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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 -
BMC Palliative Care Jul 2018This systematic review aimed to identify the unmet care needs and their associated variables in patients with advanced cancer and informal caregivers, alongside... (Review)
Review
BACKGROUND
This systematic review aimed to identify the unmet care needs and their associated variables in patients with advanced cancer and informal caregivers, alongside summarizing the tools used for needs assessment.
METHODS
Ten electronic databases were searched systematically from inception of each database to December 2016 to determine eligible studies. Studies that considered the unmet care needs of either adult patients with advanced cancer or informal caregivers, regardless of the study design, were included. The Mixed Methods Appraisal Tool was utilized for quality appraisal of the included studies. Content analysis was used to identify unmet needs, and descriptive analysis was adopted to synthesize other outcomes.
RESULTS
Fifty studies were included, and their methodological quality was generally robust. The prevalence of unmet needs varied across studies. Twelve unmet need domains were identified in patients with advanced cancer, and seven among informal caregivers. The three most commonly reported domains for patients were psychological, physical, and healthcare service and information. The most prominent unmet items of these domains were emotional support (10.1-84.4%), fatigue (18-76.3%), and "being informed about benefits and side-effects of treatment" (4-66.7%). The most commonly identified unmet needs for informal caregivers were information needs, including illness and treatment information (26-100%) and care-related information (21-100%). Unmet needs of patients with advanced cancer were associated with their physical symptoms, anxiety, and quality of life. The most commonly used instruments for needs assessment among patients with advanced cancer were the Supportive Care Needs Survey (N = 8) and Problems and Needs in Palliative Care questionnaire (N = 5). The majority of the included studies investigated unmet needs from the perspectives of either patients or caregivers with a cross-sectional study design using single time-point assessments. Moreover, significant heterogeneity, including differences in study contexts, assessment methods, instruments for measurement, need classifications, and reporting methods, were identified across studies.
CONCLUSION
Both advanced cancer patients and informal caregivers reported a wide range of context-bound unmet needs. Examining their unmet needs on the basis of viewing patients and their informal caregivers as a whole unit will be highly optimal. Unmet care needs should be comprehensively evaluated from the perspectives of all stakeholders and interpreted by using rigorously designed mixed methods research and longitudinal studies within a given context.
Topics: Caregivers; Humans; Needs Assessment; Neoplasms; Patient Care; Prevalence; Surveys and Questionnaires
PubMed: 30037346
DOI: 10.1186/s12904-018-0346-9 -
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 -
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 -
Ugeskrift For Laeger Apr 2018
Topics: Humans; Palliative Care; Patient Care Team; Rehabilitation
PubMed: 29690988
DOI: No ID Found -
Journal of General Internal Medicine Jul 2015
Topics: Continuity of Patient Care; Female; Humans; Male; Patient Navigation; Patient Readmission
PubMed: 25820547
DOI: 10.1007/s11606-015-3274-x -
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 -
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 -
American Journal of Pharmaceutical... Apr 2022Clinical reasoning is integral to the provision of patient-centered care as outlined in the Pharmacists' Patient Care Process (PPCP). However, the PPCP was not created... (Review)
Review
Clinical reasoning is integral to the provision of patient-centered care as outlined in the Pharmacists' Patient Care Process (PPCP). However, the PPCP was not created to foster clinical reasoning in student pharmacists and cannot be the sole tool used to characterize or cultivate these skills. This article describes elements of clinical reasoning, the relationship between clinical reasoning and PPCP, and concepts from the clinical reasoning literature that should inform the teaching of clinical reasoning skills. Key elements of the PPCP were identified in clinical reasoning definitions, but differences emerged. The literature supports clinical reasoning as a bidirectional, fluid process that is highly collaborative. Effective clinical reasoning requires multiple types of "thinking," interaction with others and the environment, self-assessment, and a tolerance for nuance or ambiguity. Teaching strategies can be used in the didactic and experiential setting to target the cognitive and contextual factors associated with clinical reasoning. Educators should consult the literature to enhance our understanding of clinical reasoning in seeking to teach, model, and foster these skills in our students. Future scholarship should include the development of models to support clinical reasoning within the profession of pharmacy, adoption and experimentation with clinical reasoning teaching techniques, and valuation of the utility of various assessment tools and processes.
Topics: Clinical Reasoning; Curriculum; Education, Pharmacy; Humans; Patient Care; Pharmacists; Students, Pharmacy
PubMed: 34385175
DOI: 10.5688/ajpe8697 -
Epilepsia Mar 2014Satisfaction with epilepsy care (SEC) encompasses care delivery, expectations, attitudes, and disease course. Through a systematic review of the evidence, we explore how... (Review)
Review
OBJECTIVE
Satisfaction with epilepsy care (SEC) encompasses care delivery, expectations, attitudes, and disease course. Through a systematic review of the evidence, we explore how and where the SEC of patients is being measured, the level of SEC overall and in specific domains, and its relationship to clinical and demographic variables.
METHODS
We searched Medline, PsycINFO, CINAHL, Cochrane Register of Controlled Trials, and EMBASE using medical subject headings and keywords related to satisfaction with care and epilepsy in adults and children, in all languages. Two independent reviewers screened abstracts and full-text articles. We examined the clinical context and patient characteristics, type and content of satisfaction scales, and reported outcomes. Abstracted variables were grouped for descriptive purposes and presented as medians and proportions when the data allowed it.
RESULTS
Of 25 included studies (6,336 patients), 88% were performed in the United States or the United Kingdom. Nine studies (36%) used validated instruments and 16 studies (64%) used nonvalidated instruments. For SEC domains reported in >1 study, the median proportion (interquartile range) of patients satisfied with epilepsy care was 86% (17%) for overall satisfaction with care, 85% (24%) for interpersonal skills, 78% (3%) for access to care, 67% (32%) for communication, and 65% (15%) for knowledge/technical skills. Communication and clinicians' knowledge was important in all settings. Patients seen in specialized settings and those receiving more and better information had higher SEC ratings. There was no consistent association between SEC and quality of care indicators.
SIGNIFICANCE
Data on SEC have been reported infrequently. Patients are least satisfied with communication, perceived skills, and knowledge of care providers. Epilepsy-specific SEC tools have neither been validated nor do they contain many of the important domains identified by this review. The relationship between SEC and indicators of quality of care requires further study. Measures aimed at improving education and communication could improve SEC.
Topics: Epilepsy; Humans; Patient Care; Patient Satisfaction; Quality of Health Care; Reproducibility of Results
PubMed: 24502616
DOI: 10.1111/epi.12537