Is trained communication about desire to die harmful for patients receiving palliative care? A cohort study

2021 ◽  
pp. 026921632110656
Author(s):  
Raymond Voltz ◽  
Kathleen Boström ◽  
Thomas Dojan ◽  
Carolin Rosendahl ◽  
Leonie Gehrke ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
Health Professionals ◽  
Professional Relationship ◽  
Cohen’S D ◽  
Patient Health ◽  
Wish To Hasten Death ◽  
Desire To Die ◽  
Cohen's D ◽  
Palliative Patients

Background: Palliative patients frequently express a desire to die. Health professionals report uncertainty regarding potential risks of addressing it. Aim: We aim to evaluate effects of desire to die-conversations on palliative patients. Design: Within a prospective mixed-methods cohort study, we trained health professionals in dealing with desire to die. Afterwards, they held conversations about it with patients. Effects on depressiveness, hopelessness, wish to hasten death, death anxiety, patient-health professional-relationship, and will to live were evaluated at baseline (t0), 1 (t1), and 6 weeks afterwards (t2). Results were analyzed descriptively. Setting/participants: From April 2018 to March 2020, 43 health professionals asked 173 patients from all stationary and ambulatory palliative care settings (within 80 km radius) for participation. Complete assessments were obtained from n = 85 (t0), n = 64 (t1), and n = 46 (t2). Results: At t1, patients scored significantly lower on depressiveness (med = 8, M = 8.1, SD = 5.4) than at t0 (med = 9.5, M = 10.5, SD = 5.8) with Z = −3.220, p = 0.001 and Cohen’s d = 0.42. This was due to medium-severely depressed patients: At t1, their depressiveness scores decreased significantly (med = 9, M = 9.8; SD = 5.1) compared to t0 (med = 14, M = 15.2; SD = 3.9) with Z = −3.730, p ⩽ 0.000 and Cohen’s d = 1.2, but others’ did not. All other outcomes showed positive descriptive trends. Conclusions: Desire to die-conversations through trained health professionals do not harm palliative patients. Results cautiously suggest temporary improvement.

Importance of Medication Reconciliation as a Strategy for Health Literacy

2022 ◽  
pp. 224-237
Author(s):  
José Manuel Feliz ◽  
Marta Barroca
Keyword(s):  
Health Literacy ◽  
Communication Skills ◽  
Health Professionals ◽  
Medication Reconciliation ◽  
Drug Regimen ◽  
Communication Model ◽  
Professional Relationship ◽  
Patient Health ◽  
Model Technique

Health literacy depends on communication skills of health professionals. Assertiveness, clarity, and positivity (ACP) are a communication model/technique very useful to improve the patient-health professional relationship, adherence to treatment, health literacy, and quality of life. This model can be used in medication reconciliation (MR) – the identification of the most precise list of medication that a patient has been taking and should take, which requires a multidisciplinary participation and a better communication between health professionals and between them and the patient. When the guidance from healthcare professionals is clear and effective, patients and caregivers are more compliant to the recommended drug regimen, resulting in better health outcomes.

scholarly journals Patients’ and health professionals’ attitudes and perceptions towards the initiation of preventive drugs for primary prevention of cardiovascular disease: a systematic review of qualitative studies

BJGP Open ◽  
2020 ◽  
Vol 4 (5) ◽  
pp. bjgpopen20X101087
Author(s):  
Olla Qadi ◽  
Nakawala Lufumpa ◽  
Nicola Adderley ◽  
Danai Bem ◽  
Tom Marshall ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiovascular Disease ◽  
Primary Prevention ◽  
Health Professional ◽  
Health Professionals ◽  
Antihypertensive Agents ◽  
Qualitative Studies ◽  
Professional Relationship ◽  
Patient Health ◽  
Prevention Of Cardiovascular Disease

BackgroundStatins and antihypertensive agents are recommended for primary prevention of cardiovascular disease (CVD), but they are not always prescribed to eligible patients.Design & settingA systematic review of qualitative studies.AimTo explore health professionals’ and patients’ attitudes towards cardiovascular preventive drugs.MethodMEDLINE, Embase, PsychINFO, CINAHL, ASSIA, HMIC, Conference Proceedings Citation Index, and Open Grey were searched for studies of qualitative design without restrictions on date or language. Two reviewers performed study selection, data extraction, quality assessment, and thematic synthesis.ResultsIn total, 2585 titles and abstracts were screened, yielding 27 studies, of which five met eligibility criteria on full text assessment. These included 62 patients and 47 health professionals. Five themes emerged about patient attitudes: questioning preventive drugs; perceived benefit and risks, such as improving quality of life; patient preferences; trust in health professional judgement; and family, friends, and media influences. Five themes emerged about health professional attitudes: addressing patient concerns and information; duty as a health professional to prescribe; uncertainty about preventive drug prescribing; recognising consequences of prescribing, such as unnecessary medicalisation; and personalised treatment.ConclusionThe attitudes of patients and health professionals regarding drug initiation for primary prevention reflect the complexity of the patient–health professional encounter in primary practice. For prescribing to be more adherent to guidelines, research should further investigate the patient–health professional relationship and the appropriate communication methods required when discussing drug initiation, specifically for primary prevention.

Cerebral perfusion and neurological examination characterise neonatal opioid withdrawal syndrome: a prospective cohort study

2021 ◽  
pp. fetalneonatal-2021-322192
Author(s):  
Kristen L Benninger ◽  
Jin Peng ◽  
Mai-Lan Ho ◽  
Julia Newton ◽  
Danny J J Wang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Neurological Examination ◽  
Prospective Cohort ◽  
Withdrawal Syndrome ◽  
Cerebral Perfusion ◽  
Opioid Withdrawal ◽  
Cohen’S D ◽  
Opioid Withdrawal Syndrome ◽  
Cohen's D

ObjectiveTo test the hypothesis that cerebral blood flow (CBF) assessed with arterial spin labelling (ASL) MRI is increased and standardised neurological examination is altered in infants with neonatal opioid withdrawal syndrome (NOWS) compared with those without.DesignProspective cohort study.SettingLevel IV neonatal intensive care unit and outpatient primary care centre.ParticipantsInfants with NOWS receiving pharmacological treatment and unexposed controls matched for gestational age at birth and post-menstrual age at MRI.Main outcomesCBF assessed by ASL on non-sedated 3-Tesla MRI and standardised Hammersmith Neonatal Neurological Examination (HNNE) within 14 days of birth.ResultsThirty infants with NOWS and 31 control infants were enrolled and included in the final analysis. Global CBF across the brain was higher in the NOWS group compared with controls (14.2 mL/100 g/min±5.5 vs 10.7 mL/100 g/min±4.3, mean±SD, Cohen’s d=0.72). HNNE total optimality score was lower in the NOWS group compared with controls (25.9±3.6 vs 28.4±2.4, mean±SD, Cohen’s d=0.81). A penalised logistic regression model including both CBF and HNNE items discriminated best between the two groups.ConclusionsIncreased cerebral perfusion and neurological examination abnormalities characterise infants with NOWS compared with those without intrauterine drug exposure and suggest prenatal substance exposure affects fetal brain development. Identifying neurological and neuroimaging characteristics of infants with NOWS can contribute to understanding mechanisms underlying later outcomes and to designing potential new treatments.

The Ethical Health Lawyer

2006 ◽  
Vol 34 (4) ◽  
pp. 813-816 ◽  
Author(s):  
William Winslade ◽  
E. Bernadette McKinney
Keyword(s):  
Health Care ◽  
Health Professional ◽  
Health Care Professional ◽  
Medical Errors ◽  
Medical Error ◽  
Health Professionals ◽  
Professional Relationship ◽  
Patient Health ◽  
Natural Inclination ◽  
The Right

When a health care professional contacts a health care attorney for advice about how to deal with a medical error involving a patient, what is the most ethically appropriate response? Honesty is the best policy; the ethical health lawyer should advise the client to tell the patient the truth. This advice is neither naïve nor impractical, as we will show. More importantly, it is without question the right thing to do for a number of sound reasons. It may not be a natural inclination or an easy task to accomplish; several countervailing factors discourage health professionals from telling patients the truth about medical errors. However, we will argue that resistance to truthful disclosure can and should be overcome by rational arguments that also take into consideration the psychodynamics of the patient-health professional relationship.

Phonologische Verarbeitung bei Grundschulkindern mit schwacher Lesefähigkeit

2013 ◽  
Vol 2 (4) ◽  
pp. 199-215 ◽  
Author(s):  
Maria Klatte ◽  
Claudia Steinbrink ◽  
Kirstin Bergström ◽  
Thomas Lachmann
Keyword(s):  
Cohen’S D ◽  
Phonologische Verarbeitung ◽  
Cohen's D

Defizite in der phonologischen Informationsverarbeitung werden heute als Kernsymptom der Lese-Rechtschreibstörung betrachtet. In Trainingsstudien mit betroffenen Kindern erwiesen sich Phonemwahrnehmungsfähigkeiten als trainierbar, und Programme, in denen Aufgaben zur phonologischen Bewusstheit mit der systematischen Vermittlung von Phonem-Graphem-Zuordnungen kombiniert wurden, zeigten Transfereffekte auf Lese- und Rechtschreibleistungen. Ausgehend von diesen Erkenntnissen wurde ein computerbasiertes Trainingsprogramm zur Förderung der Phonemwahrnehmung, der phonologischen Bewusstheit und der Graphem-Phonem-Zuordnungen für deutschsprachige Grundschulkinder mit Lese-Rechtschreibstörung entwickelt. Aufgrund der besonderen Relevanz der Vokallänge für die deutsche Orthographie enthält das Programm neben Aufgaben, die auf Konsonanten fokussieren, auch Vokallängenaufgaben. Bei der Konzipierung des Programms wurden etablierte, ursprünglich für andere Sprachen entwickelte Aufgaben an die deutsche Phonologie angepasst und in ein computerbasiertes Format übersetzt. Im Rahmen der vorliegenden Studie sollte überprüft werden, ob die konstruierten Trainingsaufgaben die spezifischen Defizite von Kindern mit Lese-Rechtschreibstörung wie intendiert abbilden. Hierzu wurden leseschwache Dritt- und Viertklässler (n = 35) mit mindestens durchschnittlichen Lesern derselben Klassenstufen (n = 75; Kontrollgruppe) hinsichtlich ihrer Leistungen in den Aufgaben verglichen. Die leseschwachen Kinder zeigten in allen Aufgaben schlechtere Leistungen als die Kontrollgruppe. Die Effektstärken der Gruppenunterschiede (Cohen's d) lagen im mittleren bis hohen Bereich (0.50 – 2.19). Die Ergebnisse bestätigen, dass die Aufgaben des Trainingsprogramms die spezifischen Defizite leseschwacher Kinder abbilden. Ein Training mit diesen Aufgaben erscheint daher grundsätzlich sinnvoll. Die Wirkungen eines solchen Trainings auf die schriftsprachlichen Leistungen von Kindern mit Lese-Rechtschreibstörung werden in zukünftigen Studien überprüft.

The wish to hasten death among ALS patients in a palliative care program

2007 ◽  
Vol 34 (S 2) ◽  
Author(s):  
R Jox ◽  
S Haarmann-Doetkotte ◽  
M Wasner ◽  
GD Borasio
Keyword(s):  
Palliative Care ◽  
Care Program ◽  
Palliative Care Program ◽  
Wish To Hasten Death ◽  
Als Patients

Māori Research(er) in Three Poems

2018 ◽  
Vol 2 (1) ◽  
pp. 35
Author(s):  
Jacquie Kidd
Keyword(s):  
Palliative Care ◽  
Health Literacy ◽  
Cultural Identity ◽  
Focus Groups ◽  
Health Professionals ◽  
Bell Hooks ◽  
Face To Face ◽  
The Third ◽  
Ruth Behar ◽  
Seeking Help

These three poems re-present the findings from a research project that took place in 2013 (Kidd et al. 2018, Kidd et al. 2014). The research explored what health literacy meant for Māori patients and whānau when they accessed palliative care. Through face-to-face interviews and focus groups we engaged with 81 people including patients, whānau, bereaved loved ones, support workers and health professionals. The poems are composite, written to bring some of our themes to life. The first poem is titled Aue. This is a Māori lament that aligns to English words such as ‘oh no’, or ‘arrgh’, or ‘awww’. Each stanza of the poem re-presents some of the stories we heard throughout the research. The second poem is called Tikanga. This is a Māori concept that encompasses customs, traditions and protocols. There are tikanga rituals and processes that guide all aspects of life, death, and relationships. This poem was inspired by an elderly man who explained that he would avoid seeking help from a hospice because ‘they leave tikanga at the door at those places’. His choice was to bear his pain bravely, with pride, within his cultural identity. The third poem is called ‘People Like Me’. This is an autoethnographical reflection of what I experienced as a researcher which draws on the work of scholars such as bell hooks (1984), Laurel Richardson (1997) and Ruth Behar (1996). These and many other authors encourage researchers to use frustration and anger to inform our writing; to use our tears to fuel our need to publish our research.

Political Inclusion Reduces Political Prejudice

2019 ◽  
Author(s):  
Jan G. Voelkel ◽  
Dongning Ren ◽  
Mark John Brandt
Keyword(s):  
The Political ◽  
Political Discussion ◽  
Total N ◽  
Cohen’S D ◽  
Promising Strategy ◽  
Political Inclusion ◽  
Cohen's D ◽  
Political Divide ◽  
Scenario Study ◽  
Fair Chance

The political divide is characterized by liberals and conservatives who hold strong prejudice against each other. Here we introduce one possible strategy for reducing political prejudice: political inclusion. We define political inclusion as receiving a fair chance to voice one’s opinions in a discussion of political topics with political outgroup members. This strategy may reduce political prejudice by inducing perceptions of the political outgroup as fair and respectful; however, such a strategy may also highlight conflicting attitudes and worldviews, thereby further exacerbating prejudice. In three preregistered studies (total N = 799), we test if political inclusion reduces or increases prejudice toward the political outgroup. Specifically, political inclusion was manipulated with either an imagined scenario (Study 1) or a concurrent experience in an ostensible online political discussion (Studies 2 & 3). Across all studies, participants who were politically included by political outgroup members reported reduced prejudice toward their outgroup compared to participants in a neutral control condition (Cohen’s d [-0.27, -0.50]). This effect was mediated by perceptions of the political outgroup as fairer and less dissimilar in their worldviews. Our results indicate that political discussions that are politically inclusive do not cause additional prejudice via worldview conflict, but instead give others a feeling of being heard. It is a promising strategy to reduce political prejudice.

scholarly journals Lower Extremity Rehabilitation in Patients with Post-Stroke Sequelae through Virtual Reality Associated with Mirror Therapy

2021 ◽  
Vol 18 (5) ◽  
pp. 2654
Author(s):  
Roxana Steliana Miclaus ◽  
Nadinne Roman ◽  
Ramona Henter ◽  
Silviu Caloian
Keyword(s):  
Virtual Reality ◽  
Muscle Strength ◽  
Lower Extremity ◽  
Range Of Motion ◽  
Control Group ◽  
Mirror Therapy ◽  
Cohen’S D ◽  
Cohen's D ◽  
Experimental Group ◽  
Post Therapy

More innovative technologies are used worldwide in patient’s rehabilitation after stroke, as it represents a significant cause of disability. The majority of the studies use a single type of therapy in therapeutic protocols. We aimed to identify if the association of virtual reality (VR) therapy and mirror therapy (MT) exercises have better outcomes in lower extremity rehabilitation in post-stroke patients compared to standard physiotherapy. Fifty-nine inpatients from 76 initially identified were included in the research. One experimental group (n = 31) received VR therapy and MT, while the control group (n = 28) received standard physiotherapy. Each group performed seventy minutes of therapy per day for ten days. Statistical analysis was performed with nonparametric tests. Wilcoxon Signed-Rank test showed that both groups registered significant differences between pre-and post-therapy clinical status for the range of motion and muscle strength (p < 0.001 and Cohen’s d between 0.324 and 0.645). Motor Fugl Meyer Lower Extremity Assessment also suggested significant differences pre-and post-therapy for both groups (p < 0.05 and Cohen’s d 0.254 for the control group and 0.685 for the experimental group). Mann-Whitney results suggested that VR and MT as a therapeutic intervention have better outcomes than standard physiotherapy in range of motion (p < 0.05, Cohen’s d 0.693), muscle strength (p < 0.05, Cohen’s d 0.924), lower extremity functionality (p < 0.05, Cohen’s d 0.984) and postural balance (p < 0.05, Cohen’s d 0.936). Our research suggests that VR therapy associated with MT may successfully substitute classic physiotherapy in lower extremity rehabilitation after stroke.

Development of a multimedia intervention to improve pneumoconiosis prevention in construction workers using RE-AIM framework

2021 ◽  
Author(s):  
Jieling Chen ◽  
Cho Lee Wong ◽  
Bernard Man Hin Law ◽  
Winnie Kwok Wei So ◽  
Doris Yin Ping Leung ◽  
...  
Keyword(s):  
South Asian ◽  
Educational Intervention ◽  
Self Efficacy ◽  
Intervention Mapping ◽  
Intervention Development ◽  
Educational Interventions ◽  
Construction Workers ◽  
Post Intervention ◽  
Cohen’S D ◽  
Cohen's D

Summary Pneumoconiosis is a common occupational lung disease among construction workers. Educational interventions targeting specific ethnic groups of construction workers are of benefit for pneumoconiosis prevention. The aim of this study was to develop a multimedia educational intervention for pneumoconiosis prevention for South Asian construction workers, and to evaluate its feasibility, acceptability and effectiveness in increasing knowledge of pneumoconiosis, modifying beliefs about pneumoconiosis, and enhancing intention to implement measures for its prevention among the workers. This evaluation was performed using the Reach-Effectiveness-Adoption-Implementation-Maintenance framework. A one-group design was adopted and intervention mapping was used to guide the process of intervention development, while the Health Belief Model guided the development of intervention content. The intervention was delivered at construction sites, ethnic minority associations and South Asian community centres. Data were collected via surveys completed at pre-intervention, post-intervention and 3 months after the intervention. A total of 1002 South Asian construction workers participated in the intervention. The participants reported a moderate-to-large increase in knowledge, perceived susceptibility, perceived severity, perceived benefits, cues to action and self-efficacy (Cohen’s d: 0.37–0.89), a small reduction in perceived barriers (Cohen’s d = 0.12) and a moderate improvement in attitudes and intention to practice (Cohen’s d: 0.45, 0.51) at post-intervention. A follow-up survey of 121 participants found that the implementation of preventive measures appeared to increase. Overall, the findings demonstrate that the implementation of a culturally adapted multimedia educational intervention could be an effective approach to improving knowledge, self-efficacy and intention regarding pneumoconiosis prevention among South Asian construction workers.

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