What is case management in palliative care? An expert panel study

Contains fulltext : 110207.pdf (publisher's version ) (Open Access)ABSTRACT: BACKGROUND: Case management is a heterogeneous concept of care that consists of assessment, planning, implementing, coordinating, monitoring, and evaluating the options and services required to meet the client's health and service needs. This paper describes the result of an expert panel procedure to gain insight into the aims and characteristics of case management in palliative care in the Netherlands. METHODS: A modified version of the RAND(R)/University of California at Los Angeles (UCLA) appropriateness method was used to formulate and rate a list of aims and characteristics of case management in palliative care. A total of 76 health care professionals, researchers and policy makers were invited to join the expert panel, of which 61% participated in at least one round. RESULTS: Nine out of ten aims of case management were met with agreement. The most important areas of disagreement with regard to characteristics of case management were hands-on nursing care by the case manager, target group of case management, performance of other tasks besides case management and accessibility of the case manager. CONCLUSIONS: Although aims are agreed upon, case management in palliative care shows a high level of variability in implementation choices. Case management should aim at maintaining continuity of care to ensure that patients and those close to them experience care as personalised, coherent and consistent

The evolution of health policy guidelines for assisted reproduction in the Republic of Ireland, 2004-2009

This analysis reports on Irish regulatory policies for in vitro fertilisation (IVF) from 2004-2009, in the context of membership changes within the Medical Council of Ireland. To achieve this, the current (2009) edition of the Guide to Professional Conduct & Ethics was compared with the immediately preceding version (2004). The statutory composition of the Medical Council from 2004-2009 was also studied. Content analysis of the two editions identified the following differences: 1) The 2004 guide states that IVF "should only be used after thorough investigation has failed to reveal a treatable cause of the infertility", while the 2009 guide indicates IVF "should only be used after thorough investigation has shown that no other treatment is likely to be effective"; 2) The 2004 stipulation stating that fertilized ovum (embryo) "must be used for normal implantation and must not be deliberately destroyed" is absent from the 2009 guidelines; 3) The option to donate "unused fertilised ova" (embryos) is omitted from the 2009 guidelines; 4) The 2009 guidelines state that ART should be offered only by "suitably qualified professionals, in appropriate facilities, and according to the international best practice"; 5) The 2009 guidelines introduce criteria that donations as part of a donor programme should be "altruistic and non-commercial". These last two points represent original regulatory efforts not appearing in the 2004 edition. The Medical Practitioners Act 2007 reduced the number of physicians on the Medical Council to 6 (of 25) members. The ethical guidelines from 2004 preceded this change, while the reconstituted Medical Council published the 2009 version. Between 2004 and 2009, substantial modifications in reproductive health policy were incorporated into the Medical Council's ethical guidelines. The absence of controlling Irish legislation means that patients and IVF providers in Ireland must rely upon these guidelines by default. Our critique traces the evolution of public policy on IVF during a time when the membership of the Medical Council changed radically; reduced physician contribution to decision-making was associated with diminished protection for IVF-derived embryos in Ireland. Considerable uncertainty on IVF practice in Ireland remains

Recipient screening in IVF: First data from women undergoing anonymous oocyte donation in Dublin

BACKGROUND: Guidelines for safe gamete donation have emphasised donor screening, although none exist specifically for testing oocyte recipients. Pre-treatment assessment of anonymous donor oocyte IVF treatment in Ireland must comply with the European Union Tissues and Cells Directive (Directive 2004/23/EC). To determine the effectiveness of this Directive when applied to anonymous oocyte recipients in IVF, we reviewed data derived from selected screening tests performed in this clinical setting. METHODS: Data from tests conducted at baseline for all women enrolling as recipients (n = 225) in the anonymous oocyte donor IVF programme at an urban IVF referral centre during a 24-month period were analysed. Patient age at programme entry and clinical pregnancy rate were also tabulated. All recipients had at least one prior negative test for HIV, Hepatitis B/C, chlamydia, gonorrhoea and syphilis performed by her GP or other primary care provider before reproductive endocrinology consultation. RESULTS: Mean (±SD) age for donor egg IVF recipients was 40.7 ± 4.2 yrs. No baseline positive chlamydia, gonorrhoea or syphilis screening results were identified among recipients for anonymous oocyte donation IVF during the assessment interval. Mean pregnancy rate (per embryo transfer) in this group was 50.5%. CONCLUSION: When tests for HIV, Hepatitis B/C, chlamydia, gonorrhoea and syphilis already have been confirmed to be negative before starting the anonymous donor oocyte IVF sequence, additional (repeat) testing on the recipient contributes no new clinical information that would influence treatment in this setting. Patient safety does not appear to be enhanced by application of Directive 2004/23/EC to recipients of anonymous donor oocyte IVF treatment. Given the absence of evidence to quantify risk, this practice is difficult to justify when applied to this low-risk population

Measuring the coherence of healthy and aphasic discourse production in Chinese using Rhetorical Structure Theory (RST)

INTRODUCTION: Discourse coherence refers to the semantic connectedness of propositions in a connected speech. Various theoretical bases, narrative elicitation tasks, and sample quantifications as well as small sample sizes in most studies resulted in a substantial disparity in findings regarding the micro-linguistic and macro-linguistic aspects of aphasic discourse (Armstrong, 2000). Specifically, while some reports claimed macro-linguistic skills in aphasia to be well-preserved despite lexical, grammatical, and phonological impairments, other studies demonstrated reduced discourse coherence due to omission of important content and higher proportion of irrelevant propositions. In this study we analyzed the discourse structure in aphasic ...postprin

Sexual Abuse-Current Medico-legal, Forensic and Psychiatric Aspects

Abstract Violence against women and minors is a worldwide problem that has not yet been sufficiently acknowledged. There are many obstacles especially when sexual abuses have to be evaluated. These problems are present both when victims of sexual abuse are evaluated and when sex offenders are dealt with, especially when the offenders are juvenile sex offenders (JSO). These issues give cause for great concern about prognosis, and the resulting psychosocial implications, and call for a special effort from the scientific community in identifying appropriate prevention and treatment methods. This chapter is divided into two parts. The first part deals with the forensic and psychiatric features, such as diagnostic and therapeutic/rehabilitative strategies for JSO, while the second part analyzes the legal–medicine aspects related to rape/sexual assault in a European context

Paleoseismology of a major crustal seismogenic source near Mexico City. The southern border of the Acambay Graben

The Trans-Mexican Volcanic Belt is an active continental volcanic arc related to subduction along the Middle America trench. It is characterized by intra-arc extension resulting into several major arc-parallel active fault systems and tectonic basins. The Acambay graben, one of the largest of these basins, is located near Mexico City, in the central part of this province. In 1912, a M 6.9 earthquake ruptured the surface along the northern border of the graben together with at least two other faults. In this paper, we analyze the paleoseismic history of the southern border of the Acambay Graben, with new observations made in one natural outcrop and four paleoseismological trenches excavated across branches of the Venta de Bravo Fault at the site where it overlaps with the Pastores Fault. We present evidence of at least two paleo-earthquakes that occurred between 12,190 +/- 175 and 5,822 +/- 87 cal year BP and between 647 +/- 77 and 250 cal year BP. On one of these branches, we estimate a minimum slip-rate value between 0.1 and 0.23 mm/year for the last 12 ka and a mean recurrence interval of 8.5 +/- 3 ka. By considering several likely rupture lengths along the Venta de Bravo and Pastores faults, we calculated a maximum possible magnitude of M-w 7.01 +/- 0.27. Finally, by correlating events recorded along different faults within the Acambay Graben, we discuss several possible rupture coalescent scenarios and related consequences for Mexico City

Chemical Nonequilibrium in High Energy Nuclear Collisions

Strange particles produced in S-Au/W/Pb 200 A GeV and Pb-Pb 158 A GeV reactions are described invoking final hadronic phase space in thermal equilibrium, but allowing chemical non-equilibrium. Several sets of statistical freeze-out parameters are obtained for each system, invoking different models of dense matter. We show that only when allowing for strange and non-strange flavor abundance non-equilibrium, a statistically significant description of the experimental results is obtained. Physical properties of the fireball at chemical freeze-out condition are evaluated and considerable universality of hadron freeze-out between the two different collision systems is established. The relevance of the Coulomb effect in the highly charged Pb-Pb fireballs for the chemical analysis are discussed. The influence of explosive collective matter flow is also described.Comment: Presented at the International Conference Strangeness in Quark Matter held in Padova, July 1998 To appear in: Journal of Physics G 16 pages incl. one figure; v2: minor typos correcte

Do buprenorphine doses and ratios matter in medication assisted treatment adherence?

Introduction: Buprenorphine (BUP), generally prescribed as buprenorphine/naloxone, is a key component of medication-assisted treatment (MAT) to manage opioid use disorder. Studies suggest higher doses of BUP increase treatment adherence. Routine urine drug screens (UDS) assist in monitoring MAT adherence via measurement of excreted BUP and its metabolite, norbuprenorphine (NBP). The clinical significance between BUP/NBP concentrations and their ratios for assessing adherence and substance use is not well-described. Methods: We conducted a single-center, retrospective chart review of 195 clients age ≥18 years enrolled in a local MAT program from August 2017 to February 2021. Demographics, BUP doses, prescription history, and UDS results were collected. Participants were divided based on MAT adherence (<80% vs ≥80%) and median total daily dose (TDD) of BUP (≥16 mg vs <16 mg) in addition to pre- and post-COVID-19 cohorts. Results: Median BUP/NBP urinary concentrations were significantly correlated with MAT adherence (P < .0001 for each) and a reduced percentage of positive UDS for opioids (P = .0004 and P < .0001, respectively) but not their ratios. Median TDD of BUP ≥16 mg (n = 126) vs <16 mg (n = 68) was not correlated with MAT adherence (P = .107) or incidence of nonprescription use (P = .117). A significantly higher incidence of UDS positive for opiates (P = .049) and alcohol (P = .035) was observed post-COVID-19. Discussion: Clients appearing adherent to MAT who had higher concentrations of urinary BUP/NBP demonstrated a reduced incidence of opioid-positive UDS independent of the BUP dose prescribed. An increase in opioid- and alcohol-positive UDSs were observed during the COVID-19 pandemic

Survey of prescriptive authority among psychiatric pharmacists in the United States

Introduction: Despite the high prevalence of those with mental illnesses, there is a critical shortage of psychiatric providers in the United States. Psychiatric pharmacists are valuable members of the health care team who meet patient care needs, especially those practicing with prescriptive authority (PA). Methods: A cross-sectional electronic survey was administered to Board Certified Psychiatric Pharmacists (BCPPs) and non-BCPP members of the College of Psychiatric and Neurologic Pharmacists. The objective of this study was to compare demographic and practice characteristics between respondents with and without PA. Results: Of the 334 respondents, 155 (46.4%) reported having PA. Those with PA, including those with Veterans Affairs (VA) affiliated PA, had fewer mean number of years of licensure than those without PA (P =.008 and P =.007, respectively). The majority with PA practiced in outpatient settings (53.5%). Respondents with PA (including those with VA-affiliated PA) were more likely to have their positions funded by practice sites (P <.001). The most common referral source for medication management for those with PA were physicians although pharmacists also provided referrals in both VA and non-VA settings. Pharmacists with PA were more likely to track practice outcomes versus those without PA (P<.001). Discussion: The current study confirms the variability in PA among psychiatric pharmacists. Demographics of the respondents reflect changes in residency accreditation and increased numbers of psychiatric residencies within VA facilities. Psychiatric pharmacists with PA reported treating psychiatric and medical conditions, creating added value. Psychiatric pharmacists should be empowered to track outcomes and help meet the critical shortage of psychiatric providers