Communication of palliative care needs in discharge letters from hospice providers to primary care : a multisite sequential explanatory mixed methods study

Background The provision of palliative care is increasing, with many people dying in community-based settings. It is essential that communication is effective if and when patients transition from hospice to community palliative care. Past research has indicated that communication issues are prevalent during hospital discharges, but little is known about hospice discharges. Methods An explanatory sequential mixed methods study consisting of a retrospective review of hospice discharge letters, followed by hospice focus groups, to explore patterns in communication of palliative care needs of discharged patients and describe why these patients were being discharged. Discharge letters were extracted for key content information using a standardised form. Letters were then examined for language patterns using a linguistic methodology termed corpus linguistics. Thematic analysis was used to analyse the focus group transcripts. Findings were triangulated to develop an explanatory understanding of discharge communication from hospice care. Results We sampled 250 discharge letters from five UK hospices whereby patients had been discharged to primary care. Twenty-five staff took part in focus groups. The main reasons for discharge extracted from the letters were symptoms “managed/resolved” (75.2%), and/or the “patient wishes to die/for care at home” (37.2%). Most patients had some form of physical needs documented on the letters (98.4%) but spiritual needs were rarely documented (2.4%). Psychological/emotional needs and social needs were documented in 46.4 and 35.6% of letters respectively. There was sometimes ambiguity in “who” will be following up “what” in the discharge letters, and whether described patients’ needs were resolved or ongoing for managing in the community setting. The extent to which patients received a copy of their discharge letter varied. Focus groups conveyed a lack of consensus on what constitutes “complexity” and “complex pain”. Conclusions The content and structure of discharge letters varied between hospices, although generally focused on physical needs. Our study provides insights into patterns associated with those discharged from hospice, and how policy and guidance in this area may be improved, such as greater consistency of sharing letters with patients. A patient-centred set of hospice-specific discharge letter principles could help improve future practice

The good student is more than a listener the 12+1 roles of the medical student

Background: The process of medical education, particularly in the fast evolving new era of medical metaschools, is a broad and complex issue. Harden & Crosby claimed that a good teacher is more than a lecturer, and identified 12 roles that certify a good and capable teacher. However, this is only half the truth: the good student is more than a listener. Teaching-and-learning is not simply a one-way process, and, as medical students are not children, the relationship between teacher and students involves andragogy rather than pedagogy. We therefore propose the 12+1 roles of the student. Summary of work: The Harden & Crosby paper was distributed in a class of 90 third year Ioannina University medical students, who were asked to think about the student's roles. A small discussion group brainstormed ideas, which were then refined further by the authors. Summary of results: 12+1 roles of the good medical student were produced and grouped into six areas: information receiver, in lectures and clinical context; role model in learning, in class, with the added subarea of comparative choice of role models; teaching facilitator and teacher's mentor; teacher's assessor and curriculum evaluator; active participator and keeping-up with curriculum; resource consumer/co-creator and medical literature researcher. The ideal student should fulfil the majority if not all of these complementary roles. Take-home message: These 12+1 student's roles are complementary to the 12 roles of the teacher and help reshaping our understanding of today's medical education process. © 2012 Informa UK Ltd All rights reserved

Predictive and prescriptive analytics for location selection of add‐on retail products

In this paper, we study an analytical approach to selecting expansion locations for retailers selling add-on products whose demand is derived from the demand of another base product. Demand for the add-on product is realized only as a supplement to the demand of the base product. In our context, either of the two products could be subject to spatial autocorrelation where demand at a given location is impacted by demand at other locations. Using data from an industrial partner selling add-on products, we build predictive models for understanding the derived demand of the add-on product and establish an optimization framework for automating expansion decisions to maximize expected sales. Interestingly, spatial autocorrelation and the complexity of the predictive model impact the complexity and the structure of the prescriptive optimization model. Our results indicate that the models formulated are highly effective in predicting add-on product sales, and that using the optimization framework built on the predictive model can result in substantial increases in expected sales over baseline policies.Comment: 29 pages, 3 figure