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Gage C, Spies B, Crombie K, Gwyther L, Stassen W. The use of emergency medical services for palliative situations in Western Cape Province, South Africa: A retrospective, descriptive analysis of patient records. S Afr Med J 2023; 113:41-46. [PMID: 38525628 DOI: 10.7196/samj.2023.v113i11.1136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND An estimated 56.8 million people require palliative care annually, while only 14% receive such care. This imbalance is particularly acute in low-to middle-income countries (LMICs), where up to 80% of patients requiring palliative care reside. To correct this imbalance, integration between palliative services and other disciplines has been recommended. While improved palliative care integration is a priority in the South African (SA) LMIC context, emergency medical services (EMS) and palliative care remain non-integrated. This has resulted in poor palliative situation management by EMS and a lack of research concerning their intersection. OBJECTIVE To examine EMS use for palliative situations in the Western Cape (WC) Province of SA by describing frequency of intersection, patient characteristics and outcomes. METHODS An observational, descriptive, retrospective patient record review was employed at two hospitals with palliative care services in the WC. All patient records of those who arrived at the hospitals between 1 January 2020 and 31 December 2020 via EMS conveyance leading to palliative care provision were included in the study. RESULTS In total, 1 207 unique patients received palliative care services at both hospitals during the study period. Of these, 395 (33%) made use of EMS for hospital conveyance on 494 occasions. The median (range) patient age was 60 (20 - 93) years, and most transports involved male patients (54%, n=265). Family members were the primary caregivers in most instances (89%, n=440), dyspnoea was the chief complaint (36%, n=178) and cancer was the most frequent diagnosis (32%, n=159). The median length of hospital stay was 6 days, with most patients discharged home (60%, n=295). CONCLUSION EMS in SA frequently encounter palliative situations for symptoms that may be managed within their scope of practice. Consequently, it appears that EMS have an important role to fulfil in the care of patients with palliative needs. Integrating EMS and palliative care may result in improved palliative care provision and, therefore, EMS and palliative care integration would be beneficial in SA.
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Affiliation(s)
- C Gage
- Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - B Spies
- Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - K Crombie
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - L Gwyther
- Division of Interdisciplinary Palliative Care and Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - W Stassen
- Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
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Porter LS, Weiner DK, Ramos K, Barnes DE, Schmader KE, Gwyther L, Ritchie CS, Keefe FJ. Partnering to cope with pain: A pilot study of a caregiver-assisted pain coping skills intervention for patients with cognitive impairment and dementia. Palliat Support Care 2022; 20:785-793. [PMID: 36942584 PMCID: PMC10032330 DOI: 10.1017/s1478951521001747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To develop a new caregiver-assisted pain coping skills training protocol specifically tailored for community-dwelling persons with cognitive impairment and pain, and assess its feasibility and acceptability. METHOD In Phase I, we conducted interviews with 10 patient-caregiver dyads to gather feedback about intervention content and delivery. Phase II was a single-arm pilot test to evaluate the intervention's feasibility and acceptability. Dyads in the pilot study (n = 11) completed baseline surveys, received five intervention sessions, and then completed post-intervention surveys. Analyses focused on feasibility and acceptability. RESULTS Dyads responded positively to the pain coping skills presented in the interviews; their feedback was used to refine the intervention. Findings from the pilot study suggested that the intervention was feasible and acceptable. 69% of eligible dyads consented, 82% completed all five intervention sessions, and 100% completed the post-treatment assessment. Caregivers reported high satisfaction ratings. They also reported using the pain coping skills on a regular basis, and that they found most of the skills helpful and easy to use. SIGNIFICANCE OF RESULTS These preliminary findings suggest that a caregiver-assisted pain coping skills intervention is feasible and acceptable, and that it may be a promising approach to managing pain in patients with cognitive impairment.
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Affiliation(s)
- Laura S Porter
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Debra K Weiner
- Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Katherine Ramos
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Deborah E Barnes
- University of San Francisco, UCSF Weill Institute for Neurosciences, San Francisco, CA
| | - Kenneth E Schmader
- Department of Medicine, Duke University School of Medicine and GRECC, Durham VA Medical Center, Durham, NC
| | - Lisa Gwyther
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Christine S Ritchie
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Francis J Keefe
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC
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3
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Toles M, Leeman J, Gwyther L, Vu M, Vu T, Hanson LC. Unique Care Needs of People with Dementia and Their Caregivers during Transitions from Skilled Nursing Facilities to Home and Assisted Living: A Qualitative Study. J Am Med Dir Assoc 2022; 23:1486-1491. [PMID: 35926571 PMCID: PMC9801685 DOI: 10.1016/j.jamda.2022.06.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 05/31/2022] [Accepted: 06/21/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The purpose of the study was to describe unique care needs of people with dementia (PWD) and their caregivers during transitions from skilled nursing facilities (SNF) to home. DESIGN A qualitative study using focus groups, semistructured interviews, and descriptive qualitative analysis. SETTING AND PARTICIPANTS The study was set in one state, in 4 SNFs where staff had experience using a standardized transitional care protocol. The sample included 22 SNF staff, 4 home health nurses, 10 older adults with dementia, and their 10 family caregivers of whom 39 participated in focus groups and/or interviews. METHODS Data collection included 4 focus groups with SNF staff and semistructured interviews with home health nurses, SNF staff, PWD, and their family caregivers. Standardized focus group and interview guides were used to elicit participant perceptions of transitional care. We used the framework analytic approach to qualitative analysis. A steering committee participated in interpretation of findings. RESULTS Participants described 4 unique care needs: (1) PWD and caregivers may not be ready to fully engage in dementia care planning while in the SNF, (2) caregivers are not prepared to manage dementia symptoms at home, (3) SNF staff have difficulty connecting PWD and caregivers to community supports, and (4) caregivers receive little support to address their own needs. CONCLUSIONS AND IMPLICATIONS Based on findings, recommendations are offered for adapting transitional care to address the needs of PWD and their caregivers. Further research is needed (1) to confirm these findings in larger, more diverse samples and (2) to adapt and test interventions to support successful community discharge of PWD and their caregivers.
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Affiliation(s)
- Mark Toles
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, NC, USA.
| | - Jennifer Leeman
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, NC, USA
| | - Lisa Gwyther
- Duke University, School of Medicine, Durham, NC, USA
| | - Maihan Vu
- University of North Carolina at Chapel Hill, Gillings School of Public Health, Chapel Hill, NC, USA
| | - Thi Vu
- Yale University, School of Public Health, New Haven, CT, USA
| | - Laura C Hanson
- University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, NC, USA
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4
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Blaauw D, Chambers C, Chirwa T, Duba N, Gwyther L, Hofman K, London L, Masilela T, McKerrow N, Modupe O, Moeng L, Mubaiwa V, Nematswerani N, Ramkissoon Y, Saloojee Y, Tshabalala S, Valabhjee K, Versteeg-Mojanaga M, Barsdorf N, Conco D, DiStefano M, Li R, Chalkidou K, Faden R, Goldstein S, Hofman K, Krubiner CB, Merritt MW, Mosam A, Potgieter S, Tugendhaft A. Introducing an Ethics Framework for health priority-setting in South Africa on the path to universal health coverage. S Afr Med J 2022; 112:240-244. [PMID: 35380528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/02/2022] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND South Africa (SA) has embarked on a process to implement universal health coverage (UHC) funded by National Health Insurance (NHI). The 2019 NHI Bill proposes creation of a health technology assessment (HTA) body to inform decisions about which interventions NHI funds will cover under UHC. In practice, HTA often relies mainly on economic evaluations of cost-effectiveness and budget impact, with less attention to the systematic, specific consideration of important social, organisational and ethical impacts of the health technology in question. In this context, the South African Values and Ethics for Universal Health Coverage (SAVE-UHC) research project recognised an opportunity to help shape the health priority-setting process by providing a way to take account of multiple, ethically relevant considerations that reflect SA values. The SAVE-UHC Research Team developed and tested an SA-specific Ethics Framework for HTA assessment and analysis. OBJECTIVES To develop and test an Ethics Framework for use in the SA context for health priority-setting. METHODS The Framework was developed iteratively by the authors and a multidisciplinary panel (18 participants) over a period of 18 months, using the principles outlined in the 2015 NHI White Paper as a starting point. The provisional Ethics Framework was then tested with multi-stakeholder simulated appraisal committees (SACs) in three provinces. The membership of each SAC roughly reflected the composition of a potential SA HTA committee. The deliberations and dedicated focus group discussions after each SAC meeting were recorded, analysed and used to refine the Framework, which was presented to the Working Group for review, comment and final approval. RESULTS This article describes the 12 domains of the Framework. The first four (Burden of the Health Condition, Expected Health Benefits and Harms, Cost-Effectiveness Analysis, and Budget Impact) are commonly used in HTA assessments, and a further eight cover the other ethical domains. These are Equity, Respect and Dignity, Impacts on Personal Financial Situation, Forming and Maintaining Important Personal Relationships, Ease of Suffering, Impact on Safety and Security, Solidarity and Social Cohesion, and Systems Factors and Constraints. In each domain are questions and prompts to enable use of the Framework by both analysts and assessors. Issues that arose, such as weighting of the domains and the availability of SA evidence, were discussed by the SACs. CONCLUSIONS The Ethics Framework is intended for use in priority-setting within an HTA process. The Framework was well accepted by a diverse group of stakeholders. The final version will be a useful tool not only for HTA and other priority-setting processes in SA, but also for future efforts to create HTA methods in SA and elsewhere.
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Affiliation(s)
- D Blaauw
- SAVE-UHC (South African Values and Ethics for Universal Health Coverage) Working Group.
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Porter L, Keefe F, Barnes D, Gwyther L, Schmader K, Ritchie C. Caregiver-Assisted Pain Coping Skills Training for Patients With Dementia: A Pilot Study. Innov Aging 2021. [PMCID: PMC8679282 DOI: 10.1093/geroni/igab046.1119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Pain is common and undertreated in patients with dementia, and contributes to disability, psychological distress, neuropsychiatric symptoms and caregiver stress. The goal of this study was to develop a caregiver-assisted pain coping skills training protocol tailored for community-dwelling adults with mild-moderate dementia and their family caregivers. We conducted interviews with patients and caregivers to develop the protocol. We then conducted a single arm pilot test of the intervention’s feasibility and acceptability. Patients were recruited from an outpatient memory care clinic and screened for pain using the validated Pain, Enjoyment, General Activity (PEG) scale. The intervention included five sessions of training in pain assessment, relaxation, pleasant activity scheduling, and integrative movement. Initially sessions were conducted in person or by videoconference according to the dyad’s preference; during COVID-19 (latter half of study) all sessions were conducted remotely. Eleven dyads consented and provided baseline data [patients: mean age=77.7 years (SD=4.8), 70% non-Hispanic white; caregivers: mean age=69.6 years (SD=13.3); 91% non-Hispanic white; 73% spouses]. Nine dyads (82%) completed all five sessions. Caregivers reported high levels of satisfaction with the intervention (mean=3.4 on 1-4 scale) and frequent use of pain coping skills (mean=3-4 days/week). On average, patients reported pre-post decreases in pain severity (mean=-1.2, SD=1.8) and pain interference (mean=-0.64, SD=0.67) on the Brief Pain Inventory. Overall these findings suggest that a behavioral pain coping intervention for patients with mild-moderate dementia and their caregivers is feasible, acceptable, and potentially helpful for managing pain.
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Affiliation(s)
- Laura Porter
- Duke University Medical Center, Durham, North Carolina, United States
| | - Francis Keefe
- Duke University School of Medicine, Durham, North Carolina, United States
| | - Deborah Barnes
- University of California, San Francisco, San Francisco, California, United States
| | - Lisa Gwyther
- Duke Center for Aging, Chapel Hill, North Carolina, United States
| | | | - Christine Ritchie
- Massachusetts General Hospital, Boston, Massachusetts, United States
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6
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Harding R, Snyman L, Ostgathe C, Odell S, Gwyther L. The ethical imperative to relieve suffering for people with tuberculosis by ensuring access to palliative care. Int J Tuberc Lung Dis 2021; 24:3-8. [PMID: 32553036 DOI: 10.5588/ijtld.18.0240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Patients diagnosed with tuberculosis (TB) continue to experience clinical uncertainty and high mortality and to bear a high burden of symptoms and other concerns. Additional concerns may be family support needs and stigma, particularly the latter, as TB and human immunodeficiency virus (HIV) coinfection are common. Human rights covenants, global health policy and the End TB Strategy all recommend palliative care as an essential component of care services. As established in the resolution adopted by the World Health Assembly (WHA) on "Strengthening of palliative care as a component of comprehensive care throughout the life course", there is a "need for palliative care across disease groups (non-communicable diseases, and infectious diseases, including HIV and multidrug-resistant tuberculosis), and across all age groups". We address the ethical imperative to respect the dignity and fundamental rights of people with TB by providing palliative care. We review the evidence for the need for person-centred palliative care and highlight novel models that utilise the skills and training functions of specialist palliative care to achieve better care. We outline simple recommendations for the delivery of specialist and generalist palliative care, offer suggestions on how to ensure optimal coverage by enabling access to appropriate good-quality palliative care at all points of the health system, including alongside treatment. Finally, we set out the current priorities for research and policy to ensure that quality care is delivered to all who need it irrespective of treatment outcome, to minimise distress and to optimise engagement in treatment and care.
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Affiliation(s)
- R Harding
- Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - L Snyman
- Médecins Sans Frontières South Africa, Khayelitsha, South Africa
| | - C Ostgathe
- Department fur Physik, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Bayern, Germany
| | - S Odell
- Palliative Medicine Unit, University of Cape Town, Cape Town, South Africa
| | - L Gwyther
- Palliative Medicine Unit, University of Cape Town, Cape Town, South Africa
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7
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Cocroft S, Welsh-Bohmer KA, Plassman BL, Chanti-Ketterl M, Edmonds H, Gwyther L, McCart M, MacDonald H, Potter G, Burke JR. Racially diverse participant registries to facilitate the recruitment of African Americans into presymptomatic Alzheimer's disease studies. Alzheimers Dement 2020; 16:1107-1114. [PMID: 32543781 DOI: 10.1002/alz.12048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION The Alzheimer's Disease Prevention Registry (ADPR) of the Joseph and Kathleen Bryan Alzheimer's Disease Research Center at Duke University has been successful in achieving a racially diverse and "research ready" cohort of cognitively healthy volunteers. METHODS The ADPR is based on an infrastructure that includes: (1) an administrative leadership team; (2) a coordinating center; (3) an IT management team; (4) a community engagement team; and (5) collaborations with study partners across disciplines. RESULTS The ADPR currently has more than 4677 members, 26% of whom are African American. The ADPR has supported 21 studies including 8 biomarker studies, 7 clinical trials, 4 cognitive neuroscience studies, and 2 studies assessing novel computerized measures. DISCUSSION We describe our experiences establishing and maintaining a diverse ADPR as well as insights on recruitment strategies to increase the representation of African Americans in Alzheimer's disease studies.
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Affiliation(s)
- Shelytia Cocroft
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina.,Joseph and Kathleen Bryan Alzheimer's Disease Research Center, Duke University, Durham, North Carolina
| | - Kathleen A Welsh-Bohmer
- Joseph and Kathleen Bryan Alzheimer's Disease Research Center, Duke University, Durham, North Carolina.,Department of Psychiatry and Behavioral Science, Duke University School of Medicine, Durham, North Carolina.,Department of Neurology, Duke University School of Medicine, Durham, North Carolina.,Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Brenda L Plassman
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina.,Joseph and Kathleen Bryan Alzheimer's Disease Research Center, Duke University, Durham, North Carolina.,Department of Psychiatry and Behavioral Science, Duke University School of Medicine, Durham, North Carolina.,Department of Neurology, Duke University School of Medicine, Durham, North Carolina
| | - Marianne Chanti-Ketterl
- Joseph and Kathleen Bryan Alzheimer's Disease Research Center, Duke University, Durham, North Carolina.,Department of Psychiatry and Behavioral Science, Duke University School of Medicine, Durham, North Carolina
| | - Henry Edmonds
- Joseph and Kathleen Bryan Alzheimer's Disease Research Center, Duke University, Durham, North Carolina.,Department of Psychiatry and Behavioral Science, Duke University School of Medicine, Durham, North Carolina
| | - Lisa Gwyther
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina.,Joseph and Kathleen Bryan Alzheimer's Disease Research Center, Duke University, Durham, North Carolina
| | - Michelle McCart
- Joseph and Kathleen Bryan Alzheimer's Disease Research Center, Duke University, Durham, North Carolina.,Department of Psychiatry and Behavioral Science, Duke University School of Medicine, Durham, North Carolina
| | - Heather MacDonald
- Joseph and Kathleen Bryan Alzheimer's Disease Research Center, Duke University, Durham, North Carolina.,Department of Psychiatry and Behavioral Science, Duke University School of Medicine, Durham, North Carolina
| | - Guy Potter
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina.,Joseph and Kathleen Bryan Alzheimer's Disease Research Center, Duke University, Durham, North Carolina.,Department of Psychiatry and Behavioral Science, Duke University School of Medicine, Durham, North Carolina
| | - James R Burke
- Joseph and Kathleen Bryan Alzheimer's Disease Research Center, Duke University, Durham, North Carolina.,Department of Neurology, Duke University School of Medicine, Durham, North Carolina
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8
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Leary N, Matchar B, Gwyther L. BUILDING COMMUNITY WITH PURPOSE: DEMENTIA FAMILIES STAYING CONNECTED ACROSS DISEASE TRAJECTORY. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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9
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Abdelbadee A, Abou-Taleb H, Abbas A, Ali S, Fakie N, Adams T, Gwyther L, Krause R. Road Map to Setting Up a Palliative Care Service in a Tertiary Center Gynecologic Oncology Unit in Egypt. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.77000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background and context: Developing countries struggle with high cancer mortality and low resources. Cancer patients experience pain and physical symptoms in addition to psychological, social and spiritual worries that increase as the patients' conditions progress. Palliative care (PC) primary goal is to help people live as well as they can for the duration of their illness, with the finest physical and emotional well-being possible despite complex problems. However, there are considerable barriers to PC service implementation in developing countries. Aim: Our goal is to set up a PC service and integrate it as a standard of care for gynecologic cancer patients managed at Assiut University Hospitals, Egypt. The objective of this study is to investigate the tools needed to integrate a PC service in any oncology service in developing countries. Strategy/Tactics: A capacity building and local provision PC development framework was laid. Strategies included expanding the gynecologic oncology unit, assessment of PC knowledge among health providers and medical students, assembling a multidisciplinary PC team, overseas PC training, establishing international links, providing essential medicine and addressing PC education. Program/Policy process: The gynecologic oncology unit capacity was expanded to accommodate long term admissions. PC knowledge among physicians, clinical nurse practitioners (CNPs) and medical students in Assiut University Hospitals was assessed using the modified Palliative Care Knowledge Test (PCKT). A multidisciplinary team that will deliver the PC service to our gynecologic cancer patients was assembled based on motivation and individual expertise in the aspects of PC from relevant departments as clinical oncology, surgery, pain and anesthesiology, psychiatry, physical therapy and rehabilitation and nutrition. The hospital leadership worked with the pharmacists to increase opioids quota and facilitate dispensing measures. The PC team leader engaged in a certified online PC course and arranged overseas training with the reputable Palliative Medicine Division at University of Cape Town well known for its legacy in delivering PC education. Outcomes: Ninety two physicians, 14 CNPs and 116 medical students completed the PCKT. The PCKT was composed of 20 questions and each correct answer was given 1 point. The overall total correct score was 7.41 ± 2.48 (Fig 1). Poor knowledge about PC was a strong indicator to acknowledge the gap in PC postgraduate training and undergraduate education. What was learned: Integration of a PC service for cancer patients in Egypt is feasible in spite of local resources constraints. A PC multidisciplinary team can be assembled from skilled specialists. Modifications of undergraduate and postgraduate curricula to include PC is crucial. Our model can be transferred to other low resource settings. [Figure: see text]
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Affiliation(s)
- A. Abdelbadee
- Women's Health Hospital, Faculty of Medicine, Assiut University, Obstetrics and Gynecology Department, Assiut, Egypt
| | - H. Abou-Taleb
- Women's Health Hospital, Faculty of Medicine, Assiut University, Obstetrics and Gynecology Department, Assiut, Egypt
| | - A. Abbas
- Women's Health Hospital, Faculty of Medicine, Assiut University, Obstetrics and Gynecology Department, Assiut, Egypt
| | - S. Ali
- Women's Health Hospital, Faculty of Medicine, Assiut University, Obstetrics and Gynecology Department, Assiut, Egypt
| | - N. Fakie
- Faculty of Health Sciences, University of Cape Town, Radiation Oncology Department, Cape Town, South Africa
| | - T. Adams
- Faculty of Health Sciences, University of Cape Town, Gynecologic Oncology Division, Cape Town, South Africa
| | - L. Gwyther
- Faculty of Health Sciences, University of Cape Town, Palliative Medicine Division, Cape Town, South Africa
| | - R. Krause
- Faculty of Health Sciences, University of Cape Town, Palliative Medicine Division, Cape Town, South Africa
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10
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Zimmerman S, Sloane PD, Ward K, Beeber A, Reed D, Lathren C, Matchar B, Gwyther L. Helping Dementia Caregivers Manage Medical Problems: Benefits of an Educational Resource. Am J Alzheimers Dis Other Demen 2018; 33:176-183. [PMID: 29301414 PMCID: PMC6237200 DOI: 10.1177/1533317517749466] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND/RATIONALE Family caregivers of people with dementia must attend to medical care needs of their relative, yet few available resources address comorbidities in dementia. Consequently, caregivers feel ill-equipped when medical concerns arise. In response, an educational resource-Alzheimer's Medical Advisor ( AlzMed)-was developed in 2 forms (website and book) and evaluated. METHODS Family caregivers (143 website and 51 book) used an educational resource that provides information on medical problems, vital signs, pain, dehydration, and the healthcare system. Data were collected at baseline, 3 months, and 6 months regarding confidence in sign/symptom management, burden, depression, and anxiety. RESULTS Caregivers reported significantly improved confidence and (for website users) decreased role strain. Anxiety and depression also decreased, although not significantly. Improved confidence related to a reduction in role strain and anxiety, and care recipients did not experience adverse events. CONCLUSION An educational resource focusing on care of comorbid illness may benefit caregiver outcomes.
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Affiliation(s)
- Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA
- Schools of Social Work and Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Philip D. Sloane
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA
- Department of Family Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Kimberly Ward
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA
| | - Anna Beeber
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA
- School of Nursing, University of North Carolina, Chapel Hill, NC, USA
| | - David Reed
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA
| | - Christine Lathren
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA
| | - Bobbi Matchar
- Duke Family Support Program, Duke University, Durham, NC, USA
| | - Lisa Gwyther
- Duke Family Support Program, Duke University, Durham, NC, USA
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11
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Woldemariam A, Gwyther L, Deyessa N, Kantelhardt E, Macchia G, Cammelli S, Morganti A. EP-1650: Prevalence and Management of Pain In Tikur Anbessa Hospital Radiotherapy Center. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31959-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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12
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Rawlinson F, Gwyther L, Kiyange F, Luyirika E, Meiring M, Downing J. The current situation in education and training of health-care professionals across Africa to optimise the delivery of palliative care for cancer patients. Ecancermedicalscience 2014; 8:492. [PMID: 25624873 PMCID: PMC4303614 DOI: 10.3332/ecancer.2014.492] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Indexed: 11/06/2022] Open
Abstract
The need for palliative care education remains vital to contribute to the quality of life of patients, both adults and children, with cancer in Africa. The number of patients with cancer continues to rise, and with them the burden of palliative care needs. Palliative care has been present in Africa for nearly four decades, and a number of services are developing in response to the HIV/AIDS epidemic. However, the needs of cancer patients remain a challenge. Education and training initiatives have developed throughout this time, using a combination of educational methods, including, more recently, e-learning initiatives. The role of international and national organisations in supporting education has been pivotal in developing models of education and training that are robust, sustainable, and affordable. Developing a material for education and professional development needs to continue in close collaboration with that already in production in order to optimise available resources. Seeking ways to evaluate programmes in terms of their impact on patient care remains an important part of programme delivery. This article reviews the current situation.
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Affiliation(s)
- Fm Rawlinson
- Department of Palliative Medicine, Cardiff University, Velindre Hospital, Cardiff CF14 2TL, Wales, UK
| | - L Gwyther
- Hospice Palliative Care Association of South Africa and Senior Lecturer, palliative medicine, University of Cape Town Anzio Road, Observatory, Cape Town, South Africa
| | - F Kiyange
- African Palliative Care Association, PO Box 72518, Plot 95, Dr Gibbons Road, Makindye, Kampala, Uganda
| | - E Luyirika
- African Palliative Care Association, PO Box 72518, Plot 95, Dr Gibbons Road, Makindye, Kampala, Uganda
| | - M Meiring
- Sarah Fox Convalescent Hospital and PATCH-SA (SA Children's Palliative Care Network), Lecturer, palliative medicine, University of Cape Town Anzio Road, Observatory, Cape Town, South Africa
| | - J Downing
- Honorary Professor, Makerere University, PO Box 7062, Kampala, Uganda; International Palliative Care Consultant
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De Vries E, Gwyther L, Mkhabela M. Sexuality in patients with human immunodeficiency virus at Embhuleni Hospital in Mpumalanga province. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2013.10874328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- E De Vries
- Mitchell's Plain District Hospital; Metro District Health Services, Cape Town School of Public Health and Family Medicine; University of Cape Town
| | - L Gwyther
- School of Public Health and Family Medicine; University of Cape Town Mkhabela M, Mpumulanga
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Downing J, Namisango E, Kiyange F, Luyirika E, Gwyther L, Enarson S, Kampi J, Sithole Z, Kemigisha-Ssali E, Masclee M, Mukasa I. The net effect: spanning diseases, crossing borders-highlights from the fourth triennial APCA conference and annual HPCA conference for palliative care. Ecancermedicalscience 2013; 7:371. [PMID: 24222787 PMCID: PMC3816847 DOI: 10.3332/ecancer.2013.371] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Indexed: 11/17/2022] Open
Abstract
The African Palliative Care Association (APCA) jointly hosted its triennial palliative care conference for Africa with the Hospice and Palliative Care Association of South Africa (HPCA) on 17-20 September 2013 in Johannesburg, South Africa. At the heart of the conference stood a common commitment to see patient care improved across the continent. The theme for the conference, 'The Net Effect: Spanning Diseases, Crossing Borders', reflected this joint vision and the drive to remember the 'net effect' of our work in palliative care-that is, the ultimate impact of the care that we provide for our patients and their families across the disease and age spectrum and across the borders of African countries. The conference, held in Johannesburg, brought together 471 delegates from 34 countries. The key themes and messages from the conference are encapsulated in ten 'C's of commitment to political will and support at the highest levels of governance; engaging national, regional, and international bodies; collaboration; diversity; palliative care for children; planning for human resources and capacity building; palliative care integration at all levels; developing an evidence base for palliative care in Africa; using new technologies; and improved quality of care. Participants found the conference to be a forum that challenged their understanding of the topics presented, as well as enlightening in terms of applying best practice in their own context. Delegates found a renewed commitment and passion for palliative care and related health interventions for children and adults with life-limiting and life-threatening illnesses within the region. This conference highlighted many of the developments in palliative care in the region and served as a unique opportunity to bring people together and serve as a lynchpin for palliative care provision and development in Africa. The delegates were united in the fact that together we can 'span diseases,' 'cross borders,' and realise the 'African Dream' for palliative care.
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Affiliation(s)
- J Downing
- Makerere University, Kampala, Uganda ; International Children's Palliative Care Network, Hillcrest 3624, South Africa ; African Palliative Care Association UK, London DA15 8AD, UK
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Harding R, Simms V, Krakauer E, DeLima L, Downing J, Garanganga E, Green K, Gwyther L, Lohman D. Quality HIV Care to the End of life. Clin Infect Dis 2011; 52:553-4; author reply 554. [DOI: 10.1093/cid/ciq180] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Selman L, Higginson IJ, Agupio G, Dinat N, Downing J, Gwyther L, Mashao T, Mmoledi K, Moll AP, Sebuyira LM, Panajatovic B, Harding R. Meeting information needs of patients with incurable progressive disease and their families in South Africa and Uganda: multicentre qualitative study. BMJ 2009. [DOI: 10.1136/bmj.b1326 338/apr22_1/b1326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Evans DL, Charney DS, Lewis L, Golden RN, Gorman JM, Krishnan KRR, Nemeroff CB, Bremner JD, Carney RM, Coyne JC, Delong MR, Frasure-Smith N, Glassman AH, Gold PW, Grant I, Gwyther L, Ironson G, Johnson RL, Kanner AM, Katon WJ, Kaufmann PG, Keefe FJ, Ketter T, Laughren TP, Leserman J, Lyketsos CG, McDonald WM, McEwen BS, Miller AH, Musselman D, O'Connor C, Petitto JM, Pollock BG, Robinson RG, Roose SP, Rowland J, Sheline Y, Sheps DS, Simon G, Spiegel D, Stunkard A, Sunderland T, Tibbits P, Valvo WJ. Mood disorders in the medically ill: scientific review and recommendations. Biol Psychiatry 2005; 58:175-89. [PMID: 16084838 DOI: 10.1016/j.biopsych.2005.05.001] [Citation(s) in RCA: 671] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2005] [Revised: 04/29/2005] [Accepted: 05/03/2005] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The purpose of this review is to assess the relationship between mood disorders and development, course, and associated morbidity and mortality of selected medical illnesses, review evidence for treatment, and determine needs in clinical practice and research. DATA SOURCES Data were culled from the 2002 Depression and Bipolar Support Alliance Conference proceedings and a literature review addressing prevalence, risk factors, diagnosis, and treatment. This review also considered the experience of primary and specialty care providers, policy analysts, and patient advocates. The review and recommendations reflect the expert opinion of the authors. STUDY SELECTION/DATA EXTRACTION Reviews of epidemiology and mechanistic studies were included, as were open-label and randomized, controlled trials on treatment of depression in patients with medical comorbidities. Data on study design, population, and results were extracted for review of evidence that includes tables of prevalence and pharmacological treatment. The effect of depression and bipolar disorder on selected medical comorbidities was assessed, and recommendations for practice, research, and policy were developed. CONCLUSIONS A growing body of evidence suggests that biological mechanisms underlie a bidirectional link between mood disorders and many medical illnesses. In addition, there is evidence to suggest that mood disorders affect the course of medical illnesses. Further prospective studies are warranted.
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Affiliation(s)
- Dwight L Evans
- School of Medicine, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, USA.
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Gwyther L, Rawlinson F. Symptom control in palliative care: essential for quality of life. S Afr Med J 2004; 94:437. [PMID: 15250454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
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Abstract
The purpose of this study was to describe physician-patient communication about over-the-counter medications using a data set comprised of audio-tapes and transcripts of 414 primary care medical visits. The data set was collected during 1995 at the family practice and general medicine clinics at the University of New Mexico Health Sciences Center. Twenty-seven resident physicians and 414 of their adult patients participated. Fifty-seven percent of patients reported using one or more OTC medications during the past month. Analgesics, cold or allergy products, and antacids were the most commonly used OTC medications. White patients were significantly more likely to have reported using an analgesic in the past month than non-white patients. Female, white, and younger patients were more likely to have reported using a cold or allergy product in the past month than male, non-white, and older patients. Approximately 58% of patients discussed OTC medications with their physicians. Older patients and female patients as well as patients who reported using an antacid in the past month were significantly more likely to have discussed OTC medications with their physicians. Physicians asked questions about OTC medications during only 37% of encounters. Patients asked questions about OTC medications during 11% of encounters. Patient ethnicity did not influence physician or patient question-asking and information-giving about OTC medications. Male physicians were more likely to state information and ask questions about OTC medications than female physicians. Patients were more likely to ask male physicians questions about OTC medications. Physicians were more likely to state OTC information to and ask OTC questions of female and older patients. Physicians were more likely to ask less educated patients questions about OTC medications. Less educated patients were more likely to ask physicians questions about OTC medications. Despite the fact that more than half of all patients reported using OTC medications, physicians asked questions about OTC use during only approximately one-third of encounters. Of patients who reported using an OTC medication in the past month, 58% did not tell their physicians, yet only 14% of patients believed that it was not important for the physician to know about their OTC use. Physician-patient communication about OTC medications should be encouraged so that the patient becomes a collaborative partner in medication management.
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Affiliation(s)
- B Sleath
- Cecil G. Sheps Center for Health Services Research and School of Pharmacy, University of North Carolina at Chapel Hill, Beard Hall, CB 7360, Chapel Hill, NC 27599-7360, USA.
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Abstract
OBJECTIVES The purpose of this study was to describe ethnic differences in physician-patient communication about alternative therapies, using a data set comprised of audiotapes and transcripts of primary care medical visits. METHODS The data set was collected during 1995 at the family practice and general medicine clinics at the University of New Mexico Health Sciences Center, Albuquerque, NM. Twenty-seven (27) resident physicians and 205 of their Hispanic and non-Hispanic white patients age 50 and over participated. RESULTS Almost 18 percent of patients reported using one or more alternative therapies during the preceding month. Herbal medicine was the most widely used therapy. Eighty-three percent (83%) of patients who reported using an alternative therapy in the previous month did not tell their physicians. Physicians asked one or more questions about alternative therapies during only 3.4% of encounters. Only 2% of patients asked their physicians one or more questions about alternative therapies. There were no ethnic differences in physician-older patient communication about alternative therapies. DISCUSSION Physician-patient communication could be improved to enhance physician understanding of the spectrum of interventions patients pursue to improve their health.
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Affiliation(s)
- B Sleath
- Cecil G. Sheps Center for Health Services Research, School of Pharmacy, and Institute on Aging, University of North Carolina at Chapel Hill, 27599-7590, USA.
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Doody RS, Stevens JC, Beck C, Dubinsky RM, Kaye JA, Gwyther L, Mohs RC, Thal LJ, Whitehouse PJ, DeKosky ST, Cummings JL. Practice parameter: management of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2001; 56:1154-66. [PMID: 11342679 DOI: 10.1212/wnl.56.9.1154] [Citation(s) in RCA: 580] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To define and investigate key issues in the management of dementia and to make literature-based treatment recommendations. METHODS The authors searched the literature for four clinical questions: 1) Does pharmacotherapy for cognitive symptoms improve outcomes in patients with dementia? 2) Does pharmacotherapy for noncognitive symptoms improve outcomes in patients with dementia? 3) Do educational interventions improve outcomes in patients and/or caregivers? 4) Do other nonpharmacologic interventions improve outcomes in patients and/or caregivers? RESULTS Cholinesterase inhibitors benefit patients with AD (Standard), although the average benefit appears small; vitamin E likely delays the time to clinical worsening (Guideline); selegiline, other antioxidants, anti-inflammatories, and estrogen require further study. Antipsychotics are effective for agitation or psychosis in patients with dementia where environmental manipulation fails (Standard), and antidepressants are effective in depressed patients with dementia (Guideline). Educational programs should be offered to family caregivers to improve caregiver satisfaction and to delay the time to nursing home placement (Guideline). Staff of long-term care facilities should also be educated about AD to minimize the unnecessary use of antipsychotic medications (Guideline). Behavior modification, scheduled toileting, and prompted voiding reduce urinary incontinence (Standard). Functional independence can be increased by graded assistance, skills practice, and positive reinforcement (Guideline).
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Affiliation(s)
- R S Doody
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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Gwyther L. Introduction: What is respite care? Pride Inst J Long Term Home Health Care 1987; 5:4-6. [PMID: 10317785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Gwyther L. Alzheimer's disease. N C Med J 1983; 44:435-6. [PMID: 6577299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Sloane P, Gwyther L. In support of nursing homes. J Pract Nurs 1982; 32:32-3. [PMID: 6923931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Sloane P, Gwyther L. Nursing homes. JAMA 1980; 244:1840-1. [PMID: 7420690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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