Oral Administration of Injectable Ketamine During Burn Wound Dressing Changes

2019 ◽  
pp. 089719001987649
Author(s):  
Alicia C. Lintner ◽  
Phillip Brennan ◽  
M. Victoria P. Miles ◽  
Clinton Leonard ◽  
Kaitlin M. Alexander ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Oral Administration ◽  
Wound Care ◽  
The United States ◽  
Burn Wound ◽  
Patient Centered ◽  
Safe Alternative ◽  
Oral Ketamine ◽  
Before And After ◽  
Centered Care

Providing adequate analgesia during burn wound care is essential to patient-centered care. Both oral and intravenous (IV) ketamine are often used for analgesia and sedation. Ketamine may improve analgesia and decrease opioid requirements for burn wound care. Oral ketamine wafers and tablets have been used as a safe alternative internationally but are unavailable in the United States. The purpose of this study was to compare opioid usage and patient satisfaction scores in patients with and without the use of oral injectable ketamine for burn wound care, with each patient serving as their own control. Ketamine, opioid, and benzodiazepine dosages recorded during dressing changes were compared to dressing changes without ketamine use that occurred before and after ketamine-associated sessions in each patient. Fourteen patients received oral ketamine at a median (interquartile range [IQR]) dose of 2.5 (2.2-2.7) mg/kg. Ketamine use significantly decreased opioid requirements when compared to wound care sessions that did not use ketamine both before (50 [IQR: 30-75] mg vs 75 [IQR: 46–91] mg median IV morphine equivalents, P = .0097) and after (50 [IQR: 30-75] mg vs 63 [IQR: 50-96] mg median IV morphine equivalents, P = .0042) the ketamine-associated sessions. One patient experienced hallucinations, and no adverse events were observed. Hence, oral administration of injectable ketamine was associated with a decrease in opioid requirements during dressing changes. Additionally, ketamine use improved patient satisfaction ( P = .0034). Preliminary data suggest this promising analgesia method is safe and effective for burn wound care.

scholarly journals Levels of Patient Satisfaction on Integrative Medicine Before and After Implementation of Diagnosis-related Groups

2018 ◽  
Vol 7 ◽  
pp. 216495611875925 ◽  
Author(s):  
Tobias Romeyke ◽  
Elisabeth Noehammer ◽  
Hans Christoph Scheuer ◽  
Harald Stummer
Keyword(s):  
Patient Satisfaction ◽  
Medical Treatment ◽  
Diagnosis Related Groups ◽  
Hospital Setting ◽  
Nutrition Therapy ◽  
Study Patient ◽  
Patient Centered ◽  
General Evaluation ◽  
Conventional Medical Treatment ◽  
Before And After

Objectives The aim of this article is to study patient satisfaction with complementary and alternative medicine (CAM) in an in-hospital setting before and after the introduction of diagnosis-related groups (DRGs). Methods Patients were interviewed regarding a general evaluation of their hospital stay, the psychological talking therapy, the nutrition therapy, and the overall success of the treatment. Results The medical treatment was evaluated by 1158 patients. A very good success was reported by 347, a good by 609, a moderate by 181, and none by 21 patients. DRG implementation showed no significant effects. Psychological talking therapy was evaluated as “very good” ( P ≤ .05). With regard to the success of the medical talking and nutrition therapy, there were no significant differences ( P ≥ .05) between the time before and after DRG implementation. Conclusion Broadening conventional medical treatment with CAM practices can lead to a parallel treatment of DRGs in hospitals working with complementary medicine. This results in very patient-centered therapies, which may impact patient satisfaction.

Patient Satisfaction and Patient-Centered Care

JAMA ◽  
2012 ◽  
Vol 308 (2) ◽  
pp. 139 ◽  
Author(s):  
Joel M. Kupfer ◽  
Edward U. Bond
Keyword(s):  
Patient Satisfaction ◽  
Patient Centered Care ◽  
Patient Centered ◽  
Centered Care

scholarly journals Shared Decision Making and Patient-Centered Care in Israel, Jordan, and the United States: Exploratory and Comparative Survey Study of Physician Perceptions (Preprint)

2020 ◽  
Author(s):  
Yaara Zisman-Ilani ◽  
Rana Obeidat ◽  
Lauren Fang ◽  
Sarah Hsieh ◽  
Zackary Berger
Keyword(s):  
United States ◽  
Decision Making ◽  
Shared Decision Making ◽  
The United States ◽  
Patient Centered Care ◽  
Survey Study ◽  
Shared Decision ◽  
Patient Centered ◽  
Centered Care ◽  
Comparative Survey

BACKGROUND Shared decision making (SDM) is a health communication model that evolved in Europe and North America and largely reflects the values and medical practices dominant in these areas. OBJECTIVE This study aims to understand the beliefs, perceptions, and practices related to SDM and patient-centered care (PCC) of physicians in Israel, Jordan, and the United States. METHODS A hypothesis-generating comparative survey study was administered to physicians from Israel, Jordan, and the United States. RESULTS A total of 36 surveys were collected via snowball sampling (Jordan: n=15; United States: n=12; Israel: n=9). SDM was perceived as a way to inform patients and allow them to participate in their care. Barriers to implementing SDM varied based on place of origin; physicians in the United States mentioned limited time, physicians in Jordan reported that a lack of patient education limits SDM practices, and physicians in Israel reported lack of communication training. Most US physicians defined PCC as a practice for prioritizing patient preferences, whereas both Jordanian and Israeli physicians defined PCC as a holistic approach to care and to prioritizing patient needs. Barriers to implementing PCC, as seen by US physicians, were mostly centered on limited appointment time and insurance coverage. In Jordan and Israel, staff shortage and a lack of resources in the system were seen as major barriers to PCC implementation. CONCLUSIONS The study adds to the limited, yet important, literature on SDM and PCC in areas of the world outside the United States, Canada, Australia, and Western Europe. The study suggests that perceptions of PCC might widely differ among these regions, whereas concepts of SDM might be shared. Future work should clarify these differences.

scholarly journals Developing a Co-Curricular Activity to Introduce Student Pharmacists to the Cultural Proficiency Continuum Framework

2020 ◽  
Vol 11 (1) ◽  
pp. 1
Author(s):  
Edgar S. Diaz-Cruz ◽  
Angela M. Hagan
Keyword(s):  
Cultural Sensitivity ◽  
Cultural Awareness ◽  
Cultural Proficiency ◽  
The United States ◽  
Self Awareness ◽  
Student Survey ◽  
Patient Centered ◽  
Centered Care ◽  
Curricular Structure ◽  
Survey Responses

Background: As the United States becomes more culturally diverse, health professionals must be able to demonstrate competency in caring for a multitude of diverse patients. The cultural proficiency continuum has proven to be an effective framework to assess where individuals and institutions are on the continuum of cultural sensitivity and competence in educational settings. Innovation: A co-curricular activity was developed as an exercise in self-awareness to allow first year pharmacy students the opportunity to explore potential biases by evaluating comfort in both social and patient care settings. The 90-minute activity employed a lecture, followed by both small and large group discussions and a debriefing session. Findings: Student survey responses showed their appreciation of this framework and its application to patient-centered care. Student self-rated knowledge increased by 3 points on a 10-point scale after completion of the activity. Students agreed that their level of cultural awareness would lead them to respond appropriately in cross-cultural situations, and that the provision of care is dependent on approaches that are culturally proficient. Conclusion: This activity dismantles the misconception of cultural competence as an attainable finite skill, but instead presents it as an ongoing process of self-awareness. The co-curricular activity offers an easy to implement model of education that could potentially fit the needs of pharmacy programs searching for ideas to teach cultural competency and social determinants of health, while circumventing the need to affect curricular structure.   Article Type: Note

scholarly journals �A Phenomenal Person and Doctor�: Thank You Letters to Medical Care Providers (Preprint)

2016 ◽  
Author(s):  
Talya Miron-Shatz ◽  
Stefan Becker ◽  
Franklin Zaromb ◽  
Alexander Mertens ◽  
Avi Tsafrir
Keyword(s):  
Medical Care ◽  
The United States ◽  
Care Providers ◽  
Good Care ◽  
Patient Centered ◽  
Medical Facilities ◽  
Centered Care ◽  
Quality Of Medical Care ◽  
The Web

BACKGROUND Thank you letters to physicians and medical facilities are an untapped resource, providing an invaluable glimpse into what patients notice and appreciate in their care. OBJECTIVE The aim of this study was to analyze such thank you letters as posted on the Web by medical institutions to find what patients and families consider to be good care. In an age of patient-centered care, it is pivotal to see what metrics patients and families apply when assessing their care and whether they grasp specific versus general qualities in their care. METHODS Our exploratory inquiry covered 100 thank you letters posted on the Web by 26 medical facilities in the United States and the United Kingdom. We systematically coded and descriptively presented the aspects of care that patients and their families thanked doctors and medical facilities for. We relied on previous work outlining patient priorities and satisfaction (Anderson et al, 2007), to which we added a distinction between global and specific evaluations for each of the already existing categories with two additional categories: general praise and other, and several subcategories, such as treatment outcome, to the category of medical care. RESULTS In 73% of the letters (73/100), physicians were primarily thanked for their medical treatment. In 71% (71/100) of the letters, they were thanked for their personality and demeanor. In 52% cases (52/100), these two aspects were mentioned together, suggesting that from the perspective of patient as well as the family member, both are deemed necessary in positive evaluation of medical care. Only 8% (8/100) of the letters lacked reference to medical care, personality or demeanor, or communication. No statistically significant differences were observed in the number of letters that expressed gratitude for the personality or demeanor of medical care providers versus the quality of medical care (χ21, N=200=0.1, not statistically significant). Letters tended to express more specific praise for personality or demeanor, such as being supportive, understanding, humane and caring (48/71, 68%) but more general praise for medical care (χ21, N=424=63.9, P<.01). The most often mentioned specific quality of medical care were treatment outcomes (30/73, 41%), followed by technical competence (15/73, 21%) and treatment approach (14/73, 19%). A limitation of this inquiry is that we analyzed the letters that medical centers chose to post on the Web. These are not necessarily a representative sample of all thank you letters as are sent to health care institutions but are still indicative of what centers choose to showcase on the Web. CONCLUSIONS Physician demeanor and quality of interaction with patients are pivotal in how laymen perceive good care, no less so than medical care per se. This inquiry can inform care providers and medical curricula, leading to an improvement in the perceived quality of care.

scholarly journals Clinician distress in seriously ill patient care: A dimensional analysis

2021 ◽  
pp. 096973302110032
Author(s):  
Anessa M. Foxwell ◽  
Salimah H. Meghani ◽  
Connie M. Ulrich
Keyword(s):  
Dimensional Analysis ◽  
Clinical Situation ◽  
The United States ◽  
Emotional Reactions ◽  
Ethical Review ◽  
Patient Centered ◽  
Serious Illness ◽  
Centered Care ◽  
Seriously Ill Patients ◽  
Seriously Ill

Background: Caring for patients with serious illness may severely strain clinicians causing distress and probable poor patient outcomes. Unfortunately, clinician distress and its impact historically has received little attention. Research purpose: The purpose of this article was to investigate the nature of clinician distress. Research design: Qualitative inductive dimensional analysis. Participants and research context: After review of 577 articles from health sciences databases, a total of 33 articles were eligible for analysis. Ethical considerations: This study did not require ethical review and the authors adhered to appropriate academic standards in their analysis. Findings: A narrative of clinician distress in the hospital clinician in the United States emerged from the analysis. This included clinicians’ perceptions and sense of should or the feeling that something is awry in the clinical situation. The explanatory matrix consequence of clinician distress occurred under conditions including: the recognition of conflict, the recognition of emotion, or the recognition of a mismatch; followed by a process of an inability to feel and act according to one’s values due to a precipitating event. Discussion: This study adds three unique contributions to the concept of clinician distress by (1) including the emotional aspects of caring for seriously ill patients, (2) providing a new framework for understanding clinician distress within the clinician’s own perceptions, and (3) looking at action outside of a purely moral lens by dimensionalizing data, thereby pulling apart what has been socially constructed. Conclusion: For clinicians, learning to recognize one’s perceptions and emotional reactions is the first step in mitigating distress. There is a critical need to understand the full scope of clinician distress and its impact on the quality of patient-centered care in serious illness.

scholarly journals A Brief Survey on Six Basic and Reduced eHealth Indicators in Seven Countries in 2017

2018 ◽  
Vol 09 (03) ◽  
pp. 704-713 ◽  
Author(s):  
Reinhold Haux ◽  
Elske Ammenwerth ◽  
Sabine Koch ◽  
Christoph Lehmann ◽  
Hyeoun-Ae Park ◽  
...  
Keyword(s):  
Health Care ◽  
Information Processing ◽  
Health Care Professionals ◽  
The United States ◽  
Patient Centered Care ◽  
Patient Centered ◽  
Political Will ◽  
Record Data ◽  
Centered Care ◽  
Future Work

Background Holistic, ubiquitous support of patient-centered health care (eHealth) at all health care institutions and in patients' homes through information processing is increasingly supplementing institution-centered care. While eHealth indicators may measure the transition from institution-centered (e.g., hospital-centered) information processing to patient-centered information processing, collecting relevant and timely data for such indicators has been difficult. Objectives This article aims to design some basic eHealth indicators, which are easily collected and measure how well information processing supports holistic patient-centered health care, and to evaluate penetrance of patient-centered health as measured by the indicators internationally via an expert survey. Methods We identified six basic indicators that measure access of health care professionals, patients, and caregivers to the patient's health record data and the ability of providers, patients, and caregivers to add information in the patient's record. In a survey of international informatics experts, these indicators' penetrance were evaluated for Austria, Finland, Germany, Hong Kong, South Korea, Sweden, and the United States in the summer of 2017. Results The eHealth status measured by the indicators varied significantly between these seven countries. In Finland, most practices measured by the indicators were fully implemented whereas in Germany only one practice was partially realized. Conclusion Progress in the implementation of practices that support patient-centered care could mainly be observed in those countries where the “political will” focused on achieving patient-centered care as opposed to an emphasis on institution-centered care. The six eHealth indicators seem to be useful for measuring national progress in patient-centered care. Future work will extend the number of countries analyzed.

scholarly journals The challenge of determining appropriate care in the era of patient-centered care and rising health care costs

2018 ◽  
Vol 24 (3) ◽  
pp. 201-206 ◽  
Author(s):  
Ian Coulter ◽  
Patricia Herman ◽  
Gery Ryan ◽  
Lara Hilton ◽  
Ron D. Hays ◽  
...  
Keyword(s):  
Patient Preferences ◽  
The United States ◽  
Patient Centered Care ◽  
Cost Of Care ◽  
Patient Centered ◽  
Inappropriate Care ◽  
Appropriateness Of Care ◽  
Centered Care ◽  
The Cost ◽  
Care Costs

Appropriateness of care is typically determined in the United States by evidence on efficacy and safety, combined with the judgments of experts in research and clinical practice, but without consideration of the cost of care or patient preferences. The shift in focus towards patient-centered care calls for consideration of outcomes that are important to patients, accommodation of patient preferences, and incorporation of the costs of care in patient-provider shared clinical decisions. The RAND/UCLA Appropriateness method was designed to determine rates of appropriate or inappropriate care, but the method did not include patient preferences or costs. This essay examines how methods of studying appropriateness can be made more patient-centered by describing a modification of the RAND/UCLA method by including patient outcomes, preferences, and costs.

scholarly journals 2183 Balancing patient-centeredness and patient safety in the hospitals: The case of pain care and patient satisfaction

2018 ◽  
Vol 2 (S1) ◽  
pp. 79-79
Author(s):  
Olena Mazurenko ◽  
Basia Andraka-Christou ◽  
Matthew Bair ◽  
Areeba Kara ◽  
Christopher A. Harle
Keyword(s):  
Patient Safety ◽  
Patient Satisfaction ◽  
Hospitalized Patients ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Bargaining Process ◽  
Pain Medications ◽  
Centered Care ◽  
Complex Decision Making ◽  
Pain Care

OBJECTIVES/SPECIFIC AIMS: This study seeks to understand the relationship between opioid prescribing and patient satisfaction among non-surgical, hospitalized patients. As part of this study, we qualitatively examined challenges in delivering safe and patient-centered care through voices of physicians’, and nurses.’ METHODS/STUDY POPULATION: We collected data through in-person interviews using semi-structured guides tailored to the informant roles. Study participants came from 1 healthcare system located in a mid-Western state. Each interview lasted 30–45 minutes, was audio-recorded with consent, and transcribed for analysis. Two researchers each coded 17 transcripts for discussions around patient-centeredness (including patient satisfaction, patient experiences), and patient safety for hospitalized patients experiencing pain. Analysis followed a general inductive approach, where researchers identified themes related to the research questions using an open coding technique. They discussed and reached consensus on all codes, and extracted several preliminary themes. The analysis was supported by NVivo software. RESULTS/ANTICIPATED RESULTS: The following themes emerged: (1) complex decision-making process to prescribe opioids for hospitalized patients; (2) the role of objective findings in prescribing decisions; (3) bargaining process in prescribing opioids; (4) balancing patient-centeredness and patient safety for selected populations; (5) opioids are the predominant medications for pain care. DISCUSSION/SIGNIFICANCE OF IMPACT: Clinicians’ decision to prescribe opioids for nonsurgical hospitalized patients is based on multiple factors, including patient’s condition, patient’s preference for pain medications, or standard hospital’s pain care regimen. Interventions that improve clinicians’ ability to prescribe opioids may be needed to improve delivery of patient-centered and safe pain care.

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