Identification of quality care standards and development of indicators in oncology.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 239-239
Author(s):  
Carlos Camps-Herrero
Keyword(s):  
Palliative Care ◽  
Clinical Practice ◽  
Delphi Method ◽  
Scientific Evidence ◽  
Clinical Care ◽  
Quality Care ◽  
National Level ◽  
Diagnosis And Treatment ◽  
Continuous Assessment ◽  
Organisation Of Care

239 Background: Continuous assessment of clinical practice is a fundamental strategy for improving quality care. The generation of indicators in the context of clinical practice standards is the key factor for its success. The purpose of this work is to identify and establish standards in medical care of patients with breast, lung and colon cancer and to develop their indicators. Methods: The project was performed in 4 cycles: (1) Identification of clinical care standards for patients with lung, colon and breast cancer through research for scientific evidence. It was structured in four stages: diagnosis and treatment for every cancer and organisation of palliative care services at the end of life, equal for all three groups. (2) Revision of standards by an expert group of 9 oncologists. (3) Selection of standards for the generation of the indicators using the Delphi method, modified by a panel of experts consisted of 39 oncologists. (4) Development of indicators for the selected standards. Results: During the first revision 98 recommendations and standards were approved and selected by the group of experts and presented to the second panel of experts. Finally through the Delphi method 50 standards were selected, applicable to national level. For each one of the 50 standards an indicator was formed, 10 indicators for the organisational stage, 10 for the palliative care and 10 indicators specific for the diagnosis and treatment of each one of the cancer groups (colon, breast and lung). Conclusions: A total of 50 indicators were generated as measurement of parameters related to the quality of clinical practice and the organisation of care for patients with breast, colon and lung cancer. Their use is fundamental in identifying areas for improvement that will allow the identification of future strategies of quality care.

scholarly journals Does the phthisioophthalmology section of our Ophthalmologic Society contribute in the promotion of quality care for patients with ocular tuberculosis?

2016 ◽  
Vol 9 (1) ◽  
pp. 56-63
Author(s):  
Elena I Ustinova ◽  
Olga P Ilkova
Keyword(s):  
Positive Impact ◽  
Clinical Care ◽  
Quality Care ◽  
Social Activity ◽  
Diagnosis And Treatment ◽  
Treatment Quality ◽  
Medical Society ◽  
Care Process ◽  
System Reform ◽  
Ocular Tuberculosis

The phthisioophthalmology section work over the last 15 years is analyzed. Due to the antituberculous care system reform the number of section members decreased from 27 to 17. Scientific meetings are regular, their frequency decreased up to 5-6/year. Ever and again presentations are made at plenary sessions of the St.Petersburg Scientific Medical Society of Ophthalmology (6 presentations in 15 years) and at the congresses of associations of ophthalmologists and phthisiologists. In 15 years, session members performed and published 102 studies on ocular tuberculosis, including 38 articles in scientific magazines, 5 teaching editions for doctors, 4 monographs. Based on work reports and inspection results of several institutions, it follows that the section makes positive impact on the formation in clinicians of a scientific approach to clinical care process. Some shortcomings are revealed in the application of recommended methods. We believe that for their elimination, besides social activity of the section, it is necessary to publish teaching editions at federal level on ocular tuberculosis diagnosis and treatment, as well as enhancement of diagnosis and treatment quality control by local administration.

National consensus project for quality palliative care

2015 ◽  
pp. 11-19 ◽  
Author(s):  
Constance M. Dahlin
Keyword(s):  
Older Adults ◽  
Palliative Care ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Quality Care ◽  
Life Threatening ◽  
National Consensus

The National Consensus Project for Quality Palliative Care’s Clinical Practice Guidelines for Quality Care is a significant resource that offers the nurse a framework for quality care in all settings. The Clinical Practice Guidelines are appropriate to a range of populations from neonates to children to adults and older adults; a range of chronic progressive and serious life-threatening illnesses, injuries, and trauma; and a range of vulnerable and underresourced populations. The Clinical Practice Guidelines are appropriate for any setting because they facilitate partnerships for caring for patients with debilitating and life-limiting illnesses and offer support for the nurse in delivering the care, particularly for long-term patients.

scholarly journals Real-world ethics in palliative care: A systematic review of the ethical challenges reported by specialist palliative care practitioners in their clinical practice

2020 ◽  
pp. 026921632097427
Author(s):  
Guy Schofield ◽  
Mariana Dittborn ◽  
Richard Huxtable ◽  
Emer Brangan ◽  
Lucy Ellen Selman
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Clinical Practice ◽  
Ethical Issues ◽  
Clinical Care ◽  
Ethical Principles ◽  
Original Research ◽  
Specialist Palliative Care ◽  
Ethical Challenges ◽  
Ethical Practice

Background: Ethical issues arise daily in the delivery of palliative care. Despite much (largely theoretical) literature, evidence from specialist palliative care practitioners about day-to-day ethical challenges has not previously been synthesised. This evidence is crucial to inform education and adequately support staff. Aim: To synthesise the evidence regarding the ethical challenges which specialist palliative care practitioners encounter during clinical practice. Design: Systematic review with narrative synthesis (PROSPERO registration CRD42018105365). Quality was dual-assessed using the Mixed-Methods Appraisal Tool. Tabulation, textural description, concept mapping and thematic synthesis were used to develop and present the narrative. Data sources: Seven databases (MEDLINE, Philosopher’s Index, EMBASE, PsycINFO, LILACS, Web of Science and CINAHL) were searched from inception to December 2019 without language limits. Eligible papers reported original research using inductive methods to describe practitioner-reported ethical challenges. Results: A total of 8074 records were screened. Thirteen studies from nine countries were included. Challenges were organised into six themes: application of ethical principles; delivering clinical care; working with families; engaging with institutional structures and values; navigating societal values and expectations; philosophy of palliative care. Challenges related to specific scenarios/contexts rather than the application of general ethical principles, and occurred at all levels (bedside, institution, society, policy). Conclusion: Palliative care practitioners encounter a broad range of contextual ethical challenges, many of which are not represented in palliative care ethics training resources, for example, navigating institutional policies, resource allocation and inter-professional conflict. Findings have implications for supporting ethical practice and training practitioners. The lack of low- and middle- income country data needs addressing.

Level of scientific evidence underlying palliative care recommendations arising from the National Comprehensive Cancer Network (NCCN) clinical practice guidelines.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19537-e19537
Author(s):  
Felipe Melo Cruz ◽  
Fernando Mauro Lima Prearo ◽  
Daniel Iracema Cubero ◽  
Auro Del Giglio
Keyword(s):  
Palliative Care ◽  
Clinical Practice ◽  
Supportive Care ◽  
Scientific Evidence ◽  
Relative Content ◽  
Level Of Evidence ◽  
Nccn Guidelines ◽  
Care Guidelines ◽  
High Level ◽  
Cancer Network

e19537 Background: The palliative care NCCN recommendations are classified according to the level of scientific evidence in four groups: category I, high level of evidence with uniform consensus; category IIA, lower level of evidence with uniform consensus; category IIB, lower level of evidence without a uniform consensus but with no major disagreement; and category III, any level of evidence but with major disagreement. Palliative care guidelines have not yet been judged as to the relative content of each of the aforementioned types of recommendations. Methods: We analyzed the distribution of categories of evidence cited in the 10 supportive care NCCN guidelines, version 2.2011. Results: Of the 2,537 recommendations found in the 10 guidelines, the proportion of category I, IIA and IIB recommendations were 2.9%, 95.7%, 1.4%, respectively. There wasn’t any category III recommendation (table 1). The fields with a higher rate of category I recommendations were fatigue (14.3%) and chemotherapy induced nausea and vomiting (12.7%). No category I recommendations were found on Senior Adult Oncology, Cancer and Chemotherapy induced Anemia and Adult Cancer Pain. Conclusions: : Palliative care NCCN recommendations are largely based on lower level of evidence, but with uniform expert opinion. This data show the urgent need to expand palliative care research in oncology. [Table: see text]

Nursing education in palliative care

2021 ◽  
pp. 181-190
Author(s):  
Betty R. Ferrell ◽  
Polly Mazanec ◽  
Pam Malloy ◽  
Rose Virani
Keyword(s):  
Palliative Care ◽  
Nursing Education ◽  
Clinical Practice ◽  
Nursing Care ◽  
Spiritual Care ◽  
Quality Care ◽  
Interdisciplinary Care ◽  
Serious Illness ◽  
Essential Component ◽  
Clinical Nurses

This chapter reviews advances in nursing education as well as future needs to prepare clinical nurses for palliative care. Nurses are an essential component of the palliative care workforce across all patient populations and settings. The delivery of quality palliative care requires nursing care which includes competency in physical, psychosocial, and spiritual care. Nurses work with other professionals to deliver interdisciplinary care which is the foundation of palliative care. Advancing nursing education will strengthen the clinical practice of palliative care to meet established guidelines for quality care in serious illness.

scholarly journals Implementation and Knowledge of the Clinical Practice Guide for Palliative Care in the Ecuadorian Primary Care Level

2021 ◽  
Vol 18 (21) ◽  
pp. 11573
Author(s):  
Tamara Rodríguez Quintana ◽  
Viviana Dávalos-Batallas ◽  
Ana-Magdalena Vargas-Martínez ◽  
Lucelly López ◽  
Patricia Bonilla-Sierra ◽  
...  
Keyword(s):  
Palliative Care ◽  
Clinical Practice ◽  
National Level ◽  
National Health System ◽  
Health Centers ◽  
Cross Sectional ◽  
Care Level ◽  
Primary Care Level ◽  
Practice Guide ◽  
First Choice

Ecuador assumed the commitment of including Palliative Care (PC) in its health policies. In 2014, the Ministry of Public Health (Ministerio de Salud Pública, MSP) approved the Clinical Practice Guide for Palliative Care (Guía de Práctica Clínica sobre Cuidados Paliativos, GPCCP), with application at the national level, as a mandatory internal regulation in all institutions belonging to the National Health System. In 2021, there is no evidence about the degree of implementation. The objective was to evaluate the implementation (I) of the GPCCP guide and the knowledge (C) of the health personnel working in the Zone 7 Health Centers (HCs). This is a cross-sectional, descriptive, and prospective study. A total of 292 professionals were interviewed: managers (38), physicians (150), and nurses (104). Three surveys based on the GPCCP guide were elaborated: one for the implementation, which was applied to the individuals in charge, and the others to assess the health professionals’ knowledge. The SPSS program was used, version 25. In the three groups, more than half of the participants had no training in PC, 91.2% of the HCs have the GPCCP guide, there is PC medical history (MH) in 38.2%, and morphine is used in 14.7%. The implementation of the GPCCP guide was inadequate in 52.9% of the cases. Only 25% treat the agony symptoms and 30%, delirium; 4.4% acknowledge the use of morphine in dyspnea, and 13.3% identify the subcutaneous route as the first choice for hydration at the end-of-life phase. Strategies to implement the GPCCP guide and to improve the health personnel’s knowledge must be implemented in Zone 7 centers.

A cognitive model of converting scientific evidence on treatment effects into prognostic information in clinical practice

2015 ◽  
Vol 3 (4) ◽  
pp. 513
Author(s):  
Levente Kriston
Keyword(s):  
Clinical Practice ◽  
Pilot Study ◽  
Cognitive Processes ◽  
Treatment Effects ◽  
Scientific Evidence ◽  
Clinical Care ◽  
Case Vignette ◽  
Small Scale ◽  
Clinical Context ◽  
Prognostic Information

Rationale, aims and objectives: Little is known about the cognitive processes of how population-based scientific evidence is utilized in the treatment of individual patients. The present work aims to outline a formalized framework of converting scientific evidence on treatment effects into prognostic information in clinical practice and describes a pilot study for illustration of how the framework can be used in research.Method:The proposed theoretical framework considers the human mind as a limited capacity information processing system. This system codes external stimuli into internal inputs, which are then processed through several steps towards an evidence-informed clinical output. A small-scale pilot study including 130 laypersons was performed. Participants were asked to make probabilistic prognostic statements based on a fictional study (“evidence”) and a fictional case vignette (“clinical context”).Results: Several cognitive processes were defined, including coding of the attributes of the evidence and the clinical context, integration of the information in a similarity-dissimilarity matrix and calculating the prognostic output. Frequently required operations, such as extrapolation, individualization, particularization, generalization and absolutization of the information were outlined. The presented framework was shown to be useful in analyzing and interpreting the pilot study data.Conclusions:The postulated model holds great potential for investigating cognitive processes included in evidence-informed clinical care.

scholarly journals How I treat recurrent deep-vein thrombosis

Blood ◽  
2016 ◽  
Vol 127 (6) ◽  
pp. 696-702 ◽  
Author(s):  
Paul A. Kyrle
Keyword(s):  
Deep Vein Thrombosis ◽  
Clinical Practice ◽  
Chronic Disease ◽  
Scientific Evidence ◽  
Lower Limbs ◽  
Diagnosis And Treatment ◽  
Vein Thrombosis ◽  
Clinical Scenarios ◽  
Recurrent Deep Vein Thrombosis ◽  
Deep Vein

Abstract Deep-vein thrombosis (DVT) is regarded a chronic disease as it often recurs. DVT affects most frequently the lower limbs and hence DVT of the leg will be the focus of this article. Whereas algorithms were developed and validated for the diagnosis of a first DVT, no such well-defined strategies exist in the case of recurrence of DVT. Likewise, the scientific evidence regarding the treatment of recurrent DVT is sparse, in particular when it comes to deciding on the duration of anticoagulation. Two typical cases of recurrent DVT, one with an unprovoked DVT and one with DVT during anticoagulation, will be presented. Based on these two clinical scenarios, algorithms for the diagnosis and treatment of recurrent DVT will be put forward. The purpose of this article is to discuss strategies that can be applied in daily clinical practice by physicians who do not have access to means and measures available in specialized thrombosis centers.

mHealth: Mobile Technologies to Virtually Bring the Patient Into an Oncology Practice

2017 ◽  
pp. 144-154 ◽  
Author(s):  
Nathan A. Pennell ◽  
Adam P. Dicker ◽  
Christine Tran ◽  
Heather S. L. Jim ◽  
David L. Schwartz ◽  
...  
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Health Care Providers ◽  
Care Delivery ◽  
Clinical Care ◽  
Quality Care ◽  
Cost Effective ◽  
Mobile Technologies ◽  
Care Providers ◽  
Oncology Practice

Accompanied by the change in the traditional medical landscape, advances in wireless technology have led to the development of telehealth or mobile health (mHealth), which offers an unparalleled opportunity for health care providers to continually deliver high-quality care. This revolutionary shift makes the patient the consumer of health care and empowers patients to be the driving force of management of their own health through mobile devices and wearable technology. This article presents an overview of technology as it pertains to clinical practice considerations. Telemedicine is changing the way clinical care is delivered without regard for proximity to the patient, whereas nonclinical telehealth applications affect distance education for consumers or clinicians, meetings, research, continuing medical education, and health care management. Technology has the potential to reduce administrative burdens and improve both efficiency and quality of care delivery in the clinic. Finally, the potential for telehealth approaches as cost-effective ways to improve adherence to treatment is explored. As telehealth advances, health care providers must understand the fundamental framework for applying telehealth strategies to incorporate into successful clinical practice.

scholarly journals Adherence to Clinical Practice Guidelines

2017 ◽  
Vol 157 (4) ◽  
pp. 548-550 ◽  
Author(s):  
Marisa A. Ryan
Keyword(s):  
Clinical Practice ◽  
American Academy ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Scientific Evidence ◽  
Quality Care ◽  
Neck Surgery ◽  
Relevant Research ◽  
High Quality ◽  
The Impact

Clinical practice guidelines are designed to synthesize and disseminate the best available evidence to guide clinical practice. The goal is to increase high-quality care and reduce inappropriate interventions. Clinical practice guidelines that systematically review evidence and synthesize it into recommendations are important because the available scientific evidence is normally neither rapidly nor broadly incorporated into practice. It is important to understand and improve the impact of our American Academy of Otolaryngology—Head and Neck Surgery Foundation clinical practice guidelines on this uptake of scientific knowledge. Considering the barriers to guideline adherence is a central part of this. This understanding can guide clinicians, future guideline authors, and researchers when using guidelines, writing them, and planning clinically relevant research.

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