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The Medical Clinics of North America Sep 2020Goals of care conversations are important but complex for clinicians caring for older adults. Although clinicians tend to focus on specific medical interventions, these... (Review)
Review
Goals of care conversations are important but complex for clinicians caring for older adults. Although clinicians tend to focus on specific medical interventions, these conversations are more successful if they begin with gaining a shared understanding of the medical conditions and possible outcomes, followed by discussion of values and goals. Although training in the medical setting is incomplete, there are many published and online resources that can help clinicians gain these valuable skills.
Topics: Aged; Clinical Competence; Decision Making, Shared; Humans; Palliative Care; Patient Care Planning; Physician-Patient Relations
PubMed: 32773044
DOI: 10.1016/j.mcna.2020.06.002 -
Indian Journal of Medical Ethics 2022Medical schools train us to be brilliant academicians and diagnosticians. But as physicians, we must never belittle patient communication nor be inconsiderate in our...
Medical schools train us to be brilliant academicians and diagnosticians. But as physicians, we must never belittle patient communication nor be inconsiderate in our approach to patient care. Communication as a skill gets neglected in postgraduate training as young doctors chase procedural and diagnostic excellence. It is high time we make amends.
Topics: Humans; Physicians; Schools, Medical; Patient Care; Communication
PubMed: 35695857
DOI: 10.20529/IJME.2021.091 -
Investigacion Y Educacion En Enfermeria Feb 2020This work comes from the interest and need to understand the problems arising from the activity of caring for dependent people, in the world and particularly in the... (Review)
Review
This work comes from the interest and need to understand the problems arising from the activity of caring for dependent people, in the world and particularly in the European region. Altogether, it seeks to understand the consequences of informal care on the caregiver adding to the debate a gender perspective. Through a multidisciplinary bibliographic review, the current care crisis becomes clear. The demographic and socio-cultural changes in recent years are causing dependency to increase dramatically, while putting at risk the availability of informal caregivers. Several studies have shown that women are the ones on whom the burden of care mainly falls. Therefore, under the gender perspective, it becomes clear that the consequences of caregiver burden increase gender inequalities worldwide. The study analyzes the current situation and underlines the need to promote alternatives and opportunities so that care is shared and does not fall only on the female gender. Solutions need to be included in public and community health interventions and policies, and to this respect, nurses play an important role in changing the care paradigm.
Topics: Aged; Caregivers; Cost of Illness; Europe; Female; Health Transition; Humans; Male; Middle Aged; Patient Care; Sex Factors
PubMed: 32124578
DOI: 10.17533/udea.iee.v38n1e10 -
Clinical Obstetrics and Gynecology Sep 2020Recently, greater attention has been paid to the care of gender dysphoric and gender incongruent individuals. Gynecologists may be called upon to care for individuals...
Recently, greater attention has been paid to the care of gender dysphoric and gender incongruent individuals. Gynecologists may be called upon to care for individuals who were assigned female at birth throughout or following social, medical, or surgical gender transition. Thus, gynecologists need to be aware of language regarding sex and gender, treatment typically used for the care of gender dysphoric or incongruent individuals, and aspects of well gynecologic care necessary for these individuals. This review highlights these aspects of care for transgender males to aid the general gynecologist in the care and treatment of these individuals.
Topics: Female; Gender Identity; Gynecology; Health Services for Transgender Persons; Humans; Male; Patient Care; Transgender Persons; Transsexualism
PubMed: 32568802
DOI: 10.1097/GRF.0000000000000549 -
Annals of Palliative Medicine Jul 2023Recognizing the need for palliative care (PC) and referral to PC teams improves patients' quality of life. However, in patients with moderate/severe clinical complexity,... (Review)
Review
BACKGROUND
Recognizing the need for palliative care (PC) and referral to PC teams improves patients' quality of life. However, in patients with moderate/severe clinical complexity, early recognition of the need for PC may not correspond to referral to specialized PC services. The definition for clinical complexity is still underexplored, as well as the instruments available to assess complexity. This scoping review aims to gather relevant information on the definition of clinical complexity in PC, as well as on the instruments used to objectively assess complexity.
METHODS
According to the methodology of a Scoping Review, the keywords: "palliative care", "hospitalization criteria", "complexity criteria", "complexity assessment" and "clinical complexity", were searched in PubMed, Scopus, Cochrane, and b-on databases, during April 2022, for relevant information on the definition and/or approach and/or protocols related to clinical complexity in patients followed in PC, or on the instruments used to assess it, regardless of study design, the language, or year of publication.
RESULTS
From the 626 references found, 15 studies were included in the review. According to these studies, complexity may be organized/defined into 3, 4, or 6 domains, generally including the patient, the family, the health system, and the socio-cultural context. Of the 13 instruments mentioned for the objective assessment of complexity, the HexCom, IDC-Pal, and the recent ID-PALL seem to offer the broadest determinations of complexity.
CONCLUSIONS
Complexity is a dynamic process, which reflects the reality of patients and families, and patients, families, and health professionals' perceptions, and so it must be systematically adjusted to the stage of the disease. The definition of complexity and the development and use of suitable instruments can help to identify, assess, and improve patients' quality of life, while supporting their family across the grieving process. Yet, this may not always be summarized in a quantitative value by easy-to-use instruments, highlighting the role of PC interdisciplinary teams.
Topics: Humans; Quality of Life; Palliative Care; Hospice and Palliative Care Nursing; Patient Care; Referral and Consultation
PubMed: 37038064
DOI: 10.21037/apm-22-894 -
Journal of Parkinson's Disease 2020
Topics: Antiparkinson Agents; Biomedical Research; Humans; Parkinson Disease; Patient Care; Quality of Life
PubMed: 32741843
DOI: 10.3233/JPD-209003 -
CMAJ : Canadian Medical Association... Oct 2020
Topics: COVID-19; Decision Making, Shared; Health Care Rationing; Health Equity; Humans; Palliative Care; Pandemics; Patient Care Planning; Surge Capacity; Terminal Care; Withholding Treatment
PubMed: 33077529
DOI: 10.1503/cmaj.200465-f -
The British Journal of General Practice... Dec 2022
Topics: Humans; Continuity of Patient Care; Physician-Patient Relations
PubMed: 36424148
DOI: 10.3399/bjgp22X721313 -
Research in Social & Administrative... Jul 2023Unlicensed medicines are used across the UK to treat an individual's clinical needs when there are no appropriate licensed alternatives. Patients, carers and parents... (Review)
Review
BACKGROUND
Unlicensed medicines are used across the UK to treat an individual's clinical needs when there are no appropriate licensed alternatives. Patients, carers and parents have reported facing challenges with unlicensed medicines at the points of transfer of care between settings, a key time when medication errors may occur. There is little known about the patient journey as a whole, or the factors affecting patient care when receiving an unlicensed medicine.
OBJECTIVE
A systematic review of UK literature to better understand factors that affect the entire patient journey from the decision to initiate treatment with an unlicensed medicine to the point at which treatment is supplied through a community pharmacy or ends.
METHODS
Scopus, OVID EMCARE, EMBASE, OVID Medline ALL, CINAHL, Web of Science and Joanna Briggs Institute were searched from 1968 (introduction of the Medicines Act) until November 2020, using the PRISMA guidelines. Narrative synthesis of UK studies was employed to analyse descriptive and qualitative data on any reported findings that would impact the patient journey or care related to the use of unlicensed medicines, and any described barriers or enablers.
RESULTS
Forty-five studies met criteria for final inclusion, with high levels of heterogeneity in terms of designs and methods. Specific challenges that were seen to impact the continuity of care across care settings, patient safety and provision of patient-centred care included diversity of clinical needs and impact of patient population age; healthcare professional awareness and acceptability of the use of unlicensed medicines; the hierarchical structure of the NHS; inconsistent doses and formulations with varying bioequivalence; patient/parent/carer/public awareness of unlicensed medicines use and perceived acceptability.
CONCLUSIONS
This review identified a clear need for consistent information to be provided to healthcare professional and patients alike to support the safe and effective use of unlicensed medicines across care settings.
Topics: Humans; Patient Care; Health Personnel; Caregivers; Medicine; Medication Errors
PubMed: 37121796
DOI: 10.1016/j.sapharm.2023.04.120 -
Nursing Ethics Mar 2021The identification of human rights issues has become more prominent in statements from national and international nursing organisations such as the American Nurses... (Review)
Review
The identification of human rights issues has become more prominent in statements from national and international nursing organisations such as the American Nurses Association and the United Kingdom's Royal College of Nursing with the International Council of Nursing asserting that human rights are fundamental to and inherent in nursing and that nurses have an obligation to promote people's health rights at all times in all places.However, concern has been expressed about this development. Human rights may be seen as the imposition of legal considerations for nurses and other healthcare workers to bear in mind, as yet more responsibilities with the consequent fear of litigation. Although a more hopeful scenario is that consideration of human rights is something that is supportive of good practice.If this more hopeful scenario is to be realised, the role of education will be crucial. As with human rights generally, human rights education is a global phenomenon, a practice-orientated expression of the Universal Declaration of Human Rights, and the goal of human rights education is to build a culture of respect and action for human rights for all.However, the nature of human rights has long been contested. A 'mapping exercise' of the academic literature on human rights identified 'four schools' or 'ideal types' that have shaped thinking about human rights. This sets out the conceptual context in which human rights problems are defined and solutions are proposed, which is particularly important for human rights education. However, it also complicates the picture. The different approaches taken by the four 'types' would likely lead to different outcomes in terms of human rights education.It is timely to discuss the nature of human rights education and examine its potential for impact on patient care. This will involve identifying the challenges and potential benefits of this approach and analysing the implications for professional practice.
Topics: Health Services Accessibility; Human Rights; Humans; Patient Care
PubMed: 32552480
DOI: 10.1177/0969733020921512