75 Community Dnacpr Forms: Opening A Can of Worms

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
J Odone ◽  
R Schiff
Keyword(s):  
Pilot Study ◽  
Phone Call ◽  
Post Intervention ◽  
Patient Understanding ◽  
Cardio Pulmonary Resuscitation ◽  
Pdsa Cycle ◽  
National Guidance ◽  
The Impact ◽  
Improve Patient

Abstract Background There is no national guidance for the transfer of Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) decisions between care settings. This issue has been highlighted within our Integrated Care Trust. We reviewed our local process, to improve the transfer of DNACPR decisions between care settings. Method A third PDSA cycle was completed to evaluate intervention. Intervention Frequently asked questions were added to the reverse side of the DNACPR form to improve patient understanding. All patients discharged home were given this updated form during a pilot study. The impact of the intervention was analysed with a follow-up phone call (n = 30) and discussed at a staff focus group. Results No improvement in patient understanding was shown post-intervention, however the intervention was overwhelmingly supported by staff. 60% of patients reported receiving a DNACPR form on discharge and 12% recalled being informed that they would be discharged home with a form. Conclusion Further work is required on the DNACPR pathway across primary and secondary care. The next cycle will involve ensuring that the community form is highlighted in hospital discussions regarding DNACPR decisions.

scholarly journals Aromatherapy with ylang ylang for anxiety and self-esteem: a pilot study

2014 ◽  
Vol 48 (3) ◽  
pp. 492-499 ◽  
Author(s):  
Juliana Rizzo Gnatta ◽  
Patricia Petrone Piason ◽  
Cristiane de Lion Botero Couto Lopes ◽  
Noemi Marisa Brunet Rogenski ◽  
Maria Júlia Paes da Silva
Keyword(s):  
Pilot Study ◽  
Essential Oil ◽  
Self Esteem ◽  
Physiological Parameters ◽  
Post Intervention ◽  
Temperature Method ◽  
Significant Difference ◽  
Perception Of Self ◽  
Cutaneous Application

Objective: To verify if the use of ylang ylang essential oil by cutaneous application or inhalation alters the anxiety and self-esteem perception and physiological parameters as blood pressure and temperature. Method : A pilot study with 34 professionals from a nursing group randomized in three groups: one received the ylang ylang essential oil by cutaneous application, the second received through inhalation and the third (placebo) received the ylang ylang essence through cutaneous application. The assessment was done by an Anxiety Inventory (IDATE) and the Dela Coleta self-esteem scale, applied on baseline, after 30, 60 and 90 days and after 15 days post-intervention (follow up). Results : In the pre and post-intervention intergroup analysis, there was a significant difference in self-esteem for the three groups (p values: G1=0.014; G2=0.016; G3=0.038). There were no differences in the analysis between groups for anxiety or for physiological parameters. Conclusion : It was found significant alterations only to the intergroup perception of self-esteem for the three groups.


Abstract 225: A Depression Quality Program and Cardiovascular Disease: Assessing the Impact on Care

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Linda Gordon ◽  
Amanda Malecky ◽  
Andrew Althouse ◽  
Nicole Ansani
Keyword(s):  
Usual Care ◽  
Goal Attainment ◽  
Intervention Group ◽  
Phone Call ◽  
Categorical Variables ◽  
Care Group ◽  
Control Group ◽  
Surrogate Outcome ◽  
The Impact

Background: Data demonstrate an adverse association between depression and coronary artery disease prognosis. Therefore, a depression screening program was initiated in the catheterization (cath) lab. The goals were to improve HEDIS depression compliance rates and determine the impact on clinical outcomes. Methods: Adult patients in an inpatient cath lab from 3 cardiology practices were screened for enrollment in a randomized controlled trial. All cath lab patients received a PHQ-9 depression screener. Those who screened positive for depression (score ≥ 10) were randomized to intervention or usual care. The usual care group received a follow-up phone call to re-administer the PHQ-9 at 6-8 weeks and within 210 days of discharge. The intervention group was administered the PHQ-9 and received intensive education at baseline, 6-8 weeks, and within 210 days of discharge. Education included targeted depression information with a mental health care provider and comprehensive disease management education with a cardiovascular nurse practitioner. Outcomes included: differences in HEDIS depression goal attainment; depression response/remission rates; and cardiovascular goals. Differences between groups were tested using chi-squared tests (categorical variables) and t-tests (continuous variables). Results: Baseline characteristics were similar between control (N=43) and intervention (N=40) groups, with the exception of significantly fewer African American patients in the control group (N=2, 4.7%) vs intervention (N=9, 22.5%). Changes in HEDIS goal attainment show that patients in the intervention group were slightly more likely to be referred to a provider to address depression (95.0% vs 86.0%, p=0.314), or receive meds for depression (65.0% vs 51.2%, p=0.219), but these differences are not statistically significant. More patients in the intervention group refused meds for depression compared to control (15.0% vs. 2.3%, p=0.041); have received blood work (65.0% vs 41.9%, p=0.030); and have received follow-up within 210 days (82.5% vs 46.5%, p<0.001). Treatment adjustment rate was higher in the intervention group compared to control (85.0% vs. 65.1%, p=0.037). Hospital readmission rate was similar between groups (p=0.896) and there was no difference in depression remission or response rates (p=0.426). Further, no differences were seen in cardiovascular surrogate outcome parameters, including cholesterol, A1c, CRP, or BNP between groups; except SGOT was significantly different between groups (-5.0 intervention vs 2.0 control p=0.045). Conclusions: These data demonstrate improvements in attaining a surrogate outcome measure of quality (HEDIS goals); however, this does not appear to translate to a significant clinical impact. Quality measures may need to be continuously reassessed to ensure efficiency and effectiveness of care.

scholarly journals Patient Satisfaction With Extended International Normalized Ratio Follow-up Intervals in a Veteran Population

2019 ◽  
Vol 54 (5) ◽  
pp. 442-449
Author(s):  
Rebecca R. Schoen ◽  
Michael W. Nagy ◽  
Andrea L. Porter ◽  
Amanda R. Margolis
Keyword(s):  
Patient Satisfaction ◽  
Focus Group ◽  
International Normalized Ratio ◽  
Limited Data ◽  
Participant Satisfaction ◽  
Small Effect Size ◽  
The Mean ◽  
The Impact ◽  
Improve Patient

Background: For highly stable warfarin patients, limited data exists regarding patient satisfaction on extended international normalized ratio (INR) follow-up intervals and how this population compares with patients on a direct oral anticoagulant (DOAC). Objective: To assess the impact on patient satisfaction of extending INR follow-up intervals. Methods: Veterans on stable warfarin doses had extended INR follow-up intervals up to 12 weeks in a single-arm prospective cohort study for 2 years. This analysis included participants who completed at least 2 Duke Anticoagulation Satisfaction Scales (DASS). The primary outcome was the change in the DASS. A focus group described participant experiences. Participant satisfaction was compared to patients on a DOAC. Results: Of the 51 participants, 48 were included in the warfarin extended INR follow-up group. Compared with baseline, the mean DASS score (42.9 ± 12.08) was worse at 24 months (46.82 ± 15.2, P = 0.0266), with a small effect size (Cohen’s d = 0.29). The 8 participants in the focus group were satisfied with the extended INR follow-up interval but would be uncomfortable extending follow-up past 2 to 3 months. The extended INR follow-up interval study had similar DASS scores as the 33 participants included on DOAC therapy (46.8 ± 15.1, P = 0.9970) but may be limited by differing populations using DOACs. Conclusion and Relevance: For patients currently stable on warfarin therapy, extending the INR follow-up interval up to 12 weeks or changing to a DOAC does not appear to improve patient satisfaction.

scholarly journals Evaluation of a Group-Based Resilience Intervention for Typhoon Haiyan Survivors

2016 ◽  
Vol 10 ◽  
Author(s):  
Ma Regina M. Hechanova ◽  
Lynn C. Waelde ◽  
Pia Anna P. Ramos
Keyword(s):  
Coping Skills ◽  
The Philippines ◽  
Focus Group Discussions ◽  
Post Intervention ◽  
Group Discussions ◽  
Culturally Adapted ◽  
Disaster Survivors ◽  
Resilience Intervention ◽  
The Impact

This study evaluated the impact of Katatagan, a culturally adapted, group-based, and mindfulness-informed resilience intervention developed for disaster survivors in the Philippines. The intervention aimed to teach six adaptive coping skills: harnessing strengths, managing physical reactions, managing thoughts and emotions, seeking solutions and support, identifying positive activities, and planning for the future. Pre- and post-intervention assessments were conducted with 163 Typhoon Haiyan survivors. Six-month follow-up assessments were obtained for 37 participants. Pre- and post-results showed improvements in participants’ self-efficacy on all six coping skills. The 6-month follow-up revealed significant improvements in four of the six coping skills. Focus group discussions conducted at follow-up revealed that mindfulness, self-care, strengths, and reframing were some of the topics that were most memorable to participants. Among these, participants identified mindfulness as a skill that they continued to use. Participants also shared that they felt stronger because of the intervention and have shared what they learned with others in their communities.

scholarly journals Effectiveness of Online Training and Supervisor Feedback on Safe Eating and Drinking Practices for Individuals With Developmental Disabilities

2020 ◽  
Vol 58 (2) ◽  
pp. 111-125
Author(s):  
Emaley McCulloch ◽  
Audra Cuckler ◽  
Elise Valdes ◽  
M. Courtney Hughes
Keyword(s):  
Pilot Study ◽  
Developmental Disabilities ◽  
Online Training ◽  
Direct Care ◽  
Follow Up Study ◽  
Significant Difference ◽  
The Impact

Abstract Dysphagia is common in individuals with developmental disabilities. Little research exists on the impact of trainings aimed at improving Direct Care Staff's (DCS) use of safe eating and drinking practices. This article presents two studies using pre-and postexperimental design, evaluating online training to improve DCSs' knowledge and ability to identify nonadherence to diet orders. A pilot study (n = 18) informed improvements to the intervention. The follow-up study (n = 64) compared those receiving training with those receiving training plus supervisor feedback. There was no significant difference between groups after training. Both groups increased in knowledge and identification of nonadherence to diet orders. Online training may be an effective tool for training DCS in safe eating and drinking practices.

Reducing the wait time to initiate inpatient chemotherapy at Lyndon B. Johnson Hospital.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 210-210
Author(s):  
Andrew James Wiele ◽  
Trung Nguyen ◽  
Onyebuchi Ononogbu ◽  
Kristyn-Mae Russo ◽  
Phat Le ◽  
...  
Keyword(s):  
Wait Time ◽  
Baseline Data ◽  
Post Intervention ◽  
Port Placement ◽  
Root Cause ◽  
Pdsa Cycle ◽  
Time Stamps ◽  
Administration Time ◽  
Picc Line ◽  
The Impact

210 Background: Delays in initiating inpatient (inpt) chemotherapy (chemo) for planned admissions can decrease patient (pt) satisfaction and increase length of stay and healthcare costs. Our center, a community public teaching hospital, lacked clear standard operating procedures for scheduled chemo admissions, resulting in significant delays. We developed a process improvement initiative to reduce the pt wait time from admission to chemo administration (time to chemo [TTC]). Methods: A multidisciplinary team was formed to clarify workflows and identify root causes prolonging wait times for pts admitted to the inpt chemo unit. We implemented two Plan-Do-Study-Act (PDSA) cycles over a 6-month period. First, in early March, we collaborated with pharmacy and nursing to standardize the inpt chemo operating procedures and extend pharmacy’s evening hours for chemo preparation (prep) from 7pm to 9pm. Second, in early June, we implemented a Pre-admission Checklist that was visibly displayed in clinic for fellows to review with faculty, and began discussing pts scheduled for admission during the daily, multidisciplinary huddle that already occurred on the inpt chemo unit. Using the electronic medical record and available time stamps, baseline data was collected from November-December 2019, post-intervention data for PDSA cycle 1 was collected from March-April 2020, and data collection for PDSA cycle 2 is ongoing. Results: Root cause analysis identified late afternoon admissions and PICC line placements as two main sources for TTC delays. Hospital procedures also limited inpt PICC line placement between 8am-4pm and inpt chemo prep between 7am-7pm. Baseline data revealed 77.4% (24/31) of pts were admitted between 3pm-10pm, the median TTC was 20.4 hrs, and 6.5% (2/31) of pts had chemotherapy initiated within 12 hrs of admission (TTC < 12). Additionally, 56.5% (26/46) of pts had PICC lines placed during their admission, but 69.2% (18/26) of the pts with PICC lines were eligible for outpatient port placement according to institutional intravenous (IV) access guidelines. After PDSA cycle 1, median TTC decreased by 10% to 18.4 hrs, and 33.3% (5/15) of pts had TTC < 12. Conclusions: After standardizing inpt chemo procedures and extending chemo prep times, PDSA cycle 1 resulted in a 10% reduction in TTC and a 26.8% increase in the rate of TTC < 12. Although admission times cannot be controlled at this time, the impact of improving pre-admission planning, and specifically addressing IV access, for PDSA cycle 2 is currently being evaluated and will be reported at the time of abstract presentation.

scholarly journals Assessing the feasibility of applying a combined osteopathy and psychoeducation therapy (OsteoPeCT) and its influence on levels of psychological and physiological stress in adult participants with moderate stress: A pilot study

2020 ◽  
Author(s):  
Antoine Rahier ◽  
Victoria J Taylor ◽  
Teena KJB Gamage ◽  
Alastair Treacher ◽  
Simon J O’Carroll ◽  
...  
Keyword(s):  
Pilot Study ◽  
Perceived Stress ◽  
Physiological Stress ◽  
Immunoglobulin A ◽  
Post Intervention ◽  
Adult Participants ◽  
Biomarker Analysis ◽  
Mood Scale ◽  
The Impact ◽  
Moderate Stress

Abstract Background: There is mounting evidence suggesting a relationship between stress and adverse health outcomes. Stress is a multidimensional phenomenon requiring a multimodal approach. While there is some evidence indicating a positive effect of massage therapy, there is limited research regarding the impact of related approaches such as general osteopathic techniques (GOTs). Further, research examining the feasibility and effectiveness of combining GOTs with psychoeducation in the management of stress is lacking. The present pilot study aimed to assess the feasibility of applying a therapy package consisting of GOTs and brief psychoeducation and its influence on moderate stress in a convenience sample.Methods: A pilot uncontrolled trial with mixed pragmatic and exploratory design was conducted. The therapy package comprised of ten GOTs and ten minutes of scripted psychoeducation (OsteoPeCT) was applied in two sessions over two consecutive days to 18 adult participants with moderate stress. Feedback from participants and challenges experienced by both participants and researchers were recorded. The effects of OsteoPeCT were assessed by measuring pre-and post- intervention scores of self-reported perceived stress (Perceived Stress Scale-10, PSS-10; Profile of Mood Scale, POMS) and salivary levels of physiological stress biomarkers (cortisol; secretory immunoglobulin A, sIgA and interleukin-6, IL-6).Results: All aspects related to the application of OsteoPeCT (participant recruitment, participant retention, therapy application, administration of health screen and self-reported perceived stress questionnaires, and the collection of saliva samples for biomarker analysis) were feasible. A total of 18 participants were enrolled. The timing of sessions on consecutive days was reported to be challenging. While a measurable decrease in perceived stress (PSS-10) and in mood scores (Tense, Fatigue, Depression, Anger) were noted post therapy (OsteoPeCT) application, physiological stress markers were unaffected. Diurnal variations of these biomarkers may need further consideration.Conclusion: The application of OsteoPeCT was feasible, well received with some beneficial influence on perceived stress indicating that an integration of psychoeducation and osteopathic care may confer benefits to patients. Future investigations with adapted protocols and larger sample size is warranted to assess effectiveness.Trial registration: Retrospectively registered in Australian New Zealand Clinical Trials Registry (registration number ACTRN12620000763943 ) and ICTRP .

scholarly journals Biomarkers-based Personalized Follow-up in Chronic Heart Failure Improves Patient’s Outcomes and Reduces Care Associate Cost

2020 ◽  
Author(s):  
Antonio Leon Justel ◽  
Jose Ignacio Morgado Garcia-Polavieja ◽  
Ana Isabel Alvarez Rios ◽  
Francisco Jose Caro Fernandez ◽  
Pedro Agustin Pajaro Merino ◽  
...  
Keyword(s):  
Incidence Rates ◽  
Primary Objective ◽  
Economic Problem ◽  
Functional Class ◽  
Post Intervention ◽  
Number Of Patients ◽  
Before And After ◽  
Ed Visits ◽  
The Impact

Abstract BACKGROUNDHeart failure (HF) is a major and growing medical and economic problem, with high prevalence and incidence rates worldwide. Cardiac Biomarker is emerging as a novel tool for improving management of patients with HF.METHODSThis is a real-world, before-and after-intervention trial, that assesses the impact of a personalized follow-up procedure for HF on patient’s outcomes and care associated cost, based on a clinical model of risk stratification and personalized management according to that risk. A total of 192 patients were enrolled and studied before and after an intervention. The primary objective was the rate of readmissions, due to a HF event, post-intervention compared to pre-intervention. Secondary outcomes compared the rate of ED visits and the number of patients who had reduced NYHA score pre and post-intervention. A cost- analysis was also performed on these data.RESULTSAdmission rates significantly decreased by 41% after the intervention (total length of stay was reduced by 55%). The rate of ED visits was reduced by 55%. Thirty-one percent of patients had an improved functional class score after the intervention, whereas only 7.8% got worse. The overall cost saving associated with the intervention was €139,717.65 for the whole group over 1 year.CONCLUSIONSA personalized follow-up of HF patients led to important outcome benefits and resulted in cost savings, mainly due to the reduction of patient hospitalization readmissions and a significant reduction of care- associated costs, suggesting that greater attention should be given to this high-risk cohort to minimize the risk of hospitalization readmissions.

scholarly journals LIVING LIFE TO THE FULL 55-PLUS: A COMMUNITY-BASED INTERVENTION FOR REDUCING DEPRESSION AND ANXIETY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S511-S511
Author(s):  
Nasreen Khatri ◽  
Stephen Perkovic ◽  
Tara Faghani Hamadani
Keyword(s):  
Repeated Measures ◽  
Life Stress ◽  
Local Community ◽  
Well Being ◽  
Older Individuals ◽  
Post Intervention ◽  
Community Based ◽  
The Impact ◽  
Mental Well Being

Abstract Living Life to the Full 55+ (LLTTF) was an 8-week, 12-hour, community educational program based on CBT principles. The program aim was to teach participant skills and techniques to cope effectively with life stress. Participants self-referred to the program by responding to advertisements or were otherwise referred to the program by local community centres. Following the promising results of the pilot study, a follow-up empirical study was conducted to assess the impact of the program on clinical measures and other notable measures over time. Study participants (N = 514) were recruited at partner sites hosting the program. Demographic and other data was collected to assess the impact of the program. Measures collected to assess the impact of the program were the Beck Depression Inventory (BDI-II), Beck Anxiety Inventory (BAI), Warwick-Edinburgh Mental Well-being Scale (WEMWBS), and a brief measure of loneliness/social connectedness. Participant data was collected pre/post-intervention, and at post-course follow-up periods (3/6/9-months). Preliminary repeated-measures ANOVA analyses found statistically significant changes in depression, anxiety, mental well-being, and loneliness scores, from pre- to post-intervention. Participant’ depression, anxiety, and loneliness scores significantly reduced from pre- to post-course. Participants also experienced a significant improvement in mental well-being from pre- to post-course. Observed decreases in loneliness and depression did not significantly change from post-course to any of the follow-up periods. Results suggest the viability of a nonclinical program for addressing depression and loneliness in older individuals, and have implications for community-based strategies attempting to address mental health issues in older Canadians

A pilot study of direct care nurse (DCN) education to improve adherence and knowledge of erlotinib in patients with non-small cell lung cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19637-e19637
Author(s):  
Joan Vern Lucca ◽  
Catherine L. Hooper ◽  
Jean Boucher ◽  
Lillian Vitale Pedulla ◽  
Donna Lynn Berry ◽  
...  
Keyword(s):  
Pilot Study ◽  
Side Effects ◽  
Supportive Care ◽  
Anticancer Agents ◽  
Symptom Management ◽  
Phone Call ◽  
Ambulatory Setting ◽  
Adverse Side Effects ◽  
Oral Anticancer Agents

e19637 Background: Adherence for oral anticancer agents is a major concern for patients in the ambulatory setting. Adherence rates for oral medication regimens are associated with proper knowledge and monitoring for adverse side effects including symptom management. To improve patient-reported adherence we studied feasibility of a DCN educational intervention to enhance participant knowledge and adherence to erlotinib while monitoring for side effects. Methods: A prospective, pilot study with 30 NSCLC patients was conducted. The study included a DCN structured education session utilizing an adapted educational tool (MOATT) from the Multinational Association of Supportive Care in Cancer (MASCC); followed within 72 hours by a DCN phone call to assess patient learning, adherence, and adverse side effects. Primary endpoints included participant-reported Knowledge Rating Scale (KRS) scores and adherence behaviors measured by the Morisky Medication Adherence Scale (MMAS-8). Adverse side effects and feasibility data were analyzed for each DCN/patient encounter. Results: MMAS-8 adherence scores indicated medium (n=11) to high (n=14) adherence rates and high KRS scores (mean 8.9, range of 7.5-10). Mean age of patients was 67 years (range 45-84 years), majority were female (81%), with race/ethnicity as Caucasian 80%, Asian 10%, and Black 10%. Mean number of erlotinib adverse events was 2.48 per patient and 22% reported 4 or more side effects. Patients contacted DCN 60 times between start and end of protocol. Feasibility included 90% (n=27/30) completing the protocol, mean time 30 minutes to administer educational session and 14 minutes for DCN 72-hour follow-up phone call. Documentation of visits indicated nurse education and follow-up, including monitoring side effects, provided valued supportive care. Conclusions: Data supports the need for and feasibilty of a nurse-led structured protocol to enhance adherence, knowledge, and symptom management. Further study of this education/monitoring intervention for patients initiating oral anticancer agents in the ambulatory setting is recommended.

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