scholarly journals Video hospice consultation in COVID-19: professional and patient evaluations

2021 ◽  
pp. bmjspcare-2020-002861
Author(s):  
Shannon Milne ◽  
Jennifer Palfrey ◽  
Jane Berg ◽  
Jennifer Todd

BackgroundProviding care for our patients during the COVID-19 pandemic required a rapid shift to video consultations (VCs). A service evaluation was performed to capture hospice professionals’ (HPs) and patients’ experiences of VC.MethodsOnline or postal surveys were sent to HPs and patients, who had participated in VC between March and July 2020, focusing on their experience and satisfaction with the service.Results31 responses from HPs were received. 19 (61.3%) rated their experience of VC as good, despite 29 (93.5%) having no prior VC experience. One-third of HPs had undertaken potentially sensitive consultations, including resuscitation discussions. 23 (74.2%) undertook a VC that included a family member and 18 (58.1%) had included an external healthcare professional. 25 (80.6%) wanted to offer VC as an option going forward. Well-being staff successfully provided multiple group support sessions via video. 26 responses from patients (23) and carers (3) were received. 22 (84.6%) had access to a smartphone. 8 (30.8%) included a family member in their consultation. All patients/carers reported satisfaction with their VC, although 10 (38.5%) expressed a preference for face-to-face consultations. 22 (84.6%) patients would be happy to receive care via VC going forward and 21 (80.8%) stated they would recommend the use of VC to others.ConclusionPatients reported VC to be an acceptable way to receive support from a hospice service and HPs would like to continue to offer VC in the future. VC can be offered as an alternative to face-to-face consultations with the potential to continue and improve access to a wide range of hospice services.

2011 ◽  
Vol 26 (2) ◽  
pp. 108-122 ◽  
Author(s):  
G Hubbard ◽  
K McLachlan ◽  
L Forbat ◽  
D Munday

Objective: To synthesize evidence of family members recognizing that their relative is likely to die within the year, and identifying the need for palliative care. Design: A meta-ethnography of studies of family members in multiple sclerosis (MS), Parkinson’s disease (PD) and motor neuron disease (MND). Review methods: Systematic search in electronic databases; thematic synthesis guided by the principles of meta-ethnography, which is a method for thematic synthesis of qualitative studies. Results: Nine articles were included. The results of the synthesis identified two key themes. First, family members are intimately aware of changes in their relative’s health and well-being. Sub-themes include family member awareness of different and progressive stages of the disease, noticing deterioration, noticing decline in functional abilities and recognizing that their relative will die. The second key theme is dilemmas of being involved in prognostication. Sub-themes include family member ambivalence toward hearing about prognostication, health professionals not being knowledgeable of the disease and family reluctance to receive palliative care. Conclusions: Family members monitor and recognize changes in their relative with PD, MND and MS and in themselves. Thus, drawing on the expertise of family members may be a useful tool for prognostication.


2012 ◽  
Vol 5 ◽  
pp. HSI.S10408
Author(s):  
D.A.L. Macafee ◽  
M.P. Macafee ◽  
P. Brewerton

Introduction As scientific and professional disciplines, medicine and surgery have a tendency to focus on deficiencies, namely what trainees do not know or are not good at doing. The philosophy of Positive Psychology and the notion of “Strengths” takes a different stance. It is an inherently positive process, seeing each trainee as an individual bringing a unique set of strengths to every situation. There is clear evidence from the commercial sector regarding improved performance and well-being when focusing on one's strengths. We were therefore keen to investigate its potential role in the global development of trainee surgeons. Methods Surgical trainees from Core Training 1 to Specialty Training 8 in one training region of the United Kingdom were invited to voluntarily undertake the online Strengthscope™ assessment tool. The computer-generated report was reviewed by an Occupational Psychologist and trainees were then invited to have a strengths-focused feedback discussion on that report, either face-to-face or via telephone. Results Thirty four surgical trainees ranging from CT1 to ST6 completed the tool and 28 undertook the voluntary feedback sessions. Decisiveness, self-improvement, efficiency, emotional control and critical thinking were common strengths identified. Less commonly represented were leading, creativity and developing others. Trainees found that the tool and feedback helped them identify their strengths and embrace them, rather than fitting the surgical mould. It further aided the recognition of strengths in-overdrive and for some trainees it helped explain difficulties they had experienced in previous jobs. It provided insight into individual motivations and character whilst also highlighting how others in the workplace might perceive them. Trainees liked the emphasis on the building up of positive attributes and utilizing innate skills and strengths. The feedback consultation from an accredited coach trained in the Strengthscope™ tool was judged by trainees to be crucial to a full understanding of the report and its potential implications. Conclusions Surgical trainees have a wide range of strengths which, if identified and focused upon, could help them to fulfil their greatest potential at work. Strengthscope™ has provided new insights into the range of skills and talents of surgical trainees and has a potential role in providing more advanced educational supervision and mentorship. For these trainees, the assessment and feedback discussion aided their personal and professional development, highlighting where their most significant strengths lay with a view to making their daily working lives more fulfilling and, hopefully, helping them excel.


Eye ◽  
2021 ◽  
Author(s):  
Rahul Kanabar ◽  
Wendy Craven ◽  
Helen Wilson ◽  
Rebecca Rietdyke ◽  
Felipe Dhawahir-Scala ◽  
...  

Abstract Introduction Pressure on capacity in ophthalmology alongside the coronavirus (COVID-19) pandemic led to the development of the COVID-19 Urgent Eyecare Service (CUES), allowing patients to receive a prompt ophthalmic consultation, including remotely. The aim of this study was to conduct a service evaluation of CUES in Manchester. Methods Data were collected both prospectively and retrospectively from both primary and secondary care over an 8-week period from June to August 2020. Results In primary care CUES in Greater Manchester (GM) 2461 patients were assessed, with a majority self-referring to the service (68.7%, n = 1844). 91.7% of cases initially screened for CUES were deemed eligible and given a telemedicine appointment in GM; 53.3% of these cases required face-to-face consultation. 14.3% of cases seen within in GM CUES (351 out of 2461) were provisionally referred to secondary care. Contemporaneously the main provider emergency eyecare department (EED) attendances were reduced by 37.7% per month between April and December 2020 inclusive, compared to the same months in 2019. Patients attending a CUES face-to-face assessment were more likely to have a diagnosis in agreement with secondary care, compared to patients referred in from telemedicine assessment only (P < 0.05). Conclusion This evaluation of CUES demonstrates a high level of primary care activity alongside a sustained reduction in EED cases. The case-mix of patients seen within EED following referral appears to be of a less benign nature than those cases seen prior to the introduction of CUES.


2019 ◽  
Author(s):  
Micheal O'Cathail ◽  
Luis Aznar ◽  
Mayuran Sivanandan ◽  
Judith Christian

BACKGROUND The NHS’ ‘Long term plan’ details plans to make digital interactions available to all patients in five years. Teleconsultations can improve access to specialist services however there is a lack of UK evidence for the use of teleconsultations in an Oncology setting. Here we describe a service evaluation of teleconsultations for patients attending a regional brain metastases (BM) clinic. These patients have unique travel restrictions that prevent them from driving. OBJECTIVE To assess the feasibility and acceptability of a teleconsultation service in this setting. METHODS From April 2018 to October 2018 all patients attending the BM clinic were offered the choice of a teleconsultation in place of a face-to-face appointment. Feedback was assessed using a satisfaction questionnaire and data was collected on all clinic attendances. RESULTS Sixty-nine individual patients had 119 appointments over the duration of the pilot. Of these, 36 were new patient appointments and 73 were follow ups. Of these, 24 patients (35%) took part in 41 (34%) teleconsultations. User satisfaction was high and no patients who took part in a teleconsultation reverted to face-to-face appointments. These patients avoided 2521 miles (61.6 miles per appointment) of hospital associated travel and travel costs of £441.48 (£10.78 per appointment). CONCLUSIONS Teleconsultations appear to be acceptable in this cohort of patients who have brain metastases attending a regional stereotactic radiosurgery service with the potential for significant savings in travel and expenses evident.


2001 ◽  
Vol 6 (1) ◽  
pp. 15-25 ◽  
Author(s):  
Harald Walach ◽  
Stefan Schmidt ◽  
Yvonne-Michelle Bihr ◽  
Susanne Wiesch

We studied the effect of experimenter expectations and different instructions in a balanced placebo design. 157 subjects were randomized into a 2 × 4 factorial design. Two experimenters were led to expect placebos either to produce physiological effects or not (pro- vs. antiplacebo). All subjects except a control group received a caffeine placebo. They were either made to expect coffee, no coffee, or were in a double-blind condition. Dependent measures were blood pressure, heart rate, well-being, and a cognitive task. There was one main effect on the instruction factor (p = 0.03) with the group “told no caffeine” reporting significantly better well-being. There was one main effect on the experimenter factor with subjects instructed by experimenter “proplacebo” having higher systolic blood pressure (p = 0.008). There was one interaction with subjects instructed by experimenter “proplacebo” to receive coffee doing worse in the cognitive task than the rest. Subjects instructed by experimenter “antiplacebo” were significantly less likely to believe the experimental instruction, and that mostly if they had been instructed to receive coffee. Contrary to the literature we could not show an effect of instruction, but there was an effect of experimenters. It is likely, however, that these experimenter effects were not due to experimental manipulations, but to the difference in personalities.


2012 ◽  
Vol 6 (1-3) ◽  
pp. 243-259 ◽  
Author(s):  
Yohan Yoo

This article demonstrates the need for the iconic status and function of Buddhist scripture to receive more attention by illuminating how lay Korean Buddhists try to appropriate the power of sutras. The oral and aural aspects of scripture, explained by Wilfred Cantwell Smith, provide only a limited understanding of the characteristics of scripture. It should be noted that, before modern times, most lay people, not only in Buddhist cultures but also in Christian and other traditions, neither had the chance to recite scriptures nor to listen to their recitations regularly. Several clear examples demonstrate contemporary Korean Buddhists’ acceptance of the iconic status of sutras and their attempt to appropriate the power and status of those sacred texts. In contemporary Korea, lay Buddhists try to claim the power of scriptures in their daily lives by repeating and possessing them. Twenty-first century lay believers who cannot read or recite in a traditional style have found new methods of repetition, such as internet programs for copying sacred texts and for playing recordings of their recitations. In addition, many Korean Buddhists consider the act of having sutras in one’s possession to be an effective way of accessing the sacred status and power of these texts. Hence, various ways of possessing them have been developed in a wide range of products, from fancy gilded sutras to sneakers embroidered with mantras.


2020 ◽  
Vol 75 (3) ◽  
pp. 256-263
Author(s):  
Maria Y. Egorova ◽  
Irina A. Shuvalova ◽  
Olga I. Zvonareva ◽  
Igor D. Pimenov ◽  
Olga S. Kobyakova ◽  
...  

Background. The organization of clinical trials (CTs) requires the participation and coordination of healthcare providers, patients, public and private parties. Obstacles to the participation of any of these groups pose a risk of lowering the potential for the implementation of CTs. Researchers are a key human resource in conducting of CT. Their motivation for participation can have a significant impact on the recruitment and retention of patients, on the quality of the data collected, which determines the overall outcome of the study. Aims to assess the factors affecting the inclusion of Russian physicians-researchers in CT, and to determine their role in relations with patients-participants. Materials and methods. The study was organized as a part of the Russian multicenter face-to-face study. A survey was conducted of researchers from 10 cities of Russia (20172018). The participation in the survey for doctors was anonymous and voluntary. Results. The study involved 78 respondents. Most research doctors highly value the importance of research for science (4,84 0,39), society (4,67 0,46) and slightly lower for participating patients (4,44 0,61). The expectations of medical researchers are related to improving their financial situation and attaining new experience (n = 14; 18,18%). However, the opportunity to work with new technologies of treatment and diagnosis (n = 41; 52,56%) acted as a motivating factor. According to the questionnaire, the vast majority of research doctors (n = 29; 37,18%) believe that the main reason for patients to participate in CT is to receive quality and free medical care. The most significant obstacle to the inclusion of participants in CT was the side effects of the study drug (n = 38; 48,71%). Conclusions. The potential of clinical researchers in Russia is very high. The patient-participant acts for the research doctor as the subject of the study, and not the object, so the well-being of the patient is not indifferent to the doctor. However, the features of the functioning of our health care system form the motivation of doctors-researchers (additional earnings, professional self-development) and the way they perceive the motivation of patients (CT as an opportunity to receive quality medical care).


Author(s):  
Dr. Sushma Patil ◽  
Dr. Vikrant Patil

Thyroid disorders are common worldwide. Thyroid dysfunction, both hypo- and hyperthyroidism may increase the risk of cardiovascular disorders. Current thyroid function tests may have limitations since they only measure the total or free T4 and/or T3 and TSH serum concentrations in peripheral blood and not the effect of T4 or T3 serum on different specific target tissues. Several comorbid conditions can interfere with the absorption or increase the clearance of levothyroxine. Among patients treated with thyroid replacement, under or overmedicated may-be at risk for adverse health consequences. A wide range of drugs may interfere with levothyroxine absorption, metabolism, and action. Patients report a lack of well-being, despite reaching euthyroid reference range of TSH, with psychological distress. If we will consider Thyroid related conditions as a syndrome then research perspective at the pathophysiology, interrelation between symptoms and comorbidities will be much broader that can lead researchers to get insights of different pathways in which thyroid gland functioning can be perceived and dealt therapeutically. The deliberation of thyroid disorder as a syndrome can affluence our knowledge of correlating cofounders, action of thyroid hormones on target tissues, underlying cause and thyroid health.


Author(s):  
Sigit Arifwidodo ◽  
Orana Chandrasiri

Public Park is considered one of the essential settings for physical activity, especially in urban areas. Parks support physical activity through their accessibility, their provision to facilitate active pursuits; their capacity to provide opportunities to a wide range of users; and their semi-permanent nature. The paper explores the design intervention assessment of Benchakitti Park, which serves as the pilot project for active park and showcase during the past ISPAH 2016 conference. The objective of the paper is to understand the health and well-being benefits of an urban park in increasing PA levels of urban population and promoting a healthy and active lifestyle. Keywords: Public park; physical activity; urban landscape design; public health; SOPARC


2018 ◽  
Vol 35 (4) ◽  
pp. 62-64
Author(s):  
Nazar Ul Islam Wani

Pilgrimage in Islam is a religious act wherein Muslims leave their homes and spaces and travel to another place, the nature, geography, and dispositions of which they are unfamiliar. They carry their luggage and belongings and leave their own spaces to receive the blessings of the dead, commemorate past events and places, and venerate the elect. In Pilgrimage in Islam, Sophia Rose Arjana writes that “intimacy with Allah is achievable in certain spaces, which is an important story of Islamic pilgrimage”. The devotional life unfolds in a spatial idiom. The introductory part of the book reflects on how pilgrimage in Islam is far more complex than the annual pilgrimage (ḥajj), which is one of the basic rites and obligations of Islam beside the formal profession of faith (kalima); prayers (ṣalāt); fasting (ṣawm); and almsgiving (zakāt). More pilgrims throng to Karbala, Iraq, on the Arbaeen pilgrimage than to Mecca on the Hajj, for example, but the former has received far less academic attention. The author expands her analytic scope to consider sites like Konya, Samarkand, Fez, and Bosnia, where Muslims travel to visit countless holy sites (mazarāt), graves, tombs, complexes, mosques, shrines, mountaintops, springs, and gardens to receive the blessings (baraka) of saints buried there. She reflects on broader methodological and theoretical questions—how do we define religion?—through the diversity of Islamic traditions about pilgrimage. Arjana writes that in pilgrimage—something which creates spaces and dispositions—Muslim journeys cross sectarian boundaries, incorporate non-Muslim rituals, and involve numerous communities, languages, and traditions (the merging of Shia, Sunni, and Sufi categories) even to “engende[r] a syncretic tradition”. This approach stands against the simplistic scholarship on “pilgrimage in Islam”, which recourses back to the story of the Hajj. Instead, Arjana borrows a notion of ‘replacement hajjs’ from the German orientalist Annemarie Schimmel, to argue that ziyārat is neither a sectarian practice nor antithetical to Hajj. In the first chapter, Arjana presents “pilgrimage in Islam” as an open, demonstrative and communicative category. The extensive nature of the ‘pilgrimage’ genre is presented through documenting spaces and sites, geographies, and imaginations, and is visualized through architectural designs and structures related to ziyārat, like those named qubba, mazār (shrine), qabr (tomb), darih (cenotaph), mashhad (site of martyrdom), and maqām (place of a holy person). In the second chapter, the author continues the theme of visiting sacred pilgrimage sites like “nascent Jerusalem”, Mecca, and Medina. Jerusalem offers dozens of cases of the ‘veneration of the dead’ (historically and archaeologically) which, according to Arjana, characterizes much of Islamic pilgrimage. The third chapter explains rituals, beliefs, and miracles associated with the venerated bodies of the dead, including Karbala (commemorating the death of Hussein in 680 CE), ‘Alawi pilgrimage, and pilgrimage to Hadrat Khidr, which blur sectarian lines of affiliation. Such Islamic pilgrimage is marked by inclusiveness and cohabitation. The fourth chapter engages dreams, miracles, magical occurrences, folk stories, and experiences of clairvoyance (firāsat) and the blessings attached to a particular saint or walī (“friend of God”). This makes the theme of pilgrimage “fluid, dynamic and multi-dimensional,” as shown in Javanese (Indonesian) pilgrimage where tradition is associated with Islam but involves Hindu, Buddhist and animistic elements. This chapter cites numerous sites that offer fluid spaces for the expression of different identities, the practice of distinct rituals, and cohabitation of different religious communities through the idea of “shared pilgrimage”. The fifth and final chapter shows how technologies and economies inflect pilgrimage. Arjana discusses the commodification of “religious personalities, traditions and places” and the mass production of transnational pilgrimage souvenirs, in order to focus on the changing nature of Islamic pilgrimage in the modern world through “capitalism, mobility and tech nology”. The massive changes wrought by technological developments are evident even from the profusion of representations of Hajj, as through pilgrims’ photos, blogs, and other efforts at self documentation. The symbolic representation of the dead through souvenirs makes the theme of pilgrimage more complex. Interestingly, she then notes how “virtual pilgrimage” or “cyber-pilgrimage” forms a part of Islamic pilgrimage in our times, amplifying how pilgrimage itself is a wide range of “active, ongoing, dynamic rituals, traditions and performances that involve material religions and imaginative formations and spaces.” Analyzing religious texts alone will not yield an adequate picture of pilgrimage in Islam, Arjana concludes. Rather one must consider texts alongside beliefs, rituals, bodies, objects, relationships, maps, personalities, and emotions. The book takes no normative position on whether the ziyāratvisitation is in fact a bid‘ah (heretical innovation), as certain Muslim orthodoxies have argued. The author invokes Shahab Ahmad’s account of how aspects of Muslim culture and history are seen as lying outside Islam, even though “not everything Muslims do is Islam, but every Muslim expression of meaning must be constituting in Islam in some way”. The book is a solid contribution to the field of pilgrimage and Islamic studies, and the author’s own travels and visits to the pilgrimage sites make it a practicalcontribution to religious studies. Nazar Ul Islam Wani, PhDAssistant Professor, Department of Higher EducationJammu and Kashmir, India


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