Care Team (care + team)

Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Care Team

  • health care team
  • primary care team
  • primary health care team

  • Selected Abstracts

    Home care for chronic respiratory failure in children: 15 years experience

    Background:,Advances in paediatric intensive care have reduced mortality but, unfortunately, one of the consequences is an increase in the number of patients with chronic diseases. It is generally agreed that home care of children requiring ventilatory support improves their outcomes and results in cost saving for the National Health Service. Methods:,Since 1985, the Children's Hospital Bambino Gesù of Rome has developed a program of paediatric home care. The program is performed by a committed Home Health Care Team (HHCT) which selects the eligible patients for home care and trains the families to treat their child. During the period January 1985 to January 2001, 53 children with chronic respiratory failure were included in the home care program. Of these, seven patients were successively excluded and six died in our intensive care unit (ICU), while one still lives in our ICU since 1997. The results obtained in the remaining 46 children are reported. Results:,The pathologies consisted of disorders of respiratory control related to brain damage (26%), upper airways obstructive disease (26%), spinal muscular atrophy (22%), myopathies and muscular dystrophies (6.5%), bronchopulmonary dysplasia (6.5%), tracheomalacia (6.5%), central hypoventilation syndrome (4.3%) and progressive congenital scoliosis (2.2%). Of these 46 patients, 34 children are mechanically ventilated and the median of their ICU stay was 109.5 days (range 54,214 days), while the remaining 12 children were breathing spontaneously and the median of their ICU stay was 90.5 days (range 61,134 days). We temporarily readmitted six patients to our ICU to perform scheduled otolaryngological surgery, eight patients for acute respiratory infections and two patients for deterioration of their neurological status due to high pressure hydrocephalus for placement of a ventriculoperitoneal shunt; these 16 patients were discharged back home again. Two other patients were readmitted for deterioration of their chronic disease and died in our ICU, while seven patients died at home. Conclusions:,Thirty-seven children are still alive at home and four of them improved their respiratory condition so that it was possible to remove the tracheostomy tube. Our oldest patient has now achieved 15 years of mechanical ventilation at home. [source]

    Improving Heart Failure Self-Management Support by Actively Engaging Out-of-Home Caregivers: Results of a Feasibility Study

    John D. Piette PhD
    The benefits of heart failure (HF) care management have been demonstrated, yet health systems are often unable to meet patients' needs for support between outpatient visits. Informal care provided by family or friends is a low-cost, and potentially effective, adjunct to care management services. The authors evaluated the feasibility of augmenting HF care management with weekly, automated assessment and behavior change calls to patients, feedback via the Internet to an out-of-home informal caregiver or CarePartner (CP), and faxes to the patient's health care team. The program included 52 HF patient-CP pairs participating for an average of 12 weeks. Patients completed 586 assessments (92% completion rate) and reported problems that might otherwise have gone unidentified. At follow-up, 75% had made changes in their self-care as a result of the intervention. The CP program may extend the impact of HF telemonitoring beyond what care management programs can realistically deliver. [source]

    Emergency nurse practitioners: An underestimated addition to the emergency care team

    Kylie Wilson
    No abstract is available for this article. [source]

    Experiences of alcohol drinking among Swedish youths with type 1 diabetes

    A Leger RN Diabetes Nurse
    Abstract Background: Alcohol consumption in Europe and North America is greatest in 18,25-year-olds. This behaviour can be seen as a transitional stage from childhood to adulthood, where consuming alcohol is perceived as a typical feature of adult behaviour. Youths often start to consume alcohol when they are 14,15 years of age, and one in five youngsters around 15 years of age report binge drinking. Studies of alcohol consumption among youths with type 1 diabetes have not been undertaken but it is well known that, in these people, alcohol drinking can cause hypoglycaemia and worsen the capacity to feel and interpret the symptoms of hypoglycaemia. Aim: The overall aim was to explore experiences of alcohol consumption among youths with type 1 diabetes. Another objective was to identify strategies as to how they deal with situations when they drink alcohol. Methods: Semistructured interviews with ten 18-year-old youths with type 1 diabetes, using Burnard's content analysis method. Results: This study illustrates that informants strive for security, independence and control. Frequency of binge drinking did not seem to differ from rates in other teenagers. Informants exposed themselves to considerable risks and many had met with serious incidents. Moreover, the result exemplifies how symptoms of diabetic ketoacidosis (such as nausea and vomiting) can easily be misinterpreted as a hang-over or gastroenteritis. Informants lacked age-appropriate knowledge about diabetes and the effects of alcohol, but had tested things out themselves; some involved their friends in their diabetes treatment. Moreover, three strategies occurred with the aim of normalisation and security: the 'low-consumption' strategy, the ,ambitious' strategy and the ,rather-high-than-dead' strategy. Fear of hypoglycaemia was a significant concern and the consequence was poor diabetes control. Conclusion: To increase youths' independence and security, the diabetes care team should provide adequate and relevant information about alcohol. Treatment plans might contain practical steps such as advice about responsible alcohol intake and adjustments of insulin and meals, and could also encourage young people with diabetes to carry diabetes ID and inform friends about hypoglycaemia (and how to handle situations involving alcohol). Copyright © 2009 FEND [source]

    EFNS task force on management of amyotrophic lateral sclerosis: guidelines for diagnosing and clinical care of patients and relatives

    An evidence-based review with good practice points
    Despite being one of the most devastating diseases known, there is little evidence for diagnosing and managing patients with amyotrophic lateral sclerosis (ALS). Although specific therapy is lacking, correct early diagnosis and introduction of symptomatic and specific therapy can have a profound influence on the care and quality of life of the patient and may increase survival time. This document addresses the optimal clinical approach to ALS. The final literature search was performed in the spring of 2005. Consensus recommendations are given graded according to the EFNS guidance regulations. Where there was lack of evidence but consensus was clear we have stated our opinion as good practice points. People affected with possible ALS should be examined as soon as possible by an experienced neurologist. Early diagnosis should be pursued and a number of investigations should be performed with high priority. The patient should be informed of the diagnosis by a consultant with a good knowledge of the patient and the disease. Following diagnosis, the patient and relatives should receive regular support from a multidisciplinary care team. Medication with riluzole should be initiated as early as possible. PEG is associated with improved nutrition and should be inserted early. The operation is hazardous in patients with vital capacity <50%. Non-invasive positive pressure ventilation improves survival and quality of life but is underused. Maintaining the patients ability to communicate is essential. During the entire course of the disease, every effort should be made to maintain patient autonomy. Advance directives for palliative end of life care are important and should be fully discussed early with the patient and relatives respecting the patients social and cultural background. [source]

    Family Resiliency in Childhood Cancer,

    FAMILY RELATIONS, Issue 2 2002
    Marilyn McCubbin
    Based on in-depth interviews with 42 parents (25 mothers, 17 fathers) in 26 families who had had a child treated for cancer within the previous 3 years, resiliency factors that helped the family recover were identified. The resiliency factors included internal family rapid mobilization and reorganization; social support from the health care team, extended family, the community, and the workplace; and changes in appraisal to make the situation more comprehensible, manageable, and meaningful. [source]

    Smoking after the age of 65 years: a qualitative exploration of older current and former smokers' views on smoking, stopping smoking, and smoking cessation resources and services

    Susan Kerr BA MSc PhD RN HV
    Abstract The aim of this study was to explore older current/former smokers' views on smoking, stopping smoking, and smoking cessation resources and services. Despite the fact that older smokers have been identified as a priority group, there is currently a dearth of age-related smoking cessation research to guide practice. The study adopted a qualitative approach and used the health belief model as a conceptual framework. Twenty current and former smokers aged , 65 years were recruited through general practices and a forum for older adults in the West of Scotland. Data were collected using a semistructured interview schedule. The audio-taped interviews were transcribed and then analysed using content analysis procedures. Current smokers reported many positive associations with smoking, which often prevented a smoking cessation attempt. The majority were aware that smoking had damaged their health; however, some were not convinced of the association. A common view was that ,the damage was done', and therefore, there was little point in attempting to stop smoking. When suggesting a cessation attempt, while some health professionals provided good levels of support, others were reported as providing very little. Some of the participants reported that they had never been advised to stop smoking. Knowledge of local smoking cessation services was generally poor. Finally, concern was voiced regarding the perceived health risks of using nicotine replacement therapy. The main reasons why the former smokers had stopped smoking were health-related. Many had received little help and support from health professionals when attempting to stop smoking. Most of the former smokers believed that stopping smoking in later life had been beneficial to their health. In conclusion, members of the primary care team have a key role to play in encouraging older people to stop smoking. In order to function effectively, it is essential that they take account of older smokers' health beliefs and that issues, such as knowledge of smoking cessation resources, are addressed. [source]

    Recent evidence on the development and maintenance of constructive staff,family relationships in the care of older people , a report on a systematic review update

    Emily Haesler BN PgradDipAdvNsg
    Abstract Aim, This paper is an update to a systematic review that presents the best available evidence on the factors that are most effective in promoting constructive staff,family relationships in the care of older people in the institutional healthcare setting. Methods, Systematic review. Results, The updated review supports findings from the earlier review. Additional evidence points to the importance of monitoring care, family involvement in decision-making, staff upholding the uniqueness of the older person, trust, the involvement of the multidisciplinary care team and family dynamics as factors underpinning effective staff,family relationships. Conclusion, A number of factors critical to the development and maintenance of positive staff,family relationships in the institutional setting have been identified. The delivery of quality care is predicated on staff having an understanding of these factors. [source]

    Triage, treat and transfer: reconceptualising a rural practice model,

    Elise Sullivan
    Aim., This article argues that the current model of emergency practice in rural Victorian hospitals, which relies heavily on visiting medical officers, needs to be reconceptualised if emergency services are to be supplied to rural communities. Background., Medical workforce shortages are manifesting in Victoria as a reduction in emergency care services from rural hospitals. The suggested alternative model of emergency care involves advancing nursing practice to enable a redistribution of clinical capacity across the health care team. Clinicians will need to work collaboratively and continuously negotiate their roles to meet the patient's and the clinical team's needs. Design., Systematic review. Methods., This article is based on a review of the Victorian and Australian literature on the subject of Victorian health services and policy, emergency care, collaboration, communication and rural nurse scope of practice and roles. Emergency care activity was drawn from data held in the Victorian Emergency Management Dataset and personal communications between one of the authors and hospital executives in a small selection of rural hospitals in Victoria. Results., The evidence reviewed suggests that the current emergency practice profile of rural hospitals in Victoria does not reflect the reconceptualised model of rural emergency practice. Instead, only a small proportion of non-urgent presentations is managed by nurses without medical support, and the data suggest that metropolitan nurses are more likely to manage without medical support than rural nurses. Conclusion., Reconceptualising rural emergency care in Victoria will require significantly greater investment in rural nurses' knowledge and skills to enable them to operate confidently at a more advanced level. Clinical teams that deliver emergency service in rural hospitals will be expected increasingly to work collaboratively and interprofessionally. Relevance to clinical practice., This article offers some directions for advancing nursing practice and strategies for improving interprofessional collaboration in the delivery of rural emergency care. [source]

    Hospitalized elders and family caregivers: a typology of family worry

    Hong Li PhD
    Objective., This qualitative study explored the kinds of worry that family caregivers experience when their older relatives are hospitalized. Background., Little is known about what kinds of worries family caregivers may have in association with the hospitalizations of older relatives. An understanding of the different patterns of family worry may help health care teams intervene more effectively to meet family caregiver's needs by reducing their anxiety. Design., A qualitative descriptive design with Loftland and Loftland (1984) approach for the study of a phenomenon occurring in a social setting was used. Method., A purposeful sample of 10 participants was obtained that included six family caregivers and four nurses. Participants were recruited from two hospitals in the northwest US. Intensive interviews and participant observations were used for data collection, and Loftland and Loftland's (1984) qualitative approach was used for data analysis. Results., Family worry was defined as family caregivers' felt difficulty in fulfilling their roles because of worry. Four categories of family worry were identified as a result of this study: (i) worry about the patient's condition; (ii) worry about the patient's care received from the health care team; (iii) worry about future care for the patient provided by the family caregiver; and (iv) worry about finances. Conclusions., The findings of this pilot study provide nurses with the initial knowledge of the typology of family worry associated with elderly relatives' hospitalizations. Relevance to clinical practice., The findings of this study may sensitize the nurses to more precisely evaluate family caregivers' worry about their hospitalized elders and provide more effective nursing interventions to improve outcomes of both patients and their family caregivers. [source]

    SARS , a perspective from a school of nursing in Hong Kong

    David R. Thompson PhD
    Background., Severe acute respiratory syndrome (SARS) is a new infectious disease with significant morbidity and mortality that has had a major impact on health and health care services worldwide. Hong Kong has had a significant number of cases and deaths. Nurses, at the vanguard of the clinical health care team, have been particularly affected by it. The outbreak prompted the health authorities to implement a series of public health measures and hospital policies, including a guideline for the diagnosis and management of patients with SARS. Aims and objectives., This paper aims at providing an overview of what is known about SARS and the impact it has had in Hong Kong and to highlight from the perspective of a school of nursing the major clinical, educational and public health implications. Conclusions., The lack of understanding and uncertainty about the disease led to significant variation in the provision of information, contributing to the confusion and anxiety in the community. Therefore, there is a need to revise the nursing curriculum, to provide continuing education to all health care professionals, particularly with regard to infection control measures, and to revisit the range of public health policies to ensure the health of the community is protected by these policies. There also has been a reaffirmation of the importance of health promotion that highlights the importance of the partnership between nurses, health policy makers and public health personnel. It is evident that the organization and delivery of clinical practice, teaching and health promotion have to be flexible and responsive to a changing health scenario. Relevance to clinical practice., Nurses must play a crucial role in the prevention, detection and containment of SARS. They will need to implement and ensure strict adherence to infection control measures and, in some circumstances, isolation and quarantine may be warranted. Attention to the psychological state of patients and family members should not be overlooked. Paramount is education of patients, families and members of the public at large. [source]

    Agency nursing work in acute care settings: perceptions of hospital nursing managers and agency nurse providers

    Elizabeth Manias BPHARM, FRCNA, MNursStud, MPharm
    Summary ,,There is a paucity of research in investigating agency nursing work from the perspectives of hospital nursing managers and agency nurse providers. ,,This exploratory paper examines the hospital nursing managers' and agency nurse providers' perceptions and experiences of agency nursing work. ,,Individual, in-depth interviews were conducted with three agency nurse providers and eight hospital nursing managers. Because of the lack of previous research in this area, an exploratory, semi-structured interviewing technique was deemed appropriate. ,,Three major themes emerged from interview data: planning for ward allocation, communication and professionalism. ,,In planning for ward allocation, hospital managers were primarily concerned with maintaining adequate numbers of nursing staff in the ward settings. A major concern for agency nurse providers was inappropriate allocation of temporary staff. ,,Communication was valued in different ways. While hospital managers focused on communication between the agency nurse and other permanent members of the health care team, agency providers were concerned with exchanges between agencies and hospital organizations, and between the agencies and agency nurses. ,,For both groups, responsibility for professional development and the status of agency nursing as a career choice for graduate and experienced nurses were the focal aspects for consideration. ,,A limitation of this study is the small number of individual interviews conducted with hospital nursing managers and agency nurse providers. Nevertheless, the findings represent the views of 11 individuals in senior managerial roles. ,,The findings reinforce the need to enhance collaboration between hospitals and nursing agencies, and to examine how divergent views of agency nursing work could be reconciled , with the aim of providing quality patient care. [source]

    A multi-intervention approach on drug therapy can lead to a more appropriate drug use in the elderly.

    LIMM-Landskrona Integrated Medicines Management
    Abstract Rationale, aims and objectives, To evaluate if an integrated medicines management can lead to a more appropriate drug use in elderly inpatients. Method, The study was an intervention study at a department of internal medicine in southern Sweden. During the intervention period pharmacists took part in the daily work at the wards. Systematic interventions aiming to identify, solve and prevent drug-related problems (DRPs) were performed during the patient's hospital stay by multidisciplinary teams consisting of physicians, nurses and pharmacists. DRPs identified by the pharmacist were put forward to the care team and discussed. Medication Appropriateness Index (MAI) was used to evaluate the appropriateness in the patients' drug treatment at admission, discharge and 2 weeks after discharge. In total 43 patients were included, 28 patients in the intervention group and 25 patients in the group which was used as control. Results, For the intervention group there was a significant decrease in the number of inappropriate drugs compared with the control group (P = 0.049). Indication, duration and expenses were the MAI-dimensions with most inappropriate ratings, and the drugs with most inappropriate ratings were anxiolytics, hypnotics and sedatives. Conclusion, This kind of systematic approach on drug therapy can result in a more appropriate drug use in the elderly. [source]

    Idealized design of perinatal care

    Faith McLellan PhD
    Idealized Design of Perinatal Care is an innovation project based on the principles of reliability science and the Institute for Healthcare Improvement's (IHI's) model for applying these principles to improve care.1 The project builds upon similar processes developed for other clinical arenas in three previous IHI Idealized Design projects. The Idealized Design model focuses on comprehensive redesign to enable a care system to perform substantially better in the future than the best it can do at present. The goal of Idealized Design of Perinatal Care is to achieve a new level of safer, more effective care and to minimize some of the risks identified in medical malpractice cases. The model described in this white paper, Idealized Design of Perinatal Care, represents the Institute for Healthcare Improvement's best current assessment of the components of the safest and most reliable system of perinatal care. The four key components of the model are: 1) the development of reliable clinical processes to manage labor and delivery; 2) the use of principles that improve safety (i.e., preventing, detecting, and mitigating errors); 3) the establishment of prepared and activated care teams that communicate effectively with each other and with mothers and families; and 4) a focus on mother and family as the locus of control during labor and delivery. Reviews of perinatal care have consistently pointed to failures of communication among the care team and documentation of care as common factors in adverse events that occur in labor and delivery. They are also prime factors leading to malpractice claims.2 Two perinatal care "bundles", a group of evidence-based interventions related to a disease or care process that, when executed together, result in better outcomes than when implemented individually , are being tested in this Idealized Design project: the Elective Induction Bundle and the Augmentation Bundle. Experience from the use of bundles in other clinical areas, such as care of the ventilated patient, has shown that reliably applying these evidence-based interventions can dramatically improve outcomes.3 The assumption of this innovation work is that the use of bundles in the delivery of perinatal care will have a similar effect. The authors acknowledge that other organizations have also been working on improving perinatal care through the use of simulation training and teamwork and communication training. IHI's model includes elements of these methods. The Idealized Design of Perinatal Care project has two phases. Sixteen perinatal units from hospitals around the US participated in Phase I, from February to August 2005. The goals of Phase I were identifying changes that would make the most impact on improving perinatal care, selecting elements for each of the bundles, learning how to apply IHI's reliability model to improve processes, and improving the culture within a perinatal unit. This white paper provides detail about the Idealized Design process and examines some of the initial work completed by teams. Phase II, which began in September 2005, expands on this work. This phase focuses particularly on managing second stage labor, including common interpretation of fetal heart monitoring, developing a reliable tool to identify harm, and ensuring that patient preferences are known and honored. [source]

    The Invisibility of Advanced Practice Nurses in Popular Magazines

    Susan L. Norwood EdD
    PURPOSE To determine the image portrayed in the media of nurses and particularly nurse practitioners (NPs) compared with other health care providers. DATA SOURCES An analysis of advertisements and articles in popular magazines aimed at female, male, and gender-neutral audiences was conducted between 12/99 and 06/00. Relationships between target audience and content of advertisements and articles, as well as portrayal of health care providers were also explored. CONCLUSIONS A review of 100 consecutive advertisements for health-related products and 96 consecutive health-related articles in popular magazines revealed that the media continues to overwhelmingly depict and promote physicians as the source of health care and health-related advice. IMPLICATIONS FOR PRACTICE Because when there are few references to a group, such as NPs, it is reasonable to assume group members have little influence, standing, and authority, NPs should be concerned about the implications of these findings. Strategies for increasing the visibility of NPs as credible and valuable members of the health care team are shared. [source]

    Forming professional identities on the health care team: discursive constructions of the ,other' in the operating room

    MEDICAL EDUCATION, Issue 8 2002
    L Lingard
    Background, Inter-professional health care teams represent the nucleus of both patient care and the clinical education of novices. Both activities depend upon the,talk' that team members use to interact with one another. This study explored team members' interpretations of tense team communications in the operating room (OR). Methods, The study was conducted using 52 team members divided into 14 focus groups. Team members comprised 13 surgeons, 19 nurses, nine anaesthetists and 11 trainees. Both uni-disciplinary (n = 11) and multi-disciplinary (n = 3) formats were employed. All groups discussed three communication scenarios, derived from prior ethnographic research. Discussions were audio-recorded and transcribed. Using a grounded theory approach, three researchers individually analysed sample transcripts, after which group discussions were held to resolve discrepancies and confirm a coding structure. Using the confirmed code, the complete data set was coded using the ,NVivo' qualitative data analysis software program. Results, There were substantial differences in surgeons', nurses', anaesthetists', and trainees' interpretations of the communication scenarios. Interpretations were accompanied by subjects' depictions of disciplinary roles on the team. Subjects' constructions of other professions' roles, values and motivations were often dissonant with those professions' constructions of themselves. Conclusions, Team members, particularly novices, tend to simplify and distort others' roles and motivations as they interpret tense communication. We suggest that such simplifications may be rhetorical, reflecting professional rivalries on the OR team. In addition, we theorise that novices' echoing of role simplification has implications for their professional identity formation. [source]

    Implementing the severe sepsis care bundles outside the ICU by outreach

    Chris Carter
    Abstract Sepsis is not a new challenge facing the health care team, it remains a complex disease, which is difficult to identify and treat. Mortality from sepsis remains high and continues to be a common cause of death among critically ill patients, despite advances in critical care. Sepsis accounts for an estimated 27% of all intensive care admissions in England, Wales and Northern Ireland, and accounted for 46% of all intensive care bed days. Recent research studies and the surviving sepsis campaign have shown that identifying and providing key interventions to patients with severe sepsis and septic shock prior to their admission to the intensive care unit significantly improve outcomes. The aim of this paper was to identify how the Critical Care Outreach Team at one local hospital implemented the severe sepsis resuscitation care bundle for patients in the emergency department (ED) and on the general wards. It will include a presentation on the various ways the team raised the profile of severe sepsis and the care bundle at hospital and at national level. It also includes audit data that have been collected. The results showed that if the resuscitation care bundle was implemented within the first 24 h of hospital admission, mortality was 29%, whereas if the care bundle was instigated after this time mortality was more than at 49%. Audit data showed that the commonest sign of severe sepsis seen in patients in the ED and on wards was tachypnoea. This article discusses the successful implementation of the severe sepsis resuscitation care bundle and the positive impact an Outreach team can have in changing practice in the way patients are managed with severe sepsis. The audit data support the need for regular physiological observations and the use of a Patient At Risk Trigger scoring tool to identify patients at risk of deterioration. This allows referral to the Outreach team, who assess the patient and if appropriate initiate the care bundle. [source]

    The role of the senior health care worker in critical care

    Paula Ormandy
    Summary ,,This article identifies that the introduction of the support worker role in the critical care team facilitates flexibility when organizing and managing patient care ,,Qualified nurses' time can be used more effectively, enhancing the quality of the patient care delivered ,,Aspects of the qualified nurses' workload in critical care can be shared and delegated successfully to unqualified staff ,,It is our view that staffing levels in critical care environments need to be reviewed with more flexible working practices to meet the current and future demands of critical care ,,There is a need for national consensus amongst qualified nurses to clarify and define the role of the support worker and develop a critical care competency framework to standardize training ,,To ensure proficiency, adequate training and appropriate accountability, support workers require regulation by a nationally recognized body [source]

    Anesthetic considerations for major burn injury in pediatric patients

    Summary Major burn injury remains a significant cause of morbidity and mortality in pediatric patients. With advances in burn care and with the development of experienced multi-disciplinary teams at regionalized burn centers, many children are surviving severe burn injury. As members of the multi-disciplinary care team, anesthesia providers are called upon to care for these critically ill children. These children provide several anesthetic challenges, such as difficult airways, difficult vascular access, fluid and electrolyte imbalances, altered temperature regulation, sepsis, cardiovascular instability, and increased requirements of muscle relaxants and opioids. The anesthesia provider must understand the physiologic derangements that occur with severe burn injury as well as the subsequent anesthetic implications. [source]

    Risk factors for adverse events in children with colds emerging from anesthesia: a logistic regression

    Summary Background:, Recent upper respiratory infection (URI) in children increases respiratory adverse events following anesthesia for elective surgery. The increased risk continues weeks after resolution of acute URI symptoms. Few systematic analyses have explored specific risk factors. This logistic regression explores the relationship between preoperative URI symptoms and adverse events during emergence from anesthesia. Methods:, Data were combined from control groups of several prospective observational and interventional studies in elective pediatric anesthesia in a tertiary care pediatric hospital. In each study, a blinded observer, distinct from the anesthesia care team, prospectively recorded the presence of stridor, oxygen desaturations (and their duration), coughing and laryngospasm. Parents were subsequently asked about the presence of 10 cold symptoms during the 6 weeks prior to operation. Results:, Our model, based on a dataset of 335 patients, did not demonstrate an association between any particular symptoms and the rate of respiratory adverse events during emergence from anesthesia, with the exception of low-grade fever which appeared to be mildly protective. Respiratory adverse events were affected by the airway management technique (device used and timing of extubation), and adverse events were increased if peak URI symptoms had occurred within the preceding 4 weeks. Conclusions:, Specific preoperative symptoms were not useful in predicting respiratory adverse events during emergence from anesthesia. [source]

    Psychological distress and concerns of elderly patients treated with palliative radiotherapy for lung cancer

    PSYCHO-ONCOLOGY, Issue 8 2007
    N. J. Turner
    Abstract We conducted a prospective observational cohort study of 83 elderly patients (aged 75 and above) being treated with palliative radiotherapy for lung cancer, with a comparison group of 49 younger patients (aged 65 and under). Psychological distress and concerns were measured before and after treatment using the Hospital Anxiety and Depression Scale (HADS) and a Concerns Checklist. Psychosocial morbidity was common, however, prevalence was similar in both age groups. There was a trend towards worsening of both anxiety and depression scores after treatment, but this did not reach statistical significance. Younger patients reported more concerns than the older group (median 12 vs 10) but this too was not statistically significant. Concerns about the illness and symptoms were more likely to have been addressed by the care team than were concerns about psychosocial issues such as the family and the future. People of all ages have similar concerns and levels of anxiety and depression whilst receiving palliative radiotherapy for lung cancer. Further research is needed to explore the use of screening tools, like those used in this study, to identify patients' difficulties and target interventions to improve their quality of life. Copyright © 2006 John Wiley & Sons, Ltd. [source]

    Why Current Breast Pathology Practices Must Be Evaluated.

    THE BREAST JOURNAL, Issue 5 2007
    A Susan G. Komen for the Cure White Paper: June 200
    To this end, the organization has a strong interest and proven track record in ensuring public investment in quality breast health and breast cancer care. Recently, Susan G. Komen for the Cure identified major issues in the practice of pathology that have a negative impact on the lives of thousands of breast cancer patients in the United States. These issues were identified through a comprehensive literature review and interviews conducted in 2005,2006 with experts in oncology, breast pathology, surgery, and radiology. The interviewees practiced in community, academic, and cooperative group settings. Komen for the Cure has identified four areas that have a direct impact on the quality of care breast cancer patients receive in the United States, the accuracy of breast pathology diagnostics, the effects of current health insurance, and reimbursement policies on patients who are evaluated for a possible breast cancer diagnosis, the substantial decrease in tissue banking participation, particularly during a time of rapid advances in biologically correlated clinical science and the role for the Susan G. Komen for the Cure, pathology professional societies and the Federal government in ensuring that breast pathology practices meet the highest possible standards in the United States Concerns surrounding the quality and practice of breast pathology are not limited to diagnostic accuracy. Other considerations include, training and proficiency of pathologists who are evaluating breast specimens, the lack of integration of pathologists in the clinical care team, inadequate compensation for the amount of work required to thoroughly analyze specimens, potential loss in translational research as a result of medical privacy regulations, and the lack of mandatory uniform pathology practice standards without any way to measure the degree of variation or to remedy it. [source]

    Self-assessment and continuing professional development: The Canadian perspective

    FRCPC, Ivan Silver MD
    Abstract Introduction: Several recent studies highlight that physicians are not very accurate at assessing their competence in clinical domains when compared to objective measures of knowledge and performance. Instead of continuing to try to train physicians to be more accurate self-assessors, the research suggests that physicians will benefit from learning programs that encourage them to reflect on their clinical practice, continuously seek answers to clinical problems they face, compare their knowledge and skills to clinical practice guidelines and benchmarks, and seek feedback from peers and their health care team. Methods: This article describes the self-assessment learning activities of the College of Family Physicians of Canada Maintenance of Proficiency program (Mainpro®) and the Royal College of Physicians and Surgeons of Canada Maintenance of Certification program. (MOC) Results: The MOC and the Mainpro® programs incorporate several self-evaluation learning processes and tools that encourage physicians to assess their professional knowledge and clinical performance against objective measures as well as guided self-audit learning activities that encourage physicians to gather information about their practices and reflect on it individually, with peers and their health care team. Physicians are also rewarded with extra credits when they participate in either of these kinds of learning activities. Discussion: In the future, practice-based learning that incorporates self-assessment learning activities will play an increasingly important role as regulators mandate that all physicians participate in continuing professional development activities. Research in this area should be directed to understanding more about reflection in practice and how we can enable physicians to be more mindful. [source]

    Design and implementation of training to improve management of pediatric overweight

    Continuing Medical Education, Luke Beno MD Chief
    Abstract Introduction: Clinicians report a low proficiency in treating overweight children and using behavioral management strategies. This paper documents the design and implementation of a training program to improve clinicians' skills in the assessment and behavioral management of pediatric overweight. Methods: Two one-hour CME trainings were designed using published guidelines, research findings, and expert committee recommendations. The trainings were provided to clinicians of a managed care pediatric department, utilizing novel screening and counseling tools, and interactive exercises. Surveys and focus groups were conducted 3 and 6 months post intervention to examine clinician attitudes and practices regarding the screening and counseling tools. Results: Post intervention, the majority of clinicians agreed that the clinical practice guidelines (Pediatric Obesity Practice Resource) and BMI-for-age percentile provided useful information for clinical practice. Clinicians reported an increased utilization of the recommended screening tools and changes in office practices to implement these tools. They offered suggestions to improve the ease of use of the tools and to overcome perceived clinician and/or patient barriers. Discussion: A brief, cost effective, multi-faceted training and provision of counseling tools were perceived as helpful to clinical practice. Useful lessons were learned about tool design and ways to fit tools into practice. Training the entire health care team is advantageous to the adoption of new tools and practices. [source]

    Is palliative resection of the primary tumour, in the presence of advanced rectal cancer, a safe and useful technique for symptom control?

    ANZ JOURNAL OF SURGERY, Issue 4 2004
    Nasser Al-Sanea
    Introduction: At some time, every general surgeon will be faced with the task of trying to decide what to do with a patient who presents with rectal cancer and unresectable distant metastases. How safe is resectional surgery? What sort of palliation may be expected following resection of the primary tumour? In an attempt to answer these questions, the management and outcomes of all patients with rectal cancer and distant metastases, who were primarily referred to the colorectal unit at King Faisal Specialist Hospital were examined. Methods: All patients who underwent primary surgery for rectal cancer in the presence of metastatic disease were identified. The charts of these patients were examined and their morbidity, mortality and survival were determined. Results: Over an 8-year period 22 patients (average age 54 years) underwent rectal resectional surgery in the presence of metastatic disease. There were 13 men and nine women. The commonest complaint was rectal bleeding. All patients had chest radiographs. Pulmonary metastases were identified in four patients. Nineteen abdominal and pelvic computed tomography scans were performed and eight showed evidence of metastases. Skeletal radiographs in two patients showed evidence of bone metastasis. At operation, intraperitoneal metastases were found in 18 patients. Nine of these were not identified preoperatively. Six patients underwent abdomino-perineal resection, nine anterior resection and seven a Hartmann's procedure. Eight patients developed a significant postoperative complication and one died 42 days after surgery. The mean length of hospital stay was 18.6 days. Nine patients received preoperative radiotherapy. Four patients had palliative radiotherapy, two for bony, one for liver and one for peritoneal metastases. Patients were followed up for a mean of 1.1 years. During follow up, 11 returned to the emergency room on 24 occasions. Two patients required readmission. No patient had further rectal bleeding. The mean survival was 1.3 years. Conclusion: Patients with rectal cancer and unresectable distant metastases can be successfully palliated by resection of the primary tumour with low morbidity and mortality. The early involvement of a palliative care team facilitates patient management and helps patients enjoy what remains of the rest of their lives at home, in comfort and with good symptom control. [source]

    Present and future role of Mental Illness Advocacy Associations in the management of the mentally ill: realities, needs and hopes at the edge of the third millennium

    BIPOLAR DISORDERS, Issue 3p2 2000
    Paolo Lucio Morselli
    Objective: The purpose of the present review is the analysis of the development and current status of the Mental Illness Advocacy Movement in the USA and in Europe, as well as of the role such a movement is playing in the management of the mentally ill. Methods: Information on the issue has been collected via literature search and several personal inquiries and contacts with different Mental Illness Advocacy Groups in the USA and in Europe. Results: The findings indicate that the Mental Illness Advocacy Movement is very alive and in full growth. Its role in the management of the mentally ill has become more and more important over the years. In several countries, it makes it possible to overcome some of the deficiencies of the National or Private Health Services. Thanks to the actions of the various Mental Illness Advocacy Groups, today, patients and families are more and better informed of their conditions and their rights. In many cases, this results in earlier diagnosis, better compliance and better outcomes. However, despite significant improvement in the status of the mentally ill patient, much still remains to be done. Conclusions: We need an improved dialogue with mental heath providers, public administrators, mental health policy makers, mass media and politicians. The dialogue between primary care team and the specialist must also be improved. A global alliance for action is needed to ensure better and more available services to those who suffer from mental disorders. [source]

    Caring for people with learning disability: a survey of general practitioners' attitudes in Southampton and South-west Hampshire

    Ken SteinArticle first published online: 24 DEC 200
    The aim of the present paper was to examine general practitioners' (GPs') beliefs about: the demands made on the primary care team by people with learning disability; their confidence in meeting health care needs and perceived training requirements; attitudes towards specialist or generic health service provision, and current contact with specialist teams; and attitudes towards screening in people with learning disability. A postal questionnaire was sent to a randomly selected partner from 95% of the practices in the Southampton and South-west Hampshire Health District. Forty-eight (75%) GPs responded and few were undecided about the demands placed on primary care teams, but beliefs were mixed. Most GPs were confident in dealing with the medical care needs of people with learning disability and the majority felt that training courses would not be worthwhile, except to learn more about specialist services where contact was very low and a ,link worker' scheme had had little apparent impact. Most respondents agreed that GPs should meet the medical needs of people with learning disability as part of general medical services and approximately half had a positive attitude towards providing regular health checks. Respondents were cautious about offering cervical cancer screening to women with learning disability. A small minority suggested that they would take no action to follow up a non-attendance for mammography. As a heterogeneous population, it is not surprising that GPs' attitudes vary widely. Further research is required to establish the nature and scale of demands made on primary health care teams, and to evaluate systematic means of addressing health care needs of people with learning disability. [source]

    Scabies and pyodermas , diagnosis and treatment

    R.J. Hay
    ABSTRACT Scabies and pyodermas are two of the commonest skin infections in tropical settings. They affect large numbers of people, particularly children, and account for a large burden of disease for peripheral health care teams. Despite this there have been significant advances in our knowledge of these diseases, their impact and their management. However there is a need to evaluate these developments in this specific setting, tropical health and in the context of communities with limited resources. This section will describe these advances and the challenges that remain. [source]

    Evaluating the impact of integrated health and social care teams on older people living in the community

    Louise Brown CQSW BSc(Hons) MSc
    Abstract Although it is perceived wisdom that joint working must be beneficial, there is, even at this stage, little evidence to support that notion. The present study is an evaluation of two integrated co-located health and social care teams which were established in a rural county to meet the needs of older people and their carers. This study does identify that patients from the ,integrated teams' may self-refer more and are assessed more quickly. This might indicate that the ,one-stop shop' approach is having an impact on the process of service delivery. The findings also suggest that, in the integrated teams, the initial stages of the process of seeking help and being assessed for a service may have improved through better communication, understanding and exchange of information amongst different professional groups. However, the degree of ,integration' seen within these co-located health and social care teams does not appear to be sufficiently well developed to have had an impact upon the clinical outcomes for the patients/service users. It appears unlikely from the available evidence that measures such as co-location go far enough to produce changes in outcomes for older people. If the Department of Health wishes to see benefits in process progress to benefits to service users, then more major structural changes will be required. The process of changing organisational structures can be enhanced where there is evidence that such changes will produce better outcomes. At present, this evidence does not exist, although the present study does suggest that benefits might be forthcoming if greater integration can be achieved. Nevertheless, until the social services and National Health Service trusts develop more efficient and compatible information systems, it will be impossible to evaluate what impact any further steps towards integration might have on older people without significant external resources. [source]

    The implementation of intravenous tissue plasminogen activator in acute ischaemic stroke , a scientific position statement from the National Stroke Foundation and the Stroke Society of Australasia

    Ad Hoc Committee representing the National Stroke Foundation, the Stroke Society of Australasia
    Abstract Intravenous tissue plasminogen activator (tPA) has been licensed in Australia for thrombolysis in selected patients with acute ischaemic stroke since 2003. The use of tPA is low but is increasing across Australia and national audits indicate efficacy and safety outcomes equivalent to international benchmarks. Implementing tPA therapy in clinical practice is, however, challenging and requires a coordinated multidisciplinary approach to acute stroke care across prehospital, emergency department and inpatient care sectors. Stroke care units are an essential ingredient underpinning safe implementation of stroke thrombolysis. Support systems such as care pathways, therapy delivery protocols, and thrombolysis-experienced multidisciplinary care teams are also important enablers. Where delivery of stroke thrombolysis is being planned, health systems need to be re-configured to provide these important elements. This consensus statement provides a review of the evidence for, and implementation of, tPA in acute ischaemic stroke with specific reference to the Australian health-care system. [source]