Identification Of Care Research Articles

Medical Students' Knowledge, Attitudes Toward, and Identification of Adverse Childhood Experiences and Trauma-Informed Care.

Adverse childhood experiences (ACEs) are traumatic experiences that occur prior to age 18 years and can have a long-term impact on adult physical and mental health. Knowledge of ACEs, including the link between ACEs and health, and trauma-informed care (TIC), is essential for medical professionals to ensure respectful and compassionate care for those with a history of childhood adversity. This study examined medical students' knowledge, attitudes toward, and identification of ACEs and TIC to inform curricular efforts. Using a cross-sectional design, students were recruited from 2 medical schools, one allopathic (medical degree) and one osteopathic (doctor of osteopathic medicine degree) to complete an electronic needs assessment survey. The survey included a patient vignette to assess students' ability to identify ACEs as contributing factors to patient health. The students were blind to the full purpose of the study to obtain an objective measurement of their ability to identify ACEs as contributors to patient health. Additional questions targeting knowledge and attitudes of ACEs and TIC were devised from previously published surveys with supplemental study-designed questions. Two hundred forty students completed the survey. Results demonstrated variable ability to identify ACEs; strong general knowledge of ACEs, with less developed practical knowledge; and overall positive attitudes toward ACEs and TIC. No differences were found between the medical degree and doctor of osteopathic medicine degree, or year in program. Medical students would benefit from curricular efforts that help to increase knowledge of the link between ACEs and health, increase practical application of ACEs and TIC, and improve their ability to identify ACEs in clinical scenarios.

Development of the conversation tool "I-HARP for COPD" for early identification of palliative care needs in patients with chronic obstructive pulmonary disease.

This study aimed to develop the conversation tool "I-HARP for COPD" for timely identification of palliative care needs in Dutch patients with chronic obstructive pulmonary disease (COPD). An iterative and participatory research design was used to develop "I-HARP for COPD". There were 2 phases to the development of "I-HARP for COPD": content development and testing. A review of current literature, parallel focus groups, and a questionnaire among experts were used to develop the content of "I-HARP for COPD". "I-HARP for COPD" was then assessed by health-care professionals (HCPs) in clinical practice for understanding, difficulty, and relevance. A total of 46 HCPs, 6 patients, 1 informal caregiver, and 1 bereaved informal caregiver participated in this study. "I-HARP for COPD" included 14 screening questions, additional in-depth questions, and recommendations to address identified needs. The content of "I-HARP for COPD" was accepted by 86.2% of the HCPs. "I-HARP for COPD" was successfully developed for providing guidance in the palliative care of Dutch patients with COPD and their informal caregivers. By supporting HCPs with "I-HARP for COPD", they are better able to timely identify and direct palliative care needs.

Clinician Perception of Likelihood of Death in the Next Year Is Associated With 1-Year Mortality and Hospice Use Among Older Adults Receiving Home Health Care.

Background: Given the complex care needs of older adults receiving home health care (HHC), it is important for HHC clinicians to identify those with limited prognosis who may benefit from a transition to hospice care. Objectives: To assess the association between HHC clinician-identified likelihood of death and (1) 1-year mortality, and (2) hospice use. Methods: Prospective cohort study from the National Health and Aging Trends Study (NHATS) waves 2011-2018, linked to the Outcomes and Assessment Information Set (OASIS) HHC assessment and Medicare data among 915 community-dwelling NHATS respondents. HHC clinician-identified likelihood of death/decline was determined using OASIS item M1034. Multivariable logistic regression was used to assess the association between clinician-identified likelihood of death/decline and 1-year mortality and hospice use. Results: HHC clinicians identified 42% of the sample as at increased risk of decline or death. One year mortality was 22.3% (n = 548), and 15.88% (n = 303) used hospice within 12 months of HHC. HHC clinician-perceived likelihood of death/decline was associated with greater odds of 1-year mortality (odds ratio [OR], 6.57; confidence interval (95% CI), 2.56-16.90) and was associated with greater likelihood of hospice use (OR, 1.61; 95% CI, 1.00-2.62). Conclusion: HHC clinician perception of patients' risk of death or decline is associated with 1-year mortality. A better understanding of HHC patients at high risk for mortality can facilitate improved care planning and identification of homebound older adults who may benefit from hospice.

Abstract HUP5: Patient and Hospital Characteristics Associated With Disparities in Acute Stroke Treatment in Community and Academic Hospitals

Introduction: Expedited transportation, identification, and coordination of care are essential drivers of optimal outcomes in the management of acute ischemic stroke (AIS), but systemic biases and barriers may affect these processes. We assessed patient- and hospital-level factors that may be associated with differences in prehospital and emergency department care processes for patients with AIS at academic medical centers (AMC) and those at community hospitals (CH). Methods: We retrospectively collected data from the electronic health record at an academic medical center (Tufts Medical Center) for adults age ≥ 18 hospitalized with AIS between 1/1/2018-12/31/2020, including patients who presented directly to the AMC versus patients transferred from a CH for further care. We performed multivariate analyses to assess predictors of emergency medical service (EMS) use, stroke code activation, door-to-CT time, and door-to-needle time across all patients and in each group. Results: 542 patients were included. AMC patients identifying as Asian (OR 0.25, 95% CI 0.13-0.47) and Hispanic (OR 0.19, 95% CI 0.05-0.72) and CH patients identifying as Black (OR 0.17, 95% CI 0.17-0.62) were less likely to use EMS compared to white patients. Patients with non-English primary language were less likely to use EMS (OR 0.38, 95% CI 0.23-0.63) compared to English-speaking patients in all hospitals. CH patients identifying as Hispanic were less likely to have stroke code activation (OR 0.24, 95% CI 0.05-0.86) compared to white patients. There were no differences in median door-to-CT or door-to-needle times between CH and AMC patients. In analyses including all patients, Asian race was associated with longer door-to-CT time (OR 1.25, 95% CI 1.03-1.49), and female sex was associated with longer door-to-needle time (OR 1.23, 95% CI 1.03-1.43). Conclusion: There are multiple potential sources of disparity in prehospital and hospital-based hyperacute care for patients with AIS including sex, race, ethnicity, and non-English primary language. These may represent opportunities for community outreach on EMS use, interventions to address systemic racism among healthcare providers, and interventions to alleviate language barriers.

Using implementation science to develop a familial hypercholesterolemia screening program in primary care: The CARE-FH study

We designed the Collaborative Approach to Reach Everyone with Familial Hypercholesterolemia (CARE-FH) clinical trial to improve FH screening in primary care and facilitate guideline-based care. The goal was to incorporate perspectives from end-users (healthcare system leaders, primary care clinicians, cardiologists, genetic counselors, nurses, and clinic staff) and improve translation of screening guidance into practice. We partnered with end-users to sequentially define the current state of FH screening, assess acceptability, feasibility, and appropriateness of implementing an FH screening program, and select clinically actionable strategies at the patient-, clinician-, and system-level to be deployed as a package in the CARE-FH clinical trial. Methods informed by implementation science and human centered design included: contextual inquiries, surveys, and deliberative engagement sessions. Screening for FH occurred rarely in primary care, and then only after a cardiovascular event or sometimes due to a family history of high cholesterol or early heart attack. Surveys suggested FH screening in primary care was acceptable, appropriate, and feasible. Reported and observed barriers to screening include insufficient time at patient encounters to screen, cost and convenience of testing for patients, and knowledge regarding causes of dyslipidemia. Facilitators included clear guidance on screening criteria and new therapies to treat FH. These results led to the development of multilevel strategies that were presented to end-users, modified, and then pilot tested in one primary care clinic. A refined implementation strategy package for FH screening was created with a goal of improving FH awareness, identification, and initiation of guideline-based care. https://clinicaltrials.gov/study/NCT05284513?id=NCT05284513&rank=1 Unique Identifier: NCT05284513.

Voices of unpaid carers: problems and prospects in accessing palliative care and self-care information, resources and services.

Unpaid carers make a substantial contribution to the health economy and carers of palliative patients are particularly vulnerable due to special patient needs and excessive carer burden. The Australian Government recently implemented the Integrated Carer Support Service Model to provide a range of free services to carers in the community. However, it is unclear whether such initiatives are effective and, more importantly, how carers of palliative patients gain access to information, support and services for the patient and themselves. We sought to investigate unpaid carers' experiences in accessing information and resources for support with patient care with a specific focus on palliative care resources and to determine carers' access to information and support for self-care. We also aimed to identify what opportunities and challenges remain for these particular carers according to their experiences. We conducted 18 semi-structured interviews and 3 focus groups with unpaid family or friend carers of palliative patients in South Australia from metropolitan, regional and rural communities. Grounded in a descriptive phenomenological paradigm, we conducted a hybrid approach to thematic analysis combining deductive and inductive coding following Fereday and Muir-Cochrane's method. The government's web-based initiative provided little impact in supporting carers from our cohort. There remains a substantial gap between the formal recognition of the importance of carers and their lived reality. This recognition by health professionals is vital, as carer self-identification is not common and affects help-seeking behaviour. Carers seek and respond to more grassroots, personalized forms of support and sharing of information. The lack of self-identification affects carers' help-seeking behaviours. Carer identification and recognition need to be initiated by health professionals in a proactive manner to ensure carers are prepared for their role and are emotionally supported to sustain it. Carers seek face-to-face guidance and sources of information.

Palliative Care in the Community: The Greek Version of the Supportive and Palliative Care Indicators Tool (SPICT™).

Systematic identification of persons with palliative care needs constitutes a major challenge for promoting palliative care in all levels of the health system, including primary care. The aim of this study was to translate, cross-culturally adapt, and content validate Supportive and Palliative Care Indicators Tool (SPICT) for use in the Greek primary care context. Secondary objectives were to probe the use of SPICT-GR in exemplary case vignettes, to discuss the clarity and comprehensibility of its content as well as the appropriateness, acceptability, and feasibility of the tool within the Greek primary care. The Greek translation and cross-cultural adaptation of SPICT™ followed World Health Organization recommendations for translation and adaptation of instruments. For this purpose a working group was set up consisting of 2 senior researchers, a primary care professional with postgraduate training in Palliative Medicine and a general practitioner (GP) with special interest in primary palliative care. Three focus groups comprised of health professionals (n = 23) working in primary care settings participated in the pilot testing phase. Participants also completed a questionnaire including rating their perceptions on tool's utility and feasibility as well as on the clarity and relevance of its items. Thematic analysis was used for focus groups discussions on how the tool was perceived and interpreted by health professionals in a Greek healthcare context and descriptive statistics for the quantitative analysis of the questionnaire data. The majority assessed the tool as useful (65%), considered its implementation in primary care as feasible (91%) and rated its items as "relevant" or "very relevant" and "clear" or "very clear." Three themes emerged from focus groups discussions: Guiding clinical practice and facilitating collaboration; promoting comprehensive care and awareness for palliative care; applicability in and suitability for primary care. SPICT-GR™ was identified as a practical and applicable tool for primary care, a source of guidance for the comprehensive identification of patients' palliative care needs, promoting awareness on palliative care and facilitating a shared language among health care professionals.

Identification of unmet palliative care needs of nursing home residents: A scoping review protocol.

Nursing home residents often have life limiting illnesses in combination with multiple comorbidities, cognitive deficits, and frailty. Due to these complex characteristics, a high proportion of nursing home residents require palliative care. However, many do not receive palliative care relative to this need resulting in unmet care needs. To the best of our knowledge, there have been no literature reviews to synthesise the evidence on how nursing home staff identify unmet palliative care needs and to determine what guidelines, policies, and frameworks on identifying unmet palliative care needs of nursing home residents are available. The aim of this scoping review is to map and summarise the evidence on identifying unmet palliative care needs of residents in nursing homes. This scoping review will be guided by the JBI Manual for Evidence Synthesis. The search will be conducted in CINAHL, MEDLINE, Embase, Web of Science, APA PsycINFO, and APA PsycArticles. A search of grey literature will also be conducted in databases such as CareSearch, Trip, GuidelineCentral, ClinicalTrials.gov, and the National Institute for Health and Care and Excellence website. The search strategy will be developed in conjunction with an academic librarian. Piloting of the screening process will be conducted to ensure agreement among the team on the eligibility criteria. Covidence software will be used to facilitate deduplication, screening, and blind reviewing. Four reviewers will conduct title and abstract screening. Six reviewers will conduct full text screening. Any conflicts will be resolved by a reviewer not involved in the conflict. One reviewer will conduct data extraction using pre-established data extraction tables. Results will be synthesised, and a narrative synthesis will be used to illustrate the findings of this review. Data will be presented visually using tables, figures, and word clouds, as appropriate.

How to Defeat Multidrug-Resistant Bacteria in Intensive Care Units. A Lesson from the COVID-19 Pandemic. Prevention, Reservoirs, and Implications for Clinical Practice.

Background: Intensive care unit (ICU) patients are at high risk of infection due to multiple invasive procedures, malnutrition, or immunosuppression. The rapid increase in infections with multidrug-resistant organisms (MDRO) during the COVID-19 pandemic caused a dilemma, as the rules of the sanitary regime in ICU rooms were strictly adhered to in the prevailing epidemiological situation. The combat to reduce the number of infections and pathogen transmission became a priority for ICU staff. This study aimed to assess whether eliminating environmental reservoirs and implementing improved procedures for patient care and decontamination and washing equipment in the ICU reduced the incidence of infections caused by MDR strains. Material and methods: The study retrospectively analyzed data in the ICU during the COVID-19 pandemic. The samples were collected based on microbiological culture and medical records in the newly opened ICU (10 stations) and hospital wards where COVID-19 patients were hospitalized. Environmental inoculations were performed during the COVID-19 pandemic every 4-6 weeks unless an increase in the incidence of infections caused by MDR strains was observed. Through microbiological analysis, environmental reservoirs of MDR pathogens were identified. The observation time was divided into two periods, before and after the revised procedures. The relationship between isolated strains of Klebsiella pneumoniae NDM from patients and potential reservoirs within the ICU using ERIC-PCR and dice methods was analyzed. Results: An increased frequency of infections and colonization caused by MDRO was observed compared to the preceding years. A total of 23,167 microbiological tests and 6,985 screening tests for CPE and MRSA bacilli were collected. The pathogen spread was analyzed, and the findings indicated procedural errors. Assuming that the transmission of infections through the staff hands was significantly limited by the restrictive use of personal protective equipment, the search for a reservoir of microorganisms in the environment began. MDR strains were grown from the inoculations collected from the hand-wash basins in the wards and from inside the air conditioner on the ceiling outside the patient rooms. New types of decontamination mats were used in high-risk areas with a disinfectant based on Glucoprotamine. Active chlorine-containing substances were widely used to clean and disinfect surfaces. Conclusions: Infections with MDR strains pose a challenge for health care. Identification of bacterial reservoirs and comprehensive nursing care significantly reduce the number of nosocomial infections.

Working ALL together on an integrated and patient oriented flexible carepathway for eating disorders in Flanders

20% of the adolescents have eating problems. The majority (2/3thrd) does not seek any help. The remaining group (1/3thrd) have significant problems to find adequate help. It is essential to provide adequate help, in view of the detrimental impact of eating disorders, for which appropriate care is key, during several years. Care provision was, until now, to a large extent residential, which resulted in long waiting lists.
 In this workshop we will cover the development of a new integrated care organization and care strategy. Using the pathway of eating disorders as a case, it is of special interest to policy makers, care providers, but also to experts by experience and their families.
 Eetexpert has been developing (already for 20 years) a prevention policy, early detection strategies, a network of ambulant care and its related training. The most recent initiative, was to elaborate a prevention and care strategy, in collaboration with the federal and regional governments, the care providers, and the patient organization ANBN. This was very interesting and will result in a better care, which is easier to organize and finance. 
 This workshop will be given by the coordinator of eetexpert and the coordinator of ANBN (the patient organisation). The session will be highly interactive, covering the challenges we came along when defining the care strategy. It will encompass amongst others: the objectives to realise in an early stage more accessible care and the challenges related to this objective. We will also cover the new care organization with a broad and efficient primary care for eating disorders, the importance of family support, flexibility in the level of care intensity and the importance of short deadlines when starting up ambulant care, as well as the identification of complex care needs requiring a swift startup of residential care.
 The interaction during the workshop will be discussion based.
 How can we organize good pathway coordination ? How can we collaborate better between different disciplines in the primary care ? How could residential teams support careprovision in the primary care teams ? How can we strengthen the own power of parents and the home context ? How can financial resources optimally be used for early tailored care ?
 The final word in the workshop comes from the experts by experience, providing take home messages with great added value to you.
 
 Program:
 15' Integrated Care for eating disorders in Belgium (Eetexpert) + 5' Discussion + 10' Wishlist new care organization (ANBN Expert by experience) + 5' discussion + 20' challenge-lab (Audience) + 5' takehome message (ANBN expert by experience)
 (note for the reviewers: We hesitated to bring this abstract as a workshop or as an oral presentation It is really worth to hear the perspective of the patientorganisation, but in an oral presentation only one presenter is normally admitted. )
 

Integrated Health and Social Care In A Woman's Shelter and Multi-Service Agency

Introduction: Evidence exists demonstrating that integrated health and social care (IHSC) can support enhanced care for highly vulnerable and marginalized population groups. One such group are homeless women. Street Haven (SH) is a multi-service women’s agency that serves homeless women who suffers from the intersection of critical health, social and financial disadvantages living in one of the poorest urban neighbourhoods in Toronto, Canada. SH provides shelter, supported housing, addictions treatment and training support services. Over the past ten years, client acuity has increased the health and social care needs of vulnerable women. The pandemic has exacerbated this. Clients have experienced chronic homelessness which is connected to trauma. They also suffer from mental illness conditions, and chronic diseases including respiratory illnesses, and gastro-intestinal illness, and diabetes. Street Haven has engaged in integrated health and social care (IHSC) to ensure that more comprehensive care can respond to the increasing client care complexity. 
 Approach: IHSC coordination with community partners have been undertaken in order to address unmet health and social care. Within the SH shelter services, partnerships with primary health care partners, hospital services and community-based crisis and mental health teams have been established. As a result, a primary care physician and psychiatrist can be accessed once weekly on site by clients. Homeless women are then attached to a physician and psychiatrist while accessing SH services. In addition, when clients experience crisis, community-based outreach mental health and crisis teams are dispatched by other organizations to SH locations. The SH addiction treatment residence services also integrate with psychiatry services with a community clinical services agency and with the community crisis team to introduce crisis and psychiatric supports for addiction service clients. Lastly, SH works with community policing to ensure that women who exhibit behaviours stemming from crisis, may have benefit of community policing services that provide SH and client with protection while offering crisis supports at the same time. They help to divert clients from hospital and correctional services.
 Results: IHSC enables SH to better meet the needs of its highly complex client base within its premises. Several benefits of the IHSC include the identification of unmet health and social care needs of our clients including psychiatric and mental health needs and management of chronic diseases and medication prescription needs; enhanced client community engagement through the referral and coordination of services with community health and social care partner agencies; minimization of crisis events on SH premise sites; and minimizing utilization of acute car and correctional services. The competencies that are absent in the organization are available due to IHSC.
 Lessons Learned: IHSC can act as a lever for women’s shelter and addiction treatment services to provide more comprehensive health and social care services. IHSC is crucial considering the austerity in government program funding in Toronto and Ontario. IHSC is another means to better serve marginalized, homeless and impoverished women to ensure that they have more equitable access to health and social care services especially where there is a gender-bias against women’s services in Toronto. 

Seamless Discharge Planning and Care Transition in a Tertiary Hospital

Background: As Singapore's health care landscape evolves to cope with the rapidly ageing society, growing burden of chronic disease and rising health care cost, there is an impetus need to review the hospital's discharge planning process, so as to facilitate timely discharge and safe care transition from hospital to community. In SGH, the role of the Patient Navigator (PN) is to facilitate care coordination, discharge planning and care transition from hospital to community. However, in order to meet the increasing demand and workload, there is a need to look into capability building and empowering all nurses on the essential skills to perform a comprehensive discharge planning. Nurses play a pivotal role in patient/ caregiver's care needs assessment. Having the insight and knowledge will help them facilitate safe, smooth and timely discharge. Patient's discharge planning process is a critical point in care continuity, but it is often complex and challenging. A successful discharge planning involves the proactive identification of care needs and development of individualized care plans.
 Methods: A pre-survey was done to understand the nurses' knowledge on discharge planning and care transition. 463 nurses responded to this survey. 56% of the nurses rated their knowledge on discharge planning as fair (4 to 7) from a Likert scale of 0 (no knowledge) to 10 (very knowledgeable) (9% rated as poor and 34% rated as good).
 Hence, this study aims to increase the nurses' knowledge on discharge planning and care coordination, from baseline 34% (good) to 54% (20% improvement) within 6 months.
 The team used various Quality Improvement tools and techniques, such as the 5-Why diagram to identify the root cause/s to the problem. The final root cause identified was “nurses lack the information and skills” to initiate a comprehensive discharge planning.
 Intervention: The team then conducted a survey to gather the nurses (stakeholder) feedback on what areas/topics they would like to learn. From the survey results, the team then brainstormed on the delivery mode. Due to the Covid-19 restrictions, the team opted for online e-learning via Wizlearn. The e-learning invitation was then emailed to all Registered Nurses (RNs) in SGH to complete and their feedback was gathered for continued improvement. 
 Results: Post e-learning, the nurses would rate their knowledge gained using a Likert Scale of 0 to 10 (with 0 being no knowledge gained). As of 16 Dec 2021, 504 nurses completed the wizlearn and post-survey. From the pre-post results, there was an increase in ‘Good’ by 27%.
 P value was statistically significant for “Fair” and “Good” outcomes, p=0.011117. Intangible results include the good feedback received from the nurses in wizlearn stating their appreciation for the information (staff satisfaction). 
 Sustainability plans: The e-learning module is incorporated into the Singhealth e-learning portal and is made available to all staff. New nurses are encouraged to register for this course. The next phase of the project’s sustainability plans includes measuring how the knowledge translates to actual clinical outcome, such as patient’s discharge care plan are documented timely as part of the nurse's assessment.

Utilization of Hospice Resources in Adult Intensive Care Units: A Comparison Between Users and Non-Users

The application of palliative care is limited and challenging in intensive care units (ICUs) because of complex factors such as time constraints and unpredictable disease progression. Although research results and international consensus stress the early use of palliative care, utilization remains low, resulting in increased risks of ineffective medical care and poor quality of death. Improving this situation requires a comprehensive understanding of the palliative condition in ICUs. This study was designed to investigate the utilization of hospice resources in adult ICUs and to compare this utilization between users and non-users. This retrospective correlation study recruited cases from the adult ICU database of a medical center in northern Taiwan between June and July 2022. Descriptive statistics, independent t-test and chi-square were used to analyze the data. A total of 1,181 records were analyzed, including 458 (38.8%) females and 723 (61.2%) males. Two hundred and seventeen cases (18.4%) used hospice resources. Although 124 (10.4%) of the 1181 cases were identified as "in urgent need of hospice resources" (i.e., died within 30 days of ICU admission), 25 (20.2%) did not use these resources. Significant differences between the urgent-need cases who did and did not use hospice resources were found in terms of age, disease type, degree of frailty, cardiac arrest, infection, state of consciousness, intubation and tracheostomy status, inotropic and vasopressor medication, renal replacement, ECMO placement, delirium, and Acute Physiology and Chronic Health Evaluation III and Sequential Organ Failure Assessment Scores. The roughly 20% of ICU patients in urgent needs of palliative care who did not utilize palliative care resources highlight the needs for continued discussion to better assist patients on palliative care decision-making. The findings show multifaceted differences between those who did and did not access palliative care. Future studies should design and test strategies to facilitate the identification of palliative care needs and ensure the effective allocation of palliative care resources in ICUs.

Early Disease Prediction using Ml

The approach employed in disease prediction using machine learning involves making forecasts about various diseases by utilizing symptoms provided by patients or other individuals. The supervised machine learning approaches called random forest classifier, KNN classifier, SVMs classifier are employed to forecast the disease. These algorithms are used to determine the disease's probability. Accurate medical data analysis helps with patient care and early disease identification as biomedical and healthcare data volumes rise. Diabetes, heart diseases are just a few of the illnesses we can forecast using linear regression and decision trees. Early detection is beneficial for determining the possibility of diabetes, heart disease.

Consecutive Inpatient Hematology Consultation Service Utilization across 11 Years in the Medical Intensive Care Unit

INTRODUCTION The current understanding of hematology consultation service utilization is limited to four studies in the outpatient setting and zero in the inpatient setting. While training programs in non-hematology specialties (i.e., cardiology, infectious diseases, nephrology) invest in dual-trained specialty-intensivists, investments into dual-trained hematologist-intensivists are systematically underdeveloped. Despite the high clinical volume of hematology patients admitted to the Medical Intensive Care Unit (MICU), there is currently no characterization of hematology MICU service needs. We sought to begin to fill this gap by examining the volume of consecutive consultations, time to consultation, consult patient characteristics, type, and number of consult question per patient and consult categories originating in the MICU at the largest hospital in the United States (2023 Becker's Hospital Review). METHODS We conducted a retrospective observational study of consecutive patients 18 years of age or older who had an incident (i.e., de novo) hematology consultation while admitted to the MICU from February 2013 through March 2023 at a single academic center. Inclusion criteria included (1) age of ≥ 18, and (2) initial consultation generated during MICU admission. To ensure only incident hematology consultations originating in the MICU were examined, patients with consultation placed on the medical floor with subsequent transfer to the MICU, and re-consultations in the MICU for the same patient, were excluded. Each consult note was manually reviewed to determine the exact consultation query. Descriptive statistics collected for each patient included (1) baseline demographics, (2) labs from day of consultation, (3) time to consultation, (4) binary hospital discharge status (alive or dead), and (5) number and type of consult queries within each consult. For the latter, number of queries per each consult were also recorded (i.e., anemia and thrombocytopenia would be two independent queries), and each query was further adjudicated as pertaining to either classical or malignant hematology. Descriptive statistics were tabulated using Microsoft Excel and GraphPad 9.4.1. RESULTS Across 11 years of consecutive, incident consultations requested from the MICU, there were a total of 594 hematology consults with 776 total consultation queries. At time of consultation request, the median age of patients was 60 years, 47% were of female sex, and mean time to hematology consultation was 30 hours after initial MICU admission (Table 1). Of the queries, 75% pertained to classical and 25% to malignant hematology. Of the 776 consult queries, the top three overall hematology consultation queries were for thrombocytopenia (n=105), coagulopathy (n = 86), and lymphoproliferative disorders (n=77). The top three classical hematology queries were for thrombocytopenia (n=105), coagulopathy (n=86), and thrombosis (n = 76). The top three malignant hematology queries were for lymphoproliferative disorders (n=77), acute leukemia (n=48), and plasma cell dyscrasias (n=25) (Table 1). CONCLUSIONS To our knowledge, our study is the first to describe the volume of incident inpatient hematology consultations originating from the MICU. We found that classical hematology queries constitute three quarters of consultation volume, yet the existing literature on hematologic critical care focus only on quality improvement metrics for hematologic malignancies in the ICU. The development of quality metrics for classical hematology critical care management and identification of research are needed, particularly in the context of the identified national workforce shortage in classical hematology. Future work to examine intensivists' consultation queries originating from other intensive care units (i.e., surgical, cardiac, and neurological), would allow a data-driven evaluation of the service need for dual-trained hematologist-intensivists in the United States. The volume and complexity of classical hematology consults that arise in the ICU, as demonstrated in this study, in addition to frequent ICU consultations and admission for hematologic malignancies, highlights an area of both research and clinical practice that could support developing dual trained hematologist-intensivist to help protocolize and deliver safe and expedient care for all consult queries.

Support needs of carers of cancer patients and the effects of the patient's age and cancer type on their needs

PurposeThis study aimed to investigate support needs of carers of cancer patients and the effects of the patient's age and cancer type on their needs. MethodsIn this descriptive and comparative study, the data were collected from the carers (n = 120) of the patient admitted to inpatient and outpatient clinics of a university hospital between June 2021 and October 2022. Patient identification form, carer identification form, and Carer Support Needs Assessment Tool (CSNAT) were used for data collection. The comparisons of the support needs were done for the carers according to the patient's age (<65 versus ≥65 years) and cancer type (hematological malignancies versus solid tumors). ResultsCaring duration (19.78 ± 29.64 vs 10.33 ± 18.77 months) and caring hours per week (47.58 ± 26.90 vs 32.75 ± 25.75 h) were high in those caring for older adults. Carers of older adults need more support in providing personal care for their relatives (eg dressing, washing, toileting) (X2 = 8.000, p = 0.005). Carers of patients with hematological malignancies need more support in understanding their relative's illness (X2 = 6.136, p = 0.013), having time themselves in the day (X2 = 4.089, p = 0.043), managing their relative's symptoms, including giving medicines? (X2 = 5.263, p = 0.022), and their beliefs or spiritual concerns (X2 = 4.728, p = 0.030) compared to the carers of the patients with solid tumors. ConclusionThe support needs of the carers vary depending on the patient's age and cancer type. Carers of older adults and patients with hematological malignancies need more support.

Barriers to the spiritual care of parents taking care of their child with a life-limiting condition at home

The changes that parents face when caring for a child with a life-limiting condition at home can affect them on a spiritual level. Yet, indications remain that parents do not feel supported when dealing with spiritual issues related to caring for a severely ill child. This paper explores, from the perspectives of bereaved parents, chaplains, grief counselors, and primary health care providers, the barriers to supporting the spiritual needs of parents. We conducted a qualitative focus group study from a constructivist point with chaplains/grief counselors, primary care professionals, and bereaved parents. All groups participated in two consecutive focus group sessions. Data were thematically analyzed. Six chaplains/grief counselors, 6 care professionals, and 5 parents participated. We identified six barriers: (1) There were difficulties in identifying and communicating spiritual care needs. (2) The action-oriented approach to health care hinders the identification of spiritual care needs. (3) There is an existing prejudice that spiritual care needs are by nature confrontational or difficult to address. (4) Spiritual support is not structurally embedded in palliative care. (5) There is a lack of knowledge and misconceptions about existing support. (6) Seeking out spiritual support is seen as too demanding.Conclusion: Parents of children with life-limiting conditions face existential challenges. However, care needs are often not identified, and existing support is not recognized as such. The main challenge is to provide care professionals and parents with the tools and terminology that suit existing care needs.What is Known:• Spiritual care needs are an important aspect of pediatric palliative care.• Parents of children with life-limiting conditions feel unsupported when dealing with spiritual questions.What is New:• Parents and professionals mention barriers that hinder spiritual support for parents.• There is a disconnect between existing support and the care needs that parents have.

"Palliative care is so much more than that": a qualitative study exploring experiences of hospice staff and bereaved carers during the COVID-19 pandemic.

The way in which end-of-life care was provided changed significantly during the first 2 years of the COVID-19 pandemic. The national lockdown restrictions reduced formal care support services and increased the burden on many carers taking on the caring role for the first time. We aimed to explore decision-making about the place of care during the COVID-19 pandemic and the impact on experience from the perspectives of carers and hospice staff caring for people at the end-of-life. A qualitative study using virtual interviews was conducted between October 2020 and April 2021. Data were analyzed thematically using framework analysis, an analytical framework that enables qualitative research to be organized into defined themes derived from the research question. Findings were presented to stakeholders in policy roundtables between March 2022 and March 2023 and discussed collaboratively with staff, stakeholders, and the public to inform policy and practice change. A total of 37 participants (15 bereaved carers and 22 staff) were recruited via hospice services in England and Scotland. Four key themes were identified: (1) changing preferences relating to decision-making about the place of care and the impact at the time of death and into bereavement; (2) missed opportunities related to not being there, not having others around, and being robbed of memory-making; (3) the lone carer during a period of high intensity and reduced home support; (4) process vs. person-centered care resulting from changing rules and restrictions and prioritization of regulations over essential palliative care. The study provides valuable global implications for all involved in end-of-life care. Despite great efforts to provide dignified, quality care, palliative care during the pandemic changed, focusing on essential 'physical care'. The psychological suffering experienced by staff and carers may need longer-term support mechanisms put in place, which will benefit from a public health approach. Policymakers should consider improving carer identification and resources for wider end-of-life care education to support the needs of carers, health and social care staff, and citizens.

Understanding patient views and experiences of the IDENTIfication of PALLiative care needs (IDENTI-PALL): a qualitative interview study.

Palliative care improves quality of life for people with life-threatening illnesses. There are longstanding inequalities in access to palliative care, with many people never identified as having palliative care needs, particularly frail older people, those with non-malignant disease, and people from ethnic minority backgrounds. Little is known about the process of identification of palliative care needs from a patient perspective. To provide new understanding into patient views and experiences of the process of identification of palliative care needs, and to explore the impact of identification on health care, if any, from a patient perspective. A qualitative interview study undertaken with patients and family carers in a major UK city. Semi-structured interviews were carried out with patients (and/or family carers) identified as being on general practice palliative care registers. An inductive thematic analysis was conducted to explore the data. Eleven participants were recruited: eight patients and three family carers. The following three interrelated themes were identified: 1) misconceptions about palliative care and unshared prognostic uncertainty hinder the identification of palliative care needs; 2) a compassionate, timely approach is required for identification of palliative care needs, with or without an identification tool; and 3) identification of palliative care needs is beneficial where it leads to proactive holistic care. A compassionate approach, sharing of prognostic uncertainty, and proactive primary care are key to timely, beneficial identification of palliative care needs. Future policy should ensure that identification is an adaptable, personalised process to meet the individual needs of people with advanced serious illnesses.

Consensus on acute behavioural disturbance in the UK: a multidisciplinary modified Delphi study to determine what it is and how it should be managed

BackgroundAcute behavioural disturbance (ABD) is a term used in law enforcement and healthcare, but there is a lack of clarity regarding its meaning. Common language should be used across staff...