American Journal of Hospice and Palliative Medicine®最新文献

{"title":"Teaching end-of-life issues: Current status in United Kingdom and United States medical schools","authors":"G. Dickinson, D. Field","doi":"10.1177/104990910201900309","DOIUrl":"https://doi.org/10.1177/104990910201900309","url":null,"abstract":"Our objective was to determine how broadly end-of-life issues are represented in the undergraduate medical school curricula of the United Kingdom (UK) and the United States (US). Mailed surveys yielded response rates of 100 percent in the UK and 92 percent in the US. With one exception, all medical schools in the survey offered some exposure to dying, death, and bereavement and most addressed the topic of palliative care. Hospice involvement was found in 96 percent of UK medical schools but in only 50 percent of US schools. Overall, the UK appears to provide more exposure to end-of-life issues in medical schools, although the US appears to be moving in that direction.","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"25 3 1","pages":"181 - 186"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77992581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Palliative care, burnout, and the pursuit of happiness","authors":"S. Baumrucker","doi":"10.1177/104990910201900303","DOIUrl":"https://doi.org/10.1177/104990910201900303","url":null,"abstract":"I was attending a lecture at the Third Joint Clinical Conference of the NHPCO/AAHPM/HPNA (National Hospice and Palliative Care Organization, American Academy of Hospice and Palliative Medicine, and Hospice and Palliative Nurses Association) in New Orleans last week when I had an epiphany. The talk was by John Finn, MD, the medical director of Hospice of Michigan (a large, multicenter hospice organization based in Detroit). He was speaking on “selfpreservation skills for the hospice professional” to a packed room. While Dr. Finn spoke, I suddenly realized how relevant his talk was to me and to many practitioners in our field. My “bolt of lightning,” as I will explain, struck as I pondered his words about the dangers of pessimism and cynicism and the benefits of optimism and trust. Professional burnout is not confined to palliative care, or even to medicine. “Burnout” is a response to unremitting stress and is described as a “syndrome of depersonalization, emotional exhaustion, and a sense of low personal accomplishment”1 resulting in depression, anxiety, and degraded interpersonal relationships. Overt symptoms are legion and include irritability, appetite disorders, memory disturbances, lack of impulse control (e.g., shouting, acting out), and even self-destructive behaviors. Given the stresses in dealing with death-and-dying issues, paperwork, regulatory upkeep, distressed families, late or inappropriate referrals, and marginal reimbursement, it is no surprise that nurses, social workers, aides, chaplains, physicians, and all other hospice and palliative caregivers are at risk. Before proceeding, it should be noted that palliative care physicians report lower levels of burnout and other stress-related disorders than do other specialists, at least in the United Kingdom, where these studies were performed.2 English palliative-care consultants report less stress from overload than their colleagues and relate gratification from the positive relationships they enjoy with patients. To further illustrate the point, compare the 28-percent “burnout and psychiatric disorder” rate in the UK study of oncologists and palliative care specialists2 to the 76 percent burnout rate among internal medicine residents in Rochester, Minnesota1 for a stunning juxtaposition. What was extremely interesting in the UK palliative care study was that burnout was significantly more common in those who felt they were insufficiently trained in the communication skills required for the job.3 In Dr. Finn’s talk, he referenced an article by Jim Loehr and Tony Schwarz titled “The Making of a Corporate Athlete,” which appeared in the January 2001 Harvard Business Review.4 Sounding board","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"43 1","pages":"154 - 156"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76412890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using caregivers-as-proxies to retrospectively assess and measure quality of dying of palliative care clients","authors":"M. Bridge, D. Roughton, S. Lewis, J. Barelds, S. Brenton, Sherree Cotter, Mary-lou Hagebols, Kirsty Woolman, M. Annells, T. Koch","doi":"10.1177/104990910201900311","DOIUrl":"https://doi.org/10.1177/104990910201900311","url":null,"abstract":"This study evaluated two quality-of-life assessment and measurement tools, the Client Generated Index and the McGill Quality of Life questionnaire, within palliative care nursing. Primarily tested was the feasibility of the tools to assess clients’ QOL at admission and, if necessary, when their condition altered. The reliability of the tools has previously been ascertained. Additionally, quality of dying during the last two days of life for 14 participants who died during the study was assessed and measured retrospectively by these tools, using the client’s nominated care-giver as proxy for the client. It is this second focus that we report on here. The reasons why proxy assessment and measurement of client QOD was not useful or feasible are discussed.","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"3 1","pages":"193 - 199"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75563043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"You need not make the journey alone: Overcoming impediments to providing palliative care in a public urban teaching hospital","authors":"Angèle Ryan, J. Carter, J. Lucas, J. Berger","doi":"10.1177/104990910201900308","DOIUrl":"https://doi.org/10.1177/104990910201900308","url":null,"abstract":"The majority of dying patients continue to receive care in acute, tertiary settings. This has generated the development of hospital-based palliative care (HBPC). The Symptom Management and Palliative Care Program (SMPCP) at LAC+USC Medical Center provides HBPC. The SMPCP operates as an interdisciplinary consultative service, assessing inpatients, and documenting recommendations for primary physicians. Over a 28-month period the SMPCP provided clinical recommendations, education, and research for patients, family members, and hospital staff. Demographic, clinical, psychosocial, financial, and outcome information was collected on 265 patients. The SMPCP documented the attainment of defined quality end-points, including pain control within 24 hours, a Do Not Resuscitate (DNR) discussion with patient and family within 72 hours, and control of nausea and vomiting within 24 hours. Team members also documented impediments to implementing recommendations and the success of interventions to overcome impediments. Results indicated that the SMPCP achieved a high rate of quality end-point attainment when impediments were not present. The most significant impediments resulted from behaviors by primary physicians. The SMPCP’s ability to overcome barrier behaviors improved the rate of end-point attainment, confirming the importance of palliative care at the end of life.","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"26 1","pages":"171 - 180"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72943866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A phase II study of low-dose megestrol acetate using twice-daily dosing for anorexia in nonhormonally dependent cancer","authors":"K. Nelson, D. Walsh, M. Hussein","doi":"10.1177/104990910201900313","DOIUrl":"https://doi.org/10.1177/104990910201900313","url":null,"abstract":"Anorexia is a common problem in advanced cancer. Low-dose megestrol acetate, a semi-synthetic progesterone, given twice daily, is an effective appetite stimulant in advanced cancer patients. There was an excellent correlation between patient satisfaction and the primary response criteria (appetite improvement). Given cost, side-effect profile, ease of administration, and efficacy, 80 mg twice daily after meals is an appropriate starting dose of megestrol acetate for anorexia in advanced cancer. If this is not effective, considerable dose escalation is possible.","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"26 1","pages":"206 - 210"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84727071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Book Review: Handbook for Mortals: Guidance for People Facing Serious Illness","authors":"J. Ufema","doi":"10.1177/104990910201900316","DOIUrl":"https://doi.org/10.1177/104990910201900316","url":null,"abstract":"","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"72 1","pages":"215 - 215"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82705071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Everyday hero","authors":"Hunter E Woodall","doi":"10.1177/104990910201900315","DOIUrl":"https://doi.org/10.1177/104990910201900315","url":null,"abstract":"Downloading the book in this website lists can give you more advantages. It will show you the best book collections and completed collections. So many books can be found in this website. So, this is not only this everyday hero. However, this book is referred to read because it is an inspiring book to give you more chance to get experiences and also thoughts. This is simple, read the soft file of the book and you get it.","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"35 1","pages":"213 - 214"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77749363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burnout and compassion fatigue among hospice caregivers","authors":"G. Keidel","doi":"10.1177/104990910201900312","DOIUrl":"https://doi.org/10.1177/104990910201900312","url":null,"abstract":"Burnout is a word currently used in discussions about the present nursing shortage. Hospice staff, because of their work with the terminally ill, are considered a high-risk group for burnout. Too frequently, the reason behind the decision to leave or take a sabbatical from hospice work is that the staff member reached the limits of his or her capacity to care and “couldn’t take it any more.” It is, therefore, important to discuss the concept of burnout and how it can affect hospice staff as well as the primary caregivers for hospice patients to ascertain the reasons behind it and take steps to lessen caregiver stress.","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"9 1","pages":"200 - 205"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87867880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers, challenges, and opportunities related to the provision of hospice care in assisted-living communities","authors":"S. Dixon, J. Fortner, S. Travis","doi":"10.1177/104990910201900310","DOIUrl":"https://doi.org/10.1177/104990910201900310","url":null,"abstract":"The purpose of this project was to clarify the barriers, challenges, and opportunities associated with providing care to older adults residing in assisted-living communities. Three focus groups (hospice team members, family members of individuals who received hospice care while in assisted living, and administrators of assisted-living communities) were convened to discuss hospice care. Thematic analysis of the transcribed focus group tapes was used by the authors to identify the common and unique barriers, challenges, and opportunities identified by each group. All three groups were overwhelmingly in support of the right of residents in assisted-living communities to live and die in place, without being transferred to nursing homes or other acute-care facilities, and of the role that hospice plays in enabling residents to achieve that goal. The three groups also agreed that trends in the development of assisted-living communities create difficulties for the industry, confusion for consumers, and the need for increased accountability by providers. Delivering hospice care to places where consumers want to live and die in place will be a complex task. Among other things, traditional hospice care is not easily transported into the social models of care characterized by assisted-living environments. Changes in hospice organization policies and procedures will be necessary, as will broader, industry-wide reforms in areas such as recruitment, retention of qualified staff, and consistent quality-of-care standards.","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"24 1","pages":"187 - 192"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73343243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Palliative radiation therapy in hospice care","authors":"R. Enck","doi":"10.1177/104990910201900301","DOIUrl":"https://doi.org/10.1177/104990910201900301","url":null,"abstract":"this issue of the American Journal of Hospice & Palliative Care, radiation therapy is rarely used or even contemplated in the hospice setting. The major drawbacks to this modality of treatment include a significant burden to the patient and family as well as hospice-related financial disincentives. The advent of shortened courses of radiation therapy with resultant patient ease and less cost, as noted by Fine, may cause hospice providers to rethink this option. To this end, we will briefly review the issue of palliative radiation therapy and hospice using the information noted by Fine1 and others.2-4 Radiation therapy (RT) is used for local control of cancer and is based on the number, timing, and radiation doses per session (fractionation schedule). Of note, it has been estimated that approximately one half of all RT is given with palliative intent.2 Common indications for palliative RT include the following: • Pain from bone metastases;","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"87 1","pages":"151 - 152"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75849432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}