Philosophy Of Patient Care Research Articles

PHARMACY HEALTH SYSTEM IN CANADA: AN ADOPTABLE MODEL FOR ADVANCED CLINICAL AND PHARMACEUTICAL CARE

The philosophy of patient care is a wide and complicated topic of literature. That is elaborated by different health institution to harmonize their local clinical activities. Undoubtedly, that is working successfully to satisfy patients, fulfill the requirement of clinicians and cover maximum mutual benefits within officially allocated budget. However, patient care has different comprehension in different demographic and socio-political setting. But, in general, the meaning, understanding and composition of clinical and pharmaceutical patient care may be same all over world. The pharmacists, clinicians and administration adopt, exercise and emphasize on certain parts depending upon the type of challenges, kind of patients and available health care facilities. Thus, the health care is an emerging field that always remained under consideration. The local and international experts like to work, contribute and improve it to enhance the public health. Even some time judiciary, parliament and local intelligentsia focus and emphasize to address some particular health related problems. So, we may need to elaborate the comprehension to satisfy the literature and logical need of health and medicine including identification of problems, designing treatment protocol and handling the complication of therapy. That may potentially improve the overall outcomes and maximize the patient’s benefit. After twenty five years the definition of pharmaceutical care is still unsatisfactory. The confusion remained about what this term comprises and how to distinguish it from other terms. The board of the Pharmaceutical Care Network Europe (PCNE) felt essential to rephrase pharmaceutical care and to answer the question: "What is Pharmaceutical Care ". The patient care is not perfectly incorporated into the health care system in most part of the world. However, pharmacy practice has shown positive attitudes toward patient care provision. Thus, an advanced working should focus to improve the understanding the concept of patient care and overcome barriers.

Factors Affecting the Decision to Provide Artificial Nutrition for Elderly Adults with Oral Intake Difficulty

To the Editor: One of the most distressing challenges in current geriatric practice is deciding whether to initiate artificial nutrition for elderly adults who are unable to eat. Several studies have indicated the need to improve the decision-making process for artificial nutrition.1-3 In Japan, the last decade saw increasing concern about the medical and ethical appropriateness of tube feeding in elderly adults with advanced conditions, but it appears that most medical institutions are not equipped to support the decision-making process. An explorative retrospective study on the factors affecting the decision to provide artificial nutrition in elderly adults was conducted. Fifty-nine subjects were selected from individuals admitted to St. Francis Hospital between September 2010 and February 2012. Inclusion criteria were aged 60 and older, dysphagia, and being given the decision to initiate or withhold artificial nutrition. Percutaneous endoscopic gastrostomy (PEG) was performed in 30 and enterostomy in two, total parenteral nutrition (TPN) was given in eight, nasogastric tube feeding (NGT) was administered in seven, and artificial nutrition was withheld from 12. A comparison was made between participants who did not start artificial nutrition (withholding group) and those who underwent PEG or enterostomy (tube-feeding group). Those who received TPN or NGT were excluded from the analysis because they were generally regarded as temporary treatments. Participant characteristics were compared according to sex, age, primary disease, length of hospital stay, mortality, serum albumin levels, swallowing function, physical activity, and communicative ability. The assessment methods for the last three variables have been described elsewhere.4 Analysis of the decision-making process was based on a review of participants' medical records. First, the physician's explanations about the risks and benefits of artificial nutrition were extracted from the medical records. (Analyzable data were obtained from only 23 subjects in the tube-feeding group.) Then, each explanation was typed individually onto a card. The card was then randomly presented to a speech and language therapist unrelated to the hospital, and each explanation was subsequently classified into one of two categories: positive recommendation or nonpositive recommendation. Participant characteristics of the two groups are shown in Table 1. The number of subjects in the withholding and tube-feeding groups was reduced because of lack of data for the following variables: swallowing assessment (n = 10, 15), physical activity (n = 11, 12), and communication ability (n = 11, 20). Although subjects in the withholding group were significantly older than those in the tube-feeding group (P = .04), there were no significant differences in the other participant characteristics. The distribution of primary diseases was not significantly different between the withholding and tube-feeding groups: respiratory diseases (50%, 56%), gastrointestinal diseases (33%, 16%), cardiac diseases (8%, 3%), orthopedic diseases (8%, 6%), cerebrovascular diseases (0%, 6%), and other (0%, 13%). Participants were not involved in the decision-making process because of cognitive problems, and no advance directives were reported. Families made all of the decisions with the support of physicians. Physicians provided positive recommendations more frequently for the tube-feeding group (19/23, 83%) than for the withholding group (5/12, 42%) (P = .01). Participant characteristics were not important factors in the decision-making process because there were no significant differences between the two groups except for age. Given that participant wishes were not known, the families' beliefs and physician's suggestion were considered to primarily influence the decision-making process. The analysis of the physicians' suggestions showed that they provided fewer positive recommendations for the withholding group than for the tube-feeding group. Although this might be attributable to their philosophy of patient care, an alternate point of view can be assumed in that the physicians, who after sensing reluctance from the family toward initiating artificial nutrition, were inclined to make nonpositive suggestions. Previous studies have reported that families' preferences influenced physicians in the decision-making process.5, 6 If this is the case, including a viewpoint of interactive effects between physician and family is important for improving the decision-making process. Further studies are required to create an ethically sound decision-making process that can contribute to the wellness of elderly adults who may require artificial nutrition. Conflict of Interest: The authors have no financial or any other kind of personal conflicts with this report. Author Contributions: Yoshitoshi Kuroda and Riko Kuroda were the authors of this report. Sponsor's Role: Financial support for this study was not provided.

Minimum intervention dentistry principles and objectives

Minimum intervention dentistry (MID) is the modern medical approach to the management of caries, utilizing caries risk assessment, and focusing on the early prevention and interception of disease. Moving the focus away from the restoration of teeth allows the dentist to achieve maximum intervention, with minimal invasive treatments. The four core principles of MID can be considered to be: (1) Recognition - early identification and assessment of potential caries risk factors through lifestyle analysis, saliva testing and using plaque diagnostic tests; (2) Reduction - to eliminate or minimize caries risk factors by altering diet and lifestyle habits and increasing the pH of the oral environment; (3) Regeneration - to arrest and reverse incipient lesions, using appropriate topical agents including fluorides and casein phosphopeptides-amorphous calcium phosphates (CPP-ACP); (4) Repair - when cavitation is present and surgical intervention is required, conservative caries removal is carried out to maximize the repair potential of the tooth and retain tooth structure. Bioactive materials are used to restore the tooth and promote internal healing of the dentine. Effective implementation of MID involves integrating each of these four elements into patient assessment and treatment planning. This review paper discusses the key principles of MID as a philosophy of patient care, and the practical objectives which flow into individual patient care.

"The chronic patient": in search of a title.

In 1976 I wrote the first edition of Deinstitutionalization: An Analytical Revie-wandSociologicalPerspective(1), a monograph that sought to sort out and conceptualize the many issues related to implementing a new philosophy of patient care. Since then, deinstitutionalization in its various manifestations, including its relationship to homelessness among mentally ill persons, has remained my major academic focus. The problems I discussed in 1976 have not been fully resolved, and serious new issues have arisen (2). The fact that substantial benefits have also accrued to many patients does not diminish those problems. As deinstitutionalization has evolved, new concepts and practices associated with service delivery have emerged, and a growing literature continues to catalog and assess their impact. It might be said that the major purpose of this column, The Chronic Patient, is to provide a means for documenting and disseminating new patient care strategies and the concepts underlying them. Change has also affected the language associated with deinstitutionalization. Words like “outreach,”

Communication between physicians and physical therapists.

The purposes of this study were 1) to identify therapists' and physicians' attitudes and opinions about the physician-physical therapist communication dyad, 2) to identify potential areas for improvement in this communication process, and 3) to provide physical therapists and physical therapy students with basic guidelines for optimal communications. Ten physical therapists and 8 physicians participated in individual interviews that were taped and subsequently transcribed. The transcriptions were compiled and analyzed by an interpersonal communication expert (B.W.B.) for trends and themes. Findings of the study include 1) physical therapists want increased accessibility to and communication with physicians and 2) physicians want brief communication with clear objective data provided by the therapists. Basic guidelines developed for physical therapy students as a result of this study include 1) identify physicians with whom you can communicate most easily, 2) learn your physicians' schedules, 3) organize beforehand so that communication is clear and concise, 4) be polite but self-assured, 5) ask your supervisor or other staff therapists for advice, and 6) use the telephone discriminately. This study emphasizes that communication with physicians must be approached on an individual basis. Each physician differs in personality, philosophy of patient care, and expectations of physical therapy. Therapists should take the initiative in developing good rapport and maintaining a viable relationship with physicians.

Nosocomial infections on a primary nursing unit

Primary nursing care is a philosophy of patient care in which a primary nurse is responsible for all of the patients’ nursing needs. With this type of care, a single registered nurse coordinates all of the patient’s activities throughout the entire period of hospitalization. When the primary nurse is not on duty, the patient is cared for by “associate nurses.” It is generally thought that primary nursing care offers a “hands on” approach to nursing care. Some authorities believe that primary nursing increases the quality and consistency of care for the patient.‘, 2 On the other hand, the team-leading philosophy of nursing care is based on management principles wherein registered nurses oversee the care of patients in their unit and direct the activities of other registered nurses, licensed practical nurses, and aides. The team leader is the supervisor of ward activities and may also be responsible for dispensing medications. With this philosophy of nursing care, several different nurses and aides are responsible for the total care of an individual patient. Care is

Concepts in the Use of Hypnosis for Pain Relief in Cancer

Hypnosis has no single place, but rather a broad range of application of technique and a long standing basis in the philosophy of patient care. We are not purists in any sense of the word. Our use of hypnosis in relief of pain in cases of cancer involves all formal medical procedures enhancing their potential through proper suggestions. We will endeavor to present some techniques of relaxation and pertinent case histories.

Sizing free-standing ambulatory care facilities.

This guide, written by an administrator and an industrial engineer, identifies and discusses the factors that should be considered when planning space requirements for ambulatory care facilities. The authors view sizing the ambulatory care facility as a complicated sequential task where trade-offs are made with regard to several factors: philosophy of patient care; cost; expansion requirements; patient comfort and waiting time; patient privacy; staff preferences; utilization patterns; and scurity of the faculty. It is suggested that the weight assigned to each factor when making trade-offs will be largely affected by the philosophy of patient care. The authors divide ambulatory care facilities into five functional groups: (1) basic medical services; (2) supporting medical services; (3) administrations; (4) support and service facilities; and (5) community and secondary support facilities. There are tables summarizing recommended space requirements for each of the functional groups based on mathematical models of the number and type of people using them (i.e., a typical physician is expected to see 24 patients per day). Space requirements for the whole clinic can be determined by adding together those required for each functional component. Provisions for growth and technological advances are discussed. An extensive bibliography is included.

Hearts: Their Long Follow-Up

If Dr. Paul Dudley White had published just another textbook, it would not be particularly newsworthy. However, Hearts, Their Long Follow-Up is not a textbook but is, instead, a fascinating narration of case histories which Dr. White has compiled with the help of Helen Donovan, his secretary for many years. Some of the patients have been followed for 40 years, and in describing their illnesses and followup, Dr. White exposes his philosophy of patient care and demonstrates the human concern of a great physician for his patients as individuals. The book is divided into chapters by disease headings, making it easy to browse through sections relevant to particular problems. It is reassuring to read of patients thought to have had fatal disease, leading happy and productive lives for 30 years. This can act as an antidote to the present rush to surgical treatment. Dr. White emphasizes moderation in diet and