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PubMed2004

Surviving the stresses of clinical oncology by improving communication.

Oncologists grapple with an element of psychological stress that relates to the suffering their patients experience. Although this stress may not be unique to oncology, it is profound. When these stresses become overwhelming, they lead to physician burnout. It is important to understand what makes an oncologist feel successful, what coping strategies help combat burnout, and what adds to the process of renewal. The doctor-patient relationship plays an important role for many oncologists in this regard, and communication skills are increasingly recognized for their importance in this arena. We outline several clinical scenarios that pose particular challenges to oncologists. These include breaking bad news and the patient's response to hearing bad news, transitions in care and offering end-of-life care, participation in investigational studies, error disclosure, complementary and alternative medicine, spirituality, family discussions, and cross-cultural issues. By highlighting the relevant psychosocial issues, we offer insight into, and tools for, an enriched dialogue between patient and oncologist. The doctor-patient relationship can be viewed as the ultimate buffer for dealing with the hassles encountered in clinical oncology.

Communication↗
PubMed2006

Strategies for optimizing outcomes in the NSTE-ACS patient The CATH (cardiac catheterization and antithrombotic therapy in the hospital) Clinical Consensus Panel Report.

This paper provides a comprehensive up-to-date review of the medical and invasive management of patients with non- ST-segment elevation acute coronary syndromes (NSTE-ACS). The authors have summarized findings from key clinical trials published recent years that contribute to clinicians' understanding of how best to optimize therapy. The goals for the management of NSTE-ACS are rapid and accurate risk stratification, appropriate and institution-specific triage to interventional versus medical strategies and optimal pharmacologic therapy--all of which provide for a smooth and seamless transition of care between the emergency department and the cardiology service. High-risk features or absolute treatment trigger criteria that support more aggressive medical therapy (i.e., addition of small-molecule GP IIb/IIIa inhibitor to a core regimen of aspirin, enoxaparin, and in most cases, clopidogrel) and/or that would direct clinicians toward percutaneous, mechanical/interventional strategies as the preferred modality include, but are not limited to, the presence of one or more of the following: (1) elevated cardiac markers (troponin and/or CK-MB); (2) elevated levels of inflammatory markers (particularly CRP > 3 microg/dl); (3) age > 65 years; (4) presence of ST-T wave changes; (5) TIMI Risk Score greater than or equal to 4; (6) diabetes; and/or (7) clinical instability in the setting of suspected NSTE-ACS. Specific clinical, ECG and/or biochemical trigger points modulate the aggressiveness of both the medical therapy and the propensity to perform early angiography with or without subsequent revascularization in patients with NSTE-ACS. Although additional refinements and changes in ACS management are still to come, evidence-based strategies suggest that prompt mechanical revascularization is associated with the best possible clinical outcomes, particularly for patients with high-risk features and in whom benefits of adjunctive, pharmacoinvasive antithrombotic therapies can be consolidated. Patient transfer for cardiac catheterization/percutaneous coronary intervention (PCI) is strongly recommended in patients who manifest high-risk features and/or aggressive treatment trigger criteria, so that this high-risk subgroup may receive definitive, interventional and/or cardiology-directed specialty care at appropriate sites of care. When available, interventional management is preferred in these patients. The importance of safe and effective anticoagulation in the spectrum of management strategies has been confirmed, and the evidence in support of enoxaparin and other antithrombotic agents has been reviewed. Dosing recommendations for enoxaparin use in the setting of PCI have been issued by the CATH Panel and have been summarized in this consensus report. Similar recommendations have been presented for the use of oral antiplatelet agents and GP IIb/IIIa antagonists. The addition of statins, ACE-inhibitors and beta-blockers is also stressed as part of a comprehensive secondary cardioprotective strategy for patients with coronary heart disease.

Acute Disease↗
PubMed1993

Guidelines for the care of laboratory animals in transit. Laboratory Animal Breeders Association of Great Britain Limited (LABA) and Laboratory Animal Science Association (LASA). Association of the British Pharmaceutical Industry (ABPI), British Laboratory Animal Veterinary Association (BLAVA), Institute of Animal Technology (IAT), Ministry of Agriculture, Fisheries & Food (MAFF), Universities Federation for Animal Welfare (UFAW), and Animals (Scientific Procedures) Inspectorate.

Explore the source record for details and available documents.

Animal Feed↗
PubMed1997

Chronic illness in adolescents: transfer or transition to adult services?

It is widely believed that the improved survival of young people with chronic diseases will be associated with the development of appropriate services within the adult healthcare domain. There is, however, little evidence to suggest that this is happening at a rate commensurate with clinical requirements. This paper highlights the multiplicity of barriers that impede the development of transition services to facilitate the transfer of medical care from the paediatric to the adult domain. Different models of transition care are described, and the terms 'transfer' and 'transition' are differentiated. The clinical demand for service development is highlighted, as well as the need for specific research in this area of healthcare delivery.

Adolescent↗
PubMed2005

Intensification of the transition between inpatient neurological rehabilitation and home care of stroke patients. Controlled clinical trial with follow-up assessment six months after discharge.

OBJECTIVE: An intensified transition concept between neurological inpatient rehabilitation and home care was investigated for effects on the functional status of stroke patients and the physical and emotional health of their carers. DESIGN: Controlled clinical trial allocating patients to intervention group (intensified transition on ward II) or control group (standard transition on ward I); patients were allocated to whichever ward had a vacancy. Follow-up assessment was carried out six months after discharge. SUBJECTS: Seventy-one patients and their family carers were included, of which nine cases dropped out. Therefore 62 stroke patients with persisting disability and their family carers were available for assessment at follow-up--33 patients in the intervention group, 29 patients in the control group. INTERVENTION: The intensified transition concept consisted of therapeutic weekend care, bedside teaching and structured information for relatives during the second phase of the rehabilitation. MAIN MEASURES: Patients were assessed with the Barthel Index, Functional Independence Measure, Ashworth Spastic Scale, Frenchay Arm Test, and Timed Up and Go Test. The carers completed SF-36, and were assessed using the Giessen Symptom List, Depression Scale and Burden Scale for Family Caregivers. RESULTS: The intensified transition did not lead to significant change in the functional status of the patients or in the physical and emotional health of the family carers. Within the first four weeks after discharge, the patients in the intervention group had fewer new illnesses. In the observation period the use of outpatient care services was more frequent in the intervention group than in the control group. CONCLUSION: Even though there are few differences of moderate intensity between the two groups the intensified transition programme does not affect either the functional status of the stroke patients or the health of the carers.

Aged↗
PubMedDate not supplied

Transitioning adolescents with sickle cell disease to adult-centered care.

Efforts have been made to formalize transitioning of adolescents with chronic health conditions such as sickle cell disease (SCD), from child-centered care (CCC) to adult-centered care (ACC). A dearth of literature exists that examines the transition of adolescents with SCD or offers guidance for transitioning. This study sought to explore concerns, expectations, and needs regarding the transition from CCC to ACC and to generate a framework for transitioning. Separate focus groups were conducted with adolescents (n = 22), their parents (n = 22), and practitioners (n = 8). Focus group interviews revealed that concerns, expectations, and needs for adolescents and their parents were parallel. Adolescents and their parents had concerns about: (a) leaving a familiar setting and physician whom they trusted, (b) going to an adult provider who may or may not be familiar with managing sickle cell disease, and (c) establishing new family roles. Practitioners affirm the need for transitioning that prepares the adolescents and their families for ACC. Findings led to a draft framework for transitioning that which will be tested at a later date. The framework is based on an ecological perspective that includes physiologic, developmental and psychosocial, and educational/vocational components.

Adolescent↗
PubMed2004

Hospital staff and family perspectives regarding quality of pediatric palliative care.

BACKGROUND: Development of a pediatric palliative care program was preceded by a needs assessment that included a staff survey and family interviews regarding improving pediatric palliative care. METHODS: Four hundred forty-six staff members and community physicians responded to a written survey regarding comfort and expertise in delivering end of life care. Sixty-eight family members of 44 deceased children were interviewed regarding treatment, transition to palliative care, and bereavement follow-up contact. Frequencies were generated for responses to the staff survey. Five interviewers reviewed the families' narratives and identified frequently occurring themes. RESULTS: Staff members reported feeling inexperienced in communicating with patients and families about end of life issues, transition to palliative care, and do not resuscitate status. Families reported distress caused by uncaring delivery of bad news and careless remarks made by staff members. Staff members reported feeling inexperienced in symptom and pain management and described occasions when pain could have been better managed. Families believed pain had been managed as well as possible despite observing their children suffer. Fifty-four percent of staff members reported that adequate support was not provided for those who treat dying children. Staff members and family members stated their desire for more support. Staff members who described their most difficult experiences caring for a dying child referenced personal pain and inadequate support most frequently. CONCLUSIONS: Albeit from different perspectives, staff members and family members shared common concerns and experiences regarding pediatric palliative care. These experiences emphasize the need for additional systematic study, improved education and support for staff members, and continued development of more effective and compassionate delivery of pediatric palliative care.

Attitude of Health Personnel↗
PubMed2000

Cystic fibrosis in adolescents and young adults.

Advances in knowledge and medical science have resulted in an increased life span and quality of life of patients with cystic fibrosis (CF). The median age of survival for CF patients is 32.3 years of age and patients 18 years of age or older now constitute one third of the total patients with CF. Because of these advances, a new patient population has emerged: the adolescents and young adults with CF. Adolescence is normally a time of great cognitive, social and developmental changes. Adolescents with CF not only have to deal with the normal changes expected, but also have to deal with the transition of assuming responsibility for their care from the parents and transitioning their care from a pediatric to an adult care team. Moreover, many of these young adults have to deal with the impact of the progressive deterioration of their CF disease. This review discusses issues of significance to this emerging patient population, including medical care, issues of disability, and psychosocial and other medical conditions associated with an increased life expectancy.

Adolescent↗
PubMed1993

Managed care is in your future.

Though Texas has been slower than most other large states to move into managed care, it is gaining ground. According to the Texas Health Maintenance Organization Association, 1.2 million Texans were enrolled in HMO plans in January 1990. Three years later, 1.5 million had signed on--a 24 percent increase. State enrollment in other managed care plans, which aren't required to file reports with state regulatory agencies, was estimated to be 6.9 million (41 percent of Texans) in 1991, according to Blue Cross/Blue Shield. While these state enrollment figures are large, the most recent numbers available indicate that Texas hospitals have a long way to go. A 1991 AHA survey found that 259 Texas hospitals (47 percent of those surveyed) do not have contracts with HMOs or PPOs. With changes coming at break-neck speed, how can these hospitals position themselves to survive and prosper in the managed care world? This month, HealthTexas presents three examples of hospitals and health care systems that have successfully made the transition to managed care. Their stories illustrate three very different approaches--developing a network, direct contracting, and establishing a health plan. And, those who have led these ventures offer advice to help other hospitals make the transition a little easier.

Data Collection↗
PubMed2002

[Promoting competition and improving quality. Accepting the intergenerational contract by stabilizing health care reform].

The challenge of demographic transition requires a health care reform which strengthens competition and quality in health care. With this, important contributions in stabilizing intergenerational relations, especially intergenerational solidarity in the public health care system, can be achieved. The reform proposal by an expert group, invited by the Friedrich-Ebert-Foundation to develop a concept of health care reform, takes these considerations into account.

Aged↗