Trauma Surgeon and Palliative Care Physician Attitudes Regarding Goals-of-Care Delineation for Injured Geriatric Patients

2019 ◽  
Vol 36 (8) ◽  
pp. 669-674 ◽  
Author(s):  
Holly B. Cunningham ◽  
Shannon A. Scielzo ◽  
Paul A. Nakonezny ◽  
Brandon R. Bruns ◽  
Karen J. Brasel ◽  
...  
Keyword(s):  
Palliative Care ◽  
Geriatric Patients ◽  
Care Physician ◽  
Physician Attitudes ◽  
The Other ◽  
Goals Of Care ◽  
Care Community ◽  
Trauma Surgeons ◽  
Better Than ◽  
Do So

Background: The value of defining goals of care (GoC) for geriatric patients is well known to the palliative care community but is a newer concept for many trauma surgeons. Palliative care specialists and trauma surgeons were surveyed to elicit the specialties’ attitudes regarding (1) importance of GoC conversations for injured seniors; (2) confidence in their own specialty’s ability to conduct these conversations; and (3) confidence in the ability of the other specialty to do so. Methods: A 13-item survey was developed by the steering committee of a multicenter, palliative care-focused consortium and beta-tested by trauma surgeons and palliative care specialists unaffiliated with the consortium. The finalized instrument was electronically circulated to active physician members of the American Association for the Surgery of Trauma and American Academy for Hospice and Palliative Medicine. Results: Respondents included 118 trauma surgeons (8.8%) and 244 palliative care specialists (5.7%). Palliative physicians rated being more familiar with GoC, were more likely to report high-quality training in performing conversations, believed more palliative specialists were needed in intensive care units, and had more interest in conducting conversations relative to trauma surgeons. Both groups believed themselves to perform GoC discussions better than the other specialty perceived them to do so and favored their own specialty leading team discussions. Conclusions: Both groups believe themselves to conduct GoC discussions for injured seniors better than the other specialty perceived them to do so, which led to disparate views on the optimal leadership of these discussions.

scholarly journals Burn Surgeon and Palliative Care Physician Attitudes Regarding Goals of Care Delineation for Burned Geriatric Patients

2018 ◽  
Vol 39 (6) ◽  
pp. 1000-1005 ◽  
Author(s):  
Holly B Cunningham ◽  
Shannon A Scielzo ◽  
Paul A Nakonezny ◽  
Brandon R Bruns ◽  
Karen J Brasel ◽  
...  
Keyword(s):  
Palliative Care ◽  
Geriatric Patients ◽  
Care Physician ◽  
Physician Attitudes ◽  
Goals Of Care ◽  
Palliative Care Physician

Epistemic infinitism

2018 ◽  
Author(s):  
Scott Aikin
Keyword(s):  
Infinite Series ◽  
Good Reason ◽  
The Other ◽  
Regress Problem ◽  
Two Factors ◽  
Particular Solution ◽  
Basic Beliefs ◽  
Better Than ◽  
Epistemic Regress Problem ◽  
Do So

If you believe something rationally, you believe it for a reason. And that reason can’t just be any old reason. You’ve got to rationally hold it as a good reason. In order to do so, you must have another reason. And that reason needs another. And so a regress of reasons ensues. This is a rough-and-ready picture of the epistemic regress problem. Epistemic infinitism is the view that justifying reasons are infinite, and so it is a particular solution to the regress problem. Consider, also, that justification comes in degrees – some beliefs are better justified than others. Moreover, it seems that people can know things better than others. Call this the gradability phenomenon. Epistemic infinitism is the view that for someone to be justified maximally is for that person to have an infinite series of supporting reasons. Epistemic infinitisms admit of a wide variety. Differences between versions of infinitism arise according to two factors for the view: one dialectical, the other ecumenical. The dialectical factor for epistemic infinitisms is the matter of what philosophical problems or questions they answer. Infinitisms are designed to either provide models for how to solve the epistemic regress problem or address the phenomenon of the gradability of justification and knowledge. Infinitisms will differ depending on which issue they are designed to address, and an infinitism designed to address one issue may not be the same as one designed to address another. The ecumenical factor for epistemic infinitisms is the matter of how consistent the view is with other competing theories about how to address the regress problem and the gradability phenomenon. With the regress problem, infinitism’s main competitor theories are foundationalism, the view that there are basic beliefs for which there is no need for further reason, and coherentism, the view that justifying reasons come in large mutually supporting packages. For the most part, infinitism is taken to be a form of noncoherentist antifoundationalism about justification, because the infinitist holds that reasons must be infinitely long chains of nonrepeating reasons. However, there are versions of infinitism consistent with both foundationalism and coherentism. Infinitism faces a variety of challenges, and two of particular importance are whether infinitism is actually a form of scepticism and whether infinitism is a complete theory of justification.

scholarly journals P020: Paramedic comfort with providing palliative support: pre-implementation survey

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S84-S85
Author(s):  
A. Carter ◽  
M. Arab ◽  
M. Harrison ◽  
J. Goldstein ◽  
J. Jensen ◽  
...  
Keyword(s):  
Palliative Care ◽  
Crisis Management ◽  
Online Survey ◽  
Training Session ◽  
Likert Scale ◽  
Point Scale ◽  
Goals Of Care ◽  
And Training ◽  
Healthcare Need ◽  
Do So

Introduction: Paramedics are sometimes called for crisis management and relief of symptoms or for patients receiving palliative care. To address the mismatch between the system protocols and resources, and patient’s goals of care, a new protocol, new medications, and an 8-hour training program Learning Essentials Approach to Palliative Care (LEAP) were implemented in our provincial EMS system. Methods: Prior to attending their training session paramedics received an invitation to complete an online survey regarding their comfort, confidence, and attitudes toward delivering palliative care. Comfort and confidence questions were scored on a 4-point Likert scale, while attitudes toward specific aspects of care were scored on a 7-point Likert scale. Descriptive statistics were calculated. Identifiers will permit linkage of these responses to a repeat survey post-implementation. Results: 188 (58%) paramedics completed the survey of the 325 who opened the link. 134 (68%) were male with a mean age of 38.5 years. 95 (50%) were primary care paramedics. The average experience as a paramedic was 12.7 years, with an estimated mean number of palliative calls per year of 9.6 each. On a 4 point scale, most (156, 83%) were comfortable with providing care to someone with palliative goals, and 130 (69.1%) were comfortable providing care without transport. Only 82 (43.6%) were confident they had the tools to deliver this care, and 76 (40.4%) were confident they could do so without transport to hospital. On a 7 point scale, paramedics disagreed with the statement “caring for dying persons is not a worthwhile experience for me”, median 7 (IQR 5-7). Paramedics also disagreed with the statement “Dying persons make me feel uneasy”, median 5 (IQR 4-6). Conclusion: Prior to the implementation of the new protocol, medications, and training, most paramedics were comfortable with the concept of providing care with palliative goals and felt that caring for dying persons is a worthwhile experience, but they were not confident that they have the tools and resources to do so. This suggests paramedics would be open to system improvements to meet an unmet healthcare need for crisis management of patients with palliative goals of care.

Integrating Palliative Care to Promote Earlier Conversations and to Increase the Skill and Comfort of Nonpalliative Care Clinicians: Lessons Learned From an Interventional Field Trial

2017 ◽  
Vol 35 (1) ◽  
pp. 132-137 ◽  
Author(s):  
Marilyn K. Szekendi ◽  
Jocelyn Vaughn ◽  
Beth McLaughlin ◽  
Carol Mulvenon ◽  
Karin Porter-Williamson ◽  
...  
Keyword(s):  
Palliative Care ◽  
Field Trial ◽  
Care Service ◽  
Supply And Demand ◽  
The United States ◽  
Care Physician ◽  
Lessons Learned ◽  
Service Line ◽  
Goals Of Care ◽  
Seriously Ill

While the uptake of palliative care in the United States is steadily improving, there continues to be a gap in which many patients are not offered care that explicitly elicits and respects their personal wishes. This is due in part to a mismatch of supply and demand; the number of seriously ill individuals far exceeds the workload capacities of palliative care specialty providers. We conducted a field trial of an intervention designed to promote the identification of seriously ill patients appropriate for a discussion of their goals of care and to advance the role of nonpalliative care clinicians by enhancing their knowledge of and comfort with primary palliative care skills. At 3 large Midwestern academic medical centers, a palliative care physician or nurse clinician embedded with a selected nonpalliative care service line or unit on a regularly scheduled basis for up to 6 months. Using agreed-upon criteria, patients were identified as being appropriate for a goals of care conversation; conversations with those patients and/or their families were then conducted with the palliative care specialist providing education, coaching, and mentoring to the nonpalliative care clinician, when possible. All of the sites increased the presence of palliative care within the selected service line or unit, and the nonpalliative care clinicians reported increased comfort and skill at conducting goals of care conversations. This intervention is a first step toward increasing patients’ access to palliative care to alleviate distress and to more consistently deliver care that honors patient and family preferences.

Transitions between care settings until death

2017 ◽  
pp. 287-294
Author(s):  
Elizabeth C. Gundersen ◽  
Benjamin A. Bensadon ◽  
Joseph G. Ouslander
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Geriatric Patients ◽  
Care Transitions ◽  
Healthcare Systems ◽  
Goals Of Care ◽  
Vulnerable Patients ◽  
Treatment Plans ◽  
Multifaceted Interventions ◽  
Poor Care

The problem of poor care transitions in geriatric patients is complex and challenging, and one which has become a priority across healthcare systems. Various interventions have shown success in improving transitions in care, but there is no one solution and more progress must yet be made, especially in the care of our most vulnerable patients, including those with dementia or at the end of life. Perhaps the most commonly recurring themes, however, are the need for multifaceted interventions and increased patient- and family-centred care. It is essential to discuss goals of care with patients and families, and then form treatment plans—including discharge plans—which respect those goals. Geriatric and palliative care clinicians are uniquely suited to contribute their skills in this area to improve care transitions.

Not Just Little Adults: Palliative Care Physician Attitudes Toward Pediatric Patients

2013 ◽  
Vol 16 (6) ◽  
pp. 675-679 ◽  
Author(s):  
Adam Rapoport ◽  
Christopher Obwanga ◽  
Giovanna Sirianni ◽  
S. Lawrence Librach ◽  
Amna Husain
Keyword(s):  
Palliative Care ◽  
Pediatric Patients ◽  
Care Physician ◽  
Physician Attitudes ◽  
Palliative Care Physician

scholarly journals A new principle of plural harm

2021 ◽  
Author(s):  
Magnus Jedenheim Edling
Keyword(s):  
The Other ◽  
Better Than ◽  
Do So ◽  
New View

AbstractAccording to the counterfactual comparative account (CCA), an event harms a person if and only if it makes things worse for her. Cases of overdetermination and preemption pose a serious challenge to CCA since, in these cases, although it is evident that people are harmed, there are no individual events that harm them. However, while there are no individual events that make people worse off in cases of overdetermination and preemption, there are pluralities of events that do so. In light of this feature of these cases, several philosophers have suggested that it is these pluralities that do the harming. In this article, I will argue that although the most prominent accounts of plural harm – e.g., Neil Feit’s account – fare better than one might initially think, they fail to deal adequately with a number of intriguing cases of preemption first introduced by Alastair Norcross. I will also introduce a new view on plural harm and argue that this view, apart from dealing with the cases of overdetermination and preemption that the other accounts of plural harm handle, also deals adequately with Norcross’s cases.

Exploring the Bilingual Phonological Space: Early Bilinguals’ Discrimination of Coronal Stop Contrasts

2017 ◽  
Vol 61 (2) ◽  
pp. 173-198 ◽  
Author(s):  
Yevgeniy Vasilyevich Melguy
Keyword(s):  
Speech Perception ◽  
The Other ◽  
Control Group ◽  
Sound System ◽  
Bilingual Group ◽  
Phonetic Contrasts ◽  
Contrast Discrimination ◽  
Cross Language ◽  
Better Than ◽  
Do So

It is well known that the way monolingual listeners discriminate speech sounds is strongly influenced by their native (L1) sound system. Moreover, such perceptual constraints are not limited to monolinguals: multiple studies have found evidence of language-specificity in bilingual speech perception. However, the question of whether bilinguals have simultaneous access to both of their phonologies during non-native contrast discrimination has not been systematically examined. Namely, very few studies of bilinguals have specifically examined cases where a non-native contrast pair straddles the boundary between two sound systems, with one sound corresponding to a sound in the L1, and the other to a sound in the second language (L2), but with neither the L1 nor the L2 containing both. The current study aimed to do so by comparing the ability of early bilinguals to discriminate non-native phonetic contrasts consisting of sounds that exist in either their L1 or L2, but not in both. A forced-choice perception task compared two listener groups—Spanish–English bilinguals and English monolinguals—on their perception of Nepali dental–alveolar stop contrasts. Results showed that despite displaying some sensitivity to phonetic differences within each contrast pair, the bilingual group was unable to discriminate such “cross-language contrasts” significantly better than the monolingual English control group.

Closing the GAP—A 5Å Scanning Microscope

1969 ◽  
Vol 27 ◽  
pp. 6-7
Author(s):  
A. V. Crewe
Keyword(s):  
Normal Form ◽  
The Other ◽  
Resolving Power ◽  
Scanning Microscope ◽  
Conventional Microscope ◽  
Other Hand ◽  
Closing The Gap ◽  
Thermal Sources ◽  
Better Than ◽  
Transmission Microscope

We have become accustomed to differentiating between the scanning microscope and the conventional transmission microscope according to the resolving power which the two instruments offer. The conventional microscope is capable of a point resolution of a few angstroms and line resolutions of periodic objects of about 1Å. On the other hand, the scanning microscope, in its normal form, is not ordinarily capable of a point resolution better than 100Å. Upon examining reasons for the 100Å limitation, it becomes clear that this is based more on tradition than reason, and in particular, it is a condition imposed upon the microscope by adherence to thermal sources of electrons.

Much Ado About Fried Chicken: Abetting Aspiration or Respecting Autonomy?

2019 ◽  
Vol 28 (3) ◽  
pp. 1356-1362
Author(s):  
Laurence Tan Lean Chin ◽  
Yu Jun Lim ◽  
Wan Ling Choo
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Multidisciplinary Team ◽  
Biopsychosocial Model ◽  
Family Members ◽  
Clinical Decisions ◽  
Goals Of Care ◽  
Complex Needs ◽  
Aspiration Risk ◽  
Patient Centric

Purpose Palliative care is a philosophy of care that encompasses holistic, patient-centric care involving patients and their family members and loved ones. Palliative care patients often have complex needs. A common challenge in managing patients near their end of life is the complexity of navigating clinical decisions and finding achievable and realistic goals of care that are in line with the values and wishes of patients. This often results in differing opinions and conflicts within the multidisciplinary team. Conclusion This article describes a tool derived from the biopsychosocial model and the 4-quadrant ethical model. The authors describe the use of this tool in managing a patient who wishes to have fried chicken despite aspiration risk and how this tool was used to encourage discussions and reduce conflict and distress within the multidisciplinary team.

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