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Primary Care Sep 2019Palliative care is a field of medicine that delivers patient-centered care for individuals and their families suffering from serious illness at all stages of the disease... (Review)
Review
Palliative care is a field of medicine that delivers patient-centered care for individuals and their families suffering from serious illness at all stages of the disease trajectory. It addresses the major priorities of relieving suffering, establishing goals of care, and managing physical symptoms while integrating the psychosocial, cultural, spiritual, and existential complexities of coping with chronic illness. This article discusses the role of palliative care in the health care system. It reviews the importance of prognostication, disease trajectory, and communication. The role of the primary care physician as part of a multidisciplinary team member delivering primary palliative care is emphasized.
Topics: Communication; Continuity of Patient Care; Hospice Care; Humans; Interdisciplinary Communication; Palliative Care; Patient Care Team; Patient-Centered Care; Primary Health Care; Quality of Life; Truth Disclosure
PubMed: 31375182
DOI: 10.1016/j.pop.2019.04.001 -
JAMA Jul 2023
Topics: Humans; Critical Care; Patient Care; Respiration, Artificial; Respiratory Distress Syndrome; Practice Guidelines as Topic
PubMed: 37329332
DOI: 10.1001/jama.2023.6812 -
International Journal of Nursing Studies Jan 2020Hospital readmission after discharge is a frequent, burdensome and costly event, particularly frequent in older people with multiple chronic conditions. Few literature... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Hospital readmission after discharge is a frequent, burdensome and costly event, particularly frequent in older people with multiple chronic conditions. Few literature reviews have analysed studies of continuity of care interventions to reduce readmissions of older inpatients discharged home over the short and long term.
OBJECTIVE
To evaluate the effectiveness of continuity of care interventions in older people with chronic diseases in reducing short and long term hospital readmission after hospital discharge.
DESIGN
Meta-analysis of randomized controlled trials.
DATA SOURCES
A comprehensive literature search on the databases PubMed, Medline, CINAHL and EMBASE was performed on 27 January 2019 with no language and time limits.
REVIEW METHODS
RCTs on continuity of care interventions on older people discharged from hospital having hospital readmission as outcome, were included. Two reviewers independently screened the studies and assessed methodological quality using the Cochrane Risk of Bias tool. Selected outcome data were combined and pooled using a Mantel-Haenszel random-effects model.
RESULTS
Thirty RCTs, representing 8920 patients were included. Results were stratified by time of readmissions. At 1 month from discharge, the continuity interventions were associated with lower readmission rates in 207/1595 patients in the experimental group (12.9%), versus 264/1645 patients in the control group (16%) (Relative Risk [RR], 0.84 [95% CI, 0.71-0.99]). From 1 to 3 months, readmission rates were lower in 325/1480 patients in the experimental group (21.9%), versus 455/1523 patients in the control group (29.8%) (RR 0.74 [95% CI, 0.65-0.84]). A subgroup analysis showed that this positive effect was stronger when the interventions addressed all of the continuity dimensions. After 3 months this impact became inconclusive with moderate/high statistical heterogeneity.
CONCLUSIONS
Continuity of care interventions prevent short term hospital readmission in older people with chronic diseases. However, there is inconclusive evidence about the effectiveness of continuity interventions aiming to reduce long term readmission, and it is suggested that stronger focus on it is needed.
Topics: Aged; Aged, 80 and over; Chronic Disease; Continuity of Patient Care; Hospitalization; Humans; Length of Stay; Long-Term Care; Patient Readmission; Quality of Life
PubMed: 31698168
DOI: 10.1016/j.ijnurstu.2019.103396 -
The Hastings Center Report May 2018The oncology floor can be a silent place. Unlike the cardiology floor, with its insistent telemetry beeping, or the incessant bustle of the general ward below. Silence...
The oncology floor can be a silent place. Unlike the cardiology floor, with its insistent telemetry beeping, or the incessant bustle of the general ward below. Silence can be healing, and the oncology floor reveres all forms of healing it can find. Yet some voices ring loud on this floor. As an intern, I would grimace into my scut list as oncology attendings intoned dire diagnoses and exhorted still-reeling victims to altruistically enroll in clinical trials. I mutely ground my teeth listening to the relentless stream of probabilities and adverse reactions flooding into the shocked silence of a child baffled by his or her metamorphosis into a cancer patient between breakfast and lunch. The practiced script unwound, preemptively striking down every potential worry already foreseen. But sometimes what was unspoken was even worse. Silence can give patients space to comprehend, digest, formulate questions, and enunciate fears. I believe in the silence of the "great empty cup of attention." Still, ethics can founder in silence.
Topics: Humans; Medical Oncology; Neoplasms; Pain, Intractable; Patient Care; Physician-Patient Relations
PubMed: 29806890
DOI: 10.1002/hast.845 -
American Journal of Pharmaceutical... Feb 2018The value of the arts and humanities in becoming an "educated" pharmacist is reviewed in this commentary. The term "patient care literacy" is defined as becoming a more... (Review)
Review
The value of the arts and humanities in becoming an "educated" pharmacist is reviewed in this commentary. The term "patient care literacy" is defined as becoming a more humane pharmacist. This implies not only using heads but HARTSS (humanities, arts and social sciences) for developing the necessary skills. A conceptual framework for curricular reform that focuses on using the arts and humanities is proposed for advancing patient care literacy. Methods for enhancing use of arts and humanities for developing pharmacy graduates is specifically proposed. The need for more empiric research to demonstrate the value of the arts and humanities in developing a patient care literate professional is highlighted.
Topics: Health Literacy; Humans; Literacy; Patient Advocacy; Patient Care; Pharmacists; Professional-Patient Relations
PubMed: 29491507
DOI: 10.5688/ajpe6884 -
The Veterinary Clinics of North... Sep 2021Veterinary ethical dilemmas are common, complex, and unavoidable. Creating a transparent and deliberate approach to ethical issues empowers the entire veterinary team... (Review)
Review
Veterinary ethical dilemmas are common, complex, and unavoidable. Creating a transparent and deliberate approach to ethical issues empowers the entire veterinary team and reduces stress associated with these dilemmas. This article discusses ethical considerations and principles and propose use of the 4Es model and core communication skills to address ethical dilemmas in veterinary practice. It reviews literature defining ethical issues in practice and provides case examples to show the application of our proposed methods. The goal is to provide veterinary professionals with an approach they can use to frame and address their own ethical decisions.
Topics: Animals; Ethics, Clinical; Patient Care
PubMed: 34334164
DOI: 10.1016/j.cvsm.2021.05.003 -
The Medical Clinics of North America Jan 2021
Topics: Ambulatory Care; Humans; Patient Care; Patient-Centered Care
PubMed: 33246527
DOI: 10.1016/j.mcna.2020.10.007 -
The Hastings Center Report Jul 2019"Sit down," Mr. R demanded. "I've got something to say to you." I shot the medical student a querying glance as we simultaneously sunk into our chairs. He continued,...
"Sit down," Mr. R demanded. "I've got something to say to you." I shot the medical student a querying glance as we simultaneously sunk into our chairs. He continued, "You don't know me, and I got some things to tell you." I thought I knew Mr. R, and I certainly had some idea of what he was all about. But then he called to me. In his summoning, Mr. R arrested all my preconceived ideas about him. And as the medical student and I began to understand him better, we wanted to know more. We began to engage him more deeply. In the subsequent days, caring for him somehow felt easier, akin to the care one gives a distraught friend rather than a difficult patient.
Topics: Humans; Patient Care; Physician-Patient Relations; Trust
PubMed: 31429955
DOI: 10.1002/hast.1027 -
Revista Brasileira de Enfermagem 2022To analyze the needs and facilitating and hindering elements related to transitional rehabilitation care. (Review)
Review
OBJECTIVE
To analyze the needs and facilitating and hindering elements related to transitional rehabilitation care.
METHODS
Integrative literature review oriented toward answering the question "What nursing interventions guarantee transitional rehabilitation care to dependent adult or elderly people when they return home after hospitalization?".
RESULTS
The patients did not participate much in the planning of hospital discharge and decision-making when they had to return home. Informal caretakers reported that professionals showed detachment during hospitalization and delayed guiding instructions. Health professionals mentioned lack of time to offer this care modality as a difficulty.
FINAL CONSIDERATIONS
Ensuring training, follow-up, and coordination between care levels is essential. Care integration can reduce hospital stay and the impact of post-discharge complications. Transitional care contributes to a sustainable health system, higher care quality, and client satisfaction.
Topics: Adult; Aftercare; Aged; Continuity of Patient Care; Humans; Patient Discharge; Patient Satisfaction; Transitional Care
PubMed: 35584420
DOI: 10.1590/0034-7167-2021-0399 -
ANZ Journal of Surgery Sep 2023
Topics: Humans; Patient Discharge; Patient Care; Hospitals
PubMed: 37710411
DOI: 10.1111/ans.18612