The First Domain of Palliative Care

2018 ◽  
Author(s):  
E. Alessandra Strada
Keyword(s):  
Risk Factors ◽  
Palliative Care ◽  
Clinical Practice ◽  
Clinical Case ◽  
Clinical Skills ◽  
Home Based ◽  
Professional Self ◽  
The Difference ◽  
Clinical Case Scenarios

This chapter proposes palliative psychology competencies in the first domain of palliative care based on the framework of the Clinical Practice Guidelines for Quality Palliative Care. Competencies are conceptualized as comprising knowledge, skills, and attitudes. The role of palliative psychologists is presented through the discussion of clinical case scenarios. These roles for psychologists are discussed in the context of different palliative care settings (inpatient; outpatient, home-based palliative care, hospice). The relevant application of clinical skills is discussed. The difference between palliative care and hospice is also presented. Finally, this chapter approaches the topic of professional self-care, which is conceptualized as a necessary competence for palliative psychologists. The discussion presents risk factors, protective factors, and interventions especially relevant to palliative psychologists.

THE ROLE OF A MENTOR IN THE PROCESS OF TRAINING STUDENTS IN THE SPECIALTY MIDWIFE

2020 ◽  
Vol 1 (8(77)) ◽  
pp. 23-32
Author(s):  
S. Radeva ◽  
L. Georgieva
Keyword(s):  
Clinical Practice ◽  
Practical Training ◽  
Internal Factors ◽  
Professional Orientation ◽  
Young Professionals ◽  
Motivation For Learning ◽  
Obstetric Services ◽  
Professional Self ◽  
Legislative Changes

The training of midwives in recent years has been consistent with the development of technology, the growing demands of the field of obstetric services, from patients and legislative changes, but, nevertheless, the emphasis has not yet been placed on mastering professional skills and communication. Clinical practice is a form of training associated with high responsibility, good theoretical training and mastered skills and competencies during training sessions. During clinical practice, students should master a number of practical skills, they should be able to develop the necessary confidence and the necessary professional self-esteem. Proper and appropriate organization of clinical practice contributes to the creation of positive motivation for learning, the development of cognitive interests that were once formed, become active internal factors for improving the quality, effectiveness and selfesteem in relation to educational activities. The activities of teachers and mentors should be aimed at working more closely with students during clinical practice, so that they can prepare well and fully independently during practical training to perform the specified skills. Motivation is important for creating a professional orientation that is passed on by practitioners and is a prerequisite for choosing a future workplace for students. Mentors from training bases are people who can guide young professionals to train them, educate them on professional responsibility, and teach them how to communicate with patients and colleagues. Students need daily incentives for active, purposeful and constant efforts for all types of activities, so that they can gain the necessary confidence and be ready for the requirements of their chosen profession.

Diagnostic Studies for Thrombophilia in Women on Hormonal Therapy and During Pregnancy, and in Children

2002 ◽  
Vol 126 (11) ◽  
pp. 1296-1303
Author(s):  
Benjamin R. Brenner ◽  
Ulrike Nowak-Göttl ◽  
Andrea Kosch ◽  
Marilyn Manco-Johnson ◽  
Michael Laposata
Keyword(s):  
Risk Factors ◽  
Clinical Practice ◽  
Oral Contraceptive ◽  
Medical Literature ◽  
Data Extraction ◽  
Data Sources ◽  
Current Clinical Practice ◽  
Extensive Review ◽  
Prothrombotic Risk Factors

Abstract Objective.—To review the role of acquired and inherited prothrombotic risk factors that increase the risk of thrombosis in oral contraceptive users, during pregnancy, and in neonates, infants, and children; and to determine by the consensus opinion of recognized experts in the field which risk factors should be determined in which individuals at which time. Data Sources.—Review of the medical literature and current clinical practice by a panel of experts in the field of thrombophilia. Data Extraction and Synthesis.—The experts made an extensive review of the published literature and prepared a draft manuscript, which included preliminary recommendations. The draft manuscript was circulated to participants in the College of American Pathologists Conference XXXVI: Diagnostic Issues in Thrombophilia prior to the conference. The manuscript and recommendations were then presented at the conference for discussion. Recommendations were accepted if a consensus of the 26 experts attending the conference was reached. The results of the discussion were used to revise the manuscript into its final form. Conclusions.—This report reviews the options for testing for thrombophilic states in women using oral contraceptives, during pregnancy, and in neonates and children. General guidelines for testing in these clinical situations are provided, along with citation of the appropriate supporting literature.

scholarly journals Cephalosporins: A Focus on Side Chains and β-Lactam Cross-Reactivity

Pharmacy ◽  
2019 ◽  
Vol 7 (3) ◽  
pp. 103 ◽  
Author(s):  
Saira B. Chaudhry ◽  
Michael P. Veve ◽  
Jamie L. Wagner
Keyword(s):  
Risk Factors ◽  
Clinical Practice ◽  
Antimicrobial Stewardship ◽  
Clinical Utility ◽  
Cross Reactivity ◽  
Penicillin Allergy ◽  
Side Chain ◽  
Safety And Efficacy ◽  
History Of

Cephalosporins are among the most commonly prescribed antibiotic classes due to their wide clinical utility and general tolerability, with approximately 1–3% of the population reporting a cephalosporin allergy. However, clinicians may avoid the use of cephalosporins in patients with reported penicillin allergies despite the low potential for cross-reactivity. The misdiagnosis of β-lactam allergies and misunderstanding of cross-reactivity among β-lactams, including within the cephalosporin class, often leads to use of broader spectrum antibiotics with poor safety and efficacy profiles and represents a serious obstacle for antimicrobial stewardship. Risk factors for cephalosporin allergies are broad and include female sex, advanced age, and a history of another antibiotic or penicillin allergy; however, cephalosporins are readily tolerated even among individuals with true immediate-type allergies to penicillins. Cephalosporin cross-reactivity potential is related to the structural R1 side chain, and clinicians should be cognizant of R1 side chain similarities when prescribing alternate β-lactams in allergic individuals or when new cephalosporins are brought to market. Clinicians should consider the low likelihood of true cephalosporin allergy when clinically indicated. The purpose of this review is to provide an overview of the role of cephalosporins in clinical practice, and to highlight the incidence of, risk factors for, and cross-reactivity of cephalosporins with other antibiotics.

Reversibility of Delirium in Palliative Care (DRAFT)

2018 ◽  
Author(s):  
Tiffany Shaw ◽  
Eric Prommer
Keyword(s):  
Risk Factors ◽  
Decision Making ◽  
Palliative Care ◽  
Clinical Case ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Factors Associated ◽  
Frequent Event ◽  
Study Intervention

Delirium is a frequent event in patients with advanced cancer. Untreated delirium affects assessment of symptoms, impairs communication including participation in clinical decision-making. This study used specific diagnostic criteria for delirium and prospectively identified precipitating causes of delirium. The study identified factors associated with reversible and irreversible delirium. Impact of delirium on prognosis was evaluated. This chapter describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case. Topics covered include delirium, neoplasms, palliative care, polypharmacy, risk factors, and therapeutics.

scholarly journals Understanding and Addressing the Role of Coping in Palliative Care for Patients With Advanced Cancer

2020 ◽  
Vol 38 (9) ◽  
pp. 915-925 ◽  
Author(s):  
Joseph A. Greer ◽  
Allison J. Applebaum ◽  
Juliet C. Jacobsen ◽  
Jennifer S. Temel ◽  
Vicki A. Jackson
Keyword(s):  
Palliative Care ◽  
Coping Strategies ◽  
Advanced Cancer ◽  
Physical Symptoms ◽  
Early Palliative Care ◽  
Beneficial Effects ◽  
Symptoms Of Depression ◽  
Home Based ◽  
Oncology Care

Advanced cancer, with its considerable physical symptoms and psychosocial burdens, represents an existential threat and major stressor to patients and their caregivers. In response to such stress, patients and their caregivers use a variety of strategies to manage the disease and related symptoms, such as problem-focused, emotion-focused, meaning-focused, and spiritual/religious coping. The use of such coping strategies is associated with multiple outcomes, including quality of life, symptoms of depression and anxiety, illness understanding, and end-of-life care. Accumulating data demonstrate that early palliative care, integrated with oncology care, not only improves these key outcomes but also enhances coping in patients with advanced cancer. In addition, trials of home-based palliative care interventions have shown promise for improving the ways that patients and family caregivers cope together and manage problems as a dyad. In this article, we describe the nature and correlates of coping in this population, highlight the role of palliative care to promote effective coping strategies in patients and caregivers, and review evidence supporting the beneficial effects of palliative care on patient coping as well as the mechanisms by which improved coping is associated with better outcomes. We conclude with a discussion of the limitations of the state of science, future directions, and best practices on the basis of available evidence.

Role of known risk factors in explaining the difference in the risk of coronary heart disease between eastern and southwestern Finland

1998 ◽  
Vol 30 (5) ◽  
pp. 481-487 ◽  
Author(s):  
Pekka Jousilahti ◽  
Erkki Vartiainen ◽  
Jaakko Tuomilehto ◽  
Juha Pekkanen ◽  
Pekka Puska
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
The Difference

Impact of the caregiver burden on the effectiveness of a home-based palliative care program: A mediation analysis

2019 ◽  
Vol 18 (3) ◽  
pp. 332-338 ◽  
Author(s):  
Angela J. Pereira-Morales ◽  
Luis Enrique Valencia ◽  
Luis Rojas
Keyword(s):  
Palliative Care ◽  
Caregiver Burden ◽  
Psychological Symptoms ◽  
Care Program ◽  
Palliative Care Program ◽  
Home Based ◽  
High Prevalence ◽  
The Relationship ◽  
Significant Mediator

AbstractObjectiveThe growing aging population and the high prevalence of several concomitant chronic diseases have contributed to the elevated rates of caregiver burden and suffering in patients. In turn, intending to relieve unnecessary pain in patients, there has been a rapid growth of outpatient palliative care programs. However, little has been studied about caregiver burden as a relevant factor potentially affecting the effectiveness of these programs. This study aimed to determine the extent of caregiver burden as a possible mediator on the effectiveness of a home-based palliative care program.MethodSixty-six palliative patients (56% women; mean age + SD = 71, 6 ± 17.7) and their caregivers were assessed with measures for physical, emotional, and psychological symptoms before and 1 month after the start of a home-based palliative care program.ResultsThe association between caregiver burden and palliative outcomes was corroborated with a categorical regression model (p < 0.01). Caregiver burden was found to be a significant mediator in the relationship between outcome measures for palliative care at baseline and after 1 month of enrollment in the program.Significance of resultsTo our knowledge, this is the first study to assess the role of caregiver burden in the effectiveness of a home-based palliative care program. Although further work is required, the results indicate that a patient-focused intervention does not have the same beneficial effect if the caregiver burden is not addressed. Future home-based palliative care programs should focus on caregivers as well as patients, with particular attention to psychosocial intervention on caregivers.

Finding Paradise Within: How Spirituality Protects Palliative Care Clients and Caregivers From Depression

2017 ◽  
Vol 36 (3) ◽  
pp. 243-254 ◽  
Author(s):  
Joy Penman
Keyword(s):  
Palliative Care ◽  
Secondary Analysis ◽  
South Australia ◽  
Study Data ◽  
Spiritual Beliefs ◽  
Doctoral Study ◽  
Home Based ◽  
Spiritual Engagement ◽  
Van Manen

The aims of this article are to explore the experience of depression among palliative care clients and caregivers, describe the strategies they use in coping with depression, and clarify the role of spirituality in preventing and/or overcoming depression. This article discusses an aspect of the findings of a larger doctoral study that explored the nature of spirituality and spiritual engagement from the viewpoint of individuals with life-limiting conditions and their caregivers. van Manen’s phenomenology was used in the study. The data generated from the doctoral study were subjected to secondary analysis to uncover the experience of depression. The methodology underpinning the secondary analysis was phenomenology also by van Manen. Fourteen clients and caregivers from across regional and rural South Australia informed the study. Data collection involved in-depth nonstructured home-based interviews that were audiotaped and transcribed verbatim. The findings highlighted relate to participants succumbing to depression, but having spiritual beliefs and practices helped them cope. One of the most insightful understanding was the role spirituality played in protecting individuals from depression, encapsulated in the theme “finding paradise within.” Spirituality, understood from a religious or secular perspective, must be embedded in palliative care as it assisted in preventing and overcoming depression.

scholarly journals What factors explain the much higher diabetes prevalence in Russia compared with Norway? Major sex differences in the contribution of adiposity

2021 ◽  
Vol 9 (1) ◽  
pp. e002021
Author(s):  
Olena Iakunchykova ◽  
Maria Averina ◽  
Tom Wilsgaard ◽  
Sofia Malyutina ◽  
Alexander V Kudryavtsev ◽  
...  
Keyword(s):  
Risk Factors ◽  
Glycated Hemoglobin ◽  
Population Based ◽  
Marginal Structural Models ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
High Prevalence ◽  
The Difference ◽  
Design And Methods

IntroductionCompared with many other countries Russia has a high prevalence of diabetes in men and women. However, contrary to what is found in most other populations, the risk is greater among women than men. The reasons for this are unclear.Research design and methodsPrevalence and risk factors for diabetes at ages 40–69 years were compared in two population-based studies: Know Your Heart (KYH) (Russia, 2015–2018, n=4121) and the seventh wave of the Tromsø Study (Tromsø 7) (Norway, 2015–2016, n=17 649). Diabetes was defined by the level of glycated hemoglobin and/or self-reported diabetes and/or diabetes medication use. Marginal structural models were used to estimate the role of key risk factors for diabetes in differences between the studies.ResultsAge-standardized prevalence of diabetes was higher in KYH compared with Tromsø 7 in men (11.6% vs 6.2%) and in women (13.2% vs 4.3%). Age-adjusted ORs for diabetes in KYH compared with Tromsø 7 were 2.01 (95% CI 1.68 to 2.40) for men and 3.66 (95% CI 3.13 to 4.26) for women. Adiposity (body mass index and waist circumference) explained none of this effect for men but explained 46.0% (39.6, 53.8) for women. Addition of smoking and C reactive protein, as further mediators, slightly increased the percentage explained of the difference between studies to 55.5% (46.5, 66.0) for women but only to 9.9% (−0.6, 20.8) for men.ConclusionsAdiposity is a key modifiable risk factor that appears to explain half of the almost threefold higher female prevalence of diabetes in Russia compared with Norway, but none of the twofold male difference.

Sign in / Sign up

Export Citation Format

Share Document