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Jubb AM 《Journal of medical ethics》2002,28(6):342-346
Good medical practice requires evidence of effectiveness to address deficits in care, strive for further improvements, and justly apportion finite resources. Nevertheless, the potential of palliative care is still held back by a paucity of good evidence. These circumstances are largely attributable to perceived ethical challenges that allegedly distinguish dying patients as a special client class. In addition, practical limitations compromise the quality of evidence that can be obtained from empirical research on terminally ill subjects. This critique aims to appraise the need for focused research, in order to develop clinical and policy decisions that will guide health care professionals in their care of dying patients. Weighted against this need are tenets that value the practical and ethical challenges of palliative care research as unique and insurmountable. The review concludes that, provided investigators compassionately apply ethical principles to their work, there is no justification for not endeavouring to improve the quality of palliative care through research. 相似文献
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Every physician, regardless of specialty, must advocate and facilitate patient access to comprehensive palliative and hospice care as their patients enter the last phase of life due to advanced disease or a terminal condition. Accordingly, physicians must become familiar with both the general and the disease-specific eligibility guidelines for hospice, the different levels of hospice care, physician re-imbursement for hospice patient care, and become knowledgeable in advance healthcare planning. The latter includes an understanding of Oklahoma's DNR law and the Advance Directive for Health Care (Living Will) law. Physician proficiency in the palliation of pain and non-pain symptoms that occur in patients at end-of-life is critical to alleviate patient suffering and to ensure the patient's peaceful dying. 相似文献
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海峡两岸医药卫生交流协会全科医学分会 《中国全科医学》2021,24(14):1717-1734
姑息治疗与安宁疗护是通过多学科协作的模式,有效改善患者的痛苦症状、提高生活质量,直至其舒适、有尊严离世的新兴临床学科,适用于各年龄阶段,罹患现代医学无法治愈,并伴有躯体和/或精神心理症状,严重影响生活质量的疾病终末期和临终期患者。合理使用药物是姑息治疗与安宁疗护中最为重要的内容之一,因此,指南工作组依照国际指南的制定标准、结合国内外相关研究和临床实践,制订了我国首部《姑息治疗与安宁疗护基本用药指南》。该指南围绕各种疾病终末期和临终期患者常见的33个全身性和各系统的躯体、精神心理症状及难治性症状,推荐23种治疗药物,其中20种药物收录于我国现行《国家基本药物目录》。为便于广大医务人员参阅学习,指南详细阐述了姑息治疗与安宁疗护专科的基本理论、临床用药原则、相关药物的用法用量和注意事项等内容。该指南的制定有助于提升各临床学科对疾病终末期和临终患者的诊疗服务质量,是确保患者获得舒适与尊严性医疗服务的基本保障,同时填补了我国姑息治疗与安宁疗护学科发展的空白。 相似文献
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Interventions for the treatment and management of chronic fatigue syndrome: a systematic review 总被引:26,自引:1,他引:25
CONTEXT: A variety of interventions have been used in the treatment and management of chronic fatigue syndrome (CFS). Currently, debate exists among health care professionals and patients about appropriate strategies for management. OBJECTIVE: To assess the effectiveness of all interventions that have been evaluated for use in the treatment or management of CFS in adults or children. DATA SOURCES: Nineteen specialist databases were searched from inception to either January or July 2000 for published or unpublished studies in any language. The search was updated through October 2000 using PubMed. Other sources included scanning citations, Internet searching, contacting experts, and online requests for articles. STUDY SELECTION: Controlled trials (randomized or nonrandomized) that evaluated interventions in patients diagnosed as having CFS according to any criteria were included. Study inclusion was assessed independently by 2 reviewers. Of 350 studies initially identified, 44 met inclusion criteria, including 36 randomized controlled trials and 8 controlled trials. DATA EXTRACTION: Data extraction was conducted by 1 reviewer and checked by a second. Validity assessment was carried out by 2 reviewers with disagreements resolved by consensus. A qualitative synthesis was carried out and studies were grouped according to type of intervention and outcomes assessed. DATA SYNTHESIS: The number of participants included in each trial ranged from 12 to 326, with a total of 2801 participants included in the 44 trials combined. Across the studies, 38 different outcomes were evaluated using about 130 different scales or types of measurement. Studies were grouped into 6 different categories. In the behavioral category, graded exercise therapy and cognitive behavioral therapy showed positive results and also scored highly on the validity assessment. In the immunological category, both immunoglobulin and hydrocortisone showed some limited effects but, overall, the evidence was inconclusive. There was insufficient evidence about effectiveness in the other 4 categories (pharmacological, supplements, complementary/alternative, and other interventions). CONCLUSIONS: Overall, the interventions demonstrated mixed results in terms of effectiveness. All conclusions about effectiveness should be considered together with the methodological inadequacies of the studies. Interventions which have shown promising results include cognitive behavioral therapy and graded exercise therapy. Further research into these and other treatments is required using standardized outcome measures. 相似文献
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Although information technology (IT)-based applications in healthcare have existed for more than three decades, methods to
evaluate outputs and outcomes of the use of IT-based systems in medical informatics is still a challenge for decision makers,
as well as to those who want to measure the effects of ICT in healthcare settings. The aim of this paper is to review published
articles in the area evaluations of IT-based systems in order to gain knowledge about methodologies used and findings obtained
from the evaluation of IT-based systems applied in healthcare settings. The literature review includes studies of IT-based
systems between 2003 and 2005. The findings show that economic and organizational aspects dominate evaluation studies in this
area. However, the results focus mostly on positive outputs such as user satisfaction, financial benefits and improved organizational
work. This review shows that there is no standard framework for evaluation effects and outputs of implementation and use of
IT in the healthcare setting and that until today no studies explore the impact of IT on the healthcare system’ productivity
and effectiveness. 相似文献
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目的 通过对CNKI数据库近19年来的安宁疗护文献进行可视化分析,总结安宁疗护研究领域的研究热点和研究前沿,为安宁疗护的研究提供参考。方法 运用CiteSpace可视化分析软件,对收集的有关安宁疗护的5 221篇文献进行可视化分析,绘制出作者和机构、研究热点和研究前沿的知识图谱。结果 安宁疗护研究领域共引发文量前5名的作者是施永兴、王玉梅、徐燕、袁长蓉、史宝欣;共引文献前5名的机构是中国生命关怀协会、郑州大学护理学院、上海市普陀区长征镇社区卫生服务中心、北京协和医院老年医学科、吉林医药学院;研究的主题主要集中在临终关怀、姑息治疗和护理;研究的人群主要是临终者、癌症和肿瘤患者;近3年的研究方向主要是胃癌、临终护理、姑息性手术和社区等。结论 中国安宁疗护研究领域的合作不够密切,未来可以在政府和学术组织的倡导和引领下,集结专业人员开展更加专业和系统的临床研究,为安宁疗护的进一步推广提供依据和参考。 相似文献
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Objective To assess the effectiveness of computer-aided clinical decision support systems (CDSS) in improving antibiotic prescribing in primary care.Methods A literature search utilizing Medline (via PubMed) and Embase (via Embase) was conducted up to November 2013. Randomized controlled trials (RCTs) and cluster randomized trials (CRTs) that evaluated the effects of CDSS aiming at improving antibiotic prescribing practice in an ambulatory primary care setting were included for review. Two investigators independently extracted data about study design and quality, participant characteristics, interventions, and outcomes.Results Seven studies (4 CRTs, 3 RCTs) met our inclusion criteria. All studies were performed in the USA. Proportions of eligible patient visits that triggered CDSS use varied substantially between intervention arms of studies (range 2.8–62.8%). Five out of seven trials showed marginal to moderate statistically significant effects of CDSS in improving antibiotic prescribing behavior. CDSS that automatically provided decision support were more likely to improve prescribing practice in contrast to systems that had to be actively initiated by healthcare providers.Conclusions CDSS show promising effectiveness in improving antibiotic prescribing behavior in primary care. Magnitude of effects compared to no intervention, appeared to be similar to other moderately effective single interventions directed at primary care providers. Additional research is warranted to determine CDSS characteristics crucial to triggering high adoption by providers as a perquisite of clinically relevant improvement of antibiotic prescribing. 相似文献
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Healthcare in America continues to be of paramount importance, and one of the most highly debated public policy issues of
our time. With annual expenditures already exceeding $2.4 trillion, and yielding less than optimal results, it stands to reason
that we must turn to promising tools and solutions, such as information technology (IT), to improve service efficiency and
quality of care. Presidential addresses in 2004 and 2008 laid out an agenda, framework, and timeline for national health information
technology investment and development. A national initiative was long overdue. This report we show that advancements in both
medical technologies and information systems can be capitalized upon, hence extending information systems usage beyond data
collection to include administrative and decision support, care plan development, quality improvement, etc. In this paper
we focus on healthcare services for palliative patients. We present the development and preliminary accounts of a successful
initiative in the Medical Center of Central Georgia where footprints information technology was modified and integrated into
the hospital’s palliative care service and existing EMR systems. The project provides evidence that there are a plethora of
areas in healthcare in which innovative application of information systems could significantly enhance the care delivered
to loved ones, and improve operations at the same time.. 相似文献
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目的 分析总结社区舒缓医疗的国际新进展与趋势,为促进我国的社区舒缓医疗发展路径提供参考。方法 系统检索2014年1月1日至2021年11月1日Web of Science核心合集数据库收录的关于社区舒缓医疗相关英文文献,采用CiteSpace 5.8.R1软件对纳入文献进行合作网络分析和共现网络分析。结果 共纳入1509篇英文文献。社区舒缓医疗的相关国际研究年度发文量和被引频次呈逐年上升趋势。文献高产国家为美国。高产机构为英国伦敦国王学院。高产作者为英国伦敦国王学院的Irene J Higginson。国际研究热点为以提高生命质量为目的的癌症等生命末期患者的临终关怀。未来服务对象将扩展到痴呆群体和老年人。研究对象还将涉及家庭照顾者和舒缓医疗工作者。研究内容将涉及干预方法及效果、医疗意愿和预先医疗照护计划等。结论 近年社区舒缓医疗研究快速发展,服务对象从患者拓展至全人群并提供全生命周期照护。我国应加强国际合作交流,借鉴全民化、多元化的发展路径,进一步推动社区舒缓医疗的实践与发展。 相似文献
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Keeley PW 《Journal of medical ethics》2008,34(10):757-760
The difficulties of undertaking good quality effectiveness research in palliative medicine are well documented. Much of the ethical literature in this area focuses on the vulnerability of the palliative care population. It is clear that a wider ethical approach will need to be used to justify research in the terminally ill. Some themes of ethical thought are underutilised in considering the ethics of palliative care research. Three arguments to justify the need for effectiveness research in palliative care should be highlighted: (1) there is evidence of an untapped altruism amongst the population of palliative care patients who would be keen to be involved in such research; (2) traditional Aristotelean and Thomistic virtue ethics would point to the need to gain knowledge in and of itself, but especially in palliative medicine for the benefit of PATIENTS: virtue also accrues in the acquisition of a stock of research experience which in turn makes further research feasible; (3) most compellingly, justice would dictate that palliative treatments are effective, that futile or useless treatments are avoided and that patients are not party to "n of 1" trials by default. The current state of the evidence base of effectiveness in palliative care leads us to the uncomfortable position where patients are in precisely the position of being unwitting participants in "n of 1" clinical trials by default, without their explicit consent. 相似文献
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Access to palliative care and hospice in nursing homes 总被引:2,自引:2,他引:0
Nursing homes are the site of death for many elderly patients with incurable chronic illness, yet dying nursing home residents have limited access to palliative care and hospice. The probability that a nursing home will be the site of death increased from 18.7% in 1986 to 20.0% by 1993. Dying residents experience high rates of untreated pain and other symptoms. They and their family members are isolated from social and spiritual support. Hospice improves end-of-life care for dying nursing home residents by improving pain control, reducing hospitalization, and reducing use of tube feeding, but it is rarely used. For example, in 1997 only 13% of hospice enrollees were in nursing homes while 87% were in private homes, and 70% of nursing homes had no hospice patients. Hospice use varies by region, and rates of use are associated with nursing home administrators' attitudes toward hospice and contractual obligations. Current health policy discourages use of palliative care and hospice for dying nursing home residents. Quality standards and reimbursement rules provide incentives for restorative care and technologically intensive treatments rather than labor-intensive palliative care. Reimbursement incentives, contractual requirements, and concerns about health care fraud also limit its use. Changes in health policy, quality standards, and reimbursement incentives are essential to improve access to palliative care and hospice for dying nursing home residents. JAMA. 2000;284:2489-2494. 相似文献
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Xiaohong Ning 《中国医学科学杂志(英文版)》2018,33(4):199-203
The concept of End-of-Life Care (EOLC) came into China in the late 1980s. However, hospice and palliative care in medical practice develope slowly. In recent years, profesionals, patients and their families, as well as government begin to attach importance to it. There is a hospice and palliative care movement now in China. This article gives an overview of the progress and the current status in multiple aspects of hospice and palliative care in mainland China, and points out the barriers and challenges for its further development in the future. 相似文献
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Laure Perrier Ann Farrell A Patricia Ayala David Lightfoot Tim Kenny Ellen Aaronson Nancy Allee Tara Brigham Elizabeth Connor Teodora Constantinescu Joanne Muellenbach Helen-Ann Brown Epstein Ardis Weiss 《J Am Med Inform Assoc》2014,21(6):1118-1124
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To assess the effects of librarian-provided services in healthcare settings on patient, healthcare provider, and researcher outcomes.Materials and methods
Medline, CINAHL, ERIC, LISA (Library and Information Science Abstracts), and the Cochrane Central Register of Controlled Trials were searched from inception to June 2013. Studies involving librarian-provided services for patients encountering the healthcare system, healthcare providers, or researchers were eligible for inclusion. All librarian-provided services in healthcare settings were considered as an intervention, including hospitals, primary care settings, or public health clinics.Results
Twenty-five articles fulfilled our eligibility criteria, including 22 primary publications and three companion reports. The majority of studies (15/22 primary publications) examined librarians providing instruction in literature searching to healthcare trainees, and measured literature searching proficiency. Other studies analyzed librarian-provided literature searching services and instruction in question formulation as well as the impact of librarian-provided services on patient length of stay in hospital. No studies were found that investigated librarians providing direct services to researchers or patients in healthcare settings.Conclusions
Librarian-provided services directed to participants in training programs (eg, students, residents) improve skills in searching the literature to facilitate the integration of research evidence into clinical decision-making. Services provided to clinicians were shown to be effective in saving time for health professionals and providing relevant information for decision-making. Two studies indicated patient length of stay was reduced when clinicians requested literature searches related to a patient''s case. 相似文献18.
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反思中国医科大学附属盛京医院宁养院构建宁养疗护"本土化"实践的历程。认为符合国情的"本土化"宁养服务是宁养疗护的根基所在;宁养疗护在改善癌症病人生活质量的同时,也降低了医药费用的开支;宁养疗护是对癌症患者治疗上的哲学思考,是理念不是界限。为使肿瘤防治走出"治疗过度"和"姑息不足"的误区,发展以居家服务为特色的中国宁养疗护模式,尚需全社会的共同努力。 相似文献
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Operating theatres represent a significant cost burden for healthcare providers around the world. Theatre start time is widely acknowledged as an important target for efficiency savings. However, there is uncertainty surrounding the effectiveness of strategies to improve start time, and questions regarding the barriers to their implementation. We conducted a systematic review of bibliographic databases to identify primary research papers assessing the effect of interventions on theatre start time. Two hundred and nine papers were found from electronic literature search with 14 being included in the final review. Financial incentives, educational approaches, system-based techniques, communication, the ‘golden patient’ initiative and ‘the productive operating theatre’ scheme have all been shown to improve start time. However, questions remain over which is the most effective, the longevity of their effects and whether the results can be extrapolated beyond the context in which they were studied. We summarise the key approaches reported in the literature and identify areas for future research. This is of use to clinicians and hospital managers seeking to improve efficiency and achieve cost savings. 相似文献