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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 -
Anesthesia and Analgesia Jun 2020Patients with frailty experience substantial physical and emotional distress related to their condition and face increased morbidity and mortality compared with their... (Review)
Review
Patients with frailty experience substantial physical and emotional distress related to their condition and face increased morbidity and mortality compared with their nonfrail peers. Palliative care is an interdisciplinary medical specialty focused on improving quality of life for patients with serious illness, including those with frailty, throughout their disease course. Anesthesiology providers will frequently encounter frail patients in the perioperative period and in the intensive care unit (ICU) and can contribute to improving the quality of life for these patients through the provision of palliative care. We highlight the opportunities to incorporate primary palliative care, including basic symptom management and straightforward goals-of-care discussions, provided by the primary clinicians, and when necessary, timely consultation by a specialty palliative care team to assist with complex symptom management and goals-of-care discussions in the face of team and/or family conflict. In this review, we apply the principles of palliative care to patients with frailty and synthesize the evidence regarding methods to integrate palliative care into the perioperative and ICU settings.
Topics: Aged; Anesthesiology; Critical Care; Frail Elderly; Frailty; Humans; Intensive Care Units; Interdisciplinary Communication; Palliative Care; Patient Care Team; Perioperative Period; Psychological Distress; Quality of Life; Terminal Care; Treatment Outcome
PubMed: 32384340
DOI: 10.1213/ANE.0000000000004763 -
The Journal of Head Trauma... 2019To characterize the indications, timing, barriers, and perceived value of rehabilitation currently provided for individuals with moderate or severe traumatic brain...
OBJECTIVE
To characterize the indications, timing, barriers, and perceived value of rehabilitation currently provided for individuals with moderate or severe traumatic brain injury (TBI) admitted to the intensive care unit (ICU) based on the perspectives of providers who work in the ICU setting.
PARTICIPANTS
Members (n = 66) of the Neurocritical Care Society and the American Congress of Rehabilitation Medicine.
DESIGN
An anonymous electronic survey of the timing of rehabilitation for patients with TBI in the ICU.
MAIN MEASURES
Questions asked about type and timing of rehabilitation in the ICU, extent of family involvement, participation of physiatrists in patient care, and barriers to early rehabilitation.
RESULTS
Sixty-six respondents who reported caring for patients with TBI in the ICU completed the survey; 98% recommended rehabilitative care while patients were in the ICU. Common reasons to wait for the initiation of physical therapy and occupational therapy were normalization of intracranial pressure (86% and 89%) and hemodynamic stability (66% and 69%).
CONCLUSIONS
The majority of providers caring for patients with TBI in the ICU support rehabilitation efforts, typically after a patient is extubated, intracranial pressure has normalized, and the patient is hemodynamically stable. Our findings describe current practice; future studies can be designed to determine optimal timing, intensity, and patient selection for early rehabilitation.
Topics: Brain Injuries, Traumatic; Clinical Decision-Making; Hemodynamics; Hospitalization; Humans; Intensive Care Units; Intracranial Pressure; Occupational Therapy; Patient Care Team; Physical Therapy Modalities; Speech Therapy; Surveys and Questionnaires; Time-to-Treatment
PubMed: 30829824
DOI: 10.1097/HTR.0000000000000477 -
Primary Care Sep 2019In caring for dying patients, family medicine practitioners intentionally adopt care plans that affect the manner and timing of death. These decisions are morally... (Review)
Review
In caring for dying patients, family medicine practitioners intentionally adopt care plans that affect the manner and timing of death. These decisions are morally weighty. This article provides guidance regarding the ethical and legal appropriateness of practitioner decisions near the end of life. Topics include surrogate decision making, advance care planning, medical nutrition and hydration, double effect, futile care, physician-assisted death, voluntarily stopping eating and drinking, palliative sedation to unconsciousness, and cultural humility.
Topics: Advance Care Planning; Analgesics, Opioid; Decision Making; Humans; Hypnotics and Sedatives; Nutrition Therapy; Palliative Care; Patient Care Planning; Patient Preference; Primary Health Care; Prognosis; Suicide, Assisted; Terminal Care; Withholding Treatment
PubMed: 31375188
DOI: 10.1016/j.pop.2019.05.005 -
Indian Journal of Pathology &... Feb 2020The multidisciplinary team approach has been employed internationally for decades, as an attempt to bring collaborative decision-making and concentrate clinical... (Review)
Review
The multidisciplinary team approach has been employed internationally for decades, as an attempt to bring collaborative decision-making and concentrate clinical experience from multiple specialties on single patient cases in a systematic fashion. Adoption is not yet worldwide, but is increasing. The role of the histopathologist is central, providing vital information and context to clinical diagnosis and management. Our review summarizes some of the most relevant research on the topic of MDT usage and efficacy in relation to breast cancer, attempting to draw together its advantages and challenges. It is hoped that this review will make a contribution to the current international literature regarding multidisciplinary approaches in breast cancer care.
Topics: Breast Neoplasms; Clinical Decision-Making; Decision Making; Female; Humans; Interdisciplinary Communication; Patient Care; Patient Care Team
PubMed: 32108641
DOI: 10.4103/IJPM.IJPM_885_19 -
British Journal of Nursing (Mark Allen... Jul 2020
Topics: Communication; Continuity of Patient Care; Humans; Patient Handoff; Patient Safety
PubMed: 32697634
DOI: 10.12968/bjon.2020.29.14.812 -
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 -
Journal of Nursing Care QualityEffective communication, including the complete and accurate transfer of information and the prevention of misrepresentation and misinterpretation of patient-centered...
BACKGROUND
Effective communication, including the complete and accurate transfer of information and the prevention of misrepresentation and misinterpretation of patient-centered data during handoff, can enhance the quality of patient care and safety.
PURPOSE
This study was aimed at evaluating the impact of bedside handoff using the Situation, Background, Assessment, Recommendation (SBAR) technique, on the quality of nursing care.
METHODS
The Quality Patient Care Scale (QUALPACS) was completed by the patient while nurses performed a verbal bedside shift handoff and after receiving education on the purpose and proper use of the SBAR communication tool.
RESULTS
The mean age of subjects was 51.29 ± 8.02 years. We found a significant increase in the mean score of QUALPACS dimensions, namely psychosocial (P < .001), physical (P < .001), and communication (P < .001) after SBAR implementation.
CONCLUSIONS
Findings suggest that using the SBAR handoff technique increases the quality of nursing care in all QUALPACS dimensions.
Topics: Adult; Communication; Humans; Middle Aged; Nursing Care; Patient Handoff
PubMed: 32568964
DOI: 10.1097/NCQ.0000000000000498 -
Epilepsy & Behavior : E&B Dec 2020The concept of patient navigation was first introduced in 1989 by the American Cancer Society and was first implemented in 1990 by Dr. Harold Freeman in Harlem, NY. The...
The concept of patient navigation was first introduced in 1989 by the American Cancer Society and was first implemented in 1990 by Dr. Harold Freeman in Harlem, NY. The role of a patient navigator (PN) is to coordinate care between the care team, the patient, and their family while also providing social support. In the last 30 years, patient navigation in oncological care has expanded internationally and has been shown to significantly improve patient care experience, especially in the United States cancer care system. Like oncology care, patients who require epilepsy care face socioeconomic and healthcare system barriers and are at significant risk of morbidity and mortality if their care needs are not met. Although shortcomings in epilepsy care are longstanding, the COVID-19 pandemic has exacerbated these issues as both patients and providers have reported significant delays in care secondary to the pandemic. Prior to the pandemic, preliminary studies had shown the potential efficacy of patient navigation in improving epilepsy care. Considering the evidence that such programs are helpful for severely disadvantaged cancer patients and in enhancing epilepsy care, we believe that professional societies should support and encourage PN programs for coordinated and comprehensive care for patients with epilepsy.
Topics: COVID-19; Epilepsy; Humans; Neoplasms; Pandemics; Patient Care; Patient Navigation; Social Support; United States
PubMed: 33232897
DOI: 10.1016/j.yebeh.2020.107530