scholarly journals Supportive Care Program in CKD: from dream to reality

2022 ◽  
Vol 35 (4) ◽  
Author(s):  
Ana Farinha ◽  
◽  
Patrícia Valério ◽  
Lina Borges ◽  
Ana Lourenço ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Kidney Disease ◽  
Supportive Care ◽  
Treatment Options ◽  
Care Program ◽  
Practical Implementation ◽  
Limited Information ◽  
Traditional Treatment ◽  
Implementation Steps

The number of older and frail patients has greatly increased in nephrology departments. Traditional treatment options have become inappropriate because they seem unable to achieve goals such as quality of life. Principles from palliative care have been brought to chronic kidney disease management with good results; thus a new way to approach these patients has been reported. In Portugal, in 2011, Direcção Geral de Saúde published a guideline to substantiate supportive care as an option, for certain patients, in certain circumstances. The best evidence known at the time was stated and the conditions that should be met were regulated, but limited information was given about practical implementation of what. In this article we describe our experience with a supportive care program from planning to the implementation steps, since 2015. We reflect on the flowchart, the barriers, the conquests, and the data up to the end of 2020.

Improving the quality of life for patients with cancer through the cancer supportive care program and web site

2002 ◽  
Vol 24 ◽  
pp. 11-12
Author(s):  
ErnestH. Rosenbaum ◽  
David Spiegel ◽  
Holly Gautier ◽  
Margaret Hawn ◽  
Pat Fobair ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Supportive Care ◽  
Web Site ◽  
Care Program ◽  
Patients With Cancer

scholarly journals Outcomes of A Pragmatic Trial of An Integrated Supportive Care Program

2021 ◽  
Author(s):  
Elizabeth Weinstein ◽  
Matthew Kemmann ◽  
Sara L. Douglas ◽  
Barbara Daly ◽  
Nathan Levitan
Keyword(s):  
Quality Of Life ◽  
Supportive Care ◽  
Pragmatic Trial ◽  
Stage Iv ◽  
Care Program ◽  
Total Sample ◽  
Demonstration Project ◽  
Care Utilization ◽  
Almost All

Abstract Purpose: This article reports findings from a demonstration project funded by the Center for Medicare and Medicaid Innovation (CMMI). The purpose of the project was to test a supportive care program to achieve the “triple aim” of improving quality of care of patients, enhance patient experience, and reduce costs in patients with advanced cancer. Methods: The project was conducted between February 2015 and February 2018, enrolling adult, Medicare or Medicaid beneficiaries with advanced or progressed solid tumor malignancy. A comparative longitudinal comparison of the program with both a concurrent control and an historic control was used to evaluate outcomes. The intervention included routine electronic biopsychosocial screening, early access to specialty palliative care, and nurse care coordination. Quality of life, aggressiveness of care, and health care utilization were measured.Results: 1340 people were enrolled, with 71% of the total sample being Caucasian; 41.4% had Stage IV cancer, and 20% utilized Medicaid only. Significant differences in the enrolled patients and the comparison group were controlled for through statistical analysis. There were significantly fewer ED visits, unplanned admissions and fewer total hospitalization days. Almost all measures reflected a lower aggressiveness of care for enrolled patients. Of patients who died, a significantly greater portion of enrolled patients were enrolled in hospice prior to death. Quality of life had a marked improvement for enrolled patients. Average cost per member per month was not less in the enrolled group.Conclusion: This pragmatic demonstration project provided valuable insights which can position organizations for successful integration of supportive care under value-based reimbursement.

Percutaneous Instrumentation of Pathologic Vertebral Fractures

2011 ◽  
Vol 07 (02) ◽  
pp. 98
Author(s):  
Michelle J Clarke ◽  
Reza Yassari ◽  
Daniel M Sciubba ◽  
Peter Rose ◽  
Mark B Dekutoski ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Treatment Options ◽  
Major Surgery ◽  
Spinal Fixation ◽  
Traditional Treatment ◽  
Compression Fractures ◽  
Patients With Cancer ◽  
Short Life Expectancy ◽  
Minimally Invasive Decompression

Vertebral metastatic disease leading to pathologic compression fractures is becoming increasingly common as patients with cancer are surviving for longer. Pathologic compression fractures severely limit quality of life; pain is nearly universal, and neurologic deficits are also common. Traditional treatment options have been limited to non-operative modalities, cement augmentation, or large circumferential decompressive procedures. Percutaneous spinal fixation provides another less invasive option, and can be used as a stand-alone procedure or in conjunction with open or minimally invasive decompression. This procedure may improve the quality of life of patients who would be deemed poor surgical candidates due to short life expectancy or medical comorbidities precluding major surgery.

scholarly journals Quality and cost outcomes of an integrated supportive care program

2021 ◽  
Author(s):  
Elizabeth Weinstein ◽  
Matthew Kemmann ◽  
Sara L. Douglas ◽  
Barbara Daly ◽  
Nathan Levitan
Keyword(s):  
Quality Of Life ◽  
Supportive Care ◽  
Advanced Cancer ◽  
Intervention Group ◽  
Stage Iv ◽  
Care Program ◽  
Total Sample ◽  
Demonstration Project ◽  
Clinical Benefits

Abstract Purpose This article reports findings from a demonstration project funded by the Center for Medicare and Medicaid Innovation (CMMI). The purpose of the project was to test a supportive care program on the outcomes of quality of care and quality of life, and costs in patients with advanced cancer. Methods The project was conducted between February 2015 and February 2018, enrolling adult, Medicare or Medicaid beneficiaries with advanced or progressed solid tumor malignancy. A comparative longitudinal comparison of the program with both a concurrent control and an historic control was used to evaluate outcomes. The intervention included routine electronic biopsychosocial screening, early access to specialty palliative care, and nurse care coordination. Quality of life, aggressiveness of care, and healthcare utilization were measured. Results A total of 1340 people were enrolled, with 71% of the total sample being Caucasian; 41.4% had stage IV cancer, and 20% utilized Medicaid only. Significant differences in the enrolled patients and the comparison group were controlled for through statistical analysis. There were significantly fewer ED visits, unplanned admissions, and fewer total hospitalization days in the intervention group. In the last 30 days of life, hospital and ICU admissions were less and a greater proportion of patients were enrolled in hospice in the intervention group. Quality of life had a marked improvement for enrolled patients. Average cost per member per month was not less in the enrolled group. Conclusion This pragmatic demonstration project confirmed the clinical benefits of an integration of supportive care for patients with advanced cancer, although no reduction in costs was found.

Raynaud’s phenomenon and digital ischaemia - pharmacologic approach and alternative treatment options

VASA ◽  
2016 ◽  
Vol 45 (3) ◽  
pp. 201-212 ◽  
Author(s):  
Birgit Linnemann ◽  
Matthias Erbe
Keyword(s):  
Quality Of Life ◽  
Angiotensin Receptor Blockers ◽  
Raynaud’S Phenomenon ◽  
Treatment Options ◽  
Raynaud's Phenomenon ◽  
Tissue Loss ◽  
Receptor Antagonists ◽  
Skin Ulcers ◽  
Digital Ischaemia

Abstract. The primary goal of therapy is to reduce the frequency and intensity of Raynaud’s attacks and to minimize the related morbidity rather than to cure the underlying condition. Treatment strategies depend on whether Raynaud’s phenomenon (RP) is primary or secondary. All patients should be instructed about general measures to maintain body warmth and to avoid triggers of RP attacks. Pharmacologic intervention can be useful for patients with severe and frequent RP episodes that impair the patient’s quality of life. Calcium channel blockers are currently the most prescribed and studied medications for this purpose. There has been limited evidence for the efficacy of alpha-1-adrenergic receptor antagonists, angiotensin receptor blockers, topical nitrates or fluoxetine to treat RP. The intravenously administered prostacyclin analogue iloprost can reduce the frequency and severity of RP attacks and is considered a second-line therapy in patients with markedly impaired quality of life, critical digital ischaemia and skin ulcers who are at risk for substantial tissue loss and amputation. Phosphodiesterase inhibitors (e.g., sildenafil) can also improve RP symptoms and ulcer healing whereas endothelin-1 receptor antagonists (e.g., bosentan) are mainly considered treatment options in secondary prevention for patients with digital skin ulcers related to systemic sclerosis. However, their use in clinical practice has been limited by their high cost. Antiplatelet therapy with low-dose aspirin is recommended for all patients who suffer from secondary RP due to ischaemia caused by structural vessel damage. Anticoagulant therapy can be considered during the acute phase of digital ischaemia in patients with suspected vascular occlusive disease attributed to the occurrence of new thromboses. In patients with critical digital ischaemia, consideration should be given to hospitalisation, optimisation of medical treatment in accordance with the underlying disease and evaluation for a secondary, possibly reversible process that is causing or aggravating the clinical symptoms.

HUBUNGAN EFIKASI DIRI DENGAN KUALITAS HIDUP PASIEN GAGAL GINJAL KRONIK YANG MENJALANI HEMODIALISIS

2018 ◽  
Vol 5 (2) ◽  
pp. 56-63
Author(s):  
Abdul Wakhid ◽  
Estri Linda Wijayanti ◽  
Liyanovitasari Liyanovitasari
Keyword(s):  
Quality Of Life ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Self Efficacy ◽  
Healing Process ◽  
Sampling Technique ◽  
P Value ◽  
Cross Sectional ◽  
Kolmogorov Smirnov

Background: Self efficacy can optimize the quality of life of clients who undergo the healing process due to chronic diseases. Individuals with higher self-efficacy move their personal and social resources proactively to maintain and improve the quality and length of their lives so that they experience a better quality of life. Objectives: the purpose of this study was to find the correlation between self efficacy and quality of life of patients with chronic kidney disease who undergo hemodialysis at RSUD Semarang Regency. Metode: This type of research was descriptive correlation with cross sectional approach. The samples in this study more 76 people with total sampling technique. The data collection tool for self efficacy was measured by General Self-Efficacy scale, for quality of life with WHOQoL-BREF. Statistical test used Kolmogorov-smirnov. Result: The result showed that self efficacy in patients with chronic kidney disease was mostly in moderate category (53,9%), quality of life in patients with chronic kidney disease was mostly in good category (68,4%). There was a correlation between self efficacy and quality of life of patients with chronic kidney disease who undergo hemodialysis at RSUD Semarang Regency, the result obtained p-value of 0.000 <α (0,05). Suggestion: Patients with chronic kidney disease can maintain good quality of life by helping to generate positive self-esteem and high self efficacy.

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