49 research outputs found
Factors associated with smoking in low-income persons with and without chronic illness
INTRODUCTION Tobacco disparities persist among low-income smokers who seek care from safety-net clinics. Many of these patients suffer from chronic illnesses (CILs) that are associated with and exacerbated by smoking. The objective of the current study was to examine the differences between safety-net patients with and without CILs in terms of nicotine dependence and related factors (such as depression, anxiety) and self-efficacy regarding ability to abstain from smoking. METHODS Sixty-four low-income smokers who thought about or intended to quit smoking were recruited from the San Francisco Health Network (SFHN) and assessed for CILs, nicotine dependence, depression, anxiety, and smoking abstinence self-efficacy. Four one-way analyses of variance were used to examine the difference between those with and without CIL on the latter four variables. RESULTS The CIL group had significantly higher anxiety (CIL: 8.0 ± 5.35; non-CIL: 4.44 ± 3.48; p=0.02) and tended to have higher nicotine dependence (CIL: 5.40 ± 2.58; non-CIL: 3.88 ± 2.28; p=0.04). In the CIL group, nicotine dependence was positively correlated with anxiety [r(62)=0.39; p\u3c0.01] and negatively correlated with smoking abstinence self-efficacy [r(62)= -0.38; p\u3c0.01]. Both depression (Spearmanâs rho=0.39; p\u3c0.01) and anxiety (Spearmanâs rho=0.29; p\u3c0.05) were associated with total number of CIL categories. CONCLUSIONS Safety-net patients who smoke and suffer from CILs may be suffering from higher levels of anxiety and have less confidence in their ability to quit smoking. Incorporating mood management and developing interventions that increase a sense of self-efficacy for refraining from smoking may be necessary to help low-income smokers quit smoking
Results From a Survey of American Geriatrics Society Membersâ Views on PhysicianâAssisted Suicide
Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152741/1/jgs16245_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/152741/2/jgs16245-sup-0001-Supinfo.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/152741/3/jgs16245.pd
Implementing goals of care conversations with veterans in VA long-term care setting: a mixed methods protocol
Abstract
Background
The program âImplementing Goals of Care Conversations with Veterans in VA LTC Settingsâ is proposed in partnership with the US Veterans Health Administration (VA) National Center for Ethics in Health Care and the Geriatrics and Extended Care Program Offices, together with the VA Office of Nursing Services. The three projects in this program are designed to support a new system-wide mandate requiring providers to conduct and systematically record conversations with veterans about their preferences for care, particularly life-sustaining treatments. These treatments include cardiac resuscitation, mechanical ventilation, and other forms of life support. However, veteran preferences for care go beyond whether or not they receive life-sustaining treatments to include issues such as whether or not they want to be hospitalized if they are acutely ill, and what kinds of comfort care they would like to receive.
Methods
Three projects, all focused on improving the provision of veteran-centered care, are proposed. The projects will be conducted in Community Living Centers (VA-owned nursing homes) and VA Home-Based Primary Care programs in five regional networks in the Veterans Health Administration. In all the projects, we will use data from context and barrier and facilitator assessments to design feedback reports for staff to help them understand how well they are meeting the requirement to have conversations with veterans about their preferences and to document them appropriately. We will also use learning collaborativesâmeetings in which staff teams come together and problem-solve issues they encounter in how to get veteransâ preferences expressed and documented, and acted onâto support action planning to improve performance.
Discussion
We will use data over time to track implementation success, measured as the proportions of veterans in Community Living Centers (CLCs) and Home-Based Primary Care (HBPC) who have a documented goals of care conversation soon after admission. We will work with our operational partners to spread approaches that work throughout the Veterans Health Administration.http://deepblue.lib.umich.edu/bitstream/2027.42/134645/1/13012_2016_Article_497.pd
Correction to: Implementing goals of care conversations with veterans in VA long-term care setting: a mixed methods protocol
Correction
The authors would like to correct errors in the original article [1] that may have lead readers to misinterpret the scope, evidence base and target population of VHA Handbook 1004.03 âLife-Sustaining Treatment (LST) Decisions: Eliciting, Documenting, and Honoring Patientsâ Values, Goals, and Preferencesâ.https://deepblue.lib.umich.edu/bitstream/2027.42/142349/1/13012_2018_Article_724.pd