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Start Over Topic palliative care Publication Year Range Last 10 years
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1. The Comfort Measures Order Set at a Tertiary Care Academic Hospital: Is There a Comparable Difference in End-of-Life Care Between Patients Dying in Acute Care When CMOS Is Utilized?

Author

Lau C, Stilos K, Nowell A, Lau F, Moore J, and Wynnychuk L

Subjects
Aged, Critical Care methods, Female, Humans, Male, Middle Aged, Patient Care Team organization & administration, Professional-Patient Relations, Retrospective Studies, Tertiary Healthcare, Organizational Innovation, Palliative Care methods, Patient Comfort methods, Spirituality, Terminal Care methods
Abstract

Background: Standardized protocols have been previously shown to be helpful in managing end-of-life (EOL) care in hospital. The comfort measures order set (CMOS), a standardized framework for assessing imminently dying patients' symptoms and needs, was implemented at a tertiary academic hospital., Objective: We assessed whether there were comparable differences in the care of a dying patient when the CMOS was utilized and when it was not., Methods: A retrospective chart review was completed on patients admitted under oncology and general internal medicine, who were referred to the inpatient palliative care team for "EOL care" between February 2015 and March 2016., Results: Of 83 patients, 56 (67%) received intiation of the CMOS and 27 (33%) did not for EOL care. There was significant involvement of spiritual care with the CMOS (66%), as compared to the group without CMOS (19%), P < .05. The use of CMOS resulted in 1.7 adjustments to symptom management per patient by palliative care, which was significantly less than the number of symptom management adjustments per patient when CMOS was not used (3.3), P < .05. However, initiating CMOS did not result in a signficant difference in patient distress around the time of death ( P = .11). Dyspnea was the most frequently identified symptom causing distress in actively dying patients., Conclusions: Implementation of the CMOS is helpful in providing a foundation to a comfort approach in imminently dying patients. However, more education on its utility as a framework for EOL care and assessment across the organization is still required.

Published
2018
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2. Interventions and decision-making at the end of life: the effect of establishing the terminal illness situation

Author

Rafael Montoya-Juárez, María Paz García-Caro, E. Hernández-López, César Hueso-Montoro, F. Ojeda-Virto, C. Campos-Calderón, [Campos-Calderón,C] Foundation of Progress and Health, Andalusian Health Service, Granada, Spain. [Montoya-Juárez,R, Hueso-Montoro,C, García-Caro,MP] Nursing Department, University of Granada, Granada, Spain. [Hernández-López,E] General Hospital of the Virgen de las Nieves of Granada, Andalusian Health Service, Granada, Spain. [Ojeda-Virto,F] Hospital Santa Ana, Andalusian Health Service, Motril, Spain., and This work is part of an investigative project financed by the Department of Health of the Board of Andalucía in its 2010 call for papers, titled ‘Variability of Clinical Practice and Conditional Factors in the Implementation of the Processes of Attention at End of Life’.Ref: PI-0670-2010.

Subjects
Palliative care, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Case-Control Studies::Retrospective Studies [Medical Subject Headings], medicine.medical_treatment, España, Psychological intervention, Chemicals and Drugs::Inorganic Chemicals::Elements::Chalcogens::Oxygen [Medical Subject Headings], Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings], 0302 clinical medicine, Oxygen therapy, Medicine, Analgésicos opioides, Oxígeno, 030212 general & internal medicine, Patient Comfort, Practice Patterns, Physicians', Resuscitation Orders, Health Care::Health Care Facilities, Manpower, and Services::Health Facilities::Hospitals [Medical Subject Headings], Geographicals::Geographic Locations::Europe::Spain [Medical Subject Headings], Medicine(all), Terminal Care, Palliative Care, Do not resuscitate, Symptom management, General Medicine, Prognosis, Hospitals, Humanos, End-of-life care, Teaching/learning strategies, 030220 oncology & carcinogenesis, Peripheral venous catheter, Hospitales, Research Article, medicine.medical_specialty, Clinical Decision-Making, education, M-learning, Prescripciones, Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Physiological Effects of Drugs::Peripheral Nervous System Agents::Sensory System Agents::Analgesics::Analgesics, Opioid [Medical Subject Headings], Advance Care Planning, Estudios retrospectivos, 03 medical and health sciences, Humans, Terminally Ill, Medical prescription, Órdenes de resucitación, Intensive care medicine, Retrospective Studies, Delivery of care, Hospital care, business.industry, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Emergency Treatment::Resuscitation::Resuscitation Orders [Medical Subject Headings], Andalucía, Retrospective cohort study, Spain, business, Decision making, Physical therapy, Health Care::Health Care Facilities, Manpower, and Services::Health Services::Pharmaceutical Services::Prescriptions [Medical Subject Headings]
Abstract

Background: Mobile learning (m-learning) has becoming very popular in education due to the rapidly advancing technology in our society. The potentials of the mobile applications should be used to enhance the education process. Few mobile applications have been designed to complement the study of physical therapy skills for physiotherapy students. The aim of this study was to investigate whether a mobile application, as a supplement to traditional learning, is useful for physiotherapy students in the acquisition of palpation and ultrasound skills in the shoulder area. Methods: Forty-nine students participated in this single-blinded, randomized controlled study. They were randomly distributed into two groups: experimental, with free access to the mobile application; and control, with access to traditional learning materials on the topic. Objective structured clinical evaluation (OSCE) and multiple-choice questionnaire (MCQ) were used to assess the educational intervention. Then, we also assessed the time taken to get a reliable ultrasound image and to localize a specific shoulder structure by palpation. Results: There was no significant intergroup difference in the acquisition of theoretical knowledge (p = .089). Scores were significantly higher in the experimental group than in the control group for the majority items in the ultrasound assessment; positioning of patient (p < .001), positioning of ultrasound probe (p = 0.007), handling of ultrasound probe (p = .013) and global OSCE (p < .001) and skills in palpation of the shoulder; position of patient (p = .009), direction of palpation contact (p = .021) and global OSCE (p = .034). There were no significant differences in the time required to perform the examination between groups in ultrasound (p = .944) and palpation (p = .393). The results from the post-program survey assessing the global satisfaction with the mobile application were high (8.200 ± .767), on an 11 numeric point rating scale. Conclusion: These results suggest the effectiveness of an m-learning program as a complement to traditional education for developing skills in ultrasound and palpation of the shoulder region in undergraduate physiotherapy students., The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by a grant from the Educational Innovation Unit of the University of Granada, Spain (PID 13–86).

Published
2016