1,720,973 research outputs found
How many patient deaths can a team cope with?
No full textHow many patient deaths the teams at palliative care units can cope with, the supporting factors in coping and the future prospects of the teams have not yet been subject to research in Germany. The aim of the study was to assess burden factors, burden symptoms and protective factors, the critical number and distribution of patient deaths as well as the prospects of the teams. A total of 873 members of palliative care teams from 95 (60% of n=158) German palliative care units took part in this explorative evaluation. Basic factors could be identified using factor analysis. Differences between professional groups were checked with analysis of variance. Results showed that not having reached the objectives of palliative care was the central burden factor. In the majority of cases a team reacted by being loquacious. The team itself was ranked as the most important protective factor. The mean critical number of deaths was 4.4 per week. Consecutive patient deaths were rated as being significantly more stressful than evenly spread deaths. Ratings for the future prospects of the team were significantly lower in teams where not meeting the objectives of palliative care was considered a high burden factor. A clearer definition of the objectives of palliative care and support of team communication are desirable
Evaluation of the Clinical Effectiveness of Physiotherapeutic Management of Lymphoedema in Palliative Care Patients
No full textLymphoedema is a common sequela of cancer or its treatment that affects lymph node drainage. The physiotherapist, as member of the multiprofessional team in palliative care, is one of the keys to successful rehabilitation and management of patients with cancer and non-malignant motoneuron disease such as amyotrophic lateral sclerosis and palliative care needs. The aim of the study was to evaluate the frequency and effect of manual lymphatic drainage in palliative care patients with lymphoedema in a far advanced stage of their disease. Retrospective study (reflexive control design) of data of the 208 patients admitted to our palliative care unit from January 2007 to December 2007. Demographic and disease-related data (diagnosis, symptoms, Karnofsky performance status and effect of manual lymphatic drainage interventions) were documented and compared. Statistics: mean +/- SD, median; Wilcoxon's test. Of the 208 patients, 90 who reported symptom load due to lymphoedema were included; 67 (74.4%) had pain, 23 (25.6%) dyspnoea due to progredient trunk oedema. Mean age 65.5 +/- 13.0 years; 33 (36.7%) male; Karnofsky index 50% (30-80%), mean length of stay 15.6 +/- 8.0 days. The mean number of physiotherapeutic treatment interventions was 7.0 +/- 5.8. Manual lymphatic drainage was well tolerated in 83 (92.2%) patients; 63 of 67 (94.0%) patients showed a clinically relevant improvement in pain, and 17 of 23 (73.9%) in dyspnoea. The majority of the patients showed a clinical improvement in the intensity of symptoms after manual lymphatic drainage
Konzeptabhängige und -unabhängige Versorgungseffekte standortspezifischer palliativer Versorgungskonzepte am Beispiel "Schmerz"
Get PDFHintergrund: An zwei Standorten wurden die palliativen Versorgungsstrukturen, sektorenübergreifenden Übergänge und Verlaufswege von Patienten mit einem palliativen Versorgungsbedarf untersucht. Der systematische Vergleich von Gemeinsamkeiten und Unterschieden anhand der exemplarischen Fokussierung auf den Themenkomplex „Schmerz“ soll Auskunft darüber geben, inwiefern diese mit standortspezifischen Palliativversorgungskonzepten (integriert und kooperativ)
zusammenhängen.
Methodik: Die Studie verfolgt ein Mixed-methods-Design. Neben einer Dokumentenanalyse von anonymisierten Patientenakten (n= 774) wurden Experteninterviews (n= 20), Interviews mit Patienten und Angehörigen (n= 60) sowie Fokusgruppen (n= 12) durchgeführt.
Ergebnisse: Die systematische vergleichende Analyse liefert Hinweise auf konzeptunabhängige Gemeinsamkeiten (z. B. soziodemografische Verteilungen, erschwerte medikamentöse Schmerzbehandlung aufgrund rechtlicher Rahmenbedingungen) wie auch konzeptabhängige Unterschiede (z. B. Verlaufswege, erleichterte kontinuierliche Symptomkontrolle durch integrierte Versorgungsstrukturen) im Rahmen integrierter oder kooperativer Palliativversorgung.
Diskussion: Gemeinsamkeiten und Unterschiede hinsichtlich der hier fokussierten Schmerzthematik bzw. der im Raum stehenden Symptomlast und ihre organisatorische Bearbeitung werden als Effekte der jeweiligen Organisationsstruktur (= konzeptabgängig) sowie konzeptunabhängiger äußerer Einflussfaktoren greifbar
Volunteers in Palliative Care - A Comparison of Seven European Countries: A Descriptive Study
No full textItem does not contain fulltextOBJECTIVE: In Europe, volunteers have an important role in the delivery of palliative care. As part of the EU co-funded Europall project, 4 aspects of volunteering in palliative care were studied for 7 European countries (Belgium, England, France, Germany, the Netherlands, Poland, and Spain). These included (1) involvement of volunteers in palliative care, (2) organization of palliative care volunteering, (3) legal regulations concerning volunteering, and (4) education and training of palliative care volunteering. DESIGN/SETTING/METHODS: A literature search combined with an interview study. Information from the scientific literature, and country-specific policy documents were obtained and completed, along with data of consecutive semi-structured interviews with experts in the field of palliative care in the participating countries. RESULTS: In all countries, volunteers appeared to be involved in palliative care, yet their involvement across health care settings differed per country. England, for example, has the highest number of volunteers whereas Spain has the lowest number. Volunteering is embedded in law and regulations in all participating countries except for England and the Netherlands. In all participating countries, training programs are available and volunteers are organized, both on a national and a regional level. CONCLUSION: This study provides a descriptive overview of volunteer work in palliative care in 7 European countries, with a focus on the organizational aspects. Further research should concentrate on the roles and responsibilities of volunteers in the care for the terminally ill in different European health systems
"He is not that important anymore" : General practitioners in a specialized palliative home care setting from a patient's point of view
No full textBACKGROUND: The outpatient medical care of palliative patients (PPs) has always fallen within the duties of general practitioners. Since the specialized palliative out-patient care (SAPV) legislation in 2007 palliative home care teams (PCTs) were established, providing holistic medical, nursing, and psychosocial support for patients with life-limiting illness and their care providers. OBJECTIVES: The article explores the role of GPs in palliative home care settings with PCTs from the patient's perspective. MATERIALS AND METHODS: From December 2014 to January 2015 we conducted 23 qualitative, semi-structured interviews with severely ill patients receiving specialist palliative care at home in Germany. The theory-based analysis followed the qualitative content analysis according to Mayring. RESULTS: The expectations of PPs towards their GP in integrated palliative care were influenced by individual criteria such as availability, intensity and duration of the doctor-patient-relationship. In relation to the quality of the long-term relationship and more specifically for basic medical care GPs still play an important role. On the other hand, PCTs are becoming increasingly important. In addition to the pain-management and symptom control responsibilities, they meet the daily care needs of PPs and their caregivers by coordinating the care network as well as providing psychosocial support and 24/7-care. CONCLUSIONS: Shifting of traditional tasks from GPs to PCTs influences the role of the GP. PCTs can unburden the GP from unrealistic expectations and improve the patients' quality of life. However, this leads to a tendency for reduced importance of the GP
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Comparison of legislation, regulations and national health strategies for palliative care in seven European countries (Results from the Europall Research Group): a descriptive study
No full textBACKGROUND: According to EU policy, anyone in need of palliative care should be able to have access to it. It is therefore important to investigate which palliative care topics are subject to legislation and regulations in Europe and how these are implemented in (national) health care plans. This paper aims to deliver a structured overview of the legislation, existing regulations and the different health care policies regarding palliative care in seven European countries. METHODS: In 2008 an inventory of the organisation of palliative care was developed by the researchers of the Europall project. Included were two open questions about legislation, regulations, and health policy in palliative care. This questionnaire was completed using palliative care experts selected from Belgium, England, France, Germany, the Netherlands, Poland and Spain. Additionally, (grey) literature on palliative care health policy and regulations from the participating countries was collected to complete the inventory. Comparative analysis of country specific information was performed afterwards. RESULTS: In all countries palliative care regulations and policies existed (either in laws, royal decrees, or national policies). An explicit right to palliative care was mentioned in the Belgium, French and German law. In addition, access to palliative care was mentioned by all countries, varying from explicit regulations to policy intentions in national plans. Also, all countries had a national policy on palliative care, although sometimes mainly related to national cancer plans. Differences existed in policy regarding palliative care leave, advance directives, national funding, palliative care training, research, opioids and the role of volunteers. CONCLUSIONS: Although all included European countries have policies on palliative care, countries largely differ in the presence of legislation and regulations on palliative care as well as the included topics. European healthcare policy recommendations should support palliative care access across Europe
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
- …
