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2.
Clin J Oncol Nurs ; 26(4): 391-398, 2022 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-35939720

RESUMO

BACKGROUND: Palliative care clinicians display less burnout than oncology clinicians. Little is known about the impact of providing both oncology care and primary palliative care in the same setting. OBJECTIVES: The aim was to determine whether nurses providing primary palliative care in addition to oncology care would experience less burnout over time than nurses providing oncology care only. METHODS: The authors performed secondary analysis of the CONNECT study. Three groups of nurses were evaluated: primary palliative care, non-primary palliative care, and standard care. On study enrollment and after one year, nurses completed the Maslach Burnout Inventory. Multivariable regression analyses were performed to test differences in follow-up burnout scores between groups. FINDINGS: Overall burnout rates were low at enrollment for all groups. There were no differences in burnout scores at one year between nurses who provided palliative care and nurses in the other two groups. .


Assuntos
Esgotamento Profissional , Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Enfermeiras Clínicas , Humanos , Enfermagem Oncológica , Cuidados Paliativos/métodos , Inquéritos e Questionários
4.
Continuum (Minneap Minn) ; 28(4): 1052-1082, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-35938657

RESUMO

PURPOSE OF REVIEW: This article describes an approach to symptom management in people with multiple sclerosis (MS), emphasizing healthy lifestyles and evidence-based treatments. RECENT FINDINGS: Growing evidence supports healthy nutrition, exercise, and emotional well-being (wellness) as foundational for MS symptom management. A stepped approach starts with healthy lifestyle practices and adds nonpharmacologic, pharmacologic, and procedural-based therapies balancing levels of evidence, risks, and potential benefits. The growing availability of cannabis and widespread use of dietary supplements in self-management of MS symptoms raise both therapeutic promises and challenges. SUMMARY: Wellness approaches for MS symptom management foster self-reliance and should be reinforced early and often. Recognition of symptom clusters and medical comorbidities helps limit polypharmacy.


Assuntos
Esclerose Múltipla , Comorbidade , Exercício Físico , Estilo de Vida Saudável , Humanos , Esclerose Múltipla/tratamento farmacológico , Esclerose Múltipla/terapia , Cuidados Paliativos
5.
Georgian Med News ; (325): 27-32, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35920576

RESUMO

Palliative care is a comprehensive approach that includes medical, psychological, social, and spiritual support for patients to achieve the best quality of life for patients with incurable diseases and their relatives. Nurses are one of the main links that make up mobile palliative care teams they occupy an ideal position to provide quality care at the patient's bedside. However, the knowledge and skills of nurses remain at a low level and limiting high-quality palliative care. The purpose of this review is to study the problems of readiness of nursing staff to provide palliative care. A search for scientific articles in English and Russian published no later than 2015 was conducted in databases (Scopus, EBSCOhost, Wiley, PubMed). The study was conducted in February-April 2022. Fifty publications were selected as the analytical material for the review. Nurses often experience a lack of knowledge about pain relief, care for people with dementia, pain recognition, the use of special pain assessment tools, social and cultural traditions, and beliefs of patients. Many studies confirm the lack of awareness about the essence, philosophy, and principles of palliative care. The main barriers are the lack of specialized education, lack of clarity and delineation of responsibilities between specialists, heavy workload in the workplace, and limited legitimacy. Kazakhstan has carried out many reforms in the palliative care field, however, according to statistics, over 80% of medical personnel do not have basic knowledge about palliative care. The results indicate the need to develop educational programs on palliative care for all medical universities and colleges, where special attention should be paid to the cultural characteristics of patients, communication skills, and skills of step-by-step anesthesia. A clear division of functional responsibilities, the delegation of authority, and the reduction of the burden on nurses will improve the quality of palliative nursing care.


Assuntos
Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Recursos Humanos de Enfermagem , Humanos , Dor , Cuidados Paliativos , Qualidade de Vida
6.
JAMA Netw Open ; 5(8): e2225805, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-35930281

RESUMO

Importance: Limited access to appropriate specialists and testing may be associated with delayed diagnosis and symptom management for patients with early-onset Alzheimer disease and related dementias (ADRDs). Objectives: To examine rural vs urban differences in diagnostic and symptom management service use among patients with early-onset ADRDs. Design, Setting, and Participants: This cross-sectional study was conducted using commercial claims from 2012 to 2017. Included patients were those with early-onset ADRDs aged 40 to 64 years, including new patients, defined as those with no claims of ADRDs for 36 months before the first ADRD diagnosis. The likelihood of receiving diagnostic and symptom management services was estimated, with adjustment for individual-level variables associated with health care use. Data were analyzed from February 2021 to March 2022. Exposures: Rural residence. Main Outcomes and Measures: Among patients with new, early-onset ADRDs, use of psychological assessment and neuropsychological testing performed at the initial diagnosis (index date) or 90 days or less after the index date and use of brain imaging during the 180 days before the index date were collected. Access to different clinicians on the index date or 90 days or less after the index date was also collected, including visits to primary care physicians and nurse practitioners (PCPs) and specialty visits to psychologists, neurologists, and psychiatrists. Results: Among 71 799 patients with early-onset ADRD (mean [SD] age, 56.34 [6.05] years; 39 231 women [54.64%]), 8430 individuals had new early-onset ADRDs (mean [SD] age, 55.94 [6.30] years; 16 512 women [56.65%]). There were no statistically significant differences between new patients with early-onset ADRDs in rural vs urban areas in the use of psychological assessments, imaging studies, or visits to neurologists or psychiatrists. However, new patients in rural areas were less likely to receive neuropsychological testing (odds ratio [OR], 0.83; 95% CI, 0.70-0.98) or visit a psychologist (OR, 0.72; 95% CI, 0.60-0.85) compared with patients in urban areas. However, new patients in rural areas with early-onset ADRDs were more likely to have only PCP visits for diagnosis and symptom management compared with those in urban areas (OR, 1.40; 95% CI, 1.19-1.66). Conclusions and Relevance: This study found that new patients with early-onset ADRDs in rural areas were less likely to receive neuropsychological testing or visit psychologists but more likely to be diagnosed and treated exclusively by PCPs compared with those in urban areas. These findings suggest that efforts, such as clinician education or teleconsultative guidance to PCPs, may be needed to enhance access to specialist services in rural areas.


Assuntos
Doença de Alzheimer , População Rural , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/epidemiologia , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Testes Neuropsicológicos , Cuidados Paliativos
7.
PLoS One ; 17(8): e0270961, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35930579

RESUMO

BACKGROUND: Older adults account for a large proportion of emergency department visits, but those with serious life-limiting illness may benefit most from referral to home and community services instead of hospitalization. We aim to document emergency provider perspectives on facilitators and barriers to accessing home and community services for older adults with serious life-limiting illness. METHODS: We conducted interviewer-administered semi-structured interviews with emergency providers from health systems across the United States to obtain provider perspectives on facilitators and barriers to accessing home and community services. We completed qualitative thematic analysis using an iterative process to develop themes and subthemes to summarize provider responses. RESULTS: We interviewed 8 emergency nurses and 10 emergency physicians across 11 health systems. Emergency providers were familiar with local home and community services. Facilitators to accessing these services include care management and social workers. Barriers include services that are not accessible full-time to receive referrals, insurance/payment, and the busy nature of the emergency department. The most helpful reported services were hospice, physical therapy, occupational therapy, and visiting nursing services. Home-based palliative care and full-time emergency department-based care management and social work were the services most desired by providers. Providers expressed support for improving access to home and community services in the hopes of decreasing unnecessary emergency visits and inpatient admissions, and to provide patients with greater options for supportive care. CONCLUSION: Obtaining the perspective of emergency providers highlights important considerations to accessing HCS for older-adults with serious life-limiting illness from the emergency department. This study provides foundational information for futures studies and initiatives for improving access to home and community services directly from the emergency department.


Assuntos
Cuidados Paliativos na Terminalidade da Vida , Idoso , Humanos , Cuidados Paliativos , Pesquisa Qualitativa , Encaminhamento e Consulta , Seguridade Social , Estados Unidos
8.
J Coll Physicians Surg Pak ; 32(8): 1047-1050, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35932131

RESUMO

OBJECTIVE: To evaluate the outcome of Laparoscopic Gastro-jejunostomy in patients presenting with Gastric Outlet obstruction secondary to Corrosive intake at the Services Hospital. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Department of Surgery, Services Hospital, Lahore, Pakistan, from June 2013 to June 2021. METHODOLOGY: Data was gathered from the patients who presented with gastric outlet obstruction with a pre-hospitalised history of corrosive intake. Consenting patients subsequently underwent laparoscopic gastro-jejunostomy and were followed up post-operatively at a 1-week time-point and 4-week time-point to monitor progress. Studied variables included duration of surgery, duration of hospital stay, complications, and mortality at the 1st and 4th weeks. RESULTS: A total of 30 patients participated in the study including 27 (90%) females and 3 (10%) males. The mean age was 27.2 ± 4.07 years. The mean duration of hospital stay was 9.3 ± 3.2 days. Complications were seen in 3 patients (10%) with 1 death (3.33%). CONCLUSION: Laparoscopic gastro-jejunostomy appears to be safe and effective in corrosive intake patients presenting with gastric outlet obstruction. KEY WORDS: Corrosive Intake, Gastric outlet obstruction, Laparoscopic, Gastrojejunostomy.


Assuntos
Cáusticos , Derivação Gástrica , Obstrução da Saída Gástrica , Laparoscopia , Adulto , Feminino , Derivação Gástrica/efeitos adversos , Obstrução da Saída Gástrica/etiologia , Obstrução da Saída Gástrica/cirurgia , Humanos , Jejunostomia/efeitos adversos , Laparoscopia/efeitos adversos , Masculino , Cuidados Paliativos , Estudos Retrospectivos , Adulto Jovem
11.
J Palliat Med ; 25(8): 1311-1312, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35913475
12.
Br J Community Nurs ; 27(8): 402-410, 2022 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-35924900

RESUMO

During COVID-19, it was critical that services adapted to meet the high demands of the pandemic. This qualitative study explores the experiences of several staff members of the community palliative care team, as they adapted the delivery of their services to such pressures. Semi-structured interviews via a virtual platform were conducted and four themes were identified: service development, communication, inter-professional relationships and support mechanisms. The participants supported the change in service delivery and use of technology to triage patients. The participants also reported improved collaboration and patient care-coordination, and enhanced support mechanisms used by the team helped sustain resilience and wellbeing. Although challenging, the team embraced the changes and described improved collaboration and coordination of patient care.


Assuntos
COVID-19 , Comunicação , Humanos , Cuidados Paliativos , Pandemias , Pesquisa Qualitativa
13.
Br J Community Nurs ; 27(8): 384-391, 2022 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-35924904

RESUMO

This article illustrates the completion of a scoping review of the evidence relating to the role of the palliative care key worker, providing an insight into current literature. While advocated in international and national policies, the evidence underpinning this role is lacking, with only five empirical papers: two national and three international. The review identifies the need for the key worker role in palliative care; however, little consensus exists on who should adopt this role and their remits. Several implementation barriers are cited relating to communication and training. Further research on the development, implementation and consensus on the allocation of duties of the key worker role would expand the existing evidence base.


Assuntos
Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Cuidados Paliativos , Comunicação , Humanos
14.
Biomater Adv ; 137: 212810, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35929235

RESUMO

Intestinal stents are a palliative treatment option that solves many shortcomings of traditional surgeries for cancer-induced intestinal obstructions. The present review provides an overview of the incidence, clinical manifestations and limitations in the treatment of intestinal cancers. The paper also discusses material property requirements, indications, complications and the future of stent-assisted therapy. The advantages and disadvantages of different materials and processing techniques for intestinal stents are reviewed along with new stent treatment combinations for colorectal cancer. Challenges that require further cooperative studies are also detailed. The future development of intestinal stents will depend on innovation in material designs as well as the utilization of multi-functional strategies and innovative engineering solutions.


Assuntos
Neoplasias Colorretais , Obstrução Intestinal , Neoplasias Colorretais/cirurgia , Humanos , Obstrução Intestinal/etiologia , Cuidados Paliativos/métodos , Stents/efeitos adversos , Resultado do Tratamento
16.
Curr Opin Support Palliat Care ; 16(3): 94-101, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-35929556

RESUMO

PURPOSE OF REVIEW: A rapid review was conducted to synthesize evidence of palliative care delivery changes during the COVID-19 pandemic. Changes were synthesized according to the eight domains of high-quality palliative care and enduring implications for oncology nurses beyond the pandemic discussed. RECENT FINDINGS: The most significant changes occurred in the structure and processes of palliative care (Domain 1), where increased utilization of telehealth was critical in circumventing barriers imposed by COVID-19 mitigation. The suboptimal availability of community-based psychosocial supports for patients and caregivers and inadequate health system-based psychosocial supports for healthcare providers were highlighted (Domains 3-5). The pandemic also ushered in an increased emphasis on the need for advance care planning (ACP), where integrating its delivery earlier in the outpatient setting and shifting policy to promote subsequent virtual documentation (Domain 8) were essential to ensure care preferences were clarified and accessible before health crises occurred. SUMMARY: Continuing to embrace and sustain systems-level changes with respect to telehealth, psychosocial supports, and ACP are critical to bridging gaps in palliative care delivery underscored by the pandemic. Oncology nurses are well positioned to fill these gaps in care beyond the pandemic by providing evidence-based, palliative care throughout the cancer continuum.


Assuntos
Planejamento Antecipado de Cuidados , COVID-19 , COVID-19/epidemiologia , Humanos , Enfermagem Oncológica , Cuidados Paliativos/métodos , Pandemias
18.
Sci Rep ; 12(1): 13271, 2022 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-35918513

RESUMO

The identification of subgroups of people living with HIV in China based on the severity of symptom clusters and individual symptoms is crucial to determine group-specific symptom management strategies. Participants reported 27 highly prevalent HIV/AIDS-related symptoms. Latent profile analysis based on symptom severity was used to identify person-centered subtypes of HIV/AIDS-related symptoms. Symptom networks were compared among subgroups identified by latent profile analysis. A total of 2927 eligible people living with HIV (PWH) were included in the analysis. Five profiles were identified: "Profile 1: all low symptom severity" (n2 = 2094, 71.54%), "Profile 2: medium symptom severity with syndemic conditions" (n3 = 109, 3.72%), "Profile 3: medium symptom severity with low functional status" (n1 = 165, 5.64%), "Profile 4: medium symptom severity in transitional period" (n4 = 448, 15.31%), and "Profile 5: all high symptom severity" (n5 = 111, 3.79%). Except for Profile 1 and Profile 5, the symptom severity was similar among the other three profiles. Profiles 1 (2.09 ± 0.52) and 4 (2.44 ± 0.66) had the smallest ∑s values, and Profiles 2 (4.38 ± 1.40) and 5 (4.39 ± 1.22) had the largest ∑s values. Our study demonstrates the need for health care professionals to provide PWH with group-specific symptom management interventions based on five profiles to improve their physical and psychological well-being. Future studies should be conducted in different contexts using different symptom checklists to further validate our results.


Assuntos
Síndrome de Imunodeficiência Adquirida , China/epidemiologia , Humanos , Cuidados Paliativos
19.
BMC Palliat Care ; 21(1): 140, 2022 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-35918682

RESUMO

BACKGROUND: Palliative care is among the standards of care in cancer treatment that should be provided to those in need within the existing healthcare system. In Ethiopia, patients with cervical cancer experience a long wait for curative radiotherapy, while the level of palliative care delivery is unknown. In this study, we aimed to evaluate the practice of palliative care among women diagnosed with advanced cervical cancer. METHODS: A hospital-based cross-sectional study was conducted. Using a structured questionnaire, face-to-face interviews were made with randomly selected patients with advanced cervical cancer. Information on patient characteristics, medical records, and knowledge, attitude and practice of palliative care was captured, analysed, and presented. Data collection was conducted following ethical standards after obtaining approval from the hospital. RESULTS: A total of 385 patients were interviewed, most of whom were over 50 years and illiterate. The patients had poor knowledge regarding comprehensive palliative care, a good attitude, and poor practices. Most patients either do not know about palliative care or consider it solely as a pain treatment. The patients expressed a good attitude towards palliative care; however, their attitude towards talking about suffering, death, and dying was poor. Almost all patients have received some form of palliative care. However, poor pain control, inadequate education and counselling, and poor social, economic, and spiritual supports were documented. CONCLUSIONS: Patients with advanced cervical cancer expressed a good attitude but had poor knowledge and practice of comprehensive palliative care. The palliative care delivery needs to address the communication, psychosocial, economic, and spiritual components of the comprehensive palliative care.


Assuntos
Cuidados Paliativos , Neoplasias do Colo do Útero , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Hospitais , Humanos , Dor , Cuidados Paliativos/psicologia , Neoplasias do Colo do Útero/terapia
20.
BMC Palliat Care ; 21(1): 141, 2022 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-35922778

RESUMO

BACKGROUND: Dealing with life-limiting illnesses, death, dying and grief, is uncharted territory for medical graduates. It is a field that is heavily influenced by cultural, religio-spiritual and social factors. This adds complexity to palliative and end-of-life-care, which challenges newly qualified physicians and requires the formation of appropriate knowledge, skills, and attitudes in junior doctors. This study aimed to obtain insight into the perspectives, perceived self-efficacy, and preparedness of newly qualified Nigerian physicians in practising palliative care and identify potential variables influencing them. METHODS: The study was a cross-sectional, multi-centre survey of newly qualified Nigerian physicians, using semi-structured, in-depth qualitative interviews. The data were analysed by applying content-structuring qualitative content analysis. RESULTS: Forty semi-structured interviews were conducted with medical house officers at two tertiary institutions in Nigeria. The perceived self-efficacy and preparedness of newly qualified Nigerian physicians in practising palliative care were reported to be higher in areas of family involvement, and pain and symptom management than in areas of breaking bad news, prognosis, and diagnosing dying. Major influences on the young physicians' perceived self-efficacy and preparedness in practising palliative care were socio-economic circumstances of a resource-limited setting and cultural-religious considerations. In addition, the perceived impact of palliative care education and experience was documented. CONCLUSIONS: This study offers valuable insights into the perceived self-efficacy and preparedness of newly qualified physicians and reveals the influence of socio-cultural and socio-economic variables in Nigeria. Evidence of the social, cultural, and religio-spiritual dimensions of palliative care is indispensable for culturally sensitive care. These results could aid in the development of appropriate knowledge, skills, and attitudes in newly qualified physicians through culturally and contextually appropriate palliative care training measures. The results may be applicable to other sub-Saharan African settings and may be used to improve future palliative care education, training, and practice.


Assuntos
Cuidados Paliativos , Médicos , Estudos Transversais , Humanos , Cuidados Paliativos/métodos , Pesquisa Qualitativa , Autoeficácia
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