Cultures that collide: an ethnographic study of the introduction of a palliative care consultation team on acute wards

Background Acute care and palliative care (PC) are described as different incompatible organisational care cultures. Few studies have observed the actual meeting between these two cultures. In this paper we report part of ethnographic results from an intervention study where a palliative care consultation team (PCCT) used an integrative bedside education approach, trying to embed PC principles and interventions into daily practice in acute wards. Purpose To study the meeting and interaction of two different care cultures, palliative care and curative acute wards, when a PCCT introduces consulting services to acute wards regarding end-of-life palliative care, focusing on the differences between the cultures. Methods An ethnographic study design was used, including observations, interviews and diary entries. A PCCT visited acute care wards during 1 year. The analysis was inspired by Spradleys ethnography. Results Three themes were found: 1) Anticipations meets reality; 2) Valuation of time and prioritising; and 3) The content and creation of palliative care. Conclusion There are many differences in values, and the way PC are provided in the acute care wards compared to what a PCCT expects. The didactic challenges are many and the PC require effort.

Reviewing the availability, efficacy and clinical utility of Telepsychology in dialectical behavior therapy (Tele-DBT)

Background Telepsychology is increasingly being implemented in mental health care. We conducted a scoping review on the best available research evidence regarding availability, efficacy and clinical utility of telepsychology in DBT. The review was performed using PRISMA-ScR guidelines. Our aim was to help DBT-therapists make empirically supported decisions about the use of telepsychology during and after the current pandemic and to anticipate the changing digital needs of patients and clinicians. Methods A search was conducted in PubMed, Embase, PsycARTICLES and Web of Science. Search terms for telepsychology were included and combined with search terms that relate to DBT. Results Our search and selection procedures resulted in 41 articles containing information on phone consultation, smartphone applications, internet delivered skills training, videoconferencing, virtual reality and computer- or video-assisted interventions in DBT. Conclusions The majority of research about telepsychology in DBT has focused on the treatment mode of between-session contact. However, more trials using sophisticated empirical methodologies are needed. Quantitative data on the efficacy and utility of online and blended alternatives to standard (i.e. face-to-face) individual therapy, skills training and therapist consultation team were scarce. The studies that we found were designed to evaluate feasibility and usability. A permanent shift to videoconferencing or online training is therefore not warranted as long as face-to-face is an option. In all, there is an urgent need to compare standard DBT to online or blended DBT. Smartphone apps and virtual reality (VR) are experienced as an acceptable facilitator in access and implantation of DBT skills. In addition, we have to move forward on telepsychology applications by consulting our patients, younger peers and experts in adjacent fields if we want DBT to remain effective and relevant in the digital age.

The Palliative Care Illusion on Acute Wards An Ethnographic Study of the Introduction of a Palliative Care Consultation Team

Acute care and palliative care are described as different incompatible organisational care cultures, with contrasts and contradictions. Few studies have observed the actual meeting between these two cultures. Purpose: To study the meeting and interaction of two different organisational care cultures, palliative care and curative acute wards, when a palliative care consultation team introduces consulting services to acute wards regarding end-of-life palliative care. Methods: An ethnographic study design was used, including observations, interviews and diary entries. A palliative care consultation team visited surgical and internal medicine wards during one year. An integrative bedside education approach was used, where physicians and nurses experienced in PC tried to embed PC principles and interventions into daily practice. The analysis was inspired by Spradley’s ethnography.Results: Three themes were found in the study: 1) Values, illusions, and wording in the acute care culture; 2) Didactic challenges and strategies, and 3) The palliative illusion becomes a fusion. On the acute wards, fast “turn over” was the goal of care: to treat patients quickly and send them home. Primary health care team members believed that they gave dying patients good care, a conclusion not supported by the palliative care team, who identified values problems and a knowledge shortage among all primary team members. Because the primary team did not have time for reflection regarding patients’ whole situation, and wanted to do as much as possible before “giving up”, their patients could be one hour from death before the primary team provided palliative care. After one year, primary team members wanted the palliative care consultation team to continue, since they felt they could not handle dying patients on their own.Conclusion: Palliative care consultation team make changes about end- of- life care when working with primary health care team members on acute wards. The didactic challenges are many and require efforts.

THE IMPLEMENTATION OF CHILDRENADOPTION LICENSING IN THE BENGKULU PROVINCE BASED ON GOVERNMENT REGULATION NUMBER 54 OF 2007 CONCERNING THE IMPLEMENTATION OF CHILDREN ADOPTION

The State and the Government are obliged and responsible for the orderliness of children adoption practices, both in terms of administration and legal certainty. Therefore several policies were issued through legislation and jurisprudence that regulates and handles the issue of children adoption. The implementation of children adoption must be based on Government Regulation of the Republic of Indonesia Number 54 of 2007 concerning Children Adoption. This study aims to get an overview and explanation of the Implementation of Licensing for ChildrenAdoption in Bengkulu Province Based on Government Regulation 54 of 2007 concerning the Implementation of Children Adoption. The children adoption process requires regulations that are in accordance with the Laws and Government Regulations and needs control of how they are implemented in the field. In addition to the Social Department of Bengkulu Province as the technical executor of adoption activities, it is necessary to establish a Regional Consultation Team for Children Adoption (known as PIPA in Indonesian abbreviation), to avoid irregularities in the process of implementation of children adoption, such as the adoption of children carried out without proper procedures, falsification of data and the existence of child trafficking, so the goal of adopting a child for the best interests of the child is not achieved. In analyzing the data in this thesis, the researcher applied a qualitative juridical analysis approach that describes the picture of the data obtained by researcher in the field and connects with each other to get a general conclusion. From the results of the qualitative juridical analysis, it can be seen and obtained inductive conclusions, namely the way of thinking in taking conclusions in general was based on facts that are specific. Data collection methods in this study were done through in-depth interview techniques, observation and documentation.The informants in this study were determined by selecting informants who comprehended and were directly involved in the implementation of child adoption programs. The informants consisted of the Head of Social Rehabilitation Division at the Social Department of Bengkulu Province, Head of Children and Elderly Social Rehabilitation Section at the Social Department of Bengkulu Province, Head of ChildrenProtection Section of the Women Empowerment Department and Children Protection in Bengkulu Province, Children Social Workers and Parents or Prospective Adoptive Parents who follow procedural for children adoption in accordance with applicable regulations. Data processing and analysis were conducted through data reduction, data presentation and conclusion drawing.

Dutch GPs’ experience of burden by euthanasia requests from people with dementia: a quantitative survey

BackgroundIn the Netherlands during the past decade, a growing number of people with dementia requested euthanasia, and each year more of such requests were granted.AimTo obtain quantitative insights into the problems and needs of GPs when confronted with a euthanasia request by a person with dementia.Design & settingA concept survey was composed for GPs in the Netherlands. Expert validity of the survey was achieved through pilot testing.MethodA postal survey was sent to a random sample of 900 Dutch GPs, regardless of their opinion on, or practical experience with, euthanasia. Collected data were analysed with descriptive statistics.ResultsOf 894 GPs, 423 (47.3%) completed the survey, of whom 176 (41.6%) had experience with euthanasia requests from people with dementia. Emotional burden was reported most frequently (n = 86; 52.8%), as well as feeling uncertain about the mental competence of the person with dementia (n = 77; 47.2%), pressure by relatives (n = 70; 42.9%) or the person with dementia (n = 56; 34.4%), and uncertainty about handling advance euthanasia directives (AEDs) (n = 43; 26.4%). GPs would appreciate more support from the following: a support and consultation in euthanasia in the Netherlands (SCEN) physician (an independent physician for support, information, and formal consultation around euthanasia) (n = 291; 68. 8%); a geriatric consultation team (n = 185; 43.7%); the end-of-life clinic (n = 184; 43.5%); or a palliative care consultation team (n = 179; 42.3%). Surprisingly the need for moral deliberation was hardly mentioned.ConclusionThe reported burden and the rise in numbers and complexity of euthanasia requests from people with dementia warrants primary care support. There needs to be easier access to colleagues with expertise, and training on end-of-life care needs of patients with dementia and their caregivers.

Research on Emergency Management of Pharmaceutical Care in Designated Hospital for Patients with COVID-19

Background: The novel coronavirus pneumonia (COVID-19) was entered into the critical period of epidemic prevention. Our hospital was designated as a hospital for severe pneumonia in Wuhan. Timely and effective pharmaceutical emergency support system is of great significance for the epidemic prevention and control of COVID-19. Method:In order to ensure COVID-19 patients' medication needs and ensure the safety treatment, we focus on the key points and difficult problems in the practice of pharmaceutical management during the period of COVID-19, and then formulate appropriate pharmaceutical emergency support system combined with clinical practice. Results:The pharmaceutical department quickly launched the emergency mechanism, formulated the key drug catalog for COVID-19, purchased some treatment drugs, reformed the emergency pharmacy process, established the donated drug management system, established the pharmacist consultation team, set up the "cloud pharmacy" for patients with chronic diseases other than COVID-19, and strengthened pharmacist protection management. Conclusion:During the period of COVID-19, the pharmaceutical administration is a professional, comprehensive, complex and systematic emergency project to ensure the drug supply and safety administration.

Factors Influencing the Prioritization of Injured Patients for Transfer to a Burn or Trauma Center Following a Mass Casualty Event

ABSTRACT Objectives: In New York City, a multi-disciplinary Mass Casualty Consultation team is proposed to support prioritization of patients for coordinated inter-facility transfer after a large-scale mass casualty event. This study examines factors that influence consultation team prioritization decisions. Methods: As part of a multi-hospital functional exercise, 2 teams prioritized the same set of 69 patient profiles. Prioritization decisions were compared between teams. Agreement between teams was assessed based on patient profile demographics and injury severity. An investigator interviewed team leaders to determine reasons for discordant transfer decisions. Results: The 2 teams differed significantly in the total number of transfers recommended (49 vs 36; P = 0.003). However, there was substantial agreement when recommending transfer to burn centers, with 85.5% agreement and inter-rater reliability of 0.67 (confidence interval: 0.49–0.85). There was better agreement for patients with a higher acuity of injuries. Based on interviews, the most common reason for discordance was insider knowledge of the local community hospital and its capabilities. Conclusions: A multi-disciplinary Mass Casualty Consultation team was able to rapidly prioritize patients for coordinated secondary transfer using limited clinical information. Training for consultation teams should emphasize guidelines for transfer based on existing services at sending and receiving hospitals, as knowledge of local community hospital capabilities influence physician decision-making.