Prescribing at the coalface in the era of antimicrobial resistance

Patrick Lillie;  ; Gavin Barlow

doi:10.52964/amja.0185

Xenotransplantation: the potential and the challenges

Critical Care Nurse ◽

10.4037/ccn1999.19.2.76 ◽

1999 ◽

Vol 19 (2) ◽

pp. 76-83 ◽

Cited By ~ 7

Author(s):

ET Bloom ◽

AD Moulton ◽

J McCoy ◽

LE Chapman ◽

AP Patterson

Keyword(s):

Public Health ◽

National Level ◽

Clinical Use ◽

Policy Makers ◽

The Public ◽

Human Organs ◽

Seriously Ill Patients ◽

Seriously Ill

Clinical use of xenotransplants is a potential way to provide care for a population of seriously ill patients and alleviate the demand for human organs. However, xenotransplantation also presents a spectrum of concerns, not only for individual patients but also for the public health, that must be discussed and dealt with in a science-based and public manner. Such discussions should take place on a national level and should include scientists, physicians, and policy makers from all countries in which the clinical use of xenografts is being considered.

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Seriously Ill Patients Care More About Outcomes of Care Than Treatment Burdens in End-of-Life Decision-Making

PsycEXTRA Dataset ◽

10.1037/e578252006-005 ◽

2004 ◽

Author(s):

Terri Fried

Keyword(s):

Decision Making ◽

End Of Life ◽

Outcomes Of Care ◽

Seriously Ill Patients ◽

End Of Life Decision ◽

Seriously Ill ◽

Life Decision

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Principles of care for seriously ill patients in palliative office

Medsestra (Nurse) ◽

10.33920/med-05-2005-02 ◽

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.

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

Home Health Care Management & Practice ◽

10.1177/1084822321990382 ◽

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.

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The Surprise Question and Serious Illness Conversations: A pilot study

Nursing Ethics ◽

10.1177/0969733020983392 ◽

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.

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

Resuscitation ◽

10.1016/0300-9572(96)89032-0 ◽

1996 ◽

Vol 33 (1) ◽

pp. 87 ◽

Cited By ~ 1

Author(s):

RS Phillips ◽

NS Wenger ◽

J Teno ◽

RK Oye ◽

S Youngner ◽

...

Keyword(s):

Cardiopulmonary Resuscitation ◽

Seriously Ill Patients ◽

Seriously Ill

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Giving Voice: Nurse-Patient Communication in the Intensive Care Unit

American Journal of Critical Care ◽

10.4037/ajcc2021666 ◽

2021 ◽

Vol 30 (4) ◽

pp. 256-265

Author(s):

Mary Beth Happ

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Best Practice ◽

Patient Communication ◽

Evidence Based ◽

Patient Relationship ◽

Communication Partner ◽

Seriously Ill Patients ◽

Tools And Techniques ◽

Seriously Ill

Communication is the essence of the nurse-patient relationship. The critical care nurse’s role in facilitating patient communication and enabling communication between patients and their families has never been more important or poignant than during the COVID-19 pandemic. We have witnessed tremendous examples of resourceful, caring nurses serving as the primary communication partner and support for isolated seriously ill patients during this pandemic. However, evidence-based tools and techniques for assisting awake, communication-impaired, seriously ill patients to communicate are not yet systematically applied across all settings. Missed communication or misinterpretation of patients’ messages induces panic and fear in patients receiving mechanical ventilation and can have serious deleterious consequences. This lecture presents a 23-year program of research in developing and testing combination interventions (eg, training, tailored assessment, and tools) for best practice in facilitating patient communication during critical illness. Evidence from related nursing and inter pro fessional research is also included. Guidance for unit-based assessment, tailoring, and implementation of evidence-based patient communication protocols also is provided.

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Healthcare associated pneumonia: An old concept at a hospital with high prevalence of antimicrobial resistance

MedPharmRes ◽

10.32895/ump.mpr.5.2.4 ◽

2021 ◽

Vol 5 (2) ◽

pp. 17-21

Author(s):

Lam Nguyen-Ho ◽

Duong Hoang-Thai ◽

Vu Le-Thuong ◽

Ngoc Tran-Van

Keyword(s):

Risk Factor ◽

Antimicrobial Resistance ◽

Multidrug Resistant ◽

Community Acquired Pneumonia ◽

Resistant Organism ◽

Healthcare Associated Infection ◽

Female Ratio ◽

High Prevalence ◽

Need To Evaluate ◽

Healthcare Associated

Background: One of several reasons that the concept of healthcare-associated pneumonia (HCAP) was dismissed was the same presence of multidrug resistant organism (MDRO) between community-acquired pneumonia and HCAP at countries with the low prevalence of antimicrobial resistance (AMR). However, this finding could be unsuitable for countries with the high rates of AMR. Methods: A prospective observational study was conducted at the respiratory department of Cho Ray hospital from September 2015 to April 2016. All adult patients suitable for community acquired pneumonia (CAP) with risk factor for healthcare-associated infection were included. Results: We found out 130 subjects. The median age was 71 years (interquartile range 57-81). The male/female ratio was 1.55:1. Prior hospitalization was the most common risk factor for healthcare-associated infection. There were 35 cases (26.9%) with culture-positive (sputum and/or bronchial lavage). Isolated bacteria included Pseudomonas aeruginosa (9 cases), Klebsiella pneumoniae (9 cases), Escherichia coli (4 cases), Acinetobacter baumannii (6 cases), and Staphylococcus aureus (7 cases) with the characteristic of AMR similar to the bacterial spectrum associated with hospital-acquired pneumonia. Conclusion: MDROs were detected frequently in CAP patients with risk factor for healthcare-associated infection at the hospital with the high prevalence of AMR. This requires the urgent need to evaluate risk factors for MDRO infection in community-onset pneumonia when the concept of HCAP is no longer used.

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Turismo de células madre

Medicina e Morale ◽

10.4081/mem.2012.145 ◽

2012 ◽

Vol 61 (1) ◽

Author(s):

José Luis Pérez Requejo ◽

Justo Aznar Lucea

Keyword(s):

Medical Tourism ◽

Family Doctor ◽

Medical Support ◽

Sono Stati ◽

Advanced Therapy ◽

The Family ◽

Scientific Papers ◽

Seriously Ill Patients ◽

To Receive ◽

Seriously Ill

Mai prima d’ora i pazienti gravemente malati o con malattie incurabili o croniche, sono stati così esposti a organizzazioni mediche senza scrupoli, che approfittando del loro logico disagio e della loro preoccupazione promettono cure miracolose e trattamenti, facendo pagare enormi somme di denaro per procedure senza alcuna garanzia, alcun reale beneficio e, peggio ancora, con gravi rischi per la salute. Questo articolo discute alcuni casi di pazienti che hanno pagato con la loro salute, spesso irrimediabilmente, o in maniera catastrofica, gli effetti di terapie teoricamente avanzate con cellule staminali di alcuni centri. Ci si è riferiti a diversi paesi che, in tempi anche non remoti, offrono e praticano qualcuno di questi trattamenti, il più delle volte attraverso strategie di marketing dirette e aggressive per i pazienti o le loro famiglie, mostrando reale o fittizi rapporti relativi ad altri pazienti, ma senza previ studi scientifici che avvalorino i risultati dei presunti benefici. In questo articolo, discutiamo alcuni utili suggerimenti e linee guida internazionali per riconoscerli ed evitarli. Inoltre, abbiamo discusso in dettaglio le ragioni specifiche per cui la maggior parte dei medici e clinici sollevino dei dubbi sulla competenza e le ragioni etiche di questi centri e scoraggino i viaggi di questo “turismo medico”. È sempre consigliabile chiedere il consiglio del medico di famiglia o specialista, prima della decisione dei pazienti di ricevere trattamenti dubbi, con la certezza che il paziente avrà sempre la sua comprensione e il supporto emotivo e medico. ---------- Never before seriously ill patients with chronic or incurable diseases have been so exposed to unscrupulous medical organizations that, taking advantage of their logical distress and worry, promise miracle cures and treatments and charge them huge amounts of money for procedures with no guarantee, no real benefits and, even worse, with serious risks to their health. This paper discusses some cases of patients who paid with their health, often irreparably, or catastrophically, the effects of supposedly advanced therapy centers with stem cells. Several countries are mentioned, not always as remote, which offer and practice any of these treatments, most often by direct and aggressive marketing to patients or their families, showing real or fictional accounts of other patients, but without the previous studies and scientific papers that endorse their supposed beneficial results. In this article we discuss some useful hints and international guidelines to recognize and avoid them. Also, we discussed in detail the specific reasons why most doctors and clinics doubt about the competence and ethical reasons of these centers and discourage those “medical tourism” trips. It is always advisable to seek the advice of the family doctor or specialist in charge, before the patients decision to receive dubious treatments, with the assurance that, decide what the patient decide, they will have always his understanding and his emotional and medical support.

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