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Princeton, NJ, United States

Tu H.,Care Capital
Journal of Neuroscience Nursing | Year: 2014

Patients with acute brain injury (ABI) frequently require diagnostic and therapeutic procedures in the areas located outside of the intensive care unit. Transports can be risky for critically ill patients with ABI. Secondary brain injury can occur during the transport from causes such as ischemia, hypotension, hypoxia, hypercapnia, and cerebral edema. Preparation and implementation of preventive procedures including pretransport assessment, monitoring during transport, and posttransport examination and documentation for transports of patients with ABI deem to be necessary. The purpose of this article is to review the typical risks associated with the transports of the patients with ABI out of the intensive care unit and to propose the strategies that can be used to minimize the risks of secondary brain injury. © 2014 American Association of Neuroscience Nurses.

Legrand S.B.,Cleveland Clinic | Heintz J.B.,Care Capital
Journal of Pain and Symptom Management | Year: 2012

Context: There are no data on the motives or characteristics of physicians choosing fellowship training in Hospice and Palliative Medicine (HPM). Objectives: To understand more about the residents who choose HPM and what leads them to this decision. Methods: An electronic survey of HPM fellows initiating training in July 2009. Results: Seventy-six physicians began the study, with 62 responders (82%) completing all questions. Fifty-five percent were aged 30-40 years, and 61% were female. Sixty-eight percent were non-Hispanic Caucasian, 24% were Asian, and none were African American. Fifty-five percent were trained in internal medicine. Most (86%) asserted that the care of a dying, critically ill, or symptomatic person impacted their decision to enter the field of HPM. Sixty-three percent did not feel prepared to manage dying patients, and 41% felt personal regret about the care they delivered. The major reasons for choosing the specialty were a desire to contribute to relief of suffering (79%), enhance end-of-life care (73%), and improve communication (78%). Ninety-five percent received negative comments about their career choice. Fifty-nine percent had no exposure to hospice or palliative medicine in medical school, whereas 61% had an exposure available during residency. Forty-seven percent decided to enter a fellowship in the third year of residency, and 33% applied after practicing in their primary specialty for a median of 10 years. Accreditation, strength of education, and a hospital palliative medicine service were required by the majority for selection of a fellowship program. Conclusion: Negative experiences with end-of-life care in residency, particularly in the intensive care unit, continue to be a factor in selection of HPM as a specialty. Many residents make their decision to enter the field and apply during Postgraduate Year 3. Most received negative comments about the choice. Fellows require a broad range of experience when selecting a fellowship program. © 2012 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Korsbek L.,Care Capital
Psychiatric Rehabilitation Journal | Year: 2013

Topic: This account reflects on the topic of illness insight and recovery. Purpose: The purpose of the account is to clarify our understanding about the importance of illness insight in peoples' recovery process, especially when relating the question of illness insight to the question of identity. Sources Used: The writing is based on research literature related to illness insight and on personal recovery experiences. Conclusions and Implications for Practice: It is helpful to consider the integration of the issue of illness insight when addressing the questions and consequences of diagnosis, and to assist individuals to work through the false analogy between illness and identity while supporting the transformation from patient to person. It is also necessary for clinicians to develop a clear understanding of peoples' actual needs and gain more knowledge about peoples' own views and experiences in relation to the importance of illness insight in the recovery process. © 2013 American Psychological Association.

Theou O.,Dalhousie University | Rockwood K.,Care Capital
Aging Health | Year: 2012

Not all people age the same way. Some people remain healthy until very old age, whereas others have health problems as they age and die early. Many healthy older adults are refused treatment because of their age, whereas many frail older adults who are treated do not survive. Decisions for clinical treatment based primarily on age are not best suited to the complexity of the human body, especially the complexity of older humans. The evaluation of a patients frailty status appears to represent a better way to approach the care and treatment of complex older patients, but more research is needed before the precise benefit realized by screening for frailty is known. © 2012 Future Medicine Ltd.

Song X.,Suite 1421 | Song X.,National Research Council Canada | Mitnitski A.,Suite 1421 | Mitnitski A.,Dalhousie University | And 2 more authors.
Journal of the American Geriatrics Society | Year: 2010

OBJECTIVES: To evaluate the prevalence and 10-year outcomes of frailty in older adults in relation to deficit accumulation. DESIGN: Prospective cohort study. SETTING: The National Population Health Survey of Canada, with frailty estimated at baseline (1994/95) and mortality follow-up to 2004/05. PARTICIPANTS: Community-dwelling older adults (N=2,740, 60.8% women) aged 65 to 102 from 10 Canadian provinces. During the 10-year follow-up, 1,208 died. MEASUREMENTS: Self-reported health information was used to construct a frailty index (Frailty Index) as a proportion of deficits accumulated in individuals. The main outcome measure was mortality. RESULTS: The prevalence of frailty increased with age in men and women (correlation coefficient=0.955-0.994, P<.001). The Frailty Index estimated that 622 (22.7%, 95% confidence interval (CI)=21.0-24.4%) of the sample was frail. Frailty was more common in women (25.3%, 95% CI=23.2-27.5%) than in men (18.6%, 95% CI=15.9-21.3%). For those aged 85 and older, the Frailty Index identified 39.1% (95% CI=31.3-46.9%) of men as frail, compared with 45.1% (95% CI=39.7-50.5%) of women. Frailty significantly increased the risk of death, with an age- and sex-adjusted hazard ratio for the Frailty Index of 1.57 (95% CI=1.41-1.74). CONCLUSION: The prevalence of frailty increases with age and at any age lessens survival. The Frailty Index approach readily identifies frail people at risk of death, presumably because of its use of multiple health deficits in multidimensional domains. © 2010, Copyright the Authors. Journal compilation © 2010, The American Geriatrics Society.

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