor in risk and prognosis. Primary outcomes were six-month hospital utilization including ER visits. Secondary outcomes evaluated advance care directive completion and overall mortality. Results: Patients enrolled in the PCHP group (n=54) were matched to 108 controls with an average age of 87 years. Ninety-two percent of controls and 33% of PCHP patients were admitted to the hospital at least once. The average number of hospital admissions was 1.36 per patient for controls versus 0.35 in the PCHP (p<0.001). Total hospital days were reduced by 5.13 days. There was no difference between rates of ER visits. Advanced care directive were completed more often in the intervention group (98%) as compared to controls (31%), with p<0.001. Goals of care discussions were held at least once for all patients in the PCHP group, compared to 41% in the controls. PMID:25375663

  10. Using Adult Learning Concepts To Assist Patients in Completing Advance Directives.

    ERIC Educational Resources Information Center

    Meyer, Rose Mary

    2000-01-01

    Advance directives that enable individuals to control their health care are underused due to lack of patient knowledge. Nurses can teach patients about them using adult learning principles, transformation theory, and skills for learning how to learn. (SK)

  11. Integrating Compassionate, Collaborative Care (the "Triple C") Into Health Professional Education to Advance the Triple Aim of Health Care.

    PubMed

    Lown, Beth A; McIntosh, Sharrie; Gaines, Martha E; McGuinn, Kathy; Hatem, David S

    2016-03-01

    Empathy and compassion provide an important foundation for effective collaboration in health care. Compassion (the recognition of and response to the distress and suffering of others) should be consistently offered by health care professionals to patients, families, staff, and one another. However, compassion without collaboration may result in uncoordinated care, while collaboration without compassion may result in technically correct but depersonalized care that fails to meet the unique emotional and psychosocial needs of all involved. Providing compassionate, collaborative care (CCC) is critical to achieving the "triple aim" of improving patients' health and experiences of care while reducing costs. Yet, values and skills related to CCC (or the "Triple C") are not routinely taught, modeled, and assessed across the continuum of learning and practice. To change this paradigm, an interprofessional group of experts recently recommended approaches and a framework for integrating CCC into health professional education and postgraduate training as well as clinical care. In this Perspective, the authors describe how the Triple C framework can be integrated and enhance existing competency standards to advance CCC across the learning and practice continuum. They also discuss strategies for partnering with patients and families to improve health professional education and health care design and delivery through quality improvement projects. They emphasize that compassion and collaboration are important sources of professional, patient, and family satisfaction as well as critical aspects of professionalism and person-centered, relationship-based high-quality care. PMID:26717505

  12. Integrating Compassionate, Collaborative Care (the "Triple C") Into Health Professional Education to Advance the Triple Aim of Health Care.

    PubMed

    Lown, Beth A; McIntosh, Sharrie; Gaines, Martha E; McGuinn, Kathy; Hatem, David S

    2016-03-01

    Empathy and compassion provide an important foundation for effective collaboration in health care. Compassion (the recognition of and response to the distress and suffering of others) should be consistently offered by health care professionals to patients, families, staff, and one another. However, compassion without collaboration may result in uncoordinated care, while collaboration without compassion may result in technically correct but depersonalized care that fails to meet the unique emotional and psychosocial needs of all involved. Providing compassionate, collaborative care (CCC) is critical to achieving the "triple aim" of improving patients' health and experiences of care while reducing costs. Yet, values and skills related to CCC (or the "Triple C") are not routinely taught, modeled, and assessed across the continuum of learning and practice. To change this paradigm, an interprofessional group of experts recently recommended approaches and a framework for integrating CCC into health professional education and postgraduate training as well as clinical care. In this Perspective, the authors describe how the Triple C framework can be integrated and enhance existing competency standards to advance CCC across the learning and practice continuum. They also discuss strategies for partnering with patients and families to improve health professional education and health care design and delivery through quality improvement projects. They emphasize that compassion and collaboration are important sources of professional, patient, and family satisfaction as well as critical aspects of professionalism and person-centered, relationship-based high-quality care.

  13. Palliative Care Improves Survival, Quality of Life in Advanced Lung Cancer | Division of Cancer Prevention

    Cancer.gov

    Results from the first randomized clinical trial of its kind have revealed a surprising and welcome benefit of early palliative care for patients with advanced lung cancer—longer median survival. Although several researchers said that the finding needs to be confirmed in other trials of patients with other cancer types, they were cautiously optimistic that the trial results could influence oncologists’ perceptions and use of palliative care. |

  14. 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

  15. 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

  16. African Cultural Concept of Death and the Idea of Advance Care Directives

    PubMed Central

    Ekore, Rabi Ilemona; Lanre-Abass, Bolatito

    2016-01-01

    An advance care directive is a person's oral or written instructions about his or her future medical care, if he or she becomes unable to communicate. It may be in written or oral form. Africans ordinarily do not encourage the contemplation of death or any discussion about their own or their loved ones’ death. According to the African belief system, life does not end with death, but continues in another realm. Becoming an ancestor after death is a desirable goal of every individual, a feat which cannot be achieved if an individual asks for an unnatural death by attempting to utilize advance care directives. Advance care directives are considered to be too individualistic for communitarian societies such as Africa. Coupled with the communitarian nature of African societies are issues such as lack of awareness of advance directives, fear of death and grief, and the African cultural belief system, which are potential barriers to the utilization of advance care directives in the African setting. Hence, the need for culture sensitivity which makes it imperative that patient's family and loved ones are carried along as far as possible, without compromising the autonomy of the patient in question when utilizing advance care directives. PMID:27803556

  17. Orphan symptoms in advanced cancer patients followed at home.

    PubMed

    Mercadante, Sebastiano; Porzio, Giampiero; Valle, Alessandro; Fusco, Flavio; Aielli, Federica; Adile, Claudio; Casuccio, Alessandra

    2013-12-01

    Orphan symptoms are rarely assessed, particularly at home. The aim of this multicenter prospective study was to assess the prevalence of these symptoms and eventual factors possibly associated in advanced cancer patients at admission of a home care program. A prospective study was performed at three home care programs in Italy. Patients' data were collected, including age, sex, diagnosis, and Karnofsky status. Possible contributing factors were analyzed; preexisting neurological diseases, cerebral metastases, hyperthermia, diabetes, a state of dehydration clinically evident and/or oliguria, possible biochemical parameters when available, data regarding recent chemotherapy, opioids and doses, use of neuroleptics, benzodiazepine or anticonvulsants, corticosteroids, anti-inflammatory, and antibiotics were collected. Myoclonus, hiccup, sweating, pruritus, and tenesmus, either rectal or vesical, were assessed, according to a preliminary definition, at time of home care program admission. Three hundred sixty-two patients were surveyed at the three home care programs. Globally, 48 patients presented one or more orphan symptoms in the period taken into consideration, and 7 patients presented more than 1 symptom. One patient presented occasional and diffuse myoclonus. Nineteen patients presented sweating, 13 patients presented pruritus, and 14 patients presented hiccup. Finally, nine patients presented rectal or vesical tenesmus. There was a significant correlation between sweating and transdermal fentanyl use (P = 0.044), fever (P = 0.001), hiccup (P < 0.0005), and vesical tenesmus (P = 0.028). Pruritus was not associated to any factor. Hiccup was associated with gender (males, P = 0.006) and sweating (P < 0.0005). Vesical tenesmus was associated with fever (P = 0.019) and sweating (P = 0.028). Although the symptoms examined have a low prevalence in advanced cancer patients admitted to home care, the distress for patients may be high and

  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. 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

  20. 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

  1. The application of the acute care nurse practitioner role in a cardiovascular patient population.

    PubMed

    Hernandez-Leveille, Marygrace; Bennett, Jasmiry D; Nelson, Nicole

    2014-12-01

    This article presents an overview of the role of an acute care nurse practitioner (ACNP) in an acute care setting caring for patients with cardiovascular issues. Discussion includes the evolution of the ACNP role, the consensus model for advanced practice registered nurse regulation, and a case study highlighting the role of the ACNP while caring for a hemodynamically unstable patient. The case study articulates the ACNP's role as liaison between the patient, family members, collaborating physicians, and nurses.

  2. GPs’ views on managing advanced chronic kidney disease in primary care: a qualitative study

    PubMed Central

    Tonkin-Crine, Sarah; Santer, Miriam; Leydon, Geraldine M; Murtagh, Fliss EM; Farrington, Ken; Caskey, Fergus; Rayner, Hugh; Roderick, Paul

    2015-01-01

    Background Chronic kidney disease (CKD) has become a significant part of the GP’s workload since the introduction of the National Institute for Health and Care Excellence guidelines in 2008. Patients with advanced CKD (stages G4 and G5) often have comorbidities, varied disease progression, and are likely to be older. GPs may experience difficulties with management decisions for patients with advanced CKD, including when to refer to nephrology. Aim To explore GPs’ views of managing patients with advanced CKD and referral to secondary care. Design and setting Qualitative study with GPs in four areas of England: London, Bristol, Birmingham, and Stevenage. Method Semi-structured interviews with 19 GPs. Transcribed interviews were thematically analysed. Results GPs had little experience of managing patients with advanced CKD, including those on dialysis or having conservative care (treatment without dialysis or a transplant), and welcomed guidance. Some GPs referred patients based on renal function alone and some used wider criteria including age and multimorbidity. GPs reported a tension between national guidance and local advice, and some had learnt from experience that patients were discharged back to primary care. GPs with more experience of managing CKD referred patients later, or sometimes not at all, if there were no additional problems and if dialysis was seen as not in the patient’s interests. Conclusion GPs want guidance on managing older patients with advanced CKD and comorbidities, which better incorporates agreement between local and national recommendations to clarify referral criteria. GPs are not generally aware of conservative care programmes provided by renal units, however, they appear happy to contribute to such care or alternatively, lead conservative management with input from renal teams. PMID:26120137

  3. 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.

  4. The Evolution of Health Care Advance Planning Law and Policy

    PubMed Central

    Sabatino, Charles P

    2010-01-01

    Context: The legal tools of health care advance planning have substantially changed since their emergence in the mid-1970s. Thirty years of policy development, primarily at the state legislative level addressing surrogate decision making and advance directives, have resulted in a disjointed policy landscape, yet with important points of convergence evolving over time. An understanding of the evolution of advance care planning policy has important implications for policy at both the state and federal levels. Methods: This article is a longitudinal statutory and literature review of health care advance planning from its origins to the present. Findings: While considerable variability across the states still remains, changes in law and policy over time suggest a gradual paradigm shift from what is described as a “legal transactional approach” to a “communications approach,” the most recent extension of which is the emergence of Physician Orders for Life-Sustaining Treatment, or POLST. The communications approach helps translate patients’ goals into visible and portable medical orders. Conclusions: States are likely to continue gradually moving away from a legal transactional mode of advance planning toward a communications model, albeit with challenges to authentic and reliable communication that accurately translates patients’ wishes into the care they receive. In the meantime, the states and their health care institutions will continue to serve as the primary laboratory for advance care planning policy and practice. PMID:20579283

  5. 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.

  6. Promoting perioperative advance care planning: a systematic review of advance care planning decision aids.

    PubMed

    Aslakson, Rebecca A; Schuster, Anne L R; Reardon, Jessica; Lynch, Thomas; Suarez-Cuervo, Catalina; Miller, Judith A; Moldovan, Rita; Johnston, Fabian; Anton, Blair; Weiss, Matthew; Bridges, John F P

    2015-11-01

    This systematic review identifies possible decision aids that promote perioperative advance care planning (ACP) and synthesizes the available evidence regarding their use. Using PubMed, EMBASE, Cochrane, SCOPUS, Web of Science, CINAHL, PsycINFO and Sociological Abstracts, researchers identified and screened articles for eligibility. Data were abstracted and risk of bias assessed for included articles. Thirty-nine of 5327 articles satisfied the eligibility criteria. Primarily completed in outpatient ambulatory populations, studies evaluated a variety of ACP decision aids. None were evaluated in a perioperative population. Fifty unique outcomes were reported with no head-to-head comparisons conducted. Findings are likely generalizable to a perioperative population and can inform development of a perioperative ACP decision aid. Future studies should compare the effectiveness of ACP decision aids.

  7. 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

  8. 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

  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. Advanced practice roles in the managed care environment.

    PubMed

    Madden, M J; Ponte, P R

    1994-01-01

    The role of the advanced practice nurse is based on expert clinical knowledge and skill and is practiced in multiple settings. As healthcare reform emerges, the context in which healthcare is delivered changes. The authors describe a creative approach to packaging and marketing the services of advanced practice nurses to the customers of the managed care system. PMID:8308561

  11. The views of older Malaysians on advanced directive and advanced care planning: a qualitative study.

    PubMed

    Htut, Y; Shahrul, K; Poi, P J H

    2007-01-01

    The provision of optimum care for the ageing population is dependent on the understanding of their views and values on end of life issues. A qualitative descriptive study was conducted to describe views of elderly Malaysians on Advanced Care Planning (henceforth ACP) and Advanced Directives (henceforth AD), and explore factors influencing these views. Fifteen elderly subjects with ages ranging from 65 to 83 years, representing different ethnic and religious groups in Malaysia were selected for in-depth interviews guided by a questionnaire. Five core themes were extracted from the interviews: 1) Considering the future 2) Contingency plans for future illnesses 3) Attitudes towards life prolonging treatment procedures 4) Doctor-patient relationships and 5) Influence of religion on decisions related to future illness. Despite the lack of knowledge on ACP and AD, older respondents were very receptive to their concept. Although the majority agreed on the importance of planning for future medical management and having open discussion on end of life issues with their doctor, they felt it unnecessary to make a formal written AD. Most felt that the future was best left to fate or God, and none had made any contingency plan for severe future illnesses citing religion as reason for this view. Cardiopulmonary resuscitation, mechanical ventilation and dialysis were considered by most to be invasive life prolonging treatments. We suggest that doctors initiate discussions on end of life care with every older patient and their family so as to promote awareness and introduce the concept of ACP/AD to a Malaysian setting.

  12. [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

  13. A Palliative Approach to Dialysis Care: A Patient-Centered Transition to the End of Life

    PubMed Central

    Moss, Alvin H.; Cohen, Lewis M.; Fischer, Michael J.; Germain, Michael J.; Jassal, S. Vanita; Perl, Jeffrey; Weiner, Daniel E.; Mehrotra, Rajnish

    2014-01-01

    As the importance of providing patient-centered palliative care for patients with advanced illnesses gains attention, standard dialysis delivery may be inconsistent with the goals of care for many patients with ESRD. Many dialysis patients with life expectancy of <1 year may desire a palliative approach to dialysis care, which focuses on aligning patient treatment with patients’ informed preferences. This commentary elucidates what comprises a palliative approach to dialysis care and describes its potential and appropriate use. It also reviews the barriers to integrating such an approach into the current clinical paradigm of care and existing infrastructure and outlines system-level changes needed to accommodate such an approach. PMID:25104274

  14. 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

  15. [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.

  16. Dignity-driven decision making: a compelling strategy for improving care for people with advanced illness.

    PubMed

    Vladeck, Bruce C; Westphal, Erin

    2012-06-01

    The concept of dignity-driven decision making builds on previous efforts to define and develop patient- and family-centered care for people with advanced illness. More a framework than a rigid structure, the dignity-driven decision making model emphasizes the centrality of a collaborative process in which patients, most of whom are elderly; their families; and clinicians work together continuously to define the goals of care and how best to implement them. The early experiences of some organizations already practicing dignity-driven decision making in their care suggest that the model can improve patient care. Whether the system of care can produce enough savings to pay for its increased costs in the form of additional clinicians and managers is not yet known. Policy-driven actions, such as payment reform and closer alignment of quality incentives with the model's objectives, will be integral to further development and dissemination of the model.

  17. 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

  18. 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

  19. End-of-life communication in Korean older adults: With focus on advance care planning and advance directives.

    PubMed

    Shin, Dong Wook; Lee, Ji Eun; Cho, BeLong; Yoo, Sang Ho; Kim, SangYun; Yoo, Jun-Hyun

    2016-04-01

    The present article aimed to provide a comprehensive review of current status of end-of-life (EOL) care and sociocultural considerations in Korea, with focus on the EOL communication and use of advance directives (AD) in elderly Koreans. Through literature review, we discuss the current status of EOL care and sociocultural considerations in Korea, and provide a look-ahead. In Korea, patients often receive life-sustaining treatment until the very end of life. Advance care planning is rare, and most do-not-resuscitate decisions are made between the family and physician at the very end of patient's life. Koreans, influenced mainly by Confucian tradition, prefer a natural death and discontinuation of life-sustaining treatment. Although Koreans generally believe that death is natural and unavoidable, they tend not to think about or discuss death, and regard preparation for death as unnecessary. As a result, AD are completed by just 4.7% of the general adult population. This situation can be explained by several sociocultural characteristics including opting for natural death, wish not to burden others, preference for family involvement and trust in doctor, avoidance of talking about death, and filial piety. Patients often receive life-sustaining treatment until the very EOL, advance care planning and the use of AD is not common in Korea. This was related to unique sociocultural characteristics of Korea. A more active role of physicians, development of a more deliberate EOL discussion process, development of culturally appropriate AD and promotion of advance care planning might be required to provide good EOL care in Korea.

  20. 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.

  1. 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.

  2. 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

  3. 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.

  4. 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

  5. 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.

  6. Factors associated with presentation to care with advanced HIV disease in Brussels and Northern France: 1997-2007

    PubMed Central

    2011-01-01

    Background Our objective was to determine the frequency and determinants of presentation to care with advanced HIV disease in patients who discover their HIV diagnosis at this stage as well as those with delayed presentation to care after HIV diagnosis in earlier stages. Methods We collected data on 1,819 HIV-infected patients in Brussels (Belgium) and Northern France from January 1997 to December 2007. "Advanced HIV disease" was defined as CD4 count <200/mm3 or clinically-defined AIDS at study inclusion and was stratified into two groups: (a) late testing, defined as presentation to care with advanced HIV disease and HIV diagnosis ≤6 months before initiation of HIV care; and (b) delayed presentation to care, defined as presentation to care with advanced HIV disease and HIV diagnosis >6 months before initiation of HIV care. We used multinomial logistic regression to determine the factors associated with delayed presentation to care and late testing. Results Of the 570 patients initiating care with advanced HIV disease, 475 (83.3%) were tested late and 95 (16.7%) had delayed presentation to care. Risk factors for delayed presentation to care were: age 30-50 years, injection drug use, and follow-up in Brussels. Risk factors for late testing were: sub-Saharan African origin, male gender, and older age. HIV transmission through heterosexual contact was associated with an increased risk of both delayed presentation to care and late testing. Patients who initiated HIV care in 2003-2007 were less likely to have been tested late or to have a delayed presentation to care than patients who initiated care before 2003. Conclusion A considerable proportion of HIV-infected patients present to care with advanced HIV disease. Late testing, rather than a delay in initiating care after earlier HIV testing, is the main determinant of presentation to care with advanced HIV disease. The factors associated with delay presentation to care differ from those associated with late testing

  7. A typology of advance statements in mental health care.

    PubMed

    Henderson, Claire; Swanson, Jeffrey W; Szmukler, George; Thornicroft, Graham; Zinkler, Martin

    2008-01-01

    Advance statements documenting mental health service consumers' preferences for treatment during a future mental health crisis or period of incapacity have gained currency in recent years in the United States and some European countries. Several kinds of advance statements have emerged -- some as legal instruments, others as treatment planning methods -- but no formal comparison has been made among them. This article reviews the literature in English and German to develop a comparative typology of advance statements: joint crisis plans, crisis cards, treatment plans, wellness recovery action plans, and psychiatric advance directives (with and without formal facilitation). The features that distinguish them are the extent to which they are legally binding, whether health care providers are involved in their production, and whether an independent facilitator assists in their production. The differing nature of advance statements is related to the diverse models of care upon which they are based and the legislative and service contexts in which they have been developed. However, there is recent convergence between the United Kingdom and the United States with respect to research interventions that facilitate the production of advance statements, as evidence emerges for the effectiveness of facilitated psychiatric advance directives and joint crisis plans. Different types of advance statements can coexist and in some cases may interact in complementary ways. However, the relationship of advance statements to involuntary treatment is more problematic, as is their effective implementation in many mental health service settings. PMID:18182541

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

    PubMed

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

    2016-01-01

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

  9. 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

  10. ‘Reality and desire’ in the care of advanced chronic kidney disease

    PubMed Central

    Marrón, Belén; Craver, Lourdes; Remón, César; Prieto, Mario; Gutiérrez, Josep Mª; Ortiz, Alberto

    2010-01-01

    There is a long distance between the actual worldwide reality in advanced chronic kidney disease care and the desire of how these patients should be managed to decrease cardiovascular and general morbidity and mortality. Implementation of adequate infrastructures may improve clinical outcomes and increase the use of home renal replacement therapies (RRT). Current pitfalls should be addressed to optimise care: inadequate medical training for nephrological referral and RRT selection, late referral to nephrologists, inadequate patient education for choice of RRT modality, lack of multidisciplinary advanced kidney disease clinics and lack of programmed RRT initiation. These deficiencies generate unintended consequences, such as inequality of care and limitations in patient education and selection-choice for RRT technique with limited use of peritoneal dialysis. Multidisciplinary advanced kidney disease clinics may have a direct impact on patient survival, morbidity and quality of life. There is a common need to reduce health care costs and scenarios increasing PD incidence show better efficiency. The following proposals may help to improve the current situation: defining the scope of the problem, disseminating guidelines with specific targets and quality indicators, optimising medical speciality training, providing adequate patient education, specially through the use of general decision making tools that will allow patients to choose the best possible RRT in accordance with their values, preferences and medical advice, increasing planned dialysis starts and involving all stakeholders in the process. PMID:25984045

  11. 'Reality and desire' in the care of advanced chronic kidney disease.

    PubMed

    Marrón, Belén; Craver, Lourdes; Remón, César; Prieto, Mario; Gutiérrez, Josep M; Ortiz, Alberto

    2010-10-01

    There is a long distance between the actual worldwide reality in advanced chronic kidney disease care and the desire of how these patients should be managed to decrease cardiovascular and general morbidity and mortality. Implementation of adequate infrastructures may improve clinical outcomes and increase the use of home renal replacement therapies (RRT). Current pitfalls should be addressed to optimise care: inadequate medical training for nephrological referral and RRT selection, late referral to nephrologists, inadequate patient education for choice of RRT modality, lack of multidisciplinary advanced kidney disease clinics and lack of programmed RRT initiation. These deficiencies generate unintended consequences, such as inequality of care and limitations in patient education and selection-choice for RRT technique with limited use of peritoneal dialysis. Multidisciplinary advanced kidney disease clinics may have a direct impact on patient survival, morbidity and quality of life. There is a common need to reduce health care costs and scenarios increasing PD incidence show better efficiency. The following proposals may help to improve the current situation: defining the scope of the problem, disseminating guidelines with specific targets and quality indicators, optimising medical speciality training, providing adequate patient education, specially through the use of general decision making tools that will allow patients to choose the best possible RRT in accordance with their values, preferences and medical advice, increasing planned dialysis starts and involving all stakeholders in the process.

  12. [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

  13. 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?

  14. 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

  15. Advanced practice nursing students in the patient-centered medical home: preparing for a new reality.

    PubMed

    Swartwout, Kathryn; Murphy, Marcia Pencak; Dreher, Melanie C; Behal, Raj; Haines, Alison; Ryan, Mary; Ryan, Norman; Saba, Mary

    2014-01-01

    Driven by reimbursement incentives for increased access, improved quality and reduced cost, the patient-centered medical home model of health care delivery is being adopted in primary care practices across the nation. The transition from traditional primary care models to patient-centered medical homes presents many challenges, including the assembly of a well-prepared, interprofessional provider team to achieve effective, well-coordinated care. In turn, advanced practice nursing education programs are challenged to prepare graduates who are qualified for practice in the new reality of health care reform. This article reviews the patient-centered medical home model and describes how one college of nursing joined 7 primary care physician practices to prepare advanced practice nursing students for the new realities of health care reform while supporting each practice in its transition to the patient-centered medical home. PMID:24720942

  16. Clinical Curriculum Reform and Advanced Care Training at the New England College of Optometry.

    ERIC Educational Resources Information Center

    Wilson, Roger

    1998-01-01

    Discusses how the New England College of Optometry has expanded clinical education so graduates are equipped to handle new and advanced clinical and patient-care responsibilities and meet the changing standards of professional entry-level competency. The reform process, third- and fourth-year curriculum components, rotations, and plans for…

  17. Difficult but necessary conversations--the case for advance care planning.

    PubMed

    Scott, Ian A; Mitchell, Geoffrey K; Reymond, Elizabeth J; Daly, Michael P

    2013-11-18

    Many patients at the end of life receive care that is inappropriate or futile and, if given the opportunity to discuss their care preferences well ahead of death, may well have chosen to forgo such care. Advance care planning (ACP) is a process of making decisions about future health care for patients in consultation with clinicians, family members and important others, and to safeguard such decisions if patients were to lose decisional capacity. Although ACP has existed as an idea for decades, acceptance and operationalisation of ACP within routine practice has been slow, despite evidence of its benefits. The chief barriers have been social and personal taboos about discussing the dying process, avoidance by medical professionals of responsibility for initiating, coordinating and documenting discussions about ACP, absence of robust and standardised procedures for recording and retrieving ACP documents across multiple care settings, and legal and ethical concerns about the validity of such documents. For ACP to become part of mainstream patient-centred care, accountable clinicians working in primary care, hospitals and nursing homes must effectively educate colleagues and patients about the purpose and mechanics of ACP, mandate ACP for all eligible patients, document ACP in accessible formats that enable patient wishes to accurately guide clinical management, devise methods for reviewing ACP decisions when clinically appropriate, and evaluate congruence between expressed patient wishes and actual care received. Public awareness campaigns coupled with implementation of ACP programs sponsored by collaborations between hospital and health services, Medicare locals and residential care facilities will be needed in making system-wide ACP a reality.

  18. Neonatal ethical issues: viability, advance directives, family centered care.

    PubMed

    Sudia-Robinson, Tanya

    2011-01-01

    Ethical issues in perinatal and NICU settings can arise from a variety of situations. This article focuses on issues surrounding viability and the incorporation of advance directives and family-centered care. Prenatal education about infant viability, probable scenarios, and parental involvement in decision-making are addressed. Considerations for advance directives for complex births and critical decisions at the time of birth are also discussed. Implications for nurses and suggested dialogue strategies are provided. PMID:21407121

  19. Goals of care in advanced dementia: quality of life, dignity and comfort.

    PubMed

    Volicer, L

    2007-01-01

    Prolongation of human lifespan is increasing the number of individuals suffering from Alzheimer's disease and other progressive dementia worldwide. There are about 5 million of these individuals in both United States and European Union and many more in other countries of the world (1). Because there is no curative treatment for these diseases, most individuals with dementia survive to an advanced stage of dementia at which time many of them require institutional care. Home care for individuals with advanced dementia and especially institutional care are very expensive and are becoming major public health problems. The cost of care for advanced dementia is often increased by the use of aggressive medical interventions that may not be in the best interest of the patient. Because advanced dementia is currently incurable, it should be considered a terminal illness, similar to terminal cancer. Therefore, palliative care may be the most appropriate strategy for management of advanced dementia (2). The goals of palliative care are maintenance of quality of life, dignity and comfort and the four articles in this special issue are addressing these goals. Enhancement of quality of life in dementia requires attention to three main domains: provision of meaningful activities, appropriate medical care, and treatment of behavioral symptoms (3). Individuals with advanced dementia may not be able to participate in many activity programs but they still may maintain some quality of life if they are provided care in a pleasant environment with constant presence of a caregiver. Simard describes a program, Namaste Care, which is specifically tailored for individuals with advanced dementia. This program requires neither major expenditure nor increased staffing and should be instituted in all facilities that care for individuals with advanced dementia. Maintaining functional status of individuals with advanced dementia is important because it improves their self esteem and facilitates

  20. 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.

  1. Implementation of Advanced Health Care Technology into Existing Competency-Based Health Care Program. Final Report.

    ERIC Educational Resources Information Center

    Klemovage, Shirley

    A project was undertaken to develop new curriculum materials that could be incorporated into an existing health assistant program to cover recent advances in health care technology. Area physicians' offices were toured and meetings were held with administrators of local hospitals in order to discover what kinds of advances in health care…

  2. [Advanced directives document and neurologist-patient relationship].

    PubMed

    Boada Rovira, M

    2004-12-01

    Perception of health and disease, pain and suffering, quality of life, personal relationships, privacy and intimacy, culture and social values, can now be stated in a written document, by way of a living will, giving legal legitimacy to each patient's way of being and understanding life, to be used when the subject cannot express it by him/herself. In this way, the patients will participate in the therapeutic process and will incorporate their desires and decisions through the Informed Consent and the Advanced Directives Document (ADD). Both documents translate and indicate how to treat and care for a patient who will progressively lose his/her cognitive faculties and others will decided for him/her, in the case of dementias. The basis of ADD is respect and promotion of the patient's autonomy, prolonging his/her right to decide in the stages in which he/she cannot do it. It consists in some instructions or orientations for the patient to be cared for in a certain way, according to his/her will. To this effect, a representative will be named who will act in the subject's name and who will help to interpret and make decisions when the patient cannot. Specifically, in Alzheimer's disease, ADD allows the patient to decide, in full lucidity, freedom and autonomy, how to live a progressive and irreversible disease. Explicit mention can be made to the will of making his/her disease known publically or not, the care of its aspect, privacy, type of care, whether institutionalized or home care, limitation of visits, treatment intensity and prolongation, palliative cares, donation of biological samples, participation in drug clinical trials. PMID:15719290

  3. 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.

  4. 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

  5. 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.

  6. Recent advances in topical wound care

    PubMed Central

    Sarabahi, Sujata

    2012-01-01

    There are a wide variety of dressing techniques and materials available for management of both acute wounds and chronic non-healing wounds. The primary objective in both the cases is to achieve a healed closed wound. However, in a chronic wound the dressing may be required for preparing the wound bed for further operative procedures such as skin grafting. An ideal dressing material should not only accelerate wound healing but also reduce loss of protein, electrolytes and fluid from the wound, and help to minimize pain and infection. The present dictum is to promote the concept of moist wound healing. This is in sharp contrast to the earlier practice of exposure method of wound management wherein the wound was allowed to dry. It can be quite a challenge for any physician to choose an appropriate dressing material when faced with a wound. Since wound care is undergoing a constant change and new products are being introduced into the market frequently, one needs to keep abreast of their effect on wound healing. This article emphasizes on the importance of assessment of the wound bed, the amount of drainage, depth of damage, presence of infection and location of wound. These characteristics will help any clinician decide on which product to use and where,in order to get optimal wound healing. However, there are no ‘magical dressings’. Dressings are one important aspect that promotes wound healing apart from treating the underlying cause and other supportive measures like nutrition and systemic antibiotics need to be given equal attention. PMID:23162238

  7. Advancing infection control in dental care settings

    PubMed Central

    Cleveland, Jennifer L.; Bonito, Arthur J.; Corley, Tammy J.; Foster, Misty; Barker, Laurie; Brown, G. Gordon; Lenfestey, Nancy; Lux, Linda

    2015-01-01

    Background and Overview The authors set out to identify factors associated with implementation by U.S. dentists of four practices first recommended in the Centers for Disease Control and Prevention’s Guidelines for Infection Control in Dental Health-Care Settings—2003. Methods In 2008, the authors surveyed a stratified random sample of 6,825 U.S. dentists. The response rate was 49 percent. The authors gathered data regarding dentists’ demographic and practice characteristics, attitudes toward infection control, sources of instruction regarding the guidelines and knowledge about the need to use sterile water for surgical procedures. Then they assessed the impact of those factors on the implementation of four recommendations: having an infection control coordinator, maintaining dental unit water quality, documenting percutaneous injuries and using safer medical devices, such as safer syringes and scalpels. The authors conducted bivariate analyses and proportional odds modeling. Results Responding dentists in 34 percent of practices had implemented none or one of the four recommendations, 40 percent had implemented two of the recommendations and 26 percent had implemented three or four of the recommendations. The likelihood of implementation was higher among dentists who acknowledged the importance of infection control, had practiced dentistry for less than 30 years, had received more continuing dental education credits in infection control, correctly identified more surgical procedures that require the use of sterile water, worked in larger practices and had at least three sources of instruction regarding the guidelines. Dentists with practices in the South Atlantic, Middle Atlantic or East South Central U.S. Census divisions were less likely to have complied. Conclusions Implementation of the four recommendations varied among U.S. dentists. Strategies targeted at raising awareness of the importance of infection control, increasing continuing education

  8. An assessment of social diffusion in the Respecting Choices advance care planning program.

    PubMed

    Moorman, Sara M; Carr, Deborah; Kirchhoff, Karin T; Hammes, Bernard J

    2012-04-01

    This study examines the potential social diffusion effects of the Respecting Choices advance care planning program administered in La Crosse, Wisconsin, since 1991. The program produces educational materials for patients, trains facilitators to help patients prepare for end of life, and ensures that advance directives are connected to patients' medical records. Using data from a survey of more than 5,000 White Wisconsin high school graduates in their mid-60s, we found that participants who were living in the La Crosse area were significantly less likely than their peers living elsewhere to have executed a living will or appointed a health care power of attorney. This pattern may reflect psychological reactance, where individuals reject a message or lesson when they perceive compliance as a threat to their autonomy. There was no evidence of social diffusion effects; participants who lived in the La Crosse region themselves or who had social network members residing in the area were no more likely than those with no known ties to the region to have engaged in advance care planning. Future studies should explore the processes through which individuals learn and share with others their knowledge of advance care planning.

  9. Advance care planning: A systematic review of randomised controlled trials conducted with older adults.

    PubMed

    Weathers, Elizabeth; O'Caoimh, Rónán; Cornally, Nicola; Fitzgerald, Carol; Kearns, Tara; Coffey, Alice; Daly, Edel; O'Sullivan, Ronan; McGlade, Ciara; Molloy, D William

    2016-09-01

    Advance care planning (ACP), involving discussions between patients, families and healthcare professionals on future healthcare decisions, in advance of anticipated impairment in decision-making capacity, improves satisfaction and end-of-life care while respecting patient autonomy. It usually results in the creation of a written advanced care directive (ACD). This systematic review examines the impact of ACP on several outcomes (including symptom management, quality of care and healthcare utilisation) in older adults (>65years) across all healthcare settings. Nine randomised controlled trials (RCTs) were identified by searches of the CINAHL, PubMed and Cochrane databases. A total of 3646 older adults were included (range 72-88 years). Seven studies were conducted with community dwellers and the other two RCTs were conducted in nursing homes. Most studies did not implement a standardised ACD, or measure the impact on quality of end-of-life care or on the death and dying experience. All studies had some risk of bias, with most scoring poorly on the Oxford Quality Scale. While ACP interventions are well received by older adults and generally have positive effects on outcomes, this review highlights the need for well-designed RCTs that examine the economic impact of ACP and its effect on quality of care in nursing homes and other sectors. PMID:27451328

  10. 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)

  11. 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

  12. 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…

  13. 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

  14. 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.

  15. Protein Innovations Advance Drug Treatments, Skin Care

    NASA Technical Reports Server (NTRS)

    2012-01-01

    Dan Carter carefully layered the sheets of tracing paper on the light box. On each sheet were renderings of the atomic components of an essential human protein, one whose structure had long been a mystery. With each layer Carter laid down, a never-before-seen image became clearer. Carter joined NASA s Marshall Space Flight Center in 1985 and began exploring processes of protein crystal growth in space. By bouncing intense X-rays off the crystals, researchers can determine the electron densities around the thousands of atoms forming the protein molecules, unveiling their atomic structures. Cultivating crystals of sufficient quality on Earth was problematic; the microgravity conditions of space were far more accommodating. At the time, only a few hundred protein structures had been mapped, and the methods were time consuming and tedious. Carter hoped his work would help reveal the structure of human serum albumin, a major protein in the human circulatory system responsible for ferrying numerous small molecules in the blood. More was at stake than scientific curiosity. Albumin has a high affinity for most of the world s pharmaceuticals, Carter explains, and its interaction with drugs can change their safety and efficacy. When a medication enters the bloodstream a cancer chemotherapy drug, for example a majority of it can bind with albumin, leaving only a small percentage active for treatment. How a drug interacts with albumin can influence considerations like the necessary effective dosage, playing a significant role in the design and application of therapeutic measures. In spite of numerous difficulties, including having no access to microgravity following the 1986 Space Shuttle Challenger disaster, the image Carter had hoped to see was finally clarifying. In 1988, his lab had acquired specialized X-ray and detection equipment a tipping point. Carter and his colleagues began to piece together albumin s portrait, the formation of its electron densities coalescing on

  16. Analgesia for patients with advanced disease: 2

    PubMed Central

    Hall, E; Sykes, N

    2004-01-01

    The first article in this series explored epidemiology and patterns of pain in advanced disease, non-pharmacological treatments, and the use of opioids to manage pain. This second article examines the use of non-opioid drugs and anaesthetic interventions for pain relief in advanced disease. It also discusses an approach to managing analgesia in dying patients and finally looks at future developments. PMID:15082837

  17. Informatics Systems and Tools to Facilitate Patient-centered Care Coordination

    PubMed Central

    Kneale, L.

    2015-01-01

    Summary Introduction There is a growing international focus on patient-centered care. A model designed to facilitate this type of care in the primary care setting is the patient-centered medical home. This model of care strives to be patient-focused, comprehensive, team-based, coordinated, accessible, and focused on quality and safety of care. Objective The objective of this paper is to identify the current status and future trends of patient-centered care and the role of informatics systems and tools in facilitating this model of care. Methods In this paper we review recent scientific literature of the past four years to identify trends and state of current evidence when it comes to patient-centered care overall, and more specifically medical homes. Results There are several studies that indicate growth and development in seven informatics areas within patient-centered care, namely clinical decision support, registries, team care, care transitions, personal health records, telehealth, and measurement. In some cases we are still lacking large randomized clinical trials and the evidence base is not always solid, but findings strongly indicate the potential of informatics to support patient-centered care. Conclusion Current evidence indicates that advancements have been made in implementing and evaluating patient-centered care models. Technical, legal, and practical challenges still remain. Further examination of the impact of patient-centered informatics tools and systems on clinical outcomes is needed. PMID:26293847

  18. [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.

  19. Application of Transformational Leadership Principles in the Development and Integration of Palliative Care Within an Advanced Heart Failure Program.

    PubMed

    George, Susan; Leasure, A Renee

    2016-01-01

    Heart failure (HF) is a major health problem in United States, and it has reached epidemic proportions. Heart failure is associated with significant morbidity, mortality, and cost. Although the prognosis of HF is worse than many forms of cancer, many patients, families, and clinicians are unaware of the dire prognosis. As the disease progress to advanced HF, patients are faced with many challenges, such as poor quality of life due to worsening symptoms and frequent hospitalizations. Heart failure management adds significant financial burden to the health care system. Palliative care can be integrated into HF care to improve quality of life and symptom management and to address physical, spiritual, and psychosocial needs of patients and families. Palliative care can be used concurrently with or independent of curative or life-prolonging HF therapies. Transformational leadership principles were used to guide the development of a plan to enhance integration of palliative care within traditional advanced HF care. PMID:26836596

  20. Application of Transformational Leadership Principles in the Development and Integration of Palliative Care Within an Advanced Heart Failure Program.

    PubMed

    George, Susan; Leasure, A Renee

    2016-01-01

    Heart failure (HF) is a major health problem in United States, and it has reached epidemic proportions. Heart failure is associated with significant morbidity, mortality, and cost. Although the prognosis of HF is worse than many forms of cancer, many patients, families, and clinicians are unaware of the dire prognosis. As the disease progress to advanced HF, patients are faced with many challenges, such as poor quality of life due to worsening symptoms and frequent hospitalizations. Heart failure management adds significant financial burden to the health care system. Palliative care can be integrated into HF care to improve quality of life and symptom management and to address physical, spiritual, and psychosocial needs of patients and families. Palliative care can be used concurrently with or independent of curative or life-prolonging HF therapies. Transformational leadership principles were used to guide the development of a plan to enhance integration of palliative care within traditional advanced HF care.

  1. 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

  2. An unequivocal good? Acknowledging the complexities of advance care planning.

    PubMed

    Robins-Browne, K; Palmer, V; Komesaroff, P

    2014-10-01

    Over the past few decades advance care planning (ACP) has become the subject of debate, research and legislation in many countries. Encouraging people to express their preference for treatment in advance, ideally in written form, seems a natural way to identify what someone might have wanted when they can no longer participate in decision-making. The notion of ACP as an unequivocal good permeates much of the research and policy work in this area. For example, ACP is now actively encouraged in Australian federal and state government policies and the Victorian Government has recently published a practical ACP strategy for Victorian health services (2014-2018). However, advance care plan is ethically complex and the introduction of the Victorian health services strategy provides an opportunity to reflect on this complexity, particularly on the benefits and risks of ACP.

  3. 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

  4. 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

  5. A Qualitative Analysis of an Advanced Practice Nurse–Directed Transitional Care Model Intervention

    PubMed Central

    Bradway, Christine; Trotta, Rebecca; Bixby, M.Brian; McPartland, Ellen; Wollman, M. Catherine; Kapustka, Heidi; McCauley, Kathleen; Naylor, Mary D.

    2012-01-01

    Purpose: The purpose of this study was to describe barriers and facilitators to implementing a transitional care intervention for cognitively impaired older adults and their caregivers lead by advanced practice nurses (APNs). Design and Methods: APNs implemented an evidence-based protocol to optimize transitions from hospital to home. An exploratory, qualitative directed content analysis examined 15 narrative case summaries written by APNs and fieldnotes from biweekly case conferences. Results: Three central themes emerged: patients and caregivers having the necessary information and knowledge, care coordination, and the caregiver experience. An additional category was also identified, APNs going above and beyond. Implications: APNs implemented individualized approaches and provided care that exceeds the type of care typically staffed and reimbursed in the American health care system by applying a Transitional Care Model, advanced clinical judgment, and doing whatever was necessary to prevent negative outcomes. Reimbursement reform as well as more formalized support systems and resources are necessary for APNs to consistently provide such care to patients and their caregivers during this vulnerable time of transition. PMID:21908805

  6. [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

  7. 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.

  8. 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.

  9. 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 ...

  10. 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

  11. 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

  12. 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.

  13. 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

  14. 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

  15. 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

  16. Developing Navigation Competencies to Care for Older Rural Adults with Advanced Illness.

    PubMed

    Duggleby, Wendy; Robinson, Carole A; Kaasalainen, Sharon; Pesut, Barbara; Nekolaichuk, Cheryl; MacLeod, Roderick; Keating, Norah C; Santos Salas, Anna; Hallstrom, Lars K; Fraser, Kimberly D; Williams, Allison; Struthers-Montford, Kelly; Swindle, Jennifer

    2016-06-01

    Navigators help rural older adults with advanced illness and their families connect to needed resources, information, and people to improve their quality of life. This article describes the process used to engage experts - in rural aging, rural palliative care, and navigation - as well as rural community stakeholders to develop a conceptual definition of navigation and delineate navigation competencies for the care of this population. A discussion paper on the important considerations for navigation in this population was developed followed by a four-phased Delphi process with 30 expert panel members. Study results culminated in five general navigation competencies for health care providers caring for older rural persons and their families at end of life: provide patient/family screening; advocate for the patient/family; facilitate community connections; coordinate access to services and resources; and promote active engagement. Specific competencies were also developed. These competencies provide the foundation for research and curriculum development in navigation.

  17. Developing Navigation Competencies to Care for Older Rural Adults with Advanced Illness.

    PubMed

    Duggleby, Wendy; Robinson, Carole A; Kaasalainen, Sharon; Pesut, Barbara; Nekolaichuk, Cheryl; MacLeod, Roderick; Keating, Norah C; Santos Salas, Anna; Hallstrom, Lars K; Fraser, Kimberly D; Williams, Allison; Struthers-Montford, Kelly; Swindle, Jennifer

    2016-06-01

    Navigators help rural older adults with advanced illness and their families connect to needed resources, information, and people to improve their quality of life. This article describes the process used to engage experts - in rural aging, rural palliative care, and navigation - as well as rural community stakeholders to develop a conceptual definition of navigation and delineate navigation competencies for the care of this population. A discussion paper on the important considerations for navigation in this population was developed followed by a four-phased Delphi process with 30 expert panel members. Study results culminated in five general navigation competencies for health care providers caring for older rural persons and their families at end of life: provide patient/family screening; advocate for the patient/family; facilitate community connections; coordinate access to services and resources; and promote active engagement. Specific competencies were also developed. These competencies provide the foundation for research and curriculum development in navigation. PMID:27093177

  18. As health care technology advances: benefits and risks.

    PubMed

    Funk, Marjorie

    2011-07-01

    Technology permeates every dimension of critical care. Bedside technology is integral to the assessment and monitoring of patients and to the provision of treatment. It also helps with access to vital information and can enhance communication. Although it offers extraordinary benefits to patients and clinicians, technology may also create problems. Our research addresses the wise use of technology in the care of critically ill patients. It examines the appropriate and safe use of technology, its equitable distribution, and the human-machine interface. Given that some devices are more effective and safe than others, it is important to assess the appropriateness of a specific technology in a specific situation. Just because a particular device is available, is it necessary to use it in every possible situation? Do we use it just because it is there? Do we employ "heroic" measures sometimes when it would be kinder not to? Studies on the safe use of technology in patient care lead to a consideration of the risk-benefit ratio. Our research on gender and racial differences in the use of cardiac procedures in patients with acute myocardial infarction focused on the equitable distribution of technology. The results of this line of research, along with those of numerous other studies, suggest possible racism in our health care practices. The human-machine interface, or how clinicians and patients interact with health care technology, is a crucial focus of research. Technology is at the heart of critical care. It allows clinicians to perform miracles, but is also a seductive and self-perpetuating force that needs careful monitoring by those who use it.

  19. Measuring engagement in advance care planning: a cross-sectional multicentre feasibility study

    PubMed Central

    Howard, Michelle; Bonham, Aaron J; Heyland, Daren K; Sudore, Rebecca; Fassbender, Konrad; Robinson, Carole A; McKenzie, Michael; Elston, Dawn; You, John J

    2016-01-01

    Objectives To assess the feasibility, acceptability and clinical sensibility of a novel survey, the advance care planning (ACP) Engagement Survey, in various healthcare settings. Setting A target sample of 50 patients from each of primary care, hospital, cancer care and dialysis care settings. Participants A convenience sample of patients without cognitive impairment who could speak and read English was recruited. Patients 50 and older were eligible in primary care; patients 80 and older or 55 and older with clinical markers of advanced chronic disease were recruited in hospital; patients aged 19 and older were recruited in cancer and renal dialysis centres. Outcomes We assessed feasibility, acceptability and clinical sensibility of the ACP Engagement Survey using a 6-point scale. The ACP Engagement Survey measures ACP processes (knowledge, contemplation, self-efficacy and readiness) on 5-point Likert scales and actions (yes/no). Results 196 patients (38–96 years old, 50.5% women) participated. Mean (±SD) time to administer was 48.8±19.6 min. Mean acceptability scores ranged from 3.2±1.3 in hospital to 4.7±0.9 in primary care, and mean relevance ranged from 3.5±1.0 in hospital to 4.9±0.9 in dialysis centres (p<0.001 for both). The mean process score was 3.1±0.6 and the mean action score was 11.2±5.6 (of a possible 25). Conclusions The ACP Engagement Survey demonstrated feasibility and acceptability in outpatient settings but was less feasible and acceptable among hospitalised patients due to length. A shorter version may improve feasibility. Engagement in ACP was low to moderate. PMID:27338877

  20. Can Imaging Put the “Advanced” Back in Advanced Wound Care?

    PubMed Central

    DaCosta, Ralph S.; Ottolino-Perry, Kathryn; Banerjee, Jaideep

    2016-01-01

    An effective, scientifically validated, diagnostic tool helps clinicians make better, timely, and more objective medical decisions in the care of their patients. Today, the need for such tools is especially urgent in the field of wound care where patient-centric care is the goal, under ever tightening clinical budget constraints. In an era of countless “innovative” treatment options, that is, advanced dressings, negative pressure devices, and various debridement instruments available to the wound care clinical team, one area that has arguably languished in the past decade has been innovation in wound diagnostics. Whereas medical imaging is a mainstay in the diagnostic toolkit across many other medical fields (oncology, neurology, gastroenterology, orthopedics, etc.), the field of wound care has yet to realize the full potential that advances in imaging technologies have to offer the clinician. In this issue, the first of a series in wound imaging and diagnostics, four articles have been assembled, highlighting some of the recent advances in wound imaging technologies.

  1. Can Imaging Put the “Advanced” Back in Advanced Wound Care?

    PubMed Central

    DaCosta, Ralph S.; Ottolino-Perry, Kathryn; Banerjee, Jaideep

    2016-01-01

    An effective, scientifically validated, diagnostic tool helps clinicians make better, timely, and more objective medical decisions in the care of their patients. Today, the need for such tools is especially urgent in the field of wound care where patient-centric care is the goal, under ever tightening clinical budget constraints. In an era of countless “innovative” treatment options, that is, advanced dressings, negative pressure devices, and various debridement instruments available to the wound care clinical team, one area that has arguably languished in the past decade has been innovation in wound diagnostics. Whereas medical imaging is a mainstay in the diagnostic toolkit across many other medical fields (oncology, neurology, gastroenterology, orthopedics, etc.), the field of wound care has yet to realize the full potential that advances in imaging technologies have to offer the clinician. In this issue, the first of a series in wound imaging and diagnostics, four articles have been assembled, highlighting some of the recent advances in wound imaging technologies. PMID:27602251

  2. 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.

  3. 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

  4. 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

  5. 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

  6. 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

  7. Integrative and complementary therapies for patients with advanced cancer.

    PubMed

    Marchand, Lucille

    2014-07-01

    In integrative medicine, well-being is emphasized, and in palliative care, quality of life (QOL) is a similar concept or goal. Both can occur despite advanced cancer. Integrative medicine serves to combine the best of alternative, complementary and conventional therapies to optimize well-being and QOL, whether or not a person is at the end of their life. When integrative medicine is combined with palliative care modalities, the toolbox to provide symptom control and well-being or QOL is increased or broadened. Palliative care and integrative medicine are best provided early in the trajectory of illness such as cancer, and increase in amount as the illness progresses toward end of life. In cancer care, symptoms of the cancer, as well as symptoms produced by cancer therapies, are addressed with conventional and integrative therapies. Goals of care change as the disease progresses, and a patient's unique situation creates a different balance of integrative and conventional therapies. Integrative therapies such as music, aromatherapy, and massage might appeal to more patients than more specific, less common integrative therapies that might be more expensive, or seem more unusual such as Ayurvedic medicine and energy modalities. Each person may be drawn to different integrative modalities depending on factors such as cultural traditions, beliefs, lifestyle, internet information, advice from family and friends, books, etc. This review focuses on how integrative and complementary modalities can be included in comprehensive palliative care for patients with advanced malignancies. Nutrition and movement, often neglected in conventional treatment strategies, will also be included in the larger context of integrative and palliative modalities. Both conventional and integrative modalities in palliative care help patients live with empowerment, hope, and well-being no matter how long their lives last. A comprehensive review of all integrative and complementary therapies is

  8. The patient-as-partner approach in health care: a conceptual framework for a necessary transition.

    PubMed

    Karazivan, Philippe; Dumez, Vincent; Flora, Luigi; Pomey, Marie-Pascale; Del Grande, Claudio; Ghadiri, Djahanchah Philip; Fernandez, Nicolas; Jouet, Emmanuelle; Las Vergnas, Olivier; Lebel, Paule

    2015-04-01

    The prevalence of chronic diseases today calls for new ways of working with patients to manage their care. Although patient-centered approaches have contributed to significant advances in care and to treatments that more fully respect patients' preferences, values, and personal experiences, the reality is that health care professionals still hold a monopoly on the role of healer. Patients live with their conditions every day and are experts when it comes to their own experiences of illness; this expertise should be welcomed, valued, and fostered by other members of the care team. The patient-as-partner approach embodies the ideal of making the patient a bona fide member of the health care team, a true partner in his or her care. Since 2010, the University of Montreal, through the Direction of Collaboration and Patient Partnership, has embraced this approach. Patients are not only active members of their own health care team but also are involved in research and provide valuable training to health sciences students. Including patients as full partners in the health care team entails a significant shift in both the medical practice and medical education cultures. In this perspective, the authors describe this innovative approach to patient care, including the conceptual framework used in its development and the main achievements of patient partners in education, health care, and research. PMID:25607943

  9. The patient-as-partner approach in health care: a conceptual framework for a necessary transition.

    PubMed

    Karazivan, Philippe; Dumez, Vincent; Flora, Luigi; Pomey, Marie-Pascale; Del Grande, Claudio; Ghadiri, Djahanchah Philip; Fernandez, Nicolas; Jouet, Emmanuelle; Las Vergnas, Olivier; Lebel, Paule

    2015-04-01

    The prevalence of chronic diseases today calls for new ways of working with patients to manage their care. Although patient-centered approaches have contributed to significant advances in care and to treatments that more fully respect patients' preferences, values, and personal experiences, the reality is that health care professionals still hold a monopoly on the role of healer. Patients live with their conditions every day and are experts when it comes to their own experiences of illness; this expertise should be welcomed, valued, and fostered by other members of the care team. The patient-as-partner approach embodies the ideal of making the patient a bona fide member of the health care team, a true partner in his or her care. Since 2010, the University of Montreal, through the Direction of Collaboration and Patient Partnership, has embraced this approach. Patients are not only active members of their own health care team but also are involved in research and provide valuable training to health sciences students. Including patients as full partners in the health care team entails a significant shift in both the medical practice and medical education cultures. In this perspective, the authors describe this innovative approach to patient care, including the conceptual framework used in its development and the main achievements of patient partners in education, health care, and research.

  10. 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.

  11. Managing in the trenches of consumer care: the challenges of understanding and initiating the advance care planning process.

    PubMed

    Baughman, Kristin R; Aultman, Julie; Hazelett, Susan; Palmisano, Barbara; O'Neill, Anne; Ludwick, Ruth; Sanders, Margaret

    2012-01-01

    To better understand how community-based long-term care providers define advance care planning and their role in the process, we conducted 8 focus groups with 62 care managers (social workers and registered nurses) providing care for Ohio's Medicaid waiver program. Care managers shared that most consumers had little understanding of advance care planning. The care managers defined it broadly, including legal documentation, social aspects, medical considerations, ongoing communication, and consumer education. Care managers saw their roles as information providers, healthcare team members, and educators/coaches. Better education, resources, and coordination are needed to ensure that consumer preferences are realized.

  12. 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

  13. 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

  14. End-of-Life Care for Undocumented Immigrants With Advanced Cancer: Documenting the Undocumented.

    PubMed

    Jaramillo, Sylvia; Hui, David

    2016-04-01

    There are approximately 11.1 million undocumented immigrants in the United States, with a majority being Latino. Cancer is now the leading cause of death in Latinos. There is little research guiding providers on how to deliver optimal end-of-life care in this population. We describe a case of an undocumented Latino patient with advanced cancer, and provide a review of the literature on end-of-life care in undocumented immigrants. Our patient encountered many challenges as he navigated through the healthcare system in the last months of life. These included delayed diagnosis, limited social support, financial issues, fear of deportation, and language and cultural barriers, which resulted in significant physical and psychological distress. Within the undocumented patient population, there is often a lack of advance care planning, prognostic understanding, mistrust, religious practices, and cultural beliefs that may affect decision making. Given the growing number of undocumented immigrants in the United States, it is important for clinicians and policy makers to have a better understanding of the issues surrounding end-of-life care for undocumented immigrants, and work together to improve the quality of life and quality of end-of-life care for these disadvantaged individuals.

  15. Integration of Early Specialist Palliative Care in Cancer Care and Patient Related Outcomes: A Critical Review of Evidence

    PubMed Central

    Salins, Naveen; Ramanjulu, Raghavendra; Patra, Lipika; Deodhar, Jayita; Muckaden, Mary Ann

    2016-01-01

    Introduction: World Health Organization and American Society of Clinical Oncology recommend early integration of specialist palliative care in patients with cancer. This paper focuses on critical review of evidence on integration of early specialist palliative care in cancer care and patient-related outcomes. Methods: The question for the literature search was – Does integration of early specialist palliative care in cancer care influences patient-related outcomes? 31 articles related to literature search review question were included in this paper. Results: Ten patient-related outcomes of early specialist palliative care in adult cancer care was studied. Studies by Temel et al. (2012), Bakitas et al. (2009), Zimmermann et al. (2014), Rugno et al. (2014), Lowery et al. (2013) and Walker et al. (2014) showed early specialist palliative care improves health-related quality of life (HRQOL). Studies by Pirl et al. (2012), Lowery et al. (2013), and Walker et al. (2014) showed early specialist palliative care improved mood depression and anxiety. Studies by Zimmermann et al. and Rugno et al. (2014) showed symptom control benefit of early specialist palliative care. Studies by Temel (2010), Bakitas (2015) and Rugno et al. (2014) showed survival improvement with early specialist palliative care. All these studies were carried in ambulatory palliative care setting. No survival benefit of palliative care intervention was seen in inpatient palliative care setting. The studies by Geer et al. (2012), Rugno et al. (2014), and Lowery et al. (2013) showed that early palliative care intervention positively influences treatment decision making. All the studies showed that palliative care intervention group received less intravenous chemotherapy in last few weeks of life. Studies by Yoong et al. and Temel et al. (2011) shows early specialist palliative care improves advanced care planning. Studies by Temel et al. (2010), Greer et al. (2012), McNamara et al. (2013), Hui et al. (2014

  16. 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

  17. Patient neglect in 21st century health-care institutions: a community health psychology perspective.

    PubMed

    Reader, Tom W; Gillespie, Alex; Mannell, Jenevieve

    2014-01-01

    Despite the technological and organisational advances of 21st century health-care systems, care scandals and burgeoning complaints from patients have raised concerns about patient neglect in hospitals. This article reviews the concept of patient neglect and the role of community health psychology in understanding its occurrence. Patient neglect has previously been conceptualised as a problem associated with hospital staff attitudes and behaviours, with regulation and training cited as solutions. Yet, a community health psychology perspective shows that the wider symbolic, material and relational aspects of care are crucial for understanding why patient neglect occurs and for outlining new solutions to augment existing interventions.

  18. 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…

  19. Improving End-of-Life Care Prognostic Discussions: Role of Advanced Practice Nurses.

    PubMed

    Kalowes, Peggy

    2015-01-01

    Research has validated the desire of patients and families for ongoing prognostic information; however, few conversations occur before patients reach the advanced stages of their disease trajectory. Physician hesitance and delay in discussing unfavorable prognoses deny patients and families optimal time to prepare for critical decision making. Advanced practice registered nurses can play a crucial, complementary role with the critical care interdisciplinary team to implement strategies to improve communication about prognosis and end of life with patients and families. Clinicians should discuss deterioration in disease-specific characteristics and changes (decline) in functional status. Functional status can serve as an accurate guide for forecasting prognosis, particularly in patients with heart failure, stroke, chronic lung disease, and end-stage renal disease. This article provides an overview of effective intensive care unit prognostic systems and discusses barriers and opportunities for nurses to use evidence-based knowledge related to disease trajectory and prognosis to improve communication and the quality of palliative and end-of-life care for patients.

  20. Bioinformatics Methods and Tools to Advance Clinical Care

    PubMed Central

    Lecroq, T.

    2015-01-01

    Summary Objectives To summarize excellent current research in the field of Bioinformatics and Translational Informatics with application in the health domain and clinical care. Method We provide a synopsis of the articles selected for the IMIA Yearbook 2015, from which we attempt to derive a synthetic overview of current and future activities in the field. As last year, a first step of selection was performed by querying MEDLINE with a list of MeSH descriptors completed by a list of terms adapted to the section. Each section editor has evaluated separately the set of 1,594 articles and the evaluation results were merged for retaining 15 articles for peer-review. Results The selection and evaluation process of this Yearbook’s section on Bioinformatics and Translational Informatics yielded four excellent articles regarding data management and genome medicine that are mainly tool-based papers. In the first article, the authors present PPISURV a tool for uncovering the role of specific genes in cancer survival outcome. The second article describes the classifier PredictSNP which combines six performing tools for predicting disease-related mutations. In the third article, by presenting a high-coverage map of the human proteome using high resolution mass spectrometry, the authors highlight the need for using mass spectrometry to complement genome annotation. The fourth article is also related to patient survival and decision support. The authors present datamining methods of large-scale datasets of past transplants. The objective is to identify chances of survival. Conclusions The current research activities still attest the continuous convergence of Bioinformatics and Medical Informatics, with a focus this year on dedicated tools and methods to advance clinical care. Indeed, there is a need for powerful tools for managing and interpreting complex, large-scale genomic and biological datasets, but also a need for user-friendly tools developed for the clinicians in their

  1. 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

  2. Is There a Need for Early Palliative Care in Patients With Life-Limiting Illnesses? Interview Study With Patients About Experienced Care Needs From Diagnosis Onward.

    PubMed

    Beernaert, Kim; Deliens, Luc; De Vleminck, Aline; Devroey, Dirk; Pardon, Koen; Block, Lieve Van den; Cohen, Joachim

    2016-06-01

    The early integration of specialist palliative care has been shown to benefit the quality of life of patients with advanced cancer. In order to explore whether other seriously ill people and people at even earlier phases would also benefit from early palliative care, we conducted 18 qualitative interviews with people having cancer, chronic obstructive lung disease, heart failure, or dementia at different phases of the illness trajectory about how they experienced care needs related to their disease from diagnosis onward. Respondents experienced needs within the different domains of palliative care at different stages of the illness and different illness types or duration of the illness. This study contributes to the understanding of primary care needs of patients for whom palliative care (not necessarily specialized palliative care) could be beneficial. PMID:25852203

  3. Reduction of Behavioral Psychological Symptoms of Dementia by Multimodal Comprehensive Care for Vulnerable Geriatric Patients in an Acute Care Hospital: A Case Series

    PubMed Central

    Honda, Miwako; Ito, Mio; Ishikawa, Shogo; Takebayashi, Yoichi; Tierney, Lawrence

    2016-01-01

    Management of Behavioral and Psychological Symptoms of Dementia (BPSD) is a key challenge in geriatric dementia care. A multimodal comprehensive care methodology, Humanitude, with eye contact, verbal communication, and touch as its elements, was provided to three geriatric dementia patients for whom conventional nursing care failed in an acute care hospital. Each episode was evaluated by video analysis. All patients had advanced dementia with BPSD. Failure of care was identified by patient's shouting, screaming, or abrupt movements of limbs. In this case series, conventional care failed for all three patients. Each element of care communication was much shorter than in Humanitude care, which was accepted by the patients. The average of the elements performed during the care was eye contact 0.6%, verbal communication 15.7%, and touch 0.1% in conventional care and 12.5%, 54.8%, and 44.5% in Humanitude care, respectively. The duration of aggressive behavior of each patient during care was 25.0%, 25.4%, and 66.3% in conventional care and 0%, 0%, and 0.3% in Humanitude, respectively. In our case series, conventional care was provided by less eye contact, verbal communication, and touch. The multimodal comprehensive care approach, Humanitude, decreased BPSD and showed success by patients' acceptance of care. PMID:27069478

  4. Development of advance care planning research priorities: a call to action.

    PubMed

    Johnson, Ana P; Hanvey, Louise; Baxter, Sharon; Daren, K

    2013-01-01

    The objective of this study was to develop a national, prioritized research agenda for advance care planning (ACP). We first identified a list of comprehensive ACP research topics and determined priority criteria through focus groups. We next conducted a survey wherein importance weights were assigned to priority criteria and each ACP topic was rated. We combined weights and ratings into overall scores. A total of 17 ACP topics were developed and placed into four categories: patients and family members, the general public, professionals, and the healthcare system. Four main priority criteria were created: feasibility, consistency with ethical and societal values, economic considerations, and impact. Of the 100 individuals we invited to participate in the survey, 62 accepted. Prioritized topics centred largely on the impact of ACP on health resource utilization, communicating advance care planning across settings, and the preferred manner of engaging patients in ACP.

  5. 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

  6. How Outpatient Palliative Care Teleconsultation Facilitates Empathic Patient-Professional Relationships: A Qualitative Study

    PubMed Central

    van Gurp, Jelle; van Selm, Martine; Vissers, Kris; van Leeuwen, Evert; Hasselaar, Jeroen

    2015-01-01

    Objective The problems and needs of advanced cancer patients and proxies normally increase as the disease progresses. Home-based advanced cancer patients and their proxies benefit from collaborations between primary care physicians and hospital-based palliative care specialists when confronted with complex problems in the last phase of life. Telemedicine might facilitate direct, patient-centered communication between patients and proxies, primary care physicians, and specialist palliative care teams (SPCTs). This study focuses on the impact of teleconsultation technologies on the relationships between home-based palliative care patients and hospital-based palliative care specialists. Methods This work consists of a qualitative study among patients, family members, and caregivers that utilizes long-term direct observations, semi-structured interviews, and open interviews following the observations. Results The analysis of the empirical data resulted in three key concepts that describe the impact of teleconsultation on the patient-professional relationship in palliative homecare: transcending the institutional walls of home and hospital; transparency of teleconsultation technology; and technologized, intimate patient-professional relationships. Teleconsultation offers (1) condensed encounters between home-based palliative care patients and distant professionals, (2) a unique insight into the patients’ daily lives for palliative care specialists, and (3) long-term interaction that results in trustful relationships and experiences of intimacy and relief. Conclusions Teleconsultation fits the practice of home-based palliative care. Teleconsultation can, if well applied, facilitate computer-mediated but empathic patient-palliative care specialist relationships, which enable professional care attuned to the patient’s context as well as patient involvement. This article proposes a teleconsultation implementation guide for optimal use of teleconsultation in daily

  7. [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.

  8. Patient Autonomy Investigation under the Technology-Based Health Care System

    ERIC Educational Resources Information Center

    Yang, Yi

    2012-01-01

    With widespread advances in the diffusion and application of medical technologies, the phenomena of misuse and overuse have become pervasive. These phenomena not only increase the cost of health care systems and deplete the accessibility and availability of health care services, they also jeopardize patient autonomy. From a literature review on…

  9. Advanced Practice Registered Nurses: Gateway to Screening for Bipolar Disorder in Primary Care

    PubMed Central

    Kriebel-Gasparro, Ann Marie

    2016-01-01

    Objective: The goal of this mixed methods descriptive study was to explore Advanced Practice Registered Nurses’ (APRNs’) knowledge of bipolar disorder (BPD) and their perceptions of facilitators and barriers to screening patients with known depression for BPD. Methods: A mixed method study design using surveys on BPD knowledge and screening practices as well as focus group data collection method for facilitators and barriers to screening. Results: 89 APRNs completed the survey and 12 APRNs participated in the focus groups. APRNs in any practice setting had low knowledge scores of BPD. No significant differences in screening for BPD for primary and non primary care APRNs. Qualitative findings revealed screening relates to tool availability; time, unsure of when to screen, fear of sigma, symptoms knowledge of BPD, accessible referral system, personal experiences with BPD, and therapeutic relationships with patients. Conclusion: Misdiagnosis of BPD as unipolar depression is common in primary care settings, leading to a long lag time to optimal diagnosis and treatment. The wait time to diagnosis and treatment could be reduced if APRNs in primary care settings screen patients with a diagnosis of depression by using validated screening tools. These results can inform APRN practice and further research on the effectiveness of screening for reducing the morbidity and mortality of BPDs in primary care settings; underscores the need for integration of mental health care into primary care as well as the need for more APRN education on the diagnosis and management of bipolar disorders. PMID:27347256

  10. Advanced nurse practitioner-led referral for specialist care and rehabilitation.

    PubMed

    Mashlan, Wendy; Hayes, Julie; Thomas, Ceri

    2016-02-01

    In response to the need for appropriate and timely care of frail older patients admitted to hospital, a dedicated advanced nurse practitioner (ANP)-led referral service was developed. The service has continued to evolve over the 13 years since its implementation in accordance with changing service demands. This article describes the role of the ANP in care of the elderly/rehabilitation medicine and focuses on one area of clinical practice developed by the team: an ANP-led referral service. The aim of developing the service was to ensure that patients who required specialist care and rehabilitation could be identified and assessed as soon as possible after admission, with the premise that they could be transferred to a bed in care of the elderly medical wards. This was perceived by the ANPs to be advantageous for patients, who would receive care from a specialist team, and for care of the elderly staff who could use their knowledge and skills appropriately and safely.

  11. 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

  12. Improving medical graduates’ training in palliative care: advancing education and practice

    PubMed Central

    Head, Barbara A; Schapmire, Tara J; Earnshaw, Lori; Chenault, John; Pfeifer, Mark; Sawning, Susan; Shaw, Monica A

    2016-01-01

    The needs of an aging population and advancements in the treatment of both chronic and life-threatening diseases have resulted in increased demand for quality palliative care. The doctors of the future will need to be well prepared to provide expert symptom management and address the holistic needs (physical, psychosocial, and spiritual) of patients dealing with serious illness and the end of life. Such preparation begins with general medical education. It has been recommended that teaching and clinical experiences in palliative care be integrated throughout the medical school curriculum, yet such education has not become the norm in medical schools across the world. This article explores the current status of undergraduate medical education in palliative care as published in the English literature and makes recommendations for educational improvements which will prepare doctors to address the needs of seriously ill and dying patients. PMID:26955298

  13. Improving medical graduates' training in palliative care: advancing education and practice.

    PubMed

    Head, Barbara A; Schapmire, Tara J; Earnshaw, Lori; Chenault, John; Pfeifer, Mark; Sawning, Susan; Shaw, Monica A

    2016-01-01

    The needs of an aging population and advancements in the treatment of both chronic and life-threatening diseases have resulted in increased demand for quality palliative care. The doctors of the future will need to be well prepared to provide expert symptom management and address the holistic needs (physical, psychosocial, and spiritual) of patients dealing with serious illness and the end of life. Such preparation begins with general medical education. It has been recommended that teaching and clinical experiences in palliative care be integrated throughout the medical school curriculum, yet such education has not become the norm in medical schools across the world. This article explores the current status of undergraduate medical education in palliative care as published in the English literature and makes recommendations for educational improvements which will prepare doctors to address the needs of seriously ill and dying patients.

  14. Mini Review of Integrated Care and Implications for Advanced Practice Nurse Role

    PubMed Central

    McIntosh, Diana; Startsman, Laura F.; Perraud, Suzanne

    2016-01-01

    Literature related to primary care and behavioral health integration initiatives is becoming abundant. The United States’ 2010 Patient Protection and Affordable Care Act included provisions encouraging increased collaboration of care for individuals with behavioral and physical health service needs in the public sector. There is relatively little known of Advanced Practice Registered Nurses’ (APRNs) roles with integrating primary and behavioral healthcare. The goal of this review article is to: (a) define integration of physical and behavioral healthcare and potential models; (b) answer the question as to what are effective evidence based models/strategies for integrating behavioral health and primary care; (c) explore the future role and innovations of APRNs in the integration of physical and behavioral healthcare. Results: The evidence- based literature is limited to three systematic reviews and six randomized controlled trials. It was difficult to generalize the data and the effective integration strategies varied from such interventions as care management to use of sertraline to depression management and to access. There were, though, implications for the integrated care advanced practice nurse to have roles inclusive of competencies, leadership, engagement, collaboration and advocacy. PMID:27347258

  15. Advances in migraine management: implications for managed care organizations.

    PubMed

    Dodick, David W; Lipsy, Robert J

    2004-05-01

    Migraine headache is a disabling disease that poses a significant societal burden. Stratified care and early intervention are current strategies for migraine management. It has been shown that early treatment with triptans in select patients can improve treatment outcomes. Triptans are selective 5-HT receptor agonists that are specific and effective treatments in the management of migraine, and they meet the acute treatment goal of rapid relief with minimal side effects. Triptans are associated with improved quality of life. Factors such as speed of onset, need for a second triptan dose, and patient satisfaction should be considered in the selection of a specific triptan treatment. Appropriate treatment can decrease costs. The patient's migraine history and response to prior therapy should be considered when selecting acute treatment. Cost-effectiveness models can be used to understand the effect of treatment choices on health care budgets. The direct cost per migraine episode, driven primarily by the need for rescue medications, is important to include in economic models. All aspects of effectiveness (efficacy, tolerability, and cost) should be considered to reduce overall managed care expenditures for migraine treatment. The improved clinical profiles of the triptans provide substantial value to managed care organizations.

  16. Advance Care Planning among People Living with Dialysis

    PubMed Central

    Elliott, Barbara A.; Gessert, Charles E.

    2016-01-01

    Purpose: Recent nephrology literature focuses on the need for discussions regarding advance care planning (ACP) for people living with dialysis (PWD). PWD and their family members’ attitudes toward ACP and other aspects of late-life decision making were assessed in this qualitative study. Methodology: Thirty-one interviews were completed with 20 PWD over the age of 70 (mean dialysis 34 months) and 11 family members, related to life experiences, making medical decisions, and planning for the future. Interviews were recorded, transcribed and analyzed. Findings: Four themes regarding ACP emerged from this secondary analysis of the interviews: how completing ACP, advance directives (AD), and identifying an agent fit into PWD experiences; PWD understanding of their prognosis; what gives PWD lives meaning and worth; and PWD care preferences when their defined meaning and worth are not part of their experience. These PWD and family members revealed that ACP is ongoing and common among them. They did not seem to think their medical providers needed to be part of these discussions, since family members were well informed. Practical implications: These results suggest that if health care providers and institutions need AD forms completed, it will important to work with both PWD and their family members to assure personal wishes are documented and honored. PMID:27417605

  17. [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.

  18. Advanced practice nursing, health care teams, and perceptions of team effectiveness.

    PubMed

    Kilpatrick, Kelley; Lavoie-Tremblay, Mélanie; Ritchie, Judith A; Lamothe, Lise

    2011-01-01

    This article summarizes the results of an extensive review of the organizational and health care literature of advanced practice nursing (APN) roles, health care teams, and perceptions of team effectiveness. Teams have a long history in health care. Managers play an important role in mobilizing resources, guiding expectations of APN roles in teams and within organizations, and facilitating team process. Researchers have identified a number of advantages to the addition of APN roles in health care teams. The process within health care teams are dynamic and responsive to their surrounding environment. It appears that teams and perceptions of team effectiveness need to be understood in the broader context in which the teams are situated. Key team process are identified for team members to perceive their team as effective. The concepts of teamwork, perceptions of team effectiveness, and the introduction of APN roles in teams have been studied disparately. An exploration of the links between these concepts may further our understanding the health care team's perceptions of team effectiveness when APN roles are introduced. Such knowledge could contribute to the effective deployment of APN roles in health care teams and improve the delivery of health care services to patients and families.

  19. Advanced practice nursing, health care teams, and perceptions of team effectiveness.

    PubMed

    Kilpatrick, Kelley; Lavoie-Tremblay, Mélanie; Ritchie, Judith A; Lamothe, Lise

    2014-01-01

    This article summarizes the results of an extensive review of the organizational and health care literature of advanced practice nursing (APN) roles, health care teams, and perceptions of team effectiveness. Teams have a long history in health care. Managers play an important role in mobilizing resources, guiding expectations of APN roles in teams and within organizations, and facilitating team process. Researchers have identified a number of advantages to the addition of APN roles in health care teams. The process within health care teams are dynamic and responsive to their surrounding environment. It appears that teams and perceptions of team effectiveness need to be understood in the broader context in which the teams are situated. Key team process are identified for team members to perceive their team as effective. The concepts of teamwork, perceptions of team effectiveness, and the introduction of APN roles in teams have been studied disparately. An exploration of the links between these concepts may further our understanding the health care team's perceptions of team effectiveness when APN roles are introduced. Such knowledge could contribute to the effective deployment of APN roles in health care teams and improve the delivery of health care services to patients and families.

  20. Advanced practice nursing, health care teams, and perceptions of team effectiveness.

    PubMed

    Kilpatrick, Kelley; Lavoie-Tremblay, Mélanie; Ritchie, Judith A; Lamothe, Lise

    2014-01-01

    This article summarizes the results of an extensive review of the organizational and health care literature of advanced practice nursing (APN) roles, health care teams, and perceptions of team effectiveness. Teams have a long history in health care. Managers play an important role in mobilizing resources, guiding expectations of APN roles in teams and within organizations, and facilitating team process. Researchers have identified a number of advantages to the addition of APN roles in health care teams. The process within health care teams are dynamic and responsive to their surrounding environment. It appears that teams and perceptions of team effectiveness need to be understood in the broader context in which the teams are situated. Key team process are identified for team members to perceive their team as effective. The concepts of teamwork, perceptions of team effectiveness, and the introduction of APN roles in teams have been studied disparately. An exploration of the links between these concepts may further our understanding the health care team's perceptions of team effectiveness when APN roles are introduced. Such knowledge could contribute to the effective deployment of APN roles in health care teams and improve the delivery of health care services to patients and families. PMID:25397338

  1. 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.

  2. Diabetes Drug Victoza Might Not Help Advanced Heart Failure Patients

    MedlinePlus

    ... html Diabetes Drug Victoza Might Not Help Advanced Heart Failure Patients Study participants may have been too sick ... to improve heart function in patients with advanced heart failure, a new study finds. The theory for this ...

  3. Infusing Swanson's Theory of caring into an advanced practice nursing model for an infectious diseases anal dysplasia clinic.

    PubMed

    Ahern, Richard L; Corless, Inge B; Davis, Sheila M; Kwong, Jeffrey J

    2011-01-01

    The incidence of anal cancer is increasing among HIV-infected men and women. The process of screening for anal dysplasia and the management of abnormal findings are currently and most often based on a medical model. The needs of these patients, however, go well beyond medical care. A more comprehensive and holistic approach to health care is, therefore, required. Given the scope of practice of advanced practice nurses who are involved in the diagnosis and treatment of patients with anal dysplasia, it is appropriate for them to assume leadership roles in addressing the needs of these patients. This article describes the application of a theory of caring to create an advanced practice nursing model of care for HIV-infected men and women in infectious diseases anal dysplasia clinics. PMID:22035527

  4. 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.

  5. 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

  6. Advance care planning: identifying system-specific barriers and facilitators

    PubMed Central

    Hagen, N.A.; Howlett, J.; Sharma, N.C.; Biondo, P.; Holroyd-Leduc, J.; Fassbender, K.; Simon, J.

    2015-01-01

    Background Advance care planning (acp) is an important process in health care today. How to prospectively identify potential local barriers and facilitators to uptake of acp across a complex, multi-sector, publicly funded health care system and how to develop specific mitigating strategies have not been well characterized. Methods We surveyed a convenience sample of clinical and administrative health care opinion leaders across the province of Alberta to characterize system-specific barriers and facilitators to uptake of acp. The survey was based on published literature about the barriers to and facilitators of acp and on the Michie Theoretical Domains Framework. Results Of 88 surveys, 51 (58%) were returned. The survey identified system-specific barriers that could challenge uptake of acp. The factors were categorized into four main domains. Three examples of individual system-specific barriers were “insufficient public engagement and misunderstanding,” “conflict among different provincial health service initiatives,” and “lack of infrastructure.” Local system-specific barriers and facilitators were subsequently explored through a semi-structured informal discussion group involving key informants. The group identified approaches to mitigate specific barriers. Conclusions Uptake of acp is a priority for many health care systems, but bringing about change in multi-sector health care systems is complex. Identifying system-specific barriers and facilitators to the uptake of innovation are important elements of successful knowledge translation. We developed and successfully used a simple and inexpensive process to identify local system-specific barriers and enablers to uptake of acp, and to identify specific mitigating strategies. PMID:26300673

  7. Advanced nurse-patient communication system.

    PubMed

    Unluturk, Mehmet S

    2012-08-01

    Effective communication is the most important part of any healthcare organization. For many years, hospital nurse call solutions had been stand-alone systems with occasional integration to pocket paging for outputting patient call alerts to mobile staff. In the late 1990's, technology enabled in-building wireless phones to supplement or replace paging systems as a means of not only sending alerts, but also enabling voice communication between mobile staff and patients. Today's nurse call market requires integration of additional information from location and ADT (admit, discharge, transfer) systems into what have traditionally been nurse call applications. This system information is required not only at the nursing station, pagers, and phones, but also at PC's placed on each patient care floor in hallways, nurse stations, and offices, and at areas away from the patients, including administrator and clinical engineering offices. It is crucial that nurses have the latest patient information in their hand wherever they go in the hospital. In this paper, MatchMaker.NET has been developed to integrate all these technologies into the hospital's LAN to improve nurse-patient communication. PMID:21541690

  8. Disentangling consumer and provider predictors of advance care planning.

    PubMed

    Baughman, Kristin R; Ludwick, Ruth; Merolla, David; Palmisano, Barbara; Hazelett, Susan; Allen, Kyle R; Sanders, Margaret

    2013-11-01

    Factorial surveys were used to examine community-based long-term care providers' judgments about consumers' need for advance care planning (ACP) and comfort levels in discussing ACP. Providers (448 registered nurses and social workers) judged vignettes based on hypothetical consumers. Hierarchical linear models indicated providers judged consumers who were older, had end-stage diagnoses, multiple emergency department visits, and uninvolved caregivers as most in need of ACP. These variables explained 10% of the variance in judgments. Providers' beliefs about ACP predicted judgments of need for ACP and comfort level in discussing ACP. Provider characteristics explained more variance in comfort levels (44%) than in judgments of need (20%). This study demonstrates the need for tailored educational programs to increase comfort levels and address ACP misconceptions.

  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.

  10. 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

  11. Antimicrobial stewardship in the intensive care unit: advances and obstacles.

    PubMed

    Lawrence, Kevin L; Kollef, Marin H

    2009-03-15

    Antimicrobial stewardship involves a multifaceted approach that strives to combat the emergence of resistance, improve clinical outcomes, and control costs by improving antimicrobial use. Therefore, stewardship is of great importance and relevance in the intensive care unit. Clinical decision support systems, biomarker-derived treatment algorithms, and improved knowledge regarding the different components of antimicrobial therapy represent some of the advances that have been made in stewardship. Yet, significant obstacles have prevented the full achievement of stewardship's goals, and approaches to confronting these obstacles should be appreciated. Clinicians should realize that antimicrobials are important therapeutic agents and strive to use them wisely.

  12. Case study: Transitional care for a patient with benign prostatic hyperplasia and recurrent urinary tract infections.

    PubMed

    Bradway, Christine; Bixby, M Brian; Hirschman, Karen B; McCauley, Kathleen; Naylor, Mary D

    2013-01-01

    Chronic urologic conditions, including benign prostatic hyperplasia, recurrent urinary tract infections, and urinary incontinence, are common in older adults. This article highlights the urologic and transitional care needs of an elderly, cognitively impaired male during and after an acute hospitalization. Collaboration between the patient, his family, the advanced practice nurse, primary care providers, and outpatient urology office are described. The importance of mutual goal setting and a focused plan for transitional care are discussed.

  13. 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

  14. 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

  15. Advanced practice in emergency care: the paediatric flow nurse.

    PubMed

    Gray, Constance; Hutch, Michelle; Christensen, Martin

    2016-05-01

    Children admitted to emergency departments (EDs) in Australia are often placed in an environment better suited to the treatment of adult patients. This can lead to problems because ED staff are unfamiliar with specialist paediatric care and children often find adult EDs frightening. The development of the paediatric flow nurse (PFN) role at Caboolture Hospital has meant children are treated and supported by a trained paediatric nurse and triaged and treated quickly and effectively. The PFN team collaborates with ED nursing and medical staff to start treating patients and to help move children from the ED to the paediatric emergency short stay unit or inpatient paediatric beds. Each week, the PFN team sees about 30-50 children, many of whom are cared for and discharged directly from the ED.

  16. Advances in addressing technical challenges of point-of-care diagnostics in resource-limited settings

    PubMed Central

    Wang, ShuQi; Lifson, Mark A.; Inci, Fatih; Liang, Li-Guo; Sheng, Ye-Feng; Demirci, Utkan

    2016-01-01

    The striking prevalence of HIV, TB and malaria, as well as outbreaks of emerging infectious diseases, such as influenza A (H7N9), Ebola and MERS, poses great challenges for patient care in resource-limited settings (RLS). However, advanced diagnostic technologies cannot be implemented in RLS largely due to economic constraints. Simple and inexpensive point-of-care (POC) diagnostics, which rely less on environmental context and operator training, have thus been extensively studied to achieve early diagnosis and treatment monitoring in non-laboratory settings. Despite great input from material science, biomedical engineering and nanotechnology for developing POC diagnostics, significant technical challenges are yet to be overcome. Summarized here are the technical challenges associated with POC diagnostics from a RLS perspective and the latest advances in addressing these challenges are reviewed. PMID:26777725

  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. [Vital prognosis in advanced cancer patients: a systematic literature review].

    PubMed

    Tavares, Teresa; Gonçalves, Edna

    2013-01-01

    Prognostication is a critical medical task for the adequacy of treatment and management of priorities and expectations of patients and families. In 2005, the European Association of Palliative Care (EAPC) published recommendations on the formulation of vital prognosis in advanced cancer patients. The aim of this study is to analyze the literature subsequent to this review and to update the presented recommendations. Using the same strategy of the EAPC group, we performed a systematic literature search in the electronic databases PubMed and Scopus, which included original studies in adults with advanced cancer, without tumor-directed treatment, with a median survival of less than 90 days. The articles were analyzed and classified according to the level of evidence by two independent reviewers. The 41 articles analyzed allowed to keep grade A recommendations for clinical estimation of survival and Palliative Prognostic score and now also for Palliative Prognostic Index, performance status, dyspnea, lymphopenia and lactate dehydrogenase. Recommendations regarding the use of C-reactive protein, leukocytosis, azotemia, hypoalbuminemia and male gender as predictors reached grade B. To formulate the vital prognosis and to communicate it properly to the patient and family are core competencies of physicians, particularly of those who deal with end of life patients. The clinical impression combined with scientific evidence allows us to estimate more accurately the survival, allowing prioritizing and managing more appropriately the existing resources.

  19. Patient Abuse in the Health Care Setting: The Nurse as Patient Advocate.

    PubMed

    Albina, Julie K

    2016-01-01

    Incidents of verbal and physical patient abuse in health care settings continue to occur, with some making headline news. Nurses have a professional and ethical responsibility to advocate for their patients when incidents of abuse occur. Tolerating or ignoring inappropriate behaviors occurs for multiple reasons, including ignorance, fear of retaliation, the need for peer acceptance, and concerns for personal advancement. Nurses need to reflect on their biases before they can truly respect patients' autonomy. Through the examination of reported cases of patient abuse, the need for a change in hospital culture becomes evident. The primary steps in eliminating patient abuse are opening communication, providing education, establishing competency, eliminating tolerance of unacceptable behavior, and creating a code of mutual respect. A change in culture to one of mutual respect and dignity for staff members and patients will lead to the best outcomes for all involved. PMID:26746029

  20. 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).

  1. 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.

  2. Management of a patient with advanced BRAF-mutant melanoma.

    PubMed

    Ashworth, Michelle T; Daud, Adil

    2014-03-01

    A 49-year-old man initially diagnosed in 1995 with cutaneous melanoma presented to the authors' institution in 2009 with metastatic, BRAF V600E-mutant melanoma. His treatment course to date has included surgery, adjuvant radiotherapy, and interferon, metastasectomies, granulocyte-macrophage colony-stimulating factors, a clinical trial with the BRAF inhibitor vemurafenib (PLX-4032), clinical trial with combination BRAF plus MEK inhibition with vemurafenib plus GDC-0973, and combination targeted and immune therapy with vemurafenib plus the anti-CTLA4 antibody ipilimumab. This case report illustrates the long-term management of a patient with metastatic melanoma using targeted and immune therapy, evolution in treatment guidelines, next directions in research, and the critical role of clinical trials in advancement of patient care.

  3. Measuring therapeutic alliance between oncologists and patients with advanced cancer: The Human Connection Scale

    PubMed Central

    Mack, Jennifer W; Block, Susan D.; Nilsson, Matthew; Wright, Alexi; Trice, Elizabeth; Friedlander, Robert; Paulk, Elizabeth; Prigerson, Holly G

    2009-01-01

    Objectives Patients consider having a human connection with a physician to be an important aspect of end-of-life (EOL) care. We sought to develop and validate a measure of therapeutic alliance between advanced cancer patients and their physicians, and to evaluate the effects of therapeutic alliance on EOL experiences and care. Methods We developed The Human Connection (THC) scale to measure the extent to which patients felt a sense of mutual understanding, caring, and trust with their physicians. The scale was administered to 217 advanced cancer patients along with measures of attributes hypothesized to be related to therapeutic alliance, including emotional acceptance of terminal illness. EOL outcomes in 90 patients who died during the study were also examined. Results The 16-item THC questionnaire was internally consistent (Cronbach’s α =.90) and valid, based on its expected positive association with emotional acceptance of the terminal illness (r=.31, P<.0001). THC scores were inversely related to symptom burden (r=−.19, P=.006), functional status (Karnofsky score, r=.22, P=.001), and mental illness (THC score 50.69 for patients with any DSM diagnosis versus 55.22 for those without, P=.03). THC scores were not significantly associated with EOL discussions (P=.68). Among patients who had died, EOL ICU care was inversely associated with therapeutic alliance (THC score 46.5 for those with ICU care versus 55.5 for those without, P=.002), such that patients with higher THC scores were less likely to spend time in the ICU during the last week of life. Conclusion The THC scale is a valid and reliable measure of therapeutic alliance between advanced cancer patients and their physicians. In addition, we found no evidence to suggest that EOL discussions harm patients’ therapeutic alliance. A strong therapeutic alliance is associated with emotional acceptance of a terminal illness and with decreased ICU care at the end of life among patients with advanced cancer

  4. Family support and family-centered care in the neonatal intensive care unit: origins, advances, impact.

    PubMed

    Gooding, Judith S; Cooper, Liza G; Blaine, Arianna I; Franck, Linda S; Howse, Jennifer L; Berns, Scott D

    2011-02-01

    Family-centered care (FCC) has been increasingly emphasized as an important and necessary element of neonatal intensive care. FCC is conceptualized as a philosophy with a set of guiding principles, as well as a cohort of programs, services, and practices that many hospitals have embraced. Several factors drive the pressing need for family-centered care and support of families of infants in NICUs, including the increase in the number of infants in NICUs; growth in diversity of the population and their concurrent needs; identification of parental and familial stress and lack of parenting confidence; and gaps in support for families, as identified by parents and NICU staff. We explore the origins of and advances in FCC in the NICU and identify various delivery methods and aspects of FCC and family support in the NICU. We examine the research and available evidence supporting FCC in the NICU and offer recommendations for increased dissemination and for future study.

  5. Supervision Requirements: Criteria for the Nurse and Auxiliary Staff When Providing Patient Care Visits.

    PubMed

    Vargo, Deanna; Vargo, Paige

    2016-01-01

    Physician or advanced care clinicians' (advanced practice nurses, physician assistants) orders are routinely carried out by nursing staff, with the goals of implementing treatment plans and improving patient outcomes. In the outpatient setting, nurses must consider the regulations imposed by the Centers for Medicare & Medicaid Services when initiating care and billing for services. Nurses, advanced practice nurses, and other clinicians may deliver care ordered by physicians without the physician being physically present in the room. Such services are considered to be "incident to" the physician's care, and there are requirements of supervision that must be met pertaining to the specific care setting. These guidelines and the implications for WOC nurses are the focus of this article. PMID:27163681

  6. Myofacial Trigger Points in Advanced Cancer Patients

    PubMed Central

    Hasuo, Hideaki; Ishihara, Tatsuhiko; Kanbara, Kenji; Fukunaga, Mikihiko

    2016-01-01

    Myofascial pain syndrome is started to be recognized as one of important factors of pain in cancer patients. However, no reports on features of myofascial trigger points were found in terminally-ill cancer populations. This time, we encountered 5 patients with myofascial pain syndrome and terminal cancer in whom delirium developed due to increased doses of opioid without a diagnosis of myofascial pain syndrome on initial presentation. The delirium subsided with dose reductions of opioid and treatment of myofascial pain syndrome. The common reason for a delayed diagnosis among the patients included an incomplete palpation of the painful sites, which led to unsuccessful myofascial trigger points identification. The features of myofascial trigger points included single onset in the cancer pain management site with opioid and the contralateral abdominal side muscles of the non-common sites. Withdrawal reflexes associated with cancer pain in the supine position, which are increasingly seen in the terminal cancer patients, were considered to have contributed to this siuation. We consider that careful palpation of the painful site is important, in order to obtain greater knowledge and understanding of the features of myofascial trigger points. PMID:26962285

  7. Do specialist palliative care teams improve outcomes for cancer patients? A systematic literature review.

    PubMed

    Hearn, J; Higginson, I J

    1998-09-01

    The objective of the study was to determine whether teams providing specialist palliative care improve the health outcomes of patients with advanced cancer and their families or carers when compared to conventional services. The study involved a systematic literature review of published research. The source of the data included studies identified from a systematic search of computerized databases (Medline, psychINFO, CINAHL and BIDS to the end of 1996), hand-searching specialist palliative care journals, and studying bibliographies and reference lists. The inclusion criteria for articles were that the study considered the use of specialist palliative care teams caring for patients with advanced cancer. Articles were assessed and data extracted and synthesized, with studies graded according to design. A variety of outcomes were considered by the authors. These addressed aspects of symptom control, patient and family or carer satisfaction, health care utilization and cost, place of death, psychosocial indices and quality of life. Overall, 18 relevant studies were identified, including five randomized controlled trials. Improved outcomes were seen in the amount of time spent at home by patients, satisfaction by both patients and their carers, symptom control, a reduction in the number of inpatient hospital days, a reduction in overall cost, and the patients' likelihood of dying where they wished to for those receiving specialist care from a multiprofessional palliative care team. It was concluded that all evaluations were of services considered to be leading the field, or were pioneering training and treatments. However, when compared to conventional care, there is evidence that specialist teams in palliative care improve satisfaction and identify and deal with more patient and family needs. Moreover, multiprofessional approaches to palliative care reduce the overall cost of care by reducing the amount of time patients spend in acute hospital settings.

  8. 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

  9. Validation of an advanced practice physiotherapy model of care in an orthopaedic outpatient clinic

    PubMed Central

    2013-01-01

    Background In Canada, new models of orthopaedic care involving advanced practice physiotherapists (APP) are being implemented. In these new models, aimed at improving the efficiency of care for patients with musculoskeletal disorders, APPs diagnose, triage and conservatively treat patients. Formal validation of the efficiency and appropriateness of these emerging models is scarce. The purpose of this study is to assess the diagnostic agreement of an APP compared to orthopaedic surgeons as well as to assess treatment concordance, healthcare resource use, and patient satisfaction in this new model. Methods 120 patients presenting for an initial consult for hip or knee complaints in an outpatient orthopaedic hospital clinic in Montreal, Canada, were independently assessed by an APP and by one of three participating orthopaedic surgeons. Each health care provider independently diagnosed the patients and provided triage recommendations (conservative or surgical management). Proportion of raw agreement and Cohen’s kappa were used to assess inter-rater agreement for diagnosis, triage, treatment recommendations and imaging tests ordered. Chi-Square tests were done in order to compare the type of conservative treatment recommendations made by the APP and the surgeons and Student t-tests to compare patient satisfaction between the two types of care. Results The majority of patients assessed were female (54%), mean age was 54.1 years and 91% consulted for a knee complaint. The raw agreement proportion for diagnosis was 88% and diagnostic inter-rater agreement was very high (κ=0.86; 95% CI: 0.80-0.93). The triage recommendations (conservative or surgical management) raw agreement proportion was found to be 88% and inter-rater agreement for triage recommendation was high (κ=0.77; 95% CI: 0.65-0.88). No differences were found between providers with respect to imaging tests ordered (p≥0.05). In terms of conservative treatment recommendations made, the APP gave significantly

  10. Meaningful Use of Data in Care Coordination by the Advanced Practice Registered Nurse: The TeleFamilies Project

    PubMed Central

    Looman, Wendy S.; Erickson, Mary M.; Garwick, Ann W.; Cady, Rhonda G.; Kelly, Anne; Pettey, Carrie; Finkelstein, Stanley M.

    2012-01-01

    Meaningful use of electronic health records to coordinate care requires skillful synthesis and integration of subjective and objective data by practitioners to provide context for information. This is particularly relevant in the coordination of care for children with complex special health care needs. The purpose of this paper is to present a conceptual framework and example of meaningful use within an innovative telenursing intervention to coordinate care for children with complex special health care needs. The TeleFamilies intervention engages an advanced practice nurse in a full-time care coordinator role within an existing hospital-based medical home for children with complex special health care needs. Care coordination is facilitated by the synthesis and integration of internal and external data using an enhanced electronic health record and telehealth encounters via telephone and videoconferencing between the advanced practice nurse and the family at home. The advanced practice nurse’s ability to maintain an updated plan of care that is shared across providers and systems and build a relationship over time with the patient and family supports meaningful use of these data. PMID:22948406

  11. The evolving role of health educators in advancing patient safety: forging partnerships and leading change.

    PubMed

    Mercurio, Annette

    2007-04-01

    At least 1.5 million preventable injuries because of adverse drug events occur in the United States each year, according to an Institute of Medicine report. IOM and other organizations at the forefront of health care improvement emphasize that stronger partnerships between patients, their families, and health care providers are necessary to make health care safer. Health educators possess a skill set and an ethical framework that effectively equip them to advance patient and family-centered care and contribute in other significant ways to a safer health care system. Health educators in clinical settings are playing varied and significant roles in advancing patient safety. They are removing barriers to clear communication and forging partnerships between patients, their families, and staff. Health educators are leading patient safety culture change within their institutions and contributing to the shift from provider-centric to patient-centric systems. To expand their impact in improving patient safety, health educators in clinical settings are participating in public awareness campaigns. In seeking to enhance patient safety, health educators face a number of challenges. To successfully manage those, health educators must expand their knowledge, broaden connections, and engage patients and families in meaningful ways.

  12. 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.

  13. 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.

  14. 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

  15. Positioning advanced practice registered nurses for health care reform: consensus on APRN regulation.

    PubMed

    Stanley, Joan M; Werner, Kathryn E; Apple, Kathy

    2009-01-01

    Advanced practice registered nurses (APRNs) have positioned themselves to serve an integral role in national health care reform. This article addresses both the policy and the process to develop this policy that has placed them in a strategic position. A successful transformation of the nation's health system will require utilization of all clinicians, particularly primary care providers, to the full extent of their education and scope of practice. APRNs are highly qualified clinicians who provide cost-effective, accessible, patient-centered care and have the education to provide the range of services at the heart of the reform movement, including care coordination, chronic care management, and wellness and preventive care. The APRN community faces many challenges amidst the opportunities of health reform. However, the APRN community's triumph in reaching consensus on APRN regulation signifies a cohesive approach to overcoming the obstacles. The consensus model for APRN regulation, endorsed by 44 national nursing organizations, will serve as a beacon for nursing, as well as a guidepost for consumers and policymakers, on titling, education, certification, accreditation, and licensing for all four APRN roles.

  16. 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

  17. 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

  18. Advanced Hemodynamic Management in Patients with Septic Shock

    PubMed Central

    Huber, Wolfgang; Nierhaus, Axel; Kluge, Stefan; Reuter, Daniel A.; Wagner, Julia Y.

    2016-01-01

    In patients with sepsis and septic shock, the hemodynamic management in both early and later phases of these “organ dysfunction syndromes” is a key therapeutic component. It needs, however, to be differentiated between “early goal-directed therapy” (EGDT) as proposed for the first 6 hours of emergency department treatment by Rivers et al. in 2001 and “hemodynamic management” using advanced hemodynamic monitoring in the intensive care unit (ICU). Recent large trials demonstrated that nowadays protocolized EGDT does not seem to be superior to “usual care” in terms of a reduction in mortality in emergency department patients with early identified septic shock who promptly receive antibiotic therapy and fluid resuscitation. “Hemodynamic management” comprises (a) making the diagnosis of septic shock as one differential diagnosis of circulatory shock, (b) assessing the hemodynamic status including the identification of therapeutic conflicts, and (c) guiding therapeutic interventions. We propose two algorithms for hemodynamic management using transpulmonary thermodilution-derived variables aiming to optimize the cardiocirculatory and pulmonary status in adult ICU patients with septic shock. The complexity and heterogeneity of patients with septic shock implies that individualized approaches for hemodynamic management are mandatory. Defining individual hemodynamic target values for patients with septic shock in different phases of the disease must be the focus of future studies. PMID:27703980

  19. 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.

  20. 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…

  1. [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

  2. 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

  3. Dietary intake of advanced cancer patients.

    PubMed

    Walsh, T D; Bowman, K B; Jackson, G P

    1983-02-01

    A state registered dietitian assessed the voluntary dietary intake of 13 advanced cancer inpatients on one ward of St. Christopher's Hospice for five consecutive days. There were 11 females, two males; median age 74 years (range 56 to 83). Two patients died on the fourth day of the study. A partially individualised weighed technique was used. Standard sized scoops and spoons were used to serve the food in small, medium or large standard portions (depending on appetite) and were weighed as served. Individual plate waste (by weight) was subtracted to give estimated individual intake. Foods provided by visitors was not included. The median and range of individual mean daily intakes (estimated) were: energy 5760 (938-8945) kJ, 1376 (224-2137) kcal; protein 44 (11-86) g; fat 52 (9-93) g; carbohydrate 169 (21-194) g; calcium 748 (268-1457) mg; iron 4.8 (0.5-21.0) mg; dietary fibre 5.0 (0.5-21.0) g. Compared to recommended amounts, energy, iron and dietary fibre intakes were low; calcium intake was high. Nutritional status may affect prognosis and/or subjective well-being in advanced cancer. The value of nutritional supplementation and the role of appetite stimulants in improving nutritional status needs investigation.

  4. Dietary intake of advanced cancer patients.

    PubMed

    Walsh, T D; Bowman, K B; Jackson, G P

    1983-02-01

    A state registered dietitian assessed the voluntary dietary intake of 13 advanced cancer inpatients on one ward of St. Christopher's Hospice for five consecutive days. There were 11 females, two males; median age 74 years (range 56 to 83). Two patients died on the fourth day of the study. A partially individualised weighed technique was used. Standard sized scoops and spoons were used to serve the food in small, medium or large standard portions (depending on appetite) and were weighed as served. Individual plate waste (by weight) was subtracted to give estimated individual intake. Foods provided by visitors was not included. The median and range of individual mean daily intakes (estimated) were: energy 5760 (938-8945) kJ, 1376 (224-2137) kcal; protein 44 (11-86) g; fat 52 (9-93) g; carbohydrate 169 (21-194) g; calcium 748 (268-1457) mg; iron 4.8 (0.5-21.0) mg; dietary fibre 5.0 (0.5-21.0) g. Compared to recommended amounts, energy, iron and dietary fibre intakes were low; calcium intake was high. Nutritional status may affect prognosis and/or subjective well-being in advanced cancer. The value of nutritional supplementation and the role of appetite stimulants in improving nutritional status needs investigation. PMID:6841131

  5. 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.

  6. Patient-centered care in lung cancer: exploring the next milestones

    PubMed Central

    Samuels, Noah

    2015-01-01

    In this editorial, the authors comment on a recently published review paper by Molassiotis et al. on the developments made over the past 40 years in supportive care for patients with lung cancer. During this period, a paradigm shift promoting patient-centered care (PCC) has led to an important change in the approach of supportive cancer care, from a purely disease-centered approach, measuring survival-related outcomes, to recognizing the importance of quality of life outcomes as well. This change of understanding in supportive and palliative care for patients with lung cancer can be further advanced through the understanding that there is a need to address bio-psycho-spiritual concerns and health belief models, within the context of the family socio-cultural environment, for both patients and their caregivers. There is also a need to address the psycho-spiritual effects of cancer on those health care professionals treating patients with lung cancer, in order to reduce compassion fatigue and increase resilience. Future directions for supportive care for patients with lung cancer may include the development of a patient-tailored treatment approach, assisted by the integration of a multidisciplinary team of health care providers and evidence-based complementary medicine practices, within conventional supportive care practice. PMID:26629435

  7. Palliative Care and the Humanities: Centralizing the Patient at the End of Life

    PubMed Central

    Franke, Richard J.

    2016-01-01

    Palliative care is a quickly growing facet of modern medicine. While scientific advancements have broken new ground for the possibilities of end-of-life care, sensitive treatment of the patient as an individual has lagged behind and has frequently led to an unsatisfactory experience for patients, families, and the medical community at large. This essay argues that centralizing patients during the terminal phases of treatment by using humanistic perspectives has the potential to bring new meaning and improved effectiveness to patients and physicians alike. PMID:27505023

  8. Palliative Care and the Humanities: Centralizing the Patient at the End of Life.

    PubMed

    Franke, Richard J

    2016-03-01

    Palliative care is a quickly growing facet of modern medicine. While scientific advancements have broken new ground for the possibilities of end-of-life care, sensitive treatment of the patient as an individual has lagged behind and has frequently led to an unsatisfactory experience for patients, families, and the medical community at large. This essay argues that centralizing patients during the terminal phases of treatment by using humanistic perspectives has the potential to bring new meaning and improved effectiveness to patients and physicians alike. PMID:27505023

  9. Reliability of an interactive computer program for advance care planning.

    PubMed

    Schubart, Jane R; Levi, Benjamin H; Camacho, Fabian; Whitehead, Megan; Farace, Elana; Green, Michael J

    2012-06-01

    Despite widespread efforts to promote advance directives (ADs), completion rates remain low. Making Your Wishes Known: Planning Your Medical Future (MYWK) is an interactive computer program that guides individuals through the process of advance care planning, explaining health conditions and interventions that commonly involve life or death decisions, helps them articulate their values/goals, and translates users' preferences into a detailed AD document. The purpose of this study was to demonstrate that (in the absence of major life changes) the AD generated by MYWK reliably reflects an individual's values/preferences. English speakers ≥30 years old completed MYWK twice, 4 to 6 weeks apart. Reliability indices were assessed for three AD components: General Wishes; Specific Wishes for treatment; and Quality-of-Life values (QoL). Twenty-four participants completed the study. Both the Specific Wishes and QoL scales had high internal consistency in both time periods (Knuder Richardson formula 20 [KR-20]=0.83-0.95, and 0.86-0.89). Test-retest reliability was perfect for General Wishes (κ=1), high for QoL (Pearson's correlation coefficient=0.83), but lower for Specific Wishes (Pearson's correlation coefficient=0.57). MYWK generates an AD where General Wishes and QoL (but not Specific Wishes) statements remain consistent over time. PMID:22512830

  10. Reliability of an Interactive Computer Program for Advance Care Planning

    PubMed Central

    Levi, Benjamin H.; Camacho, Fabian; Whitehead, Megan; Farace, Elana; Green, Michael J

    2012-01-01

    Abstract Despite widespread efforts to promote advance directives (ADs), completion rates remain low. Making Your Wishes Known: Planning Your Medical Future (MYWK) is an interactive computer program that guides individuals through the process of advance care planning, explaining health conditions and interventions that commonly involve life or death decisions, helps them articulate their values/goals, and translates users' preferences into a detailed AD document. The purpose of this study was to demonstrate that (in the absence of major life changes) the AD generated by MYWK reliably reflects an individual's values/preferences. English speakers ≥30 years old completed MYWK twice, 4 to 6 weeks apart. Reliability indices were assessed for three AD components: General Wishes; Specific Wishes for treatment; and Quality-of-Life values (QoL). Twenty-four participants completed the study. Both the Specific Wishes and QoL scales had high internal consistency in both time periods (Knuder Richardson formula 20 [KR-20]=0.83–0.95, and 0.86–0.89). Test-retest reliability was perfect for General Wishes (κ=1), high for QoL (Pearson's correlation coefficient=0.83), but lower for Specific Wishes (Pearson's correlation coefficient=0.57). MYWK generates an AD where General Wishes and QoL (but not Specific Wishes) statements remain consistent over time. PMID:22512830

  11. Advances in paper-based point-of-care diagnostics.

    PubMed

    Hu, Jie; Wang, ShuQi; Wang, Lin; Li, Fei; Pingguan-Murphy, Belinda; Lu, Tian Jian; Xu, Feng

    2014-04-15

    Advanced diagnostic technologies, such as polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA), have been widely used in well-equipped laboratories. However, they are not affordable or accessible in resource-limited settings due to the lack of basic infrastructure and/or trained operators. Paper-based diagnostic technologies are affordable, user-friendly, rapid, robust, and scalable for manufacturing, thus holding great potential to deliver point-of-care (POC) diagnostics to resource-limited settings. In this review, we present the working principles and reaction mechanism of paper-based diagnostics, including dipstick assays, lateral flow assays (LFAs), and microfluidic paper-based analytical devices (μPADs), as well as the selection of substrates and fabrication methods. Further, we report the advances in improving detection sensitivity, quantification readout, procedure simplification and multi-functionalization of paper-based diagnostics, and discuss the disadvantages of paper-based diagnostics. We envision that miniaturized and integrated paper-based diagnostic devices with the sample-in-answer-out capability will meet the diverse requirements for diagnosis and treatment monitoring at the POC.

  12. 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

  13. Oral health care and smoking cessation practices of interprofessional home care providers for their patients with HIV.

    PubMed

    VanDevanter, Nancy; Dorsen, Caroline G; Messeri, Peter; Shelley, Donna; Person, Andresa

    2012-07-01

    The need for oral health services among patients with HIV, especially those in advanced stages of disease and those who smoke, has been well documented. Patients receiving HIV-related home care services provide an opportunity for assessment of oral health and smoking cessation needs; however, the majority of home care providers lack formal training to provide these services, thus interprofessional collaborations may be of value. This study assessed the oral health and smoking cessation practices of a random sample of 81 HIV home care providers. Results showed very favorable attitudes toward providing these services with some differences across disciplines. More than 70% of nurses would like to receive additional training in comprehensive oral health assessment by dental professionals. The study provides evidence for the potential of expanding these services for patients with HIV through interprofessional collaboration, in particular with nurses and dentists. PMID:22506858

  14. Spirituality and meaning in supportive care: spirituality- and meaning-centered group psychotherapy interventions in advanced cancer.

    PubMed

    Breitbart, William

    2002-05-01

    Existential and spiritual issues are at the frontier of new clinical and research focus in palliative and supportive care of cancer patients. As concepts of adequate supportive care expand beyond a focus on pain and physical symptom control, existential and spiritual issues such as meaning, hope and spirituality in general have received increased attention from supportive care clinicians and clinical researchers. This paper reviews the topics of spirituality and end-of-life care, defines spirituality, and suggests measures of spirituality that deal with two of its main components: faith/religious beliefs and meaning/spiritual well-being. These two constructs of spirituality are reviewed in terms of their role in supportive care. Finally, a review of existing psychotherapeutic interventions for spiritual suffering are reviewed and a novel meaning-centered group psychotherapy for advanced cancer patients is described.

  15. Cancer Pharmacogenomics: Integrating Discoveries in Basic, Clinical and Population Sciences to Advance Predictive Cancer Care

    Cancer.gov

    Cancer Pharmacogenomics: Integrating Discoveries in Basic, Clinical and Population Sciences to Advance Predictive Cancer Care, a 2010 workshop sponsored by the Epidemiology and Genomics Research Program.

  16. [Advanced nursing practice: a must for the quality of care and mental health services].

    PubMed

    Ricard, Nicole; Page, Claire; Laflamme, France

    2014-01-01

    New professional legislation and reorganization of mental health services have had a significant influence on mental health nursing practice. Many nurses have demonstrated clinical leadership and have been able to adapt their services to the needs of the population specially in the primary health care setting. However, many believe that the role of nurses is not sufficiently known and optimally utilized in mental health services. In this article we take a critical look at the mental health nursing practice in Quebec and at the essential requirements for its development. This review aims to: 1) describe current trends in the changing roles and the modernization of mental health nursing practice in Quebec, 2) provide an overview of the development of advanced nursing practice and its impact on the quality of mental health services; 3) clarify the concept of advanced nursing practice and position its development in Quebec and 4) propose various strategies for optimizing the role of nurses and their complementarity with other professionals providing mental health services. This review presents innovative practices developed by nurses in the context of the restructuring of mental health services. For example, new nursing roles have been developed to improve the collaboration with general practitioners groups in primary care settings and facilitate the evaluation and monitoring of patient presenting medical and psychological problems. Another interesting innovation was set up by nurses in developing a new service to allow timely access to integrated care for patients with substance abuse and mental health problems. The various testimonies reported in this article illustrate the potential contribution of these nursing innovations in improving the mental health services in Quebec. Also, in few countries, the reform of mental health services has been a good time to recognize this potential. Thus, some countries have repositioned the role of mental health nurses and

  17. [Advanced nursing practice: a must for the quality of care and mental health services].

    PubMed

    Ricard, Nicole; Page, Claire; Laflamme, France

    2014-01-01

    New professional legislation and reorganization of mental health services have had a significant influence on mental health nursing practice. Many nurses have demonstrated clinical leadership and have been able to adapt their services to the needs of the population specially in the primary health care setting. However, many believe that the role of nurses is not sufficiently known and optimally utilized in mental health services. In this article we take a critical look at the mental health nursing practice in Quebec and at the essential requirements for its development. This review aims to: 1) describe current trends in the changing roles and the modernization of mental health nursing practice in Quebec, 2) provide an overview of the development of advanced nursing practice and its impact on the quality of mental health services; 3) clarify the concept of advanced nursing practice and position its development in Quebec and 4) propose various strategies for optimizing the role of nurses and their complementarity with other professionals providing mental health services. This review presents innovative practices developed by nurses in the context of the restructuring of mental health services. For example, new nursing roles have been developed to improve the collaboration with general practitioners groups in primary care settings and facilitate the evaluation and monitoring of patient presenting medical and psychological problems. Another interesting innovation was set up by nurses in developing a new service to allow timely access to integrated care for patients with substance abuse and mental health problems. The various testimonies reported in this article illustrate the potential contribution of these nursing innovations in improving the mental health services in Quebec. Also, in few countries, the reform of mental health services has been a good time to recognize this potential. Thus, some countries have repositioned the role of mental health nurses and

  18. 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

  19. Pembrolizumab for Treatment of Patients with Advanced or Unresectable Melanoma.

    PubMed

    Sullivan, Ryan J; Flaherty, Keith T

    2015-07-01

    From Coley's toxin to combination immune checkpoint inhibition, strategies to activate the immune system and generate anticancer immunity have been ongoing for well over a century. Over the past decade, the so-called immune checkpoint inhibitors, generally monoclonal antibodies that target key regulators of T-cell activation, emerged as the most effective immune-targeted agents. Pembrolizumab is the first anti-programmed death 1 (PD-1) antibody approved by the FDA for the treatment of metastatic melanoma. With responses seen in 25% to 40% of patients, depending on dose and setting (i.e., before or after ipilimumab), pembrolizumab specifically and anti-PD-1 antibodies generally are revolutionizing the treatment of melanoma. However, in the setting of other recent advances in the field, a number of practical issues are emerging that need to be addressed to optimize the care of patients with melanoma. First, the optimal sequencing of therapy (first-line immunotherapy over molecular targeted therapy, ipilimumab versus pembrolizumab as initial immune checkpoint inhibitor) is unknown and must be evaluated through randomized trials. Second, there is a strong rationale to combine immune checkpoint inhibitors (i.e., anti-PD-1 with ipilimumab) and to combine immune therapies with targeted therapy agents, so determining whether combination therapy is better than direct sequencing is another critical issue that needs to be addressed in carefully carried out studies.

  20. Cutaneous wound healing: Current concepts and advances in wound care

    PubMed Central

    Klein, Kenneth C; Guha, Somes Chandra

    2014-01-01

    A non-healing wound is defined as showing no measurable signs of healing for at least 30 consecutive treatments with standard wound care.[1] It is a snapshot of a patient's total health as well as the ongoing battle between noxious factors and the restoration of optimal macro and micro circulation, oxygenation and nutrition. In practice, standard therapies for non-healing cutaneous wounds include application of appropriate dressings, periodic debridement and eliminating causative factors.[2] The vast majority of wounds would heal by such approach with variable degrees of residual morbidity, disability and even mortality. Globally, beyond the above therapies, newer tools of healing are selectively accessible to caregivers, for various logistical or financial reasons. Our review will focus on the use of hyperbaric oxygen therapy (HBOT), as used at our institution (CAMC), and some other modalities that are relatively accessible to patients. HBOT is a relatively safe and technologically simpler way to deliver care worldwide. However, the expense for including HBOT as standard of care for recognized indications per UHMS(Undersea and Hyperbaric Medical Society) may vary widely from country to country and payment system.[3] In the USA, CMS (Centers for Medicare and Medicaid Services) approved indications for HBOT vary from that of the UHMS for logistical reasons.[1] We shall also briefly look into other newer therapies per current clinical usage and general acceptance by the medical community. Admittedly, there would be other novel tools with variable success in wound healing worldwide, but it would be difficult to include all in this treatise. PMID:25593414

  1. 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.

  2. 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

  3. 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

  4. Advance Care Planning Discussions: Why They Should Happen, Why They Don't, and How We Can Facilitate the Process.

    PubMed

    Norals, Taira Everett; Smith, Thomas J

    2015-08-01

    Recent data suggest that we are not successfully getting the message across about the importance of advance care planning for patients who have a life-ending illness. Half to three-quarters of patients with incurable cancer think that they might be cured by chemotherapy, radiation, or surgery. The source of this denial may lie with them, it may be traceable to their physicians, or it may be a combination of the two. This avoidance has consequences, since those patients with "prognostic awareness" have end-of-life care pathways that involve little use of the hospital, ICU, end-of-life chemo, or "codes" with almost no chance of success, and much more dying at home with hospice care. If we can successfully initiate advance care planning discussions with our patients and families, their end-of-life processes will improve, resulting in better care, less use of the hospital, and more honoring of newly discerned choices. We show how this can be done in regular oncology practice by introducing the Johns Hopkins "Palliative Care Temporary Tattoo" and by providing some ways to discuss cardiopulmonary resuscitation in settings where it will not be helpful.

  5. Patient first: a tri-fold approach to health care transformation.

    PubMed

    Swanson, Lisa Tucker; McDonald, Jill; Clough, Megan; McKinnon, Helen Q

    2002-06-01

    The installation of new technology affords health care facilities the tri-fold opportunity of (1) upgrading processes and systems, (2) launching providers into the forefront of health care, and (3) providing the most advanced quality of care. Redesigning patient care processes to align with new technology further presents opportunities to transform culture, enhance service excellence, increase staff accountability and promote self-esteem. Leveraging each advantage is a significant commitment that requires a comprehensive change strategy. Eastern Maine Medical Center in Bangor, ME serves as a case study for success.

  6. The Role of Social Workers in Spiritual Care to Facilitate Coping With Chronic Illness and Self-Determination in Advance Care Planning.

    PubMed

    Francoeur, Richard B; Burke, Nancy; Wilson, Alicia M

    2016-01-01

    Spiritual values and beliefs of patients and families influence resilience during chronic illness and shape patient choices during advance care planning. The spiritual needs of Baby Boomers will be more diverse than previous generations, in connection with the questioning, experimental mind-set of this group and the fact that it includes a higher proportion of immigrant populations outside the Judeo-Christian tradition. Social workers are trained explicitly to intervene with diverse populations and are well positioned to offer spiritual support in ways that do not necessarily conform to traditional religions. To the extent of their individual expertise and competence, social workers should assess and provide spiritual care to clients, including those who either are underserved or prefer not to seek assistance from clergy or chaplains because they feel alienated from religious institutions and representatives. They should also be aware of ethical dilemmas in consulting with spiritual care professionals in developing spiritual interventions. Social work education should address clients' humanistic and existential concerns, beliefs and behaviors of the major religions, and forms of nontraditional religious and spiritual experiences; it should also provide experiential opportunities for engaging with grief and earlier advance care planning. There should be attention to different theodical perspectives of the major religions regarding the problem of good and evil, which may preoccupy even clients who no longer participate in organized religion, because these unresolved existential issues may weaken client coping with chronic conditions and may diminish clarity and self-awareness for engaging authentically and effectively in advance care planning.

  7. The Role of Social Workers in Spiritual Care to Facilitate Coping With Chronic Illness and Self-Determination in Advance Care Planning.

    PubMed

    Francoeur, Richard B; Burke, Nancy; Wilson, Alicia M

    2016-01-01

    Spiritual values and beliefs of patients and families influence resilience during chronic illness and shape patient choices during advance care planning. The spiritual needs of Baby Boomers will be more diverse than previous generations, in connection with the questioning, experimental mind-set of this group and the fact that it includes a higher proportion of immigrant populations outside the Judeo-Christian tradition. Social workers are trained explicitly to intervene with diverse populations and are well positioned to offer spiritual support in ways that do not necessarily conform to traditional religions. To the extent of their individual expertise and competence, social workers should assess and provide spiritual care to clients, including those who either are underserved or prefer not to seek assistance from clergy or chaplains because they feel alienated from religious institutions and representatives. They should also be aware of ethical dilemmas in consulting with spiritual care professionals in developing spiritual interventions. Social work education should address clients' humanistic and existential concerns, beliefs and behaviors of the major religions, and forms of nontraditional religious and spiritual experiences; it should also provide experiential opportunities for engaging with grief and earlier advance care planning. There should be attention to different theodical perspectives of the major religions regarding the problem of good and evil, which may preoccupy even clients who no longer participate in organized religion, because these unresolved existential issues may weaken client coping with chronic conditions and may diminish clarity and self-awareness for engaging authentically and effectively in advance care planning. PMID:27187806

  8. Six health care trends that will reshape the patient-provider dynamic.

    PubMed

    Liao, Joshua M; Emanuel, Ezekiel J; Navathe, Amol S

    2016-09-01

    Six trends - movement towards value-based payment, rapid adoption of digital health technology, care delivery in non-traditional settings, development of individualized clinical guidelines, increased transparency, and growing cultural awareness about the harms of medical overuse - are driving the US health care system towards a future defined by quality- and patient-centric care. Health care organizations are responding to these changes by implementing provider and workforce changes, pursuing stronger payer-provider integration, and accelerating the use of digital technology and data. While these efforts can also improve the clinical relationship and create positive system redesign among health care organizations, they require alignment between organizational and physician incentives that can inadvertently harm the dynamic between patients and providers. Organizations can utilize several strategies to preserve the patient-physician relationship and advance the positive benefits of new organizational strategies while guarding against unintended consequences.

  9. Six health care trends that will reshape the patient-provider dynamic.

    PubMed

    Liao, Joshua M; Emanuel, Ezekiel J; Navathe, Amol S

    2016-09-01

    Six trends - movement towards value-based payment, rapid adoption of digital health technology, care delivery in non-traditional settings, development of individualized clinical guidelines, increased transparency, and growing cultural awareness about the harms of medical overuse - are driving the US health care system towards a future defined by quality- and patient-centric care. Health care organizations are responding to these changes by implementing provider and workforce changes, pursuing stronger payer-provider integration, and accelerating the use of digital technology and data. While these efforts can also improve the clinical relationship and create positive system redesign among health care organizations, they require alignment between organizational and physician incentives that can inadvertently harm the dynamic between patients and providers. Organizations can utilize several strategies to preserve the patient-physician relationship and advance the positive benefits of new organizational strategies while guarding against unintended consequences. PMID:27396533

  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. Use and impact of a computer-generated patient summary worksheet for primary care.

    PubMed

    Wilcox, Adam B; Jones, Spencer S; Dorr, David A; Cannon, Wayne; Burns, Laurie; Radican, Kelli; Christensen, Kent; Brunker, Cherie; Larsen, Ann; Narus, Scott P; Thornton, Sidney N; Clayton, Paul D

    2005-01-01

    Advanced clinical information systems have been proposed to improve patient care in terms of safety, effectiveness, and efficiency. In order to be effective, such systems require detailed patient-specific clinical information in a form easily reviewed by clinicians. We have developed a patient summary worksheet for use in outpatient clinics, which presents a structured overview of patient health information. The worksheet provides patient demographic information, specific problems and conditions, the patient's current medication profile, laboratory test results pertinent to patient problems, and disease-specific or preventive care actionable advisories. Usage has grown from a few hundred to over 25,000 unique patients per month during a two-year period. Diabetic patients for whom the worksheet is accessed are significantly more likely to be in compliance with accepted testing regimens for glycosolated hemoglobin (OR 1.47, 95% CI 1.28, 1.61).

  12. Effectiveness of educational technology to improve patient care in pharmacy curricula.

    PubMed

    Smith, Michael A; Benedict, Neal

    2015-02-17

    A review of the literature on the effectiveness of educational technologies to teach patient care skills to pharmacy students was conducted. Nineteen articles met inclusion criteria for the review. Seven of the articles included computer-aided instruction, 4 utilized human-patient simulation, 1 used both computer-aided instruction and human-patient simulation, and 7 utilized virtual patients. Educational technology was employed with more than 2700 students at 12 colleges and schools of pharmacy in courses including pharmacotherapeutics, skills and patient care laboratories, drug diversion, and advanced pharmacy practice experience (APPE) orientation. Students who learned by means of human-patient simulation and virtual patients reported enjoying the learning activity, whereas the results with computer-aided instruction were mixed. Moreover, the effect on learning was significant in the human-patient simulation and virtual patient studies, while conflicting data emerged on the effectiveness of computer-aided instruction.

  13. Health Information Technology Coordination to Support Patient-centered Care Coordination

    PubMed Central

    Gregg, W.

    2015-01-01

    Summary Objective To select papers published in 2014, illustrating how information technology can contribute to and improve patient-centered care coordination. Method The two section editors performed a literature review from Medline and Web of Science to select a list of candidate best papers on the use of information technology for patient-centered care coordination. These papers were peer-reviewed by external reviewers and three of them were selected as “best papers”. Results The first selected paper reports a qualitative study exploring the gap between current practices of care coordination in various settings and idealized longitudinal care plans. The second selected paper illustrates several unintended consequences of HIT designed to improve care coordination. The third selected paper shows that advanced analytic techniques in medical informatics can be instrumental in studying patient-centered care coordination. Conclusions The realization of true patient-centered care coordination is dependent upon a number of factors. Standardization of clinical documentation and HIT interoperability across organization and settings is a critical prerequisite for HIT to support patient-centered care coordination. Enabling patient involvement is an efficient means for goal setting and health information sharing. Additionally, unintended consequences of HIT tools (both positive and negative) must be measured and taken into account for quality improvement. PMID:26293848

  14. 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

  15. Respecting the spiritual side of advanced cancer care: a systematic review.

    PubMed

    Piderman, Katherine M; Kung, Simon; Jenkins, Sarah M; Euerle, Terin T; Yoder, Timothy J; Kwete, Gracia M; Lapid, Maria I

    2015-02-01

    Spirituality is among the resources that many turn to as they deal with a diagnosis of advanced cancer. Researchers have made much progress in exploring and understanding spirituality's complex and multifaceted role in the midst of metastatic disease. As a result, spirituality is seen as an important aspect of a holistic and respectful approach to clinical care for patients and their loved ones. In this article, we provide a systematic review of the literature related to the interface between spirituality and metastatic cancer. We included articles published from January 2013 to June 2014. Twenty-two articles were reviewed, consisting of clinical intervention trials, association studies, surveys, qualitative studies, and review articles. The articles discussed efforts to improve patients' spiritual well-being, with relevant measurement scales; the associations of spirituality and end of life treatment practices; and efforts to better understand and meet the spiritual needs of patients and caregivers. PMID:25681038

  16. 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.

  17. 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.

  18. Promoting Healthy Eating Attitudes Among Uninsured Primary Care Patients.

    PubMed

    Kamimura, Akiko; Tabler, Jennifer; Nourian, Maziar M; Jess, Allison; Stephens, Tamara; Aguilera, Guadalupe; Wright, Lindsey; Ashby, Jeanie

    2016-08-01

    Obesity is associated with a number of chronic health problems such as cardiovascular disease, diabetes and cancer. While common prevention and treatment strategies to control unhealthy weight gain tend to target behaviors and lifestyles, the psychological factors which affect eating behaviors among underserved populations also need to be further addressed and included in practice implementations. The purpose of this study is to examine positive and negative emotional valence about food among underserved populations in a primary care setting. Uninsured primary care patients (N = 621) participated in a self-administered survey from September to December in 2015. Higher levels of perceived benefits of healthy food choice were associated with lower levels of a negative emotional valence about food while higher levels of perceived barriers to healthy food choice are related to higher levels of a negative emotional valence about food. Greater acceptance of motivation to eat was associated with higher levels of positive and negative emotional valence about food. Spanish speakers reported greater acceptance of motivation to eat and are more likely to have a negative emotional valence about food than US born or non-US born English speakers. The results of this study have important implications to promote healthy eating among underserved populations at a primary care setting. Healthy food choice or healthy eating may not always be achieved by increasing knowledge. Psychological interventions should be included to advance healthy food choice. PMID:26831483

  19. Promoting Healthy Eating Attitudes Among Uninsured Primary Care Patients.

    PubMed

    Kamimura, Akiko; Tabler, Jennifer; Nourian, Maziar M; Jess, Allison; Stephens, Tamara; Aguilera, Guadalupe; Wright, Lindsey; Ashby, Jeanie

    2016-08-01

    Obesity is associated with a number of chronic health problems such as cardiovascular disease, diabetes and cancer. While common prevention and treatment strategies to control unhealthy weight gain tend to target behaviors and lifestyles, the psychological factors which affect eating behaviors among underserved populations also need to be further addressed and included in practice implementations. The purpose of this study is to examine positive and negative emotional valence about food among underserved populations in a primary care setting. Uninsured primary care patients (N = 621) participated in a self-administered survey from September to December in 2015. Higher levels of perceived benefits of healthy food choice were associated with lower levels of a negative emotional valence about food while higher levels of perceived barriers to healthy food choice are related to higher levels of a negative emotional valence about food. Greater acceptance of motivation to eat was associated with higher levels of positive and negative emotional valence about food. Spanish speakers reported greater acceptance of motivation to eat and are more likely to have a negative emotional valence about food than US born or non-US born English speakers. The results of this study have important implications to promote healthy eating among underserved populations at a primary care setting. Healthy food choice or healthy eating may not always be achieved by increasing knowledge. Psychological interventions should be included to advance healthy food choice.

  20. Usefulness of Palliative Care to Complement the Management of Patients on Left Ventricular Assist Devices.

    PubMed

    Luo, Nancy; Rogers, Joseph G; Dodson, Gwen C; Patel, Chetan B; Galanos, Anthony N; Milano, Carmelo A; O'Connor, Christopher M; Mentz, Robert J

    2016-09-01

    Within the last decade, advancements in left ventricular assist device therapy have allowed patients with end-stage heart failure (HF) to live longer and with better quality of life. Like other life-saving interventions, however, there remains the risk of complications including infections, bleeding episodes, and stroke. The candidate for left ventricular assist device therapy faces complex challenges going forward, both physical and psychological, many of which may benefit from the application of palliative care principles by trained specialists. Despite these advantages, palliative care remains underused in many advanced HF programs. Here, we describe the benefits of palliative care, barriers to use within HF, and specific applications to the integrated care of patients on mechanical circulatory support. PMID:27474339

  1. 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

  2. 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

  3. Attitudes towards and barriers to writing advance directives amongst cancer patients, healthy controls, and medical staff

    PubMed Central

    Sahm, S; Will, R; Hommel, G

    2005-01-01

    Objectives: After years of public discussion too little is still known about willingness to accept the idea of writing an advance directive among various groups of people in EU countries. We investigated knowledge about and willingness to accept such a directive in cancer patients, healthy controls, physicians, and nursing staff in Germany. Methods: Cancer patients, healthy controls, nursing staff, and physicians (n = 100 in each group) were surveyed by means of a structured questionnaire. Results: Only 18% and 19% of the patients and healthy controls respectively, and 10% of the medical staff had written an advance directive. However, 50–81% of those surveyed indicated that they wished to write one. This intention was associated with deteriorating health (p < 0.001). Only 29% of the healthy controls and 43% of the patients knew about the possibility of appointing a health care proxy. A majority in all groups believed that advance directives may influence the course of treatment (79–85%), yet half of those surveyed in all groups fear that patients could be pressurised into writing an advance directive, and 38–65% thought that relatives could abuse such documents. Conclusions: Only a minority of the participants had written an advance directive and knew about the possibility of authorising a health care proxy. Deteriorating health was associated with increasing willingness to make a directive. Despite a majority belief that advance directives may influence treatment at the end of life, other factors limit their employment, such as fear of abuse. PMID:16076965

  4. 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.

  5. Adaptive practices in heart failure care teams: implications for patient-centered care in the context of complexity

    PubMed Central

    Tait, Glendon R; Bates, Joanna; LaDonna, Kori A; Schulz, Valerie N; Strachan, Patricia H; McDougall, Allan; Lingard, Lorelei

    2015-01-01

    Background Heart failure (HF), one of the three leading causes of death, is a chronic, progressive, incurable disease. There is growing support for integration of palliative care’s holistic approach to suffering, but insufficient understanding of how this would happen in the complex team context of HF care. This study examined how HF care teams, as defined by patients, work together to provide care to patients with advanced disease. Methods Team members were identified by each participating patient, generating team sampling units (TSUs) for each patient. Drawn from five study sites in three Canadian provinces, our dataset consists of 209 interviews from 50 TSUs. Drawing on a theoretical framing of HF teams as complex adaptive systems (CAS), interviews were analyzed using the constant comparative method associated with constructivist grounded theory. Results This paper centers on the dominant theme of system practices, how HF care delivery is reported to work organizationally, socially, and practically, and describes two subthemes: “the way things work around here”, which were commonplace, routine ways of doing things, and “the way we make things work around here”, which were more conscious, effortful adaptations to usual practice in response to emergent needs. An adaptive practice, often a small alteration to routine, could have amplified effects beyond those intended by the innovating team member and could extend to other settings. Conclusion Adaptive practices emerged unpredictably and were variably experienced by team members. Our study offers an empirically grounded explanation of how HF care teams self-organize and how adaptive practices emerge from nonlinear interdependencies among diverse agents. We use these insights to reframe the question of palliative care integration, to ask how best to foster palliative care-aligned adaptive practices in HF care. This work has implications for health care’s growing challenge of providing care to those with

  6. 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.

  7. 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.

  8. 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....

  9. 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....

  10. 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....

  11. 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

  12. 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

  13. 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.

  14. Bevacizumab improves survival for patients with advanced cervical cancer

    Cancer.gov

    Patients with advanced, recurrent, or persistent cervical cancer that was not curable with standard treatment who received the drug bevacizumab (Avastin) lived 3.7 months longer than patients who did not receive the drug, according to an interim analysis

  15. National Institute of Biomedical Imaging and Bioengineering Point-of-Care Technology Research Network: Advancing Precision Medicine

    PubMed Central

    Ford Carleton, Penny; Parrish, John A.; Collins, John M.; Crocker, J. Benjamin; Dixon, Ronald F.; Edgman-Levitan, Susan; Lewandrowski, Kent B.; Stahl, James E.; Klapperich, Catherine; Cabodi, Mario; Gaydos, Charlotte A.; Rompalo, Anne M.; Manabe, Yukari; Wang, Tza-Huei; Rothman, Richard; Geddes, Chris D.; Widdice, Lea; Jackman, Joany; Mathura, Rishi A.; Lash, Tiffani Bailey

    2016-01-01

    To advance the development of point-of-care technology (POCT), the National Institute of Biomedical Imaging and Bioengineering established the POCT Research Network (POCTRN), comprised of Centers that emphasize multidisciplinary partnerships and close facilitation to move technologies from an early stage of development into clinical testing and patient use. This paper describes the POCTRN and the three currently funded Centers as examples of academic-based organizations that support collaborations across disciplines, institutions, and geographic regions to successfully drive innovative solutions from concept to patient care. PMID:27730014

  16. [Attitudes towards patient care at the end of life. A survey of directors of neurological departments].

    PubMed

    Borasio, G D; Weltermann, B; Voltz, R; Reichmann, H; Zierz, S

    2004-12-01

    In view of the increasing importance of palliative medicine and end-of-life care of neurological patients, a survey from the American Academy of Neurology was translated in a validated fashion and sent to all medical directors of neurological departments in Germany. The topics of the survey comprised-based on clinical scenarios-the withdrawal or withholding of life-sustaining measures, physician-assisted suicide (PAS) and euthanasia, advance directives and health care proxies, principles of palliative care, and ethical and legal questions in end-of-life care. Of 411 directors of departments, 152 participated in the survey. Almost all respondents support a patient's right to refuse life-sustaining treatment. Thirty-two percent think it is illegal to administer analgesics in doses that risk respiratory depression. Forty-five percent believe that treating terminal dyspnea with morphine is the same as euthanasia. Despite the fact that 88% of the respondents regard advance directives as helpful, only an average of 4% of their patients have completed one. About one third of the respondents have been confronted with a request by patients for PAS or euthanasia. Thirty-five percent believe that PAS should be made explicitly legal for terminally ill patients. Forty-six percent of the respondents believe that their training in end-of-life care was insufficient, and 91% express interest in education programs on palliative care. PMID:15221065

  17. 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

  18. Education and Advance Care Planning in Nursing Homes: The Impact of Ownership Type.

    ERIC Educational Resources Information Center

    Walker, Leslie C.; Bradley, Elizabeth H.

    1998-01-01

    A study of 25 nonprofit and 87 for-profit nursing homes showed both types likely to offer education on advance care planning. However, nonprofits were more likely to have ongoing discussions that covered more than life support decisions and to have ethics committees to support advance care planning. (SK)

  19. 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

  20. 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

  1. 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.

  2. 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

  3. 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

  4. The Attending Nurse Caring Model: integrating theory, evidence and advanced caring-healing therapeutics for transforming professional practice.

    PubMed

    Watson, Jean; Foster, Roxie

    2003-05-01

    This paper presents a proposed model: The Attending Nursing Caring Model (ANCM) as an exemplar for advancing and transforming nursing practice within a reflective, theoretical and evidence-based context. Watson's theory of human caring is used as a guide for integrating theory, evidence and advanced therapeutics in the area of children's pain. The ANCM is offered as a programme for renewing the profession and its professional practices of caring-healing arts and science, during an era of decline, shortages, and crises in care, safety, and hospital and health reform. The ANCM elevates contemporary nursing's caring values, relationships, therapeutics and responsibilities to a higher/deeper order of caring science and professionalism, intersecting with other professions, while sustaining the finest of its heritage and traditions of healing.

  5. 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.

  6. Exploring uncertainty in advance care planning in African Americans: does low health literacy influence decision making preference at end of life.

    PubMed

    Melhado, Lolita; Bushy, Angeline

    2011-11-01

    African Americans over 65 represent 3.5 of the 35.6 million Americans. Morbidity and mortality rates are highest among this group; associated with lack of resources and awareness of health problems. But health needs are the same at end of life, yet care is less than optimal. African Americans are less likely to have advance directives nonetheless desire communication, information, respect, and a trusting doctor-patient relationship. Low health literacy may contribute to this disparity. This scholarly review examines the health literacy in advance care planning and refines concepts of uncertainty in illness theory deriving a model for advance care planning in African Americans.

  7. Exploring uncertainty in advance care planning in African Americans: does low health literacy influence decision making preference at end of life.

    PubMed

    Melhado, Lolita; Bushy, Angeline

    2011-11-01

    African Americans over 65 represent 3.5 of the 35.6 million Americans. Morbidity and mortality rates are highest among this group; associated with lack of resources and awareness of health problems. But health needs are the same at end of life, yet care is less than optimal. African Americans are less likely to have advance directives nonetheless desire communication, information, respect, and a trusting doctor-patient relationship. Low health literacy may contribute to this disparity. This scholarly review examines the health literacy in advance care planning and refines concepts of uncertainty in illness theory deriving a model for advance care planning in African Americans. PMID:21398263

  8. Differences in Parent-Provider Concordance Regarding Prognosis and Goals of Care Among Children With Advanced Cancer

    PubMed Central

    Rosenberg, Abby R.; Orellana, Liliana; Kang, Tammy I.; Geyer, J. Russell; Feudtner, Chris; Dussel, Veronica; Wolfe, Joanne

    2014-01-01

    Purpose Concordance between parents of children with advanced cancer and health care providers has not been described. We aimed to describe parent-provider concordance regarding prognosis and goals of care, including differences by cancer type. Patients and Methods A total of 104 pediatric patients with recurrent or refractory cancer were enrolled at three large children's hospitals. On enrollment, their parents and providers were invited to complete a survey assessing perceived prognosis and goals of care. Patients' survival status was retrospectively abstracted from medical records. Concordance was assessed via discrepancies in perceived prognosis, κ statistics, and McNemar's test. Distribution of categorical variables and survival rates across cancer type were compared with Fisher's exact and log-rank tests, respectively. Results Data were available from 77 dyads (74% of enrolled). Parent-provider agreement regarding prognosis and goals of care was poor (κ, 0.12 to 0.30). Parents were more likely to report cure was likely (P < .001). The frequency of perceived likelihood of cure and the goal of cure varied by cancer type for both parents and providers (P < .001 to .004). Relatively optimistic responses were more common among parents and providers of patients with hematologic malignancies, although there were no differences in survival. Conclusion Parent-provider concordance regarding prognosis and goals in advanced pediatric cancer is generally poor. Perceptions of prognosis and goals of care vary by cancer type. Understanding these differences may inform parent-provider communication and decision making. PMID:25024073

  9. Point-of-Care Technologies for the Advancement of Precision Medicine in Heart, Lung, Blood, and Sleep Disorders.

    PubMed

    Bigelow, Mary Emma Gorham; Jamieson, Brian G; Chui, Chi On; Mao, Yufei; Shin, Kyeong-Sik; Huang, Tony Jun; Huang, Po-Hsun; Ren, Liqiang; Adhikari, Bishow; Chen, Jue; Iturriaga, Erin

    2016-01-01

    The commercialization of new point of care technologies holds great potential in facilitating and advancing precision medicine in heart, lung, blood, and sleep (HLBS) disorders. The delivery of individually tailored health care to a patient depends on how well that patient's health condition can be interrogated and monitored. Point of care technologies may enable access to rapid and cost-effective interrogation of a patient's health condition in near real time. Currently, physiological data are largely limited to single-time-point collection at the hospital or clinic, whereas critical information on some conditions must be collected in the home, when symptoms occur, or at regular intervals over time. A variety of HLBS disorders are highly dependent on transient variables, such as patient activity level, environment, time of day, and so on. Consequently, the National Heart Lung and Blood Institute sponsored a request for applications to support the development and commercialization of novel point-of-care technologies through small businesses (RFA-HL-14-011 and RFA-HL-14-017). Three of the supported research projects are described to highlight particular point-of-care needs for HLBS disorders and the breadth of emerging technologies. While significant obstacles remain to the commercialization of such technologies, these advancements will be required to achieve precision medicine. PMID:27602308

  10. Patient Centeredness and Engagement in Quality-of-Care Oncology Research.

    PubMed

    Clauser, Steven B; Gayer, Christopher; Murphy, Elizabeth; Majhail, Navneet S; Baker, K Scott

    2015-05-01

    More than a decade after the Institute of Medicine (IOM) first studied the quality of cancer care, obstacles to achieving high-quality care remain, and studies suggest that cancer care is often not as patient centered, accessible, coordinated, or evidence based as it could be. Patients, their families, and clinicians face a wide range of complex and often confusing choices regarding their health and health care concerns and require trustworthy information to decide which options are best for them. The Patient-Centered Outcomes Research Institute (PCORI) strives to fund clinical comparative effectiveness research, guided by patients, caregivers, and the broader health care community, that will provide high-integrity, evidence-based information to help people make informed health care decisions. This mission is well aligned with the IOM's recent conceptual framework and corresponding recommendations that recognize that addressing the needs of patients with cancer and their families is the most important component of a high-quality cancer care delivery system. PCORI seeks the opportunity to partner with diverse interdisciplinary research teams who demonstrate a strong commitment to the inclusion and engagement of patients and stakeholders as they work to develop high-quality cancer care delivery systems. We see rich opportunities for such partnership in the cancer care community, given the wealth of well-established patient advocacy groups and organizations and cutting-edge research institutions, all of which are working toward the common goal of improving the quality of cancer care for patients and their families. This article and the project it describes provide an example of an avenue for advancing this goal. PMID:25852140

  11. The positive attitudes and perceptions of care managers about advance directives.

    PubMed

    Golden, Adam G; Tewary, Sweta; Qadri, Syeda; Zaw, Khin; Ruiz, Jorge G; Roos, Bernard A

    2011-03-01

    In a previous intervention, we found that reminders from care managers failed to increase the number of their homebound older adult clients with advance directives. Thus, in the current study, we looked at the perceptions and attitudes of care managers about the need to discuss advance directives with their clients. Ninety-five care managers serving community-based nursing home-eligible older adults completed an 18-question survey, which found that care managers overwhelmingly believe it is important to address advance directives. Only 3.2% reported that discussing advance directives is time consuming. No attitudinal barriers were identified. Given their positive attitudes about advance directives, care managers need educational interventions that will provide the knowledge and skills to interact effectively with clients who are resistant to addressing end-of-life issues.

  12. 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

  13. 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)

  14. 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 ...

  15. 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…

  16. 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.

  17. 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)

  18. 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...

  19. 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...

  20. 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...

  1. 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...

  2. 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...

  3. 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.

  4. Evolving Approaches to Patients with Advanced Differentiated Thyroid Cancer

    PubMed Central

    Sherman, Steven I.

    2013-01-01

    Advanced differentiated thyroid cancer (DTC), defined by clinical characteristics including gross extrathyroidal invasion, distant metastases, radioiodine (RAI) resistance, and avidity for 18-fluorodeoxyglucose (positron emission tomography-positive), is found in approximately 10–20% of patients with DTC. Standard therapy (surgery, RAI, TSH suppression with levothyroxine) is ineffective for many of these patients, as is standard chemotherapy. Our understanding of the molecular mechanisms leading to DTC and the transformation to advanced DTC has rapidly evolved over the past 15–20 years. Newer targeted therapy, specifically inhibitors of intracellular kinase signaling pathways, and cooperative multicenter clinical trials have dramatically changed the therapeutic landscape for patients with advanced DTC. In this review focusing on morbidities, molecules, and medicinals, we present a patient with advanced DTC, explore the genetics and molecular biology of advanced DTC, and review evolving therapies for these patients including multikinase inhibitors, selective kinase inhibitors, and combination therapies. PMID:23575762

  5. The role of Advanced Practice Providers in interdisciplinary oncology care in the United States.

    PubMed

    Reynolds, Rae Brana; McCoy, Kimberly

    2016-06-01

    Advanced Practice Registered Nurses (APRNs) and Physician Assistants (PAs), generally referred to as Advanced Practice Providers (APPs), are fundamental to interdisciplinary oncology care. As the projected demand for oncology services is anticipated to outpace the supply of oncologists, APPs will become increasingly vital in the delivery of oncology care and services. The training, education, and scope of practice for APPs gives the interdisciplinary care team professionals that deliver high-quality clinical services and provide valuable contributions and leadership to health care quality improvement initiatives. Optimizing the integration of APPs in oncology care offers immense advantages towards improvement of clinical outcomes. PMID:27197514

  6. 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

  7. Caring for dying patients in the intensive care unit: managing pain, dyspnea, anxiety, delirium, and death rattle.

    PubMed

    Campbell, Margaret L

    2015-01-01

    Critically ill patients receiving palliative care at the end of life are at high risk for experiencing pain, dyspnea, and death rattle. Nearly all these patients are at risk for the development of delirium. Patients who are alert may experience anxiety. Advanced practice nurses and staff nurses are integral to detecting and treating these symptoms. Pain, dyspnea, and anxiety should be routinely assessed by patient self-report when possible. Routine behavioral screening for delirium is recommended. Behavioral observation tools to detect pain and dyspnea and proxy assessments guide symptom identification when the patient cannot provide a self-report. Evidence-based interventions are offered for both prevention and treatment of pain, dyspnea, anxiety, and delirium. Death rattle does not produce patient distress, and current pharmacological treatment lacks an evidence base. Pain management has a robust evidence base compared to management of dyspnea, anxiety, and delirium among this population; well-designed, adequately powered studies are needed.

  8. 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

  9. HIV Care and Treatment Beliefs among Patients Initiating Antiretroviral Treatment (ART) in Oromia, Ethiopia.

    PubMed

    Tymejczyk, Olga; Hoffman, Susie; Kulkarni, Sarah Gorrell; Gadisa, Tsigereda; Lahuerta, Maria; Remien, Robert H; Elul, Batya; El-Sadr, Wafaa; Melaku, Zenebe; Nash, Denis

    2016-05-01

    To better understand patient beliefs, which may influence adherence to HIV care and treatment, we examined three dimensions of beliefs among Ethiopian adults (n = 1177) initiating antiretroviral therapy (ART). Beliefs about benefits of ART/HIV clinical care were largely accurate, but few patients believed in the ability of ART to prevent sexual transmission and many thought Holy Water could cure HIV. Factors associated with lower odds of accurate beliefs included advanced HIV, lack of formal education, and Muslim religion (benefits of ART/clinical care); secondary or university education and more clinic visits (ART to prevent sexual transmission); and pregnancy and Orthodox Christian religion (Holy Water). Assessment of patient beliefs may help providers identify areas needing reinforcement. In this setting, counselors also need to stress the benefits of ART as prevention and that Holy Water should not be used to the exclusion of HIV care and ART.

  10. 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...

  11. 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...

  12. 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…

  13. 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.

  14. 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

  15. 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

  16. 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.

  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.

  18. 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

  19. 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

  20. 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.

  1. 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

  2. Integrating Palliative Care into Primary Care.

    PubMed

    Gorman, Rosemary D

    2016-09-01

    Improved quality of life, care consistent with patient goals of care, and decreased health care spending are benefits of palliative care. Palliative care is appropriate for anyone with a serious illness. Advances in technology and pharmaceuticals have resulted in increasing numbers of seriously ill individuals, many with a high symptom burden. The numbers of individuals who could benefit from palliative care far outweighs the number of palliative care specialists. To integrate palliative care into primary care it is essential that resources are available to improve generalist palliative care skills, identify appropriate patients and refer complex patients to specialist palliative care providers.

  3. 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

  4. Patient-centered care: the key to cultural competence.

    PubMed

    Epner, D E; Baile, W F

    2012-04-01

    Much of the early literature on 'cultural competence' focuses on the 'categorical' or 'multicultural' approach, in which providers learn relevant attitudes, values, beliefs, and behaviors of certain cultural groups. In essence, this involves learning key 'dos and don'ts' for each group. Literature and educational materials of this kind focus on broad ethnic, racial, religious, or national groups, such as 'African American', 'Hispanic', or 'Asian'. The problem with this categorical or 'list of traits' approach to clinical cultural competence is that culture is multidimensional and dynamic. Culture comprises multiple variables, affecting all aspects of experience. Cultural processes frequently differ within the same ethnic or social group because of differences in age cohort, gender, political association, class, religion, ethnicity, and even personality. Culture is therefore a very elusive and nebulous concept, like art. The multicultural approach to cultural competence results in stereotypical thinking rather than clinical competence. A newer, cross cultural approach to culturally competent clinical practice focuses on foundational communication skills, awareness of cross-cutting cultural and social issues, and health beliefs that are present in all cultures. We can think of these as universal human beliefs, needs, and traits. This patient centered approach relies on identifying and negotiating different styles of communication, decision-making preferences, roles of family, sexual and gender issues, and issues of mistrust, prejudice, and racism, among other factors. In the current paper, we describe 'cultural' challenges that arise in the care of four patients from disparate cultures, each of whom has advanced colon cancer that is no longer responding to chemotherapy. We then illustrate how to apply principles of patient centered care to these challenges.

  5. Patient and Health-Care Provider Interpretation of do not Resuscitate and do not Intubate

    PubMed Central

    Pirinea, Heather; Simunich, Thomas; Wehner, Daniel; Ashurst, John

    2016-01-01

    Background: Advance directives and end of life care are difficult discussions for both patients and health-care providers (HCPs). A HCP requires an accurate understanding of advanced directives to educate patients and their family members to allow them to make an appropriate decision. Misinterpretations of the do not resuscitate (DNR), do not intubate (DNI), and the Physicians Orders for Life-Sustaining Treatment (POLST) form result in ineffective communication and confusion between patients, family members, and HCPs. Methodology: An anonymous, multiple choice online and paper survey was distributed to patients, family members of patients (PFMs), and HCPs from December 12, 2012 to March 6, 2013. Data regarding demographics, the accuracy of determining the correct definition of DNR and DNI, the familiarity of the POLST form and if a primary care physician had discussed advanced directives with the participants were collected. Results: A total of 687 respondents participated in the survey. Patients and PFMs could not distinguish the definition of DNR (95% confidence interval [CI] [1.453–2.804]) or DNI (95% CI (1.216–2.334)) 52% of the time while HCPs 35% and 39% of the time (P < 0.0005). Regarding the POLST form, 86% of patients and PFMs and 50% of HCPs were not familiar with the POLST form. Sixty-nine percent of patients and family members reported that their primary care physician had not discussed advance directives with them. Twenty-four percent of patients and family members reported that they had previous health-care experience and this was associated with increased knowledge of the POLST form (P < 0.0005). An association was also seen between the type of HCP taking the survey and the ability to correctly identify the correct definition of DNR (P < 0.0005). Conclusion: Discussion of end of life care is difficult for patients and their family members. Often times multiple discussions are required in order to effectively communicate the definition of DNR, DNI

  6. 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

  7. 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…

  8. Anxiety and depression in patients with advanced macular degeneration: current perspectives

    PubMed Central

    Cimarolli, Verena R; Casten, Robin J; Rovner, Barry W; Heyl, Vera; Sörensen, Silvia; Horowitz, Amy

    2016-01-01

    Age-related macular degeneration (AMD) – despite advances in prevention and medical treatment options – remains prevalent among older adults, often resulting in functional losses that negatively affect the mental health of older adults. In particular, the prevalence of both anxiety and depression in patients with AMD is high. Along with medical treatment options, low vision rehabilitation and AMD-specific behavioral and self-management programs have been developed and have demonstrated effectiveness in improving the mental health of AMD patients. This article reviews the prevalence of anxiety and depression in patients with advanced AMD, discusses potential mechanisms accounting for the development of depression and anxiety in AMD patients, presents the state-of the-art of available interventions for addressing anxiety and depression in AMD patients, and delineates recommendations for eye care professionals regarding how to screen for these two prevalent mental health problems and how to facilitate appropriate treatment for patients with AMD. PMID:26766899

  9. Investigation of the oral infections and manifestations seen in patients with advanced cancer

    PubMed Central

    Xu, Lihua; Zhang, Hualin; Liu, Jinsong; Chen, Xiaowei

    2013-01-01

    Objective: A prospective, observational study was undertaken to investigate the epidemiology of oral infection among the patients with advanced malignancies, and to investigate the effects of therapy strategies and risk factors on the incidence of oral infection. Methods: The patients with advanced malignancies were enrolled into the study. The incidence of oral infection with different malignant tumor groups or different treatment methods and the diagnoses of oral infection were confirmed. Demographic data on age, gender, bed rest time, nutritional status, smoking habit and the presence of oral prosthesis were also recorded. Results: Oral infection was prevalent in 46% (391/850) of all cancer patients, with the highest rate in oral and maxillofacial cancer group (67%), followed by Hematological malignancy group (58.6%) and other groups (ranging from 43.3% to 35.3%). Oral candidiasis, oral herpes simplex, and oral mucositis were the popular infectious diseases in the patients. Chemotherapy and radiotherapy, especially combined radio- and chemotherapy, resulted in more oral infections compared with palliative care and surgery. Poor nutritional status and oral prosthesis were identified as independent risk factors associated with oral infection. Conclusion: Oral infection is prevalent among advanced cancer patients and associated with therapy methods and risk factors. More oral health care should be carried out for the patients with advanced malignant tumor. PMID:24353702

  10. Care of Patients at the End of Life: Surrogate Decision Making for Incapacitated Patients.

    PubMed

    Patel, Ami V; Ackermann, Richard J

    2016-08-01

    Competence is determined by a court of law, whereas physicians determine medical decision-making capacity (DMC). When patients lack DMC, a surrogate should be identified to make decisions. Ideally, patients will have created a durable power of attorney for health care. If a patient did not do this, state statutes specify which individuals can serve as surrogates; a current spouse typically is the first choice. Ideally, surrogates should use substituted judgment in making decisions. If this is not possible because the patient never shared end-of-life wishes with the surrogate, the surrogate can make decisions that, in the surrogate's opinion, are in the patient's best interests or that a reasonable individual would make. When no surrogate can be identified and a patient has no written advance directive, hospital ethics committees can assist with decisions, or, for some patients, a court will need to appoint a guardian. When there is a surrogate, difficulties can arise when family members disagree with the surrogate's decisions or when surrogates request treatments that, in the physician's opinion, would be futile or nonbeneficial. Hospital ethics committees may be able to assist in these situations, but appropriately conducted family meetings often resolve such difficulties. PMID:27490071

  11. 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.

  12. 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

  13. 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.

  14. 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.

  15. 'Palliative care': a contradiction in terms? A qualitative study of cancer patients with a Turkish or Moroccan background, their relatives and care providers

    PubMed Central

    2010-01-01

    Background Palliative cancer care aims to improve quality of life and ultimately quality of dying, while prolonging life is not an objective anymore when death nears. The question is, however, whether these perspectives on palliative care are congruent with the perspectives of immigrant families with a Turkish or Moroccan background. Methods A qualitative design was used as we were looking for the personal views of 'very ill' cancer patients with a Turkish or Moroccan background, their family members and their Dutch care providers. We interviewed 83 people, involved in 33 cases to obtain information about their views, values and norms on 'good care'. Results The main concerns about 'good care' expressed by Turkish and Moroccan families were: maximum treatment and curative care until the end of their lives, never having hope taken away, devoted care by their families, avoiding shameful situations, dying with a clear mind and being buried in their own country. Their views conflict, to some extent, with the dominant principles in palliative care, for example, the emphasis on quality of life and advanced care planning, which includes discussing diagnosis and prognosis with the patient. Conclusions Patients and their families with a Turkish or Moroccan background often have different ideas about 'good care' than their Dutch care providers. As many of them are aiming at cure until the end of life, they find 'good palliative care' a contradiction in terms. PMID:20831777

  16. Missing Elements Revisited: Information Engineering for Managing Quality of Care for Patients with Diabetes

    PubMed Central

    Connor, Matthew J; Connor, Michael J

    2010-01-01

    Introduction Advances in information technology offer new avenues for assembling data about diet and care regimens of diabetes patients “in the field.” This creates a challenge for their doctors and the diabetes care community—how to organize and use new data to produce better long-term outcomes for diabetes patients. Methods iAbetics approaches the challenge as a quality management problem, drawing on total quality concepts, which in turn are grounded in application of the scientific method. We frame the diabetes patient's quality-of-care problem as an ongoing scientific investigation aimed at quantifying and predicting relationships between specific care-management actions and their outcomes for individual patients in their ordinary course of life. Results Framing diabetes quality-of-care management as a scientific investigation leads to a seven-step model termed “adaptive empirical iteration.” Adaptive empirical iteration is a deliberate process to perfect the patient's choices, decisions, and actions in routine situations that make up most day-to-day life and to systematically adapt across differences in individual patients and/or changes in their physiology, diet, or environment. The architecture incorporates care-protocol management and version control, structured formats for data collection using mobile smart phones, statistical analysis on secure Web sites, tools for comparing alternative protocols, choice architecture technology to improve patient decisions, and information sharing for doctor review. Conclusions Adaptive empirical iteration is a foundation for information architecture designed to systematically improve quality-of-care provided to diabetes patients who act as their own day-to-day care provider under supervision and with support from their doctor. The approach defines “must-have” capabilities for systems using new information technology to improve long-term outcomes for diabetes patients. PMID:20920451

  17. [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.

  18. [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

  19. 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

  20. 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

  1. 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.

  2. 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

  3. 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

  4. Advance Care Planning and HIV Infection in the Era of Antiretroviral Therapy: A Review.

    PubMed

    Sangarlangkarn, Aroonsiri; Merlin, Jessica S; Tucker, Rodney O; Kelley, Amy S

    In the era of antiretroviral therapy, HIV infection has become a chronic illness with associated multimorbidity, and practitioners are faced with an emerging population of HIV-infected patients with evolving needs for advance care planning (ACP), defined as communication between individuals and their proxies to plan for future health care decisions. This article provides a review of original research studies on ACP in HIV-infected adults in the era of antiretroviral therapy (1996-present) from PubMed, EMBASE, and PsycINFO. Eleven studies conducted between 1996 and 2015 met the selection criteria, with study sizes ranging from 9 to 2864 participants. Most studies consisted of white men in outpatient settings and had poorly defined definitions of ACP. Prevalence of ACP was variable (36%-54% had end-of-life communication, 8%-47% had advance directives). Lack of ACP was most commonly associated with low income, followed by lower severity of illness, low education level, black or Hispanic race, female sex, younger age, injection drug use, and social isolation. Practitioners reported limited time or energy and inadequate preparation or training as barriers to ACP. Existing literature on ACP in the era of antiretroviral therapy is limited, but shows that ACP prevalence in HIV-infected individuals is variable depending on socioeconomic factors, severity of illness, and practitioner resources and training. More research is needed to increase ACP among HIV-infected individuals. PMID:27398771

  5. 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

  6. 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

  7. [Necessary changes for advancing nursing as caring science].

    PubMed

    de Pires, Denise Elvira Pires

    2013-09-01

    The article aimed to reflect upon the challenges involved in strengthening Nursing as a caring science. It is founded on the sociological theory, connecting three approaches: the historical-dialectic materialism perspective about the working process in health care and nursing; the sociology of professions from a critical perspective; and the philosophy of science. The discussion is organized considering the aspects of Nursing as a discipline, work and health care profession. It sustains that knowledge production should be driven both by the purpose of Nursing work which is providing care to human beings with health needs and to advocate for the indispensable work conditions to a safe and responsible practice. It concludes that to strengthening Nursing it is necessary to produce knowledge to support nursing care and the political actions defending safe work conditions, the universal right to health as well safe and high quality care. PMID:24092308

  8. 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

  9. 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

  10. 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.

  11. 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.

  12. Initial Experience of Head and Neck Cancer Patients Treated in an Oncologist Led Palliative Cancer Care Clinic at a Tertiary Cancer Care Center in Uttar Pradesh: Is the Initiative of a Full-fledged Palliative Care for Cancer Patients Justified

    PubMed Central

    Lal, Punita; Verma, Mranalini; Kumar, Gaurav; Shrivastava, Resham; Kumar, Shaleen

    2016-01-01

    Introduction: Poor socioeconomic status and illiteracy attribute to the advanced presentation of head and neck cancer (HNC) patients in India and are candidates for palliation in our setup. We set up a palliative cancer care clinic (PCCC), and an audit of initial 153 HNC patients is presented. Aims and Objectives: To assess the impact of palliative cancer care services. Methodology: Data of advanced HNC patients suited for palliation were collected to document demography, symptomatology, cancer treatment, and supportive care. Results: One hundred and fifty-three patients were seen during January 2013 to March 2015 in the PCCC. Seventy-two (47%) referral cases were due to disease progression and 81 (53%) due to de novo advanced cases. Median follow-up for this group was 5.3 months. Ninety (59%) cases needed some degree of assistance for their normal activities. Sixty-seven (44%) patients belonged to poor socioeconomic status and 65 (43%) were educated up to equivalent of high school. One hundred and thirty-five (88%) patients had an adequate family support. Pain was the most common presenting symptom in 134 (87%) cases with adequate relief in 112 (84%) patients with another 13 (09%) could not be assessed. Overall median duration of symptoms was 6 months. Cancer-directed therapy was used in 143 (93%) patients. Near the end of life in 47 (73%) out of 63 documented cases, caregivers were psychologically prepared for the inevitable. Conclusion: The role of palliative care team in alleviating physical, psychosocial, and emotional issues of patient and family members was significant. PCCC seems to be a feasible working model in our setup. PMID:27803571

  13. 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

  14. 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

  15. 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

  16. 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.

  17. Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers

    PubMed Central

    Gomes, Barbara; Calanzani, Natalia; Curiale, Vito; McCrone, Paul; Higginson, Irene J

    2013-01-01

    Background Extensive evidence shows that well over 50% of people prefer to be cared for and to die at home provided circumstances allow choice. Despite best efforts and policies, one-third or less of all deaths take place at home in many countries of the world. Objectives 1. To quantify the effect of home palliative care services for adult patients with advanced illness and their family caregivers on patients' odds of dying at home; 2. to examine the clinical effectiveness of home palliative care services on other outcomes for patients and their caregivers such as symptom control, quality of life, caregiver distress and satisfaction with care; 3. to compare the resource use and costs associated with these services; 4. to critically appraise and summarise the current evidence on cost-effectiveness. Search methods We searched 12 electronic databases up to November 2012. We checked the reference lists of all included studies, 49 relevant systematic reviews, four key textbooks and recent conference abstracts. We contacted 17 experts and researchers for unpublished data. Selection criteria We included randomised controlled trials (RCTs), controlled clinical trials (CCTs), controlled before and after studies (CBAs) and interrupted time series (ITSs) evaluating the impact of home palliative care services on outcomes for adults with advanced illness or their family caregivers, or both. Data collection and analysis One review author assessed the identified titles and abstracts. Two independent reviewers performed assessment of all potentially relevant studies, data extraction and assessment of methodological quality. We carried out meta-analysis where appropriate and calculated numbers needed to treat to benefit (NNTBs) for the primary outcome (death at home). Main results We identified 23 studies (16 RCTs, 6 of high quality), including 37,561 participants and 4042 family caregivers, largely with advanced cancer but also congestive heart failure (CHF), chronic obstructive

  18. [Endorsement of risk management and patient safety by certification of conformity in health care quality assessment].

    PubMed

    Waßmuth, Ralf

    2015-01-01

    Certification of conformity in health care should provide assurance of compliance with quality standards. This also includes risk management and patient safety. Based on a comprehensive definition of quality, beneficial effects on the management of risks and the enhancement of patient safety can be expected from certification of conformity. While these effects have strong face validity, they are currently not sufficiently supported by evidence from health care research. Whether this relates to a lack of evidence or a lack of investigation remains open. Advancing safety culture and "climate", as well as learning from adverse events rely in part on quality management and are at least in part reflected in the certification of healthcare quality. However, again, evidence of the effectiveness of such measures is limited. Moreover, additional factors related to personality, attitude and proactive action of healthcare professionals are crucial factors in advancing risk management and patient safety which are currently not adequately reflected in certification of conformity programs.

  19. Epidemiology of CKD Regression in Patients under Nephrology Care

    PubMed Central

    Borrelli, Silvio; Leonardis, Daniela; Minutolo, Roberto; Chiodini, Paolo; De Nicola, Luca; Esposito, Ciro; Mallamaci, Francesca; Zoccali, Carmine; Conte, Giuseppe

    2015-01-01

    Chronic Kidney Disease (CKD) regression is considered as an infrequent renal outcome, limited to early stages, and associated with higher mortality. However, prevalence, prognosis and the clinical correlates of CKD regression remain undefined in the setting of nephrology care. This is a multicenter prospective study in 1418 patients with established CKD (eGFR: 60–15 ml/min/1.73m²) under nephrology care in 47 outpatient clinics in Italy from a least one year. We defined CKD regressors as a ΔGFR ≥0 ml/min/1.73 m2/year. ΔGFR was estimated as the absolute difference between eGFR measured at baseline and at follow up visit after 18–24 months, respectively. Outcomes were End Stage Renal Disease (ESRD) and overall-causes Mortality.391 patients (27.6%) were identified as regressors as they showed an eGFR increase between the baseline visit in the renal clinic and the follow up visit. In multivariate regression analyses the regressor status was not associated with CKD stage. Low proteinuria was the main factor associated with CKD regression, accounting per se for 48% of the likelihood of this outcome. Lower systolic blood pressure, higher BMI and absence of autosomal polycystic disease (PKD) were additional predictors of CKD regression. In regressors, ESRD risk was 72% lower (HR: 0.28; 95% CI 0.14–0.57; p<0.0001) while mortality risk did not differ from that in non-regressors (HR: 1.16; 95% CI 0.73–1.83; p = 0.540). Spline models showed that the reduction of ESRD risk associated with positive ΔGFR was attenuated in advanced CKD stage. CKD regression occurs in about one-fourth patients receiving renal care in nephrology units and correlates with low proteinuria, BP and the absence of PKD. This condition portends better renal prognosis, mostly in earlier CKD stages, with no excess risk for mortality. PMID:26462071

  20. The desire to die: making treatment decisions for suicidal patients who have an advance directive.

    PubMed

    Salter, Erica K

    2014-01-01

    This article enumerates and critically examines the potential grounds on which we might treat the case of a patient with an advance directive who attempted suicide, differently from one whose injuries were the result of an accident. Grounds for differentiation are distilled into two potential justifications. The first addresses the concern that withholding or withdrawing care from a patient with self-inflicted injuries would be aiding and abetting suicide.The second examines concerns about the patient's decisionmaking capacity. Ultimately, it is argued that while there might be legitimate reasons to hold the advance directive of a suicidal patient to a different standard of scrutiny, the fact that the patient's medical state was self-inflicted should not, in and of itself, necessarily invalidate the guidance of the directive. Finally, four practical recommendations are offered for negotiating similar cases.

  1. 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

  2. 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

  3. [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.

  4. Integrating patient-centered care and clinical ethics into nutrition practice.

    PubMed

    Schwartz, Denise Baird

    2013-10-01

    The purpose of this article is to present the application of patient-centered care and clinical ethics into nutrition practice, illustrate the process in a case study, and promote change in the current healthcare clinical ethics model. Nutrition support clinicians have an opportunity to add another dimension to their practice with the incorporation of patient-centered care and clinical ethics. This represents a culture change for healthcare professionals, including nutrition support clinicians, patients and their family. All of these individuals are stakeholders in the process and have the ability to modify the current healthcare system to improve communication and facilitate a change by humanizing nutrition support practice. Nutrition support is a medical, life-sustaining treatment, and the use of this therapy requires knowledge by the nutrition support clinician of patient-centered care concepts, preventive clinical ethics, religion/spirituality and cultural diversity, palliative care team role, and advance care planning. Integrating these into the practice of nutrition support is an innovative approach and results in new knowledge that requires a change in the culture of care and engagement and empowerment of the patient and their family in the process. This is more than a healthcare issue; it involves a social/family conversation movement that will be enhanced by the nutrition support clinician's participation.

  5. 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.

  6. 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

  7. 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.

  8. 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

  9. 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

  10. [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

  11. 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

  12. [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.

  13. 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

  14. 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