Care Task Research Articles

Changes in university orthodontic care over a period of 20years : Patient characteristics, treatment quality, and treatment costs.

The aim of the present study was to analyze whether there were changes in the severity of malocclusions of patients treated at the Department of Orthodontics, University of Giessen, Germany over a period of 20years (1992-2012) and if the implementation of the KIG system (German index of treatment need) in 2001 had any effect on the patient cohort. Furthermore, the study aimed to analyze the influence of the severity of malocclusion on treatment quality and economic efficiency (relation payment per case/treatment effort). The files of all 5385 patients admitted to the orthodontic department between 1992 and 2012 were screened and the following information was recorded: patient characteristics, treatment duration, KIG, treatment outcome, and costs. In the KIG period, patients were older, pretreatment malocclusions were more severe, treatment took longer, required more appointments, and did not achieve the same degree of perfection as in the pre-KIG period. Patients with a higher pretreatment KIG category had longer treatments and did not achieve the same degree of perfection as patients with lower KIG categories. Although total payment was slightly higher for the more severe cases, their cost-per-appointment ratio was significantly lower. In the present university department, a shift of the orthodontic care task towards more complex cases has occurred over the last 20years. Generally the quality of orthodontic treatment was good, but it has been demonstrated that the higher KIG cases did not end up at the same level of excellence as the lower KIG cases. Furthermore, KIG5 patients had a longer treatment duration, and required more appointmentsthan lower KIG cases.

Systematic review describing the effect of early mobilisation after dysvascular major lower limb amputations.

To assess the effect of early mobilisation of patients after dysvascular lower limb amputation and to compare the effectiveness of different mobilisation regimens. Patients who have undergone dysvascular major lower limb amputations are at high risk of postoperative complications, which include loss of basic functions, and early mobilisation interventions might prevent these complications. Systematic review. Systematic searches were performed on PubMed (including MEDLINE), CINAHL and EMBASE databases to identify studies investigating the effects of (early) mobilisation interventions in dysvascular lower limb-amputated patients. Data collection and quality assessment were performed using the Cochrane Effective Practice and Organization of Care Review Group data collection checklist and the Cochrane Handbook for Systematic Reviews of Interventions, respectively. Five studies were included in the review: four pre- to post-case studies and one randomised controlled study. However, none of these studies were of high quality. Four studies investigated early mobilisation promoted by immediate postoperative prosthesis. One study investigated whether reorganizing care increases mobilisation and thereby functional outcome. This systematic review reveals a lack of evidence to determine whether early mobilisation interventions are beneficial to this vulnerable patient group. Nevertheless, ambulation from the first postoperative day with temporary prosthesis is possible among the heterogeneous population of dysvascular lower limb-amputated patients if the necessary interdisciplinary team is dedicated to the task. Mobilisation is a fundamental care task often missed for several reasons. Moreover, mobilisation of the newly amputated patient is complex, and knowledge of effective strategies to promote postoperative mobilisation in this vulnerable population is desired. Nurses are urged to take responsibility for this fundamental care task and to engage the necessary collaborative interdisciplinary team to develop, implement and evaluate ambitious early mobilisation interventions.

Position paper of the Italian Association of Medical Oncology on early palliative care in oncology practice (Simultaneous Care).

One of the priorities of personalized medicine regards the role of early integration of palliative care with cancer-directed treatments, called simultaneous care. This article, written by the Italian Association of Medical Oncology (AIOM) Simultaneous and Continuous Care Task Force, represents the position of Italian medical oncologists about simultaneous care, and is the result of a 2-step project: a Web-based survey among medical oncologists and a consensus conference. We present the opinion of more than 600 oncologists who helped formulate these recommendations. This document covers 4 main aspects of simultaneous care: 1) ethical, cultural, and relational aspects of cancer and implications for patient communication; 2) training of medical oncologists in palliative medicine; 3) research on the integration between cancer treatments and palliative care; and 4) organizational and management models for the realization of simultaneous care. The resulting recommendations highlight the role of skills and competence in palliative care along with implementation of adequate organizational models to accomplish simultaneous care, which is considered a high priority of AIOM in order to grant the best quality of life for cancer patients and their families.

Caregivers burden in people in palliative care: an integrative literature review

Study design: Integrative literature review. Objective: To summarize the main research findings and critically analyze the evidence on the burden of caregivers of people in Palliative Care. Method: Bibliographic search in the electronic databases: MEDLINE, LILACS, CINAHL and the virtual library SciELO, with crosses between the descriptors: “Caregivers”, “Palliative Care”, “Hospice Care”, “Terminal Care” and the keywords “Burden”, “Supportive Care”. Results: 23 articles were selected, having been published in journals between January 2004 and June 2014, categorized into three units of analysis: 1. the task of caring and the consequences to the life of the caregiver (N=7); 2. the caregiver burden before the approach of death (N=8); 3. programs and support services to caregivers (N=8). The articles indicate that the caregiver burden varies according to their experience of care task and the evolution of the cared person’s illness; the caregiver needs to be received on your needs and have access to reduce the burden and improve both caregiver’s quality life as the assisted one. However, scientific evidence is considered fragile, with levels 4 (65.2%) and 5 (21.8%) and only 13% of studies present evidence considered strong. Conclusion: The issue of burden of caregivers of people in palliative care is relevant for research and for clinical practice, but there is need for studies with better methodological quality and scientific evidence to support the care for this population

Effects of Support Groups for Individuals with Early-Stage Dementia and Mild Cognitive Impairment: An Integrative Review.

Support groups have demonstrated promising outcomes for individuals with mild cognitive impairment (MCI) and early-stage dementia (ESD) in previous literature reviews. However, evidence has not been updated since 2007. The current review aimed to update current evidence on the use and effects of support groups for individuals with MCI and ESD and their care partners. A literature search was conducted in seven databases and 18 eligible research articles were retrieved. Support groups showed positive impacts on participant acceptance of cognitive impairment; performance and satisfaction of meaningful activity; resilience; self-help; and care partner coping self-efficacy, perceived support, and preparation and task effectiveness. Findings also revealed that support groups were well accepted by participants and care partners. Few studies included ethnic diversity, limiting the generalizability of findings. Further large-scale studies are needed to confirm the effects of support groups for individuals with MCI and ESD in all populations. [Res Gerontol Nurs. 2017; 10(1):35-51.].

Updating the American Society of Clinical Oncology Value Framework: Revisions and Reflections in Response to Comments Received.

The mission of American Society of Clinical Oncology (ASCO) is to conquer cancer through research, education, and promotion of the highest quality patient care. Toward fulfillment of this goal and at the direction of its board of directors, the ASCOValue in Cancer Care Task Force set out to develop a framework that would enable a physician and patient to assess the value of a particular cancer treatment regimen given the patient’s individual preferences and circumstances. The rationale that served as the impetus for this initiative is many faceted. Substantial progress has been made in translating our knowledge of the biologic characteristics of cancer into novel therapies. Some of these therapies have led to major improvements in outcomes for specific diseases, and others have produced only modest advances. There is now a wide array of choices for treating many cancer types, and these treatment choices often differ by only small degrees in clinical effectiveness and toxicity. Yet, there is often a wide disparity in cost to patients and payers. Because patients are often confronted with enormous expenses when receiving cancer care, the goal of describing a relationship between the cost of an agent or regimen and the clinical benefits it delivers takes on great importance. As the primary advisor to the patient, the oncologist has an important role in providing a comparative assessment of the various treatment options available; in the spirit of shared decision making, the patient should have transparent information about the clinical impact that can be expected from the different options presented and their relative financial implications. The value framework has been constructed as a conceptual model that incorporates the elements of clinical benefit, toxicity, and symptom palliation as derived from a comparative clinical trial and combines these elements into a score termed the net health benefit (NHB). Ultimately, deployment of the framework as a software application is planned, enabling a patient to modify the weight attributed to any of the elements included in the NHB depending on his or her personal preferences and circumstances. The final NHB will therefore reflect the priorities that are most important to the patient and will be arrived at through guidance from the physician. Information on the cost of the regimens will also be presented so the patient can consider the relative financial impact of his or her treatment options. Two versions of the framework have been created: one for advanced disease and the other for potentially curable (adjuvant therapy) clinical presentations. The original framework versions are shown in Appendix Tables A1 and A2 (online only). The key elements included in the framework— namely, clinical benefit and toxicity—are also those that are regularly reported in the scientific literature when discussing the outcome of a clinical trial that compares two or more therapies. The importance of relying on high-quality, quantifiable evidence cannot be overstated, and this is most often provided by a well-designed, well-conducted prospective randomized trial. The task force recognizes that a limitation of this approach is that it does not readily permit cross-trial comparisons. Such analyses are important to patients and remain a goal for future versions of the value framework. The task force is well aware that there are many elements that might be important to individual patients in assessing the relative value of their treatment options that are not taken into account in our model. These include the convenience of receiving therapy, the avoidance of interrupting the flow of activities of daily living, and the impact of a treatment on quality of life

Improved Blood Pressure Control to Reduce Cardiovascular Disease Morbidity and Mortality: The Standardized Hypertension Treatment and Prevention Project.

Hypertension is the leading remediable risk factor for cardiovascular disease, affecting more than 1 billion people worldwide, and is responsible for more than 10 million preventable deaths globally each year. While hypertension can be successfully diagnosed and treated, only one in seven persons with hypertension have controlled blood pressure. To meet the challenge of improving the control of hypertension, particularly in low- and middle-income countries, the authors developed the Standardized Hypertension Treatment and Prevention Project, which involves a health systems-strengthening approach that advocates for standardized hypertension management using evidence-based interventions. These interventions include the use of standardized treatment protocols, a core set of medications along with improved procurement mechanisms to increase the availability and affordability of these medications, registries for cohort monitoring and evaluation, patient empowerment, team-based care (task shifting), and community engagement. With political will and strong partnerships, this approach provides the groundwork to reduce high blood pressure and cardiovascular disease-related morbidity and mortality.

Doing better with less: Can a quality improvement intervention to increase adherence to evidence-based cancer screening guidelines reduce health care costs?

6590Background: The cost of cancer care in the U.S. is projected to reach $158 billion by 2020. The ASCO Value in Cancer Care Task Force recently released a framework assessing the value of new can...

Charting the Future of SPN: The SPN Strategic Plan

Charting the Future of SPN: The SPN Strategic Plan

Communicative challenges in the home care of older persons - a qualitative exploration.

To explore communicative challenges in encounters between nurse assistants and older persons during home care visits. The older population is increasing worldwide. Currently, there is a shift in care for older people from institutional care to home care. Providing home care in a person's home involves several challenges, including the complexity of communication. A descriptive observational design with a qualitative approach was used. The data consisted of audio recordings of real-life encounters during home care visits between nurse assistants and older persons, collected in 2014. Ahermeneutic phenomenological analysis was conducted. Communicative challenges were identified: (a) insituations where the older persons had a different view than the nurse assistants on the care task and its content; and (b) when unexpected actions or turns occurred in the communication. Challenges included older person's existential issues, fragility andworries and concerns, which often appeared to be only vaguely expressed and difficult to verbally detect and tackle. This engendered a risk of misinterpretation or ignorance of these challenges. The findings point to the importance of communication as the key to facilitate person-centred home care. Communication training should focus more on addressing needs and existential issues in older persons. Person-centred home care for older persons needs to be addressed at both an individual and an organizational level.

The Effects of Vocational Training through Group Home and Workplace Instruction on the Care Task Skill of Individuals with Intellectual Disabilities

The Effects of Vocational Training through Group Home and Workplace Instruction on the Care Task Skill of Individuals with Intellectual Disabilities

Precisión diagnóstica del termómetro de distrés en neoplasias hematológicas

Objective: The present study extends the previous investigation about validity and diagnostic accuracy of the DT for detecting psychosocial distress among Spanish cancer patients. The Distress Thermometer (DT) is a common screening tool, but other methods –such as Impact Thermometer (IT)- have recently been proposed with the aim of improving its diagnostic accuracy. In this paper, we investigated the emotional symptomatology captured by the DT, and the diagnostic accuracy of both the DT alone and combined with the IT, using two possible combination methods. Methods: A sample of 81 adult patients with hematologic cancer completed the DT, the Colored Complaint Scale (CCS), the IT and the Brief Symptom Inventory-18 (BSI-18). Several indexes were calculated to study the diagnostic accuracy: the area under the receiver operating characteristics (ROC) curve (AUC); measures of occurrence (Se y Sp), measures of discrimination (PPV and NPV) and clinical utility indexes (UIs). Results: The results of the DT were comparable with those found in previous studies, indicating that the DT is adequate for ‘screening’, but has limited value for ‘case finding’. Furthermore, the DT and the IT combined show minor differences in accuracy indexes compared with the DT alone. Conclusiones: DT and IT are useful tools for routine use in clinical practice providing psychosocial relevant patient information to healthcare professional without interfering in their care task.

Ready for Discharge? A Survey of Discharge Transition-of-Care Education and Evaluation in Emergency Medicine Residency Programs.

This study aimed to assess current education and practices of emergency medicine (EM) residents as perceived by EM program directors to determine if there are deficits in resident discharge handoff training. This survey study was guided by the Kern model for medical curriculum development. A six-member Council of EM Residency Directors (CORD) Transitions of Care task force of EM physicians performed these steps and constructed a survey. The survey was distributed to program residency directors via the CORD listserve and/or direct contact. There were 119 responses to the survey, which were collected using an online survey tool. Over 71% of the 167 American College of Graduate Medical Education (ACGME) accredited EM residency programs were represented. Of those responding, 42.9% of programs reported formal training regarding discharges during initial orientation and 5.9% reported structured curriculum outside of orientation. A majority (73.9%) of programs reported that EM residents were not routinely evaluated on their discharge proficiency. Despite the ACGME requirements requiring formal handoff curriculum and evaluation, many programs do not provide formal curriculum on the discharge transition of care or evaluate EM residents on their discharge proficiency.

She's Not the Same Mother I Loved

She's Not the Same Mother I Loved

Undermining Patient Values: The ASCO Value in Cancer Care Task Force Framework

As stated in a recent article in the Journal of Clinical Oncology, ASCO established a Value in Cancer Care Task Force, with the goal of “developing a framework for comparing the relative clinical benefit, toxicity, and cost of treatment in the medical oncology setting. “ In developing this framework or tool, the Task Force runs roughshod over basic facts to create a metric that – while established to promote patient centered care – strives mightily to achieve the exact opposite outcome.

Coverage and development of specialist palliative care services across the World Health Organization European Region (2005–2012): Results from a European Association for Palliative Care Task Force survey of 53 Countries

Background: The evolution of the provision of palliative care specialised services is important for planning and evaluation. Aim: To examine the development between 2005 and 2012 of three specialised palliative care services across the World Health Organization European Region – home care teams, hospital support teams and inpatient palliative care services. Design and setting: Data were extracted and analysed from two editions of the European Association for Palliative Care Atlas of Palliative Care in Europe. Significant development of each type of services was demonstrated by adjusted residual analysis, ratio of services per population and 2012 coverage (relationship between provision of available services and demand services estimated to meet the palliative care needs of a population). For the measurement of palliative care coverage, we used European Association for Palliative Care White Paper recommendations: one home care team per 100,000 inhabitants, one hospital support team per 200,000 inhabitants and one inpatient palliative care service per 200,000 inhabitants. To estimate evolution at the supranational level, mean comparison between years and European sub-regions is presented. Results: Of 53 countries, 46 (87%) provided data. Europe has developed significant home care team, inpatient palliative care service and hospital support team in 2005–2012. The improvement was statistically significant for Western European countries, but not for Central and Eastern countries. Significant development in at least a type of services was in 21 of 46 (46%) countries. The estimations of 2012 coverage for inpatient palliative care service, home care team and hospital support team are 62%, 52% and 31% for Western European and 20%, 14% and 3% for Central and Eastern, respectively. Conclusion: Although there has been a positive development in overall palliative care coverage in Europe between 2005 and 2012, the services available in most countries are still insufficient to meet the palliative care needs of the population.

Jacob Chose Hospice: A Critique of Invasive End-of-Life Care

Jacob Chose Hospice: A Critique of Invasive End-of-Life Care

Factors associated with rushed and missed resident care in western Canadian nursing homes: a cross-sectional survey of health care aides.

To describe the nature, frequency and factors associated with care that was rushed or missed by health care aides in western Canadian nursing homes. The growing number of nursing home residents with dementia has created job strain for frontline health care providers, the majority of whom are health care aides. Due to the associated complexity of care, health care aides are challenged to complete more care tasks in less time. Rushed or missed resident care are associated with adverse resident outcomes (e.g. falls) and poorer quality of staff work life (e.g. burnout) making this an important quality of care concern. Cross-sectional survey of health care aides (n = 583) working in a representative sample of nursing homes (30 urban, six rural) in western Canada. Data were collected in 2010 as part of the Translating Research in Elder Care study. We collected data on individual health care aides (demographic characteristics, job and vocational satisfaction, physical and mental health, burnout), unit level characteristics associated with organisational context, facility characteristics (location, size, owner/operator model), and the outcome variables of rushed and missed resident care. Most health care aides (86%) reported being rushed. Due to lack of time, 75% left at least one care task missed during their previous shift. Tasks most frequently missed were talking with residents (52% of health care aides) and assisting with mobility (51%). Health care aides working on units with higher organisational context scores were less likely to report rushed and missed care. Health care aides frequently report care that is rushed and tasks omitted due to lack of time. Considering the resident population in nursing homes today--many with advanced dementia and all with complex care needs--health care aides having enough time to provide physical and psychosocial care of high quality is a critical concern.

Developing a primary care patient measure of safety (PC PMOS): a modified Delphi process and face validity testing

BackgroundPatients are a valuable source of information about ways to prevent harm in primary care and are in a unique position to provide feedback about the factors that contribute to...

General and Child and Adolescent Psychiatry Resident Training in Integrated Care: a Survey of Program Directors.

Integrated care models are an evidence-based approach for integrating physical and behavioral health services. The American Association of Directors of Psychiatric Residency Training Integrated Care Task Force sought to describe current practices for providing training in integrated care to general and child and adolescent psychiatry residents. Directors of US general and child and adolescent psychiatric residency training programs were anonymously surveyed to examine current practices in educating their residents in integrated care. Based on themes that emerged from the survey, the authors make recommendations for integrated care education of general and child and adolescent psychiatry residents. Fifty-two of 197 (26%) general and 36 of 111 (32%) child and adolescent program directors responded. Results demonstrate that a majority of responding general psychiatry (78%) and child and adolescent psychiatry (CAP) (72%) training programs offer integrated care rotations, many of which are electives for senior residents. The Veterans Health Administration (VA) and Federally Qualified Health Centers are common venues for such rotations. Sustainable funding of these rotations is a concern. Fewer than half of programs offer integrated care didactics. This report is intended to help program directors consider options for starting or optimizing their own integrated care curricula. Future research should examine the educational value, and the overall value to health care systems, of training in the integrated care model.