Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 15 de 15
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
2.
Int J Qual Health Care ; 31(Supplement_1): 29-34, 2019 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-31867661

RESUMO

OBJECTIVE: Remote monitoring (RM) of patients with cardiac rhythm management devices enables healthcare teams to effectively and efficiently monitor patients with heart problems without the requirement in-person patient visits. RM has been associated with safer and higher quality care but was not being used to its full potential in this setting. Cardiac rhythm management had observed an average implant rate of 295 devices per year over the past 13 years, resulting in a five-fold growth in patient follow-up in clinics. This increased demand was becoming unmanageable, with impacts on care quality. This study aimed to enhance the enrolment of eligible patients to RM. DESIGN: A pre-post design. SETTING: A 600-bed city centre teaching hospital in Dublin, Ireland. PARTICIPANTS: Hospital staff and patients eligible for RM. INTERVENTIONS: Lean Six Sigma methods were used to develop patient education materials on RM and the clinic area was redesigned to enable RM enrolment and monitoring. MAIN OUTCOMES MEASURES: Number of unscheduled attendances to clinic and RM enrolment. RESULTS: At baseline, the clinic was processing 102 RM follow-up checks with 140 unscheduled attendances on average per month. Following implementation, RM enrolment increased to 335 RM follow-up checks (194% increase), with 41 unscheduled attendances on average per month (70% decrease). These results were sustained one-year post-implementation. CONCLUSIONS: These process changes have streamlined workflow by reducing the number of unscheduled attendances to clinic and increased the use of RM among the eligible patient population. This has meant safer, more timely responses to cardiac events and enhanced care quality.

3.
BMJ ; 365: l2008, 2019 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-31064755
5.
Thorax ; 74(4): 354-361, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30661019

RESUMO

PURPOSE: Malignant pleural mesothelioma (MPM) has a high symptom burden and poor survival. Evidence from other cancer types suggests some benefit in health-related quality of life (HRQoL) with early specialist palliative care (SPC) integrated with oncological services, but the certainty of evidence is low. METHODS: We performed a multicentre, randomised, parallel group controlled trial comparing early referral to SPC versus standard care across 19 hospital sites in the UK and one large site in Western Australia. Participants had newly diagnosed MPM; main carers were additionally recruited. INTERVENTION: review by SPC within 3 weeks of allocation and every 4 weeks throughout the study. HRQoL was assessed at baseline and every 4 weeks with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30. PRIMARY OUTCOME: change in EORTC C30 Global Health Status 12 weeks after randomisation. RESULTS: Between April 2014 and October 2016, 174 participants were randomised. There was no significant between group difference in HRQoL score at 12 weeks (mean difference 1.8 (95% CI -4.9 to 8.5; p=0.59)). HRQoL did not differ at 24 weeks (mean difference -2.0 (95% CI -8.6 to 4.6; p=0.54)). There was no difference in depression/anxiety scores at 12 weeks or 24 weeks. In carers, there was no difference in HRQoL or mood at 12 weeks or 24 weeks, although there was a consistent preference for care, favouring the intervention arm. CONCLUSION: There is no role for routine referral to SPC soon after diagnosis of MPM for patients who are cared for in centres with good access to SPC when required. TRIAL REGISTRATION NUMBER: ISRCTN18955704.


Assuntos
Neoplasias Pulmonares/reabilitação , Mesotelioma/reabilitação , Cuidados Paliativos/organização & administração , Neoplasias Pleurais/reabilitação , Qualidade de Vida , Idoso , Cuidadores/psicologia , Feminino , Humanos , Masculino , Cooperação do Paciente , Psicometria , Encaminhamento e Consulta/organização & administração , Fatores de Tempo , Reino Unido , Austrália Ocidental
6.
BMJ ; 361: k2752, 2018 06 28.
Artigo em Inglês | MEDLINE | ID: mdl-29954732
8.
Trials ; 15: 367, 2014 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-25238873

RESUMO

BACKGROUND: Malignant pleural mesothelioma is an incurable cancer caused by exposure to asbestos. The United Kingdom has the highest death rate from mesothelioma in the world and this figure is increasing. Median survival is 8 to 12 months, and most patients have symptoms at diagnosis. The fittest patients may be offered chemotherapy with palliative intent. For patients not fit for systemic anticancer treatment, best supportive care remains the mainstay of management. A study from the United States examining advanced lung cancer showed that early specialist palliative care input improved patient health related quality of life and depression symptoms 12 weeks after diagnosis. While mesothelioma and advanced lung cancer share many symptoms and have a poor prognosis, oncology and palliative care services in the United Kingdom, and many other countries, vary considerably compared to the United States. The aim of this trial is to assess whether regular early symptom control treatment provided by palliative care specialists can improve health related quality of life in patients newly diagnosed with mesothelioma. METHODS: This multicentre study is an non-blinded, randomised controlled, parallel group trial. A total of 174 patients with a new diagnosis of malignant pleural mesothelioma will be minimised with a random element in a 1:1 ratio to receive either 4 weekly regular early specialist symptom control care, or standard care. The primary outcome is health related quality of life for patients at 12 weeks. Secondary outcomes include health related quality of life for patients at 24 weeks, carer health related quality of life at 12 and 24 weeks, patient and carer mood at 12 and 24 weeks, overall survival and analysis of healthcare utilisation and cost. DISCUSSION: Current practice in the United Kingdom is to involve specialist palliative care towards the final weeks or months of a life-limiting illness. This study aims to investigate whether early, regular specialist care input can result in significant health related quality of life gains for patients with mesothelioma and if this change in treatment model is cost-effective. The results will be widely applicable to many institutions and patients both in the United Kingdom and internationally. TRIAL REGISTRATION: Current controlled trials ISRCTN18955704. Date ISRCTN assigned: 31 January 2014.


Assuntos
Neoplasias Pulmonares/terapia , Mesotelioma/terapia , Cuidados Paliativos/métodos , Neoplasias Pleurais/terapia , Qualidade de Vida , Encaminhamento e Consulta , Projetos de Pesquisa , Afeto , Cuidadores/psicologia , Protocolos Clínicos , Efeitos Psicossociais da Doença , Análise Custo-Benefício , Custos de Cuidados de Saúde , Recursos em Saúde/economia , Recursos em Saúde/estatística & dados numéricos , Nível de Saúde , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/economia , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/psicologia , Mesotelioma/complicações , Mesotelioma/diagnóstico , Mesotelioma/economia , Mesotelioma/mortalidade , Mesotelioma/psicologia , Cuidados Paliativos/economia , Neoplasias Pleurais/complicações , Neoplasias Pleurais/diagnóstico , Neoplasias Pleurais/economia , Neoplasias Pleurais/mortalidade , Neoplasias Pleurais/psicologia , Encaminhamento e Consulta/economia , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Reino Unido
9.
BMJ Support Palliat Care ; 4(1): 87-91, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24644778

RESUMO

It is now accepted that teaching in palliative medicine should be integrated throughout the medical undergraduate curriculum. Recommendations suggest the inclusion of knowledge areas such as symptom control, as well as more attitudinal aspects such as teamwork and understanding patient and carer perspectives on illness. These subjects should be taught on a stepwise basis, introducing concepts at an early stage and then be built on throughout training. However, how this is done and how effectively all aspects are taught vary considerably. This article outlines one way of using patient and carer experiences of significant illness, and multi-disciplinary teams, to teach attitudinal concepts behind palliative care to medical students early in their undergraduate careers. Palliative care is considered here in a broad sense, with the relevance to all healthcare professionals emphasised, and specialist palliative care used as an example of holistic care. The sessions consisted of small group discussions with patient and carer representatives as well as discussions with various members of the multi-disciplinary team. These were led by the patient/carer/professionals' experiences and further explored with facilitated questions by the students. The sessions have been evaluated well by all involved, including patients, carers, multi-disciplinary team members and palliative medicine doctors. The learning objectives (to understand patient perspectives, multi-disciplinary working and holistic care) were achieved, along with discussion of professionalism.


Assuntos
Currículo , Educação de Graduação em Medicina/métodos , Cuidados Paliativos/métodos , Medicina Paliativa/educação , Competência Clínica , Humanos , Reino Unido
11.
Int J Palliat Nurs ; 16(8): 401-5, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20852516

RESUMO

Nurse independent prescribing (NIP) has been at the centre of government policy in the UK to improve patient care. Clinical nurse specialists (CNSs) are key workers in the delivery of specialist palliative care services, and NIP enables them to improve the quality of care their patients receive. However, there are known barriers that prevent qualified NIPs from prescribing, including lack of NIP policies in organizations and difficulties in ensuring ongoing mentoring and support. This article describes how an NIP policy was developed and introduced within an independent specialist palliative care setting (hospice community team). The process undertaken by the NIP policy team is described as well as approaches to overcoming potential and actual barriers. Challenges in creating a NIP policy are explored, including such issues as managing off-label prescribing, obtaining peer support and securing insurance cover. As CNSs often work independently, it was felt important to provide mentoring following qualification by senior medical staff in order to gain confidence in their new roles in NIP. Wider influences, such as initiatives to increase care of patients in the community and 7-day working by CNSs are also considered. This article aims to support other health care providers, both in the independent and national health sectors, who plan to deliver the NIP agenda. Barriers to NIP must be addressed in order to achieve success and to ensure specialist palliative care nurses trained in NIP are able to put their extended skills into practice.


Assuntos
Prescrições de Medicamentos , Cuidados Paliativos , Especialidades de Enfermagem , Política de Saúde , Medicina Estatal , Reino Unido
12.
Rev Pain ; 4(2): 14-7, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26526660

RESUMO

Be alert to possible spinal cord compression in patients who are at risk and who present with warning signs and symptomsMaintain a low threshold for further investigation of such patients and for discussing them with specialist colleaguesIf MSCC is suspected, commence high dose steroids (16mg dexamethasone orally in the morning) immediatelyEnsure imaging to confirm diagnosis of MSCC is carried out within 24 hours of clinical suspicionEnsure prompt treatment within 24 hours of diagnosis.

14.
Palliat Med ; 18(3): 234-8, 2004 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15198136

RESUMO

Depression is a significant symptom for approximately 25% of palliative care patients, but is frequently unrecognized and untreated. This study was carried out to determine how senior doctors working in palliative medicine in the UK assessed and managed depression in their patients. A questionnaire was sent to all palliative care units with a designated consultant or medical director. Questions were asked about assessment and management of depression (pharmacological and nonpharmacological); difficulties encountered, qualifications and current post. The response rate was 63%; two-thirds (90) of respondents were consultants and a further 21 medical directors. The majority (73%) routinely assessed for depression with 27% using the Hospital Anxiety and Depression (HAD) Scale and 10% asking the patient 'are you depressed'? The most frequently prescribed medication was SSRI (80%). Less than 6% prescribed psychostimulants. Respondents reported difficulties with the assessment and management of depression which mainly focused on distinguishing symptoms of depression from sadness and whether it was appropriate to treat patients when life expectancy was short. Difficulties were identified in accessing psychiatric input by 47%. Depression is identified as being a difficult symptom to manage by many senior palliative care physicians in the UK and suggestions are made as to how some of theses issues can be addressed.


Assuntos
Transtorno Depressivo/terapia , Cuidados Paliativos , Prática Profissional , Consultores , Transtorno Depressivo/diagnóstico , Inglaterra , Feminino , Humanos , Masculino , Corpo Clínico Hospitalar , Escalas de Graduação Psiquiátrica , Inquéritos e Questionários
15.
Am J Hosp Palliat Care ; 20(3): 229-30, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-12785045

RESUMO

Durogesic (fentanyl) patches have revolutionized pain relief, but patients still require breakthrough medication. A retrospective analysis of in-patient admission notes at a 25-bed hospice over a six-month period was carried out. Details of analgesia being used on admission for both background and breakthrough pain were obtained, and the appropriateness of the breakthrough dose for those patients using transdermal fentanyl was determined. During the study period 278 patients were admitted to the hospice and 56 (20 percent) were using transdermal fentanyl. Of these, 35 (62 percent) were prescribed strong opioid analgesia--the dose of breakthrough medication prescribed was appropriate in 11 patients (31 percent). Rescue dosing was less than recommended, in relation to prescribed transdermal fentanyl strength in 21 patients (60 percent) and greater than recommended in one patient (3 percent). In this study, short-acting strong opioid analgesia was not always prescribed for patients using transdermal fentanyl, and when they were prescribed, this was in the appropriate dose range in less than a third of patients.


Assuntos
Analgésicos Opioides/administração & dosagem , Revisão de Uso de Medicamentos , Fentanila/administração & dosagem , Cuidados Paliativos na Terminalidade da Vida , Morfina/administração & dosagem , Dor Intratável/tratamento farmacológico , Cuidados Paliativos , Administração Cutânea , Quimioterapia Combinada , Humanos , Neoplasias/tratamento farmacológico , Estudos Retrospectivos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA