Healthcare (Basel, Switzerland)
-
Review
End-of-Life Care Challenges from Staff Viewpoints in Emergency Departments: Systematic Review.
The hospital emergency department (ED) is the place where people most commonly seek urgent care. The initial diagnosis of an end-of-life (EOL) condition may occur in the ED. In this review we described the challenges; from the staff members' perspectives, to safe, appropriate, and high quality end-of-life care (EOLC) for people who are diagnosed with non-malignant diseases who present to ED settings internationally. ⋯ PubMed, Scopus, CINAHL, Medline, and Web of Science were searched from 2007 to 2017. In this review the challenges in providing quality EOLC from staff viewpoints, for EOL people who are diagnosed with non-malignant progressive diseases in ED settings, were classified into eight themes: (1) EOLC education and training, (2) ED design, (3) Lack of family support, (4) Work Load, (5) ED staff communication and decision making, (6) EOLC quality in ED, (7) resource availability (time, space, appropriate interdisciplinary personnel) and (8) integrating palliative care (PC) in ED. The formulation of EOLC using this review result may help to improve the quality of life for dying people by providing ED staff with clear guidelines that can guide them in their daily practice.
-
Hospital-acquired malnutrition is a significant issue with complex aetiology, hence nutrition interventions must be multifaceted and context-specific. This paper describes the development, implementation and process evaluation of a complex intervention for improving nutrition among medical patients in an Australian hospital. An integrated knowledge translation (iKT) approach was used for intervention development, informed by previous research. ⋯ Staff found all intervention strategies acceptable with benefits to practice. This study found an iKT approach useful for designing a nutrition intervention that was context-specific, feasible and acceptable to staff. This was likely due to engagement of multiple disciplines, identifying and targeting specific areas in need of improvement, and giving staff frequent opportunities to contribute to intervention development/implementation.
-
Several children receiving palliative care experience dyspnea and pain. An order protocol for distress (OPD) is available at Sainte-Justine Hospital, aimed at alleviating respiratory distress, pain and anxiety in pediatric palliative care patients. This study evaluates the clinical use of the OPD at Sainte-Justine Hospital, through a retrospective chart review of all patients for whom the OPD was prescribed between September 2009 and September 2012. ⋯ Relief was provided in 90% of cases. The interval between administration of the first protocol and death was 17 h; the interval was longer in children with cancer compared to other illnesses (p = 0.02). Data from this study support the effectiveness and safety of using an OPD for children receiving palliative care.
-
The prevalence and severity of depression differ in women and men and across racial groups. Psychosocial factors such as chronic stress have been proposed as contributors, but causes of this variation are not fully understood. Allostatic load, a measure of the physiological burden of chronic stress, is known to be associated with depression. ⋯ High-risk levels of c-reactive protein were significantly associated with increased odds of depression among white women (adjusted odds ratio (aOR) = 1.7, 95% CI: 1.1⁻2.5) and men (aOR = 1.8, 95% CI: 1.1⁻2.8) but not black women (aOR = 0.8, 95% CI: 0.6⁻1.1) or men (aOR = 0.9, 95% CI: 0.5⁻1.5). Among black men, hypertension (aOR = 1.7, 95% CI: 1.1⁻2.7) and adverse serum albumin levels (aOR = 1.7, 95% CI: 1.0⁻2.9) predicted depression, while high total cholesterol was associated with depression among black women (aOR = 1.6, 95% CI: 1.0⁻2.7). The associations between allostatic load biomarkers and depression varies with gendered race, suggesting that, despite consistent symptomatology, underlying disease mechanisms may differ between these groups.
-
Review
A Systematic Review on Healthcare Analytics: Application and Theoretical Perspective of Data Mining.
The growing healthcare industry is generating a large volume of useful data on patient demographics, treatment plans, payment, and insurance coverage—attracting the attention of clinicians and scientists alike. In recent years, a number of peer-reviewed articles have addressed different dimensions of data mining application in healthcare. However, the lack of a comprehensive and systematic narrative motivated us to construct a literature review on this topic. ⋯ Use of human-generated data is predominant considering the wide adoption of Electronic Medical Record in clinical care. However, analytics based on website and social media data has been increasing in recent years. Lack of prescriptive analytics in practice and integration of domain expert knowledge in the decision-making process emphasizes the necessity of future research.