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2.
West Afr J Med ; 36(2): 138-143, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31385600

RESUMO

BACKGROUND: Holistic ward round (HWR) is a polyadic, multiphasic, holistic model of neurosurgical patient care. It is a multidisciplinary ward round where all healthcare providers involved in patients care, the patients, the relations, as well as clergymen (depending on the patients' faith and need) collectively work to review patient's condition and make decisions in the patient's best interest. OBJECTIVES: The study assessed the effectiveness of the holistic model of care and identified the challenges facing this model of healthcare delivery. METHODS: The study was qualitative in design and In-depth Interviews (IDIs) were conducted with eighteen (18) participants who were purposively selected. They include neurosurgeons, nurses, medical social workers and physiotherapists. The data were thematically content analysed with the help of ATLAS.ti (v.7) software. RESULTS: The study found that patients and relations have immensely benefitted from the model of care through psychosocial support. The major challenges facing HWR were logistic, timing and common problems found in the Nigerian healthcare system. CONCLUSION: It was concluded that for HWR to effectively help spinal cord injured patients further, the healthcare providers, patients and their families require support in different forms from outside the hospital.


Assuntos
Saúde Holística , Equipe de Assistência ao Paciente , Assistência ao Paciente , Assistência Centrada no Paciente/métodos , Adulto , Feminino , Hospitais Universitários , Humanos , Relações Interprofissionais , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Neurocirurgiões , Neurocirurgia , Nigéria , Fisioterapeutas , Pesquisa Qualitativa , Assistentes Sociais
3.
Surg Clin North Am ; 99(5): 977-989, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31446922

RESUMO

This article provides a road map for discharge planning of adult patients with serious life-limiting illnesses. The need for early and guided conversations with specific prompts is offered to assist in the transition of care process. Transparent, patient-centered interactions are emphasized throughout with an acknowledgment that this type of direct, interpersonal communication may challenge a clinical team's typical mode of operation. Nevertheless, when done well, this approach can lead to better outcomes for everyone involved. This framework for discharge planning has led to greater patient and family satisfaction, lower mortality, reduced societal costs, and fewer instances of hospital readmission.


Assuntos
Pessoas com Deficiência/reabilitação , Alta do Paciente , Cuidados Pós-Operatórios/métodos , Adulto , Feminino , Humanos , Cuidados Paliativos/métodos , Assistência Centrada no Paciente , Sobreviventes
4.
Stud Health Technol Inform ; 264: 843-847, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438043

RESUMO

The number of patients with multimorbidity has been steadily increasing in the modern aging societies. The European C3-Cloud project provides a multidisciplinary and patient-centered "Collaborative Care and Cure-system" for the management of elderly with multimorbidity, enabling continuous coordination of care activities between multidisciplinary care teams (MDTs), patients and informal caregivers (ICG). In this study various components of the infrastructure were tested to fulfill the functional requirements and the entire system was subjected to an early application testing involving different groups of end-users. MDTs from participating European regions were involved in requirement elicitation and test formulation, resulting in 57 questions, distributed via an internet platform to 48 test participants (22 MDTs, 26 patients) from three pilot sites. The results indicate a high level of satisfaction with all components. Early testing also provided feedback for technical improvement of the entire system, and the paper points out useful evaluation methods.


Assuntos
Computação em Nuvem , Multimorbidade , Idoso , Humanos , Assistência Centrada no Paciente
6.
Stud Health Technol Inform ; 265: 128-133, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31431588

RESUMO

Patient-centred care and the empowerment of patients through shared clinical decision-making is a key goal of healthcare systems internationally. The Emergency Department is one of the first opportunities for shared decision-making to occur, with information exchanged between patient and clinician, between clinical disciplines, across the continuum of care, and between clinicians and ancillary departments including radiology and pathology laboratories. The successful development and implementation of sustainable health information technology (HIT) to support shared decision-making in Emergency care requires an understanding of the factors affecting this context. From a purposive, maximum variation sample of clinicians and a convenience sample of patients across three metropolitan and regional Emergency Departments in Australia, we identified three divergent discourses from an in-depth qualitative exploration of issues around shared decision-making. This allowed us to identify unanticipated factors affecting patient-centred care to inform context-sensitive implementation of HIT in the Emergency Department.


Assuntos
Tomada de Decisões , Serviços Médicos de Emergência , Austrália , Serviço Hospitalar de Emergência , Humanos , Assistência Centrada no Paciente
7.
Stud Health Technol Inform ; 265: 181-185, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31431596

RESUMO

The provision of individualised treatment and care from health care services to patients with chronic conditions and multi-morbidities is under pressure because of an increasing elderly population. There is a need for services that are: 1) person-centred, 2) integrated and 3) proactive, and supported by digital technology. The research project 3P-Patients and Professionals in Productive Teams aims to study different patient-centred teamwork models in Norway and Denmark. This paper presents a study on patients' experiences and digital involvement in patient-centred care teams. Qualitative research methods were applied with interviews and demonstrations of technology use made at patient's homes. The results showed that the patients were satisfied with the patient-centred service models and had an increased feeling of safety. A constraint was information sharing between the patient-centred health care team and the patients. Most of them did not have access to read own medical information and mainly verbal information was shared between the patients and the health providers.


Assuntos
Equipe de Assistência ao Paciente , Assistência Centrada no Paciente , Doença Crônica , Dinamarca , Humanos , Noruega , Pesquisa Qualitativa
9.
Stud Health Technol Inform ; 262: 110-113, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31349278

RESUMO

A 'Rapid Recommendation' has been produced by the GRADE group, in collaboration with MAGIC and BMJ, in response to an RCT showing Dual Anti-Platelet Therapy (DAPT) is superior to Aspirin alone for patients who had suffered acute high risk transient ischaemic attack or minor ischaemic stroke. The interactive MAGIC decision aid that accompanies each Rapid Recommendation is the main route to their clinical implementation. It can facilitate preference-sensitive person-centred care, but only if a Multi-Criteria Decision Analysis-based decision support tool is added. A demonstration version of such an add-on to the MAGIC aid, divested of recommendations, is available online. Exploring the results of different preference inputs into the tool raises questions about the strong recommendation for DAPT.


Assuntos
Isquemia Encefálica , Ataque Isquêmico Transitório , Acidente Vascular Cerebral , Isquemia Encefálica/tratamento farmacológico , Clopidogrel , Humanos , Ataque Isquêmico Transitório/tratamento farmacológico , Assistência Centrada no Paciente , Inibidores da Agregação de Plaquetas/uso terapêutico , Acidente Vascular Cerebral/tratamento farmacológico
10.
Stud Health Technol Inform ; 262: 118-121, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31349280

RESUMO

A growing number of condition-specific standard outcome sets have been developed by the International Consortium for Health Outcomes Measurement in pursuit of 'value-based care'. These sets embrace many Patient-Reported Outcome Measures (PROMs), reflecting a simultaneous commitment to 'patient-centred care'. However, none of these sets embody recognition of the preference-sensitive nature of the decisions that eventually generate the outcome database. 'Patient-Reported Importance Measures' (PRIMs) are the valid source of the required preferences. The ICHOM Stroke standard set is input into a hypothetical Multi-Criteria Decision Analysis-based decision support tool to provide simple confirmation that PROMs should be preference-mix adjusted as well as case-mix adjusted. PROMs need PRIMs if value-based care is to be personalised values-based care.


Assuntos
Medidas de Resultados Relatados pelo Paciente , Assistência Centrada no Paciente , Qualidade de Vida , Tomada de Decisões , Humanos , Avaliação de Resultados (Cuidados de Saúde)
11.
Rev Lat Am Enfermagem ; 27: e3151, 2019 Jul 18.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31340342

RESUMO

OBJECTIVE: to adapt the Consultation and Relational Empathy Measure (Brazilian version) for nurses; to evaluate the concurrence between empathy self-reported by nurses and that perceived by patients; To correlate self-compassion to the empathy self-reported by nurses and perceived by patients. METHOD: seven specialists validated the Consultation and Relational Empathy Measure Nurses (Brazilian version)' adaptation by original author's authorization. A sample with 15 triage nurses and 93 patients they admitted to the Emergency Department of a philanthropic private hospital were interviewed according to the following instruments: Consultation and Relational Empathy Measure - Nurses (Brazilian version) and the Self-Compassion Scale (Brazilian version). RESULTS: the psychometrics properties of Consultation and Relational Empathy Measure - Nurses (Brazilian version) showed appropriate internal consistency (Cronbach's alpha=0,799). The evaluation of empathy provided by the patients was better than that self-reported by the nurses (p<0,001). The nurses with higher level of self-compassion also showed higher empathy scores (p=0,002). CONCLUSION: our results confirmed the psychometrics properties' adequacy of Consultation and Relational Empathy Measure - Nurses (Brazilian version), allowing to compare empathy scores embased at same parameters. Self-compassion showed to influence self-reported empathy.


Assuntos
Empatia , Relações Enfermeiro-Paciente , Assistência Centrada no Paciente/normas , Autorrelato , Adolescente , Adulto , Idoso , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Triagem , Adulto Jovem
13.
N Engl J Med ; 381(3): 219-229, 2019 07 18.
Artigo em Inglês | MEDLINE | ID: mdl-31314966

RESUMO

BACKGROUND: Universal antiretroviral therapy (ART) with annual population testing and a multidisease, patient-centered strategy could reduce new human immunodeficiency virus (HIV) infections and improve community health. METHODS: We randomly assigned 32 rural communities in Uganda and Kenya to baseline HIV and multidisease testing and national guideline-restricted ART (control group) or to baseline testing plus annual testing, eligibility for universal ART, and patient-centered care (intervention group). The primary end point was the cumulative incidence of HIV infection at 3 years. Secondary end points included viral suppression, death, tuberculosis, hypertension control, and the change in the annual incidence of HIV infection (which was evaluated in the intervention group only). RESULTS: A total of 150,395 persons were included in the analyses. Population-level viral suppression among 15,399 HIV-infected persons was 42% at baseline and was higher in the intervention group than in the control group at 3 years (79% vs. 68%; relative prevalence, 1.15; 95% confidence interval [CI], 1.11 to 1.20). The annual incidence of HIV infection in the intervention group decreased by 32% over 3 years (from 0.43 to 0.31 cases per 100 person-years; relative rate, 0.68; 95% CI, 0.56 to 0.84). However, the 3-year cumulative incidence (704 incident HIV infections) did not differ significantly between the intervention group and the control group (0.77% and 0.81%, respectively; relative risk, 0.95; 95% CI, 0.77 to 1.17). Among HIV-infected persons, the risk of death by year 3 was 3% in the intervention group and 4% in the control group (0.99 vs. 1.29 deaths per 100 person-years; relative risk, 0.77; 95% CI, 0.64 to 0.93). The risk of HIV-associated tuberculosis or death by year 3 among HIV-infected persons was 4% in the intervention group and 5% in the control group (1.19 vs. 1.50 events per 100 person-years; relative risk, 0.79; 95% CI, 0.67 to 0.94). At 3 years, 47% of adults with hypertension in the intervention group and 37% in the control group had hypertension control (relative prevalence, 1.26; 95% CI, 1.15 to 1.39). CONCLUSIONS: Universal HIV treatment did not result in a significantly lower incidence of HIV infection than standard care, probably owing to the availability of comprehensive baseline HIV testing and the rapid expansion of ART eligibility in the control group. (Funded by the National Institutes of Health and others; SEARCH ClinicalTrials.gov number, NCT01864603.).


Assuntos
Antirretrovirais/uso terapêutico , Serviços de Saúde Comunitária , Infecções por HIV/tratamento farmacológico , Administração Massiva de Medicamentos , Programas de Rastreamento , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Adolescente , Adulto , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Infecções por HIV/mortalidade , Humanos , Incidência , Quênia/epidemiologia , Masculino , Pessoa de Meia-Idade , Assistência Centrada no Paciente , Prevalência , Fatores Socioeconômicos , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Uganda/epidemiologia , Carga Viral , Adulto Jovem
14.
Nephrol Nurs J ; 46(3): 340-343, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31199101

RESUMO

Nurses value patient- and family-centered care as one of the most important elements of nursing, and as such, these foundations are embedded into nursing practice and theory. Patient engagement in health research, as an evolution of patient- and family-centered care, has emerged as a critical new way of doing research over the last several years. However, the benefit, value, and exploration of ways in which patient partnerships can be built within the context of nephrology nursing research are still relatively new. This article describes patient-centered outcomes research, discusses how patients can be involved throughout the research process, and provides examples for effective partnerships in nephrology nursing research.


Assuntos
Cuidadores , Enfermagem em Nefrologia , Nefrologia , Pesquisa em Enfermagem , Humanos , Participação do Paciente , Assistência Centrada no Paciente
16.
Med Educ Online ; 24(1): 1630238, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31248353

RESUMO

Given the economic burden and numerous morbidities associated with obesity and poor dietary choices, it is increasingly important for medical students to receive education on nutrition and preventive medicine so that they are equipped to advise patients about healthy lifestyle choices. Currently, 71% of US medical schools do not reach the minimum benchmark of 25 hours of nutrition education set by the National Academy of Sciences. In order to improve the quality and quantity of nutrition education at the Keck School of Medicine of USC (KSOM), medical students and faculty have partnered with LA Kitchen (LAK), a local teaching kitchen, and the Wellness Center at LA County Medical Center (LAC+USC). They developed a hands-on preclinical culinary and nutrition course that aims to teach students practical skills and knowledge that they will be able to apply to their own lives and pass onto patients. Following the completion of the first three years of the course (2016-2018), analysis suggests that the class was well-received and has improved students' nutrition knowledge, confidence in lifestyle counseling, and personal culinary skills. Given these highly encouraging observations, the project is currently aimed at incorporating nutrition education more broadly into the required preclinical curriculum at KSOM.


Assuntos
Culinária/métodos , Dieta , Educação Médica/organização & administração , Ciências da Nutrição/educação , Assistência Centrada no Paciente/organização & administração , Currículo , Humanos , Relações Interinstitucionais , Faculdades de Medicina/organização & administração
17.
Expert Rev Med Devices ; 16(7): 617-629, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31159603

RESUMO

INTRODUCTION: Obstructive sleep apnea in children has a prevalence of 5%. Polysomnography is considered to be the gold standard for diagnosis and stratification of the condition. However, it is resource-intensive, expensive and uncomfortable for children and their families. AREAS COVERED: We focus this review on technical developments in sensor technology, materials and predictive analytics for translation to (i) patient comfort and compliance in the laboratory and (ii) validation of home sleep apnea testing in children. Key developments in adult polysomnography that could be considered for adoption in children are also highlighted. This review is organized by Sleep, Cardiovascular, Oximetry, Position, Effort, and Respiratory (SCOPER) parameters of interest. EXPERT OPINION: In the past decade, improvements in respiratory sensors and signal processing strategies have transitioned sleep apnea testing in adults from the laboratory to home, thus reducing costs and improving access. Unfortunately, such benefits have not been observed for children principally due to the lack of high-quality studies. The increasing cost of diagnosis of sleep apnea in children needs urgent attention. Recent technical developments as described in this review have the potential to support further evaluation of home sleep apnea testing while improving the current circumstances of in-lab polysomnography for children.


Assuntos
Engenharia Biomédica/métodos , Assistência Centrada no Paciente , Apneia Obstrutiva do Sono/diagnóstico , Criança , Humanos , Aprendizado de Máquina , Oximetria , Polissonografia , Apneia Obstrutiva do Sono/fisiopatologia
18.
BMC Health Serv Res ; 19(1): 368, 2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31185968

RESUMO

BACKGROUND: Healthcare professionals' person-centered communication skills are pivotal for delivering successful diabetes education. Many healthcare professionals favor person-centeredness as a concept, but implementation in practice remains challenging. Today, programs have often a fixed curriculum dominated by biomedical issues. Most person-centered methods are developed targeting individual consultations, although group-based programs are a widespread and efficient method of support. Person-centeredness in group-based programs requires a change in practice towards addressing biopsychosocial issues and facilitating group processes. The objective of this study was to explore how healthcare professionals implement new approaches to facilitate group-based, person-centered diabetes education targeting people with type 2 diabetes. METHODS: The study was guided by action research and divided into three studies: investigation, development, and pilot using a variety of qualitative methods. In the first study; observations across five settings were conducted. Forty-nine group participants and 13 professionals took part; the focus was to investigate approaches that supported or hindered person-centeredness in groups. Observations were supplemented by interviews (n = 12) and two focus groups (n = 16) with group participants, as well as interviews (n = 5) with professionals. In the second study; 14 professionals collaborated in two workshops to develop new approaches. In the third study, new approaches were pilot-tested using observations in three settings. Twenty-five group participants and five professionals took part. The analysis of the pilot test led to the final workshop where six professionals took part. RESULTS: Implementation was characterized by three categories. Some professionals chose not to implement the methods because they conflicted with their practice relying on the biomedical model. Other incorporated some approaches but was unable to structure the process, leaving participants uncertain about the aim. Finally, one setting succeeded with implementation, tailoring content and processes to group participants' needs. CONCLUSION: The use of action research created context-sensitive approaches and increased professionals' readiness to implement. More attention should be paid to systematic training of professionals. Training should be structured stepwise incorporating techniques directed towards existing skills including ample time to train and reiterate skills.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Educação de Pacientes como Assunto , Assistência Centrada no Paciente , Autogestão , Diabetes Mellitus Tipo 2/psicologia , Pessoal de Saúde/educação , Humanos , Relações Médico-Paciente , Projetos Piloto , Pesquisa Qualitativa , Autogestão/métodos , Autogestão/psicologia
19.
Clin Interv Aging ; 14: 997-1005, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31213786

RESUMO

Purpose: Advance care planning (ACP) performed by regular staff, which also includes patients with cognitive impairment and their next of kin, is scarcely studied. Thus, we planned an implementation study including key stakeholders (patients, next of kin, and health care personnel) using a whole-ward/system approach to ACP. We explored how they experienced ACP and its significance. Patients and methods: This qualitative study is part of a mixed-method implementation study of ACP. In four nursing homes, we did qualitative interviews and audio-recordings of meetings. We completed 20 individual semistructured interviews with participants soon after ACP conversations. The interviews included patients with cognitive impairment, their next of kin, and health care personnel. We also conducted four focus group interviews with staff and managers in the nursing homes and audio-recorded four network meetings with the project teams implementing ACP. Results: All participants appreciated taking part in ACP. Patients and next of kin focused more on the past and present than future treatment preferences. Still, ACP seemed to contribute to a stronger patient focus on end-of-life conversations. More generally, ACP seemed to contribute to valuable information for future decision-making, trusting relations, improved end-of-life communication, and saving time and resources. Conclusion: Safeguarding a strong patient focus on ACP and fostering a person-centered care culture in nursing home wards seem to be achievable through implementation of ACP that includes regular staff, patients with cognitive impairment, and their next of kin.


Assuntos
Planejamento Antecipado de Cuidados , Disfunção Cognitiva , Instituição de Longa Permanência para Idosos/organização & administração , Casas de Saúde/organização & administração , Assistência Centrada no Paciente , Adulto , Idoso , Atitude do Pessoal de Saúde , Cuidadores/psicologia , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/psicologia , Tomada de Decisões/ética , Feminino , Grupos Focais , Humanos , Masculino , Assistência Centrada no Paciente/ética , Assistência Centrada no Paciente/métodos , Relações Profissional-Família/ética , Pesquisa Qualitativa
20.
Niger Postgrad Med J ; 26(2): 87-93, 2019 Apr-Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31187747

RESUMO

Background: Healthcare has become complex requiring balance of ever-increasing demands on physicians against humanness of medicine. As the impetus for the delivery of patient-centred care grows, there is need to study the attitude and practice orientations of medical practitioners to patient-doctor relationship (PDR). The study was aimed at describing the attitude, practice, barriers and benefits of PDR among medical practitioners in Abia State. Participants and Methods: A descriptive cross-sectional study was carried out on 210 medical practitioners in Abia State who were consecutively recruited for the study. Data were collected using self-administered questionnaire that elicited information on attitude, practice, barriers and benefits of PDR. Attitude was assessed with the 18-item Patient-Practitioner Orientation Scale (PPOS) with subscales of caring and sharing. Results: The age of the participants ranged from 26 to 77 years with the mean of 36 ± 8.4 years. There were 173 (82.4%) male. The caring attitude score (mean = 3.57 ± 0.80) was higher than sharing (mean = 3.42 ± 0.65) (P = 0.036). Practice was predominantly doctor-centred (86.7%) than patient-centred (64.3%, P < 0.0001). The most common barrier to PDR was patient-doctor communication, while the most common benefit of PDR was improvement in patient satisfaction. Medical practitioners with duration of practice <10 years had significantly higher mean scores in attitudinal subscale of caring when compared with those with duration of practice ≥10 years (P < 0.0001). The study participants with duration of practice ≥10 years had significantly higher adequate practice (75.0%) of patient-centred care when compared with their counterparts with duration of practice <10 years (47.6%) (P = 0.00005). Conclusion: The attitude to caring did not translate to comparative disposition to sharing. The practice was more doctor-centred than patient-centred. The most common barrier and benefit of PDR were communication drawbacks and improvement in patient satisfaction, respectively. Duration of practice was associated with caring attitude and practice of patient-centred care, respectively.


Assuntos
Atitude do Pessoal de Saúde , Comunicação , Relações Médico-Paciente , Médicos/psicologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Área Carente de Assistência Médica , Pessoa de Meia-Idade , Nigéria , Assistência Centrada no Paciente , Qualidade da Assistência à Saúde , Inquéritos e Questionários
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