Essential Component Of Comprehensive Care Research Articles

Quality of Life: A Comprehensive Review on Impact of Interventions among Breast Cancer Patients

ABSTRACT The effect of various therapeutic interventions on quality of life (QoL) among breast cancer patients is vital. The purpose of this systematic review was to investigate therapies that target patients with breast cancer’s health-related QoL (HRQoL). The literature search was carried out in the Cochrane, Medline, Embase, and CINAHL databases and PubMed between January 2015 and March 2023 which included published theses and articles from a variety of national and international databases. To extract pertinent material, the text and abstract of the chosen articles were carefully reviewed and evaluated. By applying the PRISMA guidelines, the Google search engine’s search parameters were expanded to encompass open-access articles, guaranteeing a greater variety of resources for the research. Following the screening of various citations, 284 full-text articles were examined. In the end, 14 articles were included. The reviews emphasized the effectiveness of therapies meant to improve HRQoL in individuals with breast cancer. The physical, psychological, and social domains saw therapeutic effects from these therapies, which resulted in a major improvement in the HRQoL of breast cancer patients. The importance of including different therapies in the treatment of patients with breast cancer is underscored by the persistent evidence of noteworthy enhancements in HRQoL. Overall, the review supports the recommendation for incorporating counseling, psychological interventions, educational programs, and supportive therapies such as progressive muscle relaxation as essential components of comprehensive care for breast cancer patients. By addressing the multidimensional needs of patients, these interventions contribute to improved HRQoL and overall well-being throughout the breast cancer journey.

Attitudes of Physicians toward Palliative Care in Intensive Care Units: A Nationwide Cross-Sectional Survey in Japan

ContextPalliative care is an essential component of comprehensive care for patients with critical illnesses. In Japan, little is known about palliative care in intensive care units (ICUs), and palliative care approaches are not widespread. ObjectiveThis study aimed to better understand the attitudes of physicians toward palliative care and the utilization and needs of specialized palliative care consultations in ICUs in Japan. MethodsA nationwide, self-administered questionnaire was distributed ICU physician directors in all hospitals with ICUs. ResultsQuestionnaires were distributed to 873 ICU physician directors; valid responses were received from 436 ICU physician director (50% response rate). Among the respondents, 94% (n = 411) felt that primary palliative care should be strengthened in ICUs; 89% (n = 386) wanted ICU physicians to collaborate with specialists, such as palliative care teams (PCTs); and 71% (n = 311) indicated the need for specialized palliative care consultations; however, only 38% (n = 166) actually consulted, and only 6% (n = 28) consulted more than 10 patients in the past year. Physicians most commonly consulted PCT for patients with serious end-of-life illness (24%) (n = 107), intractable pain (21%) (n = 92), and providing psychological support to family members (43%, n = 187). The potential barriers in providing primary and specialized palliative care included being unable to understand the patients’ intentions (54%, n = 235), lack of knowledge and skills in palliative care (53%, n = 230), and inability to consult with PCTs in a timely manner (46%, n = 201). ConclusionsThese data suggest a need for primary palliative care education in ICUs and improved access to specialized palliative care consultations.

Variability in Palliative Care Use after Intracerebral Hemorrhage at US Hospitals: A Multilevel Analysis

Background: Palliative care (PC) is an essential component of comprehensive care of patients with intracerebral hemorrhage (ICH). In the present study, we sought to characterize the variability of PC use after ICH among US hospitals. Methods: ICH admissions from hospitals with at least 12 annual ICH cases were identified in the Nationwide Inpatient Sample between 2008 and 2011. We used multilevel logistic regression modeling to estimate between-hospital variance in PC use. We calculated the intraclass correlation coefficient (ICC), proportional variance change, and median OR after accounting for individual-level and hospital-level covariates. Results: Among 26,791 ICH admissions, 12.5% received PC (95% CI 11.5–13.5). Among the 629 included hospitals, the median rate of PC use was 9.1 (interquartile range 1.5–19.3) per 100 ICH admissions, and 150 (23.9%) hospitals had no recorded PC use. The ICC of the random intercept (null) model was 0.274, suggesting that 27.4% of the overall variability in PC use was due to between-hospital variability. Adding hospital-level covariates to the model accounted for 25.8% of the between-hospital variance observed in the null model, with 74.2% of between-hospital variance remaining unexplained. The median OR of the fully adjusted model was 2.62 (95% CI 2.41–2.89), indicating that a patient moving from 1 hospital to another with a higher intrinsic propensity of PC use had a 2.63-fold median increase in the odds of receiving PC, independent of patient and hospital factors. Conclusions: Substantial variation in PC use after ICH exists among US hospitals. A substantial proportion of this between-hospital variability remains unexplained even after accounting for patient and hospital characteristics.

Pediatric Palliative Care and the Pediatric Intensive Care Unit

The role of palliative care in pediatric critical care medicine is described, with a focus on communication practices, complex chronic medical disease, end-of-life care, and moral resiliency. Palliative care medicine has an increasing presence in pediatric critical care medicine. The model for delivering quality palliative care from a primary to consultative role is evolving, as increasing numbers of patients and families benefit from this additional layer of care and advocacy. Palliative care medicine is complementary care at all levels and focuses on collaborating with families and patients by understanding values, contextualizing the traumatic nature of their experiences, and communication through shared decision-making. Enhancing and strengthening palliative care skills of pediatric intensive care unit (PICU) clinicians will provide one possible mechanism for addressing moral distress. Palliative care is an essential component of comprehensive care for our patients and families facing critical and life-threatening illness of any severity or prognosis. It augments and complements intensive care treatments, and it is based on need, not prognosis or outcome.

Hepatitis B-Related Concerns and Anxieties Among People With Chronic Hepatitis B in Australia.

BackgroundThe psychological wellbeing of people with chronic hepatitis B (CHB) may be negatively affected due to the chronic and transmissible nature of the disease, and possible serious complications (e.g. cirrhosis and liver cancer). There are limited data investigating concerns and anxieties among people living with CHB.ObjectivesThis study examined feelings about having hepatitis B among people with CHB, including hepatitis B-related concerns and anxieties.Patients and MethodsUsing convenience sampling, people with CHB attending four public liver clinics and one general practice in three Australian jurisdictions between April and September 2013 completed a self-administered questionnaire about their feelings about having hepatitis B.ResultsNinety-three people completed the survey. Mean age was 45 years, 57% were men, and 93% were born overseas (75% from Asia). Seventy-six percent of participants reported having hepatitis B-related concerns and anxieties. The most common concerns were of developing liver cancer (57%), and infecting other people (53%). Thirty-five percent of participants were unwilling to talk to anyone about their hepatitis B while 25% changed how they lived as a result of having hepatitis B. Lower educational level was associated with feeling scared of hepatitis B (adjusted Odds Ratio [OR]: 4.04; 95%CI: 1.09, 14.90; P = 0.04), and an unwillingness to talk to anyone about hepatitis B (adjusted OR: 4.41; 95%CI: 1.09, 17.83; P = 0.04). Very good English proficiency was associated with a higher likelihood of participants changing how they lived (adjusted OR: 12.66; 95%CI: 2.21, 72.42; P < 0.01), and seeing life differently as a result of having hepatitis B (adjusted OR: 21.10; 95%CI: 3.70, 120.19; P < 0.01). Health professionals were the key person for 34% of participants in helping them cope with having hepatitis B, while 18% reported that no one supported them.ConclusionsHepatitis B-related concerns and anxieties are prevalent among people with CHB. Clinical management of people with CHB must address their psychological support needs as an essential component of comprehensive care.

Palliative Care Utilization in Nontraumatic Intracerebral Hemorrhage in the United States.

Palliative care is now recognized as an essential component of comprehensive care in serious illness that interferes with quality of life. We explored utilization of palliative care in spontaneous intracerebral hemorrhage at a population level using a large national database. Population based cross-sectional study. Inpatient hospital admissions from the Nationwide Inpatient Sample. A total of 311,217 patients with intracerebral hemorrhage. Palliative care use. Intracerebral hemorrhage patients with and without palliative care were identified from the 2007-2011 Nationwide Inpatient Sample using International Classification of Diseases, 9th Revision, codes. Demographics, comorbidities, surgical procedures, and hospital characteristics were compared between patients receiving and not receiving palliative care (code V66.7). Resource utilization measures were inflation-adjusted cost of care and length of stay. Pearson chi square and Wilcoxon-Mann-Whitney tests were used for categorical and continuous variables respectively. Logistic regression was used to construct a predictive model of palliative care. Of the 311,217 intracerebral hemorrhage patients, 32,159 (10.3%) received palliative care. Utilization of palliative care increased from 4.3% in 2007 to 16.2% in 2011 (trend p < 0.001). Patients receiving palliative care had higher Charlson comorbidity scores (p < 0.001), higher all-patient refined diagnosis-related group mortality risk (p < 0.001), and lower resource utilization measures compared with those without palliative care. Independent predictors of palliative care use were older age (odds ratio, 4.06; 95% CI, 3.87-4.23; p < 0.001), female sex (odds ratio, 1.17; 95% CI, 1.14-1.20; p < 0.001), Caucasian race (p < 0.001), Medicare insurance (p < 0.001), hospitals in the west and mid-west (p < 0.001), hospital transfer (odds ratio, 1.23; 95% CI, 1.18-1.30; p < 0.001), high intracerebral hemorrhage case volume (p < 0.001), anticoagulant use (odds ratio, 1.24; 95% CI, 1.19-1.31; p < 0.001), higher Charlson comorbidity score, ventriculostomy placement (odds ratio, 1.18; 95% CI, 1.13-1.29; p < 0.001), and mechanical ventilation (odds ratio, 1.44; 95% CI, 1.39-1.49; p < 0.001). Cerebral angiogram, craniotomy, and gastrostomy were independently associated with absence of palliative care use. An apparent increasing trend of palliative care utilization in intracerebral hemorrhage has occurred over the last decade. After clinical severity adjustment, gender and racial differences and hospital characteristics appear to influence palliative care use among intracerebral hemorrhage patients in the United States.

간경변증 환자 음주행위 관련변인 -음주행위와 질병관련 변인의 융복합 측면-

본 연구는 간경변증 환자의 음주행위와 질병관련 변인의 융복합적 측면을 고려하여 음주행위에 영향을 미치는 요인을 파악해보고자 시도하였다. 연구의 목적을 위하여 D시에 거주하며, 간경변증 진단으로 병원외래치료를 받고 있는 자로 총 157명을 대상으로 하였다. 자료분석은 SPSS win 20.0 프로그램을 이용하여, t-test, <TEX>${\chi}^2$</TEX>-test, Logistic Regression하였다. 연구결과는 간경변증 환자의 31.8%가 음주를 하고 있었으며, 단변량 로지스틱 회귀분석한 결과, 간경변 환자의 음주에 영향을 미치는 변인은 성별(men), 연령(>60), 배우자(have not), 소득만족도(low, moderato), 흡연(yes), 선행 진단명(alcoholic hepatitis), Child Pugh Score (<TEX>${\leq}9$</TEX>), 진단기간(<TEX>${\geq}3$</TEX>), 질병관련 증상경험, 불안, 우울과 사회적 지지인 것으로 나타났다. 이들 변인을 다변량 로지스틱 회귀분석 한 결과, 흡연(yes), 성별(men), 질병관련 증상경험이 낮을수록, 사회적 지지가 낮을수록, 불안의 정도가 음주행위에 영향요인으로 나타났다. 이상의 연구결과를 토대로 간경변증 음주행위를 예방하기 위해서는 음주행위 관련변인들을 고려해서 대책을 마련할 필요가 있다. This study was conducted to determine the affecting factors among patients with drinking behavior of liver cirrhosis. Data were collected by questionnaire from 157 patients who were diagnosed with liver cirrhosis at a tertiary hospital located in D-city. Measurements included patients' demographic characteristics, clinical characteristics, disease-related of symptom experience, emotional-factors of anxiety-depression and social-factor of social support. Data were analyzed using t-test, and logistic regression analyses. The incidence rate of drinking behavior was 31.8%. Multivariate analysis revealed that smoking(yes), men, symptom experience, social support and anxiety were more likely to report high level of drinking behavior. Future research should consider managing drinking behavior as an essential component of comprehensive care for patients with liver cirrhosis.

The changing role of palliative care in the ICU.

Palliative care is an interprofessional specialty as well as an approach to care by all clinicians caring for patients with serious and complex illness. Unlike hospice, palliative care is based not on prognosis but on need and is an essential component of comprehensive care for critically ill patients from the time of ICU admission. In this clinically focused article, we review evidence of opportunities to improve palliative care for critically ill adults, summarize strategies for ICU palliative care improvement, and identify resources to support implementation. We searched the MEDLINE database from inception through January 2014. We also searched the Reference Library of The Improving Palliative Care in the ICU Project website sponsored by the National Institutes of Health and the Center to Advance Palliative Care, which is updated monthly. We hand-searched reference lists and author files. Selected studies included all English-language articles concerning adult patients using the search terms 'intensive care' or 'critical care' with 'palliative care,' 'supportive care,' 'end-of-life care,' or 'ethics.' : After examination of peer-reviewed original scientific articles, consensus statements, guidelines, and reviews resulting from our literature search, we made final selections based on author consensus. Existing evidence is organized to address: 1) opportunities to alleviate physical and emotional symptoms, improve communication, and provide support for patients and families; 2) models and specific interventions for improving ICU palliative care; 3) available resources for ICU palliative care improvement; and 4) ongoing challenges and targets for future research. Key domains of ICU palliative care have been defined and operationalized as measures of quality. There is increasing recognition that effective integration of palliative care during acute and chronic critical illness may help patients and families face challenges after discharge from intensive care. Palliative care is increasingly accepted as an essential component of comprehensive care for critically ill patients, regardless of diagnosis or prognosis. A variety of strategies to improve ICU palliative care appear to be effective, and resources including technical assistance and tools are available to support improvement efforts. As the longer-term impact of intensive care on those surviving acute critical illness is increasingly documented, palliative care can help prepare and support patients and families for challenges after ICU discharge. Further research is needed to inform efforts to integrate palliative care with intensive care more effectively and efficiently in and after the ICU and to document improvement using valid and responsive outcome measures.

The cancer psychosocial care matrix: a community‐derived evaluative tool for designing quality psychosocial cancer care delivery

Although the Institute of Medicine provided a vision for effective psychosocial care for cancer survivors, limited guidance exists regarding the essential components of comprehensive care or progressive steps for implementing each component. This paper describes the development of a unique tool for assessing capacity to provide quality psychosocial care to cancer survivors and the results of the first implementation of this tool in community settings. The psychosocial working group of the National Cancer Institute Community Cancer Centers Program (NCCCP) developed the Cancer Psychosocial Care Matrix assessment tool. All NCCCP sites (n=30, enrolled in 2007 nd 2010) completed the matrix indicating their capacity for providing psychosocial care at entry into NCCCP ('baseline') after 2 years of NCCCP participation (2007 sites only) and within the coming year ('future aspirations'). At baseline, matrix responses reflected few or no systematic processes in place for most components of comprehensive psychosocial care. However, reported capacity to deliver specific components improved at 2 years post-NCCCP entry for the 2007 sites and in all NCCCP sites' future aspirations. With growing demand on cancer centers to meet new metrics of quality care, the psychosocial matrix can help centers systematically identify and develop steps to address gap areas in their capacity to meet these new standards. The Cancer Psychosocial Care Matrix appears to enable evaluation of psychosocial programs, may promote intentions to improve psychosocial services, and can facilitate communication of 'best practices' among cancer centers.

The psychosocial matrix: A community-derived evaluative tool for designing quality psychosocial cancer care.

250 Background: Although the Institute of Medicine provided a vision for effective psychosocial care for cancer survivors, guidance regarding the essential components of comprehensive care or progressive steps for implementing each component is limited. This abstract presents a unique tool for self-assessing capacity to provide quality psychosocial care to cancer survivors and results of the first full-scale implementation of this tool. Methods: The psychosocial workgroup of the National Cancer Institute Community Cancer Centers Program (NCCCP) developed the Psychosocial Care Matrix Assessment Tool which covers 7 domains (e.g., distress screening, patient-provider communication, evaluation of psychosocial programs). All NCCCP sites (16 enrolled in 2007, 14 enrolled in 2010) completed the matrix in 2010 regarding their capacity for psychosocial care at entry into NCCCP (baseline), after two years of NCCCP participation (2007 sites only), and within the coming year (future aspirations). Results: At baseline, matrix responses reflected few or no systematic processes in place for most components of psychosocial care. However, reported capacity to deliver specific components improved at two years post-NCCCP entry for the 2007 sites and in all sites’ future aspirations. For example, about 80% of all sites reported no or inconsistent distress screening at baseline. After two years, 48% of the 2007 sites reported consistent screening with a standardized tool or consistent screening plus a comprehensive interview. Nearly all 2007 sites (89%) aspired to provide consistent screening plus comprehensive interview with 50% also hoping to add systematic follow-up screenings. The majority of 2010 sites (71%) aspired to provide consistent screening with a standardized tool. Conclusions: The psychosocial matrix tool was found to be useable and valuable. At the NCCCP sites, some aspects of psychosocial care (e.g., communicating the importance of psychosocial care) are more readily implemented than others (e.g., follow-up after a positive distress screen). With growing demand on cancer centers to meet new metrics of quality care, the psychosocial matrix can help identify and develop steps to address gap areas.

Developing models of haemophilia care

Developing models of haemophilia care

Integration of Palliative Care in Chronic Critical Illness Management

Palliative care is an essential component of comprehensive care for all patients with chronic critical illness, including those receiving restorative or life-sustaining therapies. Core elements include alleviation of symptom distress, communication about care goals, alignment of treatment with the patient's values and preferences, transitional planning, and family support. Here we address strategies for assessment and management of symptoms, including pain, dyspnea, and depression, and for assisting patients to communicate while endotracheally intubated. We also discuss approaches to optimize communication among clinicians, patients, and families about care goals. Challenges for supporting families and planning for transitions between care settings are identified, while the value of interdisciplinary input is emphasized. We review "consultative" and "integrative" models for integrating palliative care and restorative critical care. Finally, we highlight key ethical issues that arise in the care of chronically critically ill patients and their families.

Depression and Risk Factors in Patients with Crohn's Disease

This study was conducted to determine the risk factors among patients with depression with Crohn's disease. Data were collected by questionnaire from 276 patients who were diagnosed with Crohn's disease at a tertiary hospital located in Seoul. Measurements included patients' demographic characteristics, clinical characteristics, depression level, and health-related quality of life. Data were analyzed using t-test, χ²-test, Wilcoxon rank sum test, and logistic regression analyses. The incidence rate of depression (BDI-II ≥ 14 scores) was 31.9% (n=88). Univariate analysis revealed that being a woman, school graduation status, economic status (low), BMI(<18.5 Kg/m²), disease duration (≥ 3 years), CDAI (≥ 150 scores), frequency of hospital admission (≥ 2), extra-intestinal manifestation (arthralgia, stomatitis), administration of 5-aminosalicylic acid, and disease related quality of life (SIBDQ<50 scores) were associated with depression. Multivariate analysis revealed that economic status (low), school graduation status, and quality of life (SIBDQ<50 scores) were more likely to report high level of depression. Future research should consider managing depression as an essential component of comprehensive care for patients with Crohn's disease. In addition, further research is needed to develop strategies to better improve quality of life among patients with Crohn's disease who are depressed.

Behavioral sleep disturbances in children clinically referred for evaluation of obstructive sleep apnea

Objective/Background Obstructive sleep apnea (OSA) and behavioral sleep disturbances (BSD) are known to have a negative health impact on children. OSA and BSD may coexist; however, such comorbidity is not fully appreciated in clinical settings. Methods Patients referred for OSA evaluation completed polysomnography and the Children’s Sleep Habits Questionnaire. Prevalence estimates for clinically significant BSD were computed and comorbidity of BSD and OSA was examined. Chart reviews were completed to determine if BSD were addressed in the medical treatment plan. Results Over one-half of the sample had a clinically significant BSD. Patients with comorbid OSA and BSD represented 39.46% of the sample. In 36–54% of the patients with a clinically significant BSD, no plan to treat the BSD was documented in the patient’s medical record. Conclusions Children referred for evaluation of OSA have a high likelihood of experiencing clinically significant BSD irrespective of OSA diagnosis. Sleep medicine clinicians should be careful not to overlook the potential impact of BSD even after a child has been formally diagnosed with OSA. Physician knowledge of empirically supported behavioral sleep treatments or access to behavioral sleep medicine services is an essential component of comprehensive care for children clinically referred for OSA evaluation.

Sexual morbidity following radical hysterectomy for cervical cancer

Radical hysterectomy for early stage cervical cancer has satisfactory results in terms of survival, but may impact negatively on a patient’s quality of life, which may include sexual dysfunctions. Female sexual dysfunctions (FSD) represent a frequent morbidity but often remain unrecognized and undertreated. Although discussions regarding sexuality are found by many medical doctors to be sensitive and embarrassing, psychosexual counseling is an essential component of comprehensive care for gynecological cancer patients and their partners. The goal of this article is to summarize and discuss available relevant data on FSD in women who have undergone radical hysterectomy for an early stage of cervical cancer.

Position of the American Dietetic Association: Providing Nutrition Services for People with Developmental Disabilities and Special Health Care Needs

It is the position of the American Dietetic Association that nutrition services provided by registered dietitians (RDs) and dietetic technicians, registered (DTRs), are essential components of comprehensive care for all people with developmental disabilities and special health care needs. Nutrition services should be provided throughout life in a manner that is interdisciplinary, family-centered, community-based, and culturally competent. People with developmental disabilities and special health care needs frequently have nutrition concerns, including growth alterations (failure to thrive, obesity, or growth retardation), metabolic disorders, poor feeding skills, medication–nutrient interactions, and sometimes partial or total dependence on enteral or parenteral nutrition. Individuals with special needs are also more likely to develop comorbid conditions such as obesity or endocrine disorders that require nutrition interventions. Poor health habits, limited access to services, and long-term use of multiple medications are considered health risk factors. Health maintenance and avoidance of complications can be promoted by timely and cost-effective nutrition interventions. Public policy for individuals with special needs has evolved over time, resulting in a transition from institutional facilities and programs to community living. The expansion of public access to technology and health information on the Internet challenges RDs and DTRs to provide accurate scientific information for those with developmental disabilities and special health care needs. Nationally credentialed RDs and DTRs are best prepared to provide appropriate nutrition information for wellness and quality of life.