scholarly journals Implementation of a Competency-Based, Interdisciplinary Pediatric Palliative Care Curriculum Using Content and Format Preferred by Pediatric Residents

Children ◽  
2018 ◽  
Vol 5 (12) ◽  
pp. 156
Author(s):  
Meaghann Weaver ◽  
Christopher Wichman
Keyword(s):  
Palliative Care ◽  
Curriculum Design ◽  
Cognitive Theory ◽  
Curriculum Implementation ◽  
Self Assessment ◽  
Training Environment ◽  
Pediatric Residents ◽  
Code Status ◽  
Personal Attitude ◽  
Competency Based

Palliative care competencies at the pediatric resident training level expand learned knowledge into behavior. The objective of this study was to investigate mode of palliative care education delivery preferred by pediatric residents and to report on participatory approach to resident palliative care curriculum design. A one-hour monthly palliative care curriculum was designed and implemented in a participatory manner with 20 pediatric residents at a free-standing Midwestern children’s hospital. Outcome measures included pediatric residents’ personal attitude and perceived training environment receptivity before and after implementation of a palliative care competency-based curriculum. An 18-item survey utilizing Social Cognitive Theory Constructs was administered at baseline and after palliative care curriculum implementation (2017–2018 curricular year). Pediatric residents prioritized real case discussions in group format (16/20) over other learning formats. Topics of highest interest at baseline were: discussing prognosis and delivering bad news (weighted average 12.9), pain control (12.3), goals of care to include code status (11.1), and integrative therapies (10.7). Summary of ordinal responses revealed improvement in self-assessment of personal attitude toward palliative care and training environment receptivity to palliative care domains after year-long curriculum implementation. Curricular approach which is attentive to pediatric residents’ preferred learning format and self-assessment of their behaviors within their care setting environment may be beneficial in competency-based primary palliative training.

Palliative Referrals in Advanced Cancer Patients: Utilizing the Supportive and Palliative Care Indicators Tool and Rothman Index

2021 ◽  
pp. 104990912110178
Author(s):  
Abigail Sy Chan ◽  
Amit Rout ◽  
Christopher R. D.’Adamo ◽  
Irina Lev ◽  
Amy Yu ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Length Of Hospital Stay ◽  
Inpatient Setting ◽  
Advanced Cancer Patients ◽  
Care Needs ◽  
Early Palliative Care ◽  
Code Status ◽  
Palliative Care Needs

Background: Timely identification of palliative care needs can reduce hospitalizations and improve quality of life. The Supportive & Palliative Care Indicators Tool (SPICT) identifies patients with advanced medical conditions who may need special care planning. The Rothman Index (RI) detects patients at high risk of acutely decompensating in the inpatient setting. SPICT and RI among cancer patients were utilized in this study to evaluate their potential roles in palliative care referrals. Methods: Advanced cancer patients admitted to an institution in Baltimore, Maryland in 2019 were retrospectively reviewed. Patient demographics, length of hospital stay (LOS), palliative care referrals, RI scores, and SPICT scores were obtained. Patients were divided into SPICT positive or negative and RI > 60 or RI < 60.Unpaired t-tests and chi-square tests were utilized to determine the associations between SPICT and RI and early palliative care needs and mortality. Results: 227 patients were included, with a mean age of 68 years, 63% Black, 59% female, with the majority having lung and GI malignancies. Sixty percent were SPICT +, 21% had RI < 60. SPICT + patients were more likely to have RI < 60 (p = 0.001). SPICT + and RI < 60 patients were more likely to have longer LOS, change in code status, more palliative/hospice referrals, and increased mortality (p <0.05). Conclusions: SPICT and RI are valuable tools in predicting mortality and palliative/hospice care referrals. These can also be utilized to initiate early palliative and goals of care discussions in patients with advanced cancer.

scholarly journals Palliative Care in Patients With High-Grade Gliomas in the Neurological Intensive Care Unit

2019 ◽  
Vol 10 (3) ◽  
pp. 163-167
Author(s):  
Jon Rosenberg ◽  
Allie Massaro ◽  
James Siegler ◽  
Stacey Sloate ◽  
Matthew Mendlik ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Intensive Care Unit ◽  
Palliative Care ◽  
High Grade ◽  
Neurological Intensive Care Unit ◽  
Code Status ◽  
Neurological Intensive Care ◽  
Palliative Care Consultation ◽  
Care Consultation

Background: Palliative care improves quality of life in patients with malignancy; however, it may be underutilized in patients with high-grade gliomas (HGGs). We examined the practices regarding palliative care consultation (PCC) in treating patients with HGGs in the neurological intensive care unit (NICU) of an academic medical center. Methods: We conducted a retrospective cohort study of patients admitted to the NICU from 2011 to 2016 with a previously confirmed histopathological diagnosis of HGG. The primary outcome was the incidence of an inpatient PCC. We also evaluated the impact of PCC on patient care by examining its association with prespecified secondary outcomes of code status amendment to do not resuscitate (DNR), discharge disposition, 30-day mortality, and 30-day readmission rate, length of stay, and place of death. Results: Ninety (36% female) patients with HGGs were identified. Palliative care consultation was obtained in 16 (18%) patients. Palliative care consultation was associated with a greater odds of code status amendment to DNR (odds ratio [OR]: 18.15, 95% confidence interval [CI]: 5.01-65.73), which remained significant after adjustment for confounders (OR: 27.20, 95% CI: 5.49-134.84), a greater odds of discharge to hospice (OR: 24.93, 95% CI: 6.48-95.88), and 30-day mortality (OR: 6.40, 95% CI: 1.96-20.94). Conclusion: In this retrospective study of patients with HGGs admitted to a university-based NICU, PCC was seen in a minority of the sample. Palliative care consultation was associated with code status change to DNR and hospice utilization. Further study is required to determine whether these findings are generalizable and whether interventions that increase PCC utilization are associated with improved quality of life and resource allocation for patients with HGGs.

scholarly journals Self-Assessment of Problem Solving Disposition in Medical Students

2014 ◽  
Vol 2014 ◽  
pp. 1-6
Author(s):  
Silvia Lizett Olivares-Olivares ◽  
Mildred Vanessa López-Cabrera
Keyword(s):  
Health Care ◽  
Medical Education ◽  
Medical Students ◽  
Problem Solving ◽  
Medical Schools ◽  
Self Assessment ◽  
Competency Based Education ◽  
Competency Based ◽  
Future Demands ◽  
Disposition Model

Medical schools are committed to both students and society to develop capabilities required to succeed in health care environments. Present diagnosis and treatment methods become obsolete faster, demanding that medical schools incorporate competency-based education to keep pace with future demands. This study was conducted to assess the problem solving disposition of medical students. A three-subcategory model of the skill is proposed. The instrument was validated on content by a group of 17 experts in medical education and applied to 135 registered students on the sixth year of the M.D. Physician Surgeon program at a private medical school. Cronbach’s alpha indicated an internal consistency of 0.751. The findings suggest that selected items have both homogeneity and validity. The factor analysis resulted in components that were associated with three problem-solving subcategories. The students’ perceptions are higher in the pattern recognition and application of general strategies for problem solving subcategories of the Problem solving disposition model.

scholarly journals Creative Solution for Implementation of Experiential, Competency-Based Palliative Care Training for Internal Medicine Residents

2011 ◽  
Vol 26 (3) ◽  
pp. 436-443 ◽  
Author(s):  
Douglas D. Ross ◽  
Deborah W. Shpritz ◽  
Susan D. Wolfsthal ◽  
Ann B. Zimrin ◽  
Timothy J. Keay ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Palliative Care ◽  
Internal Medicine Residents ◽  
Competency Based ◽  
Care Training

scholarly journals Identifying Palliative Care Needs in Assisted Living

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 788-788
Author(s):  
Daniel David ◽  
Abraham Brody ◽  
Tina Sadarangani ◽  
Bei Wu ◽  
Tara Cortez
Keyword(s):  
Palliative Care ◽  
Assisted Living ◽  
Unmet Needs ◽  
Care Needs ◽  
Code Status ◽  
Care Services ◽  
Palliative Care Services ◽  
Advance Care ◽  
Palliative Care Needs

Abstract Many residents of Assisted Living (AL) confront serious illness and therefore might benefit from greater access to Palliative Care Services to improve quality of life. We surveyed resident records and AL nursing staff to identify patients in need of Palliative Care. Preliminary findings showed that nurses predicted 23% would not be alive and 49% would no longer live in AL. A majority of residents were over the age of 90, yet 30% did not have a reported code status. These findings suggest that a substantial portion of AL residents may have unmet needs with respect to palliative care. Future interventions are needed to support advance care planning conversations and make palliative care more accessible to this population.

Abstract 68: Palliative Care Is Underutilized in Patients with Severe Intracerebral Hemorrhage

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
April Sisson ◽  
Karen C Albright ◽  
Michelle Peck ◽  
Linh M Nguyen ◽  
Michael Lyerly ◽  
...  
Keyword(s):  
Palliative Care ◽  
Poor Prognosis ◽  
Care Service ◽  
Care Center ◽  
Symptom Relief ◽  
Tertiary Care ◽  
Palliative Care Service ◽  
Code Status ◽  
Ich Score ◽  
Expected Mortality

Background and Purpose: Palliative care is an essential part of ICH care, particularly in patients with high ICH scores given their poor prognosis. Palliative care involves consultation by the Palliative Care Service and includes de-escalation of care, changing code status, and making pain and symptom relief the central goal of management. Methods: We performed a retrospective review of consecutive patients presenting to our tertiary care center from 2008-2013 with primary ICH. Demographic and clinical data were collected. Our sample included only patients who died or were transferred to hospice. We examined the proportion of patients that received an inpatient palliative care consult and compared this group to patients who did not receive an inpatient palliative care consult. Patients were categorized by ICH score. Results: Of the 99 ICH patients who died or were discharged to hospice, only 23% received a palliative care consult. Figure 1 displays death, predicted death, and palliative care consult proportions by ICH score. Patients that received a Palliative Care consult were older (mean age 65 vs. 73, p=0.018) and more frequently had evidence of infection (32% vs. 13%, p=0.038); no other significant differences were found between groups. Conclusions: In our sample of ICH patients, 23% of patients received a palliative care consult. In those with high ICH scores utilization was only 28%, despite 30 day expected mortality of 97% or greater. This raises concern that palliative care may be underutilized in patients who may benefit from it the most.

scholarly journals El médico general desde la perspectiva sociomédica, un cambio de paradigma en el diseño curricular por competencias. / The general practitioner from the medical-social perspective, a paradigm shift in competency-based curriculum design.

2014 ◽  
Vol 1 (1) ◽  
pp. 17
Author(s):  
Martina Patricia Flores-Saucedo ◽  
Laura Ernestina Barragán-Ledesma
Keyword(s):  
General Practitioner ◽  
Curriculum Design ◽  
Paradigm Shift ◽  
Social Perspective ◽  
Competency Based ◽  
Competencias Profesionales ◽  
De Medicina

La investigación se propuso conocer: el nivel de competencias profesionales que auto refieren los médicos generales en formación, la valoración que hacen del proceso educativo de calidad que los forma, que tanto saben acerca del programa de la OMS “Objetivos de Desarrollo del Milenio”; con la información recuperada contribuir a orientar el proyecto: Desarrollo curricular por competencias del programa educativo de médico cirujano en las Facultades de Medicina de la Universidad Juárez del Estado de Durango. El instrumento se construye con 160 variables ordinales; tres signalícticas, a partir de los 60 objetivos de aprendizaje de los médicos generales, definidos por el IIME; se aplica un censo a 248 sujetos pertenecientes al Décimo Semestre y a los que presentan el examen EGEL-CENEVAL, durante el semestre “A” 2007, de las Facultades de Medicina de Durango y Gómez Palacio, de la UJED y de la Universidad Autónoma de Zacatecas.

scholarly journals The Development of English Competency-Based Curriculum Integrated with Local Community for High School Students

2020 ◽  
Vol 10 (1) ◽  
pp. 39
Author(s):  
Goachagorn Thipatdee
Keyword(s):  
High School ◽  
High School Students ◽  
Local Community ◽  
Curriculum Implementation ◽  
Cluster Sampling ◽  
School Students ◽  
English Expression ◽  
Medium Level ◽  
Competency Based ◽  
Quota Sampling

The purposes of this research were to study needs of high school students and teachers on competency-based curriculum integrated with local community for high school students, develop a curriculum based on the needs, implement the developed curriculum, and evaluate the developed curriculum. The samples of the needs study stage consisted of 244 high school students, and 82 teachers in schools located in Ubon Ratchathani, and Warinchamrab Municipalities, gained by quota sampling, and those for the curriculum implementation consisted of 34 high school students studying at Luekamhan Warinchamrab School, in the second semester of academic year 2018, gained by cluster sampling. The research instruments were the developed curriculum, questionnaires for the students and the teachers, a test of English expression, a test of writing, and an attitude evaluation form. The findings revealed the students and the teachers rated their needs on competency-based curriculum at a higher level, the developed curriculum consisted of vision, mission to achieve the students&rsquo; competency through the aims, contents, and instructional procedures concentrated on practicing and the evaluation focused on performances, the students had significantly higher learning achievement and writing skills after the curriculum implementation than those before the implementation at the level .01. The developed curriculum was evaluated by the students at medium level of its feasibility.

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