scholarly journals Patient values: A foundation for eHealth design and evaluation in the BENEFIT for all study (Preprint)

JMIR Cardio ◽  
10.2196/33252 ◽  
2021 ◽  
Author(s):  
B.E. Bente ◽  
M.J. Wentzel ◽  
R.G.H. Groeneveld ◽  
R.V.H. IJzerman ◽  
D.R. de Buisonjé ◽  
...  
Keyword(s):  
Patient Values

scholarly journals Aligning use of intensive care with patient values in the USA: past, present, and future

2019 ◽  
Vol 7 (7) ◽  
pp. 626-638 ◽  
Author(s):  
Alison E Turnbull ◽  
Gabriel T Bosslet ◽  
Erin K Kross
Keyword(s):  
Intensive Care ◽  
The Usa ◽  
Patient Values

Early Palliative Care Consultation in the Burn Unit: A Quality Improvement Initiative to Increase Utilization

2021 ◽  
Author(s):  
Heather Carmichael ◽  
Hareklia Brackett ◽  
Maurice C Scott ◽  
Margaret M Dines ◽  
Sarah E Mather ◽  
...  
Keyword(s):  
Palliative Care ◽  
Small Sample ◽  
Quality Improvement Initiative ◽  
Comfort Care ◽  
Early Palliative Care ◽  
Palliative Care Consultation ◽  
Before And After ◽  
Care Consultation ◽  
Patient Values ◽  
The Impact

Abstract Despite significant morbidity and mortality for major burns, palliative care consultation (PCC) is underutilized in this population. The purpose of this study is to examine the impact of a protocol using recommended “triggers” for PCC at a single academic burn center. This is a retrospective review of patient deaths over a four-year period. Use of life-sustaining treatments, comfort care (de-escalation of one or more life-sustaining treatments) and do not attempt resuscitation (DNAR) orders were determined. Use of PCC was compared during periods before and after a protocol establishing recommended triggers for early (<72 hrs of admission) PCC was instituted in 2019. A total of 33 patient deaths were reviewed. Most patients were male (n=28, 85%) and median age was 62 years [IQR 42-72]. Median revised Baux score was 112 [IQR 81-133]. Many patients had life-sustaining interventions such as intubation, dialysis, or cardiopulmonary resuscitation, often prior to admission. Amongst patients who survived >24 hrs, 67% (n=14/21) had PCC. Frequency of PCC increased after protocol development, with 100% vs. 36% of these patients having PCC before death (p=0.004). However, even during the later period, less than half of patients had early PCC despite meeting criteria at admission. In conclusion, initiation of life-sustaining measures in severely injured burn patients occurs prior to or early during hospitalization. Thus, value-based early goals of care discussions are valuable to prevent interventions that do not align with patient values and assist with de-escalation of life-sustaining treatment. In this small sample, we found that while there was increasing use of PCC overall after developing a protocol of recommended triggers for consultation, many patients who met criteria at admission did not receive early PCC. Further research is needed to elucidate reasons why providers may be resistant to PCC.

scholarly journals Putting the Horse Before the Cart: the Ethical Case for Animal Patient Values in EBVM

2017 ◽  
Vol 2 (2) ◽  
Author(s):  
David Mills
Keyword(s):  
Animal Welfare ◽  
Surgical Intervention ◽  
Significant Risk ◽  
Therapeutic Benefit ◽  
Natural Behaviour ◽  
Do No Harm ◽  
Or Practice ◽  
Animal Welfare Science ◽  
Patient Values ◽  
The Individual

<p>Patient values represents one of the three cornerstones of contemporary human EBM definitions, and are considered vital to both protect the patient from the tyranny of unsuitable treatment and to ensure the individual is central in clinical decisions. They comprise “unique preferences, concerns and expectations of each patient” (Sackett et al 1996). By stark contrast, EBVM replaces individual patient values with “circumstances of each patient, and the circumstances and values of the owner/carer” (CEVM 2015). There is a danger that in such a conception, animal welfare may not be prioritised in EBVM practice.</p><p>Animal patients are not philosophically or scientifically likely to possess the complex values of humans, but it is conceivable that they possess ‘values’ in the context of veterinary interventions, such as preferences, wants, needs and desires; indeed these underlie much animal welfare science. They may be basic, such as the avoidance of suffering and a desire to continue life, or more complex, such as a desire to maximise pleasure or natural behaviour. They are likely to be individual and dynamic. They may be defined as the unique dynamic mental preference state of an animal during the period of veterinary medical or surgical intervention, including avoidance of suffering and maximisation of health and pleasure.</p><p>EBVM’s current consideration of patient values only extends to demonstrating effectiveness, or not, of an intervention for an animal. Any intervention involves some physical or mental welfare compromise for animal patients, which may be severe; EBVM aims to ensure this harm 'cost' is consistently outweighed by therapeutic 'benefit'. However, in current EBVM the evidence is often weak, incomplete, contradictory, fuzzy, non-existent or inapplicable, meaning there is a significant risk of causing harm to the patient’s welfare when practising EBVM. This stands in opposition to a veterinary surgeon’s oath and ethical imperative to do no harm, and to do the best for her patients’ welfare (RCVS 2015).</p><p>At what point does the risk become ethically unacceptable? The answer comprises both philosophical considerations, and empirical, critically anthropomorphic attributions of values to animals. Such conceptions and techniques are not currently explicitly expounded in EBVM research or practice. Rather than being marginalised or excluded from definitions of EBVM, this presentation will argue that patient values should be the central, primary and overriding consideration in both its practice and research if EBVM is to be an ethically acceptable pursuit.</p><br /> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access" />

scholarly journals Impact of Antibody Specificity and Calibration Material on the Measure of Agreement between Methods for Cardiac Troponin I

1999 ◽  
Vol 45 (6) ◽  
pp. 822-828 ◽  
Author(s):  
David J Newman ◽  
Yemi Olabiran ◽  
William D Bedzyk ◽  
Suzette Chance ◽  
Eileen G Gorman ◽  
...  
Keyword(s):  
Creatine Kinase ◽  
Regression Analysis ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Cardiac Troponin I ◽  
Antibody Specificity ◽  
Serum Pool ◽  
Creatine Kinase Mb ◽  
Patient Values ◽  
Calibration Material

Abstract Background: Available assays for cardiac troponin I (cTnI) yield numerically different results. The aim of this study was to compare patient values obtained from four cTnI immunoassays. Methods: We studied the Stratus® II assay, the Opus® II assay, the Access® assay, and a research-only cTnI heterogeneous immunoassay that uses the Dade Behring aca® plus immunoassay system equipped with two new noncommercial monoclonal antibodies. Because the aca plus cTnI assay is for research only, we first evaluated and analytically validated it for serum and citrated plasma. Initially, each method was calibrated using the method-specific calibrator supplied by each manufacturer; however, the aca plus cTnI assay was calibrated using patient serum pools containing cTnI and selected on the basis of increased creatine kinase MB isoenzyme and with values assigned by use of the Stratus cTnI assay. For method comparisons, individual patient sample cTnI values were determined and compared with the Stratus II assay. Results: Passing and Bablock regression analysis yielded slopes of 1.44 (r = 0.96; n = 72) for the Opus II vs Stratus II assays; 0.07 (r = 0.91; n = 72) for the Access vs Stratus II assays; and 0.90 (r = 0.91, n = 72) for the aca plus vs Stratus II assays. The recalibration of each method with a Stratus II-assigned serum pool improved, but did not entirely eliminate, the slope differences between the different assays (range, 1.00–1.16). The observed scatter in the correlation curves remained. Conclusion: There is a need to further explore the specificities of these assays with respect to the different circulating forms of cTnI.

scholarly journals Feasibility and acceptability of introducing advance care planning on a thoracic medicine inpatient ward: an exploratory mixed method study

2020 ◽  
Vol 7 (1) ◽  
pp. e000485
Author(s):  
Nina Elisabeth Hjorth ◽  
Margrethe Aase Schaufel ◽  
Katrin Ruth Sigurdardottir ◽  
Dagny R Faksvåg Haugen
Keyword(s):  
Focus Group ◽  
Advance Care Planning ◽  
Symptom Control ◽  
Care Planning ◽  
Management Support ◽  
Focus Group Interviews ◽  
Inpatient Ward ◽  
Advance Care ◽  
Patient Values ◽  
Group Interviews

Background and aimsAdvance care planning (ACP) is communication about wishes and preferences for end-of-life care. ACP is not routinely used in any Norwegian hospitals. We performed a pilot study (2014–2017) introducing ACP on a thoracic medicine ward in Norway. The aims of this study were to explore which topics patients discussed during ACP conversations and to assess how patients, relatives and clinicians experienced the acceptability and feasibility of performing ACP.MethodsConversations were led by a study nurse or physician using a semistructured guide, encouraging patients to talk freely. Each conversation was summarised in a report in the patient’s medical record. At the end of the pilot period, clinicians discussed their experiences in focus group interviews. Reports and transcribed interviews were analysed using systematic text condensation.ResultsFifty-one patients participated in ACP conversations (41–86 years; 9 COPD, 41 lung cancer, 1 lung fibrosis; 11 women); 18 were accompanied by a relative. Four themes emerged: (1) disturbing symptoms, (2) existential topics, (3) care planning and (4) important relationships. All participants appreciated the conversations. Clinicians (1 physician and 7 nurses) participated in two focus group interviews. Reports from ACP conversations revealed patient values previously unknown to clinicians; important information was passed on to primary care. Fearing they would deprive patients of hope, clinicians acted as gatekeepers for recruitment. Although they reported barriers during recruitment, many clinicians saw ACP as pertinent and called for time and skills to integrate it into their daily clinical practice.ConclusionsPatients, relatives and clinicians showed a positive attitude towards ACP. Focusing on present and future symptom control may be an acceptable way to introduce ACP. Important aspects for implementing ACP in this patient group are management support, education, training, feasible routines and allocated time to perform the conversations.

scholarly journals Genomic Testing for Relapsed and Refractory Lymphoid Cancers: Understanding Patient Values

2020 ◽  
Author(s):  
Sarah Costa ◽  
Dean A. Regier ◽  
Adam J. N. Raymakers ◽  
Samantha Pollard
Keyword(s):  
Genomic Testing ◽  
Patient Values

scholarly journals Understanding Patient Values and the Manifestations in Clinical Research with Traditional Chinese Medicine—With Practical Suggestions for Trial Design and Implementation

2013 ◽  
Vol 2013 ◽  
pp. 1-6
Author(s):  
Wei Mu ◽  
Hongcai Shang
Keyword(s):  
Chinese Medicine ◽  
Traditional Chinese Medicine ◽  
Clinical Research ◽  
Patient Reported Outcomes ◽  
Patient Choice ◽  
Rational Beliefs ◽  
Choice Preference ◽  
Patient Reported ◽  
Individual Participant ◽  
Patient Values

Objective. To define patient values, identify their manifestations in a randomized clinical trial, and investigate the possible implications for clinical research of traditional Chinese medicine.Methods. We categorized patient values manifestations into patient choice, preference, compliance, and patient-reported outcomes and summarized the underlying personal values through purposeful electronic searches for relevant reports. By hypothesizing a set of positive versus negative circumstances occurring in the enrollment, intervention allocation, treatment, and the follow-up stage of a trial, it is possible to discuss the potential implications of patient values manifestation on a trial with traditional Chinese medicine.Results. Patient values and its manifestations are ubiquitous in the process of clinical research with traditional Chinese medicine. These values may provide motivation for participation or engender the internal and external validity of the study.Conclusions. Trialists should attach sufficient importance to the needs and concerns of individual participant. To incorporate patient values into the design and conduct of a clinical study with traditional Chinese medicine, researchers are recommended to adopt participant-friendly design and use patient-reported outcomes, take convenience-for-patients measures, and help foster rational beliefs and behaviors of trial participants.

scholarly journals I Have to/Get to Teach Counseling: Now What? A Personal Essay

2018 ◽  
Vol 39 (01) ◽  
pp. 005-008
Author(s):  
Sue Hale
Keyword(s):  
Personal Essay ◽  
Self Reflection ◽  
Transferable Skills ◽  
Core Concepts ◽  
Patient Values

AbstractFaculty receiving the assignment to teach a course in counseling to Au.D. students often have limited background in teaching the requisite skills and knowledge associated with counseling. A period of self-reflection regarding transferable skills for counseling as well as guidance from colleagues may assist in developing core concepts for the content of the class. Theoretical underpinnings, understanding and respecting patient values, and listening and valuing are significant perspectives for students to develop as they approach the broad content of a counseling course.

Achieving shared treatment decisions

2017 ◽  
Author(s):  
Martin H.N. Tattersall ◽  
David W. Kissane
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Decision Aids ◽  
Treatment Options ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Shared Decision ◽  
Similar Treatment ◽  
Treatment Benefits ◽  
Patient Values

The respect of a patient’s autonomous rights within the model of patient-centred care has led to shared decision-making, rather than more paternalistic care. Understanding patient needs, preferences, and lifestyle choices are central to developing shared treatment decisions. Patients can be prepared through the use of question prompt sheets and other decision aids. Audio-recording of informative consultations further helps. A variety of factors like the patient’s age, tumour type and stage of disease, an available range of similar treatment options, and their risk-benefit ratios will impact on the use of shared decision-making. Modifiable barriers to shared decision-making can be identified. Teaching shared decision-making includes the practice of agenda setting, use of partnership statements, clarification of patient preferences, varied approaches to explaining potential treatment benefits and risks, review of patient values and lifestyle factors, and checking patient understanding–this sequence helps both clinicians and patients to optimally reach a shared treatment decision.

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