This paper points out that to persons unfamiliar with the context and suffering of dying patients, their loved ones, and last, but by no means least, the health care team can only discuss the very concrete question of euthanasia in an abstract way unaware of the fact that this question must, in the final analysis, be differently addressed in different specific patients and under specific circumstances. This paper poses questions which must be addressed and will rarely find a good answer but at least the best among a series of unpalatable options. It again points out the important and legitimate place that emotions play in decision-making. 相似文献
OBJECTIVE: Over the last 6 years, multidisciplinary teams (MDTs) have been established and play a key role in organizing the delivery of cancer care in the UK. There are no published data on the roles of their co-coordinators. To seek the views of colorectal multidisciplinary team co-ordinators (MDTCs) on what they do and how they do it. METHOD: Questionnaires were sent to the colorectal MDTC, or equivalent, in all 180 NHS hospital trusts in England and Wales where colorectal cancer surgery is performed. RESULTS: There was a 70% response rate. Seventy-one per cent of trusts now have a dedicated MDTC, whereas in 2002, only 40% had one. MDTCs generally keep their information on databases, but these differ, and are not coordinated with data entry into the national colorectal cancer database of the Association of Coloproctology of Great Britain and Ireland. In only 26 trusts does the MDTC communicate decisions to primary care, and the patients seem almost completely excluded from this process. CONCLUSION: The recently formed national MDTC Forum should grasp the opportunity of coordinating all of this well-intentioned but pluralistic activity to the benefit of patients, primary care and hospital teams. An effective MDTC with a robust database will be the key in achieving cancer waiting time targets with useful audit, thereby improving patient care. 相似文献
This audit has been conducted in order to provide an evidence base that clarifies the strengths and weaknesses of acute pain management at a UK hospital. Consequently, it sets the strategic direction for service improvement. Awarding up to three stars has identified the quality of each component that constitutes the acute pain service. Six different components were audited and star ratings have been awarded as shown below:
• Pain tool (including patient and staff understanding): no stars.
• Pain team (including education and clinical support): two stars.
• Intermittent opioid analgesia (sub-cut and oral morphine): two stars.
• Epidural patient controlled analgesia (EPCA): two stars.
• Intravenous patient controlled analgesia (IVPCA): two stars.
• Single-dose intrathecal opioid analgesia: three stars.
These star ratings were pulled together in order to award the acute pain service an overall rating. Consequently, the acute pain service was awarded two stars. The findings of this audit identify that this acute pain service provides a safe way to deliver hi-tech pain relief at ward level and can be relied upon to provide good quality pain management. However, too many patients are likely to miss out on the full benefits of the service due to the weaknesses as identified. The quality of the pain relief is impeded across the hospital due to low patient expectation and poor patient education, and also due to a lack of relevant knowledge amongst nursing staff. Developments in the role of the acute pain nurse, staff training and education programs, and a reduction in the variety of pain management pumps are combining to facilitate the opportunities required to address the weaknesses and to build on the strengths of the acute pain service. 相似文献
Summary Effective collaboration between agencies is often difficult to achieve. Children and their families/carers, who have complex therapeutic needs, present particular difficulties in that agencies need to work together, if they are to produce a co-ordinated and integrated package of care. A Multi-Agency-Consultation-Team (MACT) was set up in an attempt to overcome some of these problems of interagency co-operation. This paper describes the protocol, types of children referred and the recommendations made by the team. Follow-up of these children at 4 months suggests that a MACT does have a role to play in developing high quality services. 相似文献
We concur with Speer and Schneider's arguments (2003 ; this issue) that more psychologists should offer mental health services to older adults and that the primary care system is a good focus of such efforts. Three issues deserve more prominence in their review. First, their argument that older adults are averse to mental health services seems incorrect, given research indicating that older adults prefer psychotherapy to medication for treatment of depression. Second, psychologists working in primary care need to be aware of new Current Procedural Terminology (CPT) codes that allow documentation of psychological work in medical settings. Third, Speer and Schneider allude to interdisciplinary team functioning, but provide little information about models of team care or issues in developing a well-functioning interdisciplinary team; this commentary expands on those topics. 相似文献
The ongoing balance of service delivery and training offset with the European Working Time Directive has resulted in a requirement to review the surgical workforce and new ways of working. The extended surgical team can be utilized to support the delivery of surgical services. Surgical care practitioners are trained to care for surgical patients across the whole patient pathway: in clinics, theatre and on the ward. They are continual members of the surgical team and can support both the service and training due to the flexible nature of the role. This article gives an overview of the role of the surgical care practitioner (SCP) and how the role impacts surgical training. 相似文献