Journal of palliative care & medicine最新文献

{"title":"Patient Centered Care for Persons with HIV Disease: Protocol Review for CASA Study (Care and Support Access) Early in Chronic Disease Management","authors":"Carla S Alex, er, V. Raveis, D. Karus, Mei Ching Lee, Monique Carrero Tagle, Rebecca Brotemarkle, G. Pappas, P. Selwyn","doi":"10.4172/2165-7386.1000300","DOIUrl":"https://doi.org/10.4172/2165-7386.1000300","url":null,"abstract":"Background: In the US, more than 1.2 million adults are living with human immunodeficiency virus (HIV); gay and bisexual men account for 82% of new diagnoses annually. Young men of color account for 67% of this total. Despite advances in disease control, lack of retention in care itself remains a barrier and how outpatient staff members impact this has not been investigated. The palliative approach is patient-centered care targeting \"relief of suffering\" and \"quality of life.\" This paper describes the original protocol for the Care and Support Access Study (CASA) where outpatient HIV staff members are challenged to improve outcomes for young men who have sex with men (yMSM) by integrating the palliative approach early (ePA) with HIV care delivery. \u0000Methods: The hypothesis is that ePA can favorably impact outcomes for yMSM in one HIV clinic compared with treatment as usual (TAU) at a second clinic. In the era of HIVdisease control, we use a quasi-experimental design with mixed methods to compare patient-level outcomes at 2 HIV clinics. The intervention fosters incorporation of the ePA with care provision using didactic and iterative education. We survey HIV staff members with regard to stress of care-giving. Qualitative interviews will highlight impact of the experience. \u0000Objectives: This paper reviews the aims of the study including: 1) compare outcomes of yMSM receiving care from staff using the ePA to those receiving TAU; 2) compare work-related staff stress at a clinic receiving the ePA with staff providing standard HIV outpatient care; and 3) refine, deliver and determine the acceptability and applicability of interdisciplinary professional education to deliver the ePA in HIV management. \u0000Discussion: We will measure the impact of the ePA on care delivery relative to patientcentered benefits. Lessons learned can contribute to a model for working with diverse patients facing challenging life transitions.","PeriodicalId":91127,"journal":{"name":"Journal of palliative care & medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7386.1000300","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44083279","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":"Emergency Department Intervention Program for Enhancing Choice at the Endof Life: A Quality Improvement Project at a Comprehensive Cancer Center","authors":"M. T. Cruz-Carreras, Patrick S Chaftari, Carmen E. Gonzalez, Rowena Enojo, Jayne Viets-Upchurch","doi":"10.4172/2165-7386.1000298","DOIUrl":"https://doi.org/10.4172/2165-7386.1000298","url":null,"abstract":"Background: Advance care planning (ACP) for end-of-life care is especially important for individuals with terminal illnesses such as advanced cancer. It ensures that patients’ wishes are honored and alleviates the decisionmaking burden on family members and medical providers. It reduces unnecessary medical costs, and prevents waste of valuable resources. We proposed a quality improvement project to improve documentation of advanced care directives in the Emergency Department (ED) of a tertiary cancer center. \u0000Methods: We developed a pocket card to help emergency physicians screen patients in need of ACP. The goal was to assist ED staff in initiating conversations about end-of-life issues, and encourage patients and their caregivers to get involved in decisions about their medical treatment. \u0000Intervention: The project was implemented in a Plan-Do-Study-Act design. Baseline data was collected from the medical records of all patients visiting the ED on seven consecutive days prior to the distribution of the pocket card tool. After the launch of the intervention, the charts of all patients visiting the emergency center were reviewed for documentation of advanced care planning. Metrics polled included presence of a health care power of attorney and determination of code status, specifically the do-not-resuscitate (DNR) status. \u0000Results: 429 patients who visited the ED seven consecutive days prior to institution of the screening tool. Of these, we found that 66 (15.4%) had indicated their do-not-resuscitate (DNR) status in their charts, and 82 (19.1%) had a health care power of attorney. Post launch of the intervention, 391 patients visited the ED over seven consecutive days. Of these, 125 (32.0%) indicated their DNR status in their charts before leaving the ED, and 95 (24.3%) had a health care power of attorney. After implementation of our screening tool, there was a 107.8% increase in documentation of DNR status and a 76% increase in patients with a health care power of attorney. \u0000Conclusions: In this quality improvement project, a straightforward, low cost intervention was successfully implemented to improve documentation of patients’ ACP goals.","PeriodicalId":91127,"journal":{"name":"Journal of palliative care & medicine","volume":"2017 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7386.1000298","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70683674","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":"Medical Residents' Practices and Perceptions toward Do-Not-Resuscitate (DNR)Order","authors":"Muneerah M. Albugami, H. Bassil, Ulrike Laudon, Abeer Ibrahim, Abdelazeim Elamin, Usamah Elalem, M. Siddiquee, Muhammad Sohaib Khan, A. Alshehri","doi":"10.4172/2165-7386.1000295","DOIUrl":"https://doi.org/10.4172/2165-7386.1000295","url":null,"abstract":"The knowledge and implementation skills of the DNR order amongst physicians in training appear to be quite variable. Few studies had assessed residents' views on this complex topic. Our objective was to describe the medical residents’ practices and perceptions toward DNR order. A 26 question survey was distributed to medical residents during the academic day activity. Only 56 residents completed the questionnaire (75% response rate). 61.40% of the residents understood the definition of DNR order. 85.96% thought physicians shouldn’t order diagnostic tests for DNR patients and 92.98% thought physicians shouldn’t give blood products and antibiotics to DNR patients. 45.61% thought DNR order would lead to poor care. 36.84% thought physician alone should decide about the DNR decision. 45.61% answered that DNR order never discussed with patients. 64.91% answered that consultant discussed DNR order with patients. 42.11% of residents were involved in the discussion of DNR order. 66.67% answered that time to decide about the DNR order on day of admission. 42.11% answered there was variation between consultants regarding the care of DNR patient. 43.86% answered there was variation in the clinical care before and after DNR order was placed. 87.72% thought here was a need for formal training in DNR discussion. 68.42% didn’t know if KFSH and RC had clinical guidelines for DNR patients care. \u0000Conclusion: (1) Majority of the residents had misunderstanding regarding DNR patient care and comfortable care. There is a need for developing a structured residency program curriculum to address resident skills in end-oflife care. (2) Encouraged discussions DNR issues in the outpatient setting could prevent unwanted resuscitation in the acute setting. (3) Efforts are needed to increase patients and their families’ awareness about the meaning of DNR order. (4) There is a need to unify and improve quality of care provided to DNR patients by developing specific strategies within a framework of goals of care.","PeriodicalId":91127,"journal":{"name":"Journal of palliative care & medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7386.1000295","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42454929","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":"Poly Ulceration Patient Terminal: Kennedy Terminal Ulcer (KTU)","authors":"Sarabia-Cobo Cm","doi":"10.4172/2165-7386.1000297","DOIUrl":"https://doi.org/10.4172/2165-7386.1000297","url":null,"abstract":"The principles of palliative wound and pressure ulcer care should be integrated along the continuum of wound care to address the whole person care needs of older people who often present with chronic debilitating diseases, advanced diseases associated with major organ failure (renal, hepatic, pulmonary or cardiac), profound dementia, complex psychosocial issues, diminished self-care abilities, and challenging wound-related symptoms [1].","PeriodicalId":91127,"journal":{"name":"Journal of palliative care & medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7386.1000297","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43134279","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":"Towards a Practice Guided Evidence Based Theory of Mentoring in PalliativeCare","authors":"Loo Teck Wee Wesley, M. Ikbal, Jingting Wu, M. T. Wahab, Y. C. Teng, Ee Hui Fang Margaret, R. Kanesvaran, L. Krishna","doi":"10.4172/2165-7386.1000296","DOIUrl":"https://doi.org/10.4172/2165-7386.1000296","url":null,"abstract":"Provision of end of life care and coping with the emotional and existential distress engendered by palliative care demands the provision of holistic support and training for palliativists. Mentoring is an effective means of meeting this need; however little is known of mentoring in palliative care and a universally accepted learning theory of mentoring remains lacking in this setting. To advance mentoring practice in palliative care, we review the only two evidenced based mentoring theories based upon narrative reviews of mentoring practice in the key specialties within palliative care teams. Building upon mentoring’s mentee, mentor and organizational dependent, goal specific, context sensitive features highlighted in both recent reviews of mentoring this paper proffers a working theory of mentoring. Constructed Krishna’s Mentoring Pyramid that underlines the 5 core elements of successful mentoring programs, we propose melding elements of the cognitive apprenticeship model with the adult learning theory using the multi-theories model of adult learning offers an effective starting point for a mentoring theory. More context-specific studies are needed to provide better insight into the validity of this framework in the ongoing pursuit of an interprofessional mentoring theory in Palliative Medicine.","PeriodicalId":91127,"journal":{"name":"Journal of palliative care & medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7386.1000296","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47542907","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":"Needs for Palliative Care of Cancer Patients in Brazil: Analysis of Data from 2008-2014","authors":"C. D. Santos, J. Caldas, J. Serafim, N. Barros, A. Pereira, M. Capra, A. Stein","doi":"10.4172/2165-7386.1000294","DOIUrl":"https://doi.org/10.4172/2165-7386.1000294","url":null,"abstract":"Background: The Brazilian Health System (SUS) faces major challenges to ensure the constitutional right of universal access to health care assistance and technological advances to the entire population. Concerns with the ageing population, the increasing incidence of cancer and the emergence of chronic non-communicable diseases include palliative care as one of the objectives of the Brazilian Health System (SUS). However, considering that each disease and individual present different social and cultural factors, needs, pattern of disease progression, associated co-morbidities and access to health care, the estimation of necessary resources and the definition of specific criteria to structure and adapt palliative care in the health services have been a difficult task in Brazil. Thus, it is necessary to estimate the needs and the resources and to specify parameters to structure and tailor an adequate modality of assistance in palliative care. Aims: 1) To estimate the number of cancer patients with palliative care needs in the population; 2) To simulate palliative care methods for population based estimation. Methods: The present methodology has a quantitative approach, with descriptive, exploratory, retrospective and observational studies of hospitalized cancer patients. This is a cross-sectional study using death certificate and hospital admission data, which was collected from the Mortality Information System (SIM) and Hospital Information System (SIH) of the Brazilian Health System (SUS), obtained from the database of the Health Information Department (DATASUS). Results: Yearly around 1.1 million deaths were reported to the Brazilian Mortality Information System, being 15.9% of these related to people living with cancer. Between 2008 and 2014, there were almost 4.5 million hospitalizations (4,431,685) of patients with cancer in Brazil, and, of all the hospital admissions of cancer patients, 1.189.908 (26.85%) were related to intercurrences of the disease and/or of treatment. The average rate of hospital mortality was 7.7 for cancer in general and 21.4 for clinical intercurrence of cancer patients, while the average length of stay (LOS) was 5.7 days for cancer in general and 7.9 days for clinical intercurrence of cancer patients. Conclusion: considering that the offer and the technical guidance regarding palliative care for users served by health establishments authorized by Brazilian Health System for the specialized assistance in oncology are mandatory, we need to estimate the needs, resources and specify parameters to structure and tailor an adequate modality of assistance in palliative care.","PeriodicalId":91127,"journal":{"name":"Journal of palliative care & medicine","volume":"2017 1","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7386.1000294","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70683974","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":"Family Caregivers and Palliative Care of Patients with Disorder in Consciousness","authors":"Zahra Imani Goghary","doi":"10.4172/2165-7386.1000305","DOIUrl":"https://doi.org/10.4172/2165-7386.1000305","url":null,"abstract":"","PeriodicalId":91127,"journal":{"name":"Journal of palliative care & medicine","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7386.1000305","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70683718","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":"Will You Be My Doctor? A Different Approach to Treating Patients with ChronicPain","authors":"Padmashri Rastogi","doi":"10.4172/2165-7386.1000309","DOIUrl":"https://doi.org/10.4172/2165-7386.1000309","url":null,"abstract":"","PeriodicalId":91127,"journal":{"name":"Journal of palliative care & medicine","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7386.1000309","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70683870","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":"The Benefits of Palliative Care Interventions for Patients with Heart Failure - A Literature Review","authors":"K. Hnyda, A. Avadhani","doi":"10.4172/2165-7386.1000324","DOIUrl":"https://doi.org/10.4172/2165-7386.1000324","url":null,"abstract":"Palliative care is an underused resource with the heart failure patient population. Many of these patients suffer not only from physical alignments but mental, spiritual and financial ones. Heart failure patients face many challenges such as frequent readmissions and a declining quality of life. This not only affects the patients but their families as well. Early palliative care intervention can decrease hospital readmissions and improve quality of life. Although advances in medicine have allowed for the heart failure patient to have more options in prolonging their life, sudden cardiac death may still occur. This uncertainty with the trajectory of death makes it difficult for some health care providers to initiate early discussions of palliative care. Many heart failure patients and their families see heart failure as a benign disease which makes it seem unnecessary for early palliative care interventions. Palliative care, by some people, is perceived as imminent death and not as an improvement to the quality of life. These patients are not being offered appropriate palliative care until their disease has exhausted all treatment plans. Many medical providers do not feel comfortable discussing early palliative care interventions, which in turn can lead to the lack of initiation into the patient’s heart failure treatment. Implementing a multidisciplinary team approach will allow cardiologists to work with other health care team members to provide for the highest quality of life. The purpose of this paper is to review the implementation process and benefits palliative care services offered to the heart failure patient community.","PeriodicalId":91127,"journal":{"name":"Journal of palliative care & medicine","volume":"7 1","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7386.1000324","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70683744","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":"Effects of Synchronizied Physio and Harp Music Therapy","authors":"T. Opsahl, T. BroJorgensen, T. Ishøy","doi":"10.4172/2165-7386.1000314","DOIUrl":"https://doi.org/10.4172/2165-7386.1000314","url":null,"abstract":"","PeriodicalId":91127,"journal":{"name":"Journal of palliative care & medicine","volume":"7 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70683987","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}