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1.
Rev Infirm ; 68(254): 33-35, 2019 Oct.
Artículo en Francés | MEDLINE | ID: mdl-31587850

RESUMEN

Many rural areas, far from hospitals, are seeing a decline in the number of general practitioners, making it more difficult for patients in these regions to access care. However, there are relevant solutions, as illustrated by the Dousopal network in Normandy, which, teaming up with home care providers, contributes to organising palliative care support for all, in optimal conditions.


Asunto(s)
Cuidados Paliativos/organización & administración , Servicios de Salud Rural/organización & administración , Francia , Médicos Generales/provisión & distribución , Accesibilidad a los Servicios de Salud , Servicios de Atención de Salud a Domicilio/organización & administración , Humanos
2.
Medicine (Baltimore) ; 98(40): e17395, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31577748

RESUMEN

To date, few studies have examined the end-of-life (EOL) care for patients with hematological malignancies (HMs). We evaluated the effects of palliative care on the quality of EOL care and health care costs for adult patients with HMs in the final month of life.We conducted a population-based study and analyzed data from Taiwan's Longitudinal Health Insurance Database, which contains claims information for patient medical records, health care costs, and insurance system exit dates (our proxy for death) between 2000 and 2011.A total of 724 adult patients who died of HMs were investigated. Of these patients, 43 (5.9%) had received only inpatient palliative care (i-Pal group), and 19 (2.6%) received home palliative care (h-Pal group). The mean health care costs during the final month of life were not significantly different between the non-Pal and Pal groups (p=0.315) and between the non-Pal, i-Pal, and h-Pal groups (p=0.293) either. By the multivariate regression model, the i-Pal group had lower risks of chemotherapy, ICU admission, and receipt of CPR, but higher risks of at least two hospitalizations and dying in hospital after adjustments. The h-Pal group had the similar trends as the i-Pal group but lower risk of dying in hospital after adjustments.Patients with HMs who had received palliative care could benefit from less aggressive EOL cancer care in the final month of life. However, 8.6% patients with HMs received palliative care. The related factors of more hospitalizations and dying in hospital warrant further investigation.


Asunto(s)
Neoplasias Hematológicas/epidemiología , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Cuidados Paliativos/organización & administración , Cuidado Terminal/organización & administración , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Antineoplásicos/uso terapéutico , Comorbilidad , Femenino , Gastos en Salud/estadística & datos numéricos , Neoplasias Hematológicas/tratamiento farmacológico , Neoplasias Hematológicas/economía , Servicios de Atención de Salud a Domicilio/economía , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Humanos , Unidades de Cuidados Intensivos/economía , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Cuidados Paliativos/economía , Cuidados Paliativos/estadística & datos numéricos , Características de la Residencia , Índice de Severidad de la Enfermedad , Factores Sexuales , Factores Socioeconómicos , Taiwán , Cuidado Terminal/economía , Cuidado Terminal/estadística & datos numéricos
3.
Soins Pediatr Pueric ; 40(310): 45-48, 2019.
Artículo en Francés | MEDLINE | ID: mdl-31543235

RESUMEN

Paediatric palliative care has been set up after extensive discussion and observations regarding the need to provide different support to children with a serious and incurable disease as well as their families. The mobile palliative care team support children and their family in this specific process and train caregivers in the palliative approach.


Asunto(s)
Hospitales Pediátricos/organización & administración , Unidades Móviles de Salud/organización & administración , Cuidados Paliativos/organización & administración , Grupo de Atención al Paciente/organización & administración , Niño , Humanos
4.
Scand J Trauma Resusc Emerg Med ; 27(1): 88, 2019 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-31533807

RESUMEN

BACKGROUND: Much effort has been made to explore how patients with advanced chronic illness and their families experience care when they attend the Emergency Department, and many studies have investigated how healthcare professionals perceive Palliative Care provision in the Emergency Department. Various models exist, but nonetheless incorporating palliative care into the Emergency Department remains challenging. Considering both healthcare professionals' and users' perspective on problems encountered in delivering and receiving appropriate palliative care within this context may provide important insight into meaningful targets for improvements in quality of care. Accordingly, this study aims at exploring issues in delivering palliative care in the Emergency Department from the perspective of both providers and users, as part of a larger project on the development and implementation of a quality improvement program in Italian Emergency Departments. METHODS: A qualitative study involving focus group interviews with Emergency Department professionals and semi-structured interviews with patients with palliative care needs in the Emergency Department and their relatives was conducted. Both datasets were analyzed using Thematic Analysis. RESULTS: Twenty-one healthcare professionals, 6 patients and 5 relatives participated in this study. Five themes were identified: 1) shared priorities in Emergency Department among healthcare professionals and patients, 2) the information provided by healthcare professionals and that desired by relatives, 3) perception of environment and time, 4) limitations and barriers to the continuity of care, and 5) the contrasting interpretations of giving and receiving palliative care. CONCLUSIONS: This study provides insights into targets for changes in Italian Emergency Departments. Room for improvement relates to training for healthcare professionals on palliative care, the development of a shared care pathway for patients with palliative care needs, and the optimization of Emergency Department environment. These targets will be the basis for the development of a quality improvement program in Italian Emergency Departments.


Asunto(s)
Actitud del Personal de Salud , Enfermedad Crónica/terapia , Servicio de Urgencia en Hospital/organización & administración , Personal de Salud/normas , Cuidados Paliativos/organización & administración , Investigación Cualitativa , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad
5.
Surg Clin North Am ; 99(5): 815-821, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31446910

RESUMEN

Palliative care is an interdisciplinary field that focuses on optimizing quality of life for patients with serious, life-limiting illnesses and includes aggressive management of pain and symptoms; psychological, social, and spiritual support; and discussions of advance care planning, including treatment decision making and complex care coordination. Early palliative care is associated with increased quality of life, decreased symptom burden, decreased health care expenditures, and improved caregiver outcomes. This article discusses integrating interdisciplinary palliative care into surgical practice, and some current models of using and expanding palliative care skill sets in surgery, including training initiatives for both physicians and nurses.


Asunto(s)
Cuidados Paliativos/organización & administración , Grupo de Atención al Paciente , Atención Perioperativa , Enfermedad Crónica , Humanos , Calidad de Vida , Cuidado Terminal
6.
Surg Clin North Am ; 99(5): 823-831, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31446911

RESUMEN

A common fallacy prevalent in surgical culture is for surgical intervention and palliation to be regarded as mutually exclusive or sequential strategies in the trajectory of surgical illness. Modern surgeons play a complex role as both providers and gatekeepers in meeting the palliative needs of their patients. Surgical palliative care is ideally delivered by surgical teams as a component of routine surgical care, and includes management of physical and psychosocial symptoms, basic communication about prognosis and treatment options, and identification of patient goals and values. Specialty palliative care services may be accessed through a through a variety of models.


Asunto(s)
Cuidados Paliativos/organización & administración , Atención Perioperativa , Humanos , Grupo de Atención al Paciente , Cirujanos , Procedimientos Quirúrgicos Operativos
8.
Presse Med ; 48(7-8 Pt 1): e209-e215, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31421945

RESUMEN

AIM: Identified Palliative Care Beds (Lits Identifiés Soins Palliatifs - LISPs) is a French specificity. Primarily created to integrate palliative care culture into conventional hospital units, the relevance of this measure became a controversial issue. Nowadays, hospital teams continue to frequently encounter complex situations regarding medical care for palliative patients. To the best of our knowledge, there is only one study, a quantitative one, bridging the gap about that subject. It showed failure in practicing palliative care work around LISP. Our study is based on a qualitative method that complements the quantitative study. It aimed to describe difficulties that limit palliative care practices in managing adult patients in LISP. METHOD: This qualitative exploratory survey was conducted with a sample of health service professionals (n=20), from senior physicians to caregivers. Each semi-structured interview included open questions regarding their experiences, feelings and difficulties with palliative care practices on LISP. It also included closed questions concerning interviewee's demographics and career course. The data for this research were submitted to a two-stage analysis: first, a global review of each interview was performed to identify trends. Then, a detailed breakdown, question by question, was implemented. RESULTS: From a quantitative perspective, the interviews revealed 305 difficulties, indicating the gaps and barriers limiting the implementation of a palliative approach in these services. From a qualitative perspective, five topics raised our attention by their recurrence in discourses: (1) partial knowledge about palliative care definition and legislation mostly due to a lack of training; (2) need for time; (3) need for human resources; (4) need for communication; (5) hard time in transitioning from curative to palliative care. PERSPECTIVE: This survey gives the opportunity to understand health service professionals' difficulties in practicing palliative care in conventional medical services. It raises the central issue of the pricing reform on the health institutes activity. It also provides angles of inquiry to improve LISP effectiveness. This qualitative and descriptive study was designed to explore difficulties in practicing palliative care around LISP. Nevertheless, according to the size of the sample, results will need to be confirmed by a more extensive qualitative survey.


Asunto(s)
Continuidad de la Atención al Paciente , Unidades Hospitalarias/organización & administración , Cuidados Paliativos/organización & administración , Grupo de Atención al Paciente/organización & administración , Pautas de la Práctica en Medicina , Calidad de la Atención de Salud/organización & administración , Adulto , Actitud del Personal de Salud , Cuidadores/organización & administración , Cuidadores/normas , Barreras de Comunicación , Continuidad de la Atención al Paciente/organización & administración , Continuidad de la Atención al Paciente/normas , Prestación de Atención de Salud/métodos , Prestación de Atención de Salud/organización & administración , Prestación de Atención de Salud/normas , Arquitectura y Construcción de Instituciones de Salud/normas , Francia , Conocimientos, Actitudes y Práctica en Salud , Capacidad de Camas en Hospitales , Unidades Hospitalarias/normas , Humanos , Entrevistas como Asunto , Satisfacción en el Trabajo , Cuidados Paliativos/psicología , Cuidados Paliativos/normas , Grupo de Atención al Paciente/normas , Pautas de la Práctica en Medicina/organización & administración , Pautas de la Práctica en Medicina/normas , Investigación Cualitativa , Calidad de la Atención de Salud/normas , Estudios Retrospectivos , Encuestas y Cuestionarios
9.
Prim Care ; 46(3): 399-413, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31375189

RESUMEN

Primary care physicians are at the frontlines, often the first point of contact for many people with the medical system. They have to manage chronically ill patients with life-limiting diagnoses who also have ongoing psychosocial needs. This article discusses why cultural, spiritual, and religious interplay with medical decision making is important and provide some strategies for addressing these aspects of care.


Asunto(s)
Características Culturales , Cuidados Paliativos/organización & administración , Atención Primaria de Salud/organización & administración , Religión , Espiritualidad , Humanos , Cuidados Paliativos/psicología , Calidad de Vida
10.
Prim Care ; 46(3): 415-432, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31375190

RESUMEN

Management of chronic diseases is often palliative by definition. Empowering primary care providers to manage symptoms and effectively prognosticate is necessary for this challenging population. In this article, the authors focus specifically on end-stage congestive heart failure, chronic obstructive pulmonary disease, end-stage kidney disease, and end-stage liver disease and how palliative principles can guide decision making and symptom management in these disease states. Special considerations in advance care planning, initiation and cessation of advanced therapies, and discussions on when to initiate hospice are included in this article.


Asunto(s)
Enfermedad Crónica/terapia , Cuidados Paliativos/organización & administración , Atención Primaria de Salud/organización & administración , Planificación Anticipada de Atención , Enfermedad Hepática en Estado Terminal/terapia , Insuficiencia Cardíaca/terapia , Hospitales para Enfermos Terminales/organización & administración , Humanos , Fallo Renal Crónico/terapia , Pronóstico , Enfermedad Pulmonar Obstructiva Crónica/terapia , Calidad de la Atención de Salud
11.
Prim Care ; 46(3): 433-445, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31375191

RESUMEN

Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has metamorphosed in the past 40 years since the first cases were diagnosed. The advent of highly active antiretroviral treatment (HAART) transformed the disease trajectory for many patients with HIV/AIDS and transitioned the course from a terminal disease to a chronic disease model. This article reviews the epidemiology of HIV/AIDS, prognostic indicators, frailty, opportunistic infections, specific AIDS-defining malignancies and non-AIDS-defining malignancies, role of palliative care, advance care planning, and the role of HAART in patients dying of late-stage AIDS.


Asunto(s)
Infecciones por VIH/epidemiología , Cuidados Paliativos/organización & administración , Atención Primaria de Salud/organización & administración , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Planificación Anticipada de Atención , Factores de Edad , Fragilidad/epidemiología , Humanos , Cumplimiento de la Medicación , Neoplasias/epidemiología , Manejo del Dolor/métodos , Pronóstico
12.
Prim Care ; 46(3): 447-459, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31375192

RESUMEN

In the geriatric age group, few studies demonstrate the efficacy of aggressive treatment. Often, a more palliative approach is wanted; such an approach can lead to better quality of life and even a longer life. The author discusses the limits of medical interventions in the elderly, the paucity of data, and the benefits of palliation in certain medical conditions, including dementia, Parkinson, depression, arthritis, congestive heart failure, and pneumonia. The role of frailty is addressed; specific goals of palliative care are delineated, such as reduction of polypharmacy, fall prevention, pain reduction, and the central role of a primary care provider.


Asunto(s)
Cuidados Paliativos/organización & administración , Atención Primaria de Salud/organización & administración , Accidentes por Caídas/prevención & control , Factores de Edad , Anciano , Anciano de 80 o más Años , Enfermedad Crónica/epidemiología , Enfermedad Crónica/terapia , Fragilidad/epidemiología , Evaluación Geriátrica , Hospitalización , Humanos , Manejo del Dolor/métodos , Rol del Médico , Polifarmacia , Calidad de Vida , Factores Socioeconómicos
13.
Pediatrics ; 144(2)2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31366685

RESUMEN

Integration of pediatric palliative care (PPC) into management of children with serious illness and their families is endorsed as the standard of care. Despite this, timely referral to and integration of PPC into the traditionally cure-oriented cardiac ICU (CICU) remains variable. Despite dramatic declines in mortality in pediatric cardiac disease, key challenges confront the CICU community. Given increasing comorbidities, technological dependence, lengthy recurrent hospitalizations, and interventions risking significant morbidity, many patients in the CICU would benefit from PPC involvement across the illness trajectory. Current PPC delivery models have inherent disadvantages, insufficiently address the unique aspects of the CICU setting, place significant burden on subspecialty PPC teams, and fail to use CICU clinician skill sets. We therefore propose a novel conceptual framework for PPC-CICU integration based on literature review and expert interdisciplinary, multi-institutional consensus-building. This model uses interdisciplinary CICU-based champions who receive additional PPC training through courses and subspecialty rotations. PPC champions strengthen CICU PPC provision by (1) leading PPC-specific educational training of CICU staff; (2) liaising between CICU and PPC, improving use of support staff and encouraging earlier subspecialty PPC involvement in complex patients' management; and (3) developing and implementing quality improvement initiatives and CICU-specific PPC protocols. Our PPC-CICU integration model is designed for adaptability within institutional, cultural, financial, and logistic constraints, with potential applications in other pediatric settings, including ICUs. Although the PPC champion framework offers several unique advantages, barriers to implementation are anticipated and additional research is needed to investigate the model's feasibility, acceptability, and efficacy.


Asunto(s)
Cardiopatías/terapia , Unidades de Cuidados Intensivos/organización & administración , Cuidados Paliativos/métodos , Cuidados Paliativos/organización & administración , Niño , Cuidados Críticos/métodos , Cuidados Críticos/organización & administración , Cardiopatías/diagnóstico , Cardiopatías/epidemiología , Humanos , Lactante
14.
Cancer Control ; 26(1): 1073274819863802, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31319695

RESUMEN

Although the burden of cancer is rapidly growing in Vietnam, there was no up-to-date review that describes cancer burden and control in Vietnam throughout the literature. By identifying various risk factors, means of prevention, and methods for early detection, this review seeks to systematically summarize the evidence for the future planning and management of cancer occurrence in Vietnam. Additionally, this report aims to identify improvements which are necessary for the treatment and palliative care of patients with cancer in Vietnam. We employed a hybrid approach including both a scoping review and narrative synthesis for this study. Information was identified, extracted, and charted from various sources, which include international and domestically published studies, in addition to gray literature. Our results illustrate that the burden of cancer in Vietnam has tripled in the past 30 years, and this situation could be partly explained by the growing prevalence of both old and new risk factors. Besides hepatitis B virus, various other important risk factors such as human papilloma virus, tobacco usage, physical inactivity, and improper diets are still not under control in Vietnam. There is presently a lack of national cancer screening programs, and the capacity of cancer care services could not maintain pace with the demands of a rapidly increasing Vietnamese population. Overall, policy frameworks for cancer control in Vietnam are in place, but there is still a lack of proper financing and governing models necessary to support a sustainable program. In conclusion, Cancer and its associated consequences are both persistent and emerging problems in Vietnam, and the results of cancer control programs are limited. A comprehensive and evidence-based approach toward the prevention and treatment of cancer should be the future direction for Vietnam.


Asunto(s)
Costo de Enfermedad , Prestación de Atención de Salud/organización & administración , Medicina Basada en la Evidencia/organización & administración , Oncología Médica/organización & administración , Neoplasias/epidemiología , Prestación de Atención de Salud/métodos , Prestación de Atención de Salud/tendencias , Detección Precóz del Cáncer/métodos , Detección Precóz del Cáncer/tendencias , Medicina Basada en la Evidencia/métodos , Medicina Basada en la Evidencia/tendencias , Implementación de Plan de Salud , Humanos , Oncología Médica/métodos , Oncología Médica/tendencias , Neoplasias/terapia , Cuidados Paliativos/métodos , Cuidados Paliativos/organización & administración , Cuidados Paliativos/tendencias , Prevalencia , Factores de Riesgo , Desarrollo Sostenible , Vietnam/epidemiología
15.
Home Healthc Now ; 37(4): 208-212, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31274583

RESUMEN

In 2010, the Institute of Medicine published the vision for how to transform healthcare to achieve a more seamless patient-centered, high-quality system of care. Among the recommendations were four specifically focused on leveraging nursing which is the largest group of healthcare workers: (1) Ensure that nurses can practice to the full extent of their education and training, (2) Improve nursing education, (3) Provide opportunities for nurses to assume leadership positions and to serve as full partners in healthcare redesign and improvement efforts, and (4) Improve data collection for workforce planning and policy making. At the Care New England Health Care System's Visiting Nurse Association, located in the state of Rhode Island, we redesigned access to end-of-life care by leveraging these recommendations. An experienced palliative care nurse practitioner (NP) leads the program development to improve care delivered by home healthcare nurses and NP specialists. This program was designed to allow patients to remain in their preferred setting of care-their home-until the end of their life. In the 5 years of this program's existence, it has achieved a yearly impact on community-based palliative care and hospice services. The number of documented advance directives increased by 75%, referrals to palliative care and hospice increased by 300% and the length of time on hospice doubled. In addition, NP home visits became an accepted referral source and improvements in both the quality and satisfaction scores for the home healthcare agency were realized.


Asunto(s)
Accesibilidad a los Servicios de Salud , Enfermería de Cuidados Paliativos al Final de la Vida , Guías de Práctica Clínica como Asunto , Cuidado Terminal , Accesibilidad a los Servicios de Salud/organización & administración , Cuidados Paliativos al Final de la Vida/métodos , Cuidados Paliativos al Final de la Vida/organización & administración , Enfermería de Cuidados Paliativos al Final de la Vida/métodos , Enfermería de Cuidados Paliativos al Final de la Vida/organización & administración , Enfermería de Cuidados Paliativos al Final de la Vida/normas , Humanos , Cuidados Paliativos/métodos , Cuidados Paliativos/organización & administración , Rhode Island , Cuidado Terminal/métodos , Cuidado Terminal/organización & administración , Cuidado Terminal/normas , Cuidado Terminal/estadística & datos numéricos
16.
J Allied Health ; 48(2): 127-133, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31167015

RESUMEN

PURPOSE: The scope of hospice or palliative care has expanded since its inception, which has significant ramifications for the AH workforce. This study sought to elicit allied health (AH) clinicians' understanding and views about palliative care and its relevance to their clinical practice and to identify their educational needs. Results from analysis of free text survey responses to a single open-ended question from a larger survey are presented. METHODS: An online survey was distributed to AH clinicians via email lists for the CareSearch Allied Health Hub, Allied Health Professions Australia, and other groups. Descriptive statistics and content analysis of free text responses were used to analyse the data. RESULTS: A total of 217 AH clinicians responded to an email survey and 187 useable responses were analysed. Four themes were identified: 1) palliative care employs a client-centred model of care, 2) acknowledgement of living whilst dying, 3) interdisciplinary palliative care interventions provide active care in a range of domains, and 4) characteristics of palliative care teams and settings. CONCLUSION: AH clinicians plan an active role in physical, social, and psycho-spiritual care of palliative care patients and caregivers. Burgeoning numbers of palliative care patients in nonspecialist palliative care settings require AH clinicians to develop skills and competencies to work with people who have advanced disease.


Asunto(s)
Técnicos Medios en Salud/psicología , Cuidados Paliativos/organización & administración , Rol Profesional , Adulto , Australia , Cuidadores/psicología , Estudios Transversales , Humanos , Comunicación Interdisciplinaria , Masculino , Cuidados Paliativos/psicología , Grupo de Atención al Paciente/organización & administración , Atención Dirigida al Paciente/organización & administración
17.
BMC Palliat Care ; 18(1): 48, 2019 Jun 05.
Artículo en Inglés | MEDLINE | ID: mdl-31167656

RESUMEN

BACKGROUND: Sustainable funding is key for ensuring the quality and coverage of palliative care services. This study examined the sources of funding for stand-alone palliative care services in Uganda as well as their services financial sustainability plans. METHODS: Researchers conducted a cross sectional survey of all stand-alone palliative care organizations that have operated for five or more years. Researchers administered a questionnaire survey and interviews on the audited financial statements, services provided and sustainability plans. RESULTS: Nine of the stand-alone palliative care organizations surveyed had operated for five to 25 years. 93% of the funding for palliative care services comes from donations; while 7% is from income generating activities. 94% of the donations are from external sources. The Government of Uganda's major contribution is in the form of medicines, training and payment of taxes. All the organizations had good financial records. Six of the fifteen Hospices/palliative care providers had sustainability plans included in their operational manuals. The older organizations (those that had been operational for more than 10 years) had better resource mobilization capacity and strategies. CONCLUSION: The majority of stand-alone palliative care organizations in Uganda are largely donor funded. They have considerable financial sustainability and fund-raising capacity. Government support is in the form of medicines and training. Based on this study findings, the capacity of the stand-alone palliative care services to raise funds should be increased. The Government of Uganda should include palliative care in the national health system and increase funding for these services.


Asunto(s)
Financiación de la Atención de la Salud , Cuidados Paliativos/economía , Evaluación de Programas y Proyectos de Salud/tendencias , Estudios Transversales , Humanos , Cuidados Paliativos/organización & administración , Cuidados Paliativos/estadística & datos numéricos , Estudios Retrospectivos , Uganda
18.
Artículo en Inglés | MEDLINE | ID: mdl-31151321

RESUMEN

Opioid errors are a leading cause of patient harm. Active failures in opioid dose conversion can contribute to error. Conversion is complex and is currently performed manually using tables of approximate equivalence. Apps that offer opioid dose double-checking are available but there are concerns about their accuracy and clinical validation. This study evaluated a novel opioid dose conversion app, The Safer Prescription of Opioids Tool (SPOT), a CE-marked Class I medical device, as a clinician decision support (CDS) platform. This single-centre prospective clinical utility pilot study followed a mixed methods design. Prescribers completed an initial survey exploring their current opioid prescribing practice. Thereafter prescribers used SPOT for opioid dosage conversions in parallel to their usual clinical practice, then evaluated SPOT through a survey and focus group. SPOT matched the Gold Standard result in 258 of 268 (96.3%) calculations. The 10 instances (3.7%) when SPOT did not match were due to a rounding error. Users had a statistically significant increase in confidence in prescribing opioids after using SPOT. Focus group feedback highlighted benefits in Quality Improvement and Safety when using SPOT. SPOT is a safe, reliable and validated CDS that has potential to reduce harms from opioid dosing errors.


Asunto(s)
Analgésicos Opioides/uso terapéutico , Sistemas de Apoyo a Decisiones Clínicas/organización & administración , Cuidados Paliativos/organización & administración , Cuidado Terminal/organización & administración , Analgésicos Opioides/administración & dosificación , Sistemas de Apoyo a Decisiones Clínicas/normas , Relación Dosis-Respuesta a Droga , Humanos , Aplicaciones Móviles , Cuidados Paliativos/normas , Proyectos Piloto , Pautas de la Práctica en Medicina , Estudios Prospectivos , Cuidado Terminal/normas
19.
Healthc Q ; 22(1): 36-41, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31244466

RESUMEN

Collaborative interprofessional primary care (PC) teams are widely seen as an essential attribute of high-performing PC systems (Aggarwal and Hutchinson 2012). Effective PC teams play a key role in the mobilization of healthcare resources and navigation of the health and social care system for their patients. In Ontario, the establishment of Family Health Teams has resulted in the implementation of unique programs that deliver services to palliative and elderly patients with a focus on keeping them at home and out of hospital. Case studies cited in this article highlight two innovative programs in Family Health Teams and provide perspectives on lessons for successful implementation.


Asunto(s)
Servicios de Atención de Salud a Domicilio/organización & administración , Cuidados Paliativos/organización & administración , Anciano , Anciano de 80 o más Años , Servicios de Salud Comunitaria/organización & administración , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Humanos , Ontario , Estudios de Casos Organizacionales , Cuidados Paliativos/estadística & datos numéricos , Grupo de Atención al Paciente/organización & administración , Cuidado Terminal/organización & administración
20.
World J Pediatr Congenit Heart Surg ; 10(3): 338-342, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-31084309

RESUMEN

Surgical palliation has remarkably improved survival of functionally single ventricle (FSV) patients born in developed nations but such outcomes have not occurred in Africa. The poor care coverage for FSV patients in Africa exists within the larger sphere of deficient health care for children born with congenital heart defects (CHDs) in Africa generally. This review takes the position that to improve health-care coverage for CHD patients on the continent, political priority is paramount. This can be attained with cohesive leadership for the CHD agenda, a guiding institution, and the mobilization of civil society to drive advocacy at national and international levels.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos/métodos , Prestación de Atención de Salud/métodos , Cardiopatías Congénitas/cirugía , Ventrículos Cardíacos/anomalías , Cuidados Paliativos/organización & administración , África , Niño , Ventrículos Cardíacos/cirugía , Humanos
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