Science.gov

Sample records for hospice center model

  1. Determinants of access to pediatric hospice care: A conceptual model

    PubMed Central

    Lindley, Lisa C.

    2014-01-01

    One of the many difficult moments for families of children with life-limiting illnesses is to make the decision to access pediatric hospice care. Although determinants that influence families’ decisions to access pediatric hospice care have been recently identified, the relationship between these determinants and access to pediatric hospice care have not been explicated or grounded in accepted healthcare theories or models. Using the Andersen Behavioral Healthcare Utilization Model, this article presents a conceptual model describing the determinants of hospice access. Predisposing (demographic; social support; and knowledge, beliefs, and values), enabling (family and community resources) and need (perceived and evaluated needs) factors were identified through the use of hospice literature. The relationships among these factors are described and implications of the model for future study and practice are discussed. PMID:25983662

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

    ERIC Educational Resources Information Center

    Story, Marilyn

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

  3. The Island Hospice model of palliative care.

    PubMed

    Khumalo, Thembelihle; Maasdorp, Valerie

    2016-01-01

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

  4. The Island Hospice model of palliative care

    PubMed Central

    Khumalo, Thembelihle; Maasdorp, Valerie

    2016-01-01

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

  5. National hospice study analysis plan.

    PubMed

    Greer, D S; Mor, V; Sherwood, S; Morris, J N; Birnbaum, H

    1983-01-01

    Since the founding of the first hospice in the United States in 1974, the number of health care organizations providing hospice services has grown rapidly. In 1978, the U.S. General Accounting Office identified 59 operational hospices [1]. A survey undertaken by the National Hospice Organization (NHO) in 1980 found 235 operational programs and many more actively planning to deliver services. By the summer of 1981, the Joint Commission on the Accreditation of Hospitals (JCAH), in studying the feasibility of a voluntary hospice accreditation program, had 650 responses to a national survey [2]. Finally, the 1981 NHO directory identifies 464 operational "provider programs" as well as 33 functioning state-level hospice organizations with an additional 353 programs in various stages of establishing hospice programs of care [3]. The growth of the movement and the public recognition it has received have catalyzed advocacy of Federal support for hospice services. In 1979, the Congress responded by mandating a study to delineate the implications of inclusion of hospice services in the Medicare program. The Health Care Financing Administration (HCFA) then selected 26 hospices (from an applicant pool of 233) to participate in a two-year experimental program. These demonstration sites receive reimbursement for services provided Medicare beneficiaries not otherwise available under current regulations. The special reimbursement provisions went into effect on October 1, 1980. (See Appendix A: Description of the Hospice Reimbursement Program.) In the spring of 1980, the Robert Wood Johnson Foundation and the John A. Hartford Foundation joined with the Health Care Financing Administration (HCFA) to solicit proposals for a national evaluation of hospice care as a basis for future Federal fiscal policy and legislation. Brown University was selected as the evaluation center by competitive process and the grant was awarded on September 30, 1980. The evaluation employs a quasi

  6. Pediatric palliative and hospice care: Pennsylvania's model of collaboration.

    PubMed

    Hawley, Betsy

    2010-01-01

    In the state of Pennsylvania, a collaborative model has been developed for improving pediatric palliative care and end-of-life care services to children with life-limiting conditions and their families. The inspiration and efforts of several bereaved parents provided the initial impetus for this encouraging model. Pennsylvania's model involves cooperation and collaboration among several groups and initiatives across the state, as well as the integration of parent-professional collaboration at all levels and in each initiative. The collaborating groups include 1) a volunteer grassroots resource and education initiative, Helping Hands-Healing Hearts; 2) the Pittsburgh Pediatric Palliative Care Coalition, a coalition of concerned parents and experienced palliative and hospice care providers working together to improve service availability; and 3) the Pennsylvania Children's Hospice and Palliative Care Coalition, which developed as an outcome of a state-level Pennsylvania Pediatric Hospice Care Task Force, and which, among other activities, works with the Pennsylvania Department of Public Welfare and several Pennsylvania legislators on pertinent policy and legislative initiatives.

  7. Hospice Care

    MedlinePlus

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

  8. A flexible alternative to the Cox proportional hazards model for assessing the prognostic accuracy of hospice patient survival.

    PubMed

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

    2012-01-01

    Prognostic models are often used to estimate the length of patient survival. The Cox proportional hazards model has traditionally been applied to assess the accuracy of prognostic models. However, it may be suboptimal due to the inflexibility to model the baseline survival function and when the proportional hazards assumption is violated. The aim of this study was to use internal validation to compare the predictive power of a flexible Royston-Parmar family of survival functions with the Cox proportional hazards model. We applied the Palliative Performance Scale on a dataset of 590 hospice patients at the time of hospice admission. The retrospective data were obtained from the Lifepath Hospice and Palliative Care center in Hillsborough County, Florida, USA. The criteria used to evaluate and compare the models' predictive performance were the explained variation statistic R(2), scaled Brier score, and the discrimination slope. The explained variation statistic demonstrated that overall the Royston-Parmar family of survival functions provided a better fit (R(2) =0.298; 95% CI: 0.236-0.358) than the Cox model (R(2) =0.156; 95% CI: 0.111-0.203). The scaled Brier scores and discrimination slopes were consistently higher under the Royston-Parmar model. Researchers involved in prognosticating patient survival are encouraged to consider the Royston-Parmar model as an alternative to Cox. PMID:23082220

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

    PubMed Central

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

    2016-01-01

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

  10. Marketing imperatives for hospice and hospitals: implications of hospice headway.

    PubMed

    Dwyer, F R; Kolbe, R H

    1986-01-01

    This study reports physician perceptions of the administrative fluency of hospice programming and the comparative service qualities of hospice and acute care hospitals on 11 care needs of the terminally ill. Hospice programs evidence organizational sophistication levels which belie their institutional youth. Hospice had a clear advantage within our stacked comparison of care delivery for the terminally ill. Supporting our model of organizational adaptation, however, the performance gap was smallest on those attributes physicians rate as most important to the terminally ill. Finally, hospice referral rates are statistically explained more by administrative prowess than perceived advantages in care delivery. This compels hospital and hospice attention to informational and relational marketing to physicians.

  11. The utility of the model for end-stage liver disease score: a reliable guide for liver transplant candidacy and, for select patients, simultaneous hospice referral.

    PubMed

    Medici, Valentina; Rossaro, Lorenzo; Wegelin, Jacob A; Kamboj, Amit; Nakai, Junko; Fisher, Kelli; Meyers, Frederick J

    2008-08-01

    Patients with chronic liver disease are referred late to hospice or never referred. There are several barriers to timely referral. First, liver transplantation (LT) and hospice care have always been perceived as mutually exclusive. Yet the criteria for hospice referral and for LT are more similar than different (for example, advanced liver disease and imminent death). Second, physicians, patients, and families have not had a reliable metric to guide referral. However, many patients wait for transplantation but never receive an organ. We hypothesized that the Model for End-Stage Liver Disease (MELD) score already in use to prioritize LT could be used in selected patients for concurrent hospice referral. Furthermore, we hypothesized that patients awaiting LT can receive hospice care and remain eligible for transplantation. Patients with advanced or end-stage liver disease were referred to the University of California Davis Health System hospice program. We correlated the MELD score at admission to length of stay (LOS) in hospice. A total of 157 end-stage liver disease patients were admitted to the hospice service. At the time of hospice admission the mean MELD score was 21 (range, 6-45). The mean length of hospice stay was 38 days (range, 1-329 days). A significant correlation was observed between hospice LOS and MELD score at hospice admission (P < 0.01). Six patients were offered a liver graft while on the combined (LT and hospice) program. MELD can be used to guide clinician recommendation to families about hospice care, achieving one of the national benchmark goals of increasing hospice care duration beyond the current median of 2-3 weeks. A higher MELD score might augment physician judgment as to hospice referral. Hospice care for selected patients may be an effective strategy to improve the care of end-stage liver disease patients waiting for LT. PMID:18668666

  12. Hospice care

    MedlinePlus

    ... are nearing death. The goal is to give comfort and peace instead of a cure. Hospice care ... works together to give the patient and family comfort and support. Someone from your hospice care team ...

  13. Hospice Care

    MedlinePlus

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

  14. Selling hospice.

    PubMed

    Halabi, Sam

    2014-01-01

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

  15. Hospice Care

    MedlinePlus

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

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

    ERIC Educational Resources Information Center

    Bernard, Lori L.; Guarnaccia, Charles A.

    2003-01-01

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

  17. Children's hospice care.

    PubMed

    Corr, C A; Corr, D M

    1992-01-01

    This article seeks to define the principles that are at the heart of the concept of children's hospice care and to indicate the wide range of activities to which that concept is relevant. The discussion is organized around five main points: 1) an analysis of that which is distinctive of the hospice philosophy or hospice-like approaches to care; 2) a sketch of situations involving children to which approaches guided by such a philosophy are or might be relevant; 3) a description of the principal contexts within which these approaches might be implemented; 4) some suggestions concerning the application of ideal models to practical realities; and 5) some concluding remarks concerning issues for practice and research. References to relevant literature indicate the present status of work in this field.

  18. Symposium: Hospices.

    ERIC Educational Resources Information Center

    Mental Retardation, 1984

    1984-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  20. Medicare Hospice Benefits

    MedlinePlus

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

  1. Children's hospice care.

    PubMed

    Armstrong-Dailey, A

    1990-01-01

    Facing the inevitable death of a child is a difficult reality for many parents and health care providers as well. Children's Hospice International offers a variety of information and education services to support the provision of children's hospice care.

  2. The emergence of Medicare hospice care in US nursing homes.

    PubMed

    Miller, S C; Mor, V

    2001-11-01

    Although Medicare-financed hospice care has been provided in nursing homes in the USA for over 10 years, very little is known regarding the use of this government health care benefit in nursing homes. Using resident assessment data and hospice and inpatient Medicare claim data from five US states, we were able to identify and describe nursing home residents receiving hospice care between 1992 and 1996, and their hospice utilization patterns. Six per cent of all dying nursing home residents received hospice care at some point in time and, in 1996, an estimated 24% of all Medicare hospice patients in the five study states received hospice while in a nursing home. Of those residents beginning hospice care after nursing home admission, 48% were 85 years or older, 70% were female, 94% were white, 76% were unmarried and 62% had a non-cancer principal diagnosis. The average length of stay in the hospice programme for residents receiving hospice care while in the nursing home was 90.6 days, the median 35 and the mode 2. Hospice care in US nursing homes is a prevalent model of care that appears further to extend the Medicare hospice benefit to older adults who are female and to those with non-cancer diagnoses. Lengths of stay in the programme are similar to those observed in the community and the average length of stay is substantially shorter than previously estimated by an influential government study.

  3. Enhancing Palliative Care for Low-Income Elders with Chronic Disease: Feasibility of a Hospice Consultation Model

    PubMed Central

    Kramer, Betty J.; Cleary, Jim; Mahoney, Jane E.

    2013-01-01

    Challenges exist in assimilating palliative care within community based services for nursing home eligible low-income elders with complex chronic illness as they approach the end of life. This study assessed the feasibility of a consultation model, with hospice clinicians working with three Care Wisconsin Partnership Program teams. Consults occurred primarily during team meetings and also informally and on joint patient visits and were primarily with the palliative care nurse addressing physical issues. 57% of consultant recommendations were implemented. Benefits of consultation were identified with focus groups of clinical staff as were opportunities and barriers to the implementation. Models of integration are proposed. PMID:25494931

  4. Hospice care at the end of life.

    PubMed

    Herbst, Laurel

    2004-11-01

    Hospice care in the United States has evolved from a movement and philosophy to a new medical specialty that addresses sources of suffering at many levels. Hospice interdisciplinary teams use Maslow's hierarchy of human need to integrate the multiple domains that influence patients' well-being and assists in the development of treatment plans to prevent or alleviate suffering. Contributing to the effectiveness of this care is the Medicare Hospice Benefit, which since 1983 has served as a model and a reimbursement mechanism that has encouraged proliferation of hospices to deliver care in homes, hospitals, and long-term care facilities. The whole-person approach of hospice care may benefit all patients and can be integrated into all medical management.

  5. Characteristics of Hospice Patients Utilizing Hospice Facilities

    PubMed Central

    Chung, Kyusuk; Burke, Sloane C.

    2014-01-01

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

  6. 42 CFR 418.112 - Condition of participation: Hospices that provide hospice care to residents of a SNF/NF or ICF/IID.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  7. 42 CFR 418.112 - Condition of participation: Hospices that provide hospice care to residents of a SNF/NF or ICF/MR.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

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

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

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

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

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

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

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

    PubMed Central

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

    2015-01-01

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

  12. An educational program in a pediatric hospice setting.

    PubMed

    Wood, Isabel

    2009-01-01

    Canuck Place Children's Hospice, a family-centered pediatric hospice in Vancouver, Canada, provides family support and respite, pain and symptom management, and end-of-life care. One of the goals of pediatric hospice palliative care is to create an environment that supports a normal way of life and enhances quality of life. At Canuck Place, a unique school program for children with progressive life-threatening illnesses has been set up to meet this goal. This article describes the Canuck Place educational program, gives insights into the importance and challenges of providing a complete school experience, and discusses the expanded role of the teacher in the pediatric hospice setting.

  13. 42 CFR 418.400 - Individual liability for coinsurance for hospice care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  14. Psychological contracts of hospice nurses.

    PubMed

    Jones, Audrey Elizabeth; Sambrook, Sally

    2010-12-01

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

  15. Hispanics' experiences in the health system prior to hospice admission.

    PubMed

    Adams, Carolyn E; Horn, Kathryn; Bader, Julia

    2007-01-01

    National data document that Hispanics are under-represented in hospice. Policy makers often attribute the under-representation to Hispanics' cultural values and preferences, however, another reason may be healthcare system barriers encountered by Hispanics. We explored Hispanics' versus Whites' experiences in the healthcare system prior to hospice admission to help account for Hispanics under-representation in hospice. The conceptual model was the Agency for Healthcare Research and Quality Model on Healthcare Access. Whites' experiences were used as benchmarks to identify healthcare disparities for Hispanics. In four hospice agencies, Hispanic (n = 60) and White (n = 60) Medicare patients were interviewed. The results showed that prior to hospice admission, Hispanics had less access to health services known to be associated with hospice access.

  16. Hospice care in Calgary

    PubMed Central

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

    2016-01-01

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

  17. Exploring the dreams of hospice workers.

    PubMed

    Hess, Shirley A; Knox, Sarah; Hill, Clara E; Byers, Tara; Spangler, Patricia

    2014-06-01

    Nine adults who worked at least 1 year with patients at US hospice centers completed an in-person audiotaped dream session focusing on a dream about a patient. Data were analyzed using consensual qualitative research. Patients were generally manifestly present in participants' dreams, and dreams were typically realistic (i.e., not bizarre). In the dream, the dreamer typically interacted with the patient as a caretaker but was also typically frustrated by an inability to help as fully as desired. Dreams gave dreamers insight into the stress of hospice work, their own fears of death, and inter-/intrapersonal interactions beyond hospice work. Dreamers generally sought to take better care of themselves and find balance in their lives after the dream session. Implications for research and practice are discussed.

  18. A model of strategic marketing alliances for hospices: vertical, internal, osmotic alliances and the complete model.

    PubMed

    Starnes, B J; Self, D R

    1999-01-01

    This article develops two previous research efforts. William J. Winston (1994, 1995) has proposed a set of strategies by which health care organizations can benefit from forging strategic alliances. Raadt and Self (1997) have proposed a classification model of alliances including horizontal, vertical, internal, and osmotic. In the second of two articles, this paper presents a model of vertical, internal, and osmotic alliances. Advantages and disadvantages of each are discussed. Finally, the complete alliance system model is presented. PMID:10623195

  19. Hispanic access to hospice services in a predominantly Hispanic community.

    PubMed

    Adams, Carolyn E; Horn, Kathryn; Bader, Julia

    2006-01-01

    Although the largest minority population in the United States, Hispanics are under-represented in hospice at the national level. The study purpose was to document Hispanic access to hospice services in an environment where Hispanics are a majority population. The framework for the study was Aday and Anderson's model for access to medical care. In this framework, access is not defined as availability of services and resources, but whether services are actually used by the people who need them. We completed retrospective chart reviews of 500 Medicare beneficiaries who died in four hospices. Study variables were decedent characteristics and access to hospice and hospice disciplines. Results showed that Hispanics and whites differed on characteristics known to influence access to health services, e.g., preferred language and type of caregiver Although the proportion of Hispanic elders dying in hospice was less than the proportion living in the community, the proportions of Hispanic elders who died in the community or died in their homes were not differentfrom the proportion that died in hospice. When access to hospice disciplines was compared between Hispanic and white decendents, the results showed one difference-more whites than Hispanics had access to volunteer services. Overall, the study showed that Hispanics were not underrepresented in hospice, and they had equal access to hospice disciplines. These findings differ from national data and may be associated with Hispanics being the majority population in the community. To learn how population dominance influences minority access to services, Hispanic access to hospice could be studied in locales with varying proportions of Hispanics in the population.

  20. Medicare Program; FY 2017 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements. Final rule.

    PubMed

    2016-08-01

    This final rule will update the hospice wage index, payment rates, and cap amount for fiscal year (FY) 2017. In addition, this rule changes the hospice quality reporting program, including adopting new quality measures. Finally, this final rule includes information regarding the Medicare Care Choices Model (MCCM).

  1. Medicare Program; FY 2017 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements. Final rule.

    PubMed

    2016-08-01

    This final rule will update the hospice wage index, payment rates, and cap amount for fiscal year (FY) 2017. In addition, this rule changes the hospice quality reporting program, including adopting new quality measures. Finally, this final rule includes information regarding the Medicare Care Choices Model (MCCM). PMID:27529902

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

    ERIC Educational Resources Information Center

    Waldrop, Deborah P.; Rinfrette, Elaine S.

    2009-01-01

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

  3. Hospice payment reform: a look into the future.

    PubMed

    Simione, Robert J; Forster, Theresa M

    2011-09-01

    This article incorporates findings from the first phase of a Hospice U-shaped Modeling Project conducted by Simione Consultants that were presented on July 14 at the 17th Annual NAHC Financial Management Conference & Exposition in San Diego, CA, by Robert Simione and Theresa M. Forster. SPECIAL NOTE: The National Association for Home Care & Hospice (NAHC) and its affiliated Hospice Association of America (HAA) extend special thanks to the agencies that volunteered to participate in the hospice payment modeling study referenced in this article, and particularly to Robert Simione, Jared Shure Michael Simione, and Kaitlyn Quada of Simione Consultants, LLC, for their significant contributions to advancing knowledge of the potential impact of hospice payment reform.

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2015-01-01

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

  6. Medicare Care Choices Model Enables Concurrent Palliative and Curative Care.

    PubMed

    2015-01-01

    On July 20, 2015, the federal Centers for Medicare & Medicaid Services (CMS) announced hospices that have been selected to participate in the Medicare Care Choices Model. Fewer than half of the Medicare beneficiaries use hospice care for which they are eligible. Current Medicare regulations preclude concurrent palliative and curative care. Under the Medicare Choices Model, dually eligible Medicare beneficiaries may elect to receive supportive care services typically provided by hospice while continuing to receive curative services. This report describes how CMS has expanded the model from an originally anticipated 30 Medicare-certified hospices to over 140 Medicare-certified hospices and extended the duration of the model from 3 to 5 years. Medicare-certified hospice programs that will participate in the model are listed.

  7. Hospice Care in America

    MedlinePlus

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

  8. Hospice Care for Children With Cancer: Where Do These Children Die?

    PubMed

    Thienprayoon, Rachel; Lee, Simon C; Leonard, David; Winick, Naomi

    2015-07-01

    Hospice is an important provider of end of life care; many children who die of cancer enroll in hospice programs. How frequently such children remain in hospice to die at home, or disenroll from hospice and die in the hospital, has not been described. A child's location of death has important implications for quality of life and parental adaptation. This represents a subanalysis of a retrospective study of 202 consecutive oncology patients who died at a single center between January 1, 2006 and December 31, 2010. Of 95 children who enrolled in hospice, 82 had known location of death. Sixty (73%) died at home or an inpatient hospice unit, 15 (18%) died in the oncology unit, 5 (6%) died in the intensive care unit, and 2 (2%) died in the emergency department. The median length of hospice services was 41 days, twice the national median of 21 days reported in adults. One quarter of children disenrolled from hospice care, ultimately dying in an acute care setting. Further studies are warranted to explore the hospice experience in children, and to address modifiable factors that may impact a family's choice to withdraw from hospice care.

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

    PubMed

    Stevenson, David G; Bramson, Jeffrey S

    2009-09-01

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

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

    PubMed

    Kobayashi, Rie; McAllister, Carolyn A

    2016-01-01

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

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

    PubMed

    Wallace, Cara L

    2015-01-01

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

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

    PubMed

    Wallace, Cara L

    2015-01-01

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

  13. 42 CFR 418.205 - Special requirements for hospice pre-election evaluation and counseling services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... evaluation and counseling services. 418.205 Section 418.205 Public Health CENTERS FOR MEDICARE & MEDICAID... Services § 418.205 Special requirements for hospice pre-election evaluation and counseling services. (a... evaluation and counseling services as specified in § 418.304(d) may be made to a hospice on behalf of...

  14. 42 CFR 418.205 - Special requirements for hospice pre-election evaluation and counseling services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... evaluation and counseling services. 418.205 Section 418.205 Public Health CENTERS FOR MEDICARE & MEDICAID... Services § 418.205 Special requirements for hospice pre-election evaluation and counseling services. (a... evaluation and counseling services as specified in § 418.304(d) may be made to a hospice on behalf of...

  15. 42 CFR 417.423 - Special rules: ESRD and hospice patients.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Special rules: ESRD and hospice patients. 417.423 Section 417.423 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Special rules: ESRD and hospice patients. (a) ESRD patients. (1) A Medicare beneficiary who has...

  16. 42 CFR 417.423 - Special rules: ESRD and hospice patients.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Special rules: ESRD and hospice patients. 417.423 Section 417.423 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Contract § 417.423 Special rules: ESRD and hospice patients. (a) ESRD patients. (1) A Medicare...

  17. 42 CFR 417.423 - Special rules: ESRD and hospice patients.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Special rules: ESRD and hospice patients. 417.423 Section 417.423 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Contract § 417.423 Special rules: ESRD and hospice patients. (a) ESRD patients. (1) A Medicare...

  18. 42 CFR 417.423 - Special rules: ESRD and hospice patients.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Special rules: ESRD and hospice patients. 417.423 Section 417.423 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Contract § 417.423 Special rules: ESRD and hospice patients. (a) ESRD patients. (1) A Medicare...

  19. 42 CFR 417.423 - Special rules: ESRD and hospice patients.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Special rules: ESRD and hospice patients. 417.423 Section 417.423 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Special rules: ESRD and hospice patients. (a) ESRD patients. (1) A Medicare beneficiary who has...

  20. A descriptive study of California hospice providers' perceptions of public reporting of quality data using the Family Evaluation of Hospice Care Survey.

    PubMed

    Nelson, Marsha; Gale, Randall C; Naierman, Naomi; DeViney, Meredith

    2014-06-01

    The Affordable Care Act requires US hospices to report quality data to the Centers for Medicare and Medicaid Services (CMS) in 2013 with data eventually being made public. There may be some benefit to participating in a voluntary public-reporting program prior to public disclosure by CMS; therefore, we developed and conducted an electronic survey exploring California hospices' perceptions of public reporting. The majority (78.1%) of respondents reported current use of the Family Evaluation of Hospice Care tool and a willingness to consider voluntary participation in a public-reporting program outside of what is being implemented by CMS (58.6%). Tax status of responding hospices was not predictive of a willingness to participate in a statewide public-reporting program of hospice quality in our study.

  1. Providing nursing care in a children's hospice.

    PubMed

    Day, Alison

    Children who are admitted to hospices need specialist treatment that enables them to enjoy their childhood as much as possible while they receive the care they require. Their parents also have particular needs. During Children's Hospice Week, which started on September 21, the Association of Children's Hospices aims to raise awareness of the work done by children's hospices and the services they provide.

  2. Proposal for a university-community-hospice partnership to address organizational barriers to cultural competence.

    PubMed

    Reese, Dona J

    2011-02-01

    Models of culturally competent hospice services have been developed, but they are not generally being used. This article describes a participatory action research project which is addressing organizational barriers to cultural competence through a university-community-hospice partnership. The intervention plan is to develop a connection with the African American community, increasing community knowledge, and hospice staff cultural competence through a social work student field placement. It is hoped that, if successful, this model will be replicated to address the problem of African American utilization and access to hospice.

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

    PubMed

    Borowske, Deborah

    2012-03-01

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

  4. Does caregiver knowledge matter for hospice enrollment and beyond? Pilot study of minority hospice patients.

    PubMed

    Chung, Kyusuk; Essex, Elizabeth Lehr; Samson, Linda

    2009-01-01

    We examined the level of hospice knowledge of caregivers of minority elderly hospice patients and determined how it influences the hospice enrollment decision and the decision on the use of hospice services after enrollment. Based on qualitative analysis of medical records and interviews with caregivers of minority elderly hospice patients who received personal care from paid caregivers (eg, other than family caregivers), we found that hospice knowledge increased access to hospice among minority patients who otherwise would not opt for hospice or enroll too late for comprehensive hospice care services. Furthermore, the highest level of knowledge-acquired through caregivers' health care occupations-appears to influence hospice care after hospice enrollment. Caregivers with that level of knowledge made requests for changes in site of care and/or additional services that may enhance the quality of hospice care that their loved ones receive.

  5. Will assisted suicide kill hospice?

    PubMed

    Caplan, A L

    1997-01-01

    Hospice is often held out as an alternative to the need for assisted suicide. To date, those in the hospice movement have made any discussion of assistance in dying off-limits on the grounds that proper palliative care can address the concerns about pain that the terminally ill face. But, the movement toward assisted suicide raises questions about the future viability of the hospice movement in its current form. Many who see assistance in dying are concerned, not about pain, but about suffering and loss of dignity. Many are not terminally ill but terrified at the prospect of disability and loss of cognitive capacities. Unless hospice addresses these concerns it is not likely to survive in the face of pressures to legalize assisted suicide.

  6. 42 CFR 422.320 - Special rules for hospice care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ....320 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Payments to Medicare Advantage Organizations § 422... subpart K of this part must inform each Medicare enrollee eligible to select hospice care under §...

  7. 42 CFR 418.309 - Hospice cap amount.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Hospice cap amount. 418.309 Section 418.309 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... change in the medical care expenditure category of the Consumer Price Index (CPI) for urban...

  8. The impact of a clinical rotation in hospice: medical students' perspectives.

    PubMed

    Jacoby, Liva H; Beehler, Connie J; Balint, John A

    2011-01-01

    Medical educators agree that training in end-of-life care (EOLC) must be an integral part of medical education at all levels. While progress in this area of education has taken place, many gaps still exist. This article describes the self-reported impact of a required one-week hospice rotation for third-year medical students. Students completing their hospice rotation during a one-year period were asked to write an essay describing the most important lessons they learned. Qualitative analyses of the essays revealed 10 core themes and generated a coding schema for detailed analysis. Students' essays reflected knowledge gained, emotional reactions, cognitive insights, and relationship-centered skills. Comments focused on the following themes: benefits and philosophy of hospice; impact on future practice; interdisciplinary team approach; management of pain and suffering; facts about hospice; personal impact; communication with patients and families; dedication and skill of staff; role of families; and value of home care. Students consistently recognized the significance of positive role models. Learning about a new field of medicine helped broaden students' knowledge, skills, and beliefs, and expanded their assumptions about illness and suffering, the role of health care professionals, and the goals of medicine. Reflection and writing brought about self-awareness of the learning process itself. The study demonstrates that a robust clinical EOLC exposure can be effectively incorporated into undergraduate education and that student self-reports constitute a valuable mode of evaluation. Longitudinal assessments of trainees' competencies in EOLC are needed to optimize these educational endeavors.

  9. Find a Hospice or Palliative Care Provider

    MedlinePlus

    ... use the fields below to enter your search criteria. Zip Code: Radius: 10 20 50 100 miles Provider Name: Organization Type: Please select Hospice Multi-Location Hospice Provider Palliative Care Provider or Sitemap ...

  10. Improving Access to Hospice Care: Informing the Debate

    PubMed Central

    CARLSON, MELISSA D.A.; MORRISON, R. SEAN; BRADLEY, ELIZABETH H.

    2015-01-01

    The most frequently cited policy solution for improving access to hospice care for patients and families is to expand hospice eligibility criteria under the Medicare Hospice Benefit. However, the substantial implications of such a policy change have not been fully articulated or evaluated. This paper seeks to identify and describe the implications of expanding Medicare Hospice Benefit eligibility on the nature of hospice care, the cost of hospice care to the Medicare program, and the very structure of hospice and palliative care delivery in the United States. The growth in hospice has been dramatic and the central issue facing policymakers and the hospice industry is defining the appropriate target population for hospice care. As policymakers and the hospice industry discuss the future of hospice and potential changes to the Medicare Hospice Benefit, it is critical to clearly delineate the options—and the implications and challenges of each option—for improving access to hospice care for patients and families. PMID:18363486

  11. Profile of an Effective Hospice Team Member.

    ERIC Educational Resources Information Center

    Basile, Joseph L.; Stone, Donald B.

    1987-01-01

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

  12. Children's hospice: completing the circle of caring.

    PubMed

    Armstrong-Dailey, A

    1994-12-01

    Often an ignored area of hospice care, children's hospice programs are growing as more and more children contract cancer and AIDS. Children's hospice care differs from adult programs in its approach and requires the cooperation of families and professionals to care for the dying child.

  13. The hospice movement: institutionalizing innovation.

    PubMed

    Abel, E K

    1986-01-01

    The early leaders of the hospice movement shared a number of attitudes with the founders of the alternative institutions of the 1960s and early 1970s: nostalgia for simple, old fashioned ways, dissatisfaction with bureaucratic and authoritarian institutions, faith in the power of nature, a determination to avoid domination by experts, and a desire to improve the quality of personal relationships. However, as hospices have become better established, they gradually have been incorporated into the dominant health care system and have lost their uniqueness. Some have affiliated with hospitals or home health agencies. Even autonomous organizations are subject to pressures for accommodation because they rely on the established order for resources, personnel, and political acceptance. Organizations receiving payment under the new Medicare benefit must adhere to a set of regulations that may distort the movement. Though creation of this benefit may have been facilitated by increased support for hospice ideals, the government views hospices primarily as a way to save money. Paradoxically, as hospices have grown in popularity, the critical force of the movement has been blunted. PMID:3514497

  14. Hospice staff attitudes towards telehospice.

    PubMed

    Demiris, George; Oliver, Debra R Parker; Fleming, David A; Edison, Karen

    2004-01-01

    Telemedicine, defined as the use of advanced telecommunication technologies to bridge geographic distance and improve delivery of care, is perceived by many as a way to eliminate barriers to quality care at the end of life. The use of telemedicine in hospice, known as telehospice, is a novel approach to such care, and few pilot studies have investigated its feasibility. The purpose of this study was to assess hospice providers 'perceptions of telehospice. A focus group session was conducted with 10 staff members from five hospice agencies in Missouri. Participants included administrators, nurses, and social workers. Overall, providers had a positive perception of telehospice and found that the use of videophone technology enhanced care by enabling providers, patients, and family members a means to communicate. However, they emphasized that it was an additional tool and not a substitute for actual visits. Issues of privacy and usability were also raised.

  15. Hospice nursing. Present perspectives and future directives.

    PubMed

    Dobratz, M C

    1990-04-01

    The specialty of hospice nursing calls for a highly skilled and knowledgeable practitioner. Four categories emerge to define and describe a specialist in hospice/palliative care nursing as one who practices: (a) intensive "caring"--the management of physical, psychological, social, and spiritual problems of dying persons and their families; (b) collaborative sharing--the coordinated and collaborated efforts of the extended and expanded components of hospice care services; (c) continuous knowing--the acquisition of the counseling, managing, instructing, "caring," and communicating skills/knowledge required for the specialty of hospice nursing; and (d) continuous giving--the balance of the hospice nurse's own self-care needs with the complexities and intensities of death and dying. To provide skilled, competent hospice nursing, two levels of hospice education are proposed, and descriptions are given for (a) the "hospice nurse certified (HNC)" who delivers competent, expert, and continuous patient/family care; and (c) the "hospice nurse advanced (HNA)" who provides educational needs and administers hospice care programs. Within the expanded and extended components of hospice care, the nurse works with an interdisciplinary team to provide care that is humanistic and supportive, and that is continuous and comprehensive.

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

    PubMed

    Walker, Andreas; Breitsameter, Christof

    2013-11-01

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

  17. The Hospice: An Integrated Bibliography.

    ERIC Educational Resources Information Center

    Bodine, George E.; Sobotor, William

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

  18. Nonverbal Communication in Hospice Care.

    ERIC Educational Resources Information Center

    Jensen, Marvin D.

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

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

    PubMed

    Stelzer, Eva-Maria; Lang, Frieder R

    2016-03-01

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

  20. Contradictions in the development of new hospices: a case study.

    PubMed

    Clark, D

    1991-01-01

    Despite a decade of concern about the 'mushrooming' of new hospice developments within the British Isles, we remain remarkably ignorant about the processes which lead to the initiation of new hospice projects and the factors which affect their progress. Three inter-related issues appear important: (1) policy and resource implications; (2) changing models of hospice care; (3) 'community' factors. This paper explores the interconnections between these, using a case study approach and describes in detail the efforts of a single local voluntary group to establish a programme of community care for dying people. It shows that: (1) local 'communities' are likely to make continued demands for hospice type care, despite official scepticism about proliferation; but also that these communities should not be seen as homogeneous in their aspirations and demands; (2) new models of community care will interact with wider policy changes in the NHS and Social Services to raise questions about how terminal care services can be further developed; (3) shifts away from traditional in-patient models of care are likely to high-light divisions between 'lay' and 'professional' groups in their perceptions of how services can be delivered.

  1. [Development and prospects of hospice palliative care in Taiwan].

    PubMed

    Chao, Co-Shi Chantal

    2009-02-01

    Hospice palliative care is an approach to healthcare that integrates high technology and highly humanized care. Service, education, and policymaking are the three critical areas of focus in the development of this specialty of care. Under hospice palliative care, holistic, high quality services covering in-patient care, homecare, and shared care are provided for terminally ill patients and their families. Healthcare team members must be taught not only knowledge but also skills and attitudes that reflect their responsibilities and level of competence. General public education is important also. Regulations and relevant policies have been implemented by Department of Health (DOH) since 1995. The Natural Death Act was legislated in 2000. Members of Healthcare team concerned regarding the proper development of hospice palliative care in Taiwan have organized to, "do the right things and do things right." The future vision of hospice palliative care embraces: 1. Expanding services to other life threatening illness such as terminal liver, renal, respiratory and heart diseases; 2. Securing appropriate DOH supervision and funds; 3. Developing a care model appropriate to the needs of Taiwan's culture; 4. Expanding the limits of service models; 5. Integrating services and enhancing expertise among those charged with delivering services, conducting research, and education; 6. Integration into the long term care system and enhancing quality. PMID:19221994

  2. What Physicians Should Know About Hospice

    PubMed Central

    Vogel, Susan L

    2011-01-01

    Hospice is both a philosophy and a system of care that attends to the physical, psychosocial, and spiritual needs of patients at the end of life as well as family members. The author details hospice care as it exists in the United States, focusing on topics such as levels of care provided and by whom, Medicare coverage, the roles of physicians and other practitioners, and special issues in hospice care. PMID:22190888

  3. Death representation of caregivers in hospice.

    PubMed

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

    2012-11-01

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

  4. Creative ritual in a hospice.

    PubMed

    Roche, J

    1994-12-01

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

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

    PubMed

    Perry, Joshua E; Stone, Robert C

    2011-01-01

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

  6. Racial disparities in receipt of hospice services among nursing home residents.

    PubMed

    Frahm, Kathryn A; Brown, Lisa M; Hyer, Kathryn

    2015-03-01

    This study examined the relationship between race and advance care planning, hospitalization, and death among nursing home residents receiving hospice care. Secondary data analysis using the 2007 Minimum Data Set (MDS) was used to identify documentation of these activities for White, Black, Hispanic, and Asian residents with linear regression models fitted to each dependent variable. Across different types of advance directives, compared to White nursing home residents, Black, Hispanic, and Asian residents who received hospice services were significantly less likely overall to have documented advance directives. All racial groups were also more likely to experience hospitalization while on hospice, regardless of whether they had a documented "do not hospitalize" order. As nursing homes become more diverse, recognizing differences in hospice use and end-of-life planning will continue to increase in importance.

  7. Racial disparities in receipt of hospice services among nursing home residents.

    PubMed

    Frahm, Kathryn A; Brown, Lisa M; Hyer, Kathryn

    2015-03-01

    This study examined the relationship between race and advance care planning, hospitalization, and death among nursing home residents receiving hospice care. Secondary data analysis using the 2007 Minimum Data Set (MDS) was used to identify documentation of these activities for White, Black, Hispanic, and Asian residents with linear regression models fitted to each dependent variable. Across different types of advance directives, compared to White nursing home residents, Black, Hispanic, and Asian residents who received hospice services were significantly less likely overall to have documented advance directives. All racial groups were also more likely to experience hospitalization while on hospice, regardless of whether they had a documented "do not hospitalize" order. As nursing homes become more diverse, recognizing differences in hospice use and end-of-life planning will continue to increase in importance. PMID:24212102

  8. The ethical balancing act of hospice care.

    PubMed

    Longenecker, Paul D

    2010-01-01

    In providing hospice care, clinicians are confronted with ethical challenges on a daily basis involving their patients and families, their personal values and beliefs, and organizational practices. Being able to objectively understand these ethical challenges and having a plan of action to address is essential in effectively fulfilling the role of being a hospice professional. PMID:20592539

  9. Missed Opportunity: Hospice Care and the Family.

    PubMed

    Tabler, Jennifer; Utz, Rebecca L; Ellington, Lee; Reblin, Maija; Caserta, Michael; Clayton, Margaret; Lund, Dale

    2015-01-01

    A typical mission statement of hospice services is to provide quality, compassionate care to those with terminal illness and to support families through caregiving and bereavement. This study explored the ways that bereavement needs of caregivers, either predeath or postdeath of their spouse/partner, were addressed using qualitative retrospective phone interviews with 19 caregivers whose spouse/partner was enrolled in hospice care for cancer. Overall, participants expressed high satisfaction with hospice care, most often noting a high satisfaction with the quality of care provided to their spouse/partner. During the predeath phase, caregivers recalled being so focused on their spouse/partner's needs that they rarely spoke with hospice staff about their own personal needs and emotions. Participants said that bereavement counseling occurred primarily after the death of the spouse/partner, in the form of generic pamphlets or phone calls from someone they had not met during prior interactions with hospice staff. These findings suggest that caregivers' high satisfaction with hospice may be more associated with the quality of care provided to the spouse/partner than with bereavement support they received. Our findings illustrated a potential missed opportunity for hospices to address the family-oriented goals that are commonly put forward in hospice mission statements. PMID:26654059

  10. 75 FR 67905 - National Hospice Month, 2010

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-04

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

  11. The ethical balancing act of hospice care.

    PubMed

    Longenecker, Paul D

    2010-01-01

    In providing hospice care, clinicians are confronted with ethical challenges on a daily basis involving their patients and families, their personal values and beliefs, and organizational practices. Being able to objectively understand these ethical challenges and having a plan of action to address is essential in effectively fulfilling the role of being a hospice professional.

  12. 42 CFR 418.25 - Admission to hospice care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  13. Making explicit the contention in hospice care.

    PubMed

    Moon, Paul J

    At the core of hospice remains the defining nature of mortals tending to other mortals facing diagnosed terminality. Such situations are pregnant with meanings. As mortals are subjective beings, social engagements become inundated with meaning differences. This alludes to the inescapable occurrence of collisions and conflicts in meaning. It would behoove us to make explicit the contention that exists in hospice care, given that death is the nonnegotiable outcome to be diversely faced by all involved persons whose lived approaches related to death issues may characteristically lack unanimity. Toward elucidating the inherently contentious nature of hospice care, the dynamical influence of external forces that overlie thanatological matters in society and the complex human dynamic in hospice care situations are discussed. Practice suggestions for hospice staff are offered.

  14. "I'm not ready for hospice": strategies for timely and effective hospice discussions.

    PubMed

    Casarett, David J; Quill, Timothy E

    2007-03-20

    Hospice programs offer unique benefits for patients who are near the end of life and their families, and growing evidence indicates that hospice can provide high-quality care. Despite these benefits, many patients do not enroll in hospice, and those who enroll generally do so very late in the course of their illness. Some barriers to hospice referral arise from the requirements of hospice eligibility, which will be difficult to eliminate without major changes to hospice organization and financing. However, the challenges of discussing hospice create other barriers that are more easily remedied. The biggest communication barrier is that physicians are often unsure of how to talk with patients clearly and directly about their poor prognosis and limited treatment options (both requirements of hospice referral) without depriving them of hope. This article describes a structured strategy for discussing hospice, based on techniques of effective communication that physicians use in other "bad news" situations. This strategy can make hospice discussions both more compassionate and more effective.

  15. Hospice for aged persons without cancer: the experience of the Hampshire County (MA) hospice.

    PubMed

    Scanlan, B C

    1994-01-01

    Hospice is an option for patients with terminal illness of all types. The advent of the Medicare hospice benefit has led to a rise in numbers of hospice programs as well as hospice expenditure. Terminal care provided through hospice has a demonstrable cost advantage over conventional terminal care. This difference may dissipate as Medicare hospice expenditure continues to rise. An individual hospice program can define its mission within broad guidelines. A program electing to serve all terminally ill patients regardless of diagnosis can occasionally expect to be cast in the role of long term care-provider when six-month survival is exceeded. Precision in prediction of six-month survival would benefit patients and remove one major obstacle to participation by many primary care physicians. Prognostic techniques are being developed that, thus far, have proven no better than physician judgement in assigning risk or predicting survival. Hospice may provide a setting for clinical research of prognostication. The interdisciplinary team can facilitate hospice care and provide support to individual team members. Care of terminally ill non-cancer patients may require added human resources and alteration of team structure to cope with increased service needs and lengths of stay which may be likely to exceed those of cancer patients.

  16. American Academy of Hospice and Palliative Medicine

    MedlinePlus

    ... Hospice Practice VitalTalk Summer Institute Home Board Review Leadership Forum: Ascend Achieving Health Equity Board Review Back ... Prescriptions Key Issue Career Development Jobs Clinical Training Leadership Other Opportunities AAHPM Ignite AAHPM Ascend Leadership Forum ...

  17. Hospice: enhancing the quality of life.

    PubMed

    Lamers, W M

    1990-05-01

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

  18. 42 CFR 418.205 - Special requirements for hospice pre-election evaluation and counseling services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... evaluation and counseling services. 418.205 Section 418.205 Public Health CENTERS FOR MEDICARE & MEDICAID... Covered Services § 418.205 Special requirements for hospice pre-election evaluation and counseling... pre-election evaluation and counseling services as specified in § 418.304(d) may be made to a...

  19. 42 CFR 418.205 - Special requirements for hospice pre-election evaluation and counseling services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... evaluation and counseling services. 418.205 Section 418.205 Public Health CENTERS FOR MEDICARE & MEDICAID... Covered Services § 418.205 Special requirements for hospice pre-election evaluation and counseling... pre-election evaluation and counseling services as specified in § 418.304(d) may be made to a...

  20. 42 CFR 418.205 - Special requirements for hospice pre-election evaluation and counseling services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... evaluation and counseling services. 418.205 Section 418.205 Public Health CENTERS FOR MEDICARE & MEDICAID... Covered Services § 418.205 Special requirements for hospice pre-election evaluation and counseling... pre-election evaluation and counseling services as specified in § 418.304(d) may be made to a...

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

    ERIC Educational Resources Information Center

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

    2013-01-01

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

  2. 76 FR 28195 - Medicare Program; Hospice Wage Index for Fiscal Year 2012

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-16

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Part 418 RIN 0938-AQ31 Medicare Program; Hospice Wage Index for Fiscal Year 2012 Correction In proposed rule document 2011-10689 appearing on...

  3. Seeking and using families' views to shape children's hospice services.

    PubMed

    Maynard, Linda; Rennie, Tracy; Shirtliffe, Julia; Vickers, David

    2005-12-01

    Child and family involvement is key to improving the quality of children's hospice services. This article reports on a quality assurance initiative undertaken as one component of a clinical governance strategy. Service users participated in focus groups followed by lunch to discuss how staff communicated with them about their child's care, their family support needs, and how staff liaised with other professionals and organizations. There was general commendation of hospice services (in-house and community), but parents wished for more quantity and consistency with all elements of the care model. There was tension between respite and end-of-life care needs. Parents considered that the myth of hospices being 'just for death' needed dispelling and wanted other professionals to be more aware of its role, and the choice of earlier referral. Transition, both age and prognosis related, caused concern, with anxiety about long-term future or loss of support when prognosis improved. Parents also wanted better information about practical help and psycho-social support as well as up-to-date information about their child's treatment and management from all care providers.

  4. A comparison of hospice programs based on Medicare certification status.

    PubMed

    Sontag, M A

    1996-01-01

    This article presents results from a study of 119 hospice programs in the United States. Personal interviews and questionnaires were utilized to collect data about hospice programs, their directors, nurses, social workers, and chaplains. Specifically, this article describes reasons programs sought Medicare certification, and the perceived advantages and disadvantages to being a Medicare certified program. Characteristics of both certified and non-certified programs are presented, and examined for differences. Potential access barriers such as restrictive admission criteria are examined in this article. Finally, perceptions of staff about hospice services in certified and non-certified programs are compared. Results from this study indicate that Medicare certified programs have longer lengths of stays, were more likely to include a nurse on the first visit, and billed patients more frequently than noncertified programs. Volunteer use was lower in the Medicare certified programs. Staff in Medicare certified programs were much more likely to view patients' medical needs as the primary focus of their programs. Results from this study suggest that Medicare certified programs may reflect a more medical model of palliative care.

  5. A tribute to Susan Goldwater Levine and Hospice of the Valley.

    PubMed

    Halamandaris, Val J

    2005-11-01

    Hospice of the Valley has clearly won a place in hearts and minds of the citizens of the Greater Phoenix/Scottsdale Community. This can be seen in the thousands of letters it has received such as the one from Mrs. C.S. of Tempe, Arizona who said: "I shall never be able to repay Hospice of the Valley for the tender loving care they gave my husband, and for the wonderful physical and emotional support they gave me when I didn't know where to turn to or how to cope. My love and prayers are with you forever." It can be seen in the fact that many of the original volunteers which included Mary-Audrey Mellor, Susan Cohill, Sandy Getz, Lyn Laflin, Julie Louis, Julie Perkins, Niki Robertshaw and Gay Wray are still involved. It can be seen in the growth of the organization and in the creation of some 16 (by the end of next year) inpatient facilities. It is evident in the involvement with major corporations and in the support of prominent political figures. HOV today stands as a model of all the best that hospice can be; a testimony to what can happen when good men and women work together in their mutual interest. Hospice of the Valley, has already had a profound effect on national hospice policy. Through the leadership of Ms. Levine, who last month took over the reigns from the esteemed Carla Braveman, to become Chairman of the Hospice Association of America, HOV will continue to help forge national policy. For many years to come, Hospice of the Valley will serve as a beacon to light the path for those who follow in the cause of humanitarian care for infirm and terminally ill Americans.

  6. 42 CFR 418.24 - Election of hospice care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  7. 42 CFR 418.24 - Election of hospice care.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  8. 42 CFR 418.24 - Election of hospice care.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Election of hospice care. 418.24 Section 418.24... (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.24 Election of hospice care. (a) Filing an election statement. (1) General. An individual who meets...

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

    ERIC Educational Resources Information Center

    Becker, Janet E.

    2004-01-01

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

  10. Rethinking Family Caregiving: Tailoring Cognitive–Behavioral Therapies to the Hospice Experience

    PubMed Central

    Washington, Karla T.; Wittenberg-Lyles, Elaine; Parker Oliver, Debra; Baldwin, Paula K.; Tappana, Jessica; Wright, Jesse H.; Demiris, George

    2014-01-01

    Hospice family caregivers experience significantly higher rates of psychological distress than demographically similar noncaregivers. Interventions based on cognitive–behavioral therapy have been shown to reduce psychological distress in the general population by providing tools to modify thinking patterns that directly affect emotions and behavior. Such interventions might reasonably be incorporated into hospice social work; however, numerous contextual factors must be taken into account to ensure that any interventions are appropriate to the unique needs of clients. The purpose of the study discussed in this article was to contextualize one aspect of the cognitive–behavioral model based on firsthand accounts of hospice family caregivers. Following a modified grounded theory approach, researchers engaged in a secondary analysis of data from a larger study provided in a subsample of 90 audio-recorded conversations between hospice family caregivers and interventionists. Findings indicated that distressed caregivers engaged in five dominant thinking patterns: (1) “should” statements, (2) catastrophizing or minimizing, (3) personalizing, (4) absolute thinking, and (5) making assumptions. Implementing cognitive–behavioral therapies based on identified caregiver thinking patterns will allow hospice social workers to empower caregivers to cope more effectively with the numerous stressors they encounter while caring for a dying loved one. PMID:25369725

  11. Hospice and the politics of spirituality.

    PubMed

    Garces-Foley, Kathleen

    2006-01-01

    Within the hospice literature, spirituality and religion are usually defined in opposition to one another, with religion negatively associated with the external, authoritarian doctrines of Christianity and spirituality positively associated with the free search for truth, meaning, and authenticity. According to survey data, however, most Americans integrate spirituality and traditional religious commitments. The hospice literature is promoting spirituality to its own detriment by alienating potential patients and depriving religious patients of the resources that religious traditions and their affiliated religious communities have to offer. PMID:17165229

  12. Characteristics of Prison Hospice Patients: Medical History, Hospice Care, and End-of-Life Symptom Prevalence.

    PubMed

    Cloyes, Kristin G; Berry, Patricia H; Martz, Kim; Supiano, Katherine

    2015-07-01

    Increasing numbers of prisoners in the United States are dying from age-related and chronic illnesses while incarcerated. This study is among the first to document characteristics of a population of prison hospice patients. Retrospective review of medical records for all patients admitted to the Louisiana State Penitentiary prison hospice program between January 1, 2004, and May 31, 2012 (N = 79) examined demographics, medical history, hospice diagnosis, length of stay, and end-of-life symptom prevalence on admission and during final 72 hours before death. Resulting data were contrasted with community-based end-of-life care study data, demonstrating a unique clinical profile of this group. As prisons consider adopting programs to meet the growing need for inmate end-of-life care, more research concerning the particular characteristics and unique needs of prison hospice patients will inform these efforts.

  13. Spiritual uncertainty: exemplars of 2 hospice patients.

    PubMed

    Stephenson, Pamela Shockey

    2014-01-01

    Spirituality is important to persons approaching the end of life. The ambiguous nature of dying and spirituality creates many opportunities for uncertainty. This article presents 2 exemplars from hospice patients about the different ways that spiritual uncertainty affected their dying experience. PMID:24919092

  14. Life threatening illness and hospice care.

    PubMed

    Stein, A; Forrest, G C; Woolley, H; Baum, J D

    1989-05-01

    A retrospective study was undertaken of 25 families and their 26 ill children attending the first children's hospice in the United Kingdom. The study examined the family's perceptions of the care offered and the impact of chronic and life threatening illness. Eighteen (72%) of the families felt they had been well supported by the hospice and valued the family like atmosphere, perceiving the staff to be friendly, approachable, and helpful. The actual nature of hospice care, in an environment with other terminally ill children, was, however, considered a drawback for a few families. A number of families still had unmet needs, notably appropriate child minding when away from the hospice. The impact of chronic life threatening illness on the families was substantial. The parents (particularly the mothers), the index children, and their siblings all experienced much higher levels of psychological symptomatology than would have been expected from normal samples. While families felt greatly helped over symptom control, a proportion remained very worried about certain symptoms, particularly breathlessness, seizures, and pain. A high proportion of families were experiencing financial and employment difficulties as a result of their children's illnesses.

  15. Life threatening illness and hospice care.

    PubMed Central

    Stein, A; Forrest, G C; Woolley, H; Baum, J D

    1989-01-01

    A retrospective study was undertaken of 25 families and their 26 ill children attending the first children's hospice in the United Kingdom. The study examined the family's perceptions of the care offered and the impact of chronic and life threatening illness. Eighteen (72%) of the families felt they had been well supported by the hospice and valued the family like atmosphere, perceiving the staff to be friendly, approachable, and helpful. The actual nature of hospice care, in an environment with other terminally ill children, was, however, considered a drawback for a few families. A number of families still had unmet needs, notably appropriate child minding when away from the hospice. The impact of chronic life threatening illness on the families was substantial. The parents (particularly the mothers), the index children, and their siblings all experienced much higher levels of psychological symptomatology than would have been expected from normal samples. While families felt greatly helped over symptom control, a proportion remained very worried about certain symptoms, particularly breathlessness, seizures, and pain. A high proportion of families were experiencing financial and employment difficulties as a result of their children's illnesses. PMID:2730123

  16. Successful Interprofessional Collaboration on the Hospice Team.

    ERIC Educational Resources Information Center

    Reese, Dona J.; Sontag, Mary-Ann

    2001-01-01

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

  17. Hospice Decision Making: Diagnosis Makes a Difference

    ERIC Educational Resources Information Center

    Waldrop, Deborah P.; Meeker, Mary Ann

    2012-01-01

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

  18. National Hospice and Palliative Care Organization

    MedlinePlus

    ... Life Online Education Site Map Contact Us Privacy Information en Español Copyright Careers Press Room National Hospice and Palliative Care Organization 1731 King Street Alexandria, Virginia 22314 703-837-1500 (phone) 703-837-1233 (fax) Web Design and Development by New Target

  19. Volunteers: The Life-Line of Hospice.

    ERIC Educational Resources Information Center

    Patchner, Michael A.; Finn, Mark B.

    1988-01-01

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

  20. Older nurses embrace hospice & home care.

    PubMed

    Macdonald, N Jean

    2004-05-01

    Older nurses who have "done their time" in hospital wards sometimes find home health or hospice nursing a welcome and rewarding change of pace. While their maturity often gives them the empathy and compassion that can bring comfort to their patients, their extensive experience supplies them with the knowledge they need to work confidently in an independent setting. PMID:15168577

  1. Factors Associated with the Provision of Hospice Care for Children

    PubMed Central

    Lindley, Lisa C.; Mark, Barbara A.; Lee, Shoou-Yih Daniel; Domino, Marisa; Song, Mi-Kyung; Vann, Julie Jacobson

    2012-01-01

    Context Children at end of life often lack access to hospice care at home or in a dedicated facility. The factors that may influence whether or not hospices provide pediatric care are relatively unknown. Objectives The purpose of this study was to understand the institutional and resource factors associated with provision of pediatric hospice care. Methods This study used a retrospective, longitudinal design. The main data source was the 2002 to 2008 California State Hospice Utilization Data Files. The sample size was 311 hospices or 1368 hospice observations over seven years. Drawing on institutional and resource dependence theory, this study used generalized estimating equations to examine the institutional and resource factors associated with provision of pediatric hospice care. Interaction terms were included to assess the moderating effect of resource factors on the relationship between institutional factors and provision of care. Results Membership in professional groups increased the probability (19%) of offering hospice services for children. Small- (−22%) and medium-sized (−11%) hospices were less likely to provide care for children. The probability of providing pediatric hospice care diminished (−23%) when competition increased in the prior year. Additionally, small size attenuated the accreditation-provision relationship and medium size magnified the membership-provision relationship. Conclusion Professional membership may promote conformity to industry standards of pediatric care and remove the unknowns of providing hospice care for children. Hospices, especially medium-sized hospices, interested in developing or expanding care for children may benefit by identifying a pediatric champion to join a professional group. PMID:22921174

  2. Validation of the Quality of Dying (QOD)-Hospice Scale

    PubMed Central

    Cagle, John G.; Munn, Jean C.; Hong, Seokho; Clifford, Maggie; Zimmerman, Sheryl

    2014-01-01

    Context Measuring the quality of the dying experience is important for hospice providers. However, few instruments exist that assess the quality of one’s dying; and those that do, have not been well validated in hospice. Objectives This study tested the properties of the Quality of Death-Hospice Scale (QOD-Hospice) to provide preliminary validation data on internal consistency, inter-rater reliability, convergent validity and factorability in a hospice setting. Additionally, results of the factor analysis were used to create a brief version of the measure. Methods Bereaved informal caregivers who had provided care for a hospice patient were recruited from a large non-profit hospice. Participants completed post-death surveys, which included the QOD-Hospice and other study measures. Convergent validity was tested by exploring hypothesized associations with related instruments measuring: negative emotional states (Depression Anxiety Stress Scale-21); emotional grief (Texas Revised Inventory of Grief-2); social support (Lubben Social Network Scale-6); and a single item measure of satisfaction with hospice care. Results Seventy caregivers participated in the survey (40 primary caregivers, 30 secondary caregivers), most of whom were female (67%) and white (81%). The QOD-Hospice produced an alpha of 0.86, an intraclass correlation of 0.49 between caregivers of the same decedent, and was correlated with all measures testing convergent validity (P<0.05; in the hypothesized direction) and most, but not all, subscales. An exploratory factor analysis elicited two factors, Preparation (seven items) and Security (six items), which were combined to create a 13-item version of the scale, the QOD-Hospice-SF. Conclusion Although further testing of the QOD-Hospice measures is needed, preliminary evidence suggests the instruments are reliable and valid for use in hospice. PMID:25057986

  3. Key Results of Interaction Models with Centering

    ERIC Educational Resources Information Center

    Afshartous, David; Preston, Richard A.

    2011-01-01

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

  4. Human Centered Hardware Modeling and Collaboration

    NASA Technical Reports Server (NTRS)

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

    2013-01-01

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

  5. Exploring the experiences and perspectives of families using a children's hospice and professionals providing hospice care to identify future research priorities for children's hospice care.

    PubMed

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

    2008-12-01

    The main objective of this study is to generate a list of priority topics for children's hospice care research in Scotland from the perspective of its key stakeholders. The method consists of qualitative semi-structured interviews with families using hospice services (n = 5), four focus groups with hospice staff and volunteers (n = 44) and telephone interviews with professionals associated with the hospice (n = 18). Fourteen broad themes emerged following thematic content and interpretive analysis of the interview data. Some of the research themes were specific to certain stakeholder groups, whereas other themes were identified unanimously across all the stakeholder groups as being priority areas for future research. Increasing awareness of and improving access to children's hospice care, hospice and respite care needs of young people, community/home care and issues related to supporting the wider family arose, independently, in all three stakeholder groups as being priority topics for future research. In conclusion, a greater evidence base is required in the field of children's palliative care and the topics researched should be identified and led by those most closely involved in the hospices. Engaging families and care providers in the process of identifying research priorities resulted in the development of an extensive research agenda, which will contribute to quality hospice care for children and families.

  6. The fundamentals of hospice compliance what is it and what are the implications for the future? An overview for hospice clinicians part 2: Hospice risk areas.

    PubMed

    Balfour, Susan

    2012-05-01

    This article, Part 2 of a 2-part series, continues the examination of the Medicare compliance climate and its impact on hospice providers. This 2nd part focuses on hospice-specific compliance risk areas and specific risk-reduction strategies. The case example from Part 1 is continued.

  7. A Survey of Hospices Use of Complementary Therapy

    PubMed Central

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

    2009-01-01

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

  8. Implementing evidence-based practices: considerations for the hospice setting.

    PubMed

    Sanders, Sara; Mackin, Melissa Lehan; Reyes, Jimmy; Herr, Keela; Titler, Marita; Fine, Perry; Forcucci, Chris

    2010-09-01

    With increased regulation and scrutiny of outcomes, hospice programs are being challenged to consider the implementation of evidence-based practices (EBPs). This study reports findings from hospice director interviews and staff focus groups, which occurred following the completion of a multifaceted translating research into practice (TRIP) intervention designed to promote evidence-based pain management practices. The purpose of this article is to provide background on the use of EBPs, to report facilitators and barriers to overall implementation of pain management EBPs in hospice, and to provide recommendations for hospices interested in increasing the use of EBPs. Three areas for evaluation prior to implementing an EBP initiative in hospices were identified: community, agency, and staff cultures. Recommendations for implementation of EBPs in hospices are provided. PMID:20167834

  9. Coulombic contribution and fat center vortex model

    SciTech Connect

    Rafibakhsh, Shahnoosh; Deldar, Sedigheh

    2007-02-27

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

  10. The benefits of beneficence: rewards of hospice volunteering.

    PubMed

    Korda, L J

    1995-01-01

    Hospice volunteering can provide many benefits to the volunteer as well as to the hospice program. Identification of these benefits, which may be characterized as being of the body, mind, and spirit, is helpful in the recruitment of new volunteers as well as in the retention of current ones. It is important for hospice programs to find ways to assist volunteers to attain these rewards.

  11. Do-Not-Resuscitate Orders and/or Hospice Care, Psychological Health, and Quality of Life among Children/Adolescents with Acquired Immune Deficiency Syndrome

    PubMed Central

    Lyon, Maureen E.; Williams, Paige L.; Woods, Elizabeth R.; Hutton, Nancy; Butler, Anne M.; Sibinga, Erica; Brady, Michael T.; Oleske, James M.

    2009-01-01

    Objective The frequency of do-not-resuscitate (DNR) orders and hospice enrollment in children/adolescents living with acquired immune deficiency syndrome (AIDS) and followed in Pediatric AIDS Clinical Trials Group (PACTG) Study 219C was examined, and evaluated for any association with racial disparities or enhanced quality of life (QOL), particularly psychological adjustment. Methods A cross-sectional analysis of children with AIDS enrolled in this prospective multicenter observational study between 2000 and 2005 was conducted to evaluate the incidence of DNR/hospice overall and by calendar time. Linear regression models were used to compare caregivers' reported QOL scores within 6 domains between those with and without DNR/hospice care, adjusting for confounders. Results Seven hundred twenty-six (726) children with AIDS had a mean age of 12.9 years (standard deviation [SD] = 4.5), 51% were male, 60% black, 25% Hispanic. Twenty-one (2.9%) had either a DNR order (n = 16), hospice enrollment (n = 7), or both (n = 2). Of 41 children who died, 80% had no DNR/hospice care. Increased odds of DNR/hospice were observed for those with CD4% less than 15%, no current antiretroviral use, and prior hospitalization. No differences by race were detected. Adjusted mean QOL scores were significantly lower for those with DNR/hospice enrollment than those without across all domains except for psychological status and health care utilization. Poorer psychological status correlated with higher symptom distress, but not with DNR/hospice enrollment after adjusting for symptoms. Conclusions Children who died of AIDS rarely had DNR/hospice enrollment. National guidelines recommend that quality palliative care be integrated routinely with HIV care. Further research is needed to explore the barriers to palliative care and advance care planning in this population. PMID:18363489

  12. Provision of recreational activities in hospices in the United States.

    PubMed

    DeMong, S A

    1997-01-01

    Quality of life issues encompass the philosophies of both hospice and recreation participation. This study examines the status of recreational activities provision in hospices in the United States. The offering, frequency of offering, and location of offering of 39 recreational activities in a random sample of hospices in the United States were surveyed. The functional levels of participating patients were also recorded. Reading to patients at bedside daily was determined to be the most frequently provided recreational activity. Recreational activities are being offered in 40% of the larger U.S. hospices on a varying schedule in different locations. PMID:9305025

  13. A model nursing computer resource center.

    PubMed

    Mueller, Sheryl S; Pullen, Richard L; McGee, K Sue

    2002-01-01

    Nursing graduates are required to demonstrate computer technology skills and critical reflective thinking skills in the workplace. The authors discuss a model computer resource center that enhances the acquisition of these requisite skills by students in both an associate degree and vocational nursing program. The computer resource center maximizes student learning and promotes faculty effectiveness and efficiency by a "full-service" approach to computerized testing, information technology instruction, online research, and interactive computer program practice. PMID:12023644

  14. Social Work Assessment Notes: A Comprehensive Outcomes-Based Hospice Documentation System.

    PubMed

    Hansen, Angela Gregory; Martin, Ellen; Jones, Barbara L; Pomeroy, Elizabeth C

    2015-08-01

    This article describes the development of an integrated psychosocial patient and caregiver assessment and plan of care for hospice social work documentation. A team of hospice social workers developed the Social Work Assessment Notes as a quality improvement project in collaboration with the information technology department. Using the Social Work Assessment Tool as an organizing framework, this comprehensive hospice social work documentation system is designed to integrate assessment, planning, and outcomes measurement. The system was developed to guide the assessment of patients' and caregivers' needs related to end-of-life psychosocial issues, to facilitate collaborative care plan development, and to measure patient- and family-centered outcomes. Goals established with the patient and the caregiver are documented in the plan of care and become the foundation for patient-centered, strengths-based interventions. Likert scales are used to assign numerical severity levels for identified issues and progress made toward goals and to track the outcome of social work interventions across nine psychosocial constructs. The documentation system was developed for use in an electronic health record but can be used for paper charting. Future plans include automated aggregate outcomes measurement to identify the most effective interventions and best practices in end-of-life care.

  15. 42 CFR 417.585 - Special rules: Hospice care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Special rules: Hospice care. 417.585 Section 417... (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Medicare Payment: Risk Basis § 417.585 Special rules: Hospice care. (a) No payment is...

  16. 42 CFR 417.531 - Hospice care services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Hospice care services. 417.531 Section 417.531... (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Medicare Payment: Cost Basis § 417.531 Hospice care services. (a) If a Medicare enrollee...

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

    ERIC Educational Resources Information Center

    Wright, Kevin N.; Bronstein, Laura

    2007-01-01

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

  18. 42 CFR 418.28 - Revoking the election of hospice care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  19. 76 FR 47301 - Medicare Program; Hospice Wage Index for Fiscal Year 2012

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-04

    ... illness. Finally, this final rule will begin implementation of a hospice quality reporting program. DATES... Dowell, (410) 786-0060 for questions regarding quality reporting for hospices and collection of... Encounters 4. Hospice Aide and Homemaker Services E. Quality Reporting for Hospices 1. Background...

  20. An Analysis Model for Center Governance.

    ERIC Educational Resources Information Center

    Priselac, Nancy J.; Priselac, Stephen M.

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

  1. Center for Advanced Modeling and Simulation Intern

    ScienceCinema

    Gertman, Vanessa

    2016-07-12

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

  2. Center for Advanced Modeling and Simulation Intern

    SciTech Connect

    Gertman, Vanessa

    2010-01-01

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

  3. Infiltration Model for Center Pivot Sprinkler Irrigation

    Technology Transfer Automated Retrieval System (TEKTRAN)

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

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

    PubMed Central

    Ingebretsen, Lina Paola; Sagbakken, Mette

    2016-01-01

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

  5. The impact on families of a children's hospice program.

    PubMed

    Davies, Betty; Collins, John B; Steele, Rose; Pipke, Ingrid; Cook, Karen

    2003-01-01

    Pediatric hospice is a relatively new development in the field of hospice care. This article reports on an evaluation project that examined the effect of the Canuck Place children's hospice program on the families it served during its first two and a half years of operation. Using the principles of participatory action research, data were collected from individual interviews, focus groups, and mail-out surveys of families who used the program. Sixteen categories of hospice program effect were found to summarize how families regarded, used, and assessed their experiences. Families overwhelmingly endorsed the Canuck Place program. They also provided helpful suggestions for improvement and growth, particularly during the program's formative years. Recommendations are made with a view to promoting and solidifying the ongoing success of the Canuck Place program, as well as of children's hospice programs in general.

  6. Providing spiritual support: a job for all hospice professionals.

    PubMed

    Millison, M; Dudley, J R

    1992-01-01

    This research examines spirituality as an aspect of professional practice. A questionnaire on spirituality was sent in 1991 to the hospice directors in New York, New Jersey, and Pennsylvania. The findings strongly indicate that spirituality is important in the hospice setting and plays a prominent role in the treatment of patients. Also, hospice programs were found to be supportive of the spiritual component of care. The spiritual approaches used by the respondents were the more traditionally religious ones such as listening to the patient talk about God or referring to clergy. Approaches such as meditation or guided imagery, which are not necessarily related to religion, were used less frequently. Clergy in the study placed greater importance on spirituality in hospice work and used more traditionally religious approaches than did non-clergy. While some professional caregivers choose to leave spiritual matters to clergy, the findings reveal that many non-clergy hospice professionals are assisting patients with spiritual concerns.

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

    PubMed

    Ingebretsen, Lina Paola; Sagbakken, Mette

    2016-01-01

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

  8. The ACTive Intervention in Hospice Interdisciplinary Team Meetings: Exploring family caregiver and hospice team communication

    PubMed Central

    Wittenberg-Lyles, Elaine; Parker Oliver, Debra; Demiris, George; Baldwin, Paula

    2010-01-01

    This paper presents the theoretical framework and rationale for the ACTive intervention which proposes the use of video technology to facilitate patient and family participation in hospice interdisciplinary team meetings where plans of care are determined. It is surmised that patient and family involvement will improve communication and compliance in hospice care. An analysis of data from a pilot project of the ACTive intervention was conducted to explore active participation among family caregivers and the hospice team. Through the use of videophone technology caregivers participated in video-recorded team meetings. The actual communication behaviors of caregivers and team members were analyzed for active participation. Findings revealed that team–prompted caregiver participation was most common, however, team use of supportive talk in this context was considerably less frequent. The study also found that the team’s use of active participation behaviors elicits caregiver active participation behaviors. The results of this study suggest the intervention was an effective way to involve family caregivers as active participants in the designing of care for their loved one. Findings also suggest that hospice staff would benefit from education and training on best practices for communicating with caregivers in the team meeting setting. PMID:20543889

  9. 78 FR 48233 - Medicare Program; FY 2014 Hospice Wage Index and Payment Rate Update; Hospice Quality Reporting...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-07

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

  10. 78 FR 27823 - Medicare Program; FY 2014 Hospice Wage Index and Payment Rate Update; Hospice Quality Reporting...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-10

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

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

    PubMed Central

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

    2009-01-01

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

  12. Guiding center plasma models in three dimensions

    SciTech Connect

    Sugiyama, Linda E.

    2008-09-15

    Guiding center plasma models describe the fast charged particle gyration around magnetic field lines by an angle coordinate, defined relative to local orthogonal coordinate axes (e{sub 1},e{sub 2},b=B/B) at each guiding center location. In three dimensions (3D), unlike uniform straight two-dimensional (2D) fields, geometrical effects make the small gyroradius expansion nonuniform in velocity phase space in first order O({rho}{sub i}/L). At second order, Hamiltonian and Lagrangian solutions may be undefined even when good magnetic flux surfaces exist; existence requires the magnetic field torsion {tau}=b{center_dot}{nabla}xb=0 and {tau}{sub g}{identical_to}b{center_dot}({nabla}e{sub 1}){center_dot}e{sub 2}=0, unless the magnetic field has a 2D symmetry, such as toroidal axisymmetry. Keeping complete 3D geometrical effects also requires the magnetic vector potential term to appear in the electric field at the same order as the electrostatic potential. These problems express properties of magnetic vector potentials, Lagrangians, and the curvature of manifolds, and have analogies to attempts to connect small scale Lagrangian theories to higher dimensional, large scale ones in the grand unification theories of physics.

  13. Patient experience key in hospice refurb.

    PubMed

    Beach, Matt

    2015-03-01

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

  14. Patient experience key in hospice refurb.

    PubMed

    Beach, Matt

    2015-03-01

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

  15. Promoting volunteer capacity in hospice palliative care: a narrative review.

    PubMed

    Pesut, Barbara; Hooper, Brenda; Lehbauer, Suzanne; Dalhuisen, Miranda

    2014-02-01

    Hospice volunteers play an essential role in the primary care network for end of life. The purpose of this review was to examine the evidence on hospice volunteers published between 2002 and July 2012. An electronic search of PubMed, CINAHL and PsychINFO using controlled vocabulary, and a reference scan, yielded 54 studies focusing on hospice volunteers. Studies were primarily descriptive using quantitative, qualitative and mixed methods. Findings from studies were grouped thematically into descriptions of the work of hospice volunteers; recruitment, preparation and retention of hospice volunteers; and perspectives and outcomes of the volunteer role. A substantial body of evidence exists describing the roles, stresses and rewards of hospice volunteering. Less is known about how to adequately recruit, prepare and retain volunteers. A small but intriguing body of evidence exists around volunteers' contributions to family satisfaction and patient longevity. Although the evidence around hospice volunteers continues to grow, there is an urgent need for further research. Findings indicate that volunteers make important contributions to high quality end of life care. However, more focused research attention is required to better understand how to maximize this contribution while providing better support for volunteers.

  16. A personal exploration of the German hospice system.

    PubMed

    Farnon, C

    1996-01-01

    While on vacation in Germany, I explored the German hospice system and its differences from that in the United States. I conducted an informal survey asking 10 individuals who were not associated with hospice work, about end-of-life issues. Knowledge of the hospice movement and of advance directives was found to be quite low. Through contact with German hospice associations, I learned that the modern German hospice movement was inspired by the British example. After a difficult beginning, the German hospice system is growing steadily. Professional providers of end-of-life care are paid according to the traditional fee-for-service system. As suggested by the World Health Organization, pain management is provided according to the three-step analgesic ladder. Physician-assisted suicide is illegal as it is in the United States. A federal self-determination law has not yet been enacted. Overall, the German hospice system has many similarities and a few interesting dissimilarities with that in the United States. PMID:8850817

  17. Volunteers as members of the home healthcare and hospice teams.

    PubMed

    Harris, M D; Olson, J M

    1998-05-01

    A volunteer program has multiple advantages to the patients, their families, their nurses, the hospice, and the volunteers themselves (Harris, 1990). Home care volunteerism make good sense. If properly administered, it is cost-efficient and delivers a quality of care that can be acquired in no other way (Sodano, 1997;764). Given the many changes that continue to take place in home healthcare and hospice regulations and financing, volunteers are a vital component of both programs so that patients and families continue to receive high-quality care. Volunteers are important members of the home healthcare and hospice teams.

  18. Reflections on the development of CHASE Children's Hospice Service.

    PubMed

    Menezes, A

    2001-01-01

    The tasks along the way to developing a children's hospice service are examined. CHASE Children's Hospice Service aims to establish a network of care for life-limited and life-threatened children, young people and their families. The services will be provided for families living mainly in SW London, Surrey and parts of West Sussex. They will comprise a source of palliative and respite care for the children and their families in their own homes (community care), backed-up by a respite care service in the related hospice at Artington, near Guildford (Christopher's).

  19. Mindfulness in hospice care: practicing meditation-in-action.

    PubMed

    Bruce, Anne; Davies, Betty

    2005-12-01

    In this interpretive study, the authors explore the experience of mindfulness among hospice caregivers who regularly practice mindfulness meditation at a Zen hospice. They explore meditative awareness constituted within themes of meditation-in-action, abiding in liminal spaces, seeing differently, and resting in groundlessness. By opening into nonconceptual, paradoxical, and uncertain dimensions of experience, hospice caregivers cultivate internal and external environments in which direct experience is increasingly held without judgment. This inquiry points to in-between spaces of human experience wherein mindfulness fosters openness and supports letting go, and creating spaces for whatever is happening in attending the living-and-dying process.

  20. Joining forces, joining futures: hospice at the crossroads.

    PubMed

    Pietroburgo, Julie

    2004-01-01

    Faced with health-policy changes, increased competition, and limited funding, hospices must either find more efficient ways to provide end-of-life care or risk organizational demise. Increasingly, hospices are re-evaluating their organizations to stretch resources and remain viable. Prevalent restructuring options for addressing environmental pressures are integration, alliance, and collaboration with other organizations. This study examines the restructuring phenomenon by evaluating trends among nonprofit hospices in six states. The study identifies demographic characteristics predictive of organizational decisions to join forces, and it examines the dominant political and economic reasons that propel or impede restructuring decisions. In addition, the study evaluates the results of restructuring actions.

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

    NASA Technical Reports Server (NTRS)

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

    2011-01-01

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

  2. Dignity, death, and dilemmas: a study of Washington hospices and physician-assisted death.

    PubMed

    Campbell, Courtney S; Black, Margaret A

    2014-01-01

    The legalization of physician-assisted death in states such as Washington and Oregon has presented defining ethical issues for hospice programs because up to 90% of terminally ill patients who use the state-regulated procedure to end their lives are enrolled in hospice care. The authors recently partnered with the Washington State Hospice and Palliative Care Organization to examine the policies developed by individual hospice programs on program and staff participation in the Washington Death with Dignity Act. This article sets a national and local context for the discussion of hospice involvement in physician-assisted death, summarizes the content of hospice policies in Washington State, and presents an analysis of these findings. The study reveals meaningful differences among hospice programs about the integrity and identity of hospice and hospice care, leading to different policies, values, understandings of the medical procedure, and caregiving practices. In particular, the authors found differences 1) in the language used by hospices to refer to the Washington statute that reflect differences among national organizations, 2) the values that hospice programs draw on to support their policies, 3) dilemmas created by requests by patients for hospice staff to be present at a patient's death, and 4) five primary levels of noninvolvement and participation by hospice programs in requests from patients for physician-assisted death. This analysis concludes with a framework of questions for developing a comprehensive hospice policy on involvement in physician-assisted death and to assist national, state, local, and personal reflection.

  3. Can we be connected while remaining separate? Forging partnerships between all-volunteer & Medicare-certified hospices.

    PubMed

    Walsh, Mary Ellen

    2003-11-01

    When the Medicare hospice benefit was enacted 20 years ago, many hospices greeted the news with great relief. This benefit helped many fledgling hospices start up and survive. However, a group of hospices realized that some of the people for whom they previously cared were not eligible for services under the Medicare hospice benefit. Thus, volunteer hospices filled that need, supporting and advocating for people who did not fit the hospice benefit criteria, but who wanted hospice support. Since volunteer hospices and Medicare-certified hospices play two very different roles in the hospice care delivery system, there are many opportunities for the two types of hospices to partner to meet patient care needs.

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

    PubMed

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

    2008-06-01

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

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

    PubMed

    2014-08-22

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

  6. Use of Electronic Documentation for Quality Improvement in Hospice

    PubMed Central

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

    2015-01-01

    Little evidence exists on the use of electronic documentation in hospice and its relationship to quality improvement practices. The purposes of this study were to: (1) estimate the prevalence of electronic documentation use in hospice; (2) identify organizational characteristics associated with use of electronic documentation; and (3) determine whether quality measurement practices differed based on documentation format (electronic vs. nonelectronic). Surveys concerning the use of electronic documentation for quality improvement practices and the monitoring of quality-related care and outcomes were collected from 653 hospices. Users of electronic documentation were able to monitor a wider range of quality-related data than users of nonelectronic documentation. Quality components such as advanced care planning, cultural needs, experience during care of the actively dying, and the number/types of care being delivered were more likely to be documented by users of electronic documentation. Use of electronic documentation may help hospices to monitor quality and compliance. PMID:22267819

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

    ERIC Educational Resources Information Center

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

    1992-01-01

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

  8. NACP Data Center for Modeling and Synthesis

    NASA Astrophysics Data System (ADS)

    Cook, R. B.; Post, W. M.; Wilson, B. E.; Thornton, P. E.

    2006-12-01

    The North American Carbon Program (NACP) is designed to quantify the magnitudes and distributions of carbon sources and sinks, explain the processes controlling them, and produce a consistent analysis of North America's carbon budget. To accomplish these ambitious goals, NACP requires an integrated data and information management system that will enable researchers to access, understand, use, and analyze large volumes of diverse data at multiple thematic, temporal, and spatial scales. The Modeling and Synthesis Thematic Data Center (MAST-DC) is an integral component of the NACP data system and will support NACP by providing data products and data management services needed for modeling and synthesis activities. The overall objective of MAST-DC is to provide advanced data management support to NACP investigators and agencies performing modeling and synthesis activities. Based on specific requirements established by NACP, we will provide data products for modeling and synthesis in consistent and uniform grids, projections, and formats. The specific tasks of MAST-DC are (1) coordinate data management activities with NACP modelers and synthesis groups; (2) prepare and distribute model input data; (3) provide data management support for model outputs; (4) provide tools for accessing, subsetting and visualization; (5) provide data packages to evaluate model output; and (6) support synthesis activities, including data support for workshops. MAST-DC will provide data products and services required by NACP in a central location, with common and co-registered spatial projection, in easily converted formats. The MAST-DC will free modelers and those doing the synthesis and integration from having to perform data management functions. Consequently the MAST-DC will enable NACP participants to conduct their work more readily, facilitate the development of new model products needed by models, and assist in gaining new insights into the carbon cycle in North America.

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

    PubMed

    Boucher, Nathan A; Nix, Harvey

    2016-09-01

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

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

    PubMed

    Spicer, Sherri; Heller, Rebecca; Troth, Sarah

    2015-01-01

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

  11. Characteristics and Outcomes of Hospice Enrollees with Dementia Discharged Alive

    PubMed Central

    Johnson, Kimberly S.; Elbert-Avila, Katja; Kuchibhatla, Maragatha; Tulsky, James A.

    2013-01-01

    OBJECTIVES To examine the characteristics of hospice enrollees with dementia who were discharged alive because their condition stabilized or improved and predictors of death in the year after discharge. DESIGN Cross-sectional analysis of clinical and administrative data. SETTING For-profit hospice provider. PARTICIPANTS Hospice enrollees aged 65 and older with an admission diagnosis of dementia who died or were discharged alive because their condition stabilized or improved between January 1, 1999, and December 31, 2003. MEASUREMENTS Demographic variables and hospice length of stay; data did not include functional status or comorbidities. RESULTS Of 24,111 enrollees with dementia, 1,204 (5.0%) were discharged alive because their condition stabilized or improved; the remainder died while receiving hospice. The median length of stay for those who died was 12 versus 236 days for those discharged alive. Those discharged alive were more likely to be female or have a length of stay exceeding 180 days and less likely to be in the oldest age group (≥85), be African American, or reside in a nursing home. In a subgroup of 303 patients discharged alive, 75.5% were still alive at 1 year; none of the demographic variables were associated with death after hospice discharge. CONCLUSION A small proportion of hospice enrollees with dementia was discharged alive. Most died shortly after enrollment. Future research should examine other factors that may predict which hospice enrollees with dementia are likely to be discharged alive and their subsequent trajectory, such as functional status, comorbidities, and preferences for care. PMID:22905714

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

    PubMed

    Spicer, Sherri; Heller, Rebecca; Troth, Sarah

    2015-01-01

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

  13. Energy Modeling for the Artisan Food Center

    SciTech Connect

    Goel, Supriya

    2013-05-01

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

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

    NASA Technical Reports Server (NTRS)

    Hesse, Michael

    2006-01-01

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

  15. Space Weather Modeling at the Community Coordinated Modeling Center

    NASA Technical Reports Server (NTRS)

    Hesse M.

    2005-01-01

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

  16. Medicare program; FY 2014 hospice wage index and payment rate update; hospice quality reporting requirements; and updates on payment reform. final rule.

    PubMed

    2013-08-01

    This final rule updates the hospice payment rates and the wage index for fiscal year (FY) 2014, and continues the phase out of the wage index budget neutrality adjustment factor (BNAF). Including the FY 2014 15 percent BNAF reduction, the total 5 year cumulative BNAF reduction in FY 2014 will be 70 percent. The BNAF phase-out will continue with successive 15 percent reductions in FY 2015 and FY 2016. This final rule also clarifies how hospices are to report diagnoses on hospice claims, and provides updates to the public on hospice payment reform. Additionally, this final rule changes the requirements for the hospice quality reporting program by discontinuing currently reported measures and implementing a Hospice Item Set with seven National Quality Forum (NFQ) endorsed measures beginning July 1, 2014, as proposed. Finally, this final rule will implement the hospice Experience of Care Survey on January 1, 2015, as proposed. PMID:23977715

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

    NASA Technical Reports Server (NTRS)

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

    2011-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    ERIC Educational Resources Information Center

    Fieweger, Margaret A.

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

  20. 3 CFR 8594 - Proclamation 8594 of October 29, 2010. National Hospice Month, 2010

    Code of Federal Regulations, 2011 CFR

    2011-01-01

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

  1. 76 FR 26805 - Medicare Program; Hospice Wage Index for Fiscal Year 2012

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-09

    ... standards that included CBSAs. In the FY 2006 hospice wage index final rule (70 FR 45130), we implemented a.... Finally, this proposed rule would begin implementation of a hospice quality reporting program. DATES... CONTACT: For information regarding ``Quality Reporting for Hospices'' and ``Collection of...

  2. A Linear Programming Model for Assigning Students to Attendance Centers.

    ERIC Educational Resources Information Center

    Ontjes, Robert L.

    A linear programing model and procedures for optimal assignment of students to attendance centers are presented. An example of the use of linear programing for the assignment of students to attendance centers in a particular school district is given. (CK)

  3. CFD Modeling Activities at the NASA Stennis Space Center

    NASA Technical Reports Server (NTRS)

    Allgood, Daniel

    2007-01-01

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

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

    PubMed

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

    2014-09-20

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

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

    PubMed Central

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

    2014-01-01

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

  6. Heliophysical Modeling at the Community Coordinated Modeling Center

    NASA Astrophysics Data System (ADS)

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

    2015-12-01

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

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

    PubMed

    2015-08-01

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

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

    PubMed

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

    2016-01-01

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

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

    PubMed

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

    2016-01-01

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

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

    PubMed Central

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

    2016-01-01

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

  11. National Space Science Data Center Information Model

    NASA Astrophysics Data System (ADS)

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

    2013-12-01

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

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

    ERIC Educational Resources Information Center

    Martin, Deanna C.; And Others

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

  13. Security at a "model" psychiatric center.

    PubMed

    Camacho, H S; Cottrell, P A

    1997-01-01

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

  14. Hospice and palliation in the English-speaking Caribbean.

    PubMed

    Macpherson, Cheryl Cox; Chiochankitmun, Nina; Akpinar-Elci, Muge

    2014-07-01

    This article presents empirical data on the limited availability of hospice and palliative care to the 6 million people of the English-speaking Caribbean. Ten of the 13 nations therein responded to a survey and reported employing a total of 6 hospice or palliative specialists, and having a total of 15 related facilities. The evolving socioeconomic and cultural context in these nations bears on the availability of such care, and on the willingness to report, assess, and prioritize pain, and to prescribe opiates for pain. Socioeconomics and culture also impinge on what medications and modalities of care are routinely available for pain or other conditions and can challenge professionalism, empathy, and responsiveness to patients' unrelieved pain. Although all respondents report having a protocol for pain management, hospice, or end-of-life care, their annual medical use of opiates is well below the global mean. The International Narcotics Control Board (INCB), which monitors such use, encourages Caribbean and other low- and middle-income countries to increase their use of opiates to treat pain, and to overcome both unfounded fears of addiction and overly restrictive interpretation of related laws and regulations. Contextual considerations like those described here are important to the success of policies and capacity-building programs aiming to increase access to hospice and palliation, and perhaps to improving other aspects of health and healthcare. Exploring and responding to the realities of socioeconomic and cultural conditions will enhance public and policy dialogue and improve the design of interventions to increase access to palliative and hospice care. Improving access to palliative and hospice care in the Caribbean demonstrates beneficence and helps to fulfill human rights conventions.

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

    ERIC Educational Resources Information Center

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

    2008-01-01

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

  16. Comprehensive Career Education Center Model. Final Report.

    ERIC Educational Resources Information Center

    Stauber, Dick

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

  17. A Model Learning Resource Center. Final Report.

    ERIC Educational Resources Information Center

    Crowley's Ridge Vocational Technical School, Forrest City, AR.

    Enrollees (aged 16-21) at Crowley's Ridge Vocational Technical School (Forrest City, Arkansas) had trouble mastering the vocational curriculum because they lacked academic skills in reading, mathematics, and language. Through research, it was determined that a Learning Resource Center could be the instructional tool that would remedy the academic…

  18. IHY Modeling Support at the Community Coordinated Modeling Center

    NASA Technical Reports Server (NTRS)

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

    2005-01-01

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

  19. Introducing music therapy in hospice and palliative care: an overview of one hospice's experience.

    PubMed

    Pawuk, Laura G; Schumacher, John E

    2010-01-01

    A middle-aged man with lung cancer breathes more easily and reduces his need for pain medication after participating in music-focused relaxation. An 8-year-old boy with cancer writes songs and records a CD for his family. An elderly woman in the final stages of Alzheimer's who is no longer able to speak sings a few words of her favorite lullaby to her adult daughter. A much-loved grandmother dies peacefully as her family sings her favorite spiritual songs to the accompaniment of a music therapist's folk harp. These illustrations demonstrate the role that music therapy plays in attending to the physical, emotional, and spiritual needs of hospice and palliative care patients and families while respecting their dignity and celebrating their lives.

  20. Validating a Technology Enhanced Student-Centered Learning Model

    ERIC Educational Resources Information Center

    Kang, Myunghee; Hahn, Jungsun; Chung, Warren

    2015-01-01

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

  1. A photocapture test of DX-center models

    SciTech Connect

    Hjalmarson, H.P.; Kurtz, S.R.; Brennan, T.M.

    1989-01-01

    The DX-center model is widely used to explain data for the persistent photoconductivity (PPC) effect. An analysis of the DX-center model suggests a new experiment to test its correctness. In this experiment, photons near the threshold energy of the photoionization cross-section for the DX-center induce transitions from the partially occupied conduction band to empty DX-centers. This mechanism, which we call photocapture, competes with the usual photoionization which empties the DX-centers. The photocapture cross-section is estimated and an experimental attempt is made to detect photocapture. The null result suggests that the DX-center model is incorrect. 16 refs., 4 figs.

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

    ERIC Educational Resources Information Center

    Davies, Betty

    1996-01-01

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

  3. Adult Hospice Social Work Intervention Outcomes in the United States.

    PubMed

    Alcide, Amary; Potocky, Miriam

    2015-01-01

    A descriptive and critical analysis of the available empirical literature on social work psychosocial intervention outcomes for adult hospice patients and caregivers was conducted. The electronic bibliographic databases CINHAL (EBSCO), MEDLINE, ProQuest, EMBASE, Campbell Collaboration, and The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library) were searched. Search criteria were (a) social work interventions, (b) intervention was tested, (c) adult hospice patients and/or caregivers, (d) studies within the United States, (e) and studies between 2004 and 2014. Of the 21 studies that met the initial search criteria, 5 publications met all review criteria. Based on assessment of study results, intervention effect, and quality of evidence, the ADAPT Problem-Solving Intervention (PSI) and the Hospice Caregiver Support Project have some indications of practical effect on caregiver quality of life, anxiety, stress, and problem-solving skills. The Caregiver Life Line (CaLL) intervention had little to no effect on caregiver role stress or coping skills. The few available studies provide foundational insight into the need for the expansion of research efforts to evaluate hospice social work interventions and document the contributions of social work to the field.

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

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... care. (b) Payment amounts are determined within each of the following categories: (1) Routine home care day. A routine home care day is a day on which an individual who has elected to receive hospice care is at home and is not receiving continuous care as defined in paragraph (b)(2) of this section....

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

    ERIC Educational Resources Information Center

    Safrai, Mary B.

    2013-01-01

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

  6. 42 CFR 418.302 - Payment procedures for hospice care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    .... (b) Payment amounts are determined within each of the following categories: (1) Routine home care day. A routine home care day is a day on which an individual who has elected to receive hospice care is...) Continuous home care day. A continuous home care day is a day on which an individual who has elected...

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

    PubMed

    Short, Camille

    2011-08-24

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

  8. Materials to prepare hospice families for dying in the home.

    PubMed

    Kehl, Karen A; Kirchhoff, Karin T; Finster, Mark P; Cleary, James F

    2008-09-01

    Many changes occur in the final hours of life. Family members of those dying at home need to be prepared for these changes, both to understand what is happening and to provide care. The objectives of this study were to describe (1) the written materials used by hospices to prepare families for dying in the home setting and (2) the content of such materials. Questionnaires were sent to 400 randomly selected hospices, of which 170 responded (45.3%) sending their written materials. The most frequently used publications were Gone from My Sight (n = 118 or 69.4%), Final Gifts (n = 44 or 25.9%) and Caregiving (n = 14 or 8.2%). Half (56.5%) of the hospices used other publications and a majority (n = 87 or 51.2%) used multiple publications. Materials were given to the families by nurses (78.2%) or social workers (67.6%). More than 90% of the hospices had materials that addressed the following signs of impending death: decreased fluid intake, decreased food intake, breathing pattern changes, cold extremities, mottling, increased sleeping, changes at the moment of death, audible secretions, urinary output changes, disorientation, incontinence, overall decline and restlessness. Seven signs were addressed less than 30% of the time; pain (28.2%), dyspnea (19.4%), bed-bound state (18.2%), skin changes (18.2%), vital sign changes (17.1%), surge of energy (11.8%) and mandibular breathing (5.9%). Hospice staff should know the content of the materials offered by their agency so they can verbally address the gaps between the written materials and family needs.

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

    PubMed

    Hunt, Matthew R; Ells, Carolyn

    2013-09-01

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

  10. Implementation of hydrologic models at Goddard Space Flight Center

    NASA Technical Reports Server (NTRS)

    1974-01-01

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

  11. Staff Evaluation of the JCCC Success Center Model.

    ERIC Educational Resources Information Center

    Weglarz, Shirley G.

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

  12. The Converging Literacies Center: An Integrated Model for Writing Programs

    ERIC Educational Resources Information Center

    Carter, Shannon; Dunbar-Odom, Donna

    2009-01-01

    The Converging Literacies Center (CLiC) is a deeply integrated model for writing programs, bringing together the writing center, first-year writing, basic writing, professional development activities, graduate coursework, and research activities to re-imagine and support twenty-first-century literacies. What is unique about CLiC is not merely the…

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

    PubMed

    Tsai, Pei-Yu

    2015-01-01

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

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

    PubMed Central

    Lysaght, Susan; Ersek, Mary

    2012-01-01

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

  15. China plans large center for PDX models.

    PubMed

    2014-02-01

    The Chinese Academy of Sciences' Shanghai Institute of Materia Medica will collaborate with Crown Biosciences to build a collection of about 4,000 patient-derived xenograft models that will aid cancer drug discovery and development.

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

    PubMed Central

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

    2016-01-01

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

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

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

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

  18. Online resources for culturally and linguistically appropriate services in home healthcare and hospice, part 2: resources for Asian patients.

    PubMed

    Young, Judith S

    2012-04-01

    Home care and hospice clinicians are increasingly working with patients for whom English is not their primary language. Provision of culturally respectful and acceptable patient-centered care includes both an awareness of cultural beliefs that influence the patient's health and also the ability to provide the patient with health information in the language with which he or she is most comfortable. This article identifies resources for understanding the cultural norms of Asian-born patients and appropriate patient education materials in the many languages spoken by this population. The resources have been made available free on the Web by healthcare professionals and government agencies from around the world.

  19. Supramolecular structures modeling photosynthetic reaction center function

    SciTech Connect

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

    1992-08-20

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

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

    PubMed Central

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

    2015-01-01

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

  1. Differences between non-profit and for-profit hospices: patient selection and quality.

    PubMed

    Gandhi, Sabina Ohri

    2012-06-01

    This research compares the behavior of non-profit organizations and private for-profit firms in the hospice industry, where there are financial incentives created by the Medicare benefit. Medicare reimburses hospices on a fixed per diem basis, regardless of patient diagnosis. Because under this system patients with lower expected costs are more profitable, hospices can selectively enroll patients with longer lengths of stay. While it is illegal for hospices to reject potential patients explicitly, they can influence their patient mix through referral networks. A fixed per diem rate also creates an incentive shirk on quality and to substitute lower skilled for higher skilled labor, which has implications for quality of care. By using within-market variation in hospice characteristics, the empirical evidence suggests that for-profit hospices differentially take advantage of these incentives. The results show that for-profit hospices engage in patient selection through significantly different referral networks than non-profits. They receive more patients from long-term care facilities and fewer patients through more traditional paths, such as physician referrals. This mechanism of patient selection is supported by the result that for-profits have fewer cancer patients and more patients with longer lengths of stay. While non-profit and for-profit hospices report similar numbers of staff visits per patient, for-profit firms make significantly less use of skilled nursing providers. We also find some weak evidence of lower levels of quality in for-profit hospices.

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

    PubMed

    Chang, Cyril F; Steinberg, Stephanie C

    2006-01-01

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

  3. A system of electronic records developed by a children's hospice.

    PubMed

    Menezes, Antoinette; Esplen, Polly; Bartlett, Paul; Turner, Bridget; Keel, Mike; Etherington, Veronica; Conisbee, Elaine; Plant, Antonia; Haslam, Val; England, Julie

    2007-05-01

    This paper describes the development, implementation and dissemination of an electronic data collection system for children's hospices in the UK. In 1999, CHASE Hospice Care for Children (CHASE) began providing support for life-limited children and their families in their own homes across south-west London, Surrey and West Sussex. CHASE community team is multidisciplinary and original members of the team had to create all of the necessary administrative systems for collecting and storing information about referrals and care provided to children and their families. The community team had the foresight to record activity statistics from day one of the service. The team worked together to identify information routinely collected that could usefully be stored on a computer database and a simple solution was created for this purpose using Microsoft Access version 2. CHASE was in a privileged position because the commitment to use information technology came from people providing care to children and their families.

  4. Manual handling the deceased child in a children's hospice.

    PubMed

    Pike, Anne M

    2004-09-01

    The introduction of the Manual Handling Operation Regulations 1992 has forced organizations to review all manual handling carried out in the work-place. Safe manual handling is now a legislative requirement to enable the workforce to carry out their jobs in a safe and structured environment. This project looked in detail at the manual handling that was being carried out when caring for a child after they have died. It was undertaken at CHASE Children's Hospice in the period up until December 2002, with a telephone survey investigating practice at six other children's hospices. It aimed to identify incorrect procedures and, by applying the theory of ergonomics, identify changes that needed to occur in practice, making recommendations for environmental changes. The study led to the production of a policy for handling the children, devising child-specific handling guidelines, reducing the number of times the children are moved after they have died and providing appropriate equipment.

  5. The new hospice compliance plan: defining and addressing risk areas.

    PubMed

    Jones, D H; Woods, K

    2000-05-01

    The Department of Health and Human Services' (HHS) Office of the Inspector General (OIG), has advised hospices and other health care providers to formulate effective controls to ensure compliance with federal and state statutes, rules, and regulations, and private-payor health care program requirements. The recently released guidelines provide a blueprint for developing such programs. This is the first of four installments that focus specifically on the 28 risk areas identified in the guidance and offer strategies for incorporating them in a hospice compliance program. The authors have organized the 28 risk areas under 9 topic domains to simplify the task of tackling the guidance. This article covers the first two areas: Admission/Certification/Recertification and Billing.

  6. Medicare as insurance innovator: the case of hospice.

    PubMed

    Taylor, Donald H

    2013-09-01

    The stylized fact is that while private insurance has tended to innovate on the benefit design side of the insurance contract, Medicare has lead innovation on the payment side. Traditional or Fee-For-Service Medicare has produced many innovations in the payment for health care services, such as Prospective Payment for hospitals, Diagnostic-Related Groups to categorize care, and the Resource-Based Relative Value System used by the program to pay physicians, while private insurance has produced a series of benefit design innovations. This story misses one important example of Medicare benefit innovation: the creation of the Medicare hospice benefit. A key question is whether Medicare can again lead a system-wide benefit design effort to improve upon current hospice and palliative care policy.

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

    Montross, Lori; Winters, Kathryn D.

    2011-01-01

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

  9. Staff stress and job satisfaction at a children's hospice.

    PubMed Central

    Woolley, H; Stein, A; Forrest, G C; Baum, J D

    1989-01-01

    A study of staff stress and job satisfaction was undertaken in a children's hospice. In addition factors were investigated which might be stressful or which helped staff to manage in difficult circumstances. Three quarters were under comparatively little stress and in general showed very few psychological symptoms but a distinct subgroup were under a great deal of stress. A number of factors, notably recent personal bereavement and unresolved grief about a death that had occurred before they came to work at the hospice, distinguished this small group. Job satisfaction was generally high. The main sources of stress were: the sense of impotence staff felt when they were unable to relieve perceived needs or distress; dealing with negative responses in families, and conflicts within the staff group. The most important mitigating factors were: the informal support that staff provided for each other in this small cohesive working unit, the homelike atmosphere of the hospice, and the diversity of professional and personal skills among the staff group. The implications of these findings for reducing stress among staff dealing with dying people are discussed; this includes not only staff on paediatric wards, intensive care and neonatal units, but also community paediatric nurses. PMID:2923460

  10. Staff stress and job satisfaction at a children's hospice.

    PubMed

    Woolley, H; Stein, A; Forrest, G C; Baum, J D

    1989-01-01

    A study of staff stress and job satisfaction was undertaken in a children's hospice. In addition factors were investigated which might be stressful or which helped staff to manage in difficult circumstances. Three quarters were under comparatively little stress and in general showed very few psychological symptoms but a distinct subgroup were under a great deal of stress. A number of factors, notably recent personal bereavement and unresolved grief about a death that had occurred before they came to work at the hospice, distinguished this small group. Job satisfaction was generally high. The main sources of stress were: the sense of impotence staff felt when they were unable to relieve perceived needs or distress; dealing with negative responses in families, and conflicts within the staff group. The most important mitigating factors were: the informal support that staff provided for each other in this small cohesive working unit, the homelike atmosphere of the hospice, and the diversity of professional and personal skills among the staff group. The implications of these findings for reducing stress among staff dealing with dying people are discussed; this includes not only staff on paediatric wards, intensive care and neonatal units, but also community paediatric nurses.

  11. Assessment of need for a children's hospice program.

    PubMed

    Davies, B

    1996-01-01

    Canuck Place, North America's first free-standing pediatric hospice of its kind, opened in 1995 in British Columbia, Canada. The province-wide program encompasses a broad spectrum of services intended to support community-based care and provide periodic, facility-based respite and palliative care to children with life-threatening, progressive illness and to their families. Loss and grief support is another integral component of the program. The concept of pediatric hospice care is founded on the premise that dying children and their families can benefit from care designed to maximize present quality of life; yet, the creation of such programs must be based on demonstrated need. One vital step in the development of the Canuck Place program was assessing the need for such a program within the province. Data from both traditional quantitative and less traditional qualitative sources were used to document and put forth an argument in support of developing a children's hospice program. The final report addressed several components that are summarized in this article for the purposes of assisting others who may wish to undertake similar projects in their own communities.

  12. A learning and development strategy for children's hospices across London.

    PubMed

    Billings, Jenny; Jenkins, Linda; Black, Rachel

    2011-10-01

    Over recent years there have been several political imperatives in the UK directed toward children's palliative care and ensuring that services are high-quality, coordinated, family-centred, and able to meet the needs of children with complex disabilities. In addition, in 2010 the health and social care regulation authority in England-the Care Quality Commission (CQC)-aligned hospices with regulation and inspection requirements. This context has acted as a driver for the creation of effective education and training to ensure a skilled and expert workforce. Against this backdrop, this paper describes a project to develop a learning and development strategy for Children's Hospices across London (CHaL). CHaL educators worked with a research team to develop a unified strategy that was based on evidence of good practice, embedded in required CQC outcomes, and validated with a wider audience. The resultant strategy contains a set of four key learning and development principles that are applicable and transferable across different hospices.

  13. Interdisciplinary hospice team processes and multidimensional pain: a qualitative study.

    PubMed

    Dugan Day, Michele

    2012-01-01

    Hospice teams may address multidimensional pain through the synergistic interaction of team members from various professional disciplines during regularly scheduled team meetings. However, the occurrence of that critical exchange has not been adequately described or documented. The purpose of this qualitative study was to explore two processes in team pain palliation: communication and collaboration. Data were gathered through individual interviews and a 1-year observation of team members from two hospices (physicians, nurses, aides, chaplains, social workers). Utilizing constant comparison, 14 final thematic categories were discovered. Use of biopsychosocial/spiritual terms by all team members meant that the team had the common language needed to communicate about multidimensional pain. Interviews and observation revealed a gap in translating multidisciplinary communication in team meetings into collaborative acts for pain treatment. In addition, structural influences inhibited creativity in pain palliation. There was no mutual understanding of the purpose for team meetings, no recognition of the need to reflect on team process, or common definition of leadership. Social work roles in hospice should include leadership that moves teams toward interdisciplinary care for multidimensional pain.

  14. The impact of volunteering in hospice palliative care.

    PubMed

    Claxton-Oldfield, Stephen; Claxton-Oldfield, Jane

    2007-01-01

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

  15. Transition to Operations Support at the Community Coordinated Modeling Center

    NASA Technical Reports Server (NTRS)

    Hesse, M.

    2005-01-01

    The Community Coordinated Modeling Center (CCMC) is a multi-agency partnership, which aims at the creation of next generation space weather models. The goal of the CCMC is to support the research and developmental work necessary to substantially increase the present-day modeling capability for space weather purposes, and to provide models for transition to the rapid prototyping centers at the space weather forecast centers. This goal requires close collaborations with and substantial involvement of the research community. The physical regions to be addressed by CCMC-related activities range from the solar atmosphere to the Earth's upper atmosphere. The CCMC is an integral part of the National Space Weather Program Implementation Plan, of NASA's Living With a Star (LWS) initiative, and of the Department of Defense Space Weather Transition Plan. CCMC includes a facility at NASA Goddard Space Flight Center, as well as distributed computing facilities provided by the US Air Force. CCMC also provides, to the research community, access to state-of-the-art space research models. This paper will focus on a status report on CCMC activities in support of model transition to operations at US space weather forecasting centers. In particular, an update will be given on past and present transition activities, on developments that address operational needs, and on future opportunities for transition-to-operations support.

  16. The fundamentals of hospice compliance: what is it and what are the implications for the future? An overview for hospice clinicians, part 1.

    PubMed

    Balfour, Susan

    2012-02-01

    This article, Part 1 of a 2-part series, provides an overview of the current Medicare compliance climate and its implications for hospice providers. Content focuses on the 7 elements of a comprehensive compliance framework as defined by the Health and Human Services Office of the Inspector General in its 1999 Compliance Guidance for Hospices. A brief case example is provided and serves to set the stage for Part 2, which will explore hospice-specific risk areas and specific risk-reduction strategies.

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

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

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

  18. A Model Vocational Evaluation Center in a Public School System.

    ERIC Educational Resources Information Center

    Quinones, Wm. A.

    A model public school vocational evaluation center for handicapped students is described. The model's battery of work samples and tests of vocational aptitudes, personal and social adjustment, physical capacities, and work habits are listed. In addition, observation of such work behaviors as remembering instructions, correcting errors, reacting to…

  19. Intentional anticipatory mourning, caregiver and bereavement support program for terminally ill veterans, their families & caregivers in the VA Contract Home Hospice Program.

    PubMed

    Flanagan-Kaminsky, Donnamarie

    2013-01-01

    As a response to the increasing numbers of Veterans utilizing the Veterans Affairs (VA) Contract Home Hospice Program, and with growing awareness of the increased stress at end-of-life, the social work leadership of the Louis Stokes Cleveland VA Medical Center implemented a unique approach to support Veterans and their families. The role of a grief/bereavement counselor was added to enhance the VA Contract Home Hospice Program, to assess the needs of the Veterans and family caregivers, and to create a program in response to these findings. A three-prong module evolved encompassing: Anticipatory Mourning Support for both the Veteran and caregiver/ family; Caregiver Support; and Bereavement Support. The components of this module are described along with findings in each module.

  20. Intentional anticipatory mourning, caregiver and bereavement support program for terminally ill veterans, their families & caregivers in the VA Contract Home Hospice Program.

    PubMed

    Flanagan-Kaminsky, Donnamarie

    2013-01-01

    As a response to the increasing numbers of Veterans utilizing the Veterans Affairs (VA) Contract Home Hospice Program, and with growing awareness of the increased stress at end-of-life, the social work leadership of the Louis Stokes Cleveland VA Medical Center implemented a unique approach to support Veterans and their families. The role of a grief/bereavement counselor was added to enhance the VA Contract Home Hospice Program, to assess the needs of the Veterans and family caregivers, and to create a program in response to these findings. A three-prong module evolved encompassing: Anticipatory Mourning Support for both the Veteran and caregiver/ family; Caregiver Support; and Bereavement Support. The components of this module are described along with findings in each module. PMID:23977781

  1. Space Weather Products at the Community Coordinated Modeling Center

    NASA Technical Reports Server (NTRS)

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

    2010-01-01

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

  2. Customer-centered careflow modeling based on guidelines.

    PubMed

    Huang, Biqing; Zhu, Peng; Wu, Cheng

    2012-10-01

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

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

  4. The role of physical, occupational, and speech therapy in hospice: patient empowerment.

    PubMed

    Frost, M

    2001-01-01

    The use of physical, occupational, and speech therapy is a growing trend in hospice. The purpose of this paper is to define the role of the physical, occupational, and speech therapist as part of the hospice team in the context of the various therapies' objectives. A case study is presented and clinical implications are discussed.

  5. 42 CFR 418.110 - Condition of participation: Hospices that provide inpatient care directly.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... avoided. (b) Standard: Twenty-four hour nursing services. (1) The hospice facility must provide 24-hour... provisions applicable to nursing homes of the 2000 edition of the Life Safety Code (LSC) of the National Fire... compliance with all of the following standards: (a) Standard: Staffing. The hospice is responsible...

  6. 42 CFR 418.110 - Condition of participation: Hospices that provide inpatient care directly.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... avoided. (b) Standard: Twenty-four hour nursing services. (1) The hospice facility must provide 24-hour... provisions applicable to nursing homes of the 2000 edition of the Life Safety Code (LSC) of the National Fire... compliance with all of the following standards: (a) Standard: Staffing. The hospice is responsible...

  7. 42 CFR 418.110 - Condition of participation: Hospices that provide inpatient care directly.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... avoided. (b) Standard: Twenty-four hour nursing services. (1) The hospice facility must provide 24-hour... provisions applicable to nursing homes of the 2000 edition of the Life Safety Code (LSC) of the National Fire... compliance with all of the following standards: (a) Standard: Staffing. The hospice is responsible...

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

  9. 78 FR 26250 - Payment for Home Health Services and Hospice Care to Non-VA Providers

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-06

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

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

    ERIC Educational Resources Information Center

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

    2006-01-01

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

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

    ERIC Educational Resources Information Center

    Hayslip, Bert; Walling, Mary L.

    1986-01-01

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

  12. Netting the hospice butterfly: politics, policy, and translation of an ideal.

    PubMed

    Buck, Joy

    2007-10-01

    This article presents a historical analysis of the American hospice movement. It examines the social and political factors that created an environment for the movement to emerge. In doing so, it explores the processes by which multidisciplinary teams came together to advance hospice as a necessary healthcare reform and the challenges they faced in doing so.

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

  14. General circulation model sensitivity experiments with pole-centered supercontinents

    SciTech Connect

    Crowley, T.J.; Baum, S.K.; Kim, Kwang-Yul )

    1993-05-20

    The authors present model studies related to the general question of whether there could have been nearly ice-free climates in the past history of the Earth. Energy balance models and general circulation model calculations have addressed this question. In general this appears impossible, even with moving continents around, without postulating enhanced levels of CO[sub 2]. Early work indicated that pole centered continents could have snow free summers, but later work, with models with better physics, but poorer resolution seemed to contradict this conclusion. The authors apply the GENESIS (ver 1.02) general circulation model to this problem. Their conclusion is that with certain modifications to the application of this model, they could find pole-centered supercontinents which would be snow free in the summer.

  15. Evaluating a pilot paediatric hospice-at-home service: a literature review.

    PubMed

    Hillis, Rowan; Ling, Julie; Quinn, Claire; Brenner, Maria

    2016-02-01

    Background: This literature review aims to offer practitioners an overview of the key components involved in designing the evaluation of a paediatric hospice-at-home pilot that will assess the effectiveness, efficiency and sustainability of the programme. The literature was reviewed in two stages: the first examined existing literature in the area of paediatric palliative care. The second looked at the wider field of adult palliative care to gain further insights into evaluation tool design. The findings are presented as a conceptual model to highlight each component of the pilot development stage as identified for evaluation purposes, emphasising their role and impact on the resultant delivery of integrated care. The clarity and transparency of this model offers a comprehensive overview of the evaluation process to all involved in the pilot.

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

    PubMed

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

    2016-07-01

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

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

    PubMed

    Noh, Hyunjin

    2014-01-01

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

  18. Transitioning RN to BSN students from acute care to hospice care nursing.

    PubMed

    Mizell, Deborah; Washington-Brown, Linda J; Russell, Angela

    2014-01-01

    Today, most medical professionals focus on a cure. However, hospice care provides a quality of life for those persons nearing the end of life or persons experiencing a life-limiting illness. The distressing reality is that most nurses are not taught the full scope of end of life care (EOL) in schools of nursing. Because of this educational deficit, a variance in care is created that may adversely affect the dying patient and family's wishes. In our RN to BSN program, we established a partnership with a national hospice organization to provide (1) leadership in end-of-life course development, (2) lecturers experienced in hospice and palliative care, (3) field placement for students with hospice nurses, and (4) nursing scholarships to complete the bachelor's degree. The end result of this partnership is to educate registered nurses about hospice and palliative care, as well as to increase the nursing workforce in this area. PMID:25612396

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

    PubMed

    Brown, Mary V

    2011-09-01

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

  20. Lean business model and implementation of a geriatric fracture center.

    PubMed

    Kates, Stephen L

    2014-05-01

    Geriatric hip fracture is a common event associated with high costs of care and often with suboptimal outcomes for the patients. Ideally, a new care model to manage geriatric hip fractures would address both quality and safety of patient care as well as the need for reduced costs of care. The geriatric fracture center model of care is one such model reported to improve both outcomes and quality of care. It is a lean business model applied to medicine. This article describes basic lean business concepts applied to geriatric fracture care and information needed to successfully implement a geriatric fracture center. It is written to assist physicians and surgeons in their efforts to implement an improved care model for their patients. PMID:24721360

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

    NASA Technical Reports Server (NTRS)

    1995-01-01

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

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

    NASA Technical Reports Server (NTRS)

    Liou, William W. (Editor)

    1994-01-01

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

  3. A Development Center Through the Community Based Programming Model.

    ERIC Educational Resources Information Center

    Reichard, Donald L.; Wood, Mary T.

    1999-01-01

    Outlines the development of a leadership-training center at James Sprunt Community College. A community-based programming (CBP) model was followed to encourage community input, support, and participation in the process. CBP is recommended as a way for other colleges to collaborate with their communities on issue definition and resolution. (VWC)

  4. An Evaluation-Accountability Model for Regional Education Centers.

    ERIC Educational Resources Information Center

    Barber, R. Jerry; Benson, Charles W.

    This paper presents the rationale, techniques, and structure used to develop and implement an evaluation-accountability program for a new regional Education Service Center in Texas. Needs assessment, a critical element in this model, consists of objectively identifying the educational needs of clients and establishing an initial list of…

  5. Modeling charge transfer in the photosynthetic reaction center

    NASA Astrophysics Data System (ADS)

    Pudlak, Michal; Pinčak, Richard

    2003-12-01

    In this work, we present a model to elucidate the unidirectionality of the primary charge-separation process in the bacterial reaction centers. We have used a model of three sites/molecules with electron transfer beginning at site 1 with an option to proceed to site 2 or site 3. We used a stochastic model with arbitrary correlation functions. We get the quantum yields of electron escape via the sites 2,3 in two limiting cases that correspond to a spectral density of underdamped and overdamped Brownian oscillator. In the fast modulation limit of an overdamped regime we get the effect, which was named “fear of death,” in which for strong enough sink parameters the electron has a tendency to avoid the place with greater sink. The presented model was used to provide a plausible explanation of the temperature dependence of the quantum yields of the Rhodobacter sphaeroides photosynthetic reaction center in the high-temperature regime.

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

    PubMed

    Hirooka, Kayo; Watanabe, Miyako; Kawagoe, Koh

    2013-08-01

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

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

    PubMed

    Sanchez-Reilly, Sandra; Ross, Jeanette S

    2012-01-01

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

  8. Business models for academic medical center cyclotron operations.

    PubMed

    LeGarde, Caroline; Bledsoe, Martin L; Wahl, Richard L

    2005-06-01

    A cyclotron facility may provide a significant strategic advantage for an academic medical center that desires to build a strong research program in nuclear medicine. Such a facility may provide an advantage in obtaining support from the National Institutes of Health. A nuclear medicine research program often requires the production of short-lived radioisotopes for clinical patients. Combining the research program with a commercial production and distribution program can increase the synergies and efficiencies of an organization. This article describes various business models that combine research, clinical, and commercial operations to align an academic medical center's cyclotron program operation to its goals and resources. By coordinating these three functions, an academic medical center may be able to support extensive research capabilities that would otherwise be unattainable.

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

    NASA Astrophysics Data System (ADS)

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

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

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

    PubMed Central

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

    2016-01-01

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

  11. Work experience, work environment, and blood exposure among home care and hospice nurses.

    PubMed

    Leiss, Jack K

    2012-01-01

    Blood exposure rates among home care and hospice nurses (RNs) in the United States are markedly lower for nurses with more home care/hospice experience, whether or not they have more total years of nursing experience (i.e., in other work environments). This study examined whether the protective effect of home care/hospice experience was greater for nurses who worked under three types of circumstances that are typical of the home care/hospice work environment and conducive to blood exposure. A mail survey was conducted in 2006 among home care/hospice nurses in North Carolina, a largely rural state in the southeastern U.S. The adjusted response rate was 69% (n=833). Blood exposure rates were higher among nurses with ≤5 years' experience in home care/hospice. Contrary to expectations, the protective effect of more experience was greater among nurses who did not have limited access to safety devices/personal protective equipment, did not have to rush during home visits, and did not often visit homes with unrestrained pets, unruly children, poor lighting, or extreme clutter. These results suggest that characteristics of the home care/hospice work environment limit nurses' ability to use their experience to prevent blood exposure.

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

    PubMed

    Broom, Alex

    2012-02-01

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

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

    PubMed

    Broom, Alex

    2012-02-01

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

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

    PubMed

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

    2009-07-01

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

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

    PubMed

    Hodgson, L A

    1995-04-01

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

  16. Parents' and children's perspectives of a children's hospice bereavement program.

    PubMed

    Davies, Betty; Collins, John; Steele, Rose; Cook, Karen; Distler, Vivian; Brenner, Amy

    2007-01-01

    The provision of some form of bereavement services is an integral part of any pediatric hospice program. The Canuck Place hospice program has offered bereavement services since it began in 1995. A mixed-method evaluation of the impact of the Canuck Place program on the families it served during its first two-and-a-half years of operation was conducted. The bereavement services reviewed included follow-up care for families, and bereavement support groups for children and their parents. Eight children were interviewed in the initial phase, and nine completed a survey questionnaire; 28 parents rated their level of satisfaction with various aspects of their experience with the parent support group. Findings indicated that the follow-up component of the program was well-received by family members. When assessing their group experiences, children and parents most appreciated the support and understanding they received, the freedom to express themselves, a diminished sense of isolation, and the normalization of their emotions. Practical considerations when offering bereavement support groups are discussed in this paper.

  17. Balancing the focus: art and music therapy for pain control and symptom management in hospice care.

    PubMed

    Trauger-Querry, B; Haghighi, K R

    1999-01-01

    Pain and symptom management are a major part of hospice care. Literature and direct experience suggest that pain can be resistant if psychological, emotional, or spiritual issues are not addressed. This article explains how art and music therapies can work in conjunction with traditional medical treatment of pain control in the hospice setting. The process of pain modulation through the use of art and music interventions is diagrammed and described. Brief clinical examples demonstrate the use of art and music therapies for pain reduction with a variety of hospice patients. Information regarding appropriate education and training necessary for art and music therapists to practice in their field is presented.

  18. Residential hospice environments: evidence-based architectural and landscape design considerations.

    PubMed

    Verderber, Stephen

    2014-01-01

    The residential hospice care movement is increasingly accepted and supported globally, and yet, unfortunately, the amount of literature on best practices in the planning and design of residential hospice facilities and adjacent outdoor spaces remains relatively small. This paper reports on a compendium of architectural and landscape design considerations that reflect the fundamental dimensions of the residential hospice experience: site and context, arrival spaces, communal and private spaces of the residential milieu, transitional spaces, and nature connectivity. Additionally, key staffing and administrative ramifications of this built-environment compendium are addressed, as are prognostications and challenges for the future.

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

    ERIC Educational Resources Information Center

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

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

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

    PubMed

    Price, Jayne; Dornan, Jean; Quail, Lorraine

    2013-09-01

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

  1. Are you my nurse? Life and death in the hospice fast lane.

    PubMed

    Costea, Nancy

    2011-01-01

    From its small-scale, community-based roots, hospice care in America has evolved into a competitive, highly-regulated industry. Hospice nurses today often find themselves challenged by increased patient caseloads, faster-paced work environments, and ever-growing documentation demands. This article addresses these issues through the lived experience of the author, a registered nurse who has worked "at the bedside" with terminally ill patients for over two decades. It also touches upon some of the additional challenges associated with delivering hospice care "after hours," and in non-traditional settings such as nursing facilities and acute-care hospitals. The author concludes that it is still possible to successfully navigate the complexities of end-of-life care in the 21(st) century without losing one's "hospice heart."

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

    PubMed

    Sarginson, Andrea

    2005-09-01

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

  3. Similarities and differences in perspectives on interdisciplinary collaboration among hospice team members.

    PubMed

    Kobayashi, Rie; McAllister, Carolyn A

    2014-12-01

    This study surveyed 4 core hospice professionals (physicians, nurses, social workers, and chaplains) on their perceived level of interdisciplinary collaboration, the influences of interdisciplinary collaboration, and job satisfaction to determine potential similarities and differences based on profession and various demographic characteristics of the members or member hospices. Analysis found that there are overall no differences based on demographic characteristics. Differences between professions, while few, were largely in the area of perceptions on relationships between members of the hospice team. Specifically, social workers appear to perceive themselves as less connected to the other members of the interdisciplinary team, an area theorized to influence interdisciplinary collaboration. Difference between professions was also found in job satisfaction. Implications for hospice practice and interdisciplinary education are discussed.

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

    PubMed

    Winn, Peter; Salinas, Robert

    2005-01-01

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

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

    PubMed

    Winn, Peter; Salinas, Robert

    2004-12-01

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

  6. Professional burnout and social support in the workplace among hospice nurses and midwives in Poland.

    PubMed

    Kalicińska, Marta; Chylińska, Joanna; Wilczek-Różyczka, Ewa

    2012-12-01

    This study was conducted to determine the relationship between burnout and social support received at work among hospice nurses and midwives in Poland to reveal the connection in working conditions differing in terms of exposure to death and dying situation. A total sample of 117 nurses represented nurses working in polish hospice and maternity wards. No significant differences in the burnout scores were found between hospice nurses and midwives with high superiors' support. However, hospice nurses and midwives with low superiors' support differed significantly in almost every dimension of burnout. Further, the results showed that social support significantly predicted burnout only in case of midwives. The current findings emphasize the role of superiors and their ability to provide support. Intervention programmes targeted at preventing or reducing burnout would be especially important for maternity wards, where enhancing support at a workplace could be crucial. Confirming causality in prospective research is necessary.

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

    SciTech Connect

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

    1989-01-01

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

  8. 76 FR 26731 - Medicare Program; Hospice Wage Index for Fiscal Year 2012

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-09

    ... provide coverage for hospice care under Part A. See Tax Equity and Fiscal Responsibility Act of 1982... supplies. 42 U.S.C. 1395x(dd)(1); see also 48 FR 56,008, 56,008 (Dec. 16, 1983) (describing hospice benefit... to receive the preponderance of his or her care. 48 FR 56,008, 56,022 (Dec. 16, 1983). The...

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

    PubMed

    Buck, Joy

    2011-11-01

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

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

    PubMed Central

    Buck, Joy

    2011-01-01

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

  11. Centering or Not Centering in Multilevel Models? The Role of the Group Mean and the Assessment of Group Effects

    ERIC Educational Resources Information Center

    Paccagnella, Omar

    2006-01-01

    In multilevel regression, centering the model variables produces effects that are different and sometimes unexpected compared with those in traditional regression analysis. In this article, the main contributions in terms of meaning, assumptions, and effects underlying a multilevel centering solution are reviewed, emphasizing advantages and…

  12. Which Hospice Patients With Cancer Are Able to Die in the Setting of Their Choice? Results of a Retrospective Cohort Study

    PubMed Central

    Jeurkar, Neha; Farrington, Sue; Craig, Teresa R.; Slattery, Julie; Harrold, Joan K.; Oldanie, Betty; Teno, Joan M.; Casarett, David J.

    2012-01-01

    Purpose To determine which hospice patients with cancer prefer to die at home and to define factors associated with an increased likelihood of dying at home. Methods An electronic health record–based retrospective cohort study was conducted in three hospice programs in Florida, Pennsylvania, and Wisconsin. Main measures included preferred versus actual site of death. Results Of 7,391 patients, preferences regarding place of death were determined at admission for 5,837 (79%). After adjusting for other characteristics, patients who preferred to die at home were more likely to die at home (adjusted proportions, 56.5% v 37.0%; odds ratio [OR], 2.21; 95% CI, 1.77 to 2.76). Among those patients (n = 3,152) who preferred to die at home, in a multivariable logistic regression model, patients were more likely to die at home if they had at least one visit per day in the first 4 days of hospice care (adjusted proportions, 61% v 54%; OR, 1.23; 95% CI, 1.07 to 1.41), if they were married (63% v 54%; OR, 1.35; 95% CI, 1.10 to 1.44), and if they had an advance directive (65% v 50%; OR, 2.11; 95% CI, 1.54 to 2.65). Patients with moderate or severe pain were less likely to die at home (OR, 0.56; 95% CI, 0.45 to 0.64), as were patients with better functional status (higher Palliative Performance Scale score: < 40, 64.8%; 40 to 70, 50.2%; OR, 0.79; 95% CI, 0.67 to 0.93; > 70, 40.5%; OR, 0.53; 95% CI, 0.35 to 0.82). Conclusion Increased hospice visit frequency may increase the likelihood of patients being able to die in the setting of their choice. PMID:22734023

  13. Families' transition to a Canadian paediatric hospice. Part two: results of a pilot study.

    PubMed

    Steele, Rose; Derman, Sarah; Cadell, Susan; Davies, Betty; Siden, Hal; Straatman, Lynn

    2008-06-01

    The results from a pilot study are reported in this article, part two of a two-part paper. The experiences of parents (six mothers and two fathers) are described as their families transitioned to the Canuck Place Children's Hospice (CPHC) in Canada. The perspectives of non-hospice health care professionals (n=4) involved in the child's care are explored. Data were gathered through audio-taped, semi-structured interviews. Initially, parents and health professionals were unaware that the hospice provided more than just end-of-life services. Parents began to consider hospice care when something changed in their lives that forced them to see things differently. This became the impetus for recognizing that CPCH might be a resource for their family. The prospect of respite care was usually the deciding factor in applying to the hospice. Parents reported benefits of hospice respite for themselves and the whole family. Recommendations for practice and future research are offered, including discussion about the feasibility of the study procedures.

  14. A Descriptive, Retrospective Study of After-hours Calls in Hospice and Palliative Care

    PubMed Central

    Jiang, Yun; Gentry, Amanda L.; Pusateri, Margaret; Courtney, Karen L.

    2012-01-01

    Aims Few studies have described after-hours calls in hospice patient care. This retrospective study examines the timing of after-hours telephone triage services; the reasons for access to after-hours hospice and palliative care services; and the predominant nursing interventions offered in after-hours calls in hospice and palliative care. Methods A fixed coding scheme was used to code a de-identified after-hours triage phone log of all calls between July 2005 and June 2006 (n=4,434) from a Pennsylvania hospice and palliative care services organization. Descriptive statistics were used to identify call timing pattern, call reasons, and predominant nursing interventions. Results Triage services were utilized most frequently to request assistance with signs and symptoms control (25.7%), report death (17.8%), and to request a home visit (15.3%). The top nursing interventions included updating case managers or supervisors about the needs of follow-up (29.5%), coordinating home visits (20.5%), and instructing caregivers or patients on how to control new signs and symptoms (19.8%). Conclusions A better understanding of when and why patients and their family caregivers utilize after-hours hospice triage services can assist in the design of future proactive interventions to improve care, and enhance training for new and existing hospice triage nurses. PMID:22773920

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

    PubMed Central

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

    2010-01-01

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

  16. Galactic Center Shells and a Recurrent Starburst Model

    NASA Astrophysics Data System (ADS)

    Sofue, Yoshiaki

    2003-04-01

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

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

    NASA Technical Reports Server (NTRS)

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

    1988-01-01

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

  18. Coming to terms: a case study of hospice collaboration challenges.

    PubMed

    Pietroburgo, Julie; Bush, Richard

    Recent research has focused on the growing phenomenon of mergers, collaborations, and alliances among nonprofit organizations and what makes such arrangements work. Examination of failed collaborative efforts is perhaps just as instructive. This case study examines recent attempts at collaboration between 2 nonprofit hospice organizations. The study finds that despite compelling reasons for and significant commonalities on which to base collaboration, the organizations were initially unable to forge any ongoing and substantive collaborative arrangement because of insurmountable cultural factors and past history. Furthermore, without imminent external pressures to collaborate, these organizations had insufficient motivation to attempt to move beyond their differences. The case also reviews the changed circumstances and factors that later facilitated partnering attempts.

  19. Why hospice nurses need high self-esteem.

    PubMed

    Olthuis, Gert; Leget, Carlo; Dekkers, Wim

    2007-01-01

    This article discusses the relationship between personal and professional qualities in hospice nurses. We examine the notion of self-esteem in personal and professional identity. The focus is on two questions: (1) what is self-esteem, and how is it related to personal identity and its moral dimension? and (2) how do self-esteem and personal identity relate to the professional identity of nurses? We demonstrate it is important that the moral and personal goals in nurses' life coincide. If nurses' personal view of the good life is compatible with their experiences and feelings as professionals, this improves their performance as nurses. We also discuss how good nursing depends on the responses that nurses receive from patients, colleagues and family; they make nurses feel valued as persons and enable them to see the value of the work they do. PMID:17334171

  20. The ballet of baseball: lessons of the game for hospice.

    PubMed

    Norlander, L; Grimmer, T

    2000-01-01

    As Yogi Berra once said, "The future ain't what it used to be." In the era of rapid change in health care, hospice and palliative care programs will survive only through organizational teamwork. Using the lessons of baseball, we present a stadium-eye perspective on how programs can take the three fundamentals of baseball--pitching, batting, and fielding--and translate them into the three fundamentals of organizational teamwork--clinical, operational, and financial. The best clinicians (pitchers) are of no use if the office operations (batting) keep the patients (fans) out of the stadium and no program can survive without the financial resources (fielding.) When you come to a fork in the road, take it.

  1. The Web-based worksheet: an opportunity for prompt, consistent, and expert feedback in a community-based hospice experience.

    PubMed

    Ogle, Karen; Thompson, Margaret E; Noel, Mary Margaret

    2002-10-01

    We faced a challenge in providing a consistent high-quality learning experience in hospice care, especially because our community-based medical school has students rotating in hospices in six separated communities and the number of faculty with expertise in palliative care is limited. To address these concerns, a Web-based worksheet with interaction with a central campus faculty member was designed for use in a hospice module in a family practice clerkship.

  2. Space Weather Products at the Community Coordinated Modeling Center

    NASA Technical Reports Server (NTRS)

    Hesse, Michael

    2010-01-01

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

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

    PubMed

    Severin, Laura

    2015-01-01

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

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

    PubMed

    Weaver, Charlotte A; Teenier, Pamela

    2014-01-01

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

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

    PubMed

    Weaver, Charlotte A; Teenier, Pamela

    2014-01-01

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

  6. Model-Based Systems Engineering in Concurrent Engineering Centers

    NASA Technical Reports Server (NTRS)

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

    2015-01-01

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

  7. Model-Based Systems Engineering in Concurrent Engineering Centers

    NASA Technical Reports Server (NTRS)

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

    2015-01-01

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

  8. Center for Programming Models for Scalable Parallel Computing

    SciTech Connect

    John Mellor-Crummey

    2008-02-29

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

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

    SciTech Connect

    Mellor-Crummey, John

    2011-09-13

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

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

    PubMed Central

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

    2014-01-01

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

  11. Advances in Global Magnetosphere Modeling at the Community Coordinated Modeling Center.

    NASA Astrophysics Data System (ADS)

    Kuznetsova, Maria

    2016-07-01

    The Community Coordinated Modeling Center (CCMC) hosts a set of state-of-the-art global magnetosphere models that are capable to reproduce a broad range of physical phenomena in Earth's magnetosphere. We will discuss successes and challenges in global magnetosphere modeling and the role of non-MHD effects on global dynamics.

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

    NASA Technical Reports Server (NTRS)

    Hesse, Michael

    2006-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2012-05-01

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

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

    PubMed Central

    Cavanagh, Maureen

    2014-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  16. Chemical domain of QSAR models from atom-centered fragments.

    PubMed

    Kühne, Ralph; Ebert, Ralf-Uwe; Schüürmann, Gerrit

    2009-12-01

    A methodology to characterize the chemical domain of qualitative and quantitative structure-activity relationship (QSAR) models based on the atom-centered fragment (ACF) approach is introduced. ACFs decompose the molecule into structural pieces, with each non-hydrogen atom of the molecule acting as an ACF center. ACFs vary with respect to their size in terms of the path length covered in each bonding direction starting from a given central atom and how comprehensively the neighbor atoms (including hydrogen) are described in terms of element type and bonding environment. In addition to these different levels of ACF definitions, the ACF match mode as degree of strictness of the ACF comparison between a test compound and a given ACF pool (such as from a training set) has to be specified. Analyses of the prediction statistics of three QSAR models with their training sets as well as with external test sets and associated subsets demonstrate a clear relationship between the prediction performance and the levels of ACF definition and match mode. The findings suggest that second-order ACFs combined with a borderline match mode may serve as a generic and at the same time a mechanistically sound tool to define and evaluate the chemical domain of QSAR models. Moreover, four standard categories of the ACF-based membership to a given chemical domain (outside, borderline outside, borderline inside, inside) are introduced that provide more specific information about the expected QSAR prediction performance. As such, the ACF-based characterization of the chemical domain appears to be particularly useful for QSAR applications in the context of REACH and other regulatory schemes addressing the safety evaluation of chemical compounds.

  17. Organizational models of emerging academic health science centers in England.

    PubMed

    Ovseiko, Pavel V; Davies, Stephen M; Buchan, Alastair M

    2010-08-01

    Recent government policy initiatives to foster medical innovation and high-quality care in England have prompted academic and clinical leaders to develop new organizational models to support the tripartite Flexnerian mission of academic medicine. Medical schools and health care providers have responded by aligning their missions and creating integrated governance structures that strengthen their partnerships. In March 2009, the government officially designated five academic-clinical partnerships as England's first academic health science centers (AHSCs). As academic-clinical integration is likely to continue, future AHSC leaders could benefit from an analysis of models for organizing medical school-clinical enterprise relationships in England's emerging AHSCs. In addition, as the United States ponders health systems reform and universal coverage, U.S. medical leaders may benefit from insight into the workings of academic medicine in England's universal health system. In this article, the authors briefly characterize the organization and financing of the National Health Service and how it supports academic medicine. They review the policy behind the designation of AHSCs. Then, the authors describe contrasting organizational models adopted in two of the newly designated AHSCs and analyze these models using a framework derived from U.S. literature. The authors conclude by outlining the major challenges facing academic medicine in England and offer suggestions for future research collaborations between leaders of AHSCs in the United States and England.

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

    PubMed

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

    2016-03-28

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

  19. A multi-pathway model for photosynthetic reaction center

    NASA Astrophysics Data System (ADS)

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

    2016-03-01

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

  20. Dying from cancer in community hospitals or a hospice: closest lay carers' perceptions.

    PubMed Central

    Seamark, D A; Williams, S; Hall, M; Lawrence, C J; Gilbert, J

    1998-01-01

    BACKGROUND: Despite there being around 400 community hospitals in the United Kingdom, there is little published research on the quality of service provided by these hospitals. AIM: To compare the quality of terminal cancer care in community hospitals with a hospice as assessed by patients' closest lay carer (relative or friend). METHOD: Structured interview (or questionnaire based on the interview proforma) with closest lay carers of all patients dying over one year in 12 community hospitals in east Devon and a purpose-built hospice in the city of Exeter. RESULTS: A total of 292 cases (176 in community hospitals and 116 in a hospice) were identified, resulting in 238 carers being eligible for interview or questionnaire survey. Overall, 106 successful interviews and 55 questionnaires were completed, giving a response rate of 67.6%. Carers gave a near unanimous vote of excellence for the total care given by the hospice, while around 40% of carers of patients in community hospitals considered that improvements were possible. Community hospitals attracted more negative comments than hospices, with criticism being directed at problems of communication, lack of nursing staff, and lack of support in bereavement. Carers of hospice patients were significantly more likely to be present at the time of death than those of community hospital patients [45/70 (64%) vs. 31/89 (35%); chi 2 = 13.6, P < 0.001], an observation possibly because nursing staff in community hospitals are less experienced at dealing with terminally ill patients and such hospitals have fewer adequate facilities. CONCLUSIONS: Lay carers indicated great satisfaction with care given in the hospice and less satisfaction with care given in the community hospitals. However, the community hospitals are non-specialist units with far lower levels of trained staff. Improvements in terms of the communication skills of doctors and nurses, specific training for nurses in palliative care, and structured bereavement care

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

    PubMed

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

    2013-09-01

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

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

  3. SNAPPS: a learner-centered model for outpatient education.

    PubMed

    Wolpaw, Terry M; Wolpaw, Daniel R; Papp, Klara K

    2003-09-01

    The unique character of medical education in the outpatient setting has created challenges in teaching and learning that cannot be solved by the adaptation of traditional inpatient approaches. Previous work and the authors' own observational study describe a relatively passive learner focused on reporting history and physical examination data to the preceptor. Based on the work of Bordage in cognitive learning, and that of Osterman and Kottkamp on reflective practice for educators, the authors have developed a collaborative model for case presentations in the outpatient setting that links learner initiation and preceptor facilitation in an active learning conversation. This learner-centered model for case presentations to the preceptor follows a mnemonic called SNAPPS consisting of six steps: (1) Summarize briefly the history and findings; (2) Narrow the differential to two or three relevant possibilities; (3) Analyze the differential by comparing and contrasting the possibilities; (4) Probe the preceptor by asking questions about uncertainties, difficulties, or alternative approaches; (5) Plan management for the patient's medical issues; and (6) Select a case-related issue for self-directed learning. The authors conducted a pilot study of SNAPPS, introducing the model to both third-year medical students and their preceptors. Feedback was enthusiastic and underscored the importance of the paired approach. SNAPPS represents a paradigm shift in ambulatory education that engages the learner and creates a collaborative learning conversation in the context of patient care. PMID:14507619

  4. Staff stress in the children's hospice: causes, effects and coping strategies.

    PubMed

    Barnes, K

    2001-05-01

    Although there are an increasing number of hospices opening around the country, the concept of the children's hospice is still relatively new. Although stress involved in giving palliative care to adults has been examined quite extensively, very little work has been done on the impact of caring for children in the hospice setting. This article is a literature review, examining the causes and effects of staff stress in the children's hospice, as well as the factors that enable staff to cope with working in this environment. It concludes that the main causes of stress are often related to conflicts within the staff group, communication problems and role conflict. Poor relationships with the child's family as well as the inability to relieve distressing symptoms the child may be experiencing have also been identified as common sources of stress. Teamwork, good communication and the home-like atmosphere of the hospice all contribute to enabling staff to deal with work stress. Staff support groups may be beneficial, but need to be run well, by someone experienced in leading such groups. Additionally, stress can be reduced by providing staff with the appropriate training and education and by encouraging them to take some responsibility for preventing and relieving stress themselves.

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

    ERIC Educational Resources Information Center

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

    2008-01-01

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

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

    ERIC Educational Resources Information Center

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

    2008-01-01

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

  7. 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.

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

    EPA Science Inventory

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

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

    EPA Science Inventory

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

  10. End-of-life care in a children's hospice program.

    PubMed

    Steele, Rose; Davies, Betty; Collins, John B; Cook, Karen

    2005-01-01

    A project was completed in 1999 to evaluate the Canuck Place children's hospice program. This article reports only on the end-of-life care component. Results are provided from mail-out surveys with families who required end-of-life care and are supplemented by qualitative data which were collected from interviews with individuals prior to the survey. Eighteen families completed face-to-face interviews and another 70 families completed the mail-out questionnaire developed from the initial interviews. A total of 39 parents responded to the survey section about end-of-life care services. Results indicated that parents were reasonably comfortable discussing death with staff; they generally felt well prepared for their child's death because of the staff; the death of another child had a significant effect on families; parents' wishes at the time of their child's death were very supported by staff; and families were well supported by staff at the time of a child's death. Implications for practice and suggestions for future research are discussed.

  11. Developing competencies for pediatric hospice and palliative medicine.

    PubMed

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

    2014-12-01

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

  12. On modeling center of foot pressure distortion through a medium.

    PubMed

    Betker, Aimee L; Moussavi, Zahra M K; Szturm, Tony

    2005-03-01

    The center of foot pressure (COP) is a commonly used output measure of the postural control system as it is indicative of the systems stability. A dense piece of foam, i.e., a sponge, can be used to emulate random environmental conditions that distort the ground reaction forces received and interpreted by the cutaneous sensors in the feet; thus introducing uncertainty into the control system. In this paper, the density and size of the sponge was selected such that a subject's weight did not cause full compression. In general, the COP is measured from the bottom of the sponge. As the sponge is used to distort ground reaction forces, it is reasonable then to assume that the COP signal would also be distorted. The use of other sensory information to identify state of balance, and compute necessary balance adjustments, is therefore required. In addition to a sponge, many different types of specialized footwear and inserts are used for people with peripheral neuropathy, such as diabetics. However, it is difficult to design diabetic footwear without a better understanding of the mechanical and physiological effects that different surfaces typical of outdoor terrains, such as a sponge, which cannot be predicted without the sense of the foot, have on balance. Therefore, the goal of this study was to investigate the change of the COP signal from the top and bottom of the sponge. Portable force sensing mats from Vista Medical were used to obtain the COP from the top and bottom of the sponge. The COP measured on the bottom of the sponge is not the same as the COP measured on the top, particularly in the medial-lateral direction. Several linear and nonlinear models were used to identify the unknown plant; i.e., the sponge. Overall, the nonlinear neural network method had superior performance when compared with the linear models. Thus, the results indicate that the signals from the top and bottom of the sponge are in fact different, and furthermore, they are nonlinearly related

  13. Holding on to what you have got: keeping hospice palliative care volunteers volunteering.

    PubMed

    Claxton-Oldfield, Stephen; Jones, Richard

    2013-08-01

    In all, 119 hospice palliative care volunteers from 3 community-based hospice programs completed the Volunteer Retention Questionnaire (VRQ), a 33-item survey designed for this study. The VRQ asks volunteers to rate the importance of each item to their decision to continue volunteering. The items that received the highest mean importance ratings included enjoying the work they do, feeling adequately prepared/trained to perform their role, and learning from their patients' experiences/listening to their patients' life stories. Being recognized (eg, pins for years of service or being profiled in the hospice newsletter), receiving phone calls/cards from their volunteer coordinator on special occasions, and being reimbursed for out-of-pocket expenses were among the items that received the lowest mean importance ratings. Suggestions for improving volunteer retention are provided.

  14. Pacemaker and defibrillator deactivation in competent hospice patients: an ethical consideration.

    PubMed

    Ballentine, Jennifer M

    2005-01-01

    The Denver Community Bioethics Committee (DCBC) is an independent, community-based group that undertakes ethics consultations for any individual or organization. Its members include adult protection professionals, physicians, elder-law attorneys, chaplains, nurses, social workers, and lay persons. In its 11-year history, the Committee has heard numerous cases concerning end-of-life care, futile treatment, and patients' rights. In 2003, a Colorado hospice provider asked the DCBC for assistance in developing a policy on deactivation of pacemakers and defibrillators in competent hospice patients. The hospice had encountered concerns from some physicians and cardiac care clinicians that deactivating such devices treads the fine line between legitimate withdrawal of burdensome treatment and assisted death. Although the specific deliberations of the DCBC are confidential, this article summarizes contributions from the committee's discussion, as well as independent research undertaken by the author.

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

    PubMed

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

    2012-05-01

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

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

    PubMed

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

    2012-05-01

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

  17. Work environment facilitators to the availability of complementary and alternative therapies in perinatal hospices

    PubMed Central

    Wool, Charlotte; Kozak, Leila E.; Lindley, Lisa C.

    2015-01-01

    Increasingly, patients and clinicians are considering palliative care interventions during pregnancy for the maternal-fetal dyad, when a life-limiting diagnosis is confirmed. Nurses are at the forefront of providing hospice and palliative care that includes planning interventions for infants nearing the end of life. However, little is known about the work environment facilitators to the availability of complementary and alternative medicine (CAM) therapies. Using a national database of perinatal hospice and palliative care providers, we described the types of CAM therapies available and explored the influence of the nurse work environment on the availability of CAM therapies with multivariate regression analysis. This study showed that having an education environment where clinicians are trained, along with a highly educated RN support staff, and a BSN educated staff were critical to the availability of CAM therapies. The clinical implications for hospice and palliative nurses caring for infants and their families were discussed. PMID:26877713

  18. Unique and universal barriers: hospice care for aging adults with intellectual disability.

    PubMed

    Friedman, Sandra L; Helm, David T; Woodman, Ashley C

    2012-11-01

    As life expectancy of people with intellectual disability (ID) has increased, there has been a concurrent increase in age-related illnesses and conditions similar to that of the general population. These circumstances result in people with ID dying from typical life-ending conditions, and thus, they require similar end-of-life services such as palliative and hospice care. Although there are notable barriers to hospice for all, people with ID face additional challenges in accessing the benefits of these services. This article presents a review of the literature on these issues, underscoring the multiple challenges and the importance of a more collaborative approach between hospice and palliative care workers with people with ID, their families, and other important stakeholders.

  19. Advance directives in home health and hospice agencies: United States, 2007.

    PubMed

    Resnick, Helaine E; Hickman, Susan E; Foster, Gregory L

    2011-11-01

    This report provides nationally representative data on policies, storage, and implementation of advance directives (ADs) in home health and hospice (HHH) agencies in the United States using the National Home and Hospice Care Survey. Federally mandated ADs policies were followed in >93% of all agencies. Nearly all agencies stored ADs in a file at the agency, but only half stored them at the patient's residence. Nearly all agencies informed staff about the AD, but only 77% and 72% of home health agencies informed the attending physician and next-of-kin, respectively. Home health and hospice agencies are nearly universally compliant with ADs policies that are required in order to receive Medicare and Medicaid payments, but have much lower rates of adoption of ADs policies beyond federally mandated minimums. PMID:21398271

  20. Utilization of Hospice Bereavement Support by At-Risk Family Members

    PubMed Central

    Ghesquiere, Angela; Thomas, Julie; Bruce, Martha L.

    2015-01-01

    Approximately 10% of the bereaved are at risk of bereavement-related mental health disorders. Hospices’ bereavement services could potentially address needs of many at risk, but little is known about their service use. We analyzed data from 6160 bereaved family members of hospice patients. Risk of mental health problems was identified by hospice providers postloss. Of those characterized as “at-risk,” 52% used services compared to 18% of the “low risk.” Factors associated with service use among at-risk were female gender and younger age of death. Those who lost a child used services less than other bereaved. Although hospices appear to be skilled at identifying and providing bereavement services to the at-risk, services do not reach almost half. Results suggest the need to improve care access, especially among men and those losing a child. PMID:25326490

  1. Socioeconomic Factors Associated With Posthospitalization Hospice Care Settings: A 5-Year Perspective.

    PubMed

    Kirkendall, Abbie; Shen, Jay J; Greenway, Joseph; Bai, Wenbo

    2016-04-01

    Investigating whether socioeconomic characteristics determine if hospice is received at home or in a medical facility is important to examine, considering most patients prefer to die at home. This study relied upon The State Inpatient Data of Nevada. A total of 19 206 discharges were analyzed from the data set between 2009 and 2013. The results indicate that increasingly patients are being discharged to home and overall socioeconomic characteristics appear to have less of an influence over whether hospice is received at home or in a medical facility. Further research on the perspectives of patients would provide insight into whether patients' preferences or socioeconomic characteristics are more influential on where hospice services are received.

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

    PubMed Central

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

    2010-01-01

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

  3. A Noninferiority Trial of a Problem-Solving Intervention for Hospice Caregivers: In Person versus Videophone

    PubMed Central

    Parker Oliver, Debra; Wittenberg-Lyles, Elaine; Washington, Karla; Doorenbos, Ardith; Rue, Tessa; Berry, Donna

    2012-01-01

    Abstract Purpose of the study Problem-solving therapy (PST) has been found effective when delivered to informal caregivers of patients with various conditions. In hospice, however, its translation to practice is impeded by the increased resources needed for its delivery. The study purpose was to compare the effectiveness of a PST intervention delivered face-to-face with one delivered via videophone to hospice primary caregivers. Design and methods The study design was a randomized noninferiority trial with two groups, Group 1 in which caregivers received PST face-to-face, and Group 2 in which caregivers received PST via videophone. Family hospice caregivers were recruited from two urban hospice agencies and received the PST intervention (in three visits for Group 1 or three video-calls in Group 2) in an approximate period of 20 days after hospice admission. Standard caregiver demographic data were collected. Psychometric instruments administered to caregivers at baseline and at study completion included the CQLI-R (Caregiver Quality of Life Index–Revised), the STAI (State-Trait Anxiety Inventory), and the PSI (Problem-Solving Inventory). Results One hundred twenty-six caregivers were recruited in the study; 77 were randomly assigned to Group 1 and 49 to Group 2. PST delivered via video was not inferior to face-to-face delivery. The observed changes in scores were similar for each group. Caregiver quality of life improved and state anxiety decreased under both conditions. Conclusions The delivery of PST via videophone was not inferior to face-to-face. Audiovisual feedback captured by technology may be sufficient, providing a solution to the geographic barriers that often inhibit the delivery of these types of interventions to older adults in hospice. PMID:22536989

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

    NASA Technical Reports Server (NTRS)

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

    1995-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    1995-03-01

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

  6. Model Programs: Childhood Education. Perceptual Development Center Program.

    ERIC Educational Resources Information Center

    American Institutes for Research in the Behavioral Sciences, Silver Spring, MD.

    The Perceptual Development Center was established in 1967 through ESEA Title III funds to provide diagnostic and remedial services for reading disabled elementary-school students. Concentrating on dyslexic students, the program includes a demonstration center, a diagnostic program, inservice training programs, and community education.…

  7. Sharing atrocity stories in hospice: A study of niceness message strategies in interdisciplinary team meetings.

    PubMed

    Wittenberg-Lyles, Elaine; Oliver, Debra Parker; Demiris, George; Cunningham, Cody P

    2011-07-01

    The telling of atrocity stories offers therapeutic benefits to healthcare providers. Transcripts of hospice interdisciplinary team (IDT) meetings were used to analyze strategies for telling atrocity stories in the performance of symbiotic niceness through criticism. Symbiotic niceness draws upon niceness messages to establish reciprocal niceness by others in order to facilitate emotional labor. In IDT meetings the two predominant strategy types used were indirect and direct criticism. Nurses and medical directors engaged in niceness message strategies mostly about patients and other healthcare professionals. The study concludes that hospice IDT meetings are a venue for team members to communicate symbiotic niceness through emotional labor.

  8. The new hospice compliance plan: defining and addressing risk areas. Part 2.

    PubMed

    Jones, D H; Woods, K

    2000-06-01

    The Department of Health and Human Services' (HHS) Office of the Inspector General (OIG), has advised hospices and other health care providers to formulate effective controls to ensure compliance with federal and state statutes, rules, and regulations, and private-payor health care program requirements. This is the second of three installments that focus specifically on the 28 risk areas identified in the guidance and offer strategies for incorporating them in a hospice compliance program. This article covers the areas of Expensive Care, Documentation, Interdisciplinary Group, and Kickbacks.

  9. Treatment of lower extremity oedema by subcutaneous drainage in a home hospice patient.

    PubMed

    Rodgers, Susan; Birkholz, Lorri; Hebert, Randy

    2013-04-29

    Lower extremity oedema is common in patients with advanced illness and can normally be managed with oral diuretics and elevation of the involved extremities. The management of oedema can be more complicated in home hospice patients, however. They tend to be more frail and are often less able to tolerate usual interventions. We present a case of a home hospice patient with severe oedema treated by creating subcutaneous tracts in his legs to allow drainage of excess interstitial fluid. The procedure was very successful in improving the patient's quality of life.

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

    PubMed Central

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

    2014-01-01

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

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

    ERIC Educational Resources Information Center

    Newman, Carole; And Others

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

  12. Developing competencies for pediatric hospice and palliative medicine.

    PubMed

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

    2014-12-01

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

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

    PubMed

    Mead, Holly; Andres, Ellie; Regenstein, Marsha

    2014-02-01

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

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

    PubMed Central

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

    2015-01-01

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

  15. Center of Excellence in Model-Based Human Performance

    NASA Technical Reports Server (NTRS)

    Wandell, Brian A.

    1997-01-01

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

  16. Center of Excellence in Model-Based Human Performance

    NASA Technical Reports Server (NTRS)

    Wandell, Brian A.

    1997-01-01

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

  17. "Don't tell her she's on hospice": ethics and pastoral care for families who withhold medical information.

    PubMed

    Gentry, Jerry

    2008-01-01

    When family members enroll a patient in hospice, they sometimes request that the patient not be told of the diagnosis and their enrollment in hospice--usually so the patient won't be sad. In these situations, hospice staff face an ethical dilemma involving a patient's right to full disclosure. A discussion of this issue at an ethics committee session, chaired by the author of this article, brought to light many personal dynamics associated with these situations, and the discussion is used by the author to draw conclusions about pastoral care for these patients and families. Several responses from colleagues follow.

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

    ERIC Educational Resources Information Center

    McGrath, Pam

    2004-01-01

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

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

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-22

    ... Index) 2. Changes to Core-Based Statistical Area (CBSA) Designations 3. Definition of Rural and Urban..., social, psychological, emotional, and spiritual services through use of a broad spectrum of professional... 1861(dd) of the Social Security Act (the Act) provides for coverage of hospice care for terminally...

  1. 42 CFR 418.76 - Condition of participation: Hospice aide and homemaker services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... a minimum of 2 years nursing experience, at least 1 year of which must be in home care, or by other... standards for home health agencies. (iii) Been subjected to a suspension of Medicare payments to which it... personnel requirements specified in paragraph (j) of this section. (a) Standard: Hospice aide...

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

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... a minimum of 2 years nursing experience, at least 1 year of which must be in home care, or by other... standards for home health agencies. (iii) Been subjected to a suspension of Medicare payments to which it... personnel requirements specified in paragraph (j) of this section. (a) Standard: Hospice aide...

  3. 42 CFR 418.110 - Condition of participation: Hospices that provide inpatient care directly.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... applicable to nursing homes of the 2000 edition of the Life Safety Code (LSC) of the National Fire Protection... the following standards: (a) Standard: Staffing. The hospice is responsible for ensuring that staffing... needed to ensure that plan of care outcomes are achieved and negative outcomes are avoided. (b)...

  4. 42 CFR 418.110 - Condition of participation: Hospices that provide inpatient care directly.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... applicable to nursing homes of the 2000 edition of the Life Safety Code (LSC) of the National Fire Protection... the following standards: (a) Standard: Staffing. The hospice is responsible for ensuring that staffing... needed to ensure that plan of care outcomes are achieved and negative outcomes are avoided. (b)...

  5. 42 CFR 418.76 - Condition of participation: Hospice aide and homemaker services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... a minimum of 2 years nursing experience, at least 1 year of which must be in home care, or by other... standards for home health agencies. (iii) Been subjected to a suspension of Medicare payments to which it... personnel requirements specified in paragraph (j) of this section. (a) Standard: Hospice aide...

  6. 42 CFR 418.76 - Condition of participation: Hospice aide and homemaker services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... a minimum of 2 years nursing experience, at least 1 year of which must be in home care, or by other... standards for home health agencies. (iii) Been subjected to a suspension of Medicare payments to which it... personnel requirements specified in paragraph (j) of this section. (a) Standard: Hospice aide...

  7. 42 CFR 418.76 - Condition of participation: Hospice aide and homemaker services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... a minimum of 2 years nursing experience, at least 1 year of which must be in home care, or by other... standards for home health agencies. (iii) Been subjected to a suspension of Medicare payments to which it... personnel requirements specified in paragraph (j) of this section. (a) Standard: Hospice aide...

  8. Health Care, Hospice, and Home Economists: A Programmatic Response to Demographic Trends.

    ERIC Educational Resources Information Center

    Balkwell, Carolyn; And Others

    1986-01-01

    Suggests ways that teams of home economists, integrating information from constituent fields of the discipline, may provide important services to hospices. Suggestions are included from the areas of human development and family relations, foods and nutrition, housing and interior design, clothing and textiles, and financial management and decision…

  9. Making decisions about care: what it means for hospice inpatients with terminal progressive disease.

    PubMed

    Fisher, Simon; Colyer, Hazel

    2009-11-01

    There is very little research into patients who suffer from a terminal and progressive illness making decisions about health care in a hospice setting. What decision-making means to the inpatients in a hospice could be better understood by staff caring for this patient group. The aim of this small qualitative study was to explore the nature of decisions and the process of decision-making with patients who had been admitted to a hospice with a progressive terminal illness. A phenomenological approach was taken using a theoretical framework to explore the patients' life world and its existential meaning, and interviews were conducted with six inpatients. The decisions that came to the fore for the participants were around the driving force behind admission, which was often pain. Beyond this often traumatic event they were able to be robust in decision-making about day-to-day issues. Other decisions related to the purpose of the admission such as symptom control, achieving independence, whether to have further treatment, communication with their families and returning to the community. Patients had an increased awareness of the fragility of their existence, which was brought into focus by the decision to be admitted to the hospice. The findings give an insight into the driving forces behind decision-making and the kind of decisions that are important to the patients in this sample, which staff caring for this patient group may find valuable.

  10. 76 FR 71920 - Payment for Home Health Services and Hospice Care by Non-VA Providers

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-21

    ... medical charges associated with non-VA outpatient care, provided under 38 CFR 17.52 or 17.120. 75 FR 78901.... See 75 FR 78901. We explained: Home Health Care and Hospice Care he pricing methodology adopted by...-day period was $2,537.40 in FY 2010. The average Medicare reimbursement level for skilled home...

  11. 78 FR 38594 - Medicare and Medicaid Programs; Requirements for Long Term Care Facilities; Hospice Services

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-27

    ... the June 5, 2008 final rule (73 FR 32088) titled ``Medicare and Medicaid Program: Hospice Conditions..., 2010 (75 FR 65282). In that rule, we proposed to revise the requirements that an institution would have...'' (76 FR 9503). The interim final rule added separate standards at Sec. Sec. 483.75(r) and (s)....

  12. 75 FR 65282 - Medicare and Medicaid Programs; Requirements for Long Term Care Facilities; Hospice Services

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-22

    ... forth requirements consistent with requirements in the June 5, 2008 final rule (73 FR 32088) entitled... skilled nursing facility (SNF) in the Medicare program, or as a nursing facility (NF) in the Medicaid... the hospice) is required to have the lead in providing required end-of-life care to SNF residents...

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

    PubMed

    Chao, Co-Shi Chantal

    2015-04-01

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

  14. The Medicare Hospice Benefit: Ten Years of Federal Policy for the Terminally Ill.

    ERIC Educational Resources Information Center

    Miller, Pamela J.; Mike, Paula B.

    1995-01-01

    The political and social development of the Medicare Hospice Benefit combines humanitarian and cost-saving strategies. Although it mainstreamed care of the terminally ill and provided multiple services, four major constraints of the benefit package are identified and explored. It is important that we analyze this policy before we devise new ways…

  15. The Hospice Caregiver Assessment: A Study of a Case Management Tool for Professional Assistance.

    ERIC Educational Resources Information Center

    Etten, Mary Jean; Kosberg, Jordan I.

    1989-01-01

    Developed Hospice Caregiver Assessment Inventory to identify problems of those caring for dying patients, and Caregiver Intervention Plan. Analysis of 24 inventories and assessment plans identified problems of caregivers of dying older people. Results suggest that caregivers often need counseling assistance prior to death of patient, as well as…

  16. 76 FR 44010 - Medicare Program; Hospice Wage Index for Fiscal Year 2012; Correction

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-22

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

  17. Three-center tight-binding potential model for C and Si

    NASA Astrophysics Data System (ADS)

    Lu, Wen-Cai; Wang, C. Z.; Zhao, Li-Zhen; Qin, Wei; Ho, K. M.

    2015-07-01

    A tight-binding potential model which goes beyond the Slater-Koster two-center approximation and includes explicit three-center and crystal field expressions is presented. Using carbon and silicon as examples, we show that various bulk structures, surface reconstructions, and the structures of clusters and liquids of C and Si can be well described by the present three-center tight-binding model. These results demonstrate that three-center interaction and crystal field effect are very important for improving the transferability of tight-binding models in describing the structures and properties of materials over a broad range of bonding configurations.

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

    PubMed

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

    2015-07-01

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

  19. User Interface Models for Multidisciplinary Bibliographic Information Dissemination Centers.

    ERIC Educational Resources Information Center

    Zipperer, W. C.

    Two information dissemination centers at University of California at Los Angeles and University of Georgia studied the interactions between computer based search facilities and their users. The study, largely descriptive in nature, investigated the interaction processes between data base users and profile analysis or information specialists in…

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

    ERIC Educational Resources Information Center

    Colelli, Richard

    2009-01-01

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

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

    ERIC Educational Resources Information Center

    Sugar, William A.; Boling, Elizabeth

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

  2. The Door: A Model Youth Center. Treatment Program Monograph Series.

    ERIC Educational Resources Information Center

    National Inst. on Drug Abuse (DHHS/PHS), Rockville, MD.

    This report provides basic facts about The Door, a multifaceted youth center in New York City, which serves 300-400 young people each day. The origins, early stages, guiding philosophy, activities, and organizational structure are described. Recommendations for initiating and operating multiservice youth projects based on the experience of The…

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

    NASA Astrophysics Data System (ADS)

    Kuznetsova, Maria

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

  4. Providing Patient-Centered Culturally Sensitive Health Care: A Formative Model

    ERIC Educational Resources Information Center

    Tucker, Carolyn M.; Herman, Keith C.; Ferdinand, Lisa A.; Bailey, Tamika R.; Lopez, Manuel Thomas; Beato, Cristina; Adams, Diane; Cooper, Leslie L.

    2007-01-01

    This article describes the literature-based, testable, formative Patient-Centered Culturally Sensitive Health Care Model that explains the associations between patient-centered culturally sensitive health care, health-promoting treatment behaviors, and health outcomes and statuses. An intervention program based on the model and its foundational…

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

    Stickrath, Chad; Aagaard, Eva; Anderson, Mel

    2013-03-01

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

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

    PubMed

    Stickrath, Chad; Aagaard, Eva; Anderson, Mel

    2013-03-01

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

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

    NASA Technical Reports Server (NTRS)

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

    2010-01-01

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

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

    PubMed Central

    Kamell, Andrew

    2016-01-01

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

  10. How might Levinas' concept of the other's priority and Derrida's unconditional hospitality contribute to the philosophy of the modern hospice movement?

    PubMed

    Floriani, Ciro Augusto; Schramm, Fermin Roland

    2010-06-01

    Hospitality is commonly referred as one of the meanings of hospes, the Latin word which is also the root of hospice. This article explores the semantics of the word hospice - the seal of identity of modern hospice movement - and attempts to integrate the meaning of hospitality into the modern hospice movement, understood as unconditional reception. Therefore, the article analyzes the concept of unconditional hospitality, developed by Jacques Derrida and that of ethical responsibility proposed by Emmanuel Levinas based on the phenomenological experience of the other. From this point of view, these two concepts tie in with the meaning of hospice, bringing substantial grounding elements to the hospice movement for the construction of a protective ethos. PMID:20307370

  11. The ultimate birth center: a collaborative model for innovation.

    PubMed

    Lyons, N; Reinke, C; Sutherland, K; Zelenkov, K

    1992-03-01

    Lest these descriptions sound too good to be true, Virginia Mason Birth Center is not utopia. It is a real place with real problems and struggles. Implementing and maintaining personalized, high-quality obstetric care to the childbearing woman and her family has not come easily. Innovations continue to be developed in response to patients' and providers' desire for birth services that are flexible, sensitive, and designed around families' preferences and needs. A common philosophy continues to guide a dedicated staff, administration, and provider group within a framework of collaboration, innovation, and quality to enable a wonderful professional practice to evolve.

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

    PubMed

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

    2008-01-01

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

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

    PubMed

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

    2008-01-01

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

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

    PubMed

    Harrison, Krista L; Connor, Stephen R

    2016-08-01

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

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

    PubMed

    Gilstrap, Cristina M; White, Zachary M

    2015-01-01

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

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

    PubMed

    Harrison, Krista L; Connor, Stephen R

    2016-08-01

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

  17. Scientific Benefits of Space Science Models Archiving at Community Coordinated Modeling Center

    NASA Technical Reports Server (NTRS)

    Kuznetsova, Maria M.; Berrios, David; Chulaki, Anna; Hesse, Michael; MacNeice, Peter J.; Maddox, Marlo M.; Pulkkinen, Antti; Rastaetter, Lutz; Taktakishvili, Aleksandre

    2009-01-01

    The Community Coordinated Modeling Center (CCMC) hosts a set of state-of-the-art space science models ranging from the solar atmosphere to the Earth's upper atmosphere. CCMC provides a web-based Run-on-Request system, by which the interested scientist can request simulations for a broad range of space science problems. To allow the models to be driven by data relevant to particular events CCMC developed a tool that automatically downloads data from data archives and transform them to required formats. CCMC also provides a tailored web-based visualization interface for the model output, as well as the capability to download the simulation output in portable format. CCMC offers a variety of visualization and output analysis tools to aid scientists in interpretation of simulation results. During eight years since the Run-on-request system became available the CCMC archived the results of almost 3000 runs that are covering significant space weather events and time intervals of interest identified by the community. The simulation results archived at CCMC also include a library of general purpose runs with modeled conditions that are used for education and research. Archiving results of simulations performed in support of several Modeling Challenges helps to evaluate the progress in space weather modeling over time. We will highlight the scientific benefits of CCMC space science model archive and discuss plans for further development of advanced methods to interact with simulation results.

  18. A Model for Treatment in a Native American Family Service Center.

    ERIC Educational Resources Information Center

    Metcalf, Ann; And Others

    Contrasting the differences between a non-Indian child abuse/neglect center with an Indian model, this report highlights the qualities of the Urban Indian Child Resource Center (CRC) in Oakland, California. The non-Indian concept of the cause of child abuse/neglect, based on the abused/neglected childhood of the parent, is compared to the Indian…

  19. A New Extension Model: The Memorial Middle School Agricultural Extension and Education Center

    ERIC Educational Resources Information Center

    Skelton, Peter; Seevers, Brenda

    2010-01-01

    The Memorial Middle School Agricultural Extension and Education Center is a new model for Extension. The center applies the Cooperative Extension Service System philosophy and mission to developing public education-based programs. Programming primarily serves middle school students and teachers through agricultural and natural resource science…

  20. A Learner-Centered Molecular Modeling Exercise for Allied Health Majors in a Biochemistry Class

    ERIC Educational Resources Information Center

    Fletcher, Terace M.; Ershler, Jeff

    2014-01-01

    Learner-centered molecular modeling exercises in college science courses can be especially challenging for nonchemistry majors as students typically have a higher degree of anxiety and may not appreciate the relevance of the work. This article describes a learner-centered project given to allied health majors in a Biochemistry course. The project…

  1. The global change research center atmospheric chemistry model

    SciTech Connect

    Moraes, F.P. Jr.

    1995-01-01

    This work outlines the development of a new model of the chemistry of the natural atmosphere. The model is 2.5-dimensional, having spatial coordinates height, latitude, and, the half-dimension, land and ocean. The model spans both the troposphere and stratosphere, although the troposphere is emphasized and the stratosphere is simple and incomplete. The chemistry in the model includes the O{sub x}, HO{sub x}, NO{sub x}, and methane cycles in a highly modular fashion which allows model users great flexibility in selecting simulation parameters. A detailed modeled sensitivity analysis is also presented. A key aspect of the model is its inclusion of clouds. The model uses current understanding of the distribution and optical thickness of clouds to determine the true radiation distribution in the atmosphere. As a result, detailed studies of the radiative effects of clouds on the distribution of both oxidant concentrations and trace gas removal are possible. This work presents a beginning of this study with model results and discussion of cloud effects on the hydroxyl radical.

  2. Applying Forecast Models from the Center for Integrated Space Weather Modeling

    NASA Astrophysics Data System (ADS)

    Gehmeyr, M.; Baker, D. N.; Millward, G.; Odstrcil, D.

    2007-12-01

    The Center for Integrated Space Weather Modeling (CISM) has developed three forecast models (FMs) for the Sun-Earth chain. They have been matured by various degrees toward the operational stage. The Sun-Earth FM suite comprises empirical and physical models: the Planetary Equivalent Amplitude (AP-FM), the Solar Wind (SW- FM), and the Geospace (GS-FM) models. We give a brief overview of these forecast models and touch briefly on the associated validation studies. We demonstrate the utility of the models: AP-FM supporting the operations of the AIM (Aeronomy of Ice in the Mesosphere) mission soon after launch; SW-FM providing assistance with the interpretation of the STEREO beacon data; and GS-FM combining model and observed data to characterize the aurora borealis. We will then discuss space weather tools in a more general sense, point out where the current capabilities and shortcomings are, and conclude with a look forward to what areas need improvement to facilitate better real-time forecasts.

  3. Mouse Xenograft Model for Mesothelioma | NCI Technology Transfer Center | TTC

    Cancer.gov

    The National Cancer Institute is seeking parties interested in collaborative research to co-develop, evaluate, or commercialize a new mouse model for monoclonal antibodies and immunoconjugates that target malignant mesotheliomas. Applications of the technology include models for screening compounds as potential therapeutics for mesothelioma and for studying the pathology of mesothelioma.

  4. Data Format Standardization of Space Weather Model Output at the Community Coordinated Modeling Center

    NASA Technical Reports Server (NTRS)

    Maddox, M.; Rastatter, L.; Hesse, M.

    2005-01-01

    The disparate nature of space weather model output provides many challenges with regards to the portability and reuse of not only the data itself, but also any tools that are developed for analysis and visualization. We are developing and implementing a comprehensive data format standardization methodology that allows heterogeneous model output data to be stored uniformly in any common science data format. We will discuss our approach to identifying core meta-data elements that can be used to supplement raw model output data, thus creating self-descriptive files. The meta-data should also contain information describing the simulation grid. This will ultimately assists in the development of efficient data access tools capable of extracting data at any given point and time. We will also discuss our experiences standardizing the output of two global magnetospheric models, and how we plan to apply similar procedures when standardizing the output of the solar, heliospheric, and ionospheric models that are also currently hosted at the Community Coordinated Modeling Center.

  5. Death anxiety and job stress in hospice and medical-surgical nurses.

    PubMed

    Bené, B; Foxall, M J

    1991-01-01

    This study compared death anxiety and frequency and severity of job stress in 30 hospice and 40 medical-surgical nurses. Death anxiety was assessed through the Templer/McMordie Death Anxiety Scale, job stress through the Gray-Toft/Anderson Nursing Stress Scale. There were no significant group differences in the death anxiety scores nor in the total scores for the frequency segment of the nursing stress scale. The medical-surgical nurses scored a significantly higher total for the severity segment of the nursing stress scale. Death anxiety correlated significantly with frequency and severity of job stress for medical-surgical nurses but not for hospice nurses. Death anxiety correlated highly significantly with death and dying as a source of stress for the medical-surgical nurses.

  6. Issues of power, control and choice in children's hospice respite care services: a qualitative study.

    PubMed

    Grinyer, Anne; Payne, Sheila; Barbarachild, Zephyrine

    2010-10-01

    The changes within children's palliative care services in the UK over the last decade highlight the importance of respite provision. This article reports on an evaluation of a children's hospice in northern England that was undertaken to elicit the views of 24 service users on their experiences of respite care in the hospice: parents, children and young people, siblings, guardians and family carers. Data were collected using in-depth interviews, transcribed and submitted to framework analysis. The findings demonstrate the tensions that parents in need of respite care feel as a result of the power unconsciously exercised by staff. Redistribution of resources and reordering of priorities are recommended to prevent the inadvertent impact upon families.

  7. Gendered Processes in Hospice Palliative Home Care for Seniors With Cancer and Their Family Caregivers.

    PubMed

    Sutherland, Nisha; Ward-Griffin, Catherine; McWilliam, Carol; Stajduhar, Kelli

    2016-06-01

    There has been limited investigation into the processes that shape gender (in)equities in hospice palliative home care. As part of a larger critical ethnographic study, we examined how and why gender relations occur in this context. Using a critical feminist lens, we conducted in-depth interviews with clients living with terminal cancer, their family caregivers and primary nurses; observations of agency home visits; and review of institutional documents. A gender-based analysis revealed that gender enactments of Regulating Gender Relations were legitimized through ideological processes of Normalizing Gender Relations and Equalizing Gender Relations (Re)produced through institutional discourses of individualism and egalitarianism, these gendered processes both advantaged and disadvantaged men and women in hospice palliative home care. Findings suggest that to promote equity, health care providers and policy makers must attend to gender as a prevalent social determinant of health and health care. Implications for policy, practice, education, and research are discussed. PMID:26489710

  8. Assessment of hospice health professionals' knowledge, views, and experience with medical marijuana.

    PubMed

    Uritsky, Tanya J; McPherson, Mary Lynn; Pradel, Françoise

    2011-12-01

    The medicinal and recreational use of cannabis has been controversial, especially in the United States. Marijuana for medicinal use is approved in 14 U.S. states and has recently been considered for legalization in several additional states. Given its demonstrated efficacy in symptom management, marijuana has a potential role in palliative care. This study utilized a 16-item questionnaire to assess the knowledge, experience, and views of hospice professionals regarding the use of marijuana in terminally ill patients. The study results revealed that, like the general public, hospice health care providers are generally in favor of legalization of marijuana and, if legalized, would support its use in symptom management for their terminally ill patients.

  9. TOWER 1 IN CENTER,REPLACEMENT MODEL SINGLE CHAIR IN FOREGROUND, LOOKING ...

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

    TOWER 1 IN CENTER,REPLACEMENT MODEL SINGLE CHAIR IN FOREGROUND, LOOKING SOUTHWEST UP THE LIFT LINE. - Mad River Glen, Single Chair Ski Lift, 62 Mad River Glen Resort Road, Fayston, Washington County, VT

  10. An Integrated Model of Care: A Visit to The SPARK Center, a Program of Boston Medical Center

    ERIC Educational Resources Information Center

    Griest, Christa

    2010-01-01

    This article features The SPARK Center, a program of Boston Medical Center, located in Mattapan, Massachusetts. The Center has pioneered a whole-child approach to address the multi-dimensional needs of Boston's most at-risk children, recognizing that vulnerable children need more than educational supports to flourish. The Center's integrated model…

  11. Creatively caring: effects of arts-based encounters on hospice caregivers in South Africa.

    PubMed

    Repar, Patricia Ann; Reid, Steve

    2014-05-01

    International literature and experience suggest that arts-based encounters can be effective in reducing stress and burnout in health care workers. Are these principles universal? Are they as applicable and effective in resource-constrained situations in Africa as in other parts of the world? We describe the impact of creative and arts-based encounters on a group of hospice caregivers at South Coast Hospice in KwaZulu Natal. An experienced facilitator built a caring and trusting relationship with the participants over a three month period through a variety of means, including a singing and songwriting intervention specifically designed to empower and give voice to the hospice caregivers, most of whom were Zulu women. We documented the process through several rounds of interviews, extensive field notes, and audio recordings. This article is a reflection on the experience and draws from the interviews, correspondence among researchers, field notes, and a performance piece written by the facilitator one year after completion of the study. We found that the songwriting and other creative activities of the engagement provided affirmation and acknowledgment of the caregivers as well as an opportunity to release stress, grief, and pain. They experienced changes in terms of hope and freedom both for themselves and their patients. The conceptual themes that emerged from the interviews with the caregivers were interpreted in terms of their inherent cultural assets, a release of agency, a sense of revelation, and transformation. The expressive arts can have a significantly beneficial effect on hospice workers and their patients, and clinical engagement can be enhanced through creative encounters, even in resource-constrained situations. If such creative processes were to be promoted among a wider group of health workers, daily routine work in health care could be not just a repetition of well-rehearsed utilitarian rituals but rather a series of creative and transformative

  12. Implementation of an adaptation programme for Filipino nurses in a UK adult cancer hospice.

    PubMed

    Parry, Maria; Lipp, Allyson

    2006-02-01

    The UK has a history of recruiting international nurses successfully. This recruitment places a responsibility on healthcare providers to offer a suitable adaptation programme in order to prepare the internationally recruited nurses for registration with the regulatory body. This article outlines the organization and implementation of such an adaptation programme as a joint venture between a higher education provider and a local hospice which was designed specifically to meet the needs of palliative care patients.

  13. Creatively caring: effects of arts-based encounters on hospice caregivers in South Africa.

    PubMed

    Repar, Patricia Ann; Reid, Steve

    2014-05-01

    International literature and experience suggest that arts-based encounters can be effective in reducing stress and burnout in health care workers. Are these principles universal? Are they as applicable and effective in resource-constrained situations in Africa as in other parts of the world? We describe the impact of creative and arts-based encounters on a group of hospice caregivers at South Coast Hospice in KwaZulu Natal. An experienced facilitator built a caring and trusting relationship with the participants over a three month period through a variety of means, including a singing and songwriting intervention specifically designed to empower and give voice to the hospice caregivers, most of whom were Zulu women. We documented the process through several rounds of interviews, extensive field notes, and audio recordings. This article is a reflection on the experience and draws from the interviews, correspondence among researchers, field notes, and a performance piece written by the facilitator one year after completion of the study. We found that the songwriting and other creative activities of the engagement provided affirmation and acknowledgment of the caregivers as well as an opportunity to release stress, grief, and pain. They experienced changes in terms of hope and freedom both for themselves and their patients. The conceptual themes that emerged from the interviews with the caregivers were interpreted in terms of their inherent cultural assets, a release of agency, a sense of revelation, and transformation. The expressive arts can have a significantly beneficial effect on hospice workers and their patients, and clinical engagement can be enhanced through creative encounters, even in resource-constrained situations. If such creative processes were to be promoted among a wider group of health workers, daily routine work in health care could be not just a repetition of well-rehearsed utilitarian rituals but rather a series of creative and transformative

  14. Absolute IGS antenna phase center model igs08.atx: status and potential improvements

    NASA Astrophysics Data System (ADS)

    Schmid, R.; Dach, R.; Collilieux, X.; Jäggi, A.; Schmitz, M.; Dilssner, F.

    2016-04-01

    On 17 April 2011, all analysis centers (ACs) of the International GNSS Service (IGS) adopted the reference frame realization IGS08 and the corresponding absolute antenna phase center model igs08.atx for their routine analyses. The latter consists of an updated set of receiver and satellite antenna phase center offsets and variations (PCOs and PCVs). An update of the model was necessary due to the difference of about 1 ppb in the terrestrial scale between two consecutive realizations of the International Terrestrial Reference Frame (ITRF2008 vs. ITRF2005), as that parameter is highly correlated with the GNSS satellite antenna PCO components in the radial direction.

  15. The impact on families of respite care in a children's hospice program.

    PubMed

    Davies, Betty; Steele, Rose; Collins, John B; Cook, Karen; Smith, Stephany

    2004-01-01

    With increasing trends towards home care of children with even the most complex conditions and care requirements, respite becomes critical in improving the quality of life for terminally ill children and their families. This article reports on the respite component of an evaluation project that examined the effect of the Canuck Place children's hospice program on the families it served during its first 30 months of operation. Canuck Place, located in Vancouver, British Columbia, Canada, is the first free-standing children's hospice in North America. Findings are derived from mail-out surveys to 144 families, face-to-face interviews with 18 families, and separate questionnaires specifically directed to parents who had used Canuck Place respite services. Sixty-five parents responded to the respite questions. They cited a wide range of benefits to the ill child, the child's siblings, and to the parents themselves; they also offered a few cautions. Our discussion focuses on three "lessons learned" from this unique investigation of respite within pediatric hospice care.

  16. 'Hospice' versus 'hospital' care--re-evaluation after 10 years as seen by surviving spouses.

    PubMed Central

    Parkes, C. M.; Parkes, J.

    1984-01-01

    This study compares terminal cancer care in 1967-69 with care in 1977-79 as evaluated by surviving spouses of patients who died in St Christopher's Hospice and other local hospitals. Patients and their surviving spouses reported less personal distress in both settings in 1977-79 than in 1967-69 and the patients were also thought to have suffered less pain. These differences were found before, during and, in surviving spouses, after the period of terminal care. They were confirmed in subsamples of 30-34 patients matched for age, sex, socio-economic status and duration of terminal period. Improvements may be attributable to the training in terminal care provided by staff of the Hospice since 1967 and augmented in its Study Centre which was opened in 1973. Although pain and distress in the patient is no longer a major problem in either setting, spouses in 1977-79 remain less anxious at St Christopher's Hospice than at other hospitals; they play a larger part in the care of the patient and are in closer contact with staff before and after bereavement. PMID:6709542

  17. Evaluation of a hospice rapid response community service: a controlled evaluation

    PubMed Central

    2012-01-01

    Background While most people faced with a terminal illness would prefer to die at home, less than a third in England are enabled to do so with many dying in National Health Service hospitals. Patients are more likely to die at home if their carers receive professional support. Hospice rapid response teams, which provide specialist palliative care at home on a 24/7 on-call basis, are proposed as an effective way to help terminally ill patients die in their preferred place, usually at home. However, the effectiveness of rapid response teams has not been rigorously evaluated in terms of patient, carer and cost outcomes. Methods/Design The study is a pragmatic quasi-experimental controlled trial. The primary outcome for the quantitative evaluation for patients is dying in their preferred place of death. Carers’ quality of life will be evaluated using postal questionnaires sent at patient intake to the hospice service and eight months later. Carers’ perceptions of care received and the patient’s death will be assessed in one to one interviews at 6 to 8 months post bereavement. Service utilisation costs including the rapid response intervention will be compared to those of usual care. Discussion The study will contribute to the development of the evidence base on outcomes for patients and carers and costs of hospice rapid response teams operating in the community. Trial registration: Current controlled trials ISRCTN32119670. PMID:22846107

  18. Professional and educational needs of hospice and palliative care social workers.

    PubMed

    Weisenfluh, Sherri M; Csikai, Ellen L

    2013-01-01

    In the past decade much growth has occurred in the numbers of patients and families served by hospices and palliative care services. Thus, not surprisingly, these services have also been subject to increasing regulation by governmental and accrediting entities. In order to stay up-to-date in this ever-changing environment and to continue to provide effective interventions, social workers must stay engaged in the professional community and continuing education. In this quantitative study, 1,169 practicing hospice and palliative care social workers provided information about their practice activities and agency characteristics, professional affiliations and certification, and ongoing educational needs. About one-half of respondents carried a caseload of 21-50 and were most engaged in communicating the psychosocial needs of the patient and family to other members of the team and assessing for grief and bereavement issues. The most important educational needs pertained to the psychological and social needs of patients and families and psychosocial interventions. Most were members of professional organizations and three-quarters were members of NASW. Although many were aware of the joint NASW-NHPCO social work hospice specialty certification, few held this certification yet. The results of this survey can be utilized in the design of continuing education programs and advocacy for programmatic and policy change within agencies and the industry. PMID:23438645

  19. Use of videophones to deliver a cognitive-behavioural therapy to hospice caregivers.

    PubMed

    Demiris, George; Oliver, Debra Parker; Wittenberg-Lyles, Elaine; Washington, Karla

    2011-01-01

    We investigated the feasibility of videophones for the delivery of problem-solving therapy (PST) for informal hospice caregivers. Informal hospice caregivers were randomly assigned to receive PST from researchers using videophones, instead of communicating in face-to-face sessions. Outcome measures included caregiver anxiety, quality of life and problem-solving abilities, technical quality of videosessions and satisfaction of participants (including both subjects and researchers). A total of 42 hospice caregivers were enrolled (mean age 62 years). A total of 112 videocall attempts were documented. Of these, 100 (89%) resulted in successful videocalls and 12 (11%) were cases in which a call was not established. The average videocall duration was 38 min (range 18-84 min). The overall technical quality of the videocalls was very good. Caregivers reported a slightly higher quality of life post-intervention than at baseline, although this was not significant. Caregivers reported lower levels of anxiety post-intervention than at baseline (P = 0.04). The subjects were generally satisfied with the videophones during their exit interviews. PMID:21303934

  20. Use of videophones to deliver a cognitive-behavioural therapy to hospice caregivers

    PubMed Central

    Demiris, George; Oliver, Debra Parker; Wittenberg-Lyles, Elaine; Washington, Karla

    2011-01-01

    Summary We investigated the feasibility of videophones for the delivery of problem-solving therapy (PST) for informal hospice caregivers. Informal hospice caregivers were randomly assigned to receive PST from researchers using videophones, instead of communicating in face-to-face sessions. Outcome measures included caregiver anxiety, quality of life and problem-solving abilities, technical quality of videosessions and satisfaction of participants (including both subjects and researchers). A total of 42 hospice caregivers were enrolled (mean age 62 years). A total of 112 videocall attempts were documented. Of these, 100 (89%) resulted in successful videocalls and 12 (11%) were cases in which a call was not established. The average videocall duration was 38 min (range 18–84 min). The overall technical quality of the videocalls was very good. Caregivers reported a slightly higher quality of life post-intervention than at baseline, although this was not significant. Caregivers reported lower levels of anxiety post-intervention than at baseline (P = 0.04). The subjects were generally satisfied with the videophones during their exit interviews. PMID:21303934

  1. Center for Programming Models for Scalable Parallel Computing: Future Programming Models

    SciTech Connect

    Gao, Guang, R.

    2008-07-24

    The mission of the pmodel center project is to develop software technology to support scalable parallel programming models for terascale systems. The goal of the specific UD subproject is in the context developing an efficient and robust methodology and tools for HPC programming. More specifically, the focus is on developing new programming models which facilitate programmers in porting their application onto parallel high performance computing systems. During the course of the research in the past 5 years, the landscape of microprocessor chip architecture has witnessed a fundamental change – the emergence of multi-core/many-core chip architecture appear to become the mainstream technology and will have a major impact to for future generation parallel machines. The programming model for shared-address space machines is becoming critical to such multi-core architectures. Our research highlight is the in-depth study of proposed fine-grain parallelism/multithreading support on such future generation multi-core architectures. Our research has demonstrated the significant impact such fine-grain multithreading model can have on the productivity of parallel programming models and their efficient implementation.

  2. PACE Model Gives Advertising Campaign-Centered Curriculum (Commentary).

    ERIC Educational Resources Information Center

    Thayer, Frank

    1990-01-01

    Describes PACE (Portfolio, Assignments, Content, and Evaluation), an advertising curriculum model in which students work on real advertising campaigns. Explains that students form account groups which locate products needing promotional assistance. Identifies the goals of the curriculum to be competent writing and practical understanding of…

  3. Design Model for Learner-Centered, Computer-Based Simulations.

    ERIC Educational Resources Information Center

    Hawley, Chandra L.; Duffy, Thomas M.

    This paper presents a model for designing computer-based simulation environments within a constructivist framework for the K-12 school setting. The following primary criteria for the development of simulations are proposed: (1) the problem needs to be authentic; (2) the cognitive demand in learning should be authentic; (3) scaffolding supports a…

  4. Mentoring Resulting in a New Model: Affect-Centered Transformational Leadership

    ERIC Educational Resources Information Center

    Moffett, David W.; Tejeda, Armando R.

    2014-01-01

    The authors were professor and student, in a doctoral leadership course, during fall semester of 2013-2014. Across the term the professor mentored the mentee, guiding him to the creation of the next, needed model for leadership. The new model, known as The Affect-Centered Transformational Leadership Model, came about as the result. Becoming an…

  5. The Learner-Centered Instructional Design Model: A Modified Delphi Study

    ERIC Educational Resources Information Center

    Melsom, Duane Allan

    2010-01-01

    The learner-centered instructional design model redefines the standard linear instructional design model to form a circular model where the learner's needs are the first item considered in the development of instruction. The purpose of this modified Delphi study was to have a panel of experts in the instructional design field review the…

  6. Regional-Scale Modeling at NASA Goddard Space Flight Center

    NASA Technical Reports Server (NTRS)

    Tao, W.-K.; Adler, R.; Baker, D.; Braun, S.; Chou, M.-D.; Jasinski, M. F.; Jia, Y.; Kakar, R.; Karyampudi, M.; Lang, S.

    2003-01-01

    Over the past decade, the Goddard Mesoscale Modeling and Dynamics Group has used a popular regional scale model, MM5, to study precipitation processes. Our group is making contributions to the MM5 by incorporating the following physical and numerical packages: improved Goddard cloud processes, a land processes model (Parameterization for Land-Atmosphere-Cloud Exchange - PLACE), efficient but sophisticated radiative processes, conservation of hydrometeor mass (water budget), four-dimensional data assimilation for rainfall, and better computational methods for trace gas transport. At NASA Goddard, the MM5 has been used to study: (1) the impact of initial conditions, assimilation of satellite-derived rainfall, and cumulus parameterizations on rapidly intensifying oceanic cyclones, hurricanes and typhoons, (2) the dynamic and thermodynamic processes associated with the development of narrow cold frontal rainbands, (3) regional climate and water cycles, (4) the impact of vertical transport by clouds and lightning on trace gas distributiodproduction associated with South and North American mesoscale convective systems, (5) the development of a westerly wind burst (WWB) that occurred during the TOGA COARE and the diurnal variation of precipitation in the tropics, (6) a Florida sea breeze convective event and a Mid-US flood event using a sophisticated land surface model, (7) the influence of soil heterogeneity on land surface energy balance in the southwest GCIP region, (8) explicit simulations (with 1.33 to 4 km horizontal resolution) of hurricanes Bob (1991) and Bonnie (1998), (9) a heavy precipitation event over Taiwan, and (10) to make real time forecasts for a major NASA field program. In this paper, the modifications and simulated cases will be described and discussed.

  7. A Family-Centered Model for Sharing Genetic Risk.

    PubMed

    Daly, Mary B

    2015-01-01

    The successes of the Human Genome Project have ushered in a new era of genomic science. To effectively translate these discoveries, it will be critical to improve the communication of genetic risk within families. This will require a systematic approach that accounts for the nature of family relationships and sociocultural beliefs. This paper proposes the application of the Family Systems Illness Model, used in the setting of cancer care, to the evolving field of genomics. PMID:26479564

  8. QuickStats: Percentages* of Residential Care Communities and Adult Day Services Centers That Provided(†) Selected Services - United States, 2014.

    PubMed

    2016-01-01

    In 2014, a greater percentage of residential care communities than adult day service centers provided five of seven selected services. The majority of residential care communities provided pharmacy services (82%); followed by transportation for social activities (79%); physical, occupational, or speech therapy (69%); hospice (62%); skilled nursing (59%); and mental health services (52%). Fewer than half provided social work services (48%). The majority of adult day services centers provided transportation for social activities (69%); skilled nursing (66%); and social work (52%). %). Fewer than half provided physical, occupational, or speech therapy (49%). One third or less provided mental health (33%), pharmacy (27%), and hospice services (12%). PMID:27607333

  9. Tropical cyclone center location based on Fisher discriminant and Chan-Vese model

    NASA Astrophysics Data System (ADS)

    Qiao, Wenfeng; Li, Yuanxiang; Wei, Xian; Shen, Ji

    2011-12-01

    TC center location is important for weather forecast and TC analysis. However the appearance of TC centers has different shapes and sizes at different time. At different stages of TC lifetime, the difficulty of locating TC center is different. In order to improve the automatism and precision, we present a TC center location scheme for eye TCs and non-eye TCs. Fisher discriminant is used to segment TC so that we can get the binary image automatically and effectively. Since the cloud wall near the non-eye TC center is homocentric circle, Chan-Vese model is used to get TC contour. Experimental results on TCs show that our scheme can achieve an average error within 0.3 degrees in longitude/latitude in comparison with the best tracks by CMA and RSMC.

  10. Tropical cyclone center location based on Fisher discriminant and Chan-Vese model

    NASA Astrophysics Data System (ADS)

    Qiao, Wenfeng; Li, Yuanxiang; Wei, Xian; Shen, Ji

    2012-01-01

    TC center location is important for weather forecast and TC analysis. However the appearance of TC centers has different shapes and sizes at different time. At different stages of TC lifetime, the difficulty of locating TC center is different. In order to improve the automatism and precision, we present a TC center location scheme for eye TCs and non-eye TCs. Fisher discriminant is used to segment TC so that we can get the binary image automatically and effectively. Since the cloud wall near the non-eye TC center is homocentric circle, Chan-Vese model is used to get TC contour. Experimental results on TCs show that our scheme can achieve an average error within 0.3 degrees in longitude/latitude in comparison with the best tracks by CMA and RSMC.

  11. The changing demographics of inpatient hospice death: Population-based cross-sectional study in England, 1993–2012

    PubMed Central

    Sleeman, Katherine E; Davies, Joanna M; Verne, Julia; Gao, Wei; Higginson, Irene J

    2016-01-01

    Background: Studies in the United Kingdom and elsewhere have suggested inequality of hospice provision with respect to factors such as age, diagnosis and socio-economic position. How this has changed over time is unknown. Aim: To describe the factors associated with inpatient hospice death in England and examine how these have changed over time. Design: Population-based study. Multivariable Poisson regression compared 1998–2002, 2003–2007 and 2008–2012, with 1993–1997. Explanatory variables included individual factors (age, gender, marital status, underlying cause of death) and area-based measures of deprivation. Setting: Adults aged 25 years and over who died in inpatient hospice units in England between 1993 and 2002 (n = 446,615). Results: The annual number of hospice deaths increased from 17,440 in 1993 to 26,032 in 2012, accounting for 3.4% of all deaths in 1993 and 6.0% in 2012. A total of 50.6% of hospice decedents were men; the mean age was 69.9 (standard deviation: 12.4) years. The likelihood of hospice decedents being in the oldest age group (>85 years) increased over time (proportion ratio: 1.43, 95% confidence interval: 1.39 to 1.48 for 2008–2012 compared to 1993–1997). Just 5.2% of all hospice decedents had non-cancer diagnoses, though the likelihood of non-cancer conditions increased over time (proportion ratio: 1.41, 95% confidence interval: 1.37 to 1.46 for 2008–2012 compared to 1993–1997). The likelihood of hospice decedents being resident in the least deprived quintile increased over time (proportion ratio: 1.25, 95% confidence interval: 1.22 to 1.29 for 2008–2012 compared to 1993–1997). Conclusion: The increase in non-cancer conditions among hospice decedents is encouraging although absolute numbers remain very small. Deprivation trends are concerning and require further exploration. PMID:25991729

  12. Modeling crustal deformation near active faults and volcanic centers: a catalog of deformation models and modeling approaches

    USGS Publications Warehouse

    Battaglia, Maurizio; ,; Peter, F.; Murray, Jessica R.

    2013-01-01

    This manual provides the physical and mathematical concepts for selected models used to interpret deformation measurements near active faults and volcanic centers. The emphasis is on analytical models of deformation that can be compared with data from the Global Positioning System (GPS) receivers, Interferometric synthetic aperture radar (InSAR), leveling surveys, tiltmeters and strainmeters. Source models include pressurized spherical, ellipsoidal, and horizontal penny-shaped geometries in an elastic, homogeneous, flat half-space. Vertical dikes and faults are described following the mathematical notation for rectangular dislocations in an elastic, homogeneous, flat half-space. All the analytical expressions were verified against numerical models developed by use of COMSOL Multyphics, a Finite Element Analysis software (http://www.comsol.com). In this way, typographical errors present were identified and corrected. Matlab scripts are also provided to facilitate the application of these models.

  13. Oscillatory Pattern Generation of the Olfactory Center Using Pulse-Type Hardware Chaotic Neuron Models

    NASA Astrophysics Data System (ADS)

    Saito, Ken; Hatano, Hirokazu; Saito, Minoru; Sekine, Yoshifumi

    Oscillatory patterns of electrical activity are a ubiquitous feature in nervous systems. Oscillatory patterns play an important role in the processing of sensory information pattern recognition. For example, earlier reports describe that the oscillatory patterns in the olfactory center of the land slug are changed by odor stimuli to the tentacles. Olfactory processing has also been studied in relation to rabbits and land slugs through the construction and use of mathematical neural network models. However, a large-scale model is necessary for the study of a model which has sensory information recognition by the oscillatory pattern. Therefore, the construction of a hardware model that can generate oscillatory patterns is desired because nonlinear operations can be processed at higher speeds than the mathematical model. We are studying about the neural network using hardware neuron models to construct the olfactory center model of the living organisms. In the present study, we discuss about the oscillatory pattern generation of the olfactory center using pulse-type hardware chaotic neuron models. Our model shows periodic, quasi-periodic and chaotic oscillations such as the olfactory center of living organisms by changing the synaptic connection weights.

  14. Solar-terrestrial models at the National Space Science Data Center

    NASA Technical Reports Server (NTRS)

    Bilitza, D.

    1991-01-01

    The National Space Science Data Center (NSSDC) and World Data Center A for Rockets and Satellites (WDC-A-R&S) has a long record of participation in the worldwide efforts to establish and improve empirical models for the different regions of the solar-terrestrial environment. The center maintains a unique archive of solar-terrestrial models and related applications software, described in a recently published models catalog. The software packages are distributed on tape, diskette, and on-line on the Space Physics Analysis Network (SPAN). Four of the most frequently requested models (IRI, MSIS/CIRA, IGRF, AE-8/AP-8) can also be accessed and run on the NSSDC Online Documentation and Information Service (NODIS) account, which can be reached from any SPAN node.

  15. A Tutorial on Centering in Cross-Sectional Two-Level Models

    ERIC Educational Resources Information Center

    Myers, Nicholas D.; Brincks, Ahnalee M.; Beauchamp, Mark R.

    2010-01-01

    The primary purpose of this tutorial is to succinctly review some options for, and consequences of, centering Level 1 predictors in commonly applied cross-sectional two-level models. It is geared toward both practitioners and researchers. A general understanding of multilevel modeling is necessary prior to understanding the subtleties of centering…

  16. Mimicry of the radical pair and triplet states in photosynthetic reaction centers with a synthetic model

    SciTech Connect

    Wasielewski, M.R.; Greenfield, S.R.; Svec, W.A.

    1997-08-01

    Results are presented on a photosynthetic model system that closely mimics the spin dynamics of triplet state formation found in photosynthetic reaction centers. This research will make it possible to design new models to probe the mechanism of the primary events of photosynthesis.

  17. Clinical Assessment at College Counseling Centers: The Consultant-on-Duty Model

    ERIC Educational Resources Information Center

    Schoen, Eva; McKelley, Ryan

    2012-01-01

    The consultant-on-duty (COD) clinical consultation model maximizes efficient use of services, is distinct from other university counseling center (UCC) services, and precedes therapy. This model enables clinicians to ensure optimal fit between client need and type of UCC services provided, including brief therapy. The 4 objectives of the COD model…

  18. 42 CFR 418.26 - Discharge from hospice care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...) behavior is disruptive, abusive, or uncooperative to the extent that delivery of care to the patient or the... behavior or situation; (iii) Ascertain that the patient's proposed discharge is not due to the...

  19. 42 CFR 418.26 - Discharge from hospice care.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...'s home) behavior is disruptive, abusive, or uncooperative to the extent that delivery of care to the... the patient's behavior or situation; (iii) Ascertain that the patient's proposed discharge is not...

  20. Robust Optimization Model and Algorithm for Railway Freight Center Location Problem in Uncertain Environment

    PubMed Central

    He, Shi-wei; Song, Rui; Sun, Yang; Li, Hao-dong

    2014-01-01

    Railway freight center location problem is an important issue in railway freight transport programming. This paper focuses on the railway freight center location problem in uncertain environment. Seeing that the expected value model ignores the negative influence of disadvantageous scenarios, a robust optimization model was proposed. The robust optimization model takes expected cost and deviation value of the scenarios as the objective. A cloud adaptive clonal selection algorithm (C-ACSA) was presented. It combines adaptive clonal selection algorithm with Cloud Model which can improve the convergence rate. Design of the code and progress of the algorithm were proposed. Result of the example demonstrates the model and algorithm are effective. Compared with the expected value cases, the amount of disadvantageous scenarios in robust model reduces from 163 to 21, which prove the result of robust model is more reliable. PMID:25435867

  1. Petroleum jelly (vaseline balls) for the treatment of constipation: a survey of hospice and palliative care practitioners.

    PubMed

    Tavares, Candice Noelle; Kimbrel, Jason M; Protus, Bridget McCrate; Grauer, Phyllis A

    2014-12-01

    Constipation is a common symptom at end of life, impacting patient outcomes and healthcare costs. Hospice and palliative care professionals often use practices based on anecdotal evidence. One such intervention is an oral preparation of petroleum jelly (OPJ), referred to as "Vaseline balls." This survey was designed to collect information regarding healthcare practitioners' knowledge and attitudes toward the use of OPJ for the management of constipation in hospice and palliative care. An online survey was distributed to physicians, nurse practitioners, nurses, and pharmacists who work with hospice and palliative care patients. A total of 67% (n=237/353) of responders reported being familiar with the use of OPJ. Results indicate there is a need for further clinical research on the use of OPJ to guide practice.

  2. Hospice nurses' perceptions of caring for patients with a non-malignant diagnosis: a single-site case study.

    PubMed

    Balasubramanian, Sundar; Read, Sue

    2012-10-01

    In the early stages of its development in the UK, palliative care focused almost exclusively on the care of patients with cancer, with efforts concentrated on relieving distressing physical symptoms in the last few weeks of life-often referred to as terminal care. It is increasingly expanding to include non-malignant conditions, but is still predominantly accessed by cancer patients. This paper presents findings from a small-scale qualitative study into nurses' experiences of providing hospice care for patients with a non-malignant diagnosis. Two focus groups were conducted with nurses in one established UK hospice. The results highlight the importance of timely educational preparation, the need for proactive thinking regarding the shifting medical profiles of health care in the UK, and the need for hospice managers to critically consider existing infrastructures (including supervision and support) in anticipation of diverse patient populations. The paper also reiterates that collaboration remains the key to effective support. PMID:23123954

  3. Using synthetic model systems to understand charge separation and spin dynamics in photosynthetic reaction centers.

    SciTech Connect

    Wasielewski, M. R.

    1998-08-27

    Our current work in modeling reaction center dynamics has resulted in the observation of each major spin-dependent photochemical pathway that is observed in reaction centers. The development of new, simpler model systems has permitted us to probe deeply into the mechanistic issues that drive these dynamics. Based on these results we have returned to biomimetic chlorophyll-based electron donors to mimic these dynamics. Future studies will focus on the details of electronic structure and energetic of both the donor-acceptor molecules and their surrounding environment that dictate the mechanistic pathways and result in efficient photosynthetic charge separation.

  4. Reflections on the history of occupational stress in hospice/palliative care.

    PubMed

    Vachon, M L

    1999-01-01

    The concept of hospice and palliative care emerged a quarter of a century ago out of recognition of the unmet needs of dying persons and the social issues of the 1960s and 1970s. The issues of the day included the sexual revolution; a questioning of social values; an increased awareness of death resulting from the murder of the Kennedy brothers and Martin Luther King and daily television exposure to deaths in the Vietnam War, feminism, consumerism, reclaiming a more humanized role in the birth process, and hence in the process of death. The history of the hospice movement and the stress experienced by staff is traced from the early developmental days through to the present. Initially there was sometimes a struggle to integrate the concepts of relief of physical symptoms with meeting the psychosocial and emotional needs of patients and families, caregivers were expected to sacrifice much of their personal life for work, emotional intensity was high and supports were developed to ease some of the stress experienced by caregivers. From the early days team stress and burnout have been issues of concern. In the 1980s issues involved establishing funding sources, dealing with the new crisis of AIDS, and dealing with the gap between the ideal and the real. In the 1990s the economic climate has escalated some of the tensions that have always existed as hospice attempts to position itself within mainstream care with diminishing fiscal resources. These are issues that confront us as we move into the next century. PMID:10839014

  5. Information System Success Model for Customer Relationship Management System in Health Promotion Centers

    PubMed Central

    Choi, Wona; Rho, Mi Jung; Park, Jiyun; Kim, Kwang-Jum; Kwon, Young Dae

    2013-01-01

    Objectives Intensified competitiveness in the healthcare industry has increased the number of healthcare centers and propelled the introduction of customer relationship management (CRM) systems to meet diverse customer demands. This study aimed to develop the information system success model of the CRM system by investigating previously proposed indicators within the model. Methods The evaluation areas of the CRM system includes three areas: the system characteristics area (system quality, information quality, and service quality), the user area (perceived usefulness and user satisfaction), and the performance area (personal performance and organizational performance). Detailed evaluation criteria of the three areas were developed, and its validity was verified by a survey administered to CRM system users in 13 nationwide health promotion centers. The survey data were analyzed by the structural equation modeling method, and the results confirmed that the model is feasible. Results Information quality and service quality showed a statistically significant relationship with perceived usefulness and user satisfaction. Consequently, the perceived usefulness and user satisfaction had significant influence on individual performance as well as an indirect influence on organizational performance. Conclusions This study extends the research area on information success from general information systems to CRM systems in health promotion centers applying a previous information success model. This lays a foundation for evaluating health promotion center systems and provides a useful guide for successful implementation of hospital CRM systems. PMID:23882416

  6. Tender mercies: increasing access to hospice services for children with life-threatening conditions.

    PubMed

    Dabbs, Devon; Butterworth, Lori; Hall, Elinor

    2007-01-01

    This article describes the initiation of the Children's Hospice and Palliative Care Coalition, an organization that emerged from the concern of two women for the unique needs of children with life-threatening conditions. The Coalition, based in California, was inspired to improve care for children with life-threatening conditions and their families by the 2002 Institute of Medicine report When Children Die:... (which was printed in 2003: ). Its most recent work has been to advance legislative initiatives to develop, implement, and evaluate a pilot project waiver to provide a federally funded pediatric care benefit.

  7. Developing a long-term ventilation service in a children's hospice: an illustrative case study.

    PubMed

    Cockett, Andrea

    2012-06-01

    Children who use long-term ventilation at home and their parents find it difficult to access suitable respite services for short breaks. This article describes, through the use of a case study, a project to develop a respite service for such children at a children's hospice in England. The service development was a response to local need, which included a requirement to develop bespoke assessment documentation and processes as well as a comprehensive staff development package. The article follows the journey of one family through the development and use of the new service.

  8. Depth oriented brief therapy: an ideal technique as hospice lengths-of-stay continue to shorten.

    PubMed

    Thomson, Judith E; Jordan, Merle R

    2002-01-01

    The authors note that as hospice patients' lengths-of-stay continue to shorten, psychosocial/spiritual counselors are being challenged to help patients and families process the myriad of issues terminal illness gives rise to. Given this reality, the authors suggest that the Depth Oriented Brief Therapy (DOBT) approach should prove especially useful. The DOBT premise is that if people can be helped to experience the emotional meanings of why they hold on to emotionally painful symptoms then they can abandon their symptoms for healthier ways of being.

  9. End-of-Life Dreams and Visions: A Qualitative Perspective From Hospice Patients.

    PubMed

    Nosek, Cheryl L; Kerr, Christopher W; Woodworth, Julie; Wright, Scott T; Grant, Pei C; Kuszczak, Sarah M; Banas, Anne; Luczkiewicz, Debra L; Depner, Rachel M

    2015-05-01

    End-of-life dreams and visions (ELDVs) are well documented throughout history and across cultures with impact on the dying person and their loved ones having profound meaning. Published studies on ELDVs are primarily based on surveys or interviews with clinicians or families of dead persons. This study uniquely examined patient dreams and visions from their personal perspective. This article reports the qualitative findings from dreams and visions of 63 hospice patients. Inductive content analysis was used to examine the content and subjective significance of ELDVs. Six categories emerged: comforting presence, preparing to go, watching or engaging with the deceased, loved ones waiting, distressing experiences, and unfinished business.

  10. Center for Modeling of Turbulence and Transition (CMOTT). Research briefs: 1990

    NASA Technical Reports Server (NTRS)

    Povinelli, Louis A. (Compiler); Liou, Meng-Sing (Compiler); Shih, Tsan-Hsing (Compiler)

    1991-01-01

    Brief progress reports of the Center for Modeling of Turbulence and Transition (CMOTT) research staff from May 1990 to May 1991 are given. The objectives of the CMOTT are to develop, validate, and implement the models for turbulence and boundary layer transition in the practical engineering flows. The flows of interest are three dimensional, incompressible, and compressible flows with chemistry. The schemes being studied include the two-equation and algebraic Reynolds stress models, the full Reynolds stress (or second moment closure) models, the probability density function models, the Renormalization Group Theory (RNG) and Interaction Approximation (DIA), the Large Eddy Simulation (LES) and Direct Numerical Simulation (DNS).

  11. Center for Modeling of Turbulence and Transition (CMOTT): Research Briefs, 1992

    NASA Technical Reports Server (NTRS)

    Liou, William W. (Editor)

    1992-01-01

    The progress is reported of the Center for Modeling of Turbulence and Transition (CMOTT). The main objective of the CMOTT is to develop, validate and implement the turbulence and transition models for practical engineering flows. The flows of interest are three-dimensional, incompressible and compressible flows with chemical reaction. The research covers two-equation (e.g., k-e) and algebraic Reynolds-stress models, second moment closure models, probability density function (pdf) models, Renormalization Group Theory (RNG), Large Eddy Simulation (LES) and Direct Numerical Simulation (DNS).

  12. Information Transfer with the Ohio College Library Center Program as a Model. Paper No. 4.

    ERIC Educational Resources Information Center

    Michigan Library Consortium, Detroit.

    The Michigan Library Consortium (MLC) is studying the problems and possibilities of networking, with the Ohio College Library Center (OCLC) as a model and possible data base for the MLC. Standards on an international scale must be developed, and the need for constantly improving technology, particularly computers, must be recognized. Since the…

  13. My First Journey. A Haitian Immigration Story. A Learner-Centered Model Guide for Teachers.

    ERIC Educational Resources Information Center

    Fouche, Marie

    This document is part of a series of guides for teachers in which the Division of Bilingual Education of the New York City Board of Education presents a learner-centered model in which the learner sees himself or herself in the story. Learners are able to relive their own experiences or those of their parents or grandparents as they left their own…

  14. Stimulating Healthy Aging with a Model Nurse-Managed Free Clinic in a Senior Center.

    ERIC Educational Resources Information Center

    Franklin, Ruth H.

    As part of a Geriatric Education and Health Management program, a model nurse-managed free clinic has been established at an urban senior center by faculty and students of the University of New Mexico College of Nursing. Funded by a 3-year grant from the Department of Health and Human Services, the weekly clinic is based on Orem's self-care theory…

  15. Strategic outsourcing of clinical services: a model for volume-stressed academic medical centers.

    PubMed

    Billi, John E; Pai, Chih-Wen; Spahlinger, David A

    2004-01-01

    Many academic medical centers have significant capacity constraints and limited ability to expand services to meet demand. Health care management should employ strategic thinking to deal with service demands. This article uses three organizational models to develop a theoretical framework to guide the selection of clinical services for outsourcing.

  16. Promoting Cultural Relativism in Counselors through the Cultural De-Centering Model

    ERIC Educational Resources Information Center

    McAuliffe, Garrett J.; Milliken, Tammi F.

    2009-01-01

    Counselors who are culturally encapsulated are likely to create client mistrust and to misinterpret clients' cultural norms. This article presents the Cultural De-Centering Model (CDCM) as a constructive-developmental method for helping future counselors to be less ethnocentric in their work. The goal of the CDCM is to increase counselors'…

  17. The Center of Excellence Model for Information Services. CLIR Publication No. 163

    ERIC Educational Resources Information Center

    Kirchner, Joy; Diaz, José; Henry, Geneva; Fliss, Susan; Culshaw, John; Gendron, Heather; Cawthorne, Jon E.

    2015-01-01

    In 2013, The Andrew W. Mellon Foundation awarded a group of seven librarians from the Research Library Leadership Fellows program of the Association of Research Libraries (ARL) a planning grant to examine the center of excellence (CoE) model for information services. Used in a variety of industries, CoEs are designed to attract the most talented…

  18. Evaluation of a Family-Centered Early Childhood Special Education Preservice Model by Program Graduates

    ERIC Educational Resources Information Center

    Murray, Mary M.; Mandell, Colleen J.

    2004-01-01

    This qualitative study evaluated the impact on program graduates of two personnel preparation projects founded on a family-centered preservice model and funded by the Office of Special Education Programs. Three cohorts totaling 22 participants were interviewed to (a) determine their attitudes and skill level in working with a diverse group of…

  19. Model Validation at the 204 MW New Mexico Wind Energy Center: Preprint

    SciTech Connect

    Muljadi, E.; Butterfield, C. P.; Ellis, A.; Mechenbier, J.; Hochheimer, J.; Young, R.; Miller, N.; Delmerico, R.; Zavadil, R.; Smith, J. C.

    2006-06-01

    In this paper, we describe methods to derive and validate equivalent models for a large wind farm. FPL Energy's 204-MW New Mexico Wind Energy Center, which is interconnected to the Public Service Company of New Mexico (PNM) transmission system, was used as a case study. The methods described are applicable to any large wind power plant.

  20. The Impacts of the WIA One-Stop Center Model on Local Training Services

    ERIC Educational Resources Information Center

    Cajayon, Felicito

    2012-01-01

    This study examined the Workforce Investment Act (WIA) One-Stop Center model, which is the local service mechanism for providing employment and training services. It reviewed the processes and service patterns of four program designs that offer an array of services that align with the WIA program's allowable activities. The purpose of the…

  1. Developing of National Accreditation Model for Rural Health Centers in Iran Health System

    PubMed Central

    TABRIZI, Jafar Sadegh; GHARIBI, Farid; PIRAHARY, Samereh

    2013-01-01

    Abstract Background The primary health care has notable effects on community health and accreditation is one of the appropriate evaluation methods that led to health system performance improvement, therefore, this study aims to developing of national accreditation model for rural health centers in Iran Health System. Methods Firstly the suitable accreditation models selected to benchmarking worldwide via systematic review, the related books and medical university’s web site surveyed and some interviews hold with experts. Then the obtain standards surveyed from the experts’ perspectives via Delphi technique. Finally, the obtainedmodel assessedvia the experts’ perspective and pilot study. Results The researchers identified JCAHO and CCHSA as the most excellent models. The obtained standards and their quality accepted from experts’ perspective and pilot study, and finally the number of 55 standards acquired. Conclusion The designed model has standards with acceptable quality and quantity, and researchers’ hopeful that its application in rural health centers led to continues quality improvement. PMID:26060646

  2. [Certified prostate cancer centers and second opinion centers for testicular cancer: successful models of uro-oncology cancer care].

    PubMed

    Gschwend, J E; Albers, P; Schrader, M

    2011-08-01

    Establishment of organ site-specific cancer centers by the German Cancer Society (GCS) is part of the basic politically driven reform of oncology care in Germany. Since 2007 an increasing number of prostate cancer centers have been guided toward certification by the OnkoZert GmbH of the GCS. Currently 68 centers are certified and together with ongoing certification proceedings will amount to 81 prostate cancer centers, which cover about one fourth of cases of primary prostate cancer. Urology is of particular importance in the management of these centers. For the most part, urologists belonging to a clinical unit are the initiators of the certification process, thus ensuring that uro-oncology is firmly entrenched in the specialty with involvement of outpatient service providers. Fears that authority will be lost are unfounded as long as responsibility for this task is taken seriously and active use is made of the possibilities for creativity. A similarly important function is fulfilled by the testicular cancer centers that offer second opinion services, which were initiated by urology conjointly with German Cancer Aid to pursue the goal of quality assurance for this tumor entity and therefore likewise secure the position of this tumor in the realm of urologists. By applying such strategic approaches, urologists will succeed in sustainably safeguarding their future importance in a very competitive environment and in counteracting the encroachments of other specialties by exhibiting clear orientation.

  3. Towards a Person-Centered Model of Instruction: Can An Emphasis on the Personal Enhance Instruction in Cyberspace?

    ERIC Educational Resources Information Center

    Miller, Christopher; Mazur, Joan M.

    2001-01-01

    A person-centered instructional design model was developed for virtual, Web-based environments, based on the work of Carl Rogers. This model attempts to address several issues raised in the literature. A person-centered instructional model is described and contrasted with instructionalist and constructivist approaches. Theoretical and practical…

  4. Space Weather Data Dissemination Tools from the Community Coordinated Modeling Center

    NASA Astrophysics Data System (ADS)

    Donti, N.; Berrios, D.; Boblitt, J.; LaSota, J.; Maddox, M. M.; Mullinix, R.; Hesse, M.

    2011-12-01

    The Community Coordinated Modeling Center (CCMC) at NASA Goddard Space Flight Center has developed new space weather data dissemination products. These include a Java-based conversion software for space weather simulation data, an interactive and customizable timeline tool for time series data, and Android phone and tablet versions of the NASA Space Weather App for mobile devices. We highlight the new features of all the updated services, discuss the back-end capabilities required to realize these services, and talk about future services in development.

  5. Off-center spherical model for dosimetry calculations in chick brain tissue

    SciTech Connect

    Gonzalez, G.; Nearing, J.C.; Spiegel, R.J.; Joines, W.T.

    1986-01-01

    This paper presents calculations for the electric field and absorbed power density distribution in chick brain tissue inside a test tube, using an off-center spherical model. It is shown that the off-center spherical model overcomes many of the limitations of the concentric spherical model, and permits a more realistic modeling of the brain tissue as it sits in the bottom of the test tube surrounded by buffer solution. The effect of the unequal amount of buffer solution above the upper and below the lower surfaces of the brain is analyzed. The field distribution is obtained in terms of a rapidly converging series of zonal harmonics. A method that permits the expansion of spherical harmonics about an off-center origin in terms of spherical harmonics at the origin is developed to calculate in closed form the electric field distribution. Numerical results are presented for the absorbed power density distribution at a carrier frequency of 147 MHz. It is shown that the absorbed power density increases toward the bottom of the brain surface. Scaling relations are developed by keeping the electric field intensity in the brain tissue the same at two different frequencies. Scaling relations inside, as well as outside, the brain surface are given. The scaling relation distribution is calculated as a function of position, and compared to the scaling relations obtained in the concentric spherical model. It is shown that the off-center spherical model yields scaling ratios in the brain tissue that lie between the extreme values predicted by the concentric and isolated spherical models.

  6. Dyspnea and quality of life indicators in hospice patients and their caregivers

    PubMed Central

    Moody, Linda E; McMillan, Susan

    2003-01-01

    This study describes the assessment of dyspnea, symptom distress, and quality of life measures in 163 hospice patients with cancer who reported dyspnea. Mean age of the hospice patient sample was 70.22 years and 61.86 for caregivers (65% were spouses). The majority of patients and caregivers were white: 87%, 63% of the patients were male while 78% of caregivers were female. Mean dyspnea intensity as reported by patients was 4.52 (SD 2.29) and caregivers, 4.39 (SD 2.93). Patients' and caregivers' ratings of the patient's dyspnea intensity revealed no significant differences in ratings thus verifying that caregivers can assess dyspnea severity accurately. Patients' perceived quality of life ratings were not significantly correlated with ratings of their caregivers' perceived quality of life. For patients, symptom distress and education were significant predictors of variance in quality of life (R2 = .35, p = .04). However, mastery, symptom distress, age, and education were found to be significant predictors of variance in quality of life of caregivers (R2 = .40, p = .02). PMID:12740034

  7. Maslow's hierarchy of needs: a framework for achieving human potential in hospice.

    PubMed

    Zalenski, Robert J; Raspa, Richard

    2006-10-01

    Although the widespread implementation of hospice in the United States has led to tremendous advances in the care of the dying, there has been no widely accepted psychological theory to drive needs assessment and intervention design for the patient and family. The humanistic psychology of Abraham Maslow, especially his theory of motivation and the hierarchy of needs, has been widely applied in business and social science, but only sparsely discussed in the palliative care literature. In this article we review Maslow's original hierarchy, adapt it to hospice and palliative care, apply the adaptation to a case example, and then discuss its implications for patient care, education, and research. The five levels of the hierarchy of needs as adapted to palliative care are: (1) distressing symptoms, such as pain or dyspnea; (2) fears for physical safety, of dying or abandonment; (3) affection, love and acceptance in the face of devastating illness; (4) esteem, respect, and appreciation for the person; (5) selfactualization and transcendence. Maslow's modified hierarchy of palliative care needs could be utilized to provide a comprehensive approach for the assessment of patients' needs and the design of interventions to achieve goals that start with comfort and potentially extend to the experience of transcendence. PMID:17040150

  8. Maslow's hierarchy of needs: a framework for achieving human potential in hospice.

    PubMed

    Zalenski, Robert J; Raspa, Richard

    2006-10-01

    Although the widespread implementation of hospice in the United States has led to tremendous advances in the care of the dying, there has been no widely accepted psychological theory to drive needs assessment and intervention design for the patient and family. The humanistic psychology of Abraham Maslow, especially his theory of motivation and the hierarchy of needs, has been widely applied in business and social science, but only sparsely discussed in the palliative care literature. In this article we review Maslow's original hierarchy, adapt it to hospice and palliative care, apply the adaptation to a case example, and then discuss its implications for patient care, education, and research. The five levels of the hierarchy of needs as adapted to palliative care are: (1) distressing symptoms, such as pain or dyspnea; (2) fears for physical safety, of dying or abandonment; (3) affection, love and acceptance in the face of devastating illness; (4) esteem, respect, and appreciation for the person; (5) selfactualization and transcendence. Maslow's modified hierarchy of palliative care needs could be utilized to provide a comprehensive approach for the assessment of patients' needs and the design of interventions to achieve goals that start with comfort and potentially extend to the experience of transcendence.

  9. An examination of advanced cancer caregivers’ support provided by staff interventions at hospices in Argentina

    PubMed Central

    Luxardo, Natalia; Brage, Eugenia; Alvarado, Cynthia

    2012-01-01

    The aim of the study was to describe the type of intervention provided by hospice staff in order to address the pragmatic, psycho-social, and spiritual needs of home-caregivers for patients in the last stage of cancer. The qualitative inquiry was carried out in real life contexts. The explicit demands that caregivers (n = 40) identified in the first interviews were: (1) helping to organize the care of the patient at home; (2) unspecific demands, with unclear or unrealistic purposes (e.g., curative treatment or a miracle expected to occur); (3) specific resources (such as formal caregivers to replace them), and (4) a place to leave the patient either for a temporary period (a respite for the family) or in a permanent way. The main issues discussed were the delays in the patients’ referral to the hospice and the lack of time for long-term interventions; explicit focus is placed on the care by addressing the spiritual and emotional needs of caregivers, unlike in hospital settings where professionals avoid discussions of spiritual needs due to a lack of time, inadequate training and poor understanding of spirituality; hospices’ interventions are based upon an ethos similar to the movement’s original Christian spirit with emphasis placed on qualities of care such as love, charity, and compassion besides expertise and end-of-life competence, all while tolerating a sense of abandonment by health and social security systems following the patient’s referral. PMID:23226163

  10. Medicare reimbursement for hospice care: ethical and policy implications of cost-containment strategies.

    PubMed

    Fraser, I

    1985-01-01

    In several areas of health policy, current concern over rising costs has generated considerably political support for reforms that many in the business have advocated unsuccessfully on philosophical, ethical, or humanitarian grounds for years. Thus, for example, the spiraling cost of caring for the mentally ill and the developmentally disabled in an institutional setting has breathed new life into proposals to bring these groups out into the community where they can live more independently--and more cheaply. But this overlap of quality and frugality goals is only partial. Although alliances with cost-cutters can bring reform, health policy reformers are discovering that they may have to accept a lot of bathwater along with the baby. Medicare reimbursement for hospice care, authorized by Section 122 of PL 97-248, the Tax Equity and Fiscal Responsibility Act of 1982, provides one recent example of this dilemma. This article discusses the results of a survey--conducted by the Office of the Inspector General of the Department of Health and Human Services--to discover how many hospices would seek certification for reimbursement by Medicare, how many patients would be served, and the consequences of this legislation for cost, access, and quality of service.

  11. New organizational and funds flow models for an academic cancer center.

    PubMed

    Spahlinger, David A; Pai, Chih-Wen; Waldinger, Marcy B; Billi, John E; Wicha, Max S

    2004-07-01

    The clinical impetus to develop cancer centers has been the recognition that many cancer patients require a comprehensive treatment plan coordinated across multiple specialties. Developing an effective organizational and financial structure among the multiple entities that comprise an academic cancer center has, however, been a challenge. The authors describe an effort to realize a sustainable clinical operation at the University of Michigan Comprehensive Cancer Center (UMCCC) by developing an appropriate management structure and financial model. The modified organizational structure established a clear line of administrative authority and held faculty members accountable for their effort in the UMCCC. A unified budget aligned financial incentive among all stakeholders to increase efficiency, revenue, and margin. The authors report preliminary financial evidence of the success of the new managerial structure.

  12. New organizational and funds flow models for an academic cancer center.

    PubMed

    Spahlinger, David A; Pai, Chih-Wen; Waldinger, Marcy B; Billi, John E; Wicha, Max S

    2004-07-01

    The clinical impetus to develop cancer centers has been the recognition that many cancer patients require a comprehensive treatment plan coordinated across multiple specialties. Developing an effective organizational and financial structure among the multiple entities that comprise an academic cancer center has, however, been a challenge. The authors describe an effort to realize a sustainable clinical operation at the University of Michigan Comprehensive Cancer Center (UMCCC) by developing an appropriate management structure and financial model. The modified organizational structure established a clear line of administrative authority and held faculty members accountable for their effort in the UMCCC. A unified budget aligned financial incentive among all stakeholders to increase efficiency, revenue, and margin. The authors report preliminary financial evidence of the success of the new managerial structure. PMID:15234911

  13. Hospice Palliative Care Volunteers: A Review of Commonly Encountered Stressors, How They Cope With them, and Implications for Volunteer Training/Management.

    PubMed

    Claxton-Oldfield, Stephen

    2016-03-01

    Hospice palliative care volunteer work--being with dying persons and their often distraught family members--has the potential to take an emotional toll on volunteers. The aim of this review article is to examine the types of stressors hospice palliative care volunteers typically experience in their work and how they cope with them. The results of this literature review suggest that hospice palliative care volunteers do not generally perceive their volunteer work as highly stressful. Nonetheless, a number of potential stressors and challenges were identified in the literature, along with some strategies that volunteers commonly employ to cope with them. The implications for volunteers and volunteer training/management are discussed.

  14. Exploring Hospice Decisions: The Road from the Institute on Aging and Social Work to an ARRA Challenge Grant

    ERIC Educational Resources Information Center

    Waldrop, Deborah

    2014-01-01

    Decisions about treatment and options for care at the end stage of an advanced chronic illness are important determinants of the quality of a person's death and of how family members adapt in bereavement. This article describes the steps taken to secure federal funding to study how people make the decision to enroll in hospice. The National…

  15. Providing hospice care to children and young adults: A descriptive study of end-of-life organizations

    PubMed Central

    Lindley, Lisa; Mark, Barbara; Lee, Shoou-Yih Daniel

    2010-01-01

    Over the past two decades, end-of-life organizations have served an increasing number of children and young adults and expanded services important to terminally ill youth, and yet we know little about these organizations. The purpose of this study was to describe the characteristics of end-of-life care organizations that admitted children and young adults to hospice care. Using data from the 2007 National Hospice and Palliative Care Organization (NHPCO) Survey, we conducted a descriptive analysis of operational, mission, market, and financial characteristics, and explored a sub-analysis by age group. Our analysis revealed that these organizations had similar profit status, ownership, and payer mix when compared to the hospice industry. However, they differed in agency type, referrals, organizational size, geographic location, team member caseload, and revenues. We also found important differences in organizations that provided hospice care by age groups (infants, toddler, school-age children, and adolescents/young adults) in geographic location, region, agency type, accreditation, and team member caseload. These findings have managerial and policy implications. PMID:20606723

  16. Engaged Scholarship in Partnership with a Local Hospice: A Qualitative Case Study in a Radiation Therapy Classroom

    ERIC Educational Resources Information Center

    Trad, Megan

    2012-01-01

    This qualitative case study focuses on providing answers to the following research questions. How do radiation therapy students respond to the implementation of an engaged scholarship partnership with the local hospice in relation to educational gains, experiential learning, transformational learning, and professional growth? This question is…

  17. Ethics seminar: the hospice patient in the ED: an ethical approach to understanding barriers and improving care.

    PubMed

    Zieske, Michael; Abbott, Jean

    2011-11-01

    Emergency physicians (EPs) are asked to evaluate and treat a growing population of hospice patients who present to the emergency department (ED) for a number of important reasons. Hospice patients pose unique ethical challenges, and "best practices" for these patients can differ from the life-preserving interventions of usual ED care. Having a solid understanding of professional responsibilities and ethical principles is useful for guiding EP management of these patients. In end-of-life care, EPs need to recognize that there are barriers and complexities to the best management of hospice patients, but they need to commit to strategies that optimize their care. This article describes the case of a hospice patient who presented with sepsis and end-stage cancer to the ED. Patient, system, and physician factors made management decisions in the ED difficult. The goal in the ED should be to determine the best way to address terminally ill patient needs while respecting wishes to limit interventions that will only increase suffering near the end of life.

  18. Online resources for culturally and linguistically appropriate services for home healthcare and hospice, part 5: resources for African patients.

    PubMed

    Young, Judith S

    2013-05-01

    Providing culturally and linguistically appropriate home healthcare and hospice care to patients who have emigrated from the African continent can be a challenge. This article reviews Web sites that provide introductions to some of the predominant cultures in Africa. Web sites providing patient education material in 13 African languages are also discussed. PMID:23652979

  19. An MIP model to schedule the call center workforce and organize the breaks

    NASA Astrophysics Data System (ADS)

    Türker, Turgay; Demiriz, Ayhan

    2016-06-01

    In modern economies, companies place a premium on managing their workforce efficiently especially in labor intensive service sector, since the services have become the significant portion of the economies. Tour scheduling is an important tool to minimize the overall workforce costs while satisfying the minimum service level constraints. In this study, we consider the workforce management problem of an inbound call-center while satisfying the call demand within the short time periods with the minimum cost. We propose a mixed-integer programming model to assign workers to the daily shifts, to determine the weekly off-days, and to determine the timings of lunch and other daily breaks for each worker. The proposed model has been verified on the weekly demand data observed at a specific call center location of a satellite TV operator. The model was run on both 15 and 10 minutes demand estimation periods (planning time intervals).

  20. Model of fluorescence intermittency of single colloidal semiconductor quantum dots using multiple recombination centers.

    PubMed

    Frantsuzov, Pavel A; Volkán-Kacsó, Sándor; Jankó, Bolizsár

    2009-11-13

    We present a new physical model resolving a long-standing mystery of the power-law distributions of the blinking times in single colloidal quantum dot fluorescence. The model considers the nonradiative relaxation of the exciton through multiple recombination centers. Each center is allowed to switch between two quasistationary states. We point out that the conventional threshold analysis method used to extract the exponents of the distributions for the on times and off times has a serious flaw: the qualitative properties of the distributions strongly depend on the threshold value chosen for separating the on and off states. Our new model explains naturally this threshold dependence, as well as other key experimental features of the single quantum dot fluorescence trajectories, such as the power-law power spectrum (1/f noise).

  1. Modeling hydrothermal processes at ocean spreading centers: Magma to microbe—An overview

    NASA Astrophysics Data System (ADS)

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

    Hydrothermal processes at oceanic spreading centers encompass a number of highly interconnected processes ranging from the transport of mantle melts beneath spreading centers to the evolution of ocean chemistry and Earth's climate. This volume, which stems from a RIDGE Theoretical Institute held at Mammoth Lakes, California in June 2006, contains papers that address the complex connections among magmatic heat supply, crustal formation, seismicity, and hydrothermal circulation as well as the complex linkages among hydrothermal circulation, vent chemistry, carbon cycling, and microbial and macrofaunal ecosystems. The last paper in this volume explores the connection between hydrothermal venting and the chemical evolution of the oceans during the Phanerozoic. From reading these papers, one should recognize the wide variety of modeling approaches used and the uneven state of model development within various subdisciplines. Models of hydrothermal circulation and vent chemistry tend to be more quantitative, whereas models of carbon cycling and biological processes tend to be more conceptual. Although many of the complex linkages among the subdisciplines are understood at a conceptual level, considerable effort must be undertaken to develop integrated quantitative models of hydrothermal processes at oceanic spreading centers.

  2. Primary immunodeficiencies worldwide: an updated overview from the Jeffrey Modell Centers Global Network.

    PubMed

    Modell, Vicki; Quinn, Jessica; Orange, Jordan; Notarangelo, Luigi D; Modell, Fred

    2016-06-01

    Primary immunodeficiencies (PI) are defects of the immune system that cause severe, sometimes life-threatening, infections if not diagnosed and treated appropriately. Many patients with PI are undiagnosed, under-diagnosed, or misdiagnosed. To raise awareness and assure earliest diagnosis, appropriate treatment, and proper care management, the Jeffrey Modell Foundation (JMF) implemented a physician education and public awareness program beginning in 2003. Data are requested annually from physician experts within the Jeffrey Modell Centers Network (JMCN), consisting of 602 expert physicians, at 253 academic institutions, in 206 cities, and 84 countries spanning six continents. Center Directors reported on patients' specific PI defects and treatment modalities including immunoglobulins, transplantation, and gene therapy as well as data on gender and age. Center Directors also provided physician-reported patient outcomes as well as pre- and post-diagnosis differences. Costs were assigned to these factors. In collaboration with the Network, JMF advocated, funded, and implemented population-based newborn screening for severe combined immunodeficiency and T cell lymphopenia, covering 96.2 % of all newborns in the US. Finally, 21 JMF Centers participated in a polio surveillance study of patients with PI who either received or have been exposed to the oral polio vaccine. These initiatives have led to an overall better understanding of the immune system and will continue to improve quality of life for those with PI.

  3. Cancer patient-centered home care: a new model for health care in oncology

    PubMed Central

    Tralongo, Paolo; Ferraù, Francesco; Borsellino, Nicolò; Verderame, Francesco; Caruso, Michele; Giuffrida, Dario; Butera, Alfredo; Gebbia, Vittorio

    2011-01-01

    Patient-centered home care is a new model of assistance, which may be integrated with more traditional hospital-centered care especially in selected groups of informed and trained patients. Patient-centered care is based on patients’ needs rather than on prognosis, and takes into account the emotional and psychosocial aspects of the disease. This model may be applied to elderly patients, who present comorbid diseases, but it also fits with the needs of younger fit patients. A specialized multidisciplinary team coordinated by experienced medical oncologists and including pharmacists, psychologists, nurses, and social assistance providers should carry out home care. Other professional figures may be required depending on patients’ needs. Every effort should be made to achieve optimal coordination between the health professionals and the reference hospital and to employ shared evidence-based guidelines, which in turn guarantee safety and efficacy. Comprehensive care has to be easily accessible and requires a high level of education and knowledge of the disease for both the patients and their caregivers. Patient-centered home care represents an important tool to improve quality of life and help cancer patients while also being cost effective. PMID:21941445

  4. CenteringParenting: an innovative dyad model for group mother-infant care.

    PubMed

    Bloomfield, Joanna; Rising, Sharon Schindler

    2013-01-01

    CenteringParenting is a group model that brings a cohort of 6 to 7 mothers and infants together for care during the first year of life. During 9 group sessions the clinician provides well-baby care and also attends to the health, development, and safety issues of the mother. Ideally, CenteringParenting provides continuity of care for a cohort of women who have received care in CenteringPregnancy, group prenatal care that is 10 sessions throughout the entire pregnancy and that leads to community building, better health outcomes, and increased satisfaction with prenatal care. The postpartum year affects the entire family, but especially the mother, who is redefining herself and her own personal goals. Issues of weight/body image, breastfeeding, depression, contraception, and relationship issues all may surface. In traditional care, health resources for support and intervention are frequently lacking or unavailable. Women's health clinicians also note the loss of contact with women they have followed during the prenatal period, often not seeing a woman again until she returns for another pregnancy. CenteringParenting recognizes that the health of the mother is tied to the health of the infant and that assessment and interventions are more appropriate and efficient when done in a dyad context. Facilitative leadership, rather than didactic education, encourages women to fully engage in their care, to raise issues of importance to them, and to discuss concerns within an atmosphere that allows for the surfacing of culturally appropriate values and beliefs. Implementing the model calls for system changes that are often significant. It also requires the building of a substantial team relationship among care providers. This overview describes the CenteringParenting mother-infant dyad care model with special focus on the mother and reviews the perspectives and experiences of staff from several practice sites.

  5. CenteringParenting: an innovative dyad model for group mother-infant care.

    PubMed

    Bloomfield, Joanna; Rising, Sharon Schindler

    2013-01-01

    CenteringParenting is a group model that brings a cohort of 6 to 7 mothers and infants together for care during the first year of life. During 9 group sessions the clinician provides well-baby care and also attends to the health, development, and safety issues of the mother. Ideally, CenteringParenting provides continuity of care for a cohort of women who have received care in CenteringPregnancy, group prenatal care that is 10 sessions throughout the entire pregnancy and that leads to community building, better health outcomes, and increased satisfaction with prenatal care. The postpartum year affects the entire family, but especially the mother, who is redefining herself and her own personal goals. Issues of weight/body image, breastfeeding, depression, contraception, and relationship issues all may surface. In traditional care, health resources for support and intervention are frequently lacking or unavailable. Women's health clinicians also note the loss of contact with women they have followed during the prenatal period, often not seeing a woman again until she returns for another pregnancy. CenteringParenting recognizes that the health of the mother is tied to the health of the infant and that assessment and interventions are more appropriate and efficient when done in a dyad context. Facilitative leadership, rather than didactic education, encourages women to fully engage in their care, to raise issues of importance to them, and to discuss concerns within an atmosphere that allows for the surfacing of culturally appropriate values and beliefs. Implementing the model calls for system changes that are often significant. It also requires the building of a substantial team relationship among care providers. This overview describes the CenteringParenting mother-infant dyad care model with special focus on the mother and reviews the perspectives and experiences of staff from several practice sites. PMID:24406037

  6. Cryogenic wind-tunnel model technology development activities at the NASA Langley Research Center

    NASA Technical Reports Server (NTRS)

    Young, C. P., Jr.; Bradshaw, J. F.; Rush, H. F., Jr.; Wallace, J. W.; Watkins, V. E., Jr.

    1984-01-01

    This paper summarizes the current cryogenic wind-tunnel model technology development activities at the NASA Langley Research Center. These research and development activities are being conducted in support of the design and fabrication of models for the new National Transonic Facility (NTF). The scope and current status of major research and development work is described and where available, data are presented from various investigations conducted to date. In addition, design and fabrication experience for existing developmental models to be tested in the NTF is discussed.

  7. Community Coordinated Modeling Center Support of Operations: Real-Time Simulations and V & V.

    NASA Technical Reports Server (NTRS)

    Kuznetsova, M.; Hesse, M.; Rastaetter, L.; Maddox, M.; Macneice, P.; Chulaki, A.; Berrios, D.

    2007-01-01

    In support of Operations Community Coordinated Modeling Center (CCMC) performing validation and verification of space weather models. To identify suitable metrics the CCMC focus on parameters most useful to operations that CCMC resident models can provide. The real time simulations carried out at CCMC are an essential tool to test model performance and stability by using input conditions that may occur in nature at any time. Since 2001, the magnetospheric MHD model BATSRUS has been run in real time using ACE real time data. CCMC staff developed an experimental real-time system that controls uploading of the real-time ACE data, monitors continuous model execution, initiates automatic recovery procedure in case of data gaps or hardware failures, synchronizes BATSRUS and FRC runs, and periodically runs IDL based visualization software.

  8. The Community Coordinated Modeling Center - An Evolving Cyberinfrastructure for the Space Science Community

    NASA Astrophysics Data System (ADS)

    Maddox, M. M.; Kuznetsova, M. M.; Pulkkinen, A. A.; Rastaetter, L.; Mays, M. L.; MacNeice, P. J.; Zheng, Y.; Chulaki, A.; Shim, J. S.; Collado-Vega, Y. M.; Mendoza, A. M. M.; Taktakishvili, A.; Mullinix, R.; Boblitt, J.; Bakshi, S. S.; Patel, K.; Pembroke, A. D.

    2015-12-01

    The Community Coordinated Modeling Center (CCMC) at NASA Goddard Space Flight Center was established in 2000 as an essential element of the National Space Weather Program and was designed to be a long-term & flexible solution to the Research-to-Operations (R2O) transition problem. Over its 15-year existence, the CCMC has changed how state-of-the-art space weather models are utilized in research, and has also facilitated the transition of many research models into operational environments. The CCMC currently hosts a large and expanding collection of physics-based space weather models that have been developed by the international research community, and has amassed a peta-byte of model simulation output that represents advances in space weather modeling and space science research for the past 15 years.The ability of the CCMC to engage the international research community and support community challenges, campaigns, studies, and general research is vital to its success - so a flexible cyberinfrastructure that facilitates data discovery and interoperability with external systems is a necessity. There are many challenges associated with supporting a large number of disparate, physics-based models and the computational infrastructure to support them. This paper will highlight the CCMC's past, present, and future computational infrastructure, and showcase several examples of how the CCMC continues to support many self-organized efforts in the space science community.

  9. Pathology service line: a model for accountable care organizations at an academic medical center.

    PubMed

    Sussman, Ira; Prystowsky, Michael B

    2012-05-01

    Accountable care is designed to manage the health of patients using a capitated cost model rather than fee for service. Pay for performance is an attempt to use quality and not service reduction as the way to decrease costs. Pathologists will have to demonstrate value to the system. This value will include (1) working with clinical colleagues to optimize testing protocols, (2) reducing unnecessary testing in both clinical and anatomic pathology, (3) guiding treatment by helping to personalize therapy, (4) designing laboratory information technology solutions that will promote and facilitate accurate, complete data mining, and (5) administering efficient cost-effective laboratories. The pathology service line was established to improve the efficiency of delivering pathology services and to provide more effective support of medical center programs. We have used this model effectively at the Montefiore Medical Center for the past 14 years. PMID:22333926

  10. Data Transfer Software-SAS MetaData Server & Phoenix Integration Model Center

    SciTech Connect

    2010-04-15

    This software is a plug-in that interfaces between the Phoenix Integration's Model Center and the Base SAS 9.2 applications. The end use of the plug-in is to link input and output data that resides in SAS tables or MS SQL to and from "legacy" software programs without recoding. The potential end users are users who need to run legacy code and want data stored in a SQL database.

  11. Synthetic Model of the Oxygen-Evolving Center: Photosystem II under the Spotlight.

    PubMed

    Yu, Yang; Hu, Cheng; Liu, Xiaohong; Wang, Jiangyun

    2015-09-21

    The oxygen-evolving center (OEC) in photosystem II catalyzes a water splitting reaction. Great efforts have already been made to artificially synthesize the OEC, in order to elucidate the structure-function relationship and the mechanism of the reaction. Now, a new synthetic model makes the best mimic yet of the OEC. This recent study opens up the possibility to study the mechanism of photosystem II and photosynthesis in general for applications in renewable energy and synthetic biology.

  12. The NASA Community Coordinated Modeling Center (CCMC) Next Generation Space Weather Data Warehouse

    NASA Astrophysics Data System (ADS)

    Maddox, M. M.; Kuznetsova, M. M.; Pulkkinen, A. A.; Zheng, Y.; Rastaetter, L.; Chulaki, A.; Pembroke, A. D.; Wiegand, C.; Mullinix, R.; Boblitt, J.; Mendoza, A. M. M.; Swindell, M. J., IV; Bakshi, S. S.; Mays, M. L.; Shim, J. S.; Hesse, M.; Collado-Vega, Y. M.; Taktakishvili, A.; MacNeice, P. J.

    2014-12-01

    The Community Coordinated Modeling Center (CCMC) at NASA Goddard Space Flight Center enables, supports, and performs research and development for next generation space science and space weather models. The CCMC currently hosts a large and expanding collection of state-or-the-art, physics-based space weather models that have been developed by the international research community. There are many tools and services provided by the CCMC that are currently available world-wide, along with the ongoing development of new innovative systems and software for research, discovery, validation, visualization, and forecasting. Over the history of the CCMC's existence, there has been one constant engineering challenge - describing, managing, and disseminating data. To address the challenges that accompany an ever-expanding number of models to support, along with a growing catalog of simulation output - the CCMC is currently developing a flexible and extensible space weather data warehouse to support both internal and external systems and applications. This paper intends to chronicle the evolution and future of the CCMC's data infrastructure, and the current infrastructure re-engineering activities that seek to leverage existing community data model standards like SPASE and the IMPEx Simulation Data Model.

  13. The NASA Marshall Space Flight Center Earth Global Reference Atmospheric Model-2010 Version

    NASA Technical Reports Server (NTRS)

    Leslie, F. W.; Justus, C. G.

    2011-01-01

    Reference or standard atmospheric models have long been used for design and mission planning of various aerospace systems. The NASA Marshall Space Flight Center Global Reference Atmospheric Model was developed in response to the need for a design reference atmosphere that provides complete global geographical variability and complete altitude coverage (surface to orbital altitudes), as well as complete seasonal and monthly variability of the thermodynamic variables and wind components. In addition to providing the geographical, height, and monthly variation of the mean atmospheric state, it includes the ability to simulate spatial and temporal perturbations.

  14. Community Coordinated Modeling Center Support of Science Needs for Integrated Data Environment

    NASA Technical Reports Server (NTRS)

    Kuznetsova, M. M.; Hesse, M.; Rastatter, L.; Maddox, M.

    2007-01-01

    Space science models are essential component of integrated data environment. Space science models are indispensable tools to facilitate effective use of wide variety of distributed scientific sources and to place multi-point local measurements into global context. The Community Coordinated Modeling Center (CCMC) hosts a set of state-of-the- art space science models ranging from the solar atmosphere to the Earth's upper atmosphere. The majority of models residing at CCMC are comprehensive computationally intensive physics-based models. To allow the models to be driven by data relevant to particular events, the CCMC developed an online data file generation tool that automatically downloads data from data providers and transforms them to required format. CCMC provides a tailored web-based visualization interface for the model output, as well as the capability to download simulations output in portable standard format with comprehensive metadata and user-friendly model output analysis library of routines that can be called from any C supporting language. CCMC is developing data interpolation tools that enable to present model output in the same format as observations. CCMC invite community comments and suggestions to better address science needs for the integrated data environment.

  15. Existential concerns about death: a qualitative study of dying patients in a Danish hospice.

    PubMed

    Moestrup, Lene; Hansen, Helle Ploug

    2015-06-01

    Research suggests that addressing dying patients' existential concerns can improve their quality of life. We aimed to illuminate dying patients' existential concerns about the impending death through a descriptive analysis of semistructured interviews with 17 patients in Danish hospices. The main findings demonstrated how the patients faced the imminent death without being anxious of death but sorrowful about leaving life. Some patients expressed that they avoided thinking about death. They wished to focus on positive aspects in their daily life. We argue that the patients' existential concerns could not be fully captured by Yalom's existential psychology or by Kübler-Ross's theory about death stages. Patients' complex concerns could be more fully explained taking an outset in Heidegger's phenomenological thinking. PMID:24595321

  16. Existential concerns about death: a qualitative study of dying patients in a Danish hospice.

    PubMed

    Moestrup, Lene; Hansen, Helle Ploug

    2015-06-01

    Research suggests that addressing dying patients' existential concerns can improve their quality of life. We aimed to illuminate dying patients' existential concerns about the impending death through a descriptive analysis of semistructured interviews with 17 patients in Danish hospices. The main findings demonstrated how the patients faced the imminent death without being anxious of death but sorrowful about leaving life. Some patients expressed that they avoided thinking about death. They wished to focus on positive aspects in their daily life. We argue that the patients' existential concerns could not be fully captured by Yalom's existential psychology or by Kübler-Ross's theory about death stages. Patients' complex concerns could be more fully explained taking an outset in Heidegger's phenomenological thinking.

  17. Webcasting in home and hospice care services: virtual communication in home care.

    PubMed

    Smith-Stoner, Marilyn

    2011-06-01

    The access to free live webcasting over home computers was much more available in 2007, when three military leaders from West Point, with the purpose of helping military personnel stay connected with their families when deployed, developed Ustream.tv. There are many types of Web-based video streaming applications. This article describes Ustream, a free and effective communication tool to virtually connect staff. There are many features in Ustream, but the most useful for home care and hospice service providers is its ability to broadcast sound and video to anyone with a broadband Internet connection, a chat room for users to interact during a presentation, and the ability to have a "co-host" or second person also broadcast simultaneously. Agencies that provide community-based services in the home will benefit from integration of Web-based video streaming into their communication strategy.

  18. A study of Canadian hospice palliative care volunteers' attitudes toward physician-assisted suicide.

    PubMed

    Claxton-Oldfield, Stephen; Miller, Kathryn

    2015-05-01

    The purpose of this study was to examine the attitudes of hospice palliative care (HPC) volunteers who provide in-home support (n = 47) and members of the community (n = 58) toward the issue of physician-assisted suicide (PAS). On the first part of the survey, participants responded to 15 items designed to assess their attitudes toward PAS. An examination of individual items revealed differences in opinions among members of both the groups. Responses to additional questions revealed that the majority of volunteers and community members (1) support legalizing PAS; (2) would choose HPC over PAS for themselves if they were terminally ill; and (3) think Canadians should place more priority on developing HPC rather than on legalizing PAS. The implications of these findings are discussed.

  19. Reduced-Order Modeling: Cooperative Research and Development at the NASA Langley Research Center

    NASA Technical Reports Server (NTRS)

    Silva, Walter A.; Beran, Philip S.; Cesnik, Carlos E. S.; Guendel, Randal E.; Kurdila, Andrew; Prazenica, Richard J.; Librescu, Liviu; Marzocca, Piergiovanni; Raveh, Daniella E.

    2001-01-01

    Cooperative research and development activities at the NASA Langley Research Center (LaRC) involving reduced-order modeling (ROM) techniques are presented. Emphasis is given to reduced-order methods and analyses based on Volterra series representations, although some recent results using Proper Orthogonal Deco in position (POD) are discussed as well. Results are reported for a variety of computational and experimental nonlinear systems to provide clear examples of the use of reduced-order models, particularly within the field of computational aeroelasticity. The need for and the relative performance (speed, accuracy, and robustness) of reduced-order modeling strategies is documented. The development of unsteady aerodynamic state-space models directly from computational fluid dynamics analyses is presented in addition to analytical and experimental identifications of Volterra kernels. Finally, future directions for this research activity are summarized.

  20. Updated verification of the Space Weather Prediction Center's solar energetic particle prediction model

    NASA Astrophysics Data System (ADS)

    Balch, Christopher C.

    2008-01-01

    This paper evaluates the performance of an operational proton prediction model currently being used at NOAA's Space Weather Prediction Center. The evaluation is based on proton events that occurred between 1986 and 2004. Parameters for the associated solar events determine a set of necessary conditions, which are used to construct a set of control events. Model output is calculated for these events and performance of the model is evaluated using standard verification measures. For probability forecasts we evaluate the accuracy, reliability, and resolution and display these results using a standard attributes diagram. We identify conditions for which the model is systematically inaccurate. The probability forecasts are also evaluated for categorical forecast performance measures. We find an optimal probability and we calculate the false alarm rate and probability of detection at this probability. We also show results for peak flux and rise time predictions. These findings provide an objective basis for measuring future improvements.