The associations of palliative care experts regarding food refusal : a cross-sectional study with an open question evaluated by triangulation analysis

Introduction: Health professionals in oncologic and palliative care settings are often faced with the problem that patients stop eating and drinking. While the causes of food refusal are very different, the result is often malnutrition, which is linked to health comorbidities and a high mortality rate. However, the professionals lack the time and knowledge to clarify the cause for each patient. What associations do health professionals have when faced with food refusal? Objective: To investigate the associations that health professionals in oncological and palliative settings have about denied eating behavior. Methods: A cross-sectional study, starting with an open question focusing professionals’ associations regarding food refusal. The results were inductively analyzed, whereby generic categories were developed. Subsequently, the categories were transformed into quantitative data to calculate the relationships between the categories. Results: A total of 350 out of 2000 participants completed the survey, resulting in a response rate of 17.5%. Food refusal is primarily associated with physical and ethical aspects and with endof-life. Half of the participants frequently find that patients refuse to eat. The attitudes show that the autonomy of the patient is the highest good and is to be respected. Even in the case of patients with limited decision-making capacity, the refusal to eat is acceptable. Conclusion: Clarifying the cause of food refusal requires a great deal of knowledge and is strongly influenced by the associations of health professionals. While the associations have very negative connotations, information and training is needed to make professionals aware of this and to change their associations. With this knowledge and in an interprofessional cooperation, mis-labelling of patient settings can be avoided and fears can be reduce

“It’s hard to tell”. The challenges of scoring patients on standardised outcome measures by multidisciplinary teams: a case study of Neurorehabilitation

Background Interest is increasing in the application of standardised outcome measures in clinical practice. Measures designed for use in research may not be sufficiently precise to be used in monitoring individual patients. However, little is known about how clinicians and in particular, multidisciplinary teams, score patients using these measures. This paper explores the challenges faced by multidisciplinary teams in allocating scores on standardised outcome measures in clinical practice. Methods Qualitative case study of an inpatient neurorehabilitation team who routinely collected standardised outcome measures on their patients. Data were collected using non participant observation, fieldnotes and tape recordings of 16 multidisciplinary team meetings during which the measures were recited and scored. Eleven clinicians from a range of different professions were also interviewed. Data were analysed used grounded theory techniques. Results We identified a number of instances where scoring the patient was 'problematic'. In 'problematic' scoring, the scores were uncertain and subject to revision and adjustment. They sometimes required negotiation to agree on a shared understanding of concepts to be measured and the guidelines for scoring. Several factors gave rise to this problematic scoring. Team members' knowledge about patients' problems changed over time so that initial scores had to be revised or dismissed, creating an impression of deterioration when none had occurred. Patients had complex problems which could not easily be distinguished from each other and patients themselves varied in their ability to perform tasks over time and across different settings. Team members from different professions worked with patients in different ways and had different perspectives on patients' problems. This was particularly an issue in the scoring of concepts such as anxiety, depression, orientation, social integration and cognitive problems. Conclusion From a psychometric perspective these problems would raise questions about the validity, reliability and responsiveness of the scores. However, from a clinical perspective, such characteristics are an inherent part of clinical judgement and reasoning. It is important to highlight the challenges faced by multidisciplinary teams in scoring patients on standardised outcome measures but it would be unwarranted to conclude that such challenges imply that these measures should not be used in clinical practice for decision making about individual patients. However, our findings do raise some concerns about the use of such measures for performance management

User-centered visual analysis using a hybrid reasoning architecture for intensive care units

One problem pertaining to Intensive Care Unit information systems is that, in some cases, a very dense display of data can result. To ensure the overview and readability of the increasing volumes of data, some special features are required (e.g., data prioritization, clustering, and selection mechanisms) with the application of analytical methods (e.g., temporal data abstraction, principal component analysis, and detection of events). This paper addresses the problem of improving the integration of the visual and analytical methods applied to medical monitoring systems. We present a knowledge- and machine learning-based approach to support the knowledge discovery process with appropriate analytical and visual methods. Its potential benefit to the development of user interfaces for intelligent monitors that can assist with the detection and explanation of new, potentially threatening medical events. The proposed hybrid reasoning architecture provides an interactive graphical user interface to adjust the parameters of the analytical methods based on the users' task at hand. The action sequences performed on the graphical user interface by the user are consolidated in a dynamic knowledge base with specific hybrid reasoning that integrates symbolic and connectionist approaches. These sequences of expert knowledge acquisition can be very efficient for making easier knowledge emergence during a similar experience and positively impact the monitoring of critical situations. The provided graphical user interface incorporating a user-centered visual analysis is exploited to facilitate the natural and effective representation of clinical information for patient care

A reassuring presence: An evaluation of Bradford District Hospice at Home service

Within the United Kingdom, a developing role for primary care services in cancer and palliative care has resulted in an increase in palliative home care teams. The provision of professional care in the home setting seeks to provide necessary services and enhanced choice for patients whose preference is to die at home. A mismatch between patient preference for home death and the actual number of people who died at home was identified within Bradford, the locality of this study. In response to this mismatch, and reflecting the policy environment of wishing to enhance community service provision, the four Primary Care Trusts (PCTs) in the city sought to offer support to patients who wished to remain in their own homes through the final stages of a terminal illness. To offer this support they set up a dedicated hospice at home team. This would provide services and support for patients in achieving a dignified, symptom free and peaceful death, allowing families to maximise time spent together. The aim of the study was to evaluate the Bradford hospice at home service from the perspective of carers, nurses and General Practitioners. Postal questionnaires were sent to carers (n = 289), district nurses (n = 508) and GP's (n = 444) using Bradford's hospice at home service. Resulting quantitative data was analysed using the Statical Package for Social Sciences (SPSS) and qualitative data was analysed using grounded theory techniques. The data from carers, district nurses and GPs provide general support for the Bradford hospice at home service. Carers valued highly the opportunity to 'fulfil a promise' to the individual who wished to be cared for at home. District nurses and GPs cited the positive impact of access to specialist expertise. This was a 'reassuring presence' for primary healthcare teams and offered 'relief of carer anxiety' by providing prompt, accessible and sensitive care. Carers and health professionals welcomed the increased possibility of patients being cared for at home. The study identified the need to focus on improving skill levels of staff and on ensuring continuity of care

Perceptions of Nursing Students Regarding Evidence-Based Practice

The purpose of this descriptive quantitative study was to explore the nursing students\u27 perceptions of their attitude and knowledge regarding evidence-based practice (EBP). The Research Awareness Questionnaire (RAQ), previously used only with healthcare professionals was slightly modified and piloted with senior nursing students (N=22). Eighty-two percent (n=18) of the participants believe that EBP is part of their role. Only 41% (n=9) were confident to undertake research. On the actual knowledge measures, 96% (n=21) could define qualitative research, and 86 % (n=19) correctly defined quantitative research. Suggestions for revising the RAQ are discussed. With modifications, this instrument could be utilized by other schools to measure nursing students\u27 perceptions of their attitude and knowledge towards EBP

Gaming Disorder: A Contemporary Ampliative Account

Diagnosing gaming disorder requires that mental health practitioners weigh in patient's values in an appropriate symmetry with an evidence-based approach to deal with patient's issues. Nevertheless, to date, the science of gaming disorder tends to overemphasize psychopharmacological and therapeutic intervention, while the importance of values is ignored to the periphery. We argue in this paper, for gaming disorder formalization to be rigid, the science of gaming disorder needs further research and its scientific basis be established with an improved data of the players at the local level

Simulación y competencias no técnicas en el contexto de emergencia pre-hospitalar: estudio cualitativo

Unidade de Monitorização em Indicadores de Saúde - UMISAbstract - To understand the importance that nurses assign to simulation in the development of non-technical skills in cardiac arrest event in pre-hospital setting. Background Nursing is projected in the future, developing a patient centred approach consistent with the values, needs and desires of patients, considering process of care as a complex intervention. Simulation based on scenarios is an opportunity to recreate this complexity in a virtual way, to develop the non-technical skills. Methods This study uses an inductive, interpretative and constructivist qualitative research. 7 nurses were interviewed. It was developed a thematic analysis content. Results Three themes were identified: Simulation scenarios in pre-hospital emergencies; The acquisition of knowledge to skills development and Construction of the virtual from the real Conclusions The interviewed nurses present weakness of knowledge about simulation types. Debriefing is relevant to the learning skills: critical thinking. thinking, clinical judgement and decision making.Resumo - Compreender a importância que os enfermeiros atribuem à simulação no desenvolvimento de competências não técnicas no evento paragem cardíaca em ambiente préhospitalar. Enquadramento A enfermagem é projetada no futuro, desenvolvendo uma abordagem centrada na pessoa consistente com a valorização de valores, necessidades e desejos destes, considerando o processo de cuidados como intervenção complexa. A simulação baseada em cenários é uma oportunidade para recriar essa complexidade de forma virtual, no desenvolvimento de competências não-técnicas. Metodologia Este estudo utiliza uma pesquisa qualitativa indutiva, interpretativa e construtivista. Foram entrevistados 7 enfermeiros. Foi desenvolvida análise de conteúdo temática. Resultados Foram identificados três temas: cenários de simulação em emergências pré-hospitalares; A aquisição de conhecimento para o desenvolvimento de habilidades e Construção do virtual a partir do real. Conclusões Os enfermeiros entrevistados apresentam conhecimentos a melhorar em relação aos tipos de simulação. Consideram o Debriefing relevante para as habilidades de aprendizagem: pensamento crítico, julgamento clínico e a tomada de decisão.Resumen - Comprender la importancia que los enfermeros atribuyen a la simulación en el desarrollo de competencias no técnicas en el evento paro cardíaco en ambiente prehospitalario. Background La enfermería se proyecta en el futuro, desarrollando un enfoque centrado en la persona consistente con la valorización de valores, necesidades y deseos de éstos, considerando el proceso de cuidar como intervención compleja. La simulación basada en escenarios es una oportunidad para recrear esta complejidad de forma virtual, en el desarrollo de competencias no técnicas. Metodología Este estudio utiliza una investigación cualitativa inductiva, interpretativa y constructivista. Se entrevistaron a 7 enfermeros. Se desarrolló un análisis de contenido temático. Resultados Se identificaron tres temas: escenarios de simulación en emergencias prehospitalarias; La adquisición de conocimiento para el desarrollo de habilidades y la construcción del virtual a partir del real. Conclusiones Los enfermeros entrevistados presentan conocimientos a mejorar en relación a los tipos de simulación. El Debriefing es considerado como relevante para las habilidades de aprendizaje: el pensamiento crítico, el juicio clínico y la toma de decisiones.info:eu-repo/semantics/publishedVersio

Telecare motivational interviewing for diabetes patient education and support : a randomised controlled trial based in primary care comparing nurse and peer supporter delivery

Background: There is increasing interest in developing peer-led and 'expert patient'-type interventions, particularly to meet the support and informational needs of those with long term conditions, leading to improved clinical outcomes, and pressure relief on mainstream health services. There is also increasing interest in telephone support, due to its greater accessibility and potential availability than face to face provided support. The evidence base for peer telephone interventions is relatively weak, although such services are widely available as support lines provided by user groups and other charitable services. Methods/Design: In a 3-arm RCT, participants are allocated to either an intervention group with Telecare service provided by a Diabetes Specialist Nurse (DSN), an intervention group with service provided by a peer supporter (also living with diabetes), or a control group receiving routine care only. All supporters underwent a 2-day training in motivational interviewing, empowerment and active listening skills to provide telephone support over a period of up to 6 months to adults with poorly controlled type 2 diabetes who had been recommended a change in diabetes management (i.e. medication and/or lifestyle changes) by their general practitioner (GP). The primary outcome is self-efficacy; secondary outcomes include HbA1c, total and HDL cholesterol, blood pressure, body mass index, and adherence to treatment. 375 participants (125 in each arm) were sought from GP practices across West Midlands, to detect a difference in self-efficacy scores with an effect size of 0.35, 80% power, and 5% significance level. Adults living with type 2 diabetes, with an HbA1c > 8% and not taking insulin were initially eligible. A protocol change 10 months into the recruitment resulted in a change of eligibility by reducing HbA1c to > 7.4%. Several qualitative studies are being conducted alongside the main RCT to describe patient, telecare supporter and practice nurse experience of the trial. Discussion and implications of the research: With its focus on self-management and telephone peer support, the intervention being trialled has the potential to support improved self-efficacy and patient experience, improved clinical outcomes and a reduction in diabetes-related complications

A model for continuous monitoring of patients with major depression in short and long term periods

The final publication is available at IOS Press through http://dx.doi.org/10.3233/THC-161289BACKGROUND AND OBJECTIVE: Major depressive disorder causes more human suffering than any other disease affecting humankind. It has a high prevalence and it is predicted that it will be among the three leading causes of disease burden by 2030. The prevalence of depression, all of its social and personal costs, and its recurrent characteristics, put heavy constraints on the ability of the public healthcare system to provide sufficient support for patients with depression. In this research, a model for continuous monitoring and tracking of depression in both short-term and long-term periods is presented. This model is based on a new qualitative reasoning approach. METHOD: This paper describes the patient assessment unit of a major depression monitoring system that has three modules: a patient progress module, based on a qualitative reasoning model; an analysis module, based on expert knowledge and a rules-based system; and the communication module. These modules base their reasoning mainly on data of the patient's mood and life events that are obtained from the patient's responses to specific questionnaires (PHQ-9, M.I.N.I. and Brugha). The patient assessment unit provides synthetic and useful information for both patients and physicians, keeps them informed of the progress of patients, and alerts them in the case of necessity. RESULTS: A set of hypothetical patients has been defined based on clinically possible cases in order to perform a complete scenario evaluation. The results that have been verified by psychiatrists suggest the utility of the platform. CONCLUSION: The proposed major depression monitoring system takes advantage of current technologies and facilitates more frequent follow-up of the progress of patients during their home stay after being diagnosed with depression by a psychiatrist.Peer ReviewedPostprint (author's final draft