scholarly journals The Role of Emergency Care in Patients with Advanced Dementia

2017 ◽  
Vol 12 (1) ◽  
Author(s):  
Kieran Lewis Quinn
Keyword(s):  
Palliative Care ◽  
Emergency Care ◽  
Care Pathway ◽  
Advanced Dementia ◽  
Emergency Physicians ◽  
Comfort Zone ◽  
The Moment ◽  
Trajectory Of Care ◽  
Physician Workload

The prevalence of advanced dementia (AD) is expected to increase dramatically over the next few decades.  Patients with AD suffer from recurrent episodic illnesses that frequently result in transfers to acute care hospitals.  The default pathway followed by the emergency physicians, internists and intensivists who see those patients there is prioritize disease-directed therapies over attention to the larger picture of advanced dementia.  While this strategy is desired by many families, some families prefer a different approach.  This essay examines the reason why this phenomenon occurs and offers suggestions for improvement.  Gaps in information and physician workload are important factors, but we argue that until physicians who see patients in emergency departments learn to pause first and ask “Why are we doing this?" they will revert to their comfort zone of ordering tests and therapies that may be unwanted.  A separate emergency palliative care pathway may be one solution.  Shifting the focus back to the larger picture of AD and away from the physiologic disturbance of the moment may alter the trajectory of care in ways that truly respect the wishes of some patients and their families.

Palliative Care in SARS-CoV-2: A Systematic Review

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
González-Botello AL ◽  
◽  
Elías-Pérez KI ◽  
Caballero-Martínez AA ◽  
Martínez-Del Campo-Cerrilla M ◽  
...  
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Specific Treatment ◽  
Curative Treatment ◽  
The Moment ◽  
Do So

Objective: Gather information about an important aspect of SARS-CoV-2 disease, regard to palliative care. Introduction: SARS-CoV-2 disease started by the ending of 2019 in Wuhan-China and given the lack of a specific treatment, the role of palliative care in SARS-CoV-2 infection has been drawn to the spotlight. Method: A systematic review was carried out between June and October of 2020. A total of 25 articles were totally reviewed. Results: The management of symptoms, is the main objective of palliative care in SARS-CoV-2. We find ourselves with the interrogant of when to start palliative care and with what medications and measures it is preferred to do so. Discussion: As SARS-CoV-2 currently does not have a curative treatment, palliative care is the centerpiece of its management. Conclusion: Palliative care should be considered as a protocol in any disease with no curative treatment at the moment, just like SARS-CoV-2.

scholarly journals Emergency Department Physical Therapist Service: A Pilot Study Examining Physician Perceptions

2010 ◽  
Author(s):  
Michele Lebec ◽  
Steven Cernohous ◽  
Lisa Tenbarge ◽  
Colleen Gest ◽  
Kristen Severson ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pilot Study ◽  
Emergency Care ◽  
Qualitative Methodology ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Emergency Physicians ◽  
Physician Perceptions ◽  
Potential Benefits

Though physical therapist consultation has been described as a means of enhancing care in the Emergency Department (ED), such services are rare and often poorly understood. This pilot study utilizes qualitative methodology for the purpose of describing how one group of emergency physicians experienced with physical therapist consultation in the ED perceive these services and the challenges associated with their provision. Transcripts of interviews with 11 emergency physicians were analyzed for recurrent themes. Findings indicated that these physicians found ED physical therapist services to be of value for themselves, their patients, and the department as a whole and described specific manners in which such consultations enhanced emergency care. Implementation and maintenance of the program, however, presented various challenges. Furthermore, physicians perceived that possession of certain characteristics better prepared physical therapists for success in this practice environment. These findings may help clarify the role of the ED physical therapist and aid in communicating the potential benefits and complications associated with the delivery of such services.

scholarly journals Challenges Faced by Prehospital Emergency Physicians Providing Emergency Care to Patients with Advanced Incurable Diseases

2019 ◽  
Vol 2019 ◽  
pp. 1-11 ◽  
Author(s):  
Anne Kamphausen ◽  
Hanna Roese ◽  
Karin Oechsle ◽  
Malte Issleib ◽  
Christian Zöllner ◽  
...  
Keyword(s):  
Palliative Care ◽  
Family Caregivers ◽  
Home Environment ◽  
Emergency Care ◽  
Medical Documentation ◽  
Prehospital Emergency Care ◽  
Emergency Physicians ◽  
Caregiver Support ◽  
Specialized Palliative Care ◽  
Prehospital Emergency

Introduction. The aim of our study was to investigate challenges faced by emergency physicians (EPs) who provide prehospital emergency care to patients with advanced incurable diseases and family caregivers in their familiar home environment. Methods. Qualitative study using semistructured interviews with open-ended questions to collect data from 24 EPs. Data were analyzed using qualitative content analysis. Results. We identified nine categories of challenges: structural conditions of prehospital emergency care, medical documentation and orders, finding optimal patient-centered therapy, uncertainty about legal consequences, challenges at the individual (EP) level, challenges at the emergency team level, family caregiver’s emotions, coping and understanding of patient’s illness, patient’s wishes, coping and understanding of patient’s illness, and social, cultural, and religious background of patients and families. EPs strengthened that the integrations of specialized prehospital palliative care services improved emergency care by providing resources to patients and family caregivers, enhancing the quality and availability of medical documentation and accessibility of aftercare in emergencies. Areas of improvement that were identified were to promote emergency physicians’ knowledge and skills in palliative care, communication, and family caregiver support by education and training. Furthermore, structures for better care on-site, thorough medical documentation, and specialized palliative care emergency facilities in hospital and prehospital care were requested. Conclusion. Prehospital emergency care in patients with advanced incurable diseases in their familiar home environment may be improved by training EPs in palliative care, communication, and caregiver support competences. Results underline the importance of collaborative specialized palliative care and prehospital emergency care.

Is there a role for an advanced practitioner in UK military prehospital care?

2021 ◽  
pp. e001781
Author(s):  
Elizabeth Paxman ◽  
D Lamb ◽  
S Findlay
Keyword(s):  
Patient Care ◽  
Clinical Experience ◽  
Emergency Care ◽  
Healthcare Professionals ◽  
Care Pathway ◽  
Prehospital Care ◽  
Advanced Practice ◽  
Advanced Practitioner ◽  
The Military

Recruitment and retention of doctors have been highlighted as some of the leading causes of the current perceived crisis within civilian emergency care. Indeed, the NHS recognises the contribution made by other healthcare professionals by supporting accreditation in advanced practice to mitigate the risks associated with these capability gaps. Consequently, roles such as the advanced clinical practitioner are now well established. Previous research and clinical experience in the civilian sector suggest that the advanced practitioner (AP) role could be used within Defence. Operationally, the role could be advantageous for the Defence Medical Services in the delivery of deployed healthcare. However, there is no available research that defines the role of UK military APs and, more specifically, their potential to support deployed prehospital care. Further work is required to determine how an AP might be effectively used within the military prehospital patient care pathway.

PINGVINAS IR PROTĖJAS. Įsivaizdavimas kaip kitybė manyje

2007 ◽  
Vol 4 ◽  
pp. 21-37
Author(s):  
Kristupas Sabolius
Keyword(s):  
Fight Club ◽  
The World ◽  
The Moment ◽  
Hollywood Movie

Kitybės klausimas dažniausiai kyla iš ego santykio su kitais arba su pasauliu. Šiame straipsnyje daroma prielaida, kad įsivaizdavimo funkcija ištirpdo subjektą ir jame pačiame atveria intersubjektyvią perspektyvą. Šiuo tikslu sugretinami Sartre’o, Husserlio bei Merleau-Ponty įsivaizdavimo funkcijos tyrimai, kuriuose išryškėja vaizdo kaip iš ego centro išslystančios ribos statusas, ir Holivudo filmo „Kovos klubas“ siužetas. Viename iš šios juostos epizodų pasirodantis pingvinas žymi egologinės schizmos akimirką ir tampa fantazijos apsireiškimu ir įsikūnijimu.Išgryninus žaidybinį, savarankišką ir multiformišką charakterį, galime konstantuoti, kad įsivaizdavimas, jei kalbėtume Kanto terminais, yra ne papildanti tarpinė funkcija, bet transcendentalinio subjekto genezėje atlieka paradoksalų „svetimos vidujybės“ arba „vidinės svetimybės“ vaidmenį. Vaizduotė yra katalizatoriaus, kuris, likdamas šalia, įgalina transcendentalinių formų išsikristalizavimą.Pagrindiniai žodžiai: vaizduotė, įsivaizdavimas, fantazija, ego, kitybė, sąmonė.PENGUIN AND PROTEUSImagination as Otherness in meKristupas Sabolius SummaryThe question of Otherness is usually taken into account while discussing the Ego’s relation with Others as well as with the World. This article is based on the premises that the function of phantasy melts the subjectivity, revealing the perspective of intersubjectivity within it. On this purpose Sartre’s, Husserl’s and Merleau-Ponty’s researches on the function of imagination, which elucidate the image as the boundary slipping from the centre of Ego, are compared to the story of Hollywood’ movie „Fight Club“. The penguin, which appears in one of the episodes, registers the moment of egological schism, thus becoming the revelation and incarnation of phantasy. While the playful, autonomous and multiform character of imaginary is cleared out, we can ascertain, speaking in Kantian terms, that it has not a complementary or intermediary function, but, in the genesis of transcendental subject, plays the paradoxical role of „allien innerness“ or „inner alienity“. Thought remaining always beside, imagination is a catalyzer which enables crystallization of transcendental forms.Keywords: imagination, imaginary, phantasy, ego, otherness, consciousness.

OBOLESCENCE AND THE DIFFUSION OF INNOVATIONS

2020 ◽  
pp. 113-130
Author(s):  
A.V. GOLUBEV ◽  
Keyword(s):  
Diffusion Of Innovations ◽  
Time Lag ◽  
Practical Implementation ◽  
Primary Role ◽  
Innovation Development ◽  
Scientific Hypothesis ◽  
Scientific Papers ◽  
The Moment ◽  
Sociological Studies

The diffusion of innovations is described as a process in a number of scientific papers. At the same time, the causes of this process have not been sufficiently studied. The author’s goal is to consider the main regularities, under which the life cycle of innovations begins, and propose measures to enhance diffusion in modern conditions. As a scientific hypothesis, the author accepts the postulate about the primary role of the obolescence of attracted innovations in this process. The analysis revealed not only the economic proportions that initiate the start of innovation promotion, but also the influence on the diffusion rate of the obsolescence degree of innovations and the market share occupied by the new product. Methodological approaches have been developed to determine economic efficiency depending on the moment of technological change-over, as well as to determine the absolute and relative speed of innovation diffusion. Sociological studies were conducted to determine the state of innovation development and the time lag between obtaining information about an innovation and its practical implementation. The author presents his “Agroopyt” information system developed to disseminate knowledge in the agricultural sphere and ensure technology transfer in agriculture. Digital methods provide for significant accelerateion of the diffusion of innovations and expand its scope.

The role of nutritional support in the provision of palliative care

2020 ◽  
pp. 55-64
Author(s):  
N. Zarechnov ◽  
A. Kuznetsov ◽  
N. Seliverstova
Keyword(s):  
Palliative Care ◽  
Nutritional Support

The article is devoted to the problem of nutrition of patients receiving palliative care. The authors emphasize the importance of nutritional support for this group of patients and describe the experience of enteral and paraenteral nutrition.

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