The impact of Nursing Homes staff education on end-of-life care in residents with advanced dementia: a quality improvement study

Context. End-of-life care in nursing homes (NHs) needs improvement. We carried out a study in 29 NHs in the Lombardy Region (Italy).Objectives. The objective of this study was to compare end-of-life care in NH residents with advanced dementia before and after an educational intervention aimed to improving palliative care.Methods. The intervention consisted of a seven-hour lecture, followed by two 3-hour meetings consisting of case discussions. The intervention was held in each NH and well attended by NH staff. This multicenter, comparative, observational study included up to 20 residents with advanced dementia from each NH: the last 10 who died before the intervention (preintervention group, 245 residents) and the first 10 who died at least three months after the intervention (postintervention group, 237 residents). Data for these residents were collected from records for 60 days and seven days before death.Results. The use of "comfort hydration" (< 1000 mL/day subcutaneously) tended to increase from 16.9% to 26.8% in the postintervention group. The number of residents receiving a palliative approach for nutrition and hydration increased, though not significantly, from 24% preintervention to 31.5% postintervention. On the other hand, the proportion of tube-fed residents and residents receiving intravenous hydration decreased from 15.5% to 10.5%, and from 52% to 42%, respectively. Cardiopulmonary resuscitations decreased also from 52/245 (21%) to 18/237 (7.6%) cases (P = 0.002).Conclusion. The short educational intervention modified some practices relevant to the quality of end-of-life care of advanced dementia patients in NHs, possibly raising and reinforcing beliefs and attitudes already largely present. (C) 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved

The last week of life of nursing home residents with advanced dementia: a retrospective study

Background Barriers to palliative care still exist in long-term care settings for older people, which can mean that people with advanced dementia may not receive of adequate palliative care in the last days of their life; instead, they may be exposed to aggressive and/or inappropriate treatments. The aim of this multicentre study was to assess the clinical interventions and care at end of life in a cohort of nursing home (NH) residents with advanced dementia in a large Italian region. Methods This retrospective study included a convenience sample of 29 NHs in the Lombardy Region. Data were collected from the clinical records of 482 residents with advanced dementia, who had resided in the NH for at least 6 months before death, mainly focusing on the 7 days before death. Results Most residents (97.1%) died in the NH. In the 7 days before death, 20% were fed and hydrated by mouth, and 13.4% were tube fed. A median of five, often inappropriate, drugs were prescribed. Fifty-seven percent of residents had an acknowledgement of worsening condition recorded in their clinical records, a median of 4 days before death. Conclusions Full implementation of palliative care was not achieved in our study, possibly due to insufficient acknowledgement of the appropriateness of some drugs and interventions, and health professionals' lack of implementation of palliative interventions. Future studies should focus on how to improve care for NH residents

La terapia del dolore: orientamenti bioetici

1. Il contesto sanitario e culturale Il documento del Comitato Nazionale per la Bioetica La terapia del dolore: orientamenti bioetici porta la data del 30 marzo 2001, nella quale è stato approvato in seduta plenaria. Il tema si collocava all’interno di una riflessione più ampia relativa ai problemi etici correlati con la cura e l’assistenza nella fase terminale della vita, comprendente anche lo stato vegetativo persistente e le direttive anticipate. Il sottogruppo che si è concentrato sulla t..

Medical professionalism e costruzione dell'identità professionale negli studenti di medicina. Riflessioni e proposte didattiche per la formazione in Italia

Il tema della professionalità medica, o medical professionalism, da anni è presente nel contesto internazionale, ma in Italia non ha ancora un testo di riferimento per l’insegnamento universitario. I Corsi di laurea in Medicina e Chirurgia italiani stanno dedicando un’attenzione crescente ai temi della buona comunicazione medico-paziente, alle medical humanities, ai temi eticamente sensibili, nonché alle dimensioni socioeconomiche della professione medica. Il volume curato da Montagna e Consorti è il primo che riunisce e analizza le diverse componenti di un costrutto così complesso come quello del medical professionalism e – ancora di più – della nascente identità professionale medica negli studenti. Si tratta, quindi, di una prospettiva innovativa, da anni presente nella letteratura internazionale, e che trova in questo manuale il suo spazio, insieme a molte indicazioni di metodo didattico. Il libro, nascendo dalla passione per l’insegnamento, dall’interesse profondo verso l’educazione medica e dalla curiosità di confrontarsi sempre con la letteratura internazionale più recente, è pensato sia come un manuale di studio e di approfondimento per gli studenti di medicina, sia come uno strumento didattico per i docenti