PubMed Health⌕ Search

Biomedical subjects

Alvin H Moss

Publications and source records attributed to Alvin H Moss.

18 recordsLinked to original sources
PubMed2006

Efficacy of the world health organization analgesic ladder to treat pain in end-stage renal disease.

Pain is the one of the most common symptoms experienced by patients with ESRD; it impairs their quality of life and is undertreated. Most pain clinicians believe that the pain management approach of the World Health Organization (WHO) three-step analgesic ladder is applicable to the treatment of patients with ESRD, but this approach has not been validated for them. A cohort of 45 hemodialysis patients were assessed for type and severity of pain using the Short-Form McGill Pain Questionnaire and then treated during a 4-wk period according to the WHO analgesic ladder. Mean age was 65 +/- 12.5 yr, and 22 (49%) patients had diabetic nephropathy as the cause of ESRD. Initial pain was rated severe by 34 (76%) patients. There was no difference in initial pain rating by gender, age, race, or type of pain. Forty percent of patients reported nociceptive pain, 31% neuropathic, and 29% both. Adequate analgesia was achieved in 43 (96%) of 45 patients. The mean pain score decreased from 7.8 +/- 1.2 to 1.6 +/- 1.3 (P < 0.001). Patients who were 65 yr and older had higher posttreatment scores than those who were younger than 65 (2.1 +/- 1.4 versus 0.94 +/- 0.93; P = 0.002) and more medication adverse effects. It is concluded that the use of the WHO three-step analgesic ladder leads to effective pain relief in hemodialysis patients. Older patients will need more careful pain management to achieve the same results as younger patients. Further studies are needed to confirm these results in a larger, more diverse dialysis population.

Aged↗
PubMed2006

Renal palliative care.

Patients with chronic kidney disease have a shortened life expectancy and carry a high symptom burden. Clinicians need sophisticated expertise in pain and symptom management and skills in communication to meet the many needs of this population. This article reviews the literature and discusses prognosis, ethical and legal considerations, symptoms, treatment, and end-of-life issues. The field of nephrology is shifting from an exclusive focus on increasing survival to one that provides greater attention to quality of life. There is an opportunity to integrate many of the advances of palliative medicine into the comprehensive treatment of these patients.

Adult↗
PubMed2005

Communicating prognosis in the dialysis consent process: a patient-centered, guideline-supported approach.

Recent guidelines recommend shared decision making between patients and nephrologists as the model for dialysis decision making. A key component of this shared decision making is obtaining informed consent. As part of this process, nephrologists have an obligation to inform patients with chronic kidney disease of their prognosis. Ideally, patients themselves should be involved in the decision-making process; however, some patients will not possess decision-making capacity, and others may be unwilling to participate. Determining what to tell patients about prognosis requires tailoring the conversation to the individual patient's preferences. Conversations about prognosis need to occur in a timely fashion so that patients have the opportunity to consider options and make decisions before dialysis is inevitable. Communication strategies are available to assist nephrologists in breaking the bad news of the need for dialysis and its associated burdens. The approach described in this article should help nephrologists discuss prognosis with their patients in a way that is patient centered and in accordance with clinical practice guideline recommendations.

Communication↗
PubMed2005

The development and outcomes of a statewide network of hospital-based palliative care teams.

BACKGROUND: Health care systems need to be developed that meet the palliative care needs of patients and their families. OBJECTIVE: The West Virginia Initiative to Improve End-of-Life Care charged its Palliative Care Delivery System Task Force with developing hospital-based palliative care teams in West Virginia. SETTING/SUBJECTS: A descriptive study of a state-community partnership to improve palliative care. MEASUREMENTS: Numbers of member hospitals, number and nature of palliative care consultations, number of patients referred to hospice programs. RESULTS: What began as a palliative care network of five hospitals has grown into a network of 16. Network members advise one another on financing, staffing, and obtaining administrative buy-in, and the network leaders provide educational programs to prepare physicians and nurses to serve as consultants on hospital-based palliative care teams. There was a 300% increase in the number of palliative care consultations between 2000 and 2003 in 49 of West Virginia's 55 counties. Analysis of the submitted data collections forms has allowed the network to promote improvement in palliative care consultations in member hospitals and to initiate interventions on a statewide basis to improve decision-making with the appropriate legal agent, treatment of pain, and referral of patients for hospice care. CONCLUSION: Hospital participation in the Palliative Care Delivery System Task Force led to a sustained membership organization, the West Virginia Palliative Care Network that promotes hospital-based palliative care.

Advisory Committees↗
PubMed2004

Palliative care.

Explore the source record for details and available documents.

Advance Care Planning↗
PubMed2004

The frequency and significance of the "difficult" patient: The nephrology community's perceptions.

Based on casual conversations among those working in dialysis units, dialysis facility staff often face situations created by difficult or disruptive patients, yet relatively little is known about these situations. A computer interactive session at a national meeting in April 2000 was used to gather information on this topic from 203 persons who worked in dialysis facilities. Most respondents viewed situations with such patients as an increasing problem for the nephrology community. Although 71% of the respondents were frequently involved in the attempted resolution of these situations, only 50% indicated that they were adequately trained to intervene. Approximately 38% of the participants' facilities had discharged a patient because of behavioral difficulties in the preceding year. Many facilities lacked policies that could provide guidance to both staff and patients about their rights and responsibilities, as well as policies that specifically addressed difficult/disruptive patient situations. These results highlight the need for increased training for personnel and the development of policies by dialysis units to address this increasingly common problem.

Adult↗
PubMed2003

The need for end-of-life care training in nephrology: national survey results of nephrology fellows.

Because of the high mortality rate of end-stage renal disease, nephrologists care for many dying patients. However, the education of nephrology fellows in palliative care has not been assessed. We surveyed second-year nephrology fellows to assess the quantity and quality of teaching they received in palliative medicine and also asked about their preparedness to manage patients at the end of life. A 63% survey response rate yielded 173 surveys for evaluation. Nearly all fellows (99%) agreed that physicians have a responsibility to help patients at the end of life; half thought it was very important to learn how to care for dying patients. On a 10-point scale in which 0 is no teaching and 10 is a lot of teaching, fellows reported significantly less teaching in end-of-life care (mean score, 3.8 +/- 2.6) than in managing a patient with distal renal tubular acidosis (mean score, 6.3 +/- 2.5) or on hemodialysis therapy (mean score, 8.9 +/- 1.5; all P < 0.0001). Specific palliative care content areas were taught infrequently; only 22% of fellows were taught how to tell a patient he or she is dying. Fellows who had contact with a palliative care specialist reported more education on end-of-life issues and believed they were better prepared to provide such care. Fellows' palliative care experiences during fellowship frequently occurred without attending nephrologist supervision; 32% of fellows had conducted 2 or fewer family meetings, and 26% of all family meetings occurred without an attending nephrologist. Fellows believed they were best prepared to manage a patient on hemodialysis therapy (mean score, 8.9 +/- 1) and least prepared to manage a patient at the end of life (mean score, 6.1 +/- 2; P < 0.0001). Our results show that most nephrology fellows believe they should learn how to care for dying patients, but most fellowship programs do not offer this training. Our study therefore suggests that training in palliative care be incorporated into fellowship program curricula.

Data Collection↗
PubMed2003

ESRD patient quality of life: symptoms, spiritual beliefs, psychosocial factors, and ethnicity.

BACKGROUND: Recent research suggests that patients' perceptions may be more important than objective clinical assessments in determining quality of life (QOL) for patients with end-stage renal disease (ESRD). METHODS: We interviewed 165 hemodialysis patients from 3 sites using a QOL questionnaire that included the Satisfaction With Life Scale (SWLS) and the McGill QOL (MQOL) scale, which includes a single-item global measure of QOL (Single-Item QOL Scale [SIS]). The MQOL scale asks patients to report their most troublesome symptoms. We also initiated the use of a Support Network Scale and a Spiritual Beliefs Scale. RESULTS: Mean patient age was 60.9 years, 52% were men, 63% were white, and 33% were African American. Patients had a mean treatment time for ESRD of 44 months, mean hemoglobin level of 11.8 g/dL (118 g/L), mean albumin level of 3.7 g/dL (37 g/L), and mean Kt/V of 1.6. Forty-five percent of patients reported symptoms. Pain was the most common symptom (21% of patients). There was an inverse relationship between reported number of symptoms and SWLS (P < 0.01), MQOL scale score (P < 0.001), and SIS (P < 0.001). The Spiritual Beliefs Scale correlated with the MQOL scale score, SWLS (both P < 0.01), and SIS (P < 0.05). The Support Network Scale score correlated with the MQOL Existential (P = 0.01) and MQOL Support (P < 0.01) subscales. No clinical parameter correlated with any measure of QOL, spiritual beliefs, or social support. CONCLUSION: Symptoms, especially pain, along with psychosocial and spiritual factors, are important determinants of QOL of patients with ESRD. Additional studies, particularly a longitudinal trial, are needed to determine the reproducibility and utility of these QOL measures in assessing patient long-term outcome and their association with other QOL indices in larger and more diverse patient populations.

Adaptation, Psychological↗
PubMedDate not supplied

Barriers to quality end-of-life care in West Virginia ICU units: physicians' and nurses' prospectives.

Most deaths in West Virginia occur in hospitals and a high proportion take place in intensive care units (ICU). This study was undertaken to determine what West Virginia physicians and nurses treating patients in ICUs perceive to be the barriers to quality end-of-life care. A total of 626 physicians and nurses practicing in 28 hospitals completed surveys and the results showed that physicians and nurses agree the top three barriers are patient/family demands for all possible treatment; inadequate insurance coverage; and lack of health care professional education. The study indicated that the majority of physicians were satisfied with their end-of-life care skills. In addition, it showed that physicians referred an average of 10 patients to hospice in the preceding year and that they did not refer more patients because the patient or family did not accept that the patient was dying. Futher education of physicians, nurses and especially the public is needed to improve end-of-life care in West Virginia.

Adult↗