Clinical impact of a sub-epidermal moisture scanner: what is the real-world use?

2021 ◽  
Vol 30 (3) ◽  
pp. 198-208
Author(s):  
Louisa Musa ◽  
Nicky Ore ◽  
Gillian Raine ◽  
Glenn Smith
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Real World ◽  
Early Identification ◽  
Care Setting ◽  
Clinical Decision Making ◽  
Community Care ◽  
Clinical Decision ◽  
Increased Risk ◽  
Palliative Care Setting

Objective: The presence of sub-epidermal moisture (SEM) over a bony prominence is indicative of incipient pressure ulcer (pressure injury/decubitus/bedsore) (PU). Early identification of patients at increased risk of PU can prompt interventions that reduce the incidence and severity of hospital (or community)-acquired PUs (HAPUs). This study evaluated the clinical utility of a SEM Scanner device in HAPU management. Method: The study used a pragmatic ‘real-world’ approach. HAPU data before and during SEM Scanner use were obtained through routine audit. Patients had regular visual and daily SEM Scanner skin assessments over the sacrum and heels. Nursing care otherwise followed standard of care according to the established protocols of individual participating sites. HAPU incidence rates were determined and feedback gathered from health professionals on how the device influenced HAPU-related clinical decision-making. Results: There were 15 participating sites: 13 acute care, one palliative care and one community care setting. The sample size was 1478 patients. All sites reported a substantial reduction in mean HAPU incidence: 87.2% in acute care settings; 46.7% in the palliative care setting and 26.7% in the community care setting. A 100% incidence reduction was reported in 10 (66.7%) sites. In the palliative care setting, SEM Scanner results changed HAPU-related clinical decision-making for 40% of patients scanned. The community care site demonstrated a 82% change in clinical decision-making. Conclusion: In this study, SEM analysis fitted seamlessly into routine skin assessment and enabled early identification of increased risk of tissue damage, with clinically important reductions in the incidence of HAPU across all participating sites.

scholarly journals Collusion in palliative care: an exploratory study with the Collusion Classification Grid

2019 ◽  
Vol 17 (6) ◽  
pp. 637-642
Author(s):  
Friedrich Stiefel ◽  
Kenji Nakamura ◽  
Kunihiko Ishitani ◽  
Céline Bourquin ◽  
Michael Saraga
Keyword(s):  
Palliative Care ◽  
Care Setting ◽  
Clinical Decision Making ◽  
Negative Impact ◽  
Case Series ◽  
Clinical Decision ◽  
Conceptual Clarity ◽  
Palliative Care Setting ◽  
Different Types ◽  
The Impact

AbstractObjectiveCollusion is a largely unconscious, dynamic bond, which may occur between patients and clinicians, between patients and family members, or between different health professionals. It is widely prevalent in the palliative care setting and provokes intense emotions, unreflective behavior, and negative impact on care. However, research on collusion is limited due to a lack of conceptual clarity and robust instruments to investigate this complex phenomenon. We have therefore developed the Collusion Classification Grid (CCG), which we aimed to evaluate with regard to its potential utility to analyze instances of collusion, be it for the purpose of supervision in the clinical setting or research.MethodSituations of difficult interactions with patients with advanced disease (N = 10), presented by clinicians in supervision with a liaison psychiatrist were retrospectively analyzed by means of the CCG.Result1) All items constituting the grid were mobilized at least once; 2) one new item had to be added; and 3) the CCG identified different types of collusion.Significance of resultsThis case series of collusions assessed with the CCG is a first step before the investigation of larger samples with the CCG. Such studies could search and identify setting-dependent and recurrent types of collusions, and patterns emerging between the items of the CCG. A better grasp of collusion could ultimately lead to a better understanding of the impact of collusion on the patient encounter and clinical decision-making.

scholarly journals Awareness, Knowledge, and Utility of RCT Data vs RWE: Results From a Survey of US Cardiologists: Real-world Evidence in Clinical Decision Making

2020 ◽  
Vol 14 ◽  
pp. 117954682095341 ◽  
Author(s):  
Todd C Villines ◽  
Mark J Cziraky ◽  
Alpesh N Amin
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Real World ◽  
Randomized Clinical Trials ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
The Body ◽  
Representative Sampling ◽  
Real World Evidence ◽  
Wide Range

Real-world evidence (RWE) provides a potential rich source of additional information to the body of data available from randomized clinical trials (RCTs), but there is a need to understand the strengths and limitations of RWE before it can be applied to clinical practice. To gain insight into current thinking in clinical decision making and utility of different data sources, a representative sampling of US cardiologists selected from the current, active Fellows of the American College of Cardiology (ACC) were surveyed to evaluate their perceptions of findings from RCTs and RWE studies and their application in clinical practice. The survey was conducted online via the ACC web portal between 12 July and 11 August 2017. Of the 548 active ACC Fellows invited as panel members, 173 completed the survey (32% response), most of whom were board certified in general cardiology (n = 119, 69%) or interventional cardiology (n = 40, 23%). The survey results indicated a wide range of familiarity with and utilization of RWE amongst cardiologists. Most cardiologists were familiar with RWE and considered RWE in clinical practice at least some of the time. However, a significant minority of survey respondents had rarely or never applied RWE learnings in their clinical practice, and many did not feel confident in the results of RWE other than registry data. These survey findings suggest that additional education on how to assess and interpret RWE could help physicians to integrate data and learnings from RCTs and RWE to best guide clinical decision making.

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.

Creation of a palliative care advanced practice registered nurse peer-review process

2019 ◽  
Vol 25 (12) ◽  
pp. 596-602
Author(s):  
Patrice R. Fedel ◽  
Nicole E. Hembel ◽  
Lindsey M. Mueller
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Peer Review ◽  
Professional Growth ◽  
Review Process ◽  
Clinical Decision Making ◽  
Peer Review Process ◽  
Clinical Decision ◽  
Advanced Practice ◽  
Case Review

The mark of a true profession is the ability to self-regulate. As such, advanced practice registered nurses (APRNs) are challenged by their professional organisations to participate in self-evaluation and peer review. Peer review is a method for evaluating the care provided by the APRN to both ensure quality nursing care and promote professional growth. Despite guidelines to participate in a formal peer-review process, there is little information within the nursing profession on how to accomplish peer review. A comprehensive literature review failed to provide a framework for peer review that is practice focused, fosters a learning environment and encompasses the thought process and clinical decision-making of the palliative care advanced practice nurse. A group of palliative care APRNs set out to create a process that encompassed the breadth of clinical decision-making in palliative care advanced nursing practice. Using the eight domains of palliative care, a narrative case review structure was created. The resulting process both assisted the APRNs in professional growth and provided timely feedback for the annual performance evaluation.

scholarly journals Competências do enfermeiro para o cuidado paliativo em cardiologia

2018 ◽  
Vol 12 (9) ◽  
pp. 2341 ◽  
Author(s):  
Bruna Christine Floriano Brabo ◽  
Manoela Gomes Grossi Laprano
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Intensive Care ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Structured Interview ◽  
Social Needs ◽  
Joint Decision ◽  
Multiprofessional Team ◽  
Terapia Intensiva

RESUMOObjetivo: analisar as competências profissionais do enfermeiro para o cuidado paliativo em Unidade de Terapia Intensiva Cardiológica. Método: estudo qualitativo, descritivo e exploratório fundamentado no referencial teórico das Competências Centrais em Cuidados Paliativos e realizado na UTI de um hospital cardiológico. Realizou-se a entrevista semiestruturada com oito enfermeiros. Para a interpretação dos dados, utilizaram-se a análise de conteúdo e a categorização. Resultados: prevaleceram enfermeiras de 31 a 41 anos, com mais de dez anos de experiência na profissão e com, ao menos, um curso de pós-graduação. As competências mais citadas estão relacionadas aos constituintes centrais dos cuidados paliativos, à família, ao autoconhecimento, ao desenvolvimento profissional e ao conforto físico. As categorias menos citadas retratam as necessidades psicológicas, espirituais, o trabalho em equipe, a comunicação e a tomada de decisão ética e clínica. Não houve relatos das necessidades sociais. As competências não aplicadas referem-se à atuação na equipe multiprofissional, à tomada de decisão conjunta e à educação dos profissionais e da família. Conclusão: prevaleceram citações de competências relacionadas à assistência. Após recente implantação do serviço, observa-se a necessidade do fortalecimento da equipe multiprofissional e da educação dos profissionais de Enfermagem. Descritores: Cuidados Paliativos; Competência Profissional; Cuidados Críticos; Enfermagem; Unidade de Terapia Intensiva; Cardiologia.ABSTRACT Objective: to analyze the professional competencies of the nurse for palliative care in the Cardiology Intensive Care Unit. Method: a qualitative, descriptive, exploratory study based on the theoretical reference of the Central Skills in Palliative Care and carried out at the ICU of a cardiological hospital. A semi-structured interview was conducted with eight nurses. For the interpretation of the data, the content analysis and the categorization were used. Results: nurses from 31 to 41 years old, with more than ten years of experience in the profession and with at least one postgraduate course prevailed. The most cited competences are related to the central constituents of palliative care, family, self-knowledge, professional development and physical comfort. The less-quoted categories portray psychological, spiritual, teamwork, communication, and ethical and clinical decision-making. There were no reports of social needs. The competences that were not applied, refer to the performance in the multiprofessional team, the joint decision making and the education of the professionals and the family. Conclusion: citations of competence related to care prevailed. After the recent implementation of the service, the need to strengthen the multiprofessional team and the education of nursing professionals is observed. Descritores: Palliative Care; Profissional Competence; Critical Care; Nursing; Intensive Care Units; Cardiology.RESUMEN Objetivo: analizar las competencias profesionales del enfermero para el cuidado paliativo en Unidad de Terapia Intensiva Cardiológica. Método: estudio cualitativo, descriptivo, exploratorio fundamentado en el referencial teórico de las Competencias Centrales en Cuidados Paliativos y realizado en la UTI de un hospital cardiológico. Se realizó la entrevista semiestructurada con ocho enfermeros. Para la interpretación de los datos, se utilizaron el análisis de contenido y la categorización. Resultados: prevalecieron enfermeras de 31 a 41 años, con más de diez años de experiencia en la profesión y con, al menos, un curso de postgrado. Las competencias más citadas están relacionadas a los constituyentes centrales de los cuidados paliativos, a la familia, al autoconocimiento, al desarrollo profesional y al confort físico. Las categorías menos citadas retratan las necesidades psicológicas, espirituales, el trabajo en equipo, la comunicación y la toma de decisión ética y clínica. No hubo informes de las necesidades sociales. Las competencias no aplicadas se refieren a la actuación en el equipo multiprofesional, a la toma de decisión conjunta y a la educación de los profesionales y de la familia. Conclusión: prevalecieron citaciones de competencias relacionadas a la asistencia. Después de la reciente implantación del servicio, se observa la necesidad del fortalecimiento del equipo multiprofesional y de la educación de los profesionales de Enfermería. Descritores: Cuidados Paliativos; Competencia Profissional; Cuidados críticos; Enfermería; Unidades de cuidados intensivos; Cardiología.   

Assessment and Clinical Decision-Making During Imminent Death in Hospice Music Therapy

2021 ◽  
Author(s):  
Erin Fox ◽  
Alexa Economos ◽  
Noah Potvin
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Music Therapy ◽  
Clinical Decision Making ◽  
Ways Of Knowing ◽  
Clinical Decision ◽  
Constructivist Grounded Theory ◽  
Situational Analysis ◽  
Music Therapists ◽  
Hospice And Palliative Care

Abstract Assessment is a critical aspect of treatment planning, and while there exist standards for facilitating music therapy assessments in a variety of clinical settings, no such standards exist for music therapists in hospice and palliative care. This gap in knowledge, which limits music therapists’ ability to provide patients and caregivers best practices promoting supported movement through the dying process, becomes particularly problematic when assessing patients who are imminently dying with a 24–72 hour prognosis. To further develop and define assessment and clinical decision-making processes used by music therapists in hospice and palliative care, the authors used a constructivist grounded theory and situational analysis methodology to analyze interviews of 15 hospice music therapists. The resulting theoretical model describes an ongoing process of assessment and clinical decision-making shaped by participants’ individual epistemologies. Epistemologies were comprised of 5 ways of knowing, which were termed experiential, personal, musical, ethical, and integral, and provided participants critical foundations for their practice. The results support a development of a model for reflective practice as well as continued research on epistemological foundations of clinical practice.

AI-based clinical decision-making systems in palliative medicine: ethical challenges

2021 ◽  
pp. bmjspcare-2021-002948
Author(s):  
Ludovica De Panfilis ◽  
Carlo Peruselli ◽  
Silvia Tanzi ◽  
Carlo Botrugno
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Palliative Care ◽  
Clinical Decision Making ◽  
Ethical Decision Making ◽  
Clinical Decision ◽  
Point Of View ◽  
Ethical Challenges ◽  
Palliative Care Consultation

BackgroundImproving palliative care (PC) is demanding due to the increase in people with PC needs over the next few years. An early identification of PC needs is fundamental in the care approach: it provides effective patient-centred care and could improve outcomes such as patient quality of life, reduction of the overall length of hospitalisation, survival rate prolongation, the satisfaction of both the patients and caregivers and cost-effectiveness.MethodsWe reviewed literature with the objective of identifying and discussing the most important ethical challenges related to the implementation of AI-based data processing services in PC and advance care planning.ResultsAI-based mortality predictions can signal the need for patients to obtain access to personalised communication or palliative care consultation, but they should not be used as a unique parameter to activate early PC and initiate an ACP. A number of factors must be included in the ethical decision-making process related to initiation of ACP conversations, among which are autonomy and quality of life, the risk of worsening healthcare status, the commitment by caregivers, the patients’ psychosocial and spiritual distress and their wishes to initiate EOL discussionsConclusionsDespite the integration of artificial intelligence (AI)-based services into routine healthcare practice could have a positive effect of promoting early activation of ACP by means of a timely identification of PC needs, from an ethical point of view, the provision of these automated techniques raises a number of critical issues that deserve further exploration.

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