A longitudinal method of teaching pediatric palliative care to interns: Preliminary findings regarding changes in interns' comfort level

2010 ◽  
Vol 8 (1) ◽  
pp. 35-40 ◽  
Author(s):  
Shahram Yazdani ◽  
Elana Evan ◽  
Danielle Roubinov ◽  
Paul J. Chung ◽  
Lonnie Zeltzer
Keyword(s):  
Palliative Care ◽  
Los Angeles ◽  
Assessment Tool ◽  
Death And Dying ◽  
Comfort Level ◽  
Pediatric Palliative Care ◽  
First Year ◽  
Comfort Levels ◽  
Before And After ◽  
Life Threatening

AbstractObjective:A longitudinal pediatric palliative care curriculum was introduced into the pediatric residency program at the University of California, Los Angeles. The present study explores the possible effects of this curriculum on the interns' self-assessed comfort levels regarding caring for children with life-threatening conditions.Methods:A newly created assessment tool was administered to interns in order to rate their comfort regarding pediatric palliative care at the beginning and conclusion of their intern year.Results:Twenty-two of the 29 interns completed this survey. Baseline data indicated 55% of the interns had some experience with taking care of a dying pediatric patient during their medical school training, and 79% indicated that they had taken care of a dying adult. Only 7% of the interns felt adequately prepared to deal with death and dying, but all interns indicated interest in further learning about pediatric palliative care. Comparison of the overall comfort levels of the 22 responding residents before and after the first year of training in 20 different related tasks demonstrated a significant self-assessed improvement of comfort in seven areas. There was no increase in self-reported comfort in communication related to palliative care.Significance of results:Residents indicated increased comfort in some areas of pediatric palliative care after the first year of their training. The underlying cause of this increased comfort is unclear at this time. The overall effect of longitudinal palliative care curriculums on residents' level of comfort in caring for this population deserves further assessment.

Parent and child perspectives on physician communication in pediatric palliative care

2007 ◽  
Vol 5 (4) ◽  
pp. 355-365 ◽  
Author(s):  
Jennifer L. Hsiao ◽  
Elana E. Evan ◽  
Lonnie K. Zeltzer
Keyword(s):  
Palliative Care ◽  
Los Angeles ◽  
Information Exchange ◽  
Relationship Building ◽  
Pediatric Palliative Care ◽  
Physician Communication ◽  
Breaking Bad ◽  
Parents And Children ◽  
Palliative Care Setting ◽  
Life Threatening

ABSTRACTObjective:Despite growing recognition of the importance of communication with children with life-limiting illnesses and their families, there has been limited research that includes the child's perspective. The purpose of the current study was to identify the aspects of physician communication that children with life-limiting illnesses and their parents perceived to be facilitative or obstructive in pediatric palliative care.Methods:This qualitative study reports on the first 20 parent and child pairs of pediatric oncology and cardiology patients (mean age 14.25 years, range 9-21 years) with a poor prognosis (physician reported likely <20% chance of survival beyond 3 years) from two children's hospitals and one pediatric hospice in Los Angeles, California. Perspectives on physician communication were elicited from children's and parents' individual narratives, recorded, coded, and analyzed using qualitative grounded theory methodology.Results:Both children and parents identified five domains of physician communication deemed to be highly salient and influential in quality of care. These included relationship building, demonstration of effort and competence, information exchange, availability, and appropriate level of child and parent involvement. Parents identified coordination of care as another important communication domain. The characteristics of physicians that were deemed most harmful to satisfying communication included having a disrespectful or arrogant attitude, not establishing a relationship with the family, breaking bad news in an insensitive manner, withholding information from parents and losing their trust, and changing a treatment course without preparing the patient and family.Significance of results:The six positive communication domains are areas for clinicians to recognize and monitor in communicating with children and families in the pediatric palliative care setting. Knowledge of the qualities of communication that are satisfying to and valued by children and their parents have the potential to lead to more effective communication around the difficult decisions faced by physicians, parents, and children with life-threatening conditions.

OP08 Levels and sources of stress reported by first year paramedic students associated with their first ambulance placement

2021 ◽  
Vol 38 (9) ◽  
pp. A4.2-A4
Author(s):  
Matthew Warren-James ◽  
Julie Hanson ◽  
Belinda Flanagan ◽  
Mary Katsikitis ◽  
Bill Lord
Keyword(s):  
Death And Dying ◽  
Educational Interventions ◽  
Fear Of Failure ◽  
Anxiety And Depression ◽  
Control Group ◽  
First Year ◽  
Before And After ◽  
Quasi Experimental ◽  
And Control ◽  
Experimental Group

BackgroundWhilst there is evidence to suggest paramedics experience significant stress when working in the ambulance setting little is known about the experiences of first year paramedic students. This research aimed to: (i) identify whether levels of stress, anxiety and depression experienced by first year paramedic students changed after ambulance placement compared to a control group, and (ii) identify the main perceived and actual sources of stress around ambulance placement.MethodsA before-and-after quasi-experimental design was used to compare whether the experience of ambulance placement altered the levels of stress, anxiety and depression in an experimental group that attended an ambulance placement (n = 20) and the control group who did not (n = 10). Online surveys encompassing the Depression, Anxiety and Stress Scale (DASS-21) and qualitative questions about sources of stress were concurrently deployed to both the experimental and control groups before and after the ambulance placement. Participants were first year paramedic students working in Queensland Ambulance Service, Australia.ResultsThere was a significant reduction in levels of stress in participants after undertaking their first ambulance placement (Mdn = -4.00) when compared to a control group (Mdn = 0.00), U = 52.5, p = .035, n2 = 0.15. Responses to survey questions suggest anticipation about experiencing death and dying of patients was the most frequently reported stressor of student paramedics before undertaking ambulance placements, however insecurity about knowledge, competence and fear of failure was the most frequently experienced stressor reported after completing ambulance placements.ConclusionsThe findings from this study suggest that the fear of the unknown may be worse than the reality. Anticipatory stress is the foremost problem for first year paramedic students attending their first ambulance placement. Placement pre-briefing should focus on educational interventions to build knowledge and skills competency to reduce stress levels and fear of failure.

scholarly journals A Novel Narrative E-Writing Intervention for Parents of Children With Chronic Life-Threatening Illnesses: Protocol for a Pilot, Open-Label Randomized Controlled Trial (Preprint)

2020 ◽  
Author(s):  
Andy Hau Yan Ho ◽  
Oindrila Dutta ◽  
Geraldine Tan-Ho ◽  
Toh Hsiang Benny Tan ◽  
Casuarine Xinyi Low ◽  
...  
Keyword(s):  
Palliative Care ◽  
Controlled Trial ◽  
Well Being ◽  
Mobile App ◽  
Pediatric Palliative Care ◽  
Writing Intervention ◽  
Open Label ◽  
Web Based ◽  
Randomized Controlled ◽  
Life Threatening

BACKGROUND A novel evidence-based Narrative e-Writing Intervention (NeW-I) has been developed and tested in Singapore to advance psychosociospiritual support for parents of children with chronic life-threatening illnesses. NeW-I is informed by an international systematic review and a Singapore-based qualitative inquiry on the lived experience of parental bereavement and supported by literature on anticipatory grief interventions for improving the holistic well-being of parent caregivers of seriously ill children. OBJECTIVE This study's aim was to provide an accessible platform, NeW-I—which is a strengths- and meaning-focused and therapist-facilitated mobile app and web-based counseling platform—that aims to enhance quality of life, spiritual well-being, hope, and perceived social support and reduce depressive symptoms, caregiver burden, and risk of complicated grief among parents of children with chronic life-threatening illnesses. METHODS The NeW-I therapist-facilitated web-based platform comprises a mobile app and a website (both of which have the same content and functionality). NeW-I has been implemented in Singapore as a pilot open-label randomized controlled trial comprising intervention and control groups. Both primary and secondary outcomes will be self-reported by participants through questionnaires. In collaboration with leading pediatric palliative care providers in Singapore, the trial aims to enroll 36 participants in each group (N=72), so that when allowing for 30% attrition at follow-up, the sample size will be adequate to detect a small effect size of 0.2 in the primary outcome measure, with 90% power and two-sided significance level of at least .05. The potential effectiveness of NeW-I and the accessibility and feasibility of implementing and delivering the intervention will be assessed. RESULTS Funding support and institutional review board approval for this study have been secured. Data collection started in January 2019 and is ongoing. CONCLUSIONS NeW-I aspires to enhance holistic pediatric palliative care services through a structured web-based counseling platform that is sensitive to the unique cultural needs of Asian family caregivers who are uncomfortable with expressing emotion even during times of loss and separation. The findings of this pilot study will inform the development of a full-scale NeW-I protocol and further research to evaluate the efficacy of NeW-I in Singapore and in other Asian communities around the world. CLINICALTRIAL ClinicalTrials.gov NCT03684382; https://clinicaltrials.gov/ct2/show/NCT03684382 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/17561

Management of Acute Contrast Reactions—Understanding Radiologists' Preparedness and the Efficacy of Simulation-Based Training in Canada

2018 ◽  
Vol 69 (4) ◽  
pp. 349-355 ◽  
Author(s):  
Tyler M. Coupal ◽  
Anne R. Buckley ◽  
Sanjiv Bhalla ◽  
Jessica L. Li ◽  
Stephen G.F. Ho ◽  
...  
Keyword(s):  
National Level ◽  
Daily Practice ◽  
Training Model ◽  
Initial Management ◽  
Mandated Training ◽  
Comfort Levels ◽  
Correct Dose ◽  
Simulation Based ◽  
Before And After ◽  
Life Threatening

Purpose Acute radiologic emergencies, primarily severe contrast reactions, are rare but life-threatening events. Given a generalized paucity of formalized or mandated training, studies have shown that radiologists and trainees perform poorly when acutely managing such events. Moreover, skill base, knowledge, and comfort levels precipitously decline over time given the infrequent occurrence of these events during one's daily practice. The primary aim of this study was to assess radiologists' preparedness for managing acute radiologic emergencies and to determine the efficacy of a high-fidelity simulation based training model in an effort to provide a rationale for similar programs to be implemented on a provincial or national level. Methods This was a prospective, observational study of radiology residents and attending radiologists throughout the province who were recruited to attend a full-day simulation-based course presenting various cases of acute radiologic emergencies. Participant demographics were collected at the time of commencement of the workshop. Course materials were disseminated 4 weeks prior to the workshop, and a 17-question knowledge quiz was administered before and after the workshop. Likert-type questionnaires were also distributed to survey comfort levels and equipment familiarity. The knowledge quiz and questionnaire were redistributed at 3- and 6-month intervals for acquisition of follow-up data. Results A total of 14 attending radiologists and 7 residents attended the workshop, with all participants completing the preworkshop questionnaire and 90.5% (19 of 21) completing the post-workshop questionnaire. Participants' principle locations of practice were as follows: academic institutions (50%), community hospitals (36.9%), and private clinics (13.1%). A significant increase in knowledge was demonstrated, with average scores of 10 out of 17 (59%) and 14.5 out of 17 (85%) ( P < .001) before and after the workshop, respectively. A significant increase in participants' comfort levels in recognizing acute anaphylactic reactions (3.5; 4.7, P < .001), commencing initial management for acute radiologic emergencies (3.3; 5.0, P < .001), and administering the correct dose for anaphylactic reactions (2.5; 4.8, P < .001) was also demonstrated. Moreover, participants became increasingly familiar with the contents and equipment found within contrast reaction kits (2.8; 3.8, P < .01). Repeat evaluations at 3 and 6 months found an average knowledge test score of 13.8 out of 17 (81%) and 10.8 out of 17 (64%), respectively. Comfort levels were also reassessed in recognizing acute anaphylactic reactions (4.5; 4.1), commencing initial management (4.0; 3.9) and administering the correct dose of medication (4.0; 3.7) at 3- and 6-month intervals. Conclusions Acute radiologic emergencies are rare but life-threatening events that require rapid diagnosis and treatment to mitigate associated morbidity and mortality. Simulation-based workshops are a highly efficacious training model to increase knowledge, comfort levels, and equipment familiarity for radiologists and trainees alike; however, retraining at regular intervals is required.

scholarly journals Article Commentary: Pediatric Palliative Care: A Reflection on Terminology

2013 ◽  
Vol 7 ◽  
pp. PCRT.S12800 ◽  
Author(s):  
Eva Bergstraesser
Keyword(s):  
Palliative Care ◽  
Supportive Care ◽  
Pediatric Palliative Care ◽  
Life Threatening ◽  
Definition Of ◽  
Medical Subspecialty

The definition of palliative care is the cornerstone of a medical subspecialty that plays a particular role for all who need it, for all who practice it, and increasingly for those who try to understand it. The difficulties around the definition and terminology arise from problems in separating it from other concepts such as supportive care, constructs such as “palliative care is only about dying”, or, in children, the rather vague use of terms like life-threatening and life-limiting diseases. These weaknesses have been recognized and important steps have been taken. This review discusses current definitions as well as efforts to overcome their weaknesses and make the term palliative care—for both children and adults—more intelligible.

Automatic Facial Feature Extraction for Predicting Designers' Comfort With Engineering Equipment During Prototype Creation

2017 ◽  
Vol 139 (2) ◽  
Author(s):  
Shruthi Bezawada ◽  
Qianyu Hu ◽  
Allison Gray ◽  
Timothy Brick ◽  
Conrad Tucker
Keyword(s):  
Facial Feature ◽  
Specific Model ◽  
Comfort Level ◽  
Support Vector ◽  
Design Teams ◽  
Concept Generation ◽  
Engineering Equipment ◽  
Comfort Levels ◽  
Machine Learning Model ◽  
Before And After

Designers frequently utilize engineering equipment to create physical prototypes during the iterative concept generation and prototyping phases of design. Currently, evaluating designers' efficiency during prototype creation is a manual process that either involves observational or survey based approaches. Real-time feedback when using engineering equipment has the potential to enhance designers' efficiency or mitigate potential injuries that may result from incorrect use of equipment. Toward an automated approach to addressing these challenges, the authors of this work test the hypotheses that (i) there exists a difference in designers' comfort levels before and after they use a piece of engineering prototyping equipment and (ii) a machine learning model predicts the level of comfort a designer has while using engineering prototyping equipment with accuracies greater than random chance. It has been shown that the level of comfort that an individual has while completing a task impacts their performance. The authors investigate whether automatic tracking of designers' facial expressions during prototype creation predicts their level of comfort. A study, involving 37 participants using various engineering equipment, is used to validate the approach. The support vector machine (SVM) regression model yielded a range of R squared values from 0.82 to 0.86 for an equipment-specific model. A general model built to predict comfort level across all engineering equipment yielded an R squared value of 0.68. This work has the potential to transform the manner in which design teams utilize engineering equipment toward more efficient concept generation and prototype creation processes.

scholarly journals A PRE-EXPERIMENTAL STUDY ON THE EFFECT OF DRAIN FRIENDLY JACKETS ON COMFORT IN POST MASTECTOMY SUBJECTS IN WARDS OF A SELECTED HOSPITALS IN A METROPOLITAN CITY

2021 ◽  
pp. 56-57
Author(s):  
Apurva Atmaram Yenji
Keyword(s):  
Experimental Study ◽  
Assessment Tool ◽  
Research Problem ◽  
Primary Objective ◽  
Comfort Level ◽  
Metropolitan City ◽  
Comfort Levels ◽  
Significant Difference ◽  
Routine Tasks

Research Problem: A pre-experimental study on the effect of Drain Friendly Jackets on Comfort in post mastectomy subjects in wards of a selected hospitals in a metropolitan city. Primary Objective: To compare the level of comfort in post mastectomy subjects with and without use of Drain Friendly Jackets. Research Methodology:Population of the study was subjects underwent mastectomy post operatively with drains day 1 in a hospital. The investigator used comfort assessment tool to assess the comfort levels in the patient pre & postintervention. Opinionnaire taken for the intervention given. Study was conducted with 45 subjects. Results: The comfort score was assessed Drain Friendly Jacket was given to the subjects, there was a significant difference between comfort level achieved while using the jacket compared to the without use of jacket with an average comfort score for with jacket and without jacket and with it is statistically significant. Conclusion: Findings of the study indicated that Drain Friendly Jacket has helped to improve subjects comfort during post mastectomy period. Patient were able comfortably perform their routine tasks.

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