The Interaction of Pulmonary Physiology and Swallowing: A Juggling Act for the Physician and Speech-Language Pathologist

2009 ◽  
Vol 18 (1) ◽  
pp. 34-40
Author(s):  
Karen J. Dikeman ◽  
Marta S. Kazandjian ◽  
Elbert Tun ◽  
Panina Niyazova ◽  
Tien-Tsai Tsai ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Medical Condition ◽  
Team Approach ◽  
Care Providers ◽  
Geriatric Population ◽  
Pulmonary Physiology ◽  
Speech Language Pathologist ◽  
Ventilator Dependence ◽  
Clinical Case Studies ◽  
Single Disease Entity

Abstract Patients who are dependent upon tracheostomy and/or ventilator use present a particular challenge to health-care providers. The interaction of pulmonary physiology and deglutition is complex, as illustrated in the course of patients who are in the weaning process. Speech language pathologists (SLPs) should work closely with their physician colleagues to understand the influence of multiple medical co-morbidities on intervention. In traditional medicine, the clinician's objective is to connect a patient's many symptoms and complaints to a single disease entity. However, in caring for the ventilator dependent geriatric population, a symptom such as dysphagia typically results from the interplay of various, multi-organ symptoms, and conditions. This article strives to demonstrate the “juggling act” that the physician and SLP must balance between the patient's current medical condition, pulmonary dysfunction, and disordered swallowing. Clinical case studies illustrate the benefit of swallowing intervention on quality of life. While the care of patients with tracheostomy and ventilator dependence requires a team approach, with respiratory therapy and nursing vital members, this article emphasizes the roles of the SLP and physician.

scholarly journals A descriptive analysis of end-of-life discussions for high-grade glioma patients

2021 ◽  
Author(s):  
Ai Chikada ◽  
Sayaka Takenouchi ◽  
Yoshiki Arakawa ◽  
Kazuko Nin
Keyword(s):  
End Of Life ◽  
Health Care Providers ◽  
Patient Participation ◽  
High Grade Glioma ◽  
Team Approach ◽  
High Grade ◽  
Care Providers ◽  
Patient Goals ◽  
Significant Difference ◽  
Eol Care

Abstract Background End-of-life discussions (EOLDs) in patients with high-grade glioma (HGG) have not been well described. Therefore, this study examined the appropriateness of timing and the extent of patient involvement in EOLDs and their impact on HGG patients. Methods A cross-sectional survey was conducted among 105 bereaved families of HGG patients at a university hospital in Japan between July and August 2019. Fisher’s exact test and the Wilcoxon rank-sum test were used to assess the association between patient participation in EOLDs and their outcomes. Results In total, 77 questionnaires were returned (response rate 73%), of which 20 respondents replied with refusal documents. Overall, 31/57 (54%) participated in EOLDs at least once in acute hospital settings, and a significant difference was observed between participating and nonparticipating groups in communicating the patient’s wishes for EOL care to the family (48% vs 8%, P = .001). Moreover, >80% of respondents indicated that the initiation of EOLDs during the early diagnosis period with patients and families was appropriate. Most EOLDs were provided by neurosurgeons (96%), and other health care providers rarely participated. Additionally, patient goals and priorities were discussed in only 28% of the EOLDs. Patient participation in EOLDs was not associated with the quality of EOL care and a good death. Conclusions Although participation in EOLDs is relatively challenging for HGG patients, this study showed that participation in EOLDs may enable patients to express their wishes regarding EOL care. It is important to initiate EOLDs early on through an interdisciplinary team approach while respecting patient goals and priorities.

Weight Bias and Psychosocial Implications for Acute Care of Patients With Obesity

2017 ◽  
Vol 28 (3) ◽  
pp. 254-262 ◽  
Author(s):  
Rachel Smigelski-Theiss ◽  
Malisa Gampong ◽  
Jill Kurasaki
Keyword(s):  
Health Care ◽  
Acute Care ◽  
Health Care Providers ◽  
Physical Environment ◽  
Medical Condition ◽  
Weight Bias ◽  
Care Providers ◽  
Optimal Care ◽  
Childhood Experiences ◽  
Appropriate Care

Obesity is a complex medical condition that has psychosocial and physiological implications for those suffering from the disease. Factors contributing to obesity such as depression, childhood experiences, and the physical environment should be recognized and addressed. Weight bias and stigmatization by health care providers and bedside clinicians negatively affect patients with obesity, hindering those patients from receiving appropriate care. To provide optimal care of patients with obesity or adiposity, health care providers must understand the physiological needs and requirements of this population while recognizing and addressing their own biases. The authors describe psychosocial and environmental factors that contribute to obesity, discuss health care providers’ weight biases, and highlight implications for acute care of patients suffering from obesity.

Psychiatric morbidity and acute hospitalization in elderly people

2006 ◽  
Vol 18 (4) ◽  
pp. 701-711 ◽  
Author(s):  
Tze Pin Ng ◽  
Liang Feng ◽  
Peak Chiang Chiam ◽  
Ee Heok Kua
Keyword(s):  
Elderly People ◽  
Health Care Providers ◽  
Mental State ◽  
Medical Condition ◽  
Psychiatric Morbidity ◽  
Population Based ◽  
Care Providers ◽  
Acute Hospitalization ◽  
Fitness And Health ◽  
State Examination

Background: Few studies have investigated the association of psychiatric morbidity with acute hospitalization risk in elderly people.Method: We examined this association using population-based data for 1092 older adults aged ≥60 years in Singapore, including subjects who reported at least one acute hospitalization from any medical condition(s) in the 12 months prior to interview (N = 136). Psychiatric morbid/comorbid disorders were diagnosed using the Geriatric Mental State examination.Results: In a multivariate analysis, comorbid psychiatric disorders were inde-pendently associated with hospitalization [adjusted odds ratio 2.76, 95% confidence interval 1.20–6.33], after controlling for age, ethnicity, employment status, number of medical comorbidities, number of activities of daily living limitations, hearing and visual impairment, SF-12 Physical and Mental Component Summary scores, social, productive, fitness and health activities, and regular visits to health-care providers. Neither dementia diagnosis nor cognitive impairment measured by the Mini-mental State Examination was associated with increased hospitalization risk.Conclusion: Psychiatric morbidity in old age was significantly associated with increased hospitalization risk. This finding underlines the importance of treating psychiatric illness to reduce the risk of acute hospitalization in elderly patients.

Employability

1997 ◽  
Vol 2 (6) ◽  
pp. 1-2
Author(s):  
Alan Engelberg
Keyword(s):  
Health Status ◽  
Human Resources ◽  
Health Care Providers ◽  
Medical Information ◽  
Medical Condition ◽  
Disability Evaluation ◽  
Care Providers ◽  
Fourth Edition ◽  
Basic Principles

Abstract The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, provides useful definitions of employability, employability determination, and medical determinations related to employability. As the AMA Guides notes, and the term medical determination related to employability has supplanted the use of employability. Clearly, factors unrelated to health status affect both employability and its determination, but the physician's role is limited to providing useful medical information, culminating in a statement of risk to the employer. The physician's purview never includes a determination of employability, nor does it justify an opinion that an individual is or is not employable. Managers in human resources departments can clarify the basic principles of equal employment opportunity and thereby minimize the risk of intentional or inadvertent discriminatory actions. Disability evaluation covers the interplay of the injured employee, the human resources function, and the health care providers. When a worker's health status is a factor, the physician's assistance in helping an employer determine employability is crucial, but physicians must never voluntarily state that a person is or is not employable. Physicians can assist an employer in determining if a medical condition precludes travel to work, being at work for a specified time, and assignment of appropriate tasks with or without reasonable accommodation.

Prevalence of written advance directives (AD) among cancer care providers at a community-based cancer center

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 18563-18563
Author(s):  
B. A. Hammes ◽  
J. A. Lee ◽  
M. A. Mathiason ◽  
M. T. Ertz ◽  
L. L. Sheldon ◽  
...  
Keyword(s):  
End Of Life ◽  
Health Care Providers ◽  
Nurse Practitioners ◽  
Cancer Care ◽  
Medical Condition ◽  
Cancer Center ◽  
Care Providers ◽  
Community Based ◽  
Life Planning ◽  
End Of Life Planning

18563 Background: Cancer care providers frequently discuss AD with their patients. The providers’ own attitudes toward end-of-life planning likely influence the choices and actions of their patients. We investigated the prevalence of written AD among the care providers at our community-based cancer center. Methods: All cancer center employees who have face-to-face contacts with patients (N=170) were sent an email survey in October 2005. This included medical (physicians, 15), associate (physician assistants and nurse practitioners, 7), and support (nurses, radiation therapists, medical or nurse assistants, and patient liaisons; 148) staffs. We collected data on demographics, work history, and AD. Results: A reply was obtained from 136 (80%) individuals. There were more females (90.2%) and the median age was 43 years (range, 20–63). While 82.8% reported to have discussed their wishes regarding future life-sustaining medical care with those closest to them, only 35.1% had a written AD: medical (58.3%), associate (50%), and support staffs (32.2%). Among those with AD, only 66% had made their own care providers aware of this. The top 5 factors that influenced providers whether to have or not to have AD were: experience at work (36.6%), spouse/domestic partner (25.4%), time to complete written AD (23.9%), family members/friends (21.6%) and children (19.4%). Interestingly, no one considered medical condition or illness as a factor. Increased age was significantly associated with having AD (odds ratio: 1.068; 95% CI:1.029–1.108), while the sex, number of years working with cancer patients, provider role, and marital/living status were not. Among the medical and associate staffs, 55.6% reported routinely discussing AD with their patients. Although all medical/associate staffs rated themselves as knowledgeable about and comfortable with discussing AD, the group who had AD was more apt to rate themselves as very knowledgeable and very comfortable. Conclusions: Only about a third of all cancer care providers and about half of cancer physicians at our institution have a written AD. Despite work experience with a patient population having a high mortality rate, cancer care providers do not adequately communicate end-of-life planning to their own health care providers. No significant financial relationships to disclose.

Management of Heart Failure in the Older Adult: Treatment and Opportunities

2019 ◽  
Vol 34 (3) ◽  
pp. 169-186
Author(s):  
Kimberly J. Won ◽  
Laressa Bethishou ◽  
Laura V. Tsu
Keyword(s):  
Heart Failure ◽  
Elderly Patients ◽  
Health Care Providers ◽  
Improve Patient Care ◽  
Transitions Of Care ◽  
Care Process ◽  
Research Review ◽  
Original Research ◽  
Care Providers ◽  
Geriatric Population

OBJECTIVE: To provide a review of the available evidence regarding pharmacotherapy and areas of pharmacist intervention in transitions of care (TOC) for the geriatric population with heart failure (HF).<br/> DATA SOURCES: A PubMed search of articles published from 1995 through July 2018 was performed using a combination of the following words: heart failure, geriatric, elderly, (TOC), multidisciplinary, pharmacist.<br/> STUDY SELECTION/DATA EXTRACTION: Relevant original research, review articles, and guidelines were assessed for the management of elderly patients with HF. References from the above literature were also evaluated. Articles were selected for inclusion based on relevance to the topic, detailed methods, and complete results.<br/> DATA SYNTHESIS: HF is a common cause of morbidity, mortality, and hospitalizations in the elderly population. While it is important that patients adhere to evidencebased medications for HF, there are additional precautions and monitoring recommendations for this population because of a higher risk of adverse effects. Elderly patients with HF also require additional care during the transition of care process because they are at high risk for readmission during this time because of a variety of factors, including medication changes, barriers to medication use, and lack of communication between health care providers. As part of a multidisciplinary team, pharmacists can help to identify and address issues.<br/> CONCLUSION: Pharmacists can improve patient care outcomes in patients with HF by providing updated recommendations on pharmacotherapy and being involved in the TOC process.<br/>

Psychopharmacology concerns in older individuals

2012 ◽  
Vol 1 (11) ◽  
pp. 285-287
Author(s):  
Eric C. Kutscher ◽  
Megan R. Leloux
Keyword(s):  
Health Care Providers ◽  
The United States ◽  
Screening Tools ◽  
Beers Criteria ◽  
Potentially Inappropriate Medications ◽  
Older Individuals ◽  
Care Providers ◽  
Geriatric Population ◽  
Number Of Individuals ◽  
Inappropriate Medications

The geriatric population is continually growing in the United States, and the number of individuals over the age of 65 is expected to double by the year 2050. Changes in the pharmacokinetic profiles of elderly patients make appropriate medication dosing more challenging for health care providers. The Beers Criteria is a validated, consensus-based screening tool to help identify potentially inappropriate medications in geriatric patients. This article reviews recent updates to the Beers Criteria, as well as other screening tools which have been developed for this purpose.

scholarly journals Developing and Implementing a Community-Based Model of Care for Fibromyalgia: A Feasibility Study

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Michelle Teo ◽  
Bindu Mohan ◽  
Nelly D. Oelke
Keyword(s):  
Feasibility Study ◽  
Health Care Providers ◽  
Program Effectiveness ◽  
Primary Care Providers ◽  
Team Approach ◽  
Care Providers ◽  
Model Of Care ◽  
Community Based ◽  
Integration Of Care

Background. Fibromyalgia (FM) is a complex disease posing challenges for primary care providers and specialists in its management. Aim. To evaluate the development and implementation of a comprehensive, integrated, community-based model of care for FM. Methods. A mixed methods feasibility study was completed in a small urban centre in southern British Columbia, Canada. Eleven adults with FM and a team of seven health care providers (HCPs) participated in a 10-week intervention involving education, exercise, and sleep management. Monthly “team-huddle” sessions with HCPs facilitated the integration of care. Data included health questionnaires, patient interviews, provider focus group/interviews, and provider surveys. Results. Both patients and HCPs valued the interprofessional team approach to care. Other key aspects included the benefits of the group, exercise, and the positive focus of the program. Effectiveness of the model showed promising results: quality of care for chronic illness, quality of life, and sleep showed significant (P<0.05) differences from baseline to follow-up. Conclusions. Our community-based model of care for FM was successfully implemented. Further testing of the model will be required with a larger sample to determine its effectiveness, although promising results were apparent in our feasibility study.

Facing up to Stigma: Workplace and Personal Strategies

2001 ◽  
Vol 38 (3) ◽  
pp. 245-247 ◽  
Author(s):  
Robert W. Kelton
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Team Approach ◽  
Hemifacial Microsomia ◽  
Care Providers ◽  
Professional Success ◽  
The Family ◽  
Life Success

This paper examines some of the influences that contribute to health, life success, and resiliency in persons with craniofacial conditions. Those influences are examined from the perspective of the author, a 50-year-old man with cleft palate, right microtia, and hemifacial microsomia. A biosketch describes the author as one example of someone with craniofacial conditions who has also achieved significant personal and professional success. Central to that success were the influences of health care providers and parents as well as other people with craniofacial conditions. Specific attention is given to the benefits of a team approach to the care of patients with craniofacial conditions; the role of health care professionals in fostering the optimism that can mobilize the family for action; the importance of acknowledging the intransigence of stigma in our culture; the value of practical advice that affected individuals can offer one another.

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