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Parkland, UT, United States

Luft J.P.,Parkland Health Hospital System
The journal of pastoral care & counseling : JPCC | Year: 2016

The aim of this article is to provide the experience of one chaplain resident in a clinical pastoral education program specializing in women and infants health and the intersection of professional spiritual care for this particular patient population. Spiritual care can be an elusive, non-tangible form of professional healthcare, and so within the clinical setting the chaplain is called to act as spiritual care provider, emotions facilitator, grief counselor, cultural and religious expert and administrative specialist in decedent care. Gaining a better perspective on the contributions the clinical chaplain makes in healthcare allows other clinicians (nurses and physicians) to better serve and provide quality holistic care to patients and their families during moments of great emotional, spiritual and psychosocial loss and grief. Both nursing and physician staff must be aware of the relevance, importance and complementary role of the spiritual care provider (clinical chaplain) in the provision of quality holistic healthcare. © The Author(s) 2016. Source

Parkland Health & Hospital System | Date: 2013-09-05

A dashboard user interface method comprises displaying a navigable list of at least one target disease, displaying a navigable list of patient identifiers associated with a target disease selected in the target disease list, displaying historic and current data associated with a patient in the patient list identified as being associated with the selected target disease, including clinician notes at admission, receiving, storing, and displaying reviews comments, and displaying automatically-generated intervention and treatment recommendations.

Singal A.G.,Parkland Health Hospital System | Singal A.G.,Southwestern University | Yopp A.C.,Southwestern University | Gupta S.,Parkland Health Hospital System | And 9 more authors.
Cancer Prevention Research | Year: 2012

Hepatocellular carcinoma (HCC) surveillance is underutilized among patients with cirrhosis. Understanding which steps in the surveillance process are not being conducted is essential for designing effective interventions to improve surveillance rates. The aim of our study was to characterize reasons for failure in the HCC surveillance process among a cohort of cirrhotic patients with HCC. We conducted a retrospective cohort study of cirrhotic patients diagnosed withHCCat a large urban safety-net hospital between 2005 and 2011. Patients were characterized by receipt of HCC surveillance over a two-year period before HCC diagnosis. Among patients without HCC surveillance, we classified reasons for failure into four categories: failure to recognize liver disease, failure to recognize cirrhosis, failure to order surveillance, and failure to complete surveillance despite orders. Univariate and multivariate analyses were conducted to identify predictors of failures. We identified 178 patients with HCC, of whom 20% had undergone surveillance. There were multiple points of failure - 20% had unrecognized liver disease, 19% had unrecognized cirrhosis, 38% lacked surveillance orders, and 3% failed to complete surveillance despite orders. Surveillance was more likely among patients seen by hepatologists [OR, 6.11; 95% confidence interval (CI), 2.5-14.8] and less likely in those with alcohol abuse (OR, 0.14; 95% CI, 0.03-0.65). Although a retrospective analysis in a safety-net hospital, our data suggest that only one in five patients received surveillance before HCCdiagnosis. There are multiple points of failure in the surveillance process, with the mostcommonbeing failure to order surveillance in patients with known cirrhosis. Future interventions must target multiple failure points in the surveillance process to be highly effective. ©2012 AACR. Source

Patel J.,Parkland Health Hospital System | Yopp A.,Harold mmons Cancer Center | Waljee A.K.,Harold mmons Cancer Center | Waljee A.K.,Center for Clinical Management Research | And 2 more authors.
Journal of Clinical Gastroenterology | Year: 2016

Background: Surveillance for hepatocellular carcinoma (HCC) is recommended in patients with cirrhosis; however, early detection efforts are limited by suboptimal effectiveness. Aim: To derive and validate a model to accurately distinguish cirrhotic patients with and without HCC and compare the accuracy of the model to that of a-fetoprotein (AFP) alone. Methods: We conducted a case-control study of cirrhotic patients with and without HCC seen at a large urban hospital system between January 2005 and June 2012. We derived multivariate logistic regression models for the presence of HCC and early-stage HCC. Discriminatory power was evaluated using receiver operating characteristic curve analysis in derivation and validation cohorts using a 10-fold cross-validation approach. Results: We identified 1356 patients with cirrhosis, with (n = 455, 147 early stage) and without (n = 901) HCC. We found that AFP > 20 ng/mL and FIB-4, a noninvasive marker of fibrosis, were significantly associated with the presence of HCC (OR = 10.5; 95% CI, 7.9-13.9 and OR = 1.05; 95% CI, 1.03-1.07, respectively) and early-stage HCC (OR = 4.4; 95% CI, 2.9-6.5 and OR = 1.06; 95% CI, 1.03-1.09, respectively). Models incorporating AFP and FIB-4 had good discriminatory power, with c-statistics of approximately 0.80, in both derivation and validation cohorts. The model for early-stage HCC had higher discriminatory power than AFP alone (c-statistic 0.73; 95% CI, 0.69-0.78) in derivation and validation cohorts (P = 0.02 and 0.15, respectively). Conclusions: Models including AFP and FIB-4 can accurately discriminate cirrhotic patients with early-stage HCC from those without HCC. © 2015 Wolters Kluwer Health, Inc. All rights reserved. Source

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