How hospitalized older adults share concerns during daily rounds

ObjectiveTo explore how hospitalized older adults’ concerns are solicited and shared during daily rounds.MethodsWe audio recorded 40 physician-patient conversations during daily rounds in a Veterans Affairs Hospital. We developed codes from the conversation analysis (a qualitative method) for the event sequence analysis (a quantitative method) to calculate the conditional probabilities of physicians soliciting for general concerns leading to patients sharing concerns. We used a mixed-effects Poisson regression to calculate the relationship between number of concerns shared and patient education.ResultsMost of the 141 concerns were shared during the assessment questions and discussion of the plan of care, such as concerns about the patient’s caregiving responsibilities. The conditional probability was higher when physicians solicited for concerns after the assessment questions (0.56) than during the opening (0.25) or the closing (0.19) of the conversation. The design of the solicitation influenced the probability of patients sharing concerns. The number of concerns shared did not differ by level of education.ConclusionPhysicians can provide opportunities for patients to share concerns.Practice implicationsSoliciting for concerns after the assessment questions, asking “what” concerns a patient may have, and asking about caregiving responsibilities may be useful for patients to share their concerns.     

Moving from physician-centered care towards patient-centered care for Parkinson's disease patients

Today's society is changing rapidly and individuals increasingly favor an active role in designing their own lives. Contemporary patients are no exception, but the present health care system–which is organized primarily from the provider's perspective–is not yet prepared for this development. Here, we argue that an alternative way to organize health care, namely more from the patient's perspective, may help to contain costs, while improving the quality, safety and access to care. This involves a redefinition of the patient–doctor relationship, such that patients are no longer regarded as passive objects, but rather as active subjects who work as partners with health care professionals to optimize health (‘participatory medicine’). The opportunities that come with such a collaborative and patient-centered care model are reviewed within the context of patients with Parkinson's disease. We also discuss societal and Parkinson-specific barriers that could impede implementation of this alternative care model to the management of Parkinson's disease and other chronic conditions.     

Creating space to discuss end-of-life issues in cancer care

Objectives

Analyze entire oncology clinical visits and examine instances in which oncologists have to break the bad news that patients’ treatments are no longer effective.

Evidence-based recommendations for the management of anterior cruciate ligament (ACL) rupture

Anterior cruciate ligament (ACL) rupture occurs most commonly in young and active individuals and can have negative long-term physical and psychological impacts. The diagnosis is made with a combination of patient's history, clinical examination, and, if appropriate, magnetic resonance imaging. The objectives of management are to restore knee function, address psychological barriers to activity participation, prevent further injury and osteoarthritis, and optimize long-term quality of life. The three main treatment options for ACL rupture are (1) rehabilitation as first-line treatment (followed by ACL reconstruction (ACLR) in patients, who develop functional instability), (2) ACLR and post-operative rehabilitation as the first-line treatment, and (3) pre-operative rehabilitation followed by ACLR and post-operative rehabilitation. We provide practical recommendations for informing and discussing management options with patients, and describe patient-related factors associated with a worse ACL-rupture outcome. Finally, we define evidence-based rehabilitation and present phase-specific rehabilitation recommendations and criteria to inform return to sport decisions.     

Educación interprofesional: una propuesta de la Universidad de Navarra

Patient-centered healthcare is the key to humane care for the person and their family. Collaborative practice in interprofessional teams is essential to achieve quality healthcare. The University has the responsibility to prepare its graduates to work in interprofessional teams. A person-centered teaching-learning, based on the competences that define interprofessional education, is key for our students to recognize the need for a collaborative work. This article details a teaching project on interprofessional education at the University of Navarra, where students from medical, nursing school nad pharmacy gradually learn together the keys of a teamwork.     

Gender impact of caring on the health of caregivers of persons with dementia

BackgroundDementia is a brain syndrome that affects a growing number of persons worldwide and generates a strong and progressive demand for care from a family caregiver, usually females.ObjectiveWe aimed to describe the care provided by family caregivers of persons with dementia as well as the impact on their health and its interrelation with gender.Patient involvementThis study was carried out in collaboration with the 13 associations of family caregivers of persons with dementia that are part of a Regional Federation. This partnership worked towards bettering patient care and proposing improvements to the public health system.MethodsA multi-institutional cross-sectional study. A total of 462 primary family caregivers of persons with dementia from north-west Spain were included. Data were collected between January and April 2019 with an anonymous self-administered validated questionnaire (ICUB-97) based on Virginia Henderson’s nursing care model.ResultsThe most affected needs in family caregivers are those related to “recreational activities”, “communication” and “rest and sleep”. Statistically significant differences between male and female participants’ pattern of care and health-related impacts were found, especially in issues related to work and family reconciliation.DiscussionCare plans should be developed taking gender perspective into account. From a nurse model point of view, more research is necessary to reduce health disparities. This study provides an assessment of gender differences in care and the impact on caregivers’ health.Practical valueRegarding the specific health conditions of female caregivers and from a holistic point of view, these findings could provide novel and interesting data that might help to implement gender perspective in nursing care plans, generally invisible in routine clinical practice.