Spirituality is an essential element of person-centered care and a critical factor in the way patients with cancer cope with their illness from diagnosis through treatment, survival, recurrence and ...dying. Studies have indicated a significant relationship between spirituality and quality of life. Spirituality, in its broadest sense speaks to the meaning patients find in their lives especially during times of stress, illness and dying. Illness can trigger deep existential issues that could trigger profound suffering and distress. A model is presented that describes the role of each member of the healthcare team in addressing patients' spirituality. Spiritual distress, as a diagnosis, requires attention and treatment just as any other clinical symptom. Spiritual resources of strength need to be identifies and recognized as positive factors in patients' coping. Finally a treatment plan needs to include the spiritual as well as the physical and psychosocial issues of patients. Chaplains and other spiritual care professionals need to be recognized as the experts in spiritual care and should be integral members of the healthcare team. Integrating spirituality as an essential domain of care will result in better health outcomes, particularly quality of life for patients across the trajectory of cancer care.
Two conferences, Creating More Compassionate Systems of Care (November 2012) and On Improving the Spiritual Dimension of Whole Person Care: The Transformational Role of Compassion, Love and ...Forgiveness in Health Care (January 2013), were convened with the goals of reaching consensus on approaches to the integration of spirituality into health care structures at all levels and development of strategies to create more compassionate systems of care. The conferences built on the work of a 2009 consensus conference, Improving the Quality of Spiritual Care as a Dimension of Palliative Care. Conference organizers in 2012 and 2013 aimed to identify consensus-derived care standards and recommendations for implementing them by building and expanding on the 2009 conference model of interprofessional spiritual care and its recommendations for palliative care. The 2013 conference built on the 2012 conference to produce a set of standards and recommended strategies for integrating spiritual care across the entire health care continuum, not just palliative care. Deliberations were based on evidence that spiritual care is a fundamental component of high-quality compassionate health care and it is most effective when it is recognized and reflected in the attitudes and actions of both patients and health care providers.
The State of the Science in Spirituality and Palliative Care was convened to address the current landscape of research at the intersection of spirituality and palliative care and to identify critical ...next steps to advance this field of inquiry. Part I of the SOS-SPC two-part series focuses on questions of 1) What is spirituality? 2) What methodological and measurement issues are most salient for research in palliative care? And 3) What is the evidence relating spirituality and health outcomes? After describing current evidence we make recommendations for future research in each of the three areas of focus. Results show wide variance in the ways spirituality is operationalized and the need for definition and conceptual clarity in research in spirituality. Furthermore, the field would benefit from hypothesis-driven outcomes research based on a priori specification of the spiritual dimensions under investigation and their longitudinal relationship with key palliative outcomes, the use of validated measures of predictors and outcomes, and rigorous assessment of potential confounding variables. Finally, results highlight the need for research in more diverse populations.
Data from bi-weekly passive samplers from 18 of the longest operating National Atmospheric Deposition Program’s (NADP) Ammonia Monitoring Network (AMoN) sites (most operating from 2008 to 2015) show ...that concentrations of NH3 have been increasing (p-value < 0.0001) over large regions of the USA. This trend is occurring at a seasonal and annual level of aggregation. Using random coefficient models (RCM), the mean slope for the 18 sites combined shows an increase of NH3 concentration of +7% per year, with a 95% confidence interval (C.I.) from +5% to +9% per year. Travel blank corrected data using the same approach show increasing NH3 concentrations of +9% (95% C.I. +5% to +13%) per year. During a comparable period (2008–2014) NADP precipitation chemistry sites in the same regions show significant increasing (p-value = 0.0001) precipitation NH4+ concentrations trends for all sites combined of +5% (95% C.I. +3% to +7%) per year.
Emissions inventory data for the study period show nearly constant rates of NH3 emissions, but large reductions in NOx and SO2 emissions. Seasonal air quality data from the Clean Air Status and Trends Network (CASTNET) sites in these regions show significant declines in atmospheric particulate SO42− and NH4+, and particulate NO3− plus HNO3 (total NO3−) during the same period. Less formation of acidic SO4 and NO3, due to reduced SO2 and NOx emissions, provide less substrate to interact with NH3 and form particulate ammonium species. Thus, concentrations of NH3 can increase in the atmosphere even if emissions remain constant. A likely result may be more localized deposition of NH3, as opposed to the more long-range transport and deposition of ammonium nitrate (NH4NO3) and sulfate (NH4)2SO4). Additionally, the spatial distribution of wet and dry acidic deposition will be impacted.
Seasonal regressions of log-transformed NH3 concentrations (μg NH3/m3) for USA regions (MT = mountain (west), MW = midwest, NE = northeast, OT = Oklahoma – Texas, SE = southeast) 2008 to 2015. On the x-axis all years, 2008 to 2015 are represented, but are not displayed, for each region and season. The upper (blue) regression lines are for the ambient NH3 concentration data and the lower (red) regression lines are the travel blank corrected NH3 concentration data. Display omitted
•Emissions of NH3 are assessed to be nearly constant in the USA from 2008 to 2014.•NH3 air concentrations and precipitation NH4+ show increasing trends over a large area of the USA from 2008 to 2015.•Particulate NH4+, NO3− and SO42− show decreasing trends in these regions.•Declining NOx and SO2 emissions provide less H2SO4 and HNO3 for neutralization of NH3 in the atmosphere.•Greater NH3 concentrations may change the spatial pattern of N deposition.
Context. The high spectral resolution R ∼ 45 000 provided by IGRINS (Immersion Grating INfrared Spectrometer) at MacDonald Observatory and R ∼ 100 000 achieved by CRIRES (CRyogenic high-resolution ...InfraRed Echelle Spectrograph) at VLT (Very Large Telescope) challenges the present knowledge of infrared spectra. Aims. We aim to predict the full infrared spectrum of molecular hydrogen at a comparable accuracy. Methods. We take advantage of the recent theoretical ab initio studies on molecular hydrogen to compute both the electric quadrupole and magnetic dipole transitions taking place within the ground electronic molecular state of hydrogen. Results. We computed the full infrared spectrum of molecular hydrogen at an unprecedented accuracy and derive for the first time the emission probabilities including both electric quadrupole (ΔJ = 0, ±2) and magnetic dipole transitions (ΔJ = 0) as well as the total radiative lifetime of each rovibrational state. Inclusion of magnetic dipole transitions increases the emission probabilities by factors of a few for highly excited rotational levels, which occur in the 3–20 μ range.
Abstract Objective To explore similarities and differences in challenges to maternal health and evidence implementation in general across several low- and middle-income countries (LMICs) and to ...identify common and unique themes representing barriers to and facilitators of evidence implementation in LMIC healthcare settings. Study Design Secondary analysis of qualitative data. Setting Meeting reports and manuscripts describing projects undertaken by the authors in five LMICs on three continents were analyzed. Projects focused on identifying barriers to and facilitators of implementation of evidence products: five World Health Organization maternal health guidelines, and a knowledge translation strategy to improve adherence to tuberculosis treatment. Data were analyzed using thematic content analysis. Results Among identified barriers to evidence implementation, a high degree of commonality was found across countries and clinical areas, with lack of financial, material, and human resources most prominent. In contrast, few facilitators were identified varied substantially across countries and evidence implementation products. Conclusion By identifying common barriers and areas requiring additional attention to ensure capture of unique barriers and facilitators, these findings provide a starting point for development of a framework to guide the assessment of barriers to and facilitators of maternal health and potentially to evidence implementation more generally in LMICs.
Little is known about how to build leadership capacity to support implementation of evidence-based practices within health systems. We observed substantial variability across sites in uptake and ...sustainability of a peer-led educational outreach intervention for lay health workers (LHWs) providing tuberculosis care in Malawi. Feedback from peer-trainers (PTs) suggested that leadership may have contributed to the variation. We sought to assess the impact of PT leadership style on implementation, and to identify leadership traits of more successful PTs, to inform future implementation planning and to identify targets for leadership capacity building.
Qualitative study employing interviews with PTs and LHWs at high and low implementation sites, and review of study team and quarterly PT meeting notes. High implementation sites achieved high uptake, sustainability and fidelity of implementation including: close adherence to training content and process, high levels of coverage (training most or all eligible LHWs at their site), and outcomes were achieved with high levels of self reported competence with the intervention among both PTs and LHWs. Low implementation sites achieved limited coverage (<= 50% of LHWs trained), and intervention fidelity.
Eight PTs and 10 LHWs from eight high and 10 low implementation sites participated in interviews. Leadership traits of more successful PTs included: flexibility in their approach to training, role modeling and provision of supportive supervision to support learning; addressing challenges proactively and as they occurred; collaborative planning; knowledgeable; and availability to support implementation. Traits unique to less successful PTs included: a poor attitude toward their role as PT and a passive-avoidant approach to challenges.
This study identified leadership traits more common among unit level leaders at sites with higher uptake, sustainability, and fidelity of implementation. These findings provide a starting point for development and evaluation of a leadership capacity building intervention for unit level leaders to support implementation.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Evaluation of the FICA Tool for Spiritual Assessment Borneman, Tami, RN, MSN, CNS, FPCN; Ferrell, Betty, RN, PhD, MA, FAAN, FPCN; Puchalski, Christina M., MD, MS, FACP
Journal of pain and symptom management,
08/2010, Letnik:
40, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Abstract Context The National Consensus Project for Quality Palliative Care includes spiritual care as one of the eight clinical practice domains. There are very few standardized spirituality history ...tools. Objectives The purpose of this pilot study was to test the feasibility for the Faith, Importance and Influence, Community, and Address (FICA) Spiritual History Tool in clinical settings. Correlates between the FICA qualitative data and quality of life (QOL) quantitative data also were examined to provide additional insight into spiritual concerns. Methods The framework of the FICA tool includes Faith or belief, Importance of spirituality, individual's spiritual Community , and interventions to Address spiritual needs. Patients with solid tumors were recruited from ambulatory clinics of a comprehensive cancer center. Items assessing aspects of spirituality within the Functional Assessment of Cancer Therapy QOL tools were used, and all patients were assessed using the FICA. The sample ( n = 76) had a mean age of 57, and almost half were of diverse religions. Results Most patients rated faith or belief as very important in their lives (mean 8.4; 0–10 scale). FICA quantitative ratings and qualitative comments were closely correlated with items from the QOL tools assessing aspects of spirituality. Conclusion Findings suggest that the FICA tool is a feasible tool for clinical assessment of spirituality. Addressing spiritual needs and concerns in clinical settings is critical in enhancing QOL. Additional use and evaluation by clinicians of the FICA Spiritual Assessment Tool in usual practice settings are needed.
Summary
Computed tomography (CT) with CT myelography is a novel imaging modality for detailed anatomical imaging and precise diagnosis of equine cervical spine pathology. Computed tomography of the ...complete cervical vertebral column in live horses has not been reported previously. The objectives of this study were to describe the diagnostic utility of CT and CT myelography in horses, the technique, the type and distribution of lesions and procedure‐related complications. Medical records of horses subjected to cervical CT and CT myelography between 2013 and 2018 were reviewed for this retrospective descriptive study. The examinations were performed with horses in lateral recumbency using a large‐bore CT scanner. In total, 180 horses were included. The study population consisted of 79.4% Warmblood breed horses, 68.3% were male, the mean age was 7.1 years (range 21 days–21 years), and the bodyweight ranged from 61 to 717 kg (mean 530 kg). Pathology of the cervical vertebral column was identified in 176/180 horses (97.8%) and included osteoarthritis of the articular process joints in 83%. Impingement and compression of the spinal cord were detected using CT myelography in 125/147 horses (85%). Pathology was localised caudal to C5 in 90%. The mean ± s.d. anaesthesia time was 34 ± 19 min and 52 ± 13 min for CT examinations, excluding and including myelography, respectively. Adverse events occurred in 7.2% of the examined horses. The caudal location of the majority of lesions emphasises the importance of good‐quality imaging of the most caudal cervical vertebrae in horses with suspected cervical spinal pathology and/or spinal cord compression. Computed tomography imaging enables identification of bony and soft tissue lesions of the entire cervical vertebral column in live, large‐breed adult horses.
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