Care in the final hours and days

Author(s):  
Dawn Davies ◽  
Justin Baker

Caring for a child and his or her family during the last hours and days of the child’s life is emotionally charged, with inherent pressure to ‘get things right.’ Anticipation and treatment of the patient’s changing symptoms are essential to stave off emergency situations or, at least, to be optimally prepared to deal with them. Parents must be actively supported during this time, regardless of the setting, and the availability of professional assistance must be continuous, even if this can be only by telephone in some circumstances. Access to emergency medications must be anticipated in this context. Communication must be seamless, and care providers must be prepared for sudden changes in the desired setting of care. It is much easier to plan for every contingency, knowing that some plans will go unused, than to have to cobble together suboptimal arrangements at the last minute.

1988 ◽  
Vol 10 (2) ◽  
pp. 37-47
Author(s):  
George D. Comerci

Anorexia nervosa and bulimia nervosa must be understood and appreciated to be chronic disorders. Too often pediatricians and other health care providers expect that the patient with an eating disorder will be quickly cured. We anticipate and readily accept patient relapses in other chronic conditions such as diabetes, cystic fibrosis, or rheumatoid arthritis, but we do not expect, nor do we tolerate, relapses in patients with eating disorders! Rather, we perceive the relapse as a treatment failure, often blaming ourselves and our lack of knowledge and skills, our treatment team, and, of course, the patient and his or her family. During medical school and residency training there are few good role models for the care of chronically ill patients. We have not learned to enjoy caring for people who do not rapidly improve and recover, especially when the illness is their "personal choice." Little wonder that so many pediatricians reject the responsibility to care for patients with an eating disorder and elect to refer them to others.


2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Dessalegn Ajema ◽  
Tamiru Shibru ◽  
Temesgen Endalew ◽  
Selamawit Gebeyehu

Abstract Background Non-adherence to anti-TB treatment is one of the crucial challenges in improving tuberculosis (TB) treatment outcomes and reducing healthcare costs. The poor adherence to anti-TB treatment among patients with TB is a major problem in Ethiopia. This study aimed to assess the level of and associated factors for non-adherence to anti-TB therapy among patients with tuberculosis in the Gamo Gofa Zone. Methods A cross-sectional study was conducted at Gamo Gofa Zone from July 20 – August 30, 2017. A multi-stage sampling technique was used. The study included 289 patients who were on anti-TB treatment. Data were collected by trained data collectors using a structured and pre-tested questionnaire through interviews. A multiple logistic regression model was fitted using SPSS 23 to identify factors associated with non-adherence to anti-TB treatment at a 5% significance level. Results We found that 16.5% of the participants were non-adherent for anti-TB treatment. Failure to disclose one’s TB status to his or her family (AOR = 31.7; 95% CI: 9.1–111.1), having no information on the expected adverse events (AOR = 31.1; 95% CI: 7.5–128.3), past anti-TB treatment history (AOR = 5.3; 95% CI: 1.5–18.8) and a smoking cigarette (AOR = 11.7; 95% CI: 3.2–43.03) were found to be associated with a higher odds of being non-adherent to anti-TB treatment. Conclusions The level of non-adherence to anti-TB treatment among TB patients was high. Health care providers should counsel TB patients on the expected adverse events and measures to be taken when patients face the expected adverse events. They should also counsel their patients to disclose their TB status to his or her family and for ceasing cigarette smoking.


2019 ◽  
Vol 34 (s1) ◽  
pp. s155-s155
Author(s):  
Vaclav Jordan

Introduction:Spontaneous delivery is a completely physiological phenomenon. Occupational obstetric care in a hospital environment focuses on supporting the mother, the smooth progression of the baby, and the treatment of the newborn child. Occupational activities play a rather supportive and assisting role. The obstetrician and the midwife are ready to respond immediately in the hospital environment to any complications or sudden emergencies. During a birth outside of the hospital environment, there are a number of influences that can cause complications in an unprepared environment without professional assistance, endangering the condition of both the child and the woman.Methods:The educational concept of PARABORN focuses on situations outside the hospital environment. It is generalized and adaptable to varying geographic, economic, and cultural-political conditions of the target providers, particularly to rescue and paramedic teams. Educational concepts are specialized, interactive courses. The course includes a theoretical and practical block. In the theoretical part, the participants acquire knowledge of urgent obstetric conditions in an out-of-hospital environment including an overweight birth, bleeding, premature delivery, or a complicated delivery (non-standard position, umbilical cord prolapse, etc.). In the practical block, participants acquire the skills of acute interventions as well as methods of communication in these emergency situations. Practical training takes the form of case studies and can be tailored to the real geographic and cultural conditions in which the intervention units operate such as remote terrain, conflicts zones, etc.Discussion:The knowledge of the cultural and political environment is a necessary prerequisite for managing the urgent situation. Paramedics, as first responders, should have adequate training to manage maternity situations in an out-of-hospital environment where a hospital environment is not available or accessible either by choice or circumstance.


1911 ◽  
Vol 5 (3) ◽  
pp. 70-76
Author(s):  
Adelia M. Hoyt

The story opens on a June afternoon as Mabel Forrester, a young blind girl, is traveling homeward from the State School for the Blind. She graduated with honors, and while she regrets leaving school and being separated from her friends, she is looking forward to a bright and hopeful future. When she is met at the station by her father and they drive to the farm which is their home, and where, since her mother's death, her aunt has been mistress; she is disappointed at the slight interest which her father manifests in her graduation and the discouraging way in which he speaks of her home life. It is no less disheartening when she talks with her aunt and sister, and she realizes that they have no confidence in her ability. She endeavors to help with the household duties, always against their wishes, but the climax is reached when she accidentally upsets a dishpan of water. After this she is not permitted to assist in any way. She wanders around aimlessly, becoming almost distracted at times because of her great disappointment. Finally, realizing that something must be done, she decides to write to Miss Lane, her former teacher, knowing that from her she will receive sympathy and assistance. Miss Lane, to whom Mabel appeals for advice, responds instantly with a very helpful letter. She herself is blind, and so can enter fully into Mabel's difficulties and point the best way out of them. She advises Mabel, instead of despairing over being shut out of the household tasks, to set about finding little unobtrusive ways of helping without asking leave. Mabel acts upon this advice, and though there are many discouraging days, she perseveres, and in time she has the comfort of feeling that little sister Lizzie is finding in the blind sister the nearest approach to a mother's love that she has ever known. Out of this companionship comes one of Mabel's sweetest rewards, for little Lizzie falls into a delightful habit of reading aloud to Mabel, who is hungry for books. Next Mabel finds herself assisting her fifteen-year-old brother Rob with his lessons. Mary, the older sister, too, begins to find in Mabel a very sympathetic companion, and in her turn tries to share her little social pleasures with Mabel. Even the aunt begins to see that this niece is a help to her in many ways. Most of all, Mabel rejoices when her father shows an appreciation of her thoughtfulness toward him, and she feels that she has at last won the confidence and respect of all her family. Almost from the first of her home-coming it has been apparent to Mabel that it was only by strictest economy the father has been able to maintain his large family. Now comes Mabel's hardest trial. She sees Mary ready to help by teaching; Rob, at the close of school, is to work for a neighboring farmer. What can Mabel do to help ? She works and waits and hopes, and of course her opportunity arrives. She has but to act — and act she does.


1993 ◽  
Vol 21 (2) ◽  
pp. 238-240 ◽  
Author(s):  
Gail Geller ◽  
Ellen S. Tambor ◽  
Barbara A. Bernhardt ◽  
Gary A. Chase ◽  
Karen J. Hofman ◽  
...  

Confidentiality is a cornerstone of the physician-patient relationship. Breaches of confidentiality in the context of genetic testing are of particular concern for a number of reasons. First, genetic testing reveals information not only about a particular patient, but also about his or her family members. Second,genetic testing can label healthy people as “at risk,” subjecting them to possible stigmatization or discrimination by third parties. Third, as genetic testing becomes more widespread and is incorporated into primary care, breaches of confidentiality might inadvertently occur more frequently because primary care providers may not be trained to understand the uniqueness of genetic information. Until now, genetic services have been provided primarily by medical geneticists and genetic counselors. However, with the proliferation of new genetic presymptomatic and carrier tests, primary care physicians are going to become increasingly involved in genetic testing. Currently, little is known about physicians’ attitudes (other than those of medical geneticists) toward disclosure of confidential genetic information to third parties.


2012 ◽  
Vol 4 (3) ◽  
pp. 147-150
Author(s):  
Maninder Ahuja

ABSTRACT For centuries it is common myth to advice bed rest during pregnancy. At the least pretext bed rest is advised by family members and by health care providers also. But review of literature and RCT shows that in reality bed rest does not alter the course of pregnancy in various complications. Role of bed rest has been examined in singleton, twin and triplet pregnancies but was not found useful. Prolonged bed rest is rather harmful as it causes increased calcium excretion, loss of muscle mass, financial loss and increased psychological rest for the pregnant woman and her family. Moderate exercise is advisable throughout pregnancy to maintain tone of muscles and range of movements. So till we have more proof we should be cautious in advising pregnant patients about bed rest. It can be limited activity where we feel it is not advisable to overexert her. How to cite this article Ahuja M. Bed Rest in Pregnancy and Its Related Complications: Is It Needed?. J South Asian Feder Obst Gynae 2012;4(3):147-150.


2021 ◽  
Vol 6 (2) ◽  
pp. 261-268
Author(s):  
Dinda Sinta Rahayu ◽  
Ari Udiyono ◽  
Lintang Dian Saraswati

Background: Systemic Lupus Erythematosus (SLE) is an autoimmune disease with varied manifestations and characterized by recurring flares. Lack of disease knowledge and non-compliance with drug therapy are an important cause of not achieving treatment targets and worsening lupus symptoms.Methods: This research is a descriptive study with a cross-sectional approach. The research method is quantitative. The sample in this study were 136 patients who came to examine themselves at Central-General Hospital in Semarang City. The sampling technique used in this study was total sampling. This study used a questionnaire to determine the variables studied.Result: The results of this study indicate a significant correlation between the level of knowledge (r=-0,332; p < 0,05) and level of drug adherence (r=-0,644; p < 0,05) to the level of systemic lupus erythematosus flaresConclusion : Based on the results, there is a correlation between knowledge and drug adherence to the level of systemic lupus erythematosus flares. The recommendation given is an integrated approach between patients and health care providers to improve patients understanding of systemic lupus erythematosus flares. Beside of that, specific attention should be paid to integrate the service provision system into the collaborative approach of the patients and his/her family in order to promote the level of drug adherence. 


2008 ◽  
Vol 7 (3) ◽  
pp. 159-171 ◽  
Author(s):  
Cher Kinamore

AbstractBackground: Breast cancer is the most common cancer and most common cancer cause of death in women aged 20–49 years in Canada. Developing a functional definition of ‘young’ is imperative in assessing and providing appropriate emotional support to the unique body image and sexuality concerns facing ‘young’ women with breast cancer. These concerns require proper assessment in order to provide appropriate interventions.Aims and objectives: To seek a functional definition of ‘young’ and to determine what body image and sexuality assessment tools and interventions are the most appropriate for young women with breast cancer.Methods: A literature search was undertaken to determine what body image and sexuality assessment tools and interventions are available and relevant to young women with breast cancer. Also, the assessment and interventions available to this patient cohort in the author's clinic were explored.Conclusions: Body image and sexuality questionnaires encourage young women and health-care providers (HCPs) to openly discuss these issues. Annon's PLISSIT model is an assessment and intervention strategy that enables HCPs to adequately assess and refer young women to suitable programs such as support groups and counsellors. The multi-disciplinary team should provide continuous emotional assessment and support throughout the cancer journey by collaborating to develop the best interventional strategies to the patient and her family.


2015 ◽  
Vol 23 (1) ◽  
pp. 87-122
Author(s):  
Lydia Wytenbroek

AbstractFrom November 1954 to November 1956, Canadian nurse Margaret Campbell Jackson was employed by the World Health Organization (WHO) and was stationed in Tehran, Iran, where she participated in the establishment of a Maternal and Child Health (MCH) Centre. The objective of the project, known as Iran 10, was twofold: to set up a health service for mothers and children and to initiate a field training program for Iranian physicians, nurses, and other health care providers. Drawing on 180 letters Jackson wrote to her family in Canada from Iran, this article analyzes the MCH Centre as a contact zone and considers the relationships Jackson developed with staff affiliated with the project. The Centre became a space of cross-cultural encounters, where locally and foreign-trained Iranian staff and expatriates mingled and shared working relationships. I argue that authority was negotiated and contested through interactions and associations that were often unequal and framed by notions of progress, modernization, race, and health. Personality also played an important role.


Author(s):  
Tianfeng He ◽  
Lefan Liu ◽  
Jing Huang ◽  
Guoxing Li ◽  
Xinbiao Guo

Limited empirical work has been done to compare the effects that health knowledge and advice from doctors have on smokers’ intentions to quit. This paper examines the association of smokers’ intentions to quit with health knowledge, advice from doctors, and self-perceived health. A sample of 2509 smokers aged 15–69 years old in Ningbo was used from China’s National Health Literacy Surveillance survey, conducted in 2018 and 2019. Respondents were asked whether they agree smoking causes stroke, heart attack, lung cancer; and heart diseases in adults, lung illnesses in children, and lung cancer in adults, by secondhand smoke, respectively. Using the logistic model, we found that knowing that smoking causes stroke and lung cancer more than doubles the odds of one’s intention to quit (OR = 2.705, p < 0.01), the effect of which is much greater than knowing that smoking causes lung cancer only (OR = 1.795, p < 0.01). Doctors’ advice to quit is more important than health knowledge, in terms of predicting smokers’ past cessation behaviours. In addition, smokers’ self-perceived health is negatively associated with their decisions to quit. This paper highlights that more resources should be directed towards training health care providers to advise smokers to quit, which might be more effective than health education alone.


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