Search Results (15)

Background and Objectives: The increasing prevalence of end-of-life care needs in the emergency department necessitates training for emergency staff in managing terminal symptoms, facilitating serious illness conversations and ensuring goal-concordant interventions. This study aims to evaluate the longitudinal effects of an end-of-life care educational intervention on various emergency professionals. Materials and Methods: An interrupted time series study was conducted among emergency physicians and nurses at three public healthcare institutions over two-and-a-half years. The study had three phases: Phase 1—5 pre-intervention surveys, Phase 2—intervention with an online training course, and Phase 3—5 post-intervention surveys. The impact of the intervention was scored based on staff perceptions of end-of-life care in 3 domains: 1. Knowledge of palliative care (Knowledge), 2. Quality of end-of-life care provided (Care), and 3. Ability to communicate with patients and families (Communication). Results: There were 990 participants with 6450 questionnaires distributed and an 87% response rate of completed questionnaires. Phase 3 had generally higher levels of agreement in all 3 domains compared to Phase 1, with a continued upward trend in Knowledge scores. Upward trends in the Care and Communication domains were less pronounced. Among the 631 (out of 990) participants who completed the training, test scores showed a median improvement of 37.5% (p < 0.001). Conclusions: This study supports the feasibility of online end-of-life care training tailored specifically for emergency professionals, with promising results in the Knowledge, Care, and Communication domains. The findings can help guide the further development of training programs or the adoption of similar interventions for basic palliative care training for emergency physicians and nurses. Full article

Background: Serious illness conversation (SIC) in an important skillset for clinicians. A review of mortality meetings from an urban academic hospital highlighted the need for early engagement in SICs and advance care planning (ACP) to align medical treatments with patient-centered outcomes. The aim of this study was to increase SICs and their documentation in patients with low one-year survival probability identified by updated Charlson Comorbidity Index (CCI) scores. Methods: This was a quality improvement study with data collected pre- and post-intervention at a large urban level one trauma center in Virginia, which also serves as a primary teaching hospital to about 400 residents and fellows. Patient chart reviews were completed to assess medical records and hospitalization data. Chi square tests were used to identify statistical significance with the alpha level set at <0.05. Integrated care managers were trained to identify and discuss high CCI scores during interdisciplinary rounds. Providers were encouraged to document SICs with identified patients in extent of care (EOC) notes within the hospital’s cloud-based electronic health record known as EPIC. Results: Sixty-two patients with high CCI scores were documented, with 16 (25.81%, p = 0.0001) having EOC notes. Patients with documented EOC notes were significantly more likely to change their focus of care, prompting palliative care (63.04% vs. 50%, p = 0.007) and hospice consults (93.48% vs. 68.75%, p = 0.01), compared to those without. Post-intervention surveys revealed that although 50% of providers conducted SICs, fewer used EOC notes for documentation. Conclusion: This initial intervention suggests that the documentation of SICs increases engagement in ACP, palliative care, hospice consultations, and do not resuscitate decisions. Full article

Clinicians have a sincere desire to ensure that the decision-making processes of seriously ill patients are well informed throughout illness trajectories. A quagmire of variable terminology (e.g., advance care planning, serious illness conversations, goals-of-care discussions, etc.), however, currently predominates the field of serious illness communication. This creates uncertainty among clinicians as to the overall purpose, tasks, and specific outcomes of conversations that address serious illness. The Preparing or Deciding model is a unifying framework that provides conceptual clarity by helping clinicians understand their role in leading these important conversations. The Preparing or Deciding model simply posits that conversations with seriously ill patients are about either preparing or deciding. It considers these tasks to be mutually exclusive, which can help bypass many of the barriers to having these conversations. The Preparing or Deciding model compliments all existing resources and frameworks and is applicable to all healthcare practitioners in every care setting. To help move forward serious illness communication education and research, as well as process improvement efforts more effectively, here, we describe the Preparing or Deciding model. Full article

Cardiovascular illnesses remain the primary cause of death, accounting for at least 17.9 million fatalities per year and posing a significant public health problem because of its extensive predominance and effect on healthcare systems. The etiology of cardiovascular disease is complex and involves several environmental and lifestyle factors. Alcohol use is a highly important determinant because of its dual-edged effect on cardiovascular health. Multiple studies indicate that moderate alcohol consumption may have certain advantages, such as slight enhancements in lipid profiles. Conversely, excessive alcohol intake is associated with serious negative consequences, including cardiomyopathy, hypertension, arrhythmias, and even mortality. The aim of this study is to provide a comprehensive analysis of the several effects of alcohol on cardiovascular health and their understanding within the medical field over time. It uses an interpretative narrative review methodology and analyzes studies that focus on genetic risk factors, gender differences, and shifts in paradigms in recent years. This article highlights the need for obtaining a thorough understanding of the effects of alcohol on cardiovascular health to support public health guidelines and clinical practice, and it underscores the significance of including alcohol consumption into the broader context of cardiovascular risk management and identifies important subjects for further study. Full article

Background: Vaccinations protect the public against serious diseases or death; however, some individuals are hesitant in obtaining them. We aim to contribute to the understanding of the challenges of vaccination roll-out by examining the motivations, hesitancies, and their associated factors, in obtaining the COVID-19 vaccines two years into the pandemic. Methods: Cross-sectional online surveys were conducted in Norway, the USA, the UK, and Australia (N = 1649). The participants self-reported whether they had obtained one of the COVID-19 vaccines. Those who had obtained a vaccine reported the reason for their motivation, and those who had not obtained a vaccine reported the reason for their hesitancies. Results: More than 80% of the total sample obtained a COVID-19 vaccine because of public health recommendations and trusted that it was safe. Among those who had not obtained one, the most frequent reason was concerns about side effects. Most who obtained the vaccine reported that they believed in science, but many of those who had not obtained one reported distrust. Among those who had not obtained a vaccine, reports of distrust in policies and science were frequent. Concerns about side effects were more common in males and those with lower education, and those living in rural or remote areas. Conclusion: People who endorsed the vaccine believed that the vaccine reduces the risk of illness, protects the health of others, and had trust in scientific vaccination research. Conversely, the most frequent reason for vaccine hesitancy was concerns about side effects, followed by distrust in healthcare and science. These findings could inform public health strategies that aim to increase vaccination rates. Full article

According to the World Health Organization (WHO), stress can be defined as any type of alteration that causes physical, emotional, or psychological tension. A very important concept that is sometimes confused with stress is anxiety. The difference between stress and anxiety is that stress usually has an existing cause. Once that activator has passed, stress typically eases. In this respect, according to the American Psychiatric Association, anxiety is a normal response to stress and can even be advantageous in some circumstances. By contrast, anxiety disorders differ from temporary feelings of anxiousness or nervousness with more intense feelings of fear or anxiety. The Diagnostic and Statistical Manual (DSM-5) explicitly describes anxiety as exorbitant concern and fearful expectations, occurring on most days for at least 6 months, about a series of events. Stress can be measured by some standardized questionnaires; however, these resources are characterized by some major disadvantages, the main one being the time consumed to interpret them; i.e., qualitative information must be transformed to quantitative data. Conversely, a physiological recourse has the advantage that it provides quantitative spatiotemporal information directly from brain areas and it processes data faster than qualitative supplies. A typical option for this is an electroencephalographic record (EEG). We propose, as a novelty, the application of time series (TS) entropies developed by us to inspect collections of EEGs obtained during stress situations. We investigated this database related to 23 persons, with 1920 samples (15 s) captured in 14 channels for 12 stressful events. Our parameters reflected that out of 12 events, event 2 (Family/financial instability/maltreatment) and 10 (Fear of disease and missing an important event) created more tension than the others. In addition, the most active lobes reflected by the EEG channels were frontal and temporal. The former is in charge of performing higher functions, self-control, self monitoring, and the latter is in charge of auditory processing, but also emotional handling. Thus, events E2 and E10 triggering frontal and temporal channels revealed the actual state of participants under stressful situations. The coefficient of variation revealed that E7 (Fear of getting cheated/losing someone) and E11 (Fear of suffering a serious illness) were the events with more changes among participants. In the same sense, AF4, FC5, and F7 (mainly frontal lobe channels) were the most irregular on average for all participants. In summary, by means of dynamic entropy analysis, the goal is to process the EEG dataset in order to elucidate which event and brain regions are key for all participants. The latter will allow us to easily determine which was the most stressful and on which brain zone. This study can be applied to other caregivers datasets. All this is a novelty. Full article

The tryptophan–kynurenine pathway (Trp–KYN) is the major route for tryptophan conversion in the brain and in the periphery. Kynurenines display a wide range of biological actions (which are often contrasting) such as cytotoxic/cytoprotective, oxidant/antioxidant or pro-/anti-inflammatory. The net effect depends on their local concentration, cellular environment, as well as a complex positive and negative feedback loops. The imbalance between beneficial and harmful kynurenines was implicated in the pathogenesis of various neurodegenerative disorders, psychiatric illnesses and metabolic disorders, including diabetes mellitus (DM). Despite available therapies, DM may lead to serious macro- and microvascular complications including cardio- and cerebrovascular disease, peripheral vascular disease, chronic renal disease, diabetic retinopathy, autonomic neuropathy or cognitive impairment. It is well established that low-grade inflammation, which often coincides with DM, can affect the function of KP and, conversely, that kynurenines may modulate the immune response. This review provides a detailed summary of findings concerning the status of the Trp–KYN pathway in DM based on available animal, human and microbiome studies. We highlight the importance of the molecular interplay between the deranged (functionally and qualitatively) conversion of Trp to kynurenines in the development of DM and insulin resistance. The Trp–KYN pathway emerges as a novel target in the search for preventive and therapeutic interventions in DM. Full article

Health and social care professionals (HCPs) who work in nursing homes (NHs) are increasingly required to sustain serious illness conversations about care goals and preferences. Although these conversations may also be challenging for experienced HCPs and the literature recognizes high-quality communication as key to providing patient-centered care, so far, no specific educational program has been developed for the NH setting to improve HCPs’ communication skills. Our study aims to test the feasibility and potential effectiveness of an innovative, blended communication skills training program (Teach-to-Communicate) targeting the HCPs who work in NHs. This program includes classroom-based theory, experiential learning, and e-learning, and relies on interdisciplinary contexts and several didactic methods. The study consists of two phases: phase I is the development of written resources that employ focus group discussion involving field experts and external feedback from key stakeholders. Phase II consists of a multicenter, pilot, pre-post study with nested qualitative study. The Teach-to-Communicate training program is expected to enhance the quality of communication in NH and HCPs’ confidence in sustaining serious illness conversations, reduce family carers’ psycho-emotional burden and improve their satisfaction with the care received, and increase advance care planning documentation. Our protocol will provide insight for future researchers, healthcare providers, and policymakers and pave the way for blended educational approaches in the field of communication skills training. Full article

Patients with head and neck cancer report high unmet psychosocial needs as they undergo lifesaving treatments that can significantly alter their appearance and cause functional impairments. This qualitative analysis of recordings of 88 pre- and post-surgical consultations involving 20 patients respond to the need for empirical studies of patient–provider conversations about body image concerns. It indicates that the emphasis on concerns about survival, cure, and physical recovery during clinical consultations may leave concerns about the impacts of surgery on appearance and function unexplored and even silenced. The interviews with patients and medical team members that complement the analysis of the recordings suggest that an emphasis on survival, cure, and physical recovery can respond to the need for reassurance in the context of serious illness. However, it can also be problematic as it contributes to the silencing of patients’ concerns and to a potential lack of preparedness for the consequences of surgery. The results of this study can contribute to raising surgeons’ awareness of the interactional dynamics during clinical consultations. Moreover, the results highlight the unique role that surgeons can play in validating patients’ psychosocial concerns to support patients’ rehabilitation in both physical and psychosocial domains. Full article

Serious illness conversations aim to align medical care and treatment with patients’ values, goals, priorities, and preferences. Timely and accurate identification of patients for serious illness conversations is essential; however, existent methods for patient identification in different settings and population groups have not been compared and contrasted. This study aimed to examine the current literature regarding patient identification for serious illness conversations within the context of the Serious Illness Care Program and/or the Serious Illness Conversation Guide. A scoping review was conducted using the Joanna Briggs Institute guidelines. A comprehensive search was undertaken in four databases for literature published between January 2014 and September 2021. In total, 39 articles met the criteria for inclusion. This review found that patients were primarily identified for serious illness conversations using clinical/diagnostic triggers, the ’surprise question’, or a combination of methods. A diverse assortment of clinicians and non-clinical resources were described in the identification process, including physicians, nurses, allied health staff, administrative staff, and automated algorithms. Facilitators and barriers to patient identification are elucidated. Future research should test the efficacy of adapted identification methods and explore how clinicians inform judgements surrounding patient identification. Full article

The Serious Illness Care Program (SICP), designed by Ariadne Labs, is a multicomponent intervention to improve conversations about values and goals for patients with a life-limiting illness. In oncology, implementation of the SICP achieved more, earlier, and better-quality conversations and reduced anxiety and depression among patients with advanced cancer. In this commentary, we describe the SICP, including results from the cluster-randomized trial, provide examples of real-world implementation of this program, and highlight ongoing challenges and barriers that are preventing widespread adoption of this intervention into routine practice. For the SICP to be successfully embedded into routine patient care, it will require significant effort, including ongoing leadership support and training opportunities, champions from all sectors of the interdisciplinary team, and adaptation of the program to a wider range of patients. Future research should also investigate how early conversations can be translated into personalized care plans for patients. Full article

Muscle fatigue (MF) declines the capacity of muscles to complete a task over time at a constant load. MF is usually short-lasting, reversible, and is experienced as a feeling of tiredness or lack of energy. The leading causes of short-lasting fatigue are related to overtraining, undertraining/deconditioning, or physical injury. Conversely, MF can be persistent and more serious when associated with pathological states or following chronic exposure to certain medication or toxic composites. In conjunction with chronic fatigue, the muscle feels floppy, and the force generated by muscles is always low, causing the individual to feel frail constantly. The leading cause underpinning the development of chronic fatigue is related to muscle wasting mediated by aging, immobilization, insulin resistance (through high-fat dietary intake or pharmacologically mediated Peroxisome Proliferator-Activated Receptor (PPAR) agonism), diseases associated with systemic inflammation (arthritis, sepsis, infections, trauma, cardiovascular and respiratory disorders (heart failure, chronic obstructive pulmonary disease (COPD))), chronic kidney failure, muscle dystrophies, muscle myopathies, multiple sclerosis, and, more recently, coronavirus disease 2019 (COVID-19). The primary outcome of displaying chronic muscle fatigue is a poor quality of life. This type of fatigue represents a significant daily challenge for those affected and for the national health authorities through the financial burden attached to patient support. Although the origin of chronic fatigue is multifactorial, the MF in illness conditions is intrinsically linked to the occurrence of muscle loss. The sequence of events leading to chronic fatigue can be schematically denoted as: trigger (genetic or pathological) -> molecular outcome within the muscle cell -> muscle wasting -> loss of muscle function -> occurrence of chronic muscle fatigue. The present review will only highlight and discuss current knowledge on the molecular mechanisms that contribute to the upregulation of muscle wasting, thereby helping us understand how we could prevent or treat this debilitating condition. Full article

The increase of mental illness cases around the world can be described as an urgent and serious global health threat. Around 500 million people suffer from mental disorders, among which depression, schizophrenia, and dementia are the most prevalent. Revolutionary technological paradigms such as the Internet of Things (IoT) provide us with new capabilities to detect, assess, and care for patients early. This paper comprehensively survey works done at the intersection between IoT and mental health disorders. We evaluate multiple computational platforms, methods and devices, as well as study results and potential open issues for the effective use of IoT systems in mental health. We particularly elaborate on relevant open challenges in the use of existing IoT solutions for mental health care, which can be relevant given the potential impairments in some mental health patients such as data acquisition issues, lack of self-organization of devices and service level agreement, and security, privacy and consent issues, among others. We aim at opening the conversation for future research in this rather emerging area by outlining possible new paths based on the results and conclusions of this work. Full article

Liguria is a northwestern region of Italy that, since the WHO has declared COVID-19 as a pandemic (11 March 2020), presented 108 patients hospitalized, 34 of which were in the intensive care unit. Due to this serious epidemiological emergency, the transformation of a long-distance ferry ship into a hospital ship for COVID-19 patients who were still positive after the acute phase of the illness was carried out to free up hospital beds for patients in the acute phase. The ship was moored in the port of Genoa, the capital of Liguria. The conversion was localized to a single deck, where designated healthcare areas were identified. From 23 March to 18 June 2020, 191 patients were admitted onto the ship; they were provided with high-level healthcare guaranteed by the multi-disciplinary nature of clinical competencies available. Patients had a favorable outcome in all cases, confirmed by their recovery and negative swab results. Moreover, no cases of voluntary discharge were recorded. To the best of our knowledge, this is the only example in the world in which a passenger ship was transformed into a ship hospital for COVID patients. Full article

The Serious Illness Conversation Guide program developed by Ariadne Labs, a Joint Center for Health Systems Innovation, includes a list of patient-centered questions designed to assist clinicians to gain a more thorough understanding of their patient’s life in order to inform future care decisions. In July 2017, specialist pediatric palliative care clinicians at Canuck Place Children’s Hospice (CPCH) (Vancouver, BC, Canada), adapted the original guide to use with parents of children with serious illness. This tool is referred to as the Serious Illness Conversation Guide-Peds (SICG-Peds). Using the SICG-Peds, along with enhanced communication skills, can help illuminate the parents’ (child’s) understanding of illness and the values they hold. Expanding the application of the guide will promote goal-based, efficient, comprehensive and consistent communication between families and clinicians and help ensure that seriously ill children receive care that is tailored to their needs through the disease trajectory. This paper explores the guide through the lens of a case study. The steps—seeking permission, assessing understanding, sharing prognosis and exploring key topics (hopes, fears, strengths, critical abilities and trade-offs)—as well as formulating clinician recommendations, are described. Full article