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Kasper LA, Pfeifer AC, Volkert J, Schiltenwolf M, Taubner S. [Mentalizing the pain-Implementation of a mentalization-based manual for the therapeutic support of pain patients.]. Schmerz 2024; 38:118-124. [PMID: 37071211 DOI: 10.1007/s00482-023-00709-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 04/19/2023]
Abstract
Chronic pain is usually a complex disorder with possible indications for an impairment at the personality functioning level. Guidelines recommend a multiprofessional interdisciplinary treatment approach. Based on the alternative model of personality disorders of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) and the International Classification of Diseases, eleventh revision (ICD-11), an integrative manual was designed to exactly fit the interdisciplinary multimodal treatment of patients of the day clinic for pain at the orthopedic clinic of the University Hospital Heidelberg. The treatment manual specifically promotes various areas of personality functioning levels, such as emotion regulation, identity, empathy and relationships through individual and group interventions against the background of a mentalization-based therapeutic attitude. A focus group was used to qualitatively evaluate the implementation of the new treatment manual. With good applicability of the manual and satisfaction of the therapy team, a common language for the interdisciplinary team could be created to improve the therapeutic interaction.
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Affiliation(s)
- L A Kasper
- Institut für Psychosoziale Prävention, Universitätsklinikum Heidelberg, Bergheimerstr. 54, 69115, Heidelberg, Deutschland.
- Psychologisches Institut, Universität Heidelberg, Heidelberg, Deutschland.
| | - A-C Pfeifer
- Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - J Volkert
- Abteilung Psychologie, Medical School Berlin, Berlin, Deutschland
| | - M Schiltenwolf
- Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - S Taubner
- Institut für Psychosoziale Prävention, Universitätsklinikum Heidelberg, Bergheimerstr. 54, 69115, Heidelberg, Deutschland
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2
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Faber AM, Krieg T, Hunzelmann N. [Systemic sclerosis]. Dermatologie (Heidelb) 2024; 75:181-196. [PMID: 38366245 DOI: 10.1007/s00105-024-05298-8] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/10/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Systemic sclerosis (SSc) is a very heterogeneous, chronic, rare, but socioeconomically important disease with a severe disease course and severe impairment of the quality of life of affected patients. OBJECTIVES Overview of the current state of research on the pathogenesis, diagnosis and therapy of SSc. METHODS A literature search was performed. RESULTS The pathogenesis of SSc is not fully understood. ACR/EULAR criteria allow the diagnosis of early forms of SSc. Classification into limited cutaneous SSc and diffuse cutaneous SSc is of prognostic and therapeutic relevance. New organ-specific treatment options for SSc have led to improved quality of life and prognosis.
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Affiliation(s)
- A-M Faber
- Klinik und Poliklinik für Dermatologie und Venerologie, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - T Krieg
- Translational Matrix Biology, Medizinische Fakultät, Universität zu Köln, Köln, Deutschland
| | - N Hunzelmann
- Klinik und Poliklinik für Dermatologie und Venerologie, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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Imhof S, Hochadel M, Konstantinides S, Voigtländer T, Schmitt C, Nowak B, Rassaf T, Senges J, Münzel T, Giannitsis E, Breuckmann F. Cardiac, possible cardiac, and likely non-cardiac origin of chest pain : A hitherto underestimated parameter in German chest pain units. Herz 2023:10.1007/s00059-023-05230-1. [PMID: 38155226 DOI: 10.1007/s00059-023-05230-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Current guidelines emphasize the diagnostic value of non-cardiac or possibly cardiac chest pain. The goal of this analysis was to determine whether German chest pain units (CPUs) adequately address conditions with "atypical" chest pain in existing diagnostic structures. METHOD A total of 11,734 patients from the German CPU registry were included. The analyses included mode of admission, critical time intervals, diagnostic steps, and differential diagnoses. RESULTS Patients with unspecified chest pain were younger, more often female, were less likely to have classic cardiovascular risk factors and tended to present more often as self-referrals. Patients with acute coronary syndrome (ACS) mostly had prehospital medical contact. Overall, there was no difference between these two groups regarding the time from the onset of first symptoms to arrival at the CPU. In the CPU, the usual basic diagnostic measures were performed irrespective of ACS as the primary working diagnosis. In the non-ACS group, further ischemia-specific diagnostics were rarely performed. Extra-cardiac differential diagnoses were not specified. CONCLUSION The establishment of broader awareness programs and opening CPUs for low-threshold evaluation of self-referring patients should be discussed. Regarding the rigid focus on the clarification of cardiac causes of chest pain, a stronger interdisciplinary approach should be promoted.
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Affiliation(s)
- Sebastian Imhof
- Department of Cardiology, Pneumology, Neurology and Intensive Care, Klinik Kitzinger Land, Kitzingen, Germany
| | - Matthias Hochadel
- Institute for Myocardial Infarction Research Foundation, Ludwigshafen, Germany
| | - Stavros Konstantinides
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | | | - Claus Schmitt
- Clinic for Cardiology and Angiology, Municipal Hospital Karlsruhe, Karlsruhe, Germany
| | - Bernd Nowak
- CCB, Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany
| | - Jochen Senges
- Institute for Myocardial Infarction Research Foundation, Ludwigshafen, Germany
| | - Thomas Münzel
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany
| | | | - Frank Breuckmann
- Department of Cardiology, Pneumology, Neurology and Intensive Care, Klinik Kitzinger Land, Kitzingen, Germany.
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany.
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Kurtzman ET, Barnow BS, Korer B. Differences in the Patterns of Care Between Emergency Department Visits with and Without a Physician. J Emerg Med 2023; 65:e337-e354. [PMID: 37709576 DOI: 10.1016/j.jemermed.2023.05.011] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/20/2023] [Accepted: 05/26/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND A variety of clinicians practice in emergency departments (EDs). Although most ED patients prefer seeing physicians, a subset sees no physician. OBJECTIVES We sought to determine the factors that predict when an ED patient is seen by at least one physician and compared the practice patterns of patient visits seen by at least one physician compared with those seen by no physician. METHODS We used 11 years of cross-sectional data from the National Hospital Ambulatory Medical Care Survey and focused on the sample of ED patient visits seen by at least one physician and those seen by no physician. We used bivariate statistics to compare characteristics between samples and used multivariate logistic regression analysis to identify the factors that predicted being seen by a physician. Finally, we compared the practice patterns of patient visits seen by at least one physician compared with those seen by no physician. RESULTS Approximately 10% of the sample was not seen by any physician. Patients seen by at least one physician had, on average, 0.8 more diagnostic services ordered/provided and 0.1 more procedures provided compared with patients who were not seen by any physician. Patients seen by at least one physician had longer visits by 29.4 min, on average, and had increased odds of being hospitalized (adjusted odds ratio 3.9, 95% confidence interval 2.9-5.2). CONCLUSIONS A variety of patient and hospital characteristics influenced whether ED patients were seen by physicians. Diagnostic services, procedures, visit length, and hospital admission differed by physician presence. Findings have implications for ED practice and future research.
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Affiliation(s)
- Ellen T Kurtzman
- Health Administration, Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, New Jersey
| | - Burt S Barnow
- Department of Public Service and Economics, Trachtenberg School of Public Policy and Public Administration
| | - Burton Korer
- Graduate Research, The School of Nursing, George Washington University, Washington, DC
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Lindelöf N, Nilsson I, Littbrand H, Gustafson Y, Olofsson B, Fjellman-Wiklund A. A focus groups study of staff team experiences of providing interdisciplinary rehabilitation for people with dementia and their caregivers-a co-creative journey. BMC Geriatr 2023; 23:572. [PMID: 37723442 PMCID: PMC10507912 DOI: 10.1186/s12877-023-04269-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/31/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND The World Health Organization claims that rehabilitation is important to meet the needs of persons with dementia. Rehabilitation programmes, however, are not routinely available. Person-centred, multidimensional, and interdisciplinary rehabilitation can increase the opportunities for older adults with dementia and their informal primary caregivers to continue to live an active life and participate in society. To our knowledge, staff team experiences of such rehabilitation programmes, involving older adults with dementia and their informal caregivers has not been previously explored. METHODS The aim of this qualitative focus group study was to explore the experiences of a comprehensive staff team providing person-centred multidimensional, interdisciplinary rehabilitation to community-dwelling older adults with dementia, including education and support for informal primary caregivers. The 13 staff team members comprised 10 professions who, during a 16-week intervention period, provided individualised interventions while involving the rehabilitation participants. After the rehabilitation period the staff team members were divided in two focus groups who met on three occasions each (in total six focus groups) and discussed their experiences. The Grounded Theory method was used for data collection and analysis. RESULTS The analysis resulted in four categories: Achieving involvement in rehabilitation is challenging, Considering various realities by acting as a link, Offering time and continuity create added value, and Creating a holistic view through knowledge exchange, and the core category: Refining a co-creative process towards making a difference. The core category resembles the collaboration that the staff had within their teams, which included participants with dementia and caregivers, and with the goal that the intervention should make a difference for the participants. This was conducted with flexibility in a collaborative and creative process. CONCLUSIONS The staff team perceived that by working in comprehensive teams they could provide individualised rehabilitation in creative collaboration with the participants through interaction, knowledge exchange, time and continuity, coordination and flexibility, and a holistic view. Challenges to overcome were the involvement of the person with dementia in goal setting and the mediating role of the staff team members. The staff pointed out that by refinement they could achieve well-functioning, competence-enhancing and timesaving teamwork.
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Affiliation(s)
- Nina Lindelöf
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, SE-90187, Sweden.
| | - Ingeborg Nilsson
- Department of Community Medicine and Rehabilitation, Occupational therapy, Umeå University, Umeå, Sweden
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Håkan Littbrand
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Yngve Gustafson
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Birgitta Olofsson
- Department of Nursing, Umeå University, Umeå, Sweden
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
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Rafferty M, Stoff L, Smith JD, Hansen P, Briody M, Diaz C, O'Donnell L, Heinemann AW, Brown CH, Lieber RL. Promoting Evidence-Based Practice: The Influence of Novel Structural Change to Accelerate Translational Rehabilitation. Arch Phys Med Rehabil 2023; 104:1289-1299. [PMID: 36924817 PMCID: PMC10502191 DOI: 10.1016/j.apmr.2023.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/09/2022] [Revised: 01/16/2023] [Accepted: 02/15/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVE To evaluate changes in clinicians' use of evidence-based practice (EBP), openness toward EBP, and their acceptance of organizational changes after a rehabilitation hospital transitioned to a new facility designed to accelerate clinician-researcher collaborations. DESIGN Three repeated surveys of clinicians before, 7-9 months, and 2.5 years after transition to the new facility. SETTING Inpatient rehabilitation hospital. PARTICIPANTS Physicians, nurses, therapists, and other health care professionals (n=410, 442, and 448 respondents at Times 1, 2, and 3, respectively). INTERVENTIONS Implementation of physical (architecture, design) and team-focused (champions, leaders, incentives) changes in a new model of care to promote clinician-researcher collaborations. MAIN OUTCOME MEASURES Adapted versions of the Evidence-Based Practice Questionnaire (EBPQ), the Evidence-Based Practice Attitudes Scale (EBPAS), and the Organizational Change Recipients' Beliefs Scale (OCRBS) were used. Open-ended survey questions were analyzed through exploratory content analysis. RESULTS Response rates at Times 1, 2, and 3 were 67% (n=410), 69% (n=422), and 71% (n=448), respectively. After accounting for familiarity with the model of care, there was greater reported use of EBP at Time 3 compared with Time 2 (adjusted meant2=3.51, standard error (SE)=0.05; adj. meant3=3.64, SE=0.05; P=.043). Attitudes toward EBPs were similar over time. Acceptance of the new model of care was lower at Time 2 compared with Time 1, but rebounded at Time 3 (adjusted meant1=3.44, SE=0.04; adj. meant2=3.19, SE=0.04; P<.0001; adj. meant3=3.51, SE=0.04; P<.0001). Analysis of open-ended responses suggested that clinicians' optimism for the model of care was greater over time, but continued quality improvement should focus on cultivating communication between clinicians and researchers. CONCLUSIONS Accelerating clinician-researcher collaborations in a rehabilitation setting requires sustained effort for successful implementation beyond novel physical changes. Organizations must be responsive to clinicians' changing concerns to adapt and sustain a collaborative translational medicine model and allow sufficient time, probably years, for such transitions to occur.
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Affiliation(s)
- Miriam Rafferty
- Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | | | - Justin D Smith
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City, UT
| | - Piper Hansen
- Shirley Ryan AbilityLab, Chicago, IL; Occupational Therapy Department, Rush University, Chicago, IL
| | | | - Carmen Diaz
- Northwestern University, Kellogg School of Management, Chicago, IL
| | | | - Allen W Heinemann
- Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - C Hendricks Brown
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Richard L Lieber
- Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL; Hines V.A. Medical Center, Hines, IL
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7
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Mattes MD, Ye JC, Peters GW, Rizvi F, Thomas TO, Chandra RA, Weiss E, Gutiontov SI, Motwani SB. Pilot Study Demonstrating the Value of Interdisciplinary Education on the Integration of Radiation Therapy in Lung Cancer Management. J Cancer Educ 2023; 38:590-595. [PMID: 35357645 PMCID: PMC8967926 DOI: 10.1007/s13187-022-02158-8] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/27/2022] [Indexed: 05/20/2023]
Abstract
This study aimed to understand baseline knowledge of basic principles of radiation therapy for lung cancer among medical oncology, thoracic surgery, and pulmonology trainees and practicing physicians and also assess whether a didactic lecture will improve objective knowledge and perceived comfort level in making appropriate referrals to radiation oncology (RO). Radiation oncologists at 8 academic institutions offered a presentation covering indications, logistics, efficacy, and toxicity of thoracic radiation. Participants completed a survey to assess their prior exposures to RO and perceived value of the lecture, and objective knowledge gained based on pre/post-lecture questions. Among 121 attendees, 76 completed the pre-test, and 25 the post-test (response rates 62.8% and 20.7%, respectively). Fifty-seven (75.0%) had never previously experienced a RO didactic about lung cancer, 62 (81.6%) had never seen a linear accelerator, and 65 (85.5%) had never rotated in a RO department. The mean pre-test score was 53.5% (SD 17.6%), with a trend (p = 0.066) towards thoracic surgeons (61.5%) performing better than medical oncologists (55.5%) or pulmonologists (48.3%). Level of training (p = 0.130), and prior RO exposures (p = 0.240), did not significantly impact pre-test scores. The mean post-test score of 75.1% (SD 3.6%) was significantly higher than mean pre-test score (p < 0.001). After the lecture, 25 participants (100%) felt more knowledgeable about RO, and 24 (96%) felt more comfortable making appropriate referrals to RO. A didactic lecture about RO for trainees and physicians who treat lung cancer at 8 academic institutions was feasible, filled a gap in exposure, and improved knowledge.
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Affiliation(s)
- Malcolm D Mattes
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08901, USA.
| | - Jason C Ye
- Department of Radiation Oncology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Gabrielle W Peters
- Department of Radiation Oncology, Yale School of Medicine, New Haven, CT, USA
| | - Faryal Rizvi
- Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Tarita O Thomas
- Department of Radiation Oncology, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Ravi A Chandra
- Department of Radiation Oncology, Oregon Health Sciences University, Portland, OR, USA
| | - Elisabeth Weiss
- Department of Radiation Oncology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Stanley I Gutiontov
- Department of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Sabin B Motwani
- Department of Radiology, St. Joseph's University Medical Center, Paterson, NJ, USA
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Bray M, Heruc G, Byrne S, Wright ORL. Collaborative dietetic and psychological care in Interprofessional Enhanced Cognitive Behaviour Therapy for adults with Anorexia Nervosa: a novel treatment approach. J Eat Disord 2023; 11:31. [PMID: 36849895 PMCID: PMC9972764 DOI: 10.1186/s40337-023-00743-w] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/02/2023] [Indexed: 03/01/2023] Open
Abstract
Clinical practice guidelines for anorexia nervosa (AN) and atypical anorexia nervosa recommend treatment from a team including a mental health professional and a dietitian. To date, however, AN treatment models such as Enhanced Cognitive Behaviour Therapy (CBT-E) seldom include dietitians and have low to moderate treatment efficacy. Given interprofessional approaches to healthcare have been shown to improve treatment outcomes and enhance patient and clinician satisfaction, formalising collaborative dietetic and psychological treatment may be a feasible strategy to improve treatment outcomes and the patient and clinician experience of treatment. Moreover, malnutrition is a serious consequence of AN, and dietitians are considered experts in its diagnosis and treatment. This paper proposes a novel treatment approach, Interprofessional Enhanced Cognitive Behaviour Therapy (CBT-IE), an adaptation of CBT-E where dietitians deliver content related to malnutrition and dietary restraint and mental health professionals deliver content related to cognitive and behavioural change. The rationale for developing CBT-IE, treatment structure, and future research directions is discussed.
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Affiliation(s)
- Megan Bray
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia.
| | - Gabriella Heruc
- Eating Disorders and Nutrition Research Group (ENRG), School of Medicine, Western Sydney University, Penrith, Australia
| | | | - Olivia R L Wright
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
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Ngu NL, Saxby E, Worland T, Anderson P, Stothers L, Figredo A, Hunter J, Elford A, Ha P, Hartley I, Roberts A, Seah D, Tambakis G, Liew D, Rogers B, Sievert W, Bell S, Le S. A home-based, multidisciplinary liver optimisation programme for the first 28 days after an admission for acute-on-chronic liver failure (LivR well): a study protocol for a randomised controlled trial. Trials 2022; 23:744. [PMID: 36064596 PMCID: PMC9444080 DOI: 10.1186/s13063-022-06679-x] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 08/20/2022] [Indexed: 11/22/2022] Open
Abstract
Background Acute-on-chronic liver failure (ACLF) represents a rising global healthcare burden, characterised by increasing prevalence among patients with decompensated cirrhosis who have a 28-day transplantation-free mortality of 33.9%. Due to disease complexity and a high prevalence of socio-economic disadvantage, there are deficits in quality of care and adherence to guideline-based treatment in this cohort. Compared to other chronic conditions such as heart failure, those with liver disease have reduced access to integrated ambulatory care services. The LivR Well programme is a multidisciplinary intervention aimed at improving 28-day mortality and reducing 30-day readmission through a home-based, liver optimisation programme implemented in the first 28 days after an admission with either ACLF or hepatic decompensation. Outcomes from our feasibility study suggest that the intervention is safe and acceptable to patients and carers. Methods We will recruit adult patients with chronic liver disease from the emergency departments, in-patient admissions, and an ambulatory liver clinic of a multi-site quaternary health service in Melbourne, Australia. A total of 120 patients meeting EF-Clif criteria will be recruited to the ACLF arm, and 320 patients to the hepatic decompensation arm. Participants in each cohort will be randomised to the intervention arm, a 28-day multidisciplinary programme or to standard ambulatory care in a 1:1 ratio. The intervention arm includes access to nursing, pharmacy, physiotherapy, dietetics, social work, and neuropsychiatry clinicians. For the ACLF cohort, the primary outcome is 28-day mortality. For the hepatic decompensation cohort, the primary outcome is 30-day re-admission. Secondary outcomes assess changes in liver disease severity and quality of life. An interim analysis will be performed at 50% recruitment to consider early cessation of the trial if the intervention is superior to the control, as suggested in our feasibility study. A cost-effectiveness analysis will be performed. Patients will be followed up for 12 weeks from randomisation. Three exploratory subgroup analyses will be conducted by (a) source of referral, (b) unplanned hospitalisation, and (c) concurrent COVID-19. The trial has been registered with the Australian New Zealand Clinical Trials Registry. Discussion This study implements a multidisciplinary intervention for ACLF patients with proven benefits in other chronic diseases with the addition of novel digital health tools to enable remote patient monitoring during the COVID-19 pandemic. Our feasibility study demonstrates safety and acceptability and suggests clinical improvement in a small sample size. An RCT is required to generate robust outcomes in this frail, high healthcare resource utilisation cohort with high readmission and mortality risk. Interventions such as LivR Well are urgently required but also need to be evaluated to ensure feasibility, replicability, and scalability across different healthcare systems. The implications of this trial include the generalisability of the programme for implementation across regional and urban centres. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621001703897. Registered on 13 December 2021. WHO Trial Registration Data Set. See Appendix 1 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06679-x.
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Affiliation(s)
- Natalie Ly Ngu
- Department of Gastroenterology and Hepatology, Monash Health, Level 3, 246 Clayton Rd, Clayton, Victoria, 3168, Australia. .,Faculty of Medicine, Nursing and Health Sciences, Monash University, Wellington Rd, Clayton, Victoria, 3800, Australia.
| | - Edward Saxby
- Department of Gastroenterology and Hepatology, Monash Health, Level 3, 246 Clayton Rd, Clayton, Victoria, 3168, Australia
| | - Thomas Worland
- Department of Gastroenterology and Hepatology, Monash Health, Level 3, 246 Clayton Rd, Clayton, Victoria, 3168, Australia
| | - Patricia Anderson
- Department of Gastroenterology and Hepatology, Monash Health, Level 3, 246 Clayton Rd, Clayton, Victoria, 3168, Australia
| | - Lisa Stothers
- Department of Gastroenterology and Hepatology, Monash Health, Level 3, 246 Clayton Rd, Clayton, Victoria, 3168, Australia
| | - Anita Figredo
- Hospital in the Home, Level 4, 246 Clayton Rd, Clayton, Victoria, 3168, Australia
| | - Jo Hunter
- Department of Gastroenterology and Hepatology, Monash Health, Level 3, 246 Clayton Rd, Clayton, Victoria, 3168, Australia
| | - Alexander Elford
- Department of Gastroenterology and Hepatology, Monash Health, Level 3, 246 Clayton Rd, Clayton, Victoria, 3168, Australia
| | - Phil Ha
- Department of Gastroenterology and Hepatology, Monash Health, Level 3, 246 Clayton Rd, Clayton, Victoria, 3168, Australia
| | - Imogen Hartley
- Department of Gastroenterology and Hepatology, Monash Health, Level 3, 246 Clayton Rd, Clayton, Victoria, 3168, Australia
| | - Andrew Roberts
- Department of Gastroenterology and Hepatology, Monash Health, Level 3, 246 Clayton Rd, Clayton, Victoria, 3168, Australia
| | - Dean Seah
- Department of Gastroenterology and Hepatology, Monash Health, Level 3, 246 Clayton Rd, Clayton, Victoria, 3168, Australia
| | - George Tambakis
- Department of Gastroenterology and Hepatology, Monash Health, Level 3, 246 Clayton Rd, Clayton, Victoria, 3168, Australia
| | - Danny Liew
- Adelaide Medical School, The University of Adelaide, Corner of North Terrace & George St, Adelaide, South Australia, 5000, Australia
| | - Benjamin Rogers
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Wellington Rd, Clayton, Victoria, 3800, Australia.,Hospital in the Home, Level 4, 246 Clayton Rd, Clayton, Victoria, 3168, Australia
| | - William Sievert
- Department of Gastroenterology and Hepatology, Monash Health, Level 3, 246 Clayton Rd, Clayton, Victoria, 3168, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Wellington Rd, Clayton, Victoria, 3800, Australia
| | - Sally Bell
- Department of Gastroenterology and Hepatology, Monash Health, Level 3, 246 Clayton Rd, Clayton, Victoria, 3168, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Wellington Rd, Clayton, Victoria, 3800, Australia
| | - Suong Le
- Department of Gastroenterology and Hepatology, Monash Health, Level 3, 246 Clayton Rd, Clayton, Victoria, 3168, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Wellington Rd, Clayton, Victoria, 3800, Australia
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Cheng AL, Carbonell KV, Prather H, Hong BA, Downs DL, Metzler JP, Hunt DM. Unique characteristics of patients who choose an intensive lifestyle medicine program to address chronic musculoskeletal pain. PM R 2022. [PMID: 35567523 PMCID: PMC9659670 DOI: 10.1002/pmrj.12847] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/20/2022] [Accepted: 05/01/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Factors that motivate musculoskeletal patients to pursue an intensive, lifestyle medicine based approach to care are poorly understood. OBJECTIVE To determine whether, compared to patients seeking musculoskeletal care through traditional pathways, patients who choose an intensive lifestyle medicine program for musculoskeletal pain endorse greater physical dysfunction, worse psychological health, and/or more biopsychosocial comorbidities. DESIGN Cross-sectional analysis of existing medical records from 2018-2021. SETTING Orthopedic department of one academic medical center. PATIENTS Fifty consecutive patients who enrolled in an intensive lifestyle medicine program to address a musculoskeletal condition. Comparison groups were: 1.) 100 patients who presented for standard non-operative musculoskeletal care, and 2.) 100 patients who presented for operative evaluation by an orthopedic surgeon and qualified for joint arthroplasty. INTERVENTION Not applicable. MAIN OUTCOME MEASURES Primary outcomes were age-adjusted, between-group differences in Patient-Reported Outcomes Measurement Information System (PROMIS) physical and psychological health measures. Secondary outcomes were between-group differences in sociodemographic and medical history characteristics. RESULTS Patients who enrolled in the intensive lifestyle medicine program were more racially diverse (non-white race: lifestyle cohort 34% versus comparison cohorts 16-18%, p≤.029) and had a higher prevalence of obesity and diabetes than both comparison groups (mean body mass index: lifestyle cohort 37.6 kg/m2 versus comparison cohorts 29.3-32.0, p<.001; diabetes prevalence: lifestyle cohort 32% versus comparison cohorts 12-16%, p≤.024). Compared to standard non-operative patients, there were no clear between-group differences in PROMIS physical or psychological health scores. Compared to standard operative evaluation patients, patients in the lifestyle program reported worse anxiety but less pain interference (PROMIS Anxiety: B=3.8 points [0.1-7.4], p=.041; Pain Interference: B=-3.6 [-6.0- -1.2], p=.004). CONCLUSIONS Compared to musculoskeletal patients who sought care through traditional pathways, patients who chose an intensive lifestyle medicine pathway had a higher prevalence of metabolic comorbidities, but there was substantial overlap in patients' physical, psychological, and sociodemographic characteristics. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Abby L Cheng
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO
| | | | - Heidi Prather
- Department of Physiatry, Hospital for Special Surgery, Weill Cornell Medical College, New York City, NY
| | - Barry A Hong
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Dana L Downs
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - John P Metzler
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Devyani M Hunt
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO
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Tetzner F, Schlüter-Albrecht S, Rackwitz L, Clarius M, Nöth U, Reyle-Hahn SM. [Pain therapy and anaesthesiological procedures in fast-track arthroplasty]. Orthopade 2022; 51:358-365. [PMID: 35412088 DOI: 10.1007/s00132-022-04248-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 12/19/2022]
Abstract
Since the introduction of fast-track surgery in the field of arthroplasty, all disciplines involved have been challenged with the task of close and continuous joint communication in the context of daily routine care. Processes that have been agreed upon interdisciplinarily must be reviewed at regular intervals, and, if necessary, adapted and newly agreed upon with the aim of optimizing the perioperative risks both medically and along the therapeutic pathway. The responsibility of the anaesthesiologist is not only limited to the performance of anaesthesia, but also includes the care of patients with a view to optimal pain therapy, maintenance of homeostasis and ensuring a rapid return of the patient's self-determination.
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Affiliation(s)
- Fabian Tetzner
- Klinik für Anästhesiologie und Interdisziplinäre Intensivmedizin, Evangelisches Waldkrankenhaus Spandau, Stadtrandstraße 555, 13589, Berlin, Deutschland
| | - Sabine Schlüter-Albrecht
- Klinik für Anästhesiologie und Interdisziplinäre Intensivmedizin, Evangelisches Waldkrankenhaus Spandau, Stadtrandstraße 555, 13589, Berlin, Deutschland
| | - Lars Rackwitz
- Klinik für Orthopädie und Unfallchirurgie, Evangelisches Waldkrankenhaus Spandau, Berlin, Deutschland
| | - Michael Clarius
- Klinik für Orthopädie, Orthopädische Chirurgie und Unfallchirurgie, Vulpius Klinik, Bad Rappenau, Deutschland
| | - Ulrich Nöth
- Klinik für Orthopädie und Unfallchirurgie, Evangelisches Waldkrankenhaus Spandau, Berlin, Deutschland
| | - Stephan-Matthias Reyle-Hahn
- Klinik für Anästhesiologie und Interdisziplinäre Intensivmedizin, Evangelisches Waldkrankenhaus Spandau, Stadtrandstraße 555, 13589, Berlin, Deutschland.
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12
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Niemier K, Liefring V, Beyer L. [A functional approach to disorders of the loco-motor system-a way to a better understanding?]. Orthopade 2022; 51:325-332. [PMID: 35230455 DOI: 10.1007/s00132-022-04231-y] [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] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/03/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Disorders of the loco-motor system are frequent and expensive. The current method of diagnosing and treating these disorders does not appear to be successful. DIAGNOSTICS A functional approach based on the model of the functional system incorporates all aspects relevant to disorders of the loco-motor system. Most disturbances the system can compensate. If compensating mechanisms are not sufficient, the system decompensates, and symptoms develop. It is important to search not only for structural changes but also for somatic dysfunction, psychosocial factors, and changes in neuromodulation. On this basis, treatment strategies can be developed. If there are complex disturbances on different levels, a multimodal interdisciplinary treatment is indicated. The model of the functional system highlights the important role of manual medicine in the diagnostics, treatment, prevention, and rehabilitation of disorders of the loco-motor system.
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Affiliation(s)
- Kay Niemier
- Schmerz- und Rückenzentrum, Westmecklenburg Kliniken Helene von Bülow, Parkstr. 12, 19230, Hagenow, Deutschland.
| | - Volker Liefring
- Sana Rehabilitationsklinik für Orthopädie Sommerfeld GmbH, Kremmen, Deutschland
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13
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Middeldorf S. [Pain management in the rehabilitative setting]. Orthopade 2021; 50:916-925. [PMID: 34613437 DOI: 10.1007/s00132-021-04171-z] [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] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/08/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND In rehabilitation medicine, differentiated concepts of interdisciplinary multimodal pain management have existed for years, or even decades. OBJECTIVES What does orthopedic pain management include? How do these treatment measures carried out in the curative and rehabilitative setting differ? METHODS In addition to the content of rehabilitative pain management, further established models such as IMST (interdisciplinary multimodal pain therapy) are discussed. RESULTS The duration and intensity of the rehabilitation treatment differ from the models offered in topical medicine or in the curative sector. The treatment is also based on different questions or goals. In addition to the actual treatment, the aspect of complaint validation and socio-medical assessment is also typical for the rehabilitation sector. CONCLUSIONS Orthopedic rehabilitation through pain management provisos is part of a tiered and diversified system of treatment methods and models; A leap in quality was again achieved in the past few years through the introduction of behavioral medicine-oriented rehabilitation (VMO).
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Affiliation(s)
- Stefan Middeldorf
- Schön Klinik Bad Staffelstein, Am Kurpark 11, 96231, Bad Staffelstein, Deutschland.
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14
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Abstract
Pathological tumor-associated fractures are overall rare. They can occur in every age group and every bone. Although tumor-related fractures only form a small proportion of bone fractures, the early recognition of the cause of the fracture and treatment according to oncological guidelines are of enormous importance for affected patients. False treatment is frequently associated with far-reaching negative consequences with respect to the course of the disease. The great challenge is not the expeditious surgical treatment but much more the adequate diagnostics and the incorporation of local fracture treatment into an interdisciplinary overall oncological concept.
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Affiliation(s)
- Arne Streitbürger
- Klinik für Tumororthopädie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - Markus Nottrott
- Klinik für Tumororthopädie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - Wiebke Guder
- Klinik für Tumororthopädie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - Lars Podleska
- Klinik für Tumororthopädie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - Marcel Dudda
- Klinik für Unfall‑, Hand-, und Wiederherstellungschirurgie, Universitätsmedizin Essen, Essen, Deutschland
| | - Jendrik Hardes
- Klinik für Tumororthopädie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
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15
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Gushikem A, Cardoso MDM, Cabral ALL, Barros CSM, Isidro HBTM, Silva JR, Kauer JB, Soares RT. Predictive factors for return to work or study and satisfaction in traumatic brachial plexus injury individuals undergoing rehabilitation: A retrospective follow-up study of 101 cases. J Hand Ther 2021; 36:103-109. [PMID: 34392998 DOI: 10.1016/j.jht.2021.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 01/19/2021] [Accepted: 06/23/2021] [Indexed: 02/09/2023]
Abstract
BACKGROUND An important focus of rehabilitation is thereturn to the meningful occupations which may include work and school activities. PURPOSE The aim of this study is to investigate predictive factors for return to work/study in traumatic brachial plexus injury patients undergoing rehabilitation and to investigate the level of satisfaction with treatment. STUDY DESIGN Retrospective observational study with at least 1 year of follow-up. METHODS One hundred and one individuals with traumatic brachial plexus injury enrolled in this study. Primary outcomes were return to work/study and satisfaction with treatment. A secondary outcome was the self-perception of what influenced return to work. Sociodemographic and related to injury data, rehabilitation interventions, muscle strength, and disability were analyzed as predictors. Associations were investigated using univariable and discriminant analysis and considered a level of significance of P < .05. RESULTS Return to work/study occurred in 55% of the patients who participated in this study. Muscle strength discerned those who returned to work. Time interval between trauma and surgery and age were lower in those who returned to work. Thirty-one patients answered the question regarding self-perception of what influenced return to work. They indicated "necessity", "rehabilitation", "my desire" and "not become depressed". Satisfaction was graded between 8.9 and 9.5 in 95% of the cases. CONCLUSIONS Return to work/study was related to muscle strength improvement and those who returned were younger and had less time elapsed from trauma. Individual factors and rehabilitation were pointed out as helpful in aiding return to work. Satisfaction with treatment was high. These findings can help to optimize goals in the rehabilitation environment.
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Affiliation(s)
- Andreia Gushikem
- Physiotherapy department, SARAH Rehabilitation Hospital Network, Brasilia, Brazil.
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16
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Radtke C, Meyer-Marcotty M. [Reconstruction of soft tissue defects of the lower extremities]. Unfallchirurg 2021. [PMID: 34379162 DOI: 10.1007/s00113-021-01069-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
A reliable reconstruction of soft tissue defects of the lower extremities especially in the distal third of the leg is still a special challenge for reconstructive surgeons. The possibility of salvaging the leg has to be evaluated in the setting of an interdisciplinary team and the timing of the operation(s) with respect to the safety of the patient and a systematic approach with the selection of a suitable flap have to be defined. Traditionally local muscle flaps or free flaps have been established for coverage of defects of the lower extremities. Recently perforator-based flaps have gained popularity for reconstruction of lower extremity defects. Furthermore, new surgical techniques and developments in association with the demographic change have led to a paradigm shift.
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17
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Jonsson K, Brulin C, Härgestam M, Lindkvist M, Hultin M. Do team and task performance improve after training situation awareness? A randomized controlled study of interprofessional intensive care teams. Scand J Trauma Resusc Emerg Med 2021; 29:73. [PMID: 34078432 PMCID: PMC8170734 DOI: 10.1186/s13049-021-00878-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 04/21/2021] [Indexed: 11/27/2022] Open
Abstract
Background When working in complex environments with critically ill patients, team performance is influenced by situation awareness in teams. Moreover, improved situation awareness in the teams will probably improve team and task performance. The aim of this study is to evaluate an educational programme on situation awareness for interprofessional teams at the intensive care units using team and task performance as outcomes. Method Twenty interprofessional teams from the northern part of Sweden participated in this randomized controlled intervention study conducted in situ in two intensive care units. The study was based on three cases (cases 0, 1 and 2) with patients in a critical situation. The intervention group (n = 11) participated in a two-hour educational programme in situation awareness, including theory, practice, and reflection, while the control group (n = 9) performed the training without education in situation awareness. The outcomes were team performance (TEAM instrument), task performance (ABCDE checklist) and situation awareness (Situation Awareness Global Assessment Technique (SAGAT)). Generalized estimating equation were used to analyse the changes from case 0 to case 2, and from case 1 to case 2. Results Education in situation awareness in the intervention group improved TEAM leadership (p = 0.003), TEAM task management (p = 0.018) and TEAM total (p = 0.030) when comparing cases 1 and 2; these significant improvements were not found in the control group. No significant differences were observed in the SAGAT or the ABCDE checklist. Conclusions This intervention study shows that a 2-h education in situation awareness improved parts of team performance in an acute care situation. Team leadership and task management improved in the intervention group, which may indicate that the one or several of the components in situation awareness (perception, comprehension and projection) were improved. However, in the present study this potential increase in situation awareness was not detected with SAGAT. Further research is needed to evaluate how educational programs can be used to increase situation awareness in interprofessional ICU teams and to establish which components that are essential in these programs. Trial registration This randomized controlled trial was not registered as it does not report the results of health outcomes after a health care intervention on human participants. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00878-2.
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Affiliation(s)
- Karin Jonsson
- Department of Nursing and Department of Surgical and Perioperative Sciences, Anesthesiology and Critical Care Medicine, Umeå University, S-901 87, Umeå, Sweden.
| | | | - Maria Härgestam
- Department of Nursing, Umeå University, S-901 87, Umeå, Sweden
| | - Marie Lindkvist
- Department of Epidemiology and Global Health, Umeå University, S-901 87, Umeå, Sweden
| | - Magnus Hultin
- Department of Surgical and Perioperative Sciences, Anesthesiology and Critical Care Medicine, Umeå University, S-901 87, Umeå, Sweden
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18
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Abstract
Every year, more than 20,000 patients with polytrauma are treated in Germany. The term polytrauma refers to simultaneous injury to several body regions that are individually or collectively life-threatening for the patient. However, this assessment is made based on appropriate scoring systems. Adequate treatment of these patients requires not only medical care at the highest level, but also coordination of organizational/logistical processes. The link between preclinical and clinical care is treatment in the shock room, which should be led by a defined, experienced "trauma leader". Treatment algorithms are based on the current S3 guideline Polytrauma/Serious Injury Treatment of the AWMF and the White Paper on Serious Injury Care. Here, recommendations are defined regarding personnel, spatial, logistical and material requirements. Every shock room team should be trained regularly and have theoretical and practical knowledge on the application of shock room algorithms. This can improve the quality of treatment and thus the probability of survival of critically ill patients. In the shock room itself, the focus is on standardized and priority-oriented assessment and stabilization of the patient. Due to the varying quality of care for severely injured patients in Germany, the TraumaNetwork DGU® initiative was implemented by the German Society of Trauma Surgery to improve the treatment of polytrauma patients by defining standards and improving processes and organization in the care of severely injured patients. In Germany, there are currently 615 participating hospitals that are organized in 52 local trauma networks, some of which are cross state borders.
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Affiliation(s)
- Vanessa Ketter
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Baldingerstraße, 35043, Marburg, Deutschland
| | - Steffen Ruchholtz
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Baldingerstraße, 35043, Marburg, Deutschland
| | - Michael Frink
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Baldingerstraße, 35043, Marburg, Deutschland.
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Ismaier J. [Occupational therapy after complex hand injuries : Remedy with focus on activity and participation]. Unfallchirurg 2021; 124:465-72. [PMID: 33791823 DOI: 10.1007/s00113-021-00996-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Clients with complex hand injuries are considerably restricted in their daily and occupational activities as well as participation in society. OBJECTIVE Presentation and classification of complex hand injuries, description of the important hand therapies and occupational therapy as a remedy with a focus on occupation, case presentation. MATERIAL AND METHODS Evaluation of official statistics, analysis of publications and literature, discussion of basic occupational therapy work, expert recommendation. RESULTS Within the framework of reported occupational accidents, annually approximately 41% of all injured parts of the body affect the hands. The number of unreported hand injuries that occur each year in Germany is probably much higher. The hand as a multifunctional organ for gripping and perception enables people to carry out activities in a wide variety of areas of life and is the basis for a successful participation in society. The restoration of the function after a complex hand injury necessitates a multimodal approach. CONCLUSION By virtue of its unique perspective on human activity including the work context, occupational therapy plays a decisive role in the treatment process for clients with complex hand injuries. The aim of the rehabilitation is a successful performance of meaningful activities in the respective life context. This can only be successful through a close cooperation between all the specialist disciplines involved in the treatment. Such an interdisciplinary treatment approach enables activity and participation of the client.
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20
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Abstract
Seit 2018 ist es nach einer Novellierung des SGB V psychiatrischen Kliniken möglich, stationäre aufsuchende Behandlung im Lebensumfeld psychiatrisch Erkrankter zu realisieren. Dabei sind besondere Strukturmerkmale und Dokumentationspflichten zu beachten. So muss dem Behandlungsteam neben einem Mitglied der ärztlichen und der pflegerischen Berufsgruppe auch mindestens ein Mitglied einer dritten Berufsgruppe angehören (z. B. Ergotherapie, Sozialarbeit, Physiotherapie). Die Leistungsvergütung wird zwischen der jeweiligen Klinik und den Krankenkassen verhandelt und schließt, regional divergent, Abrechnungen nach Pauschalen, nach geleisteten Minuten oder gemischte Modelle ein. Aus psychiatrisch-psychotherapeutischer Sicht bietet die Behandlung gerontopsychiatrischer Patienten in ihrem Wohnumfeld und damit in ihren sozialen Kontexten viele Vorteile. Voraussetzung für ein Gelingen dieses Ansatzes ist ein auch in somatischen Erkrankungen erfahrenes und logistisch hochflexibles multiprofessionelles Behandlungsteam. Unter den Bedingungen der Coronapandemie stellen sich besondere Herausforderungen aufgrund der Besuchsverbote in Pflegeheimen und der mit aufsuchender Arbeit verbundenen Infektionsgefahr für Patienten und Mitglieder des Behandlungsteams.
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Affiliation(s)
- S Spannhorst
- Klinik für Psychiatrie und Psychotherapie für Ältere, Klinikum Stuttgart - Krankenhaus Bad Cannstatt, Prießnitzweg 24, 70374, Stuttgart, Deutschland
| | - S Weller
- Klinik für Psychiatrie und Psychotherapie für Ältere, Klinikum Stuttgart - Krankenhaus Bad Cannstatt, Prießnitzweg 24, 70374, Stuttgart, Deutschland
| | - C Thomas
- Klinik für Psychiatrie und Psychotherapie für Ältere, Klinikum Stuttgart - Krankenhaus Bad Cannstatt, Prießnitzweg 24, 70374, Stuttgart, Deutschland.
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Warner R, Hoinville L, Pottle E, Taylor C, Green J. Refocusing cancer multidisciplinary team meetings in the United Kingdom: comparing urology with other specialties. Ann R Coll Surg Engl 2020; 103:10-17. [PMID: 32981347 DOI: 10.1308/rcsann.2020.0212] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 12/16/2022] Open
Abstract
INTRODUCTION Multidisciplinary team (MDT) meetings have been the gold standard of cancer care in the UK since the 1990s. We aimed to identify the views of urology cancer MDT members in the UK on improving the functioning of meetings and compare them with those of other specialties to manage the increasing demand on healthcare resources and enhance the care of complex cancer cases. METHODS We analysed data from 2 national surveys distributed by Cancer Research UK focusing on the views of 2,294 and 1,258 MDT members about cancer MDT meetings. FINDINGS Most breast, colorectal, lung and urology cancer MDT members felt meetings could be improved in the following areas: time for meeting preparation in job plans, streamlining of patients, auditing meeting decisions and prioritising complex cases. Most urology respondents (87%) agreed some patients could be managed outside a full MDT discussion, but this was lower for other specialties (lung 78%, breast 75%, colorectal 64%). CONCLUSIONS To facilitate decisions on which patients require discussion in an MDT meeting, factors adding to case complexity across all tumour types were identified, including rare tumour type, cognitive impairment and previous treatment failure. This study confirms that urology MDT members are supportive of changing from reviewing all new cancer diagnoses to discussing complex cases but managing others with a more protocolised pathway. The mechanisms for how to do this and how to ensure the safety of patients require further clarification.
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Affiliation(s)
- R Warner
- Northampton General Hospital NHS Trust, UK.,University of Surrey, UK
| | | | - E Pottle
- Wirral University Teaching Hospital NHS Foundation Trust, UK
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Augustin H, Unger L, Lüthke K, Gräßler A. [Outpatient specialist medical care : Regulations and practical example of rheumatology]. Internist (Berl) 2020; 61:922-8. [PMID: 32681226 DOI: 10.1007/s00108-020-00841-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Outpatient specialist medical care targets the intersectoral and interdisciplinary cooperation between hospital physicians and panel physician structures in the diagnostics and treatment of certain disease symptoms under the same framework conditions. The administrative coordination bundled through one person has contributed to an effective placement of applications. In this way the daunting effect of bureaucratic hurdles for potential team members could be intercepted. A close and constructive collaboration of all participants is helpful to come to terms with the new treatment structure and to achieve the anticipated targets for patients, panel physicians and hospitals.
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Cammarata-Scalisi F, Blanco Lago R, Barruz Galián P, Lapunzina Badía P, Araque D, Da Silva G, Lacruz-Rengel MA, Avendaño A, Nevado Blanco J. [Wolf-Hirschhorn syndrome. Description of five cases characterized by means of single nucleotide polymorphism microarrays]. ARCH ARGENT PEDIATR 2020; 117:e406-e412. [PMID: 31339285 DOI: 10.5546/aap.2019.e406] [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] [Received: 07/14/2018] [Accepted: 02/14/2019] [Indexed: 11/12/2022]
Abstract
Wolf-Hirschhorn syndrome is a polymalformative entity due to the microdeletion in the distal region of the short arm of chromosome 4 (4p16.3), which produces a series of clinical manifestations that can vary depending on the type and size of the genetic defect in this contiguous gene syndrome. Five patients are presented, three of them female, all with the primary clinical findings, characterized by "Greek warrior helmet appearance" facial feature, growth retardation and psychomotor development delay. In addition to the partial deletion in the distal region of the short arm of chromosome 4, two additional genetic alterations were found in two patients, through the use of single nucleotide polymorphism arrays. The clinical characteristics of Wolf-Hirschhorn syndrome are highlighted in order to guide the diagnosis, provide interdisciplinary medical care and, through its confirmation, provide adequate family genetic counseling.
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Affiliation(s)
- Francisco Cammarata-Scalisi
- Unidad de Genética Médica, Departamento de Puericultura y Pediatría, Facultad de Medicina, Universidad de Los Andes, Mérida, Venezuela.
| | - Raquel Blanco Lago
- Servicio de Neuropediatría, Hospital Universitario Central de Asturias, Oviedo, España
| | - Pilar Barruz Galián
- Instituto de Genética Médica y Molecular (INGEMM) e Instituto de Investigación del Hospital Universitario La Paz (IdIPaz), Madrid, España
| | - Pablo Lapunzina Badía
- Instituto de Genética Médica y Molecular (INGEMM) e Instituto de Investigación del Hospital Universitario La Paz (IdIPaz), Madrid, España.,Centro de Investigación Biomédica en RED de Enfermedades Raras (CIBERER), Madrid, España
| | - Dianora Araque
- Unidad de Genética Médica, Departamento de Puericultura y Pediatría, Facultad de Medicina, Universidad de Los Andes, Mérida, Venezuela
| | - Gloria Da Silva
- Unidad de Genética Médica, Departamento de Puericultura y Pediatría, Facultad de Medicina, Universidad de Los Andes, Mérida, Venezuela
| | - María A Lacruz-Rengel
- Servicio de Neuropediatría, Departamento de Puericultura y Pediatría, Facultad de Medicina, Universidad de Los Andes, Mérida, Venezuela
| | - Andrea Avendaño
- Unidad de Genética Médica, Departamento de Puericultura y Pediatría, Facultad de Medicina, Universidad de Los Andes, Mérida, Venezuela
| | - Julián Nevado Blanco
- Instituto de Genética Médica y Molecular (INGEMM) e Instituto de Investigación del Hospital Universitario La Paz (IdIPaz), Madrid, España.,Centro de Investigación Biomédica en RED de Enfermedades Raras (CIBERER), Madrid, España
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24
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Abstract
BACKGROUND Fragility fractures are fractures in multimorbid, geriatric patients. Currently, their number is already high and is likely to increase in the future. OBJECTIVE This article gives an overview of the principles in the management of patients with fragility fractures. MATERIAL AND METHODS A selective literature review was performed to describe the epidemiology and relevance of fragility fractures. In addition, the principles of the perioperative management and surgical treatment of patients with fragility fractures are shown. RESULTS Due to the significant number of comorbidities, the treatment of patients with fragility fractures represents an interdisciplinary challenge. Ideally, treatment should be carried out in an interdisciplinary team under the leadership of orthopedic surgeons and geriatricians. Treatment should be based on consensus guidelines, which have been adapted to the local circumstances. Attention should be paid to some special aspects of the surgical treatment in this vulnerable patient cohort. Important are optimal soft tissue management, cement augmentation procedures and joint replacement in cases of periarticular fractures. CONCLUSION There is evidence that with optimal care the treatment of patients with fragility fractures can be significantly improved.
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Affiliation(s)
- B Bücking
- Klinik für Orthopädie, Unfallchirurgie und Alterstraumatologie, DRK-Kliniken Nordhessen Gemeinnützige GmbH, Standort Wehlheiden, Hansteinstr. 29, 34121, Kassel, Deutschland.
| | - C Neuerburg
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, München, Deutschland
| | - M Knobe
- Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, Luzern, Schweiz
| | - U Liener
- Klinik für Orthopädie, Unfallchirurgie und Wiederherstellungschirurgie, Vinzenz von Paul Kliniken gGmbH Marienhospital Stuttgart, Stuttgart, Deutschland
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25
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Auvinen K, Räisänen J, Merikoski M, Mäntylä A, Kumpusalo-Vauhkonen A, Enlund H, Liukkonen T, Jyrkkä J, Lönnroos E, Mäntyselkä P. The Finnish Interprofessional Medication Assessment (FIMA): baseline findings from home care setting. Aging Clin Exp Res 2019; 31:1471-1479. [PMID: 30519976 PMCID: PMC6763522 DOI: 10.1007/s40520-018-1085-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 11/21/2018] [Indexed: 10/30/2022]
Abstract
PURPOSE Medication-related problems and declined functional capacity are closely associated factors among older people. The purpose of this study is to describe the procedure of interprofessional medication assessment in home care context and the baseline characteristics of the study population. METHODS The FIMA study was a randomized, controlled intervention study comparing general practitioner-led interprofessional medication assessment and usual care. Patients' chronic diagnoses and medication use as well as physical and cognitive functions were investigated. Performance in daily activities, use of care services and help from family and relatives, self-rated health and health-related quality of life, and adverse effects commonly related to medication were assessed. RESULTS The home care patients (n = 512) had significant disease burden and functional limitations. The mean number of all medicines was 15 and that of regularly taken medicines 10. The majority of patients (87%) had excessive polypharmacy. The most commonly used (97%) ATC medicine class was nervous system medicines. Clinically relevant (class C or D SFINX record) drug-drug interactions were seen in 74% of the patients. The most frequent risks of adverse effects were risk of bleeding (66%), constipation (58%) and orthostatism (54%) occurring in over half of the patients. Medicines affecting renal function were used by 85% of the patients. CONCLUSIONS There is an evident need and justification for medication assessments in home care. In most cases, home care patients fulfill the criteria for regular medication assessments.
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Schoeneberg C, Friess T, Buecking B, Krinner S, Lendemans S, Schumacher J. [Online survey for assessment of geriatric early rehabilitation complex treatment in geriatric trauma centers of the DGU by the medical services of the health funds]. Unfallchirurg 2019; 123:368-374. [PMID: 31451842 DOI: 10.1007/s00113-019-00715-3] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Orthogeriatric co-management of proximal femoral fractures has been proven to effectively reduce mortality rates. This involves extending resources in hospitals treating these patients as well as dealing with the possibility of prolonged periods of hospitalization. The increase in costs of orthogeriatric co-management are best illustrated by the implementation of geriatric early rehabilitation complex treatment. In view of the problems concerning billing this complex treatment, an online survey was carried among certified geriatric trauma centers of the German Trauma Society (DGU®). METHODS Based on a trauma-geriatric consensus 20 questions were formulated by the Academy of Trauma Surgery (AUC) as an online questionnaire and sent to all 75 certified geriatric trauma centers. Apart from a description of the results, a subanalysis based on the figures presented by the case closing departments (geriatrics or trauma surgery) was included. The questions covered a 2-year period of experiences from 2016 to 2018. RESULTS A total of 26 of the 75 certified geriatric trauma centers participated (35%). A continuous increase in cost analysis evaluations by the medical services of the health funds was observed. A rise from 38% in 2016 to 45% in 2018 was seen. An analogous rejection trend from 16% to 24% during this period was evident as well. Subanalysis revealed significantly higher cost evaluation by the medical services of the health funds and cost rejection rates if trauma departments were the case closing disciplines. CONCLUSION The online survey revealed significantly higher assessment and rejection rates when compared to other hospital services. This could prove potentially detrimental to the future of orthogeriatric co-management.
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Affiliation(s)
- Carsten Schoeneberg
- Klinik für Orthopädie und Unfallchirurgie, Alfried Krupp Krankenhaus, Hellweg 100, 45276, Essen, Deutschland.
| | - Thomas Friess
- Projektkoordination AltersTraumaZentrum DGU®, Herne, Deutschland
| | - Benjamin Buecking
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Marburg, Deutschland
| | | | - Sven Lendemans
- Klinik für Orthopädie und Unfallchirurgie, Alfried Krupp Krankenhaus, Hellweg 100, 45276, Essen, Deutschland
| | - Jens Schumacher
- Klinik für Orthopädie und Unfallchirurgie, Innere Medizin, Städtisches Klinikum Dessau, Dessau, Deutschland
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Wang YC, Chou MY, Liang CK, Peng LN, Chen LK, Loh CH. Post-Acute Care as a Key Component in a Healthcare System for Older Adults. Ann Geriatr Med Res 2019; 23:54-62. [PMID: 32743289 PMCID: PMC7387590 DOI: 10.4235/agmr.19.0009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 03/23/2019] [Accepted: 03/26/2019] [Indexed: 11/30/2022] Open
Abstract
Older adults often experience functional decline following acute medical care. This functional decline may lead to permanent disability, which will increase the burden on the medical and long-term care systems, families, and society as a whole. Post-acute care aims to promote the functional recovery of older adults, prevent unnecessary hospital readmission, and avoid premature admission to a long-term care facility. Research has shown that post-acute care is a cost-effective service model, with both the hospital-at-home and community hospital post-acute care models being highly effective. This paper describes the post-acute care models of the United States and the United Kingdom and uses the example of Taiwan’s highly effective post-acute care system to explain the benefits and importance of post-acute care. In the face of rapid demographic aging and smaller household size, a post-acute care system can lower medical costs and improve the health of older adults after hospitalization.
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Affiliation(s)
- Yu-Chun Wang
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ming-Yueh Chou
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Department of Geriatric Medicine, National Yang Ming University, Taipei, Taiwan
| | - Chih-Kuang Liang
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Department of Geriatric Medicine, National Yang Ming University, Taipei, Taiwan
| | - Li-Ning Peng
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Department of Geriatric Medicine, National Yang Ming University, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Liang-Kung Chen
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Department of Geriatric Medicine, National Yang Ming University, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ching-Hui Loh
- Department of Geriatric Medicine, National Yang Ming University, Taipei, Taiwan.,Center for Aging and Community Health, Hualien Tzu Chi Hospital, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
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28
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Schwarzkopf D. [Nonbeneficial care-a burden for clinicians and relatives]. Med Klin Intensivmed Notfmed 2019; 114:222-228. [PMID: 30918982 DOI: 10.1007/s00063-019-0531-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 12/14/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Ethically demanding decisions in intensive care as well as the perception of nonbeneficial care can be a burden for clinicians and patients' relatives. OBJECTIVES An overview of prevalence, causes, and consequences of perceived nonbeneficial care and possible interventions is provided. MATERIALS AND METHODS Narrative review. RESULTS AND CONCLUSIONS The perception of nonbeneficial care is a subjective moral judgement. Almost every ICU clinician regularly perceives nonbeneficial care. There is clear evidence that perceived nonbeneficial care is associated with burnout of clinicians and intention to leave the job. For relatives being involved in end-of-life decisions is of particular burden. Clinicians often state that relatives' whishes are the reason for nonbeneficial life-sustaining treatment. A good ethical climate as well as good nurse-physician collaboration are associated with less perception of nonbeneficial care and shorter time to therapy limitations. Structured communication to plan therapy involving relatives might reduce nonbeneficial care and together with supporting interventions reduce staff burnout. Improving communication by consultants in charge has been shown to reduce the burden of relatives. In future, co-treating surgeons must be more strongly involved in interventions.
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Affiliation(s)
- D Schwarzkopf
- Klinik für Anästhesiologie und Intensivmedizin, Center for Sepsis Control and Care, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
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29
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Abstract
OPINION STATEMENT Multiple randomized controlled trials have underscored the importance of timely referral to palliative care for patients with advanced cancer. Outpatient palliative care can facilitate timely referral and is increasingly available in many cancer centers. The key question is which model of outpatient palliative care is optimal. There are currently many variations for how palliative care is delivered in the outpatient setting, including (1) Interdisciplinary Specialist Palliative Care in Stand-Alone Clinics, (2) Physician-Only Specialist Palliative Care in Stand-Alone Clinics, (3) Nurse-Led Specialist Palliative Care in Stand-Alone Clinics, (4) Nurse-Led Specialist Palliative Care Telephone-Based Interventions, (5) Embedded Specialist Palliative Care with Variable Team Makeup, and (6) Advanced Practice Providers-Based Enhanced Primary Palliative Care. It is important to make a clear distinction among these delivery models of outpatient palliative care because they have different structures, processes, and outcomes, along with unique strengths and limitations. In this review article, we will provide a critical appraisal of the literature on studies investigating these models. At this time, interdisciplinary specialist palliative care in stand-alone clinics remains the gold standard for ambulatory palliative care because this approach has the greatest impact on multiple patient and caregiver outcomes. Although the other models may require fewer resources, they may not be able to provide the same level of comprehensive palliative care as an interdisciplinary team. Further research is needed to evaluate the optimal model of palliative care delivery in different settings.
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Affiliation(s)
- David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414 - 1515 Holcombe Blvd., Houston, TX, 77030, USA. .,Department of General Oncology, MD Anderson Cancer Center, Houston, TX, USA.
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30
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Shimpi N, Bharatkumar A, Jethwani M, Chyou PH, Glurich I, Blamer J, Acharya A. Knowledgeability, Attitude and Behavior of Primary Care Providers Towards Oral Cancer: a Pilot Study. J Cancer Educ 2018; 33:359-364. [PMID: 27448614 DOI: 10.1007/s13187-016-1084-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The objective of this study was to assess current knowledgeability, attitudes, and practice behaviors of primary care providers (PCPs) towards oral cancer screening. Applying a cross-sectional design, a 14-question survey was emailed to 307 PCPs practicing at a large, multi-specialty, rurally based healthcare system. Survey data were collected and managed using REDCap and analyzed applying descriptive statistics. A 20 % response rate (n = 61/307) was achieved for survey completion. Approximately 70 % of respondents were physicians, 16 % were nurse practitioners, and 13 % were physician assistants. Nearly 60 % of respondents were family medicine practitioners. Limited training surrounding oral cancer screening during medical training was reported by 64 %. Although 78 % of respondents reported never performing oral cancer screening on patients in their practice, >90 % answered knowledge-based questions correctly. Frequency rate for specialist referral for suspicious lesions by PCPs was 56 % "frequently". Optimal periodicity for oral cancer screening on all patients selected by respondents was 61 % "annually", 3 % "every 6 months", 3 % "every visit", 2 % "not at all", and 31 % "unsure". This study established a baseline surrounding current knowledgeability, practice patterns, and opinions of PCPs towards oral cancer screening at a single, large, regional healthcare system. In the absence of evidence-based support for population-based cancer screening, this study result suggests a need for better integration of oral cancer surveillance into the medical setting, supplemented by education and training with emphasis on assessment of high-risk patients to achieve early detection. Prospectively, larger studies are needed to validate these findings.
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Affiliation(s)
- Neel Shimpi
- Institute for Oral and Systemic Health, Marshfield Clinic Research Foundation, 1000 North Oak Avenue, Marshfield, WI, 54449, USA
| | - Aditi Bharatkumar
- Institute for Oral and Systemic Health, Marshfield Clinic Research Foundation, 1000 North Oak Avenue, Marshfield, WI, 54449, USA
- Family Health Center of Marshfield, 1307 N St. Joseph Avenue, Marshfield, WI, 54449, USA
- Division of Education, Marshfield Clinic Research Foundation, 1000 North Oak Avenue, Marshfield, WI, 54449, USA
| | - Monica Jethwani
- Institute for Oral and Systemic Health, Marshfield Clinic Research Foundation, 1000 North Oak Avenue, Marshfield, WI, 54449, USA
- Family Health Center of Marshfield, 1307 N St. Joseph Avenue, Marshfield, WI, 54449, USA
- Division of Education, Marshfield Clinic Research Foundation, 1000 North Oak Avenue, Marshfield, WI, 54449, USA
| | - Po-Huang Chyou
- Division of Education, Marshfield Clinic Research Foundation, 1000 North Oak Avenue, Marshfield, WI, 54449, USA
| | - Ingrid Glurich
- Institute for Oral and Systemic Health, Marshfield Clinic Research Foundation, 1000 North Oak Avenue, Marshfield, WI, 54449, USA
| | - Jake Blamer
- Institute for Oral and Systemic Health, Marshfield Clinic Research Foundation, 1000 North Oak Avenue, Marshfield, WI, 54449, USA
| | - Amit Acharya
- Institute for Oral and Systemic Health, Marshfield Clinic Research Foundation, 1000 North Oak Avenue, Marshfield, WI, 54449, USA.
- Biomedical Informatics Research Center, Marshfield Clinic Research Foundation, 1000 North Oak Avenue, Marshfield, WI, 54449, USA.
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31
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Schwarzkopf D, Rüddel H, Gründling M, Putensen C, Reinhart K. The German Quality Network Sepsis: study protocol for the evaluation of a quality collaborative on decreasing sepsis-related mortality in a quasi-experimental difference-in-differences design. Implement Sci 2018; 13:15. [PMID: 29347952 PMCID: PMC5774030 DOI: 10.1186/s13012-017-0706-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 12/29/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND While sepsis-related mortality decreased substantially in other developed countries, mortality of severe sepsis remained as high as 44% in Germany. A recent German cluster randomized trial was not able to improve guideline adherence and decrease sepsis-related mortality within the participating hospitals, partly based on lacking support by hospital management and lacking resources for documentation of prospective data. Thus, more pragmatic approaches are needed to improve quality of sepsis care in Germany. The primary objective of the study is to decrease sepsis-related hospital mortality within a quality collaborative relying on claims data. METHOD The German Quality Network Sepsis (GQNS) is a quality collaborative involving 75 hospitals. This study protocol describes the conduction and evaluation of the start-up period of the GQNS running from March 2016 to August 2018. Democratic structures assure participatory action, a study coordination bureau provides central support and resources, and local interdisciplinary quality improvement teams implement changes within the participating hospitals. Quarterly quality reports focusing on risk-adjusted hospital mortality in cases with sepsis based on claims data are provided. Hospitals committed to publish their individual risk-adjusted mortality compared to the German average. A complex risk-model is used to control for differences in patient-related risk factors. Hospitals are encouraged to implement a bundle of interventions, e.g., interdisciplinary case analyses, external peer-reviews, hospital-wide staff education, and implementation of rapid response teams. The effectiveness of the GQNS is evaluated in a quasi-experimental difference-in-differences design by comparing the change of hospital mortality of cases with sepsis with organ dysfunction from a retrospective baseline period (January 2014 to December 2015) and the intervention period (April 2016 to March 2018) between the participating hospitals and all other German hospitals. Structural and process quality indicators of sepsis care as well as efforts for quality improvement are monitored regularly. DISCUSSION The GQNS is a large-scale quality collaborative using a pragmatic approach based on claims data. A complex risk-adjustment model allows valid quality comparisons between hospitals and with the German average. If this study finds the approach to be useful for improving quality of sepsis care, it may also be applied to other diseases. TRIAL REGISTRATION ClinicalTrials.gov NCT02820675.
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Affiliation(s)
- Daniel Schwarzkopf
- Integrated Research and Treatment Center for Sepsis Control and Care (CSCC), Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
- Department for Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Hendrik Rüddel
- Integrated Research and Treatment Center for Sepsis Control and Care (CSCC), Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
- Department for Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Matthias Gründling
- Department of Anesthesiology and Intensive Care Medicine, Ernst-Moritz-Arndt-University, Sauerbruchstraße, 17475 Greifswald, Germany
| | - Christian Putensen
- Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - Konrad Reinhart
- Integrated Research and Treatment Center for Sepsis Control and Care (CSCC), Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
- Department for Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
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Abstract
In addition to surgical and drug therapy, radiotherapy (or radiation therapy) is one of the three mainstays of modern oncological therapy regimes. It uses ionizing radiation to control tumors by damaging the DNA of cancerous tissue leading to cellular death. Although advances have been made in recent years resulting in a reduced dosage to the surrounding tissues, radiation injuries and tissue-related side effects cannot be completely avoided. Knowledge of the pathophysiology, treatment modalities and interdisciplinary treatment approaches are essential for effective therapy whilst limiting side effects. Surgery within the irradiated area is technically demanding due to tissue alterations and unpredictable wound healing. The plastic reconstructive surgeon either faces the challenge of delayed wound healing following neoadjuvant radiation or chronic radiation-linked changes following previous radiotherapy, which can also occur after a latency period of many years. Reconstructive interventions can be essential to repair deficits of a functional and/or aesthetic nature in order to maintain a high quality of life for oncology patients. This can also be of benefit to patients in a palliative oncological setting to improve daily functions and quality of life.
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Affiliation(s)
- P M Vogt
- Klinik für Plastische, Ästhetische, Hand- und Wiederherstellungschirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - T R Mett
- Klinik für Plastische, Ästhetische, Hand- und Wiederherstellungschirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - C Henkenberens
- Klinik für Strahlentherapie und Spezielle Onkologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - C Radtke
- Klinik für Plastische, Ästhetische, Hand- und Wiederherstellungschirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - R Ipaktchi
- Klinik für Plastische, Ästhetische, Hand- und Wiederherstellungschirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
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Floyd BD, Block JM, Buckingham BB, Ly T, Foster N, Wright R, Mueller CL, Hood KK, Shah AC. Stabilization of glycemic control and improved quality of life using a shared medical appointment model in adolescents with type 1 diabetes in suboptimal control. Pediatr Diabetes 2017; 18:204-212. [PMID: 26919322 DOI: 10.1111/pedi.12373] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 01/19/2016] [Accepted: 01/28/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Declining glycemic control in type 1 diabetes (T1D) during adolescence persists despite treatment advances. Non-adherence, peer relations, diabetes burnout, risk taking, transition to autonomy, family conflict, and poor quality of life (QOL) are recognized barriers. Shared medical appointments (SMAs) in adolescent T1D may offer benefits, but data are limited. Our objective was to determine whether SMAs, with multi-component interventions utilizing multidisciplinary teams, improve glycemic control and psychosocial outcomes in poorly controlled adolescent T1D. METHODS SMAs focused on self-management, communication skills, goal setting, glucose pattern recognition, and peer/diabetes team support. SMAs included: individual history and physical, labs, surveys, multidisciplinary educational ice breakers, group session, and individual wrap up. Outcomes were QOL, adherence, and retrospective and prospective glycemic control. Three to six subjects and families came to 3 SMAs and 1 individual appointment every 3 months over 9 months. SUBJECTS A total of 37 English speaking subjects, ages 12-16 yrs, with T1D ≥ 1 year, and hemoglobin A1c (HbA1c) 7.5-11% enrolled. Thirty-two subjects attended 75% of visits, meeting inclusion criteria. RESULTS HbA1c worsened in the 9 months before study (ΔHbA1c= 0.7 ± 1.2; p < 0.01), but remained stable during study (ΔHbA1c = 0.01 ± 1.2; p > 0.05). There were significant improvements in overall QOL (p = 0.005), school function (p = 0.006), psychosocial function (p = 0.008), barriers (p = 0.02), adherence (p = 0.01), and communication (p = 0.02). Improvements in school function and communication reached clinical significance. CONCLUSION SMAs are feasible replacements to individual appointments in adolescent T1D, stabilizing glycemic control and improving QOL. Randomized controlled trials with optimizations are needed to further explore and refine this intervention.
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Affiliation(s)
- Baraka D Floyd
- Department of General Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Jennifer M Block
- Department of Pediatric Endocrinology and Metabolism, Stanford University School of Medicine, Stanford, CA, USA
| | - Bruce B Buckingham
- Department of Pediatric Endocrinology and Metabolism, Stanford University School of Medicine, Stanford, CA, USA
| | - Trang Ly
- Department of Pediatric Endocrinology and Metabolism, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Robert Wright
- Department of Psychology, University of California Riverside, Riverside, CA, USA
| | - Claudia L Mueller
- Department of Pediatric Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Korey K Hood
- Department of Pediatric Endocrinology and Metabolism, Stanford University School of Medicine, Stanford, CA, USA
| | - Avni C Shah
- Department of Pediatric Endocrinology and Metabolism, Stanford University School of Medicine, Stanford, CA, USA
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Hofer B, Nagl L, Hofer F, Stauder R. [Geriatric assessment of patients with hematological neoplasms]. Z Gerontol Geriatr 2017; 50:247-258. [PMID: 28364257 DOI: 10.1007/s00391-017-1222-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 03/03/2017] [Accepted: 03/08/2017] [Indexed: 10/19/2022]
Abstract
Hematological malignancies are typical diseases of the elderly. The aging of the population in the Western World results in a significant increase in the number of elderly patients with hematological malignant diseases. This has important consequences for medicine. One consequence of this development is that the need for tools for the evaluation of both functional and global status of the elderly increases. The use of these tools enables the hematologist to better stratify the patients, to individualize therapy better, to possibly modify therapy in order to improve implementation of supportive measures and interventions, to minimize toxicity and side effects and ultimately to tailor the treatment to the individual patient. Several tools are available for geriatric assessment (GA) and there is strong evidence that an effective GA can detect previously unknown problems. The targeted intervention improves the prognosis and compliance of therapy in elderly patients with hematological malignant diseases.
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Affiliation(s)
- Benedikt Hofer
- Univ.-Klinik für Innere Medizin V (Hämatologie und Onkologie), Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich.
| | - Laurenz Nagl
- Univ.-Klinik für Innere Medizin V (Hämatologie und Onkologie), Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich
| | - Florian Hofer
- Univ.-Klinik für Innere Medizin V (Hämatologie und Onkologie), Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich
| | - Reinhard Stauder
- Univ.-Klinik für Innere Medizin V (Hämatologie und Onkologie), Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich.
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Gruhn KM, Knossalla F, Schwenkreis P, Hamsen U, Schildhauer TA, Tegenthoff M, Sczesny-Kaiser M. [Neurological diseases after lightning strike : Lightning strikes twice]. Nervenarzt 2017; 87:623-8. [PMID: 26873252 DOI: 10.1007/s00115-015-0062-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Lightning strikes rarely occur but 85 % of patients have lightning-related neurological complications. This report provides an overview about different modes of energy transfer and neurological conditions related to lightning strikes. Moreover, two case reports demonstrate the importance of interdisciplinary treatment and the spectrum of neurological complications after lightning strikes.
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Affiliation(s)
- K M Gruhn
- Neurologische Universitäts- und Poliklinik, Ruhr-Universität Bochum, BG-Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland.
| | - Frauke Knossalla
- Neurologische Klinik, Universitätsklinikum Erlangen, Schwabachanlage 6, 91054, Erlangen, Deutschland
| | - Peter Schwenkreis
- Neurologische Universitäts- und Poliklinik, Ruhr-Universität Bochum, BG-Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland
| | - Uwe Hamsen
- Chirurgische Klinik und Poliklinik, Ruhr-Universität Bochum, BG-Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland
| | - Thomas A Schildhauer
- Chirurgische Klinik und Poliklinik, Ruhr-Universität Bochum, BG-Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland
| | - Martin Tegenthoff
- Neurologische Universitäts- und Poliklinik, Ruhr-Universität Bochum, BG-Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland
| | - Matthias Sczesny-Kaiser
- Neurologische Universitäts- und Poliklinik, Ruhr-Universität Bochum, BG-Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland
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Swenty CL, Schaar GL, Butler RM. An academic-VA partnership: Student interprofessional teams integrated with VA PACT teams. Nurse Educ Today 2016; 47:89-91. [PMID: 26897318 DOI: 10.1016/j.nedt.2016.01.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 12/15/2015] [Accepted: 01/28/2016] [Indexed: 06/05/2023]
Abstract
Veterans are challenged with multiple unique healthcare issues related to their military service environment. Likewise, health care providers must understand the special concerns associated with military conflict and recognize how the veteran's care can be optimized by interprofessional care delivery. Little is taught didactically or clinically that supports nursing students in addressing the unique issues of the veteran or the student's need to work collaboratively with allied health team members to enhance the veteran's care. Because of limited exposure to the veteran's special conditions, nursing students who may seek a career with the veteran population often face challenges in rendering appropriate care. The VA offers an invaluable opportunity for health profession students to collaborate with VA interprofessional Patient Aligned Care Teams (PACT) ultimately optimizing veteran health outcomes. This academic partnership, that implements an interprofessional model, will prepare students to better embrace the veteran population. This article describes the immersion of health profession students in interprofessional collaborative practice (IPCP) using PACT team principles which ultimately promotes the students' ability to link theory content to patient care delivery.
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Affiliation(s)
- Constance L Swenty
- University of Southern Indiana, College of Nursing and Health Professions, Evansville, Indiana, United States.
| | - Gina L Schaar
- University of Southern Indiana, College of Nursing and Health Professions, Evansville, Indiana, United States
| | - Ryan M Butler
- University of Southern Indiana, College of Nursing and Health Professions, Evansville, Indiana, United States
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Sánchez Ferrer F, Grima Murcia MD. [Progressive moderate mitral regurgitation in a children with Axenfeld-Rieger syndrome. The importance of cardiologic follow up]. ARCH ARGENT PEDIATR 2016; 114:e417-e420. [PMID: 27869423 DOI: 10.5546/aap.2016.e417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 05/11/2016] [Indexed: 11/12/2022]
Abstract
Axenfeld-Rieger syndrome is a congenital disease with an estimated prevalence of one in 200,000 individuals. This is an ophthalmic disorder related to anterior segment dysgenesis, which may be present from the neonatal period. It is associated with extraocular affectations such as cranial dimorphism, maxillofacial or dental anomalies. Cardiological or pituitary manifestations are less common. The congenital heart disease in Axenfeld-Rieger syndrome has been described in very few cases in the literature. We report a 7-year-old patient with Axenfeld-Rieger syndrome and mild mitral insufficiency since the age of 3 years, which is progressing to moderate mitral regurgitation at the present time. The cardiologic follow up may be indicated in patients with Axenfeld-Rieger syndrome.
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Affiliation(s)
- Francisco Sánchez Ferrer
- Unidad de Cardiología Pediátrica, Servicio de Pediatría, Hospital Universitario de San Juan de Alicante, Alicante, España.
| | - María D Grima Murcia
- Instituto de Bioingeniería y Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Universidad Miguel Hernández, Alicante, España
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Morlán Herrador L, de Arriba A, Miguel G, Ferrera M, Labarta JI. [Study of Medullary Thyroid Carcinoma from a proband]. ARCH ARGENT PEDIATR 2016; 114:e421-e424. [PMID: 27869424 DOI: 10.5546/aap.2016.e421] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 05/18/2015] [Indexed: 11/12/2022]
Abstract
Thyroid cancer is an uncommon type of cancer, accounting less than 1% of all cancers in adults, and 0.5-3% of all cancers in children. There are four different types: papillary carcinoma (80-90% of cases), follicular (5-10%), medullary (5%) and anaplastic cell (2-3%). Eighty per cent of cases of medullary thyroid cancer are sporadic, but 20% are associated with an inherited syndrome that is divided into three groups: multiple endocrine neoplasia type 1, multiple endocrine neoplasia type 2 and familial medullary thyroid carcinoma. The inherited forms are caused by a disruption in the RET oncogene, which is located in the long arm of chromosome 10. A hereditary case of medullary thyroid carcinoma is presented. It was detected because of a familial genetic study. The purpose of the paper is emphasize the importance of the early diagnosis and the intervention of multidisciplinary teams of experts.
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Affiliation(s)
- Laura Morlán Herrador
- Hospital Universitario Miguel Servet, Servicio de Endocrinología Pediátrica, Zaragoza, España
| | - Antonio de Arriba
- Hospital Universitario Miguel Servet, Servicio de Endocrinología Pediátrica, Zaragoza, España.
| | - Gloria Miguel
- Hospital Universitario Miguel Servet, Servicio de Endocrinología Pediátrica, Zaragoza, España
| | - Marta Ferrera
- Hospital Universitario Miguel Servet, Servicio de Endocrinología Pediátrica, Zaragoza, España
| | - José I Labarta
- Hospital Universitario Miguel Servet, Servicio de Endocrinología Pediátrica, Zaragoza, España
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Donnelly C, Shulha L, Klinger D, Letts L. Using program evaluation to support knowledge translation in an interprofessional primary care team: a case study. BMC Fam Pract 2016; 17:142. [PMID: 27716161 PMCID: PMC5053347 DOI: 10.1186/s12875-016-0538-4] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 09/23/2016] [Indexed: 12/01/2022]
Abstract
Background Evaluation is a fundamental component in building quality primary care and is ideally situated to support individual, team and organizational learning by offering an accessible form of participatory inquiry. The evaluation literature has begun to recognize the unique features of KT evaluations and has described attributes to consider when evaluating KT activities. While both disciplines have focused on the evaluation of KT activities neither has explored the role of evaluation in KT. The purpose of the paper is to examine how participation in program evaluation can support KT in a primary care setting. Methods A mixed methods case study design was used, where evaluation was conceptualized as a change process and intervention. A Memory Clinic at an interprofessional primary care clinic was the setting in which the study was conducted. An evaluation framework, Pathways of Influence provided the theoretical foundation to understand how program evaluation can facilitate the translation of knowledge at the level of the individual, inter-personal (Memory Clinic team) and the organization. Data collection included questionnaires, interviews, evaluation log and document analysis. Questionnaires and interviews were administered both before and after the evaluation: Pattern matching was used to analyze the data based on predetermined propositions. Results Individuals gained program knowledge that resulted in changes to both individual and program practices. One of the key themes was the importance clinicians placed on local, program based knowledge. The evaluation had less influence on the broader health organization. Conclusions Program evaluation facilitated individual, team and organizational learning. The use of evaluation to support KT is ideally suited to a primary care setting by offering relevant and applicable knowledge to primary care team members while being sensitive to local context. Electronic supplementary material The online version of this article (doi:10.1186/s12875-016-0538-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Catherine Donnelly
- School of Rehabilitation Therapy, Queen's University, 31 George Street, Kingston, ON, K7L 4B4, Canada.
| | - Lyn Shulha
- Faculty of Education, Queen's University, Duncan McArthur Hall, 511 Union Street, Kingston, ON, K7M 5R7, Canada
| | - Don Klinger
- Faculty of Education, Queen's University, Duncan McArthur Hall, 511 Union Street, Kingston, ON, K7M 5R7, Canada
| | - Lori Letts
- School of Rehabilitation Science, McMaster University, Room 403, 1400 Main St. W., Hamilton, ON, L8S 1C7, Canada
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Milani GP, Vianello FA, Cantoni B, Agostoni C, Fossali EF. New program for identification of child maltreatment in emergency department: preliminary data. Ital J Pediatr 2016; 42:66. [PMID: 27411332 PMCID: PMC4944310 DOI: 10.1186/s13052-016-0275-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 06/29/2016] [Indexed: 11/23/2022] Open
Abstract
Early detection of child maltreatment in pediatric emergency department is one of the most important challenges for the Italian and European medical care system. Several interventions have been proposed, but results are often unquantifiable or inadequate to face this problem. We promoted an educational program and built up an interdisciplinary team to improve the identification and management of maltreated children. Aim of this study is to report preliminary results of these interventions. Meetings structured with lecture-based teaching and case-based lessons were focused on identification and management of maltreatment cases. An interdisciplinary team with forensic physicians, dermatologists, orthopedics, radiologists, gynecologists, oculists, psychologists and psychiatrics, was created to manage children with suspected diagnosis of maltreatment. We analysed the characteristics of subjects diagnosed after these interventions and their number was compared with the one in the two previous years. An increased rate of diagnoses of 16.9 % was found. Results of the reported program are encouraging, but many efforts are still mandatory to improve the child maltreatment identification in emergency departments.
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Affiliation(s)
- Gregorio P Milani
- Pediatric Emergency Department, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy. .,Fondazione IRCCS, Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 9, 20122, Milan, Italy.
| | - Federica A Vianello
- Pediatric Emergency Department, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Barbara Cantoni
- Pediatric Emergency Department and SITRA Pediatric Area, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Agostoni
- Department of Pediatrics, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Emilio F Fossali
- Pediatric Emergency Department, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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Abstract
BACKGROUND Fragility fractures are becoming more common and are leading to significantly increased morbidity and mortality rates. METHOD In order to improve the outcome of these patients, they are increasingly being treated from the beginning interdisciplinarily and interprofessionally as part of co-management models. The main contents of these systems are rapid surgical stabilization for rapid remobilization, treatment with standardized paths and regular communication within the team and a well-functioning discharge management. Furthermore, the organization is a key ingredient in secondary prevention of geriatric traumatology. CONCLUSION If this system can be implemented as a whole, this will lead to an improvement of the functional outcomes for the patient as well as to cost savings.
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Novoa NM, Gómez MT, Rodríguez M, Jiménez López MF, Aranda JL, Bollo de Miguel E, Diez F, Hernández Hernández J, Varela G. e-Consultation Improves Efficacy in Thoracic Surgery Outpatient Clinics. Arch Bronconeumol 2016; 52:549-552. [PMID: 27208914 DOI: 10.1016/j.arbres.2016.04.002] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 03/20/2016] [Accepted: 04/03/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study is analysing the impact of the systematic versus occasional videoconferencing discussion of patients with two respiratory referral units along 6 years of time over the efficiency of the in-person outpatient clinics of a thoracic surgery service. METHOD Retrospective and comparative study of the evaluated patients through videoconferencing and in-person first visits during two equivalents periods of time: Group A (occasional discussion of cases) between 2008-2010 and Group B (weekly regular discussion) 2011-2013. Data were obtained from two prospective and electronic data bases. The number of cases discussed using e-consultation, in-person outpatient clinics evaluation and finally operated on under general anaesthesia in each period of time are presented. For efficiency criteria, the index: number of operated on cases/number of first visit outpatient clinic patients is created. Non-parametric Wilcoxon test is used for comparison. RESULTS The mean number of patients evaluated at the outpatient clinics/year on group A was 563 versus 464 on group B. The median number of cases discussed using videoconferencing/year was 42 for group A versus 136 for group B. The mean number of operated cases/first visit at the outpatient clinics was 0.7 versus 0.87 in group B (P=.04). CONCLUSIONS The systematic regular discussion of cases using videoconferencing has a positive impact on the efficacy of the outpatient clinics of a Thoracic Surgery Service measured in terms of operated cases/first outpatient clinics visit.
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Affiliation(s)
- Nuria M Novoa
- Servicio de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, España.
| | - Maria Teresa Gómez
- Servicio de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, España
| | - María Rodríguez
- Servicio de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, España
| | | | - Jose L Aranda
- Servicio de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, España
| | | | - Florentino Diez
- Servicio de Neumología, Complejo Asistencial Universitario de León, León, España
| | | | - Gonzalo Varela
- Servicio de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, España
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Foletti JM, Bruneau S, Puech B, Guyot L, Chossegros C. Life-threatening hemorrhage after zygomatic bone surgery. About 2 posttraumatic cases. ACTA ACUST UNITED AC 2016; 117:183-7. [PMID: 27185204 DOI: 10.1016/j.revsto.2016.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 04/18/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Management of zygomatic bone fractures is still debated. Method and delay for intervention has to be chosen considering respective issues of operative or conservative treatments, especially hemorrhagic complications. The maxillofacial surgeon must be able to determine life-threatening situations and to react appropriately. CASES REPORT We report 2 cases of external carotid branches pseudoaneurysm leading to massive hemorrhage after early or delayed zygomatic fracture surgery. The first patient underwent open reduction of fracture by intraoral approach. An active bleeding occurred in the immediate postoperative time. In the second case, a zygomatic osteotomy was performed 1 year after fracture. Bleeding occurred 2 weeks after surgery. In both cases, angiography demonstrated a pseudoaneurysm developed from the external carotid branches. Embolisation led to rapid bleeding control. DISCUSSION Severe hemorrhage resulting from maxillofacial trauma may be life-threatening. Once the "damage control" principles applied, selective embolisation of external carotid branches is an efficient alternative to surgery for the control of bleeding resulting from ruptured pseudoaneurysm.
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Affiliation(s)
- J-M Foletti
- Aix Marseille université, IFSTTAR, LBA UMR_T 24, 13916 Marseille, France; Service de chirurgie maxillo-faciale et plastique de la face, hôpital Nord, CHU Nord, AP-HM, chemin des Bourrely, 13915 Marseille cedex 20, France; Aix-Marseille université, 13284 Marseille, France.
| | - S Bruneau
- Service de chirurgie maxillo-faciale et plastique de la face, hôpital Nord, CHU Nord, AP-HM, chemin des Bourrely, 13915 Marseille cedex 20, France; Aix-Marseille université, 13284 Marseille, France
| | - B Puech
- Aix-Marseille université, 13284 Marseille, France; Service d'imagerie, hôpital Nord, AP-HM, 13915 Marseille cedex 20, France
| | - L Guyot
- Service de chirurgie maxillo-faciale et plastique de la face, hôpital Nord, CHU Nord, AP-HM, chemin des Bourrely, 13915 Marseille cedex 20, France; Aix-Marseille université, 13284 Marseille, France
| | - C Chossegros
- Aix Marseille université, IFSTTAR, LBA UMR_T 24, 13916 Marseille, France; Service de chirurgie maxillo-faciale, hôpital de la Conception, hôpital Nord, AP-HM, pavillon étoile, chemin des Bourrely, 13005 Marseille, France
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Abstract
BACKGROUND The interdisciplinary, interprofessional, and transsectoral cooperation of partners in a network is prerequisite for the certification of a prostate cancer center. The network reflects all phases and aspects of the disease from the patient's point of view. On the basis of quality indicators that are audited annually, the qualified partners of the network ensure quality of care. Quality indicators reflect the quality of the cooperation in the network, the treatment according to the evidence-based guideline, and the specific expertise of the partners. METHODS The results of the quality indicators are evaluated annually and summarized in individual and general reports. The system of the quality indicators is an important tool for quality management and to improve daily oncological care. In the future, this system will be extended to include patient-reported outcomes in combination with the OncoBox. CONCLUSIONS The ongoing quantitative and qualitative improvement makes the certification system a relevant instrument for health policy institutions and is useful in political discussions regarding quality assurance and improvement.
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Affiliation(s)
- S Wesselmann
- Bereichsleitung Zertifizierung, Deutsche Krebsgesellschaft e.V., Kuno-Fischer-Straße 8, 14057, Berlin, Deutschland.
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Nydahl P, Dewes M, Dubb R, Filipovic S, Hermes C, Jüttner F, Kaltwasser A, Klarmann S, Klas K, Mende H, Rothaug O, Schuchhardt D. [Early mobilization. Competencies, responsibilities, milestones]. Med Klin Intensivmed Notfmed 2015; 111:153-9. [PMID: 26346679 DOI: 10.1007/s00063-015-0073-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/20/2015] [Accepted: 07/21/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Early mobilization is an evident, interprofessional concept to improve the outcome of intensive care patients. It reduces psychocognitive deficits and delirium and attenuates a general deconditioning, including atrophy of the respiratory pump and skeletal muscles. In this regard the interdisciplinary approach of early mobilization, taking into account different levels of mobilization, appears to be beneficial. The purpose of this study was to explore opinions on collaboration and tasks between different professional groups. METHOD During the 25th Bremen Conference on Intensive Medicine and Nursing on 20 February 2015, a questionnaire survey was carried out among the 120 participants of the German Early Mobilization Network meeting. RESULTS In all, 102 questionnaires were analyzed. Most participants reported on the interdisciplinarity of the approach, but none of the tasks and responsibilities concerning early mobilization can be assigned to a single professional group. The practical implementation of mobilizing orally intubated patients may require two registered nurses as well as a physical therapist. Implementation in daily practice seems to be heterogeneous. CONCLUSIONS There is no consensus regarding collaboration, competencies, and responsibilities with respect to early mobilization of intensive care patients. The approach to date has been characterized by a lack of interprofessional communication, which may lead to an inefficient use of the broad and varied base of knowledge and experienceof the different professions.
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Affiliation(s)
- P Nydahl
- Pflegeforschung, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Haus 31, Brunswiker Str. 10, 24105, Kiel, Deutschland.
| | - M Dewes
- Anästhesie und Intensivpflege, ALIAR - Association luxemburgeoise des Infirmier(e)s en Anästhesie et Réanimation, Dudelange, Luxemburg
| | - R Dubb
- Akademie der Kreiskliniken Reutlingen, Kreiskliniken Reutlingen GmbH, Steinenbergstr. 31, 72764, Reutlingen, Deutschland
| | - S Filipovic
- Abteilung Physiotherapie, Universitätsklinikum Gießen und Marburg (UKGM) Standort Marburg, Baldinger Straße, 35033, Marburg, Deutschland
| | - C Hermes
- Anästhesie und Intensivpflege, HELIOS Klinikum Siegburg, Ringstraße 49, 53721, Siegburg, Deutschland
| | - F Jüttner
- Anästhesie und Intensivpflege, Asklepios Klinik Langen, Röntgenstraße 20, 63325, Langen, Deutschland
| | - A Kaltwasser
- Akademie der Kreiskliniken Reutlingen, Kreiskliniken Reutlingen GmbH, Steinenbergstr. 31, 72764, Reutlingen, Deutschland
| | - S Klarmann
- Fachleitung Zentrale Einrichtung Physiotherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Haus 31, Brunswiker Str. 10, 24105, Kiel, Deutschland
| | - K Klas
- Gesundheits- und Krankenpflege, IMC Fachhochschule Krems, Am Campus Krems, 3500, Krems, Österreich
| | - H Mende
- Anästhesiologie & Intensivmedizin, Neurologische Intensivstation, Klinik für Neurologie, Christophsbad Göppingen, Faurndauerstrasse 6-28, 73035, Göppingen, Deutschland
| | - O Rothaug
- Intensiv- und Anästhesiepflege, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37077, Göttingen, Deutschland
| | - D Schuchhardt
- Zentrum für Anästhesie, Intensiv- und Notfallmedizin, Zentralklinik Bad Berka GmbH, Robert-Koch-Allee 9, 99437, Bad Berka, Deutschland
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Schwarzkopf D, Westermann I, Skupin H, Riedemann NC, Reinhart K, Pfeifer R, Fritzenwanger M, Günther A, Witte OW, Hartog CS. A novel questionnaire to measure staff perception of end-of-life decision making in the intensive care unit--development and psychometric testing. J Crit Care 2014; 30:187-95. [PMID: 25311265 DOI: 10.1016/j.jcrc.2014.09.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 08/16/2014] [Accepted: 09/14/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE The aim of this study was to create a questionnaire that measures barriers and facilitators of effective end-of-life (EOL) decision making and communication and associated stress as perceived by intensive care unit (ICU) staff. METHODS The questionnaire was developed on the basis of a theoretical framework and discussion with ICU staff. It was pretested among 15 ICU nurses and physicians. A field test was conducted in 4 interdisciplinary ICUs of one university hospital Descriptive item analysis, exploratory factor analysis, and reliability and validity analysis were performed. RESULTS Overall, 174 of 284 ICU staff participated in the field test (61% response). Factor analysis indicated a 7-factor solution: (1) collaboration in the EOL context, (2) role clarity in the EOL context, (3) work-related interruptions of communication with families, (4) emotional support, (5) stress by involvement in EOL decision making and communication with families, (6) stress by work overload, and (7) taking initiative toward EOL decision making. Internal consistency of the scales was acceptable (range, 0.69-0.85). Construct validity was shown by relationships of the scales to several constructs, for example, satisfaction with EOL decision making and emotional exhaustion. Overall, 26 of 31 expected relationships achieved significance. CONCLUSIONS The new questionnaire meets psychometric criteria of reliability and validity and promises to be a useful quality measure of EOL decision making in the ICU.
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Affiliation(s)
- Daniel Schwarzkopf
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital (JUH), Erlanger Allee 101, 07747 Jena, Germany.
| | - Isabella Westermann
- Department of Anesthesiology and Intensive Care Medicine, JUH, Erlanger Allee 101, 07747 Jena, Germany.
| | - Helga Skupin
- Department of Anesthesiology and Intensive Care Medicine, JUH, Erlanger Allee 101, 07747 Jena, Germany.
| | - Niels C Riedemann
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital (JUH), Erlanger Allee 101, 07747 Jena, Germany; Department of Anesthesiology and Intensive Care Medicine, JUH, Erlanger Allee 101, 07747 Jena, Germany.
| | - Konrad Reinhart
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital (JUH), Erlanger Allee 101, 07747 Jena, Germany; Department of Anesthesiology and Intensive Care Medicine, JUH, Erlanger Allee 101, 07747 Jena, Germany.
| | - Ruediger Pfeifer
- Department of Internal Medicine I, JUH, Erlanger Allee 101, 07747 Jena, Germany.
| | | | - Albrecht Günther
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital (JUH), Erlanger Allee 101, 07747 Jena, Germany; Department of Neurology, JUH, Erlanger Allee 101, 07747 Jena, Germany.
| | - Otto W Witte
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital (JUH), Erlanger Allee 101, 07747 Jena, Germany; Department of Neurology, JUH, Erlanger Allee 101, 07747 Jena, Germany.
| | - Christiane S Hartog
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital (JUH), Erlanger Allee 101, 07747 Jena, Germany; Department of Anesthesiology and Intensive Care Medicine, JUH, Erlanger Allee 101, 07747 Jena, Germany.
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Prades J, Remue E, van Hoof E, Borras JM. Is it worth reorganising cancer services on the basis of multidisciplinary teams (MDTs)? A systematic review of the objectives and organisation of MDTs and their impact on patient outcomes. Health Policy 2014; 119:464-74. [PMID: 25271171 DOI: 10.1016/j.healthpol.2014.09.006] [Citation(s) in RCA: 240] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 09/08/2014] [Accepted: 09/09/2014] [Indexed: 02/06/2023]
Abstract
Multidisciplinary teams (MDTs) are considered the gold standard of cancer care in many healthcare systems, but a clear definition of their format, scope of practice and operational criteria is still lacking. The aims of this review were to assess the impact of MDTs on patient outcomes in cancer care and identify their objectives, organisation and ability to engage patients in their care. We conducted a systematic review of the literature in the Medline database. Fifty-one peer-reviewed papers were selected from November 2005 to June 2012. MDTs resulted in better clinical and process outcomes for cancer patients, with evidence of improved survival among colorectal, head and neck, breast, oesophageal and lung cancer patients in the study period. Also, it was observed that MDTs have been associated with changes in clinical diagnostic and treatment decision-making with respect to urological, pancreatic, gastro-oesophageal, breast, melanoma, bladder, colorectal, prostate, head and neck and gynaecological cancer. Evidence is consistent in showing positive consequences for patients' management in multiple dimensions, which should encourage the development of structured multidisciplinary care, minimum standards and exchange of best practices.
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Affiliation(s)
- Joan Prades
- Catalan Cancer Plan, Duran i Reynals Hospital, 199-203 Gran Via de l'Hospitalet Av., Hospitalet de Llobregat, 08908 Barcelona, Spain.
| | - Eline Remue
- Belgian Cancer Centre, Scientific Institute of Public Health, Rue Juliette Wytsman 14, 1050 Brussels, Belgium.
| | - Elke van Hoof
- Experimental and applied psychology, Faculty of educational an psychology sciences, Vrije Universiteit Brusel, Brussels, Belgium.
| | - Josep M Borras
- Catalan Cancer Plan, Duran i Reynals Hospital, 199-203 Gran Via de l'Hospitalet Av., Hospitalet de Llobregat, 08908 Barcelona, Spain; Department of Clinical Sciences, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona (UB), Spain.
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Abstract
The University of Alabama's Graduate Geropsychology Education program (GGE) was conceived and implemented in the years prior to the design of the Pike's Peak Model (PPM) of geropsychology training. The GGE program provides a unique opportunity to evaluate the PPM, and this paper outlines the GGE program in the framework of the model. Three primary goals defined the GGE program: recruitment and retention of students in the geropsychology program, a doctoral level interdisciplinary class, and a set of clinical rotations in urban and rural sites. Outcomes were promising, indicating that geropsychology students were able to provide services with positive outcomes to underserved older adults in primary care settings and in a legal clinic, students from several disciplines rated the course very highly, and psychology students indicated that they were likely to continue in the field of geriatric care. Participating students have gone on to careers in geropsychology. Findings from this program support the design of the Pike's Peak Model, and provide support for broader implementation of similar training programs.
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Affiliation(s)
- Tracy Wharton
- Department of Psychiatry, University of Michigan Medical School ; VA Ann Arbor Health Care System Center for Clinical Management Research (CCMR)
| | - Avani Shah
- School of Social Work, The University of Alabama
| | | | - Rebecca S Allen
- Department of Psychology, The University of Alabama ; Center for Mental Health & Aging, The University of Alabama
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Abstract
PURPOSE In the past, health management in Geneva's six post-trial prisons had been variable and inconsistent. In 2008, the unit of penitentiary medicine of the Geneva University Hospitals was mandated to re-organize and provide health care at all six prison facilities. The specific aim of this paper is to outline the example as a practical solution to some of the common challenges in unifying the structure and process of health services across multiple small facilities, while meeting European prison health and local quality standards. DESIGN/METHODOLOGY/APPROACH Geneva's post-trial prisons are small and close to one another in geographical proximity - ideal conditions for the construction of a health mobile team (HMT). This multidisciplinary mobile team operated like a community ambulatory care model; it was progressively launched in all prison facilities in Geneva. The authors incorporated an implementation strategy where health providers partnered with prison and community stakeholders in the health delivery model's development and adaption process. FINDINGS The model's strategic initiatives are described along the following areas, in light of other international prison health activity and prior care models: access to a health care professional, equivalence of care, patient consent, confidentiality, humanitarian interventions, and professional competence and independence. ORIGINALITY/VALUE From the perspective of the HMT members, the authors provide the "lessons learned" through this experience, especially to providers who are working on prison health services reform and coordination improvement. The paper particularly stresses the importance of partnering with community health stakeholders and prison staff, a key component to the approach.
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Affiliation(s)
- Jean-Pierre Rieder
- Unit of Penitentiary Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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