Case Management: Who Needs it? Does it Work?

2002 ◽  
Vol 3 (4) ◽  
pp. 178-184 ◽  
Author(s):  
Carol D. Austin
Keyword(s):  
Quality Of Life ◽  
Case Management ◽  
Management Practice ◽  
Years Of Experience ◽  
Management Effectiveness ◽  
Policy System ◽  
The Right

Even after 30 years of experience, two questions persist about case management practice. Who needs it and does it work? Answers to these questions are neither direct nor simple. This article examines the significance of various contexts (policy, system, community, and organization) to efforts attempting to provide responses to these basic questions. Beyond the question of who needs case management, two additional questions are addressed. Who needs it and who gets it? Clients’ qualitative perspectives on case management effectiveness, beyond attempts to measure satisfaction and quality of life, are usually absent. The article concludes with a discussion of whether these are the right questions.

scholarly journals Emergency Medicine Palliative Care Access (EMPallA): protocol for a multicentre randomised controlled trial comparing the effectiveness of specialty outpatient versus nurse-led telephonic palliative care of older adults with advanced illness

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e025692 ◽  
Author(s):  
Corita R Grudzen ◽  
Deborah J Shim ◽  
Abigail M Schmucker ◽  
Jeanne Cho ◽  
Keith S Goldfeld
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Palliative Care ◽  
Randomised Controlled Trial ◽  
Case Management ◽  
Controlled Trial ◽  
Chronic Obstructive ◽  
Randomised Controlled ◽  
End Stage

IntroductionEmergency department (ED)-initiated palliative care has been shown to improve patient-centred outcomes in older adults with serious, life-limiting illnesses. However, the optimal modality for providing such interventions is unknown. This study aims to compare nurse-led telephonic case management to specialty outpatient palliative care for older adults with serious, life-limiting illness on: (1) quality of life in patients; (2) healthcare utilisation; (3) loneliness and symptom burden and (4) caregiver strain, caregiver quality of life and bereavement.Methods and analysisThis is a protocol for a pragmatic, multicentre, parallel, two-arm randomised controlled trial in ED patients comparing two established models of palliative care: nurse-led telephonic case management and specialty, outpatient palliative care. We will enrol 1350 patients aged 50+ years and 675 of their caregivers across nine EDs. Eligible patients: (1) have advanced cancer (metastatic solid tumour) or end-stage organ failure (New York Heart Association class III or IV heart failure, end-stage renal disease with glomerular filtration rate <15 mL/min/m2, or global initiative for chronic obstructive lung disease stage III, IV or oxygen-dependent chronic obstructive pulmonary disease); (2) speak English; (3) are scheduled for ED discharge or observation status; (4) reside locally; (5) have a working telephone and (6) are insured. Patients will be excluded if they: (1) have dementia; (2) have received hospice care or two or more palliative care visits in the last 6 months or (3) reside in a long-term care facility. We will use patient-level block randomisation, stratified by ED site and disease. Effectiveness will be compared by measuring the impact of each intervention on the specified outcomes. The primary outcome will measure change in patient quality of life.Ethics and disseminationInstitutional Review Board approval was obtained at all study sites. Trial results will be submitted for publication in a peer-reviewed journal.Trial registration numberNCT03325985; Pre-results.

Advantages of a mini right axillary thoracotomy for congenital heart defect repair in children

2021 ◽  
pp. 1-6
Author(s):  
Jannika Dodge-Khatami ◽  
Ali Dodge-Khatami
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Global Health ◽  
Congenital Heart ◽  
Surgical Repair ◽  
Median Sternotomy ◽  
Axillary Approach ◽  
Post Operative Pain ◽  
The Right

Abstract Objectives: The mini right axillary thoracotomy is an alternative surgical approach to repair certain congenital heart defects. Quality-of-life metrics and clinical outcomes in children undergoing either the right axillary approach or median sternotomy were compared. Methods: Patients undergoing either approach for the same defects between 2018 and 2020 were included. Demographic details, operative data, and outcomes were compared between both groups. An abbreviated quality of life questionnaire based on the Infant/Toddler/Child Health Questionnaires focused on the patient’s global health, physical activity, and pain/discomfort was administered to all parents/guardians within two post-operative years. Results: Eighty-seven infants and children underwent surgical repair (right axillary thoracotomy, n = 54; sternotomy, n = 33) during the study period. There were no mortalities in either group. The right axillary thoracotomy group experienced significantly decreased red blood cell transfusion, intubation, intensive care, and hospital durations, and earlier chest tube removal. Up to 1 month, parents’ perception of their child’s degree and frequency of post-operative pain was significantly less after the right axillary thoracotomy approach. No difference was found in the patient’s global health or physical activity limitations beyond a month between the two groups. Conclusions: With the mini right axillary approach, surrogates of faster clinical recovery and hospital discharge were noted, with a significantly less perceived degree and frequency of post-operative pain initially, but without the quality of life differences at last follow-up. While providing obvious cosmetic advantages, the minimally invasive right axillary thoracotomy approach for the surgical repair of certain congenital heart lesions is a safe alternative to median sternotomy.

Nordic retirement contracts and the economic situation of widows

2006 ◽  
Vol 21 (3) ◽  
pp. 383-418 ◽  
Author(s):  
BEATRICE MORING
Keyword(s):  
Quality Of Life ◽  
Eighteenth Century ◽  
Economic Status ◽  
Economic Situation ◽  
Standard Of Living ◽  
The Family ◽  
Early Eighteenth Century ◽  
The Right

The aim of this article is to explore the economic status and the quality of life of widows in the Nordic past, based on the evidence contained in retirement contracts. Analysis of these contracts also shows the ways in which, and when, land and the authority invested in the headship of the household were transferred between generations in the Nordic countryside. After the early eighteenth century, retirement contracts became more detailed but these should be viewed not as a sign of tension between the retirees and their successors but as a family insurance strategy designed to protect the interests of younger siblings of the heir and his or her old parents, particularly if there was a danger of the property being acquired by a non-relative. Both the retirement contracts made by couples and those made by a widow alone generally guaranteed them an adequate standard of living in retirement. Widows were assured of an adequately heated room of their own, more generous provision of food than was available to many families, clothing and the right to continue to work, for example at spinning and milking, but to be excused heavy labour. However, when the land was to be retained by the family, in many cases there was no intention of establishing a separate household.

Support for People with Dementia

2009 ◽  
Vol 2 (4) ◽  
pp. 245-249
Author(s):  
Neil Hunt
Keyword(s):  
Quality Of Life ◽  
Early Intervention ◽  
Support Services ◽  
Daily Life ◽  
Terminal Condition ◽  
People With Dementia ◽  
The Right

Dementia is a progressive and eventually terminal condition, but with early intervention and the right support, people with dementia can continue to enjoy a good quality of life for many years. Living with dementia can be challenging both for those affected and their families as it can affect all aspects of daily life. It is vital that people with dementia and their carers are signposted to the support services that can help them take control of their condition and help them remain active and independent.

Quality of life outcome in a randomized controlled trial of case management

2001 ◽  
Vol 36 (5) ◽  
pp. 249-255 ◽  
Author(s):  
Peter Huxley ◽  
Sherrill Evans ◽  
Tom Burns ◽  
Tom Fahy ◽  
John Green
Keyword(s):  
Quality Of Life ◽  
Randomized Controlled Trial ◽  
Case Management ◽  
Controlled Trial ◽  
Randomized Controlled

scholarly journals Impact of case management on rural women's quality of life and substance use

2007 ◽  
Author(s):  
Megan Passey ◽  
Michelle Sheldrake ◽  
Kerry Leitch ◽  
Val Gilmore
Keyword(s):  
Quality Of Life ◽  
Substance Use ◽  
Case Management

scholarly journals Euthanasia and suicide: a medical and social discourse

2021 ◽  
Vol 25 (1) ◽  
pp. 107-112
Author(s):  
V. N. Ostapenko ◽  
I. V. Lantukh ◽  
A. P. Lantukh
Keyword(s):  
Quality Of Life ◽  
Assisted Suicide ◽  
Human Life ◽  
Modern Science ◽  
Physician Assisted Suicide ◽  
Adequate Quality ◽  
The Subject ◽  
Strong Explosion ◽  
The Right

Annotation. The problem of suicide and euthanasia has been particularly updated with the spread of the COVID-19 pandemic, which caused a strong explosion of suicide, because medicine was not ready for it, and the man was too weak in front of its pressure. The article considers the issue of euthanasia and suicide based on philosophical messages from the position of a doctor, which today goes beyond medicine and medical ethics and becomes one of the important aspects of society. Medicine has achieved success in the continuation of human life, but it is unable to ensure the quality of life of those who are forced to continue it. In these circumstances, the admission of suicide or euthanasia pursues the refusal of the subject to achieve an adequate quality of life; an end to suffering for those who find their lives unacceptable. The reasoning that banned suicide: no one should harm or destroy the basic virtues of human nature; deliberate suicide is an attempt to harm a person or destroy human life; no one should kill himself. The criterion may be that suicide should not take place when it is committed at the request of the subject when he devalues his own life. According to supporters of euthanasia, in the conditions of the progress of modern science, many come to the erroneous opinion that medicine can have total control over human life and death. But people have the right to determine the end of their lives while using the achievements of medicine, as well as the right to demand an extension of life with the help of the same medicine. They believe that in the era of a civilized state, the right to die with medical help should be as natural as the right to receive medical care. At the same time, the patient cannot demand death as a solution to the problem, even if all means of relieving him from suffering have been exhausted. In defense of his claims, he turns to the principle of beneficence. The task of medicine is to alleviate the suffering of the patient. But if physician-assisted suicide and active euthanasia become part of health care, theoretical and practical medicine will be deprived of advances in palliative and supportive therapies. Lack of adequate palliative care is a medical, ethical, psychological, and social problem that needs to be addressed before resorting to such radical methods as legalizing euthanasia.

scholarly journals THE PRINCIPLE OF QUALITY OF LIFE VERSUS SANCTITY OF LIFE IN THE EUTHANASIA DEBATE: WHERE DOES ISLAMIC LAW STANDS?

2012 ◽  
Vol 19 (1) ◽  
Author(s):  
Omipidan Bashiru Adeniyi
Keyword(s):  
Quality Of Life ◽  
Terminal Illness ◽  
Assisted Suicide ◽  
Islamic Law ◽  
The Other ◽  
Western World ◽  
Sanctity Of Life ◽  
World Today ◽  
The Right

The trend in most part of the western world today is the agitations for a person to have the right to take his own life, when such life, becomes unbearable due to pain, being the result of a severe or terminal illness. This is the position of proponents of the concept of euthanasia and assisted suicide. Opponents of the concept on the other hand are of the view that no matter the circumstances, a person should not take his own life because he has contributed nothing to its creation. They therefore uphold the sanctity of life as against its quality. This paper seeks to examine the relative arguments and will address the position of Islamic law governing the euthanasia debate.

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