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Teaching end-of-life issues: Current status in United Kingdom and United States medical schools 临终问题教学:英国和美国医学院的现状
Pub Date : 2002-05-01 DOI: 10.1177/104990910201900309
G. Dickinson, D. Field
Our objective was to determine how broadly end-of-life issues are represented in the undergraduate medical school curricula of the United Kingdom (UK) and the United States (US). Mailed surveys yielded response rates of 100 percent in the UK and 92 percent in the US. With one exception, all medical schools in the survey offered some exposure to dying, death, and bereavement and most addressed the topic of palliative care. Hospice involvement was found in 96 percent of UK medical schools but in only 50 percent of US schools. Overall, the UK appears to provide more exposure to end-of-life issues in medical schools, although the US appears to be moving in that direction.
我们的目标是确定生命终结问题在英国(UK)和美国(US)的本科医学院课程中有多广泛。邮寄调查的回复率在英国为100%,在美国为92%。除了一个例外,调查中所有的医学院都提供了一些关于死亡、死亡和丧亲之痛的内容,而且大多数都讨论了姑息治疗的话题。英国96%的医学院都有临终关怀课程,而美国只有50%。总体而言,尽管美国似乎正朝着这个方向发展,但英国似乎在医学院提供了更多关于生命终结问题的机会。
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引用次数: 53
Palliative care, burnout, and the pursuit of happiness 姑息治疗,倦怠,追求幸福
Pub Date : 2002-05-01 DOI: 10.1177/104990910201900303
S. Baumrucker
I was attending a lecture at the Third Joint Clinical Conference of the NHPCO/AAHPM/HPNA (National Hospice and Palliative Care Organization, American Academy of Hospice and Palliative Medicine, and Hospice and Palliative Nurses Association) in New Orleans last week when I had an epiphany. The talk was by John Finn, MD, the medical director of Hospice of Michigan (a large, multicenter hospice organization based in Detroit). He was speaking on “selfpreservation skills for the hospice professional” to a packed room. While Dr. Finn spoke, I suddenly realized how relevant his talk was to me and to many practitioners in our field. My “bolt of lightning,” as I will explain, struck as I pondered his words about the dangers of pessimism and cynicism and the benefits of optimism and trust. Professional burnout is not confined to palliative care, or even to medicine. “Burnout” is a response to unremitting stress and is described as a “syndrome of depersonalization, emotional exhaustion, and a sense of low personal accomplishment”1 resulting in depression, anxiety, and degraded interpersonal relationships. Overt symptoms are legion and include irritability, appetite disorders, memory disturbances, lack of impulse control (e.g., shouting, acting out), and even self-destructive behaviors. Given the stresses in dealing with death-and-dying issues, paperwork, regulatory upkeep, distressed families, late or inappropriate referrals, and marginal reimbursement, it is no surprise that nurses, social workers, aides, chaplains, physicians, and all other hospice and palliative caregivers are at risk. Before proceeding, it should be noted that palliative care physicians report lower levels of burnout and other stress-related disorders than do other specialists, at least in the United Kingdom, where these studies were performed.2 English palliative-care consultants report less stress from overload than their colleagues and relate gratification from the positive relationships they enjoy with patients. To further illustrate the point, compare the 28-percent “burnout and psychiatric disorder” rate in the UK study of oncologists and palliative care specialists2 to the 76 percent burnout rate among internal medicine residents in Rochester, Minnesota1 for a stunning juxtaposition. What was extremely interesting in the UK palliative care study was that burnout was significantly more common in those who felt they were insufficiently trained in the communication skills required for the job.3 In Dr. Finn’s talk, he referenced an article by Jim Loehr and Tony Schwarz titled “The Making of a Corporate Athlete,” which appeared in the January 2001 Harvard Business Review.4 Sounding board
上周,我在新奥尔良参加了NHPCO/AAHPM/HPNA(国家临终关怀和姑息治疗组织,美国临终关怀和姑息医学学会,以及临终关怀和姑息护理协会)第三届联合临床会议的演讲,当时我顿悟了。演讲人是密歇根临终关怀医院(一家总部设在底特律的大型多中心临终关怀机构)的医学主任约翰·芬恩医学博士。他的演讲主题是“临终关怀专业人员的自我保护技能”,听众座无虚席。在芬恩博士的演讲中,我突然意识到他的演讲对我和我们这个领域的许多从业者来说是多么的相关。当我思考他关于悲观和玩世不恭的危险以及乐观和信任的好处的话时,我的“闪电”击中了我。职业倦怠并不局限于姑息治疗,甚至不局限于医学。“倦怠”是对持续压力的反应,被描述为一种“人格解体、情绪衰竭和个人成就感低的综合征”,导致抑郁、焦虑和人际关系恶化。明显的症状有很多,包括易怒、食欲失调、记忆障碍、缺乏冲动控制(如大喊大叫、情绪失控),甚至有自我毁灭的行为。考虑到在处理死亡和临终问题、文书工作、监管维护、痛苦的家庭、延迟或不适当的转诊以及边际报销方面的压力,护士、社会工作者、助手、牧师、医生以及所有其他临终关怀和姑息治疗护理人员都处于危险之中就不足为奇了。在继续之前,应该指出的是,至少在进行这些研究的英国,姑息治疗医生报告的倦怠和其他压力相关疾病的水平低于其他专家与他们的同事相比,英国姑息治疗咨询师报告说,超负荷工作带来的压力更小,他们与病人之间的积极关系也让他们感到满足。为了进一步说明这一点,将英国肿瘤学家和姑息治疗专家研究中28%的“倦怠和精神障碍”率与明尼苏达州罗切斯特市内科住院医生的76%的倦怠率进行比较,这是一个惊人的对比。在英国的缓和治疗研究中,非常有趣的是,在那些认为自己在工作所需的沟通技巧方面没有得到充分培训的人身上,倦怠明显更常见在Finn博士的演讲中,他引用了Jim Loehr和Tony Schwarz在2001年1月的《哈佛商业评论》上发表的一篇题为《企业运动员的形成》的文章
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引用次数: 11
Using caregivers-as-proxies to retrospectively assess and measure quality of dying of palliative care clients 使用照护者作为代理对姑息治疗病人的死亡质量进行回顾性评估和测量
Pub Date : 2002-05-01 DOI: 10.1177/104990910201900311
M. Bridge, D. Roughton, S. Lewis, J. Barelds, S. Brenton, Sherree Cotter, Mary-lou Hagebols, Kirsty Woolman, M. Annells, T. Koch
This study evaluated two quality-of-life assessment and measurement tools, the Client Generated Index and the McGill Quality of Life questionnaire, within palliative care nursing. Primarily tested was the feasibility of the tools to assess clients’ QOL at admission and, if necessary, when their condition altered. The reliability of the tools has previously been ascertained. Additionally, quality of dying during the last two days of life for 14 participants who died during the study was assessed and measured retrospectively by these tools, using the client’s nominated care-giver as proxy for the client. It is this second focus that we report on here. The reasons why proxy assessment and measurement of client QOD was not useful or feasible are discussed.
本研究评估了姑息治疗护理中的两种生活质量评估和测量工具,即客户生成指数和麦吉尔生活质量问卷。主要测试的是在入院时评估患者生活质量的工具的可行性,如果有必要,当他们的病情发生变化时。这些工具的可靠性先前已得到确认。此外,14名在研究期间死亡的参与者在生命最后两天的死亡质量通过这些工具进行回顾性评估和测量,使用客户指定的护理人员作为客户的代理。我们在这里报道的是第二个重点。讨论了代理评价和测量客户QOD不实用和不可行的原因。
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引用次数: 12
You need not make the journey alone: Overcoming impediments to providing palliative care in a public urban teaching hospital 你不需要独自旅行:克服在城市公立教学医院提供姑息治疗的障碍
Pub Date : 2002-05-01 DOI: 10.1177/104990910201900308
Angèle Ryan, J. Carter, J. Lucas, J. Berger
The majority of dying patients continue to receive care in acute, tertiary settings. This has generated the development of hospital-based palliative care (HBPC). The Symptom Management and Palliative Care Program (SMPCP) at LAC+USC Medical Center provides HBPC. The SMPCP operates as an interdisciplinary consultative service, assessing inpatients, and documenting recommendations for primary physicians. Over a 28-month period the SMPCP provided clinical recommendations, education, and research for patients, family members, and hospital staff. Demographic, clinical, psychosocial, financial, and outcome information was collected on 265 patients. The SMPCP documented the attainment of defined quality end-points, including pain control within 24 hours, a Do Not Resuscitate (DNR) discussion with patient and family within 72 hours, and control of nausea and vomiting within 24 hours. Team members also documented impediments to implementing recommendations and the success of interventions to overcome impediments. Results indicated that the SMPCP achieved a high rate of quality end-point attainment when impediments were not present. The most significant impediments resulted from behaviors by primary physicians. The SMPCP’s ability to overcome barrier behaviors improved the rate of end-point attainment, confirming the importance of palliative care at the end of life.
大多数垂死病人继续在急性三级环境中接受治疗。这促成了以医院为基础的姑息治疗(HBPC)的发展。LAC+USC医疗中心的症状管理和姑息治疗项目(SMPCP)提供HBPC。SMPCP作为一种跨学科的咨询服务,评估住院病人,并为初级医生提供建议。在28个月的时间里,SMPCP为患者、家属和医院工作人员提供了临床建议、教育和研究。收集了265名患者的人口学、临床、社会心理、财务和结局信息。SMPCP记录了达到定义的质量终点,包括24小时内疼痛控制,72小时内与患者和家属进行不复苏(DNR)讨论,24小时内恶心和呕吐的控制。小组成员还记录了执行建议的障碍和克服障碍的干预措施的成功情况。结果表明,当障碍不存在时,SMPCP达到高质量终点的率。最显著的障碍来自于主治医生的行为。SMPCP克服障碍行为的能力提高了终点达到率,证实了临终时姑息治疗的重要性。
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引用次数: 20
A phase II study of low-dose megestrol acetate using twice-daily dosing for anorexia in nonhormonally dependent cancer 低剂量醋酸甲地孕酮每日两次治疗非激素依赖性癌症患者厌食症的II期研究
Pub Date : 2002-05-01 DOI: 10.1177/104990910201900313
K. Nelson, D. Walsh, M. Hussein
Anorexia is a common problem in advanced cancer. Low-dose megestrol acetate, a semi-synthetic progesterone, given twice daily, is an effective appetite stimulant in advanced cancer patients. There was an excellent correlation between patient satisfaction and the primary response criteria (appetite improvement). Given cost, side-effect profile, ease of administration, and efficacy, 80 mg twice daily after meals is an appropriate starting dose of megestrol acetate for anorexia in advanced cancer. If this is not effective, considerable dose escalation is possible.
厌食症是晚期癌症的常见问题。低剂量的醋酸甲孕酮是一种半合成的黄体酮,每天服用两次,对晚期癌症患者是一种有效的食欲兴奋剂。患者满意度与主要反应标准(食欲改善)之间存在极好的相关性。考虑到成本、副作用、给药的便捷性和疗效,80mg醋酸甲地孕酮餐后服用是治疗晚期癌症厌食症的合适起始剂量。如果不有效,可能会有相当大的剂量增加。
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引用次数: 9
Book Review: Handbook for Mortals: Guidance for People Facing Serious Illness 书评:凡人手册:面对严重疾病的人的指导
Pub Date : 2002-05-01 DOI: 10.1177/104990910201900316
J. Ufema
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引用次数: 0
Everyday hero 日常的英雄
Pub Date : 2002-05-01 DOI: 10.1177/104990910201900315
Hunter E Woodall
Downloading the book in this website lists can give you more advantages. It will show you the best book collections and completed collections. So many books can be found in this website. So, this is not only this everyday hero. However, this book is referred to read because it is an inspiring book to give you more chance to get experiences and also thoughts. This is simple, read the soft file of the book and you get it.
下载这个网站列表中的书可以给你更多的好处。它会向你展示最好的藏书和完整的藏书。在这个网站上可以找到很多书。所以,这不仅仅是一个普通的英雄。然而,这本书是值得阅读的,因为它是一本鼓舞人心的书,给你更多的机会获得经验和思想。这很简单,阅读这本书的软文件,你就明白了。
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引用次数: 1
Burnout and compassion fatigue among hospice caregivers 临终关怀照护者的倦怠与同情疲劳
Pub Date : 2002-05-01 DOI: 10.1177/104990910201900312
G. Keidel
Burnout is a word currently used in discussions about the present nursing shortage. Hospice staff, because of their work with the terminally ill, are considered a high-risk group for burnout. Too frequently, the reason behind the decision to leave or take a sabbatical from hospice work is that the staff member reached the limits of his or her capacity to care and “couldn’t take it any more.” It is, therefore, important to discuss the concept of burnout and how it can affect hospice staff as well as the primary caregivers for hospice patients to ascertain the reasons behind it and take steps to lessen caregiver stress.
职业倦怠是目前在讨论护理短缺时使用的一个词。临终关怀的工作人员,因为他们的工作是与临终病人打交道,被认为是倦怠的高风险群体。通常情况下,决定离开或休假的原因是工作人员达到了他或她的护理能力的极限,“再也不能忍受了”。因此,重要的是要讨论倦怠的概念,以及它如何影响安宁疗护人员以及安宁疗护病人的主要照护者,以确定其背后的原因,并采取措施减轻照护者的压力。
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引用次数: 196
Barriers, challenges, and opportunities related to the provision of hospice care in assisted-living communities 在辅助生活社区提供安宁疗护的障碍、挑战与机会
Pub Date : 2002-05-01 DOI: 10.1177/104990910201900310
S. Dixon, J. Fortner, S. Travis
The purpose of this project was to clarify the barriers, challenges, and opportunities associated with providing care to older adults residing in assisted-living communities. Three focus groups (hospice team members, family members of individuals who received hospice care while in assisted living, and administrators of assisted-living communities) were convened to discuss hospice care. Thematic analysis of the transcribed focus group tapes was used by the authors to identify the common and unique barriers, challenges, and opportunities identified by each group. All three groups were overwhelmingly in support of the right of residents in assisted-living communities to live and die in place, without being transferred to nursing homes or other acute-care facilities, and of the role that hospice plays in enabling residents to achieve that goal. The three groups also agreed that trends in the development of assisted-living communities create difficulties for the industry, confusion for consumers, and the need for increased accountability by providers. Delivering hospice care to places where consumers want to live and die in place will be a complex task. Among other things, traditional hospice care is not easily transported into the social models of care characterized by assisted-living environments. Changes in hospice organization policies and procedures will be necessary, as will broader, industry-wide reforms in areas such as recruitment, retention of qualified staff, and consistent quality-of-care standards.
这个项目的目的是为了澄清为居住在辅助生活社区的老年人提供护理的障碍、挑战和机会。三个焦点小组(安宁疗护团队成员,在辅助生活中接受安宁疗护的个人的家庭成员,以及辅助生活社区的行政人员)被召集来讨论安宁疗护。作者对焦点小组录音进行了专题分析,以确定每个小组确定的共同和独特的障碍、挑战和机会。这三个群体绝大多数都支持生活辅助社区的居民有权在自己的地方生活和死亡,而不是被转移到养老院或其他急症护理机构,以及临终关怀在帮助居民实现这一目标方面所起的作用。这三个组织还一致认为,生活辅助社区的发展趋势给这个行业带来了困难,给消费者带来了困惑,也需要加强服务提供者的责任。将临终关怀送到消费者想要生活和死亡的地方将是一项复杂的任务。除此之外,传统的临终关怀不容易被转移到以辅助生活环境为特征的社会护理模式中。临终关怀组织政策和程序的改变将是必要的,在招聘、保留合格员工和一致的护理质量标准等领域进行更广泛的、全行业的改革也是必要的。
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引用次数: 21
Palliative radiation therapy in hospice care 临终关怀中的姑息性放射治疗
Pub Date : 2002-05-01 DOI: 10.1177/104990910201900301
R. Enck
this issue of the American Journal of Hospice & Palliative Care, radiation therapy is rarely used or even contemplated in the hospice setting. The major drawbacks to this modality of treatment include a significant burden to the patient and family as well as hospice-related financial disincentives. The advent of shortened courses of radiation therapy with resultant patient ease and less cost, as noted by Fine, may cause hospice providers to rethink this option. To this end, we will briefly review the issue of palliative radiation therapy and hospice using the information noted by Fine1 and others.2-4 Radiation therapy (RT) is used for local control of cancer and is based on the number, timing, and radiation doses per session (fractionation schedule). Of note, it has been estimated that approximately one half of all RT is given with palliative intent.2 Common indications for palliative RT include the following: • Pain from bone metastases;
这期《美国临终关怀与姑息治疗杂志》指出,在临终关怀的环境中,放射治疗很少被使用,甚至很少被考虑。这种治疗方式的主要缺点包括对病人和家属的重大负担,以及与临终关怀相关的经济障碍。正如Fine所指出的那样,缩短放射治疗疗程的出现,使患者感到轻松,成本更低,可能会导致临终关怀提供者重新考虑这一选择。为此,我们将利用Fine1和其他人提到的信息简要回顾姑息性放射治疗和临终关怀的问题。2-4放射治疗(RT)用于局部控制癌症,其依据是每次治疗的次数、时间和辐射剂量(分段治疗计划)。值得注意的是,据估计,大约一半的放射治疗是为了缓解病情姑息性放疗的常见适应症包括:•骨转移引起的疼痛;
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引用次数: 8
期刊
American Journal of Hospice and Palliative Medicine®
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