scholarly journals Histamine and stress ulcer: New components in organizing a sequential trial on cimetidine prophylaxis in seriously Ill patients and definition of a special group at risk (severe polytrauma)

1980 ◽  
Vol 58 (13) ◽  
pp. 653-665 ◽  
Author(s):  
W. Lorenz ◽  
M. Fischer ◽  
H. Rohde ◽  
H. Troidl ◽  
H. J. Reimann ◽  
...  
Keyword(s):  
At Risk ◽  
Stress Ulcer ◽  
Special Group ◽  
Sequential Trial ◽  
Definition Of ◽  
Seriously Ill Patients ◽  
Seriously Ill

Factors Considered Important at the End of Life (DRAFT)

2018 ◽  
Author(s):  
Ravi B. Parikh ◽  
Oreofe O. Odejide
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Survey Study ◽  
Good Death ◽  
Life Care ◽  
Care Providers ◽  
Broad Variation ◽  
Definition Of ◽  
Seriously Ill Patients ◽  
Seriously Ill

The chapter describes the national survey study by Steinhauser and colleagues, which assessed perspectives of seriously ill patients, family members, physicians, and other care providers (i.e., nurses, social workers, and chaplains) regarding the importance of several factors at the end of life. Survey respondents were asked to rate and rank the importance of attributes of quality at the end of life. This chapter highlights attributes that met consensus among all groups of respondents, those that were important to patients but not physicians, and attributes that had broad variation across all groups. It also includes items that were ranked the most important and least important by all groups. This chapter emphasizes areas of agreement as well as areas of diversity in the definition of a “good death” and discusses implications of these findings in providing end-of-life care.

Stress Ulcers: Current Understanding of Pathogenesis and Prophylaxis

1988 ◽  
Vol 22 (6) ◽  
pp. 452-460 ◽  
Author(s):  
Rachel L. Kleiman ◽  
Colin G. Adair ◽  
Kimberly S. Ephgrave
Keyword(s):  
Stress Ulcer ◽  
Bacterial Overgrowth ◽  
Ulcer Formation ◽  
Stress Ulcers ◽  
Ulcer Disease ◽  
Routine Prophylaxis ◽  
Effective Prophylaxis ◽  
Seriously Ill Patients ◽  
Seriously Ill ◽  
Stress Bleeding

Stress-related gastrointestinal bleeding is known to occur in approximately 25 percent of untreated seriously ill patients, but with appropriate prophylaxis is largely preventable. Since the treatment of stress bleeding is generally unsatisfactory and has a high mortality, routine prophylaxis should be instituted for susceptible patients. Multiple mechanisms contribute to stress ulcer formation, the most important of which appear to be mucosal ischemia and the inability to control back-diffused hydrogen. Antacids and histamine2-blocking agents are presently the cornerstone of effective prophylaxis, but because they have been implicated as contributors to nosocomial pneumonias due to bacterial overgrowth in the stomach, investigation is ongoing into such alternative prophylactic agents as sucralfate and prostaglandins that do not alter the normal gastric acidity. This article presents a review of the literature on the development and prevention of stress ulcer disease.

Principles of care for seriously ill patients in palliative office

2020 ◽  
pp. 15-18
Author(s):  
Nina Tishchenko
Keyword(s):  
Palliative Care ◽  
The State ◽  
State Budget ◽  
Oncological Patients ◽  
Seriously Ill Patients ◽  
Seriously Ill

The article reflects the importance and importance of the work of nurses of the Department of Palliative Care for Oncological Patients of the State Budget Health Establishment «Samara Regional Clinical Oncological Clinic». Important stages and features of care when dealing with seriously ill patients.

Home Health Agencies: Empirical Evidence on the Patient-Driven Groupings Model’s Expected Effects on Agency Reimbursements

2021 ◽  
pp. 108482232199038
Author(s):  
Elizabeth Plummer ◽  
William F. Wempe
Keyword(s):  
Ordinary Least Squares ◽  
Process Quality ◽  
Home Health ◽  
Least Squares Regression ◽  
Residual Variation ◽  
Health Agencies ◽  
Dual Eligible ◽  
Home Health Agencies ◽  
Seriously Ill Patients ◽  
Seriously Ill

Beginning January 1, 2020, Medicare’s Patient-Driven Groupings Model (PDGM) eliminated therapy as a direct determinant of Home Health Agencies’ (HHAs’) reimbursements. Instead, PDGM advances Medicare’s shift toward value-based payment models by directly linking HHAs’ reimbursements to patients’ medical conditions. We use 3 publicly-available datasets and ordered logistic regression to examine the associations between HHAs’ pre-PDGM provision of therapy and their other agency, patient, and quality characteristics. Our study therefore provides evidence on PDGM’s likely effects on HHA reimbursements assuming current patient populations and service levels do not change. We find that PDGM will likely increase payments to rural and facility-based HHAs, as well as HHAs serving greater proportions of non-white, dual-eligible, and seriously ill patients. Payments will also increase for HHAs scoring higher on quality surveys, but decrease for HHAs with higher outcome and process quality scores. We also use ordinary least squares regression to examine residual variation in HHAs’ expected reimbursement changes under PDGM, after accounting for any expected changes related to their pre-PDGM levels of therapy provision. We find that larger and rural HHAs will likely experience residual payment increases under PDGM, as will HHAs with greater numbers of seriously ill, younger, and non-white patients. HHAs with higher process quality, but lower outcome quality, will similarly benefit from PDGM. Understanding how PDGM affects HHAs is crucial as policymakers seek ways to increase equitable access to safe and affordable non-facility-provided healthcare that provides appropriate levels of therapy, nursing, and other care.

scholarly journals Definitions and Concepts for Quantitative Rockfall Hazard and Risk Analysis

Geosciences ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 158
Author(s):  
Didier Hantz ◽  
Jordi Corominas ◽  
Giovanni B. Crosta ◽  
Michel Jaboyedoff
Keyword(s):  
Risk Assessment ◽  
At Risk ◽  
Failure Probability ◽  
Rockfall Hazard ◽  
Process Failure ◽  
Failure Propagation ◽  
Element At Risk ◽  
Hazard And Risk ◽  
Hazard And Risk Assessment ◽  
Definition Of

There is an increasing need for quantitative rockfall hazard and risk assessment that requires a precise definition of the terms and concepts used for this particular type of landslide. This paper suggests using terms that appear to be the most logic and explicit as possible and describes methods to derive some of the main hazards and risk descriptors. The terms and concepts presented concern the rockfall process (failure, propagation, fragmentation, modelling) and the hazard and risk descriptors, distinguishing the cases of localized and diffuse hazards. For a localized hazard, the failure probability of the considered rock compartment in a given period of time has to be assessed, and the probability for a given element at risk to be impacted with a given energy must be derived combining the failure probability, the reach probability, and the exposure of the element. For a diffuse hazard that is characterized by a failure frequency, the number of rockfalls reaching the element at risk per unit of time and with a given energy (passage frequency) can be derived. This frequency is relevant for risk assessment when the element at risk can be damaged several times. If it is not replaced, the probability that it is impacted by at least one rockfall is more relevant.

The Surprise Question and Serious Illness Conversations: A pilot study

2021 ◽  
pp. 096973302098339
Author(s):  
Kathy Le ◽  
Jenny Lee ◽  
Sameer Desai ◽  
Anita Ho ◽  
Holly van Heukelom
Keyword(s):  
Pilot Study ◽  
Healthcare Professionals ◽  
Post Intervention ◽  
Acute Medicine ◽  
Serious Illness ◽  
Patient Goals ◽  
Ethical Approval ◽  
Seriously Ill Patients ◽  
Surprise Question ◽  
Seriously Ill

Background: Serious Illness Conversations aim to discuss patient goals. However, on acute medicine units, seriously ill patients may undergo distressing interventions until death. Objectives: To investigate the feasibility of using the Surprise Question, “Would you be surprised if this patient died within the next year?” to identify patients who would benefit from early Serious Illness Conversations and study any changes in the interdisciplinary team’s beliefs, confidence, and engagement as a result of asking the Surprise Question. Design: A prospective cohort pilot study with two Plan-Do-Study-Act cycles. Participants/context: Fifty-eight healthcare professionals working on Acute Medicine Units participated in pre- and post-intervention questionnaires. The intervention involved asking participants the Surprise Question for each patient. Patient charts were reviewed for Serious Illness Conversation documentation. Ethical considerations: Ethical approval was granted by the institutions involved. Findings: Equivocal overall changes in the beliefs, confidence, and engagement of healthcare professionals were observed. Six out of 23 patients were indicated as needing a Serious Illness Conversation; chart review provided some evidence that these patients had more Serious Illness Conversation documentation compared with the 17 patients not flagged for a Serious Illness Conversation. Issues were identified in equating the Surprise Question to a Serious Illness Conversation. Discussion: Appropriate support for seriously ill patients is both a nursing professional and ethical duty. Flagging patients for conversations may act as a filtering process, allowing healthcare professionals to focus on conversations with patients who need them most. There are ethical and practical issues as to what constitutes a “serious illness” and if answering “no” to the Surprise Question always equates to a conversation. Conclusion: The barriers of time constraints and lack of training call for institutional change in order to prioritise the moral obligation of Serious Illness Conversations.

Choices of seriously ill patients about cardiopulmonary resuscitation: Correlates and outcomes

Resuscitation ◽  
1996 ◽  
Vol 33 (1) ◽  
pp. 87 ◽  
Author(s):  
RS Phillips ◽  
NS Wenger ◽  
J Teno ◽  
RK Oye ◽  
S Youngner ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Seriously Ill Patients ◽  
Seriously Ill

scholarly journals Neonatal Hypoglycaemia: A Never-Ending Story?

Neonatology ◽  
2021 ◽  
pp. 1-8
Author(s):  
Nestor E. Vain ◽  
Florencia Chiarelli
Keyword(s):  
At Risk ◽  
Neonatal Period ◽  
Newborn Infants ◽  
Neonatal Hypoglycaemia ◽  
Rational Decision Making ◽  
Weak Evidence ◽  
Universal Approach ◽  
Definition Of ◽  
Therapeutic Alternatives ◽  
Current Guidelines

Neonatal hypoglycaemia is a common metabolic disorder presenting in the first days of life and one potentially preventable cause of brain injury. However, a universal approach to diagnosis and management is still lacking. The rapid decrease in blood glucose (BG) after birth triggers homeostatic mechanisms. Most episodes of hypoglycaemia are asymptomatic, and symptoms, when they occur, are nonspecific. Therefore, neonatologists are presented with the challenge of identifying infants at risk who might benefit from a rapid and effective therapy while sparing others unnecessary sampling and overtreatment. There is much controversy regarding the definition of hypoglycaemia, and one level does not fit all infants since postnatal age and clinical situations trigger different accepted thresholds for therapy. The concentration and duration of BG which cause neurological damage are unclear. Recognizing which newborn infants are at risk of hypoglycaemia and establishing protocols for treatment are essential to avoid possible deleterious effects on neurodevelopment. Early breastfeeding may reduce the risk of hypoglycaemia, but in some cases, the amount of breast milk available immediately after birth is insufficient or non-existent. In these situations, other therapeutic alternatives such as oral dextrose gel may lower the risk for NICU admissions. Current guidelines continue to be based on expert opinion and weak evidence. However, malpractice litigation related to neurodevelopmental disorders is frequent in children who suffered hypoglycaemia in the neonatal period even if they had other important factors contributing to the poor outcome. This review is aimed to help the practicing paediatricians and neonatologists to comprehend neonatal hypoglycaemia from physiology to therapy, hoping it will result in a rational decision-making process in an area not sufficiently supported by evidence.

Thematic expansion: A new strategy for theory development

2021 ◽  
pp. 019394592098479
Author(s):  
Katherine P. Kelly ◽  
Kathleen A. Knafl ◽  
Susan Keller ◽  
Pamela S. Hinds
Keyword(s):  
Grounded Theory ◽  
Theory Development ◽  
Good Parent ◽  
Child Study ◽  
Worked Example ◽  
New Strategy ◽  
Definition Of ◽  
Purposeful Selection ◽  
Seriously Ill ◽  
Multiple Conditions

We developed and applied metasynthesis methods to expand previously reported thematic descriptions of parents’ internal definition of “being a good parent to my seriously ill child” as part of a larger study to examine parenting of children with serious illness. Our systematic approach included: literature search, purposeful selection of grounded theories regarding parenting a seriously ill child, study summaries, mapping evidence of good parent themes onto structural elements of grounded theory, cross-study comparisons, and theoretical memoing to summarize analytic insights. Twenty-five grounded theory studies from 32 reviewed reports reflected multiple conditions (n=5), countries (n=10) and family members (n=386 families). We report a worked example of the processes used to extend the original good parent themes and detail our processes through one good parent theme. The methods we describe are a promising approach to extend thematic analysis findings and advance thematic expansions toward development of more formal theoretical syntheses.

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