scholarly journals Person‐centred care planning as foundational to clinical practice

2022 ◽  
Vol 21 (1) ◽  
pp. 1-2
Author(s):  
Larry Davidson ◽  
Janis Tondora
Keyword(s):  
Clinical Practice ◽  
Care Planning

An introduction to advance care planning: practice at the frontline

2018 ◽  
Author(s):  
Anjali Mullick ◽  
Jonathan Martin
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Communication Skills ◽  
Advance Care Planning ◽  
Use Case ◽  
Care Planning ◽  
Practical Advice ◽  
Future Care ◽  
Case Vignettes ◽  
Advance Care

Advance care planning (ACP) is a process of formal decision-making that aims to help patients establish decisions about future care that take effect when they lose capacity. In our experience, guidance for clinicians rarely provides detailed practical advice on how it can be successfully carried out in a clinical setting. This may create a barrier to ACP discussions which might otherwise benefit patients, families and professionals. The focus of this paper is on sharing our experience of ACP as clinicians and offering practical tips on elements of ACP, such as triggers for conversations, communication skills, and highlighting the formal aspects that are potentially involved. We use case vignettes to better illustrate the application of ACP in clinical practice.

scholarly journals The Development and Use of Advance Care Planning Aids in Clinical Practice: A Systematic Review (S758)

2014 ◽  
Vol 47 (2) ◽  
pp. 501
Author(s):  
Jessica Reardon ◽  
Anne Schuster ◽  
Matthew Weiss ◽  
Catalina Suarez-Cuervo ◽  
Fabian Johnston ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Advance Care Planning ◽  
Care Planning ◽  
Advance Care

scholarly journals Breast unit and caring, gordon nursing model and NNN taxonomies: the nursing care planning from efficacy in trials to effectiveness in clinical practice

2017 ◽  
Vol 28 ◽  
pp. vi110
Author(s):  
L. Bertocchi ◽  
L. Sambo ◽  
S. Bradaschia ◽  
M. Cimolino ◽  
K.H. Szymska ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Nursing Care ◽  
Care Planning ◽  
Breast Unit

scholarly journals Individualized Clinical Practice Guidelines for Pressure Injury Management: Development of an Integrated Multi-Modal Biomedical Information Resource (Preprint)

2018 ◽  
Author(s):  
Kath M Bogie ◽  
Guo-Qiang Zhang ◽  
Steven K Roggenkamp ◽  
Ningzhou Zeng ◽  
Jacinta Seton ◽  
...  
Keyword(s):  
Risk Factors ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Clinical Practice ◽  
Injury Risk ◽  
Tissue Injury ◽  
Care Planning ◽  
Deep Tissue ◽  
Cord Injury ◽  
Pressure Injury

BACKGROUND Pressure ulcers (PU) and deep tissue injuries (DTI), collectively known as pressure injuries are serious complications causing staggering costs and human suffering with over 200 reported risk factors from many domains. Primary pressure injury prevention seeks to prevent the first incidence, while secondary PU/DTI prevention aims to decrease chronic recurrence. Clinical practice guidelines (CPG) combine evidence-based practice and expert opinion to aid clinicians in the goal of achieving best practices for primary and secondary prevention. The correction of all risk factors can be both overwhelming and impractical to implement in clinical practice. There is a need to develop practical clinical tools to prioritize the multiple recommendations of CPG, but there is limited guidance on how to prioritize based on individual cases. Bioinformatics platforms enable data management to support clinical decision support and user-interface development for complex clinical challenges such as pressure injury prevention care planning. OBJECTIVE The central hypothesis of the study is that the individual’s risk factor profile can provide the basis for adaptive, personalized care planning for PU prevention based on CPG prioritization. The study objective is to develop the Spinal Cord Injury Pressure Ulcer and Deep Tissue Injury (SCIPUD+) Resource to support personalized care planning for primary and secondary PU/DTI prevention. METHODS The study is employing a retrospective electronic health record (EHR) chart review of over 75 factors known to be relevant for pressure injury risk in individuals with a spinal cord injury (SCI) and routinely recorded in the EHR. We also perform tissue health assessments of a selected sub-group. A systems approach is being used to develop and validate the SCIPUD+ Resource incorporating the many risk factor domains associated with PU/DTI primary and secondary prevention, ranging from the individual’s environment to local tissue health. Our multiscale approach will leverage the strength of bioinformatics applied to an established national EHR system. A comprehensive model is being used to relate the primary outcome of interest (PU/DTI development) with over 75 PU/DTI risk factors using a retrospective chart review of 5000 individuals selected from the study cohort of more than 36,000 persons with SCI. A Spinal Cord Injury Pressure Ulcer and Deep Tissue Injury Ontology (SCIPUDO) is being developed to enable robust text-mining for data extraction from free-form notes. RESULTS The results from this study are pending. CONCLUSIONS PU/DTI remains a highly significant source of morbidity for individuals with SCI. Personalized interactive care plans may decrease both initial PU formation and readmission rates for high-risk individuals. The project is using established EHR data to build a comprehensive, structured model of environmental, social and clinical pressure injury risk factors. The comprehensive SCIPUD+ health care tool will be used to relate the primary outcome of interest (pressure injury development) with covariates including environmental, social, clinical, personal and tissue health profiles as well as possible interactions among some of these covariates. The study will result in a validated tool for personalized implementation of CPG recommendations and has great potential to change the standard of care for PrI clinical practice by enabling clinicians to provide personalized application of CPG priorities tailored to the needs of each at-risk individual with SCI. REGISTERED REPORT IDENTIFIER RR1-10.2196/10871

scholarly journals Pain management in patients with end-stage renal disease and calciphylaxis- a survey of clinical practices among physicians

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Rajkumar Chinnadurai ◽  
Smeeta Sinha ◽  
Aoife C Lowney ◽  
Mary Miller
Keyword(s):  
Palliative Care ◽  
Clinical Practice ◽  
Pain Management ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Palliative Medicine ◽  
Current Practice ◽  
Care Planning ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Calciphylaxis is a rare condition usually seen in patients with end-stage renal disease. Pain is a hallmark of this condition and can be extremely difficult to control. Anecdotal data suggests that pain management in calciphylaxis is challenging with variable approaches across the United Kingdom (UK) and internationally. A knowledge and practice survey was conducted to establish current practice in the management of pain in patients with calciphylaxis, in the UK. Based on the results and clinical experience the authors suggest a clinical practice guideline. Methods An online questionnaire was circulated among physicians (renal and palliative care) involved in the management of pain in calciphylaxis. The questionnaire included a mix of open-ended questions and questions with drop down options. Results One hundred and six clinicians responded to the survey of which 60 (57%) respondents were from palliative medicine; the remaining 46 (43%) were from renal medicine. 31 (30%) respondents across both specialties had not encountered any patients with a diagnosis of calciphylaxis (renal-2, palliative care-29). A referral to the palliative care team was undertaken by 18% of renal physicians, 32% referred to the pain team and 50% referred to both. Only 3% of the palliative medicine respondents indicated that they had received a referral from the renal team at the time of diagnosis. Opioids were the preferred initial drug of choice for the management of all types of pain. Paracetamol was universally selected as the preferred first-choice adjuvant agent for management of all types of pain. The importance of advance care planning was highlighted with 72% undertaking advanced care planning discussions often or most of the time. Conclusion There was wide variation in the current practice of pain management in patients with calciphylaxis, with variation between renal specialists and palliative care specialists. Referral to specialists in pain management is not universal despite the severe nature of the pain experienced by patients with calciphylaxis. The data generated has facilitated the development of a clinical practice guideline to support complex pain management in a group of patients with multiple comorbidities.

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