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Clague-Baker N, Bull M, Leslie K, Hilliard N. Survey of people with Myalgic Encephalomyelitis (ME) to explore their use and experiences of physiotherapy services in the UK. Physiotherapy 2021. [DOI: 10.1016/j.physio.2021.10.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Wu EX, Collins A, Briggs S, Stajduhar KI, Kalsi A, Hilliard N. Prolonged Grief and Bereavement Supports Within a Caregiver Population Who Transition Through a Palliative Care Program in British Columbia, Canada. Am J Hosp Palliat Care 2021; 39:361-369. [PMID: 34259023 PMCID: PMC8847765 DOI: 10.1177/10499091211030442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the prevalence of prolonged grief disorder (PGD), and self-reported resilience among bereaved caregivers within a palliative care program that serves a large region of the Lower Mainland in British Columbia, Canada. Additionally, to discern effective bereavement supports utilized by caregivers following the loss of a loved one. METHODS A descriptive study using both quantitative and qualitative methods. Sociodemographic information (n = 427) was collected from bereaved caregivers 3 months after their loss. PGD and resilience were prospectively assessed 12 months post-loss using the prolonged grief scale (PG-13, n = 212) and brief resilience scale (BRS, n = 215), respectively. A qualitative thematic analysis was conducted on responses to the open-ended question on what bereavement services or activities caregivers found helpful in coping with the loss of a loved one. RESULTS Of the 212 individuals that completed the PG-13, 4.7% met diagnostic criteria for PGD, 27.4% were moderate risk, and 67.9% were low risk for PGD. Of the 215 caregivers that completed the BRS, 48.4% had low resilience, 51.6% had normal resilience, and 0% had high resilience. The major themes of formal supports, informal supports, and self-care activities emerged from caregiver comments regarding effective bereavement supports. CONCLUSION The incidence of PGD in caregivers is low within the Fraser Health Palliative Care program. Bereaved caregivers mainly utilize existing social networks and activities to cope with their loss. Focusing on a community-based approach to supports may improve bereavement experiences and lower rates of prolonged grief.
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Affiliation(s)
- Elizabeth X Wu
- Division of Palliative Care, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Collins
- Division of Palliative Care, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Palliative Medicine, Fraser Health Authority, British Columbia, Canada
| | - Shelley Briggs
- Department of Palliative Medicine, Fraser Health Authority, British Columbia, Canada
| | - Kelli I Stajduhar
- School of Nursing & Institute on Aging and Lifelong Health, University of Victoria, British Columbia, Canada
| | - Asha Kalsi
- Health Information Science University of Victoria, Victoria, British Columbia, Canada
| | - Neil Hilliard
- Division of Palliative Care, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Palliative Medicine, Fraser Health Authority, British Columbia, Canada
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Schick-Makaroff K, Karimi-Dehkordi M, Cuthbertson L, Dixon D, Cohen SR, Hilliard N, Sawatzky R. Using Patient- and Family-Reported Outcome and Experience Measures Across Transitions of Care for Frail Older Adults Living at Home: A Meta-Narrative Synthesis. Gerontologist 2021; 61:e23-e38. [PMID: 31942997 DOI: 10.1093/geront/gnz162] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Our aim was to create a "storyline" that provides empirical explanation of stakeholders' perspectives underlying the use of patient- and family-reported outcome and experience measures to inform continuity across transitions in care for frail older adults and their family caregivers living at home. RESEARCH DESIGN AND METHODS We conducted a meta-narrative synthesis to explore stakeholder perspectives pertaining to use of patient-reported outcome and experience measures (PROMs and PREMs) across micro (patients, family caregivers, and healthcare providers), meso (organizational managers/executives/programs), and macro (decision-/policy-makers) levels in healthcare. Systematic searches identified 9,942 citations of which 40 were included based on full-text screening. RESULTS PROMs and PREMS (54 PROMs; 4 PREMs; 1 with PROM and PREM elements; 6 unspecified PROMs) were rarely used to inform continuity across transitions of care and were typically used independently, rarely together (n = 3). Two overarching traditions motivated stakeholders' use. The first significant motivation by diverse stakeholders to use PROMs and PREMs was the desire to restore/support independence and care at home, predominantly at a micro-level. The second motivation to using PROMs and PREMs was to evaluate health services, including cost-effectiveness of programs and hospital discharge (planning); this focus was rarely at a macro-level and more often split between micro- and meso-levels of healthcare. DISCUSSION AND IMPLICATIONS The motivations underlying stakeholders' use of these tools were distinct, yet synergistic between the goals of person/family-centered care and healthcare system-level goals aimed at efficient use of health services. There is a missed opportunity here for PROMs and PREMs to be used together to inform continuity across transitions of care.
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Affiliation(s)
| | - Mehri Karimi-Dehkordi
- Department of Medicine and Community Health Sciences, University of Calgary, Vancouver
| | - Lena Cuthbertson
- Office of Patient-Centered Measurement, British Columbia, Ministry of Health, Vancouver
| | - Duncan Dixon
- Norma Marion Alloway Library, Trinity Western University, Langley
| | - S Robin Cohen
- Department of Oncology and Medicine, McGill University, Montréal.,Lady Davis Institute, Palliative Care Research, Montréal
| | | | - Richard Sawatzky
- School of Nursing, Trinity Western University, Langley.,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, Canada.,Sahlgrenska Academy, University of Gothenburg, Sweden
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Sawatzky R, Laforest E, Schick-Makaroff K, Stajduhar K, Reimer-Kirkham S, Krawczyk M, Öhlén J, McLeod B, Hilliard N, Tayler C, Robin Cohen S. Design and introduction of a quality of life assessment and practice support system: perspectives from palliative care settings. J Patient Rep Outcomes 2018; 2:36. [PMID: 30175318 PMCID: PMC6104521 DOI: 10.1186/s41687-018-0065-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 07/23/2018] [Indexed: 12/02/2022] Open
Abstract
Background Quality of life (QOL) assessment instruments, including patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs), are increasingly promoted as a means of enabling clinicians to enhance person-centered care. However, integration of these instruments into palliative care clinical practice has been inconsistent. This study focused on the design of an electronic Quality of Life and Practice Support System (QPSS) prototype and its initial use in palliative inpatient and home care settings. Our objectives were to ascertain desired features of a QPSS prototype and the experiences of clinicians, patients, and family caregivers in regard to the initial introduction of a QPSS in palliative care, interpreting them in context. Methods We applied an integrated knowledge translation approach in two stages by engaging a total of 71 clinicians, 18 patients, and 17 family caregivers in palliative inpatient and home care settings. Data for Stage I were collected via 12 focus groups with clinicians to ascertain desirable features of a QPSS. Stage II involved 5 focus groups and 24 interviews with clinicians and 35 interviews with patients or family caregivers during initial implementation of a QPSS. The focus groups and interviews were recorded, transcribed, and analyzed using the qualitative methodology of interpretive description. Results Desirable features focused on hardware (lightweight, durable, and easy to disinfect), software (simple, user-friendly interface, multi-linguistic, integration with e-health systems), and choice of assessment instruments that would facilitate a holistic assessment. Although patient and family caregiver participants were predominantly enthusiastic, clinicians expressed a mixture of enthusiasm, receptivity, and concern regarding the use of a QPSS. The analyses revealed important contextual considerations, including: (a) logistical, technical, and aesthetic considerations regarding the QPSS as a technology, (b) diversity in knowledge, skills, and attitudes of clinicians, patients, and family caregivers regarding the integration of electronic QOL assessments in care, and (c) the need to understand organizational context and priorities in using QOL assessment data. Conclusion The process of designing and integrating a QPSS in palliative care for patients with life-limiting conditions and their family caregivers is complex and requires extensive consultation with clinicians, administrators, patients, and family caregivers to inform successful implementation.
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Affiliation(s)
- Richard Sawatzky
- 1School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC V2Y 1Y1 Canada.,2Centre for Health Evaluation and Outcome Sciences, Providence Health Care, 588 - 1081 Burrard Street, St. Paul's Hospital, Vancouver, BC V6Z 1Y6 Canada.,13Salgrenska Academy, University of Gothenburg, Box 457, 405 30 Göteborg, Sweden
| | - Esther Laforest
- 3Ingram School of Nursing, McGill University, 680 Sherbrooke Street West, Montreal, QC H3A 2M7 Canada
| | - Kara Schick-Makaroff
- 4Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Kelli Stajduhar
- 5School of Nursing and Institute on Aging & Lifelong Health, (IALH), University of Victoria, PO Box 1700, STN CSC, Victoria, BC V8W 2Y2 Canada.,6Palliative Care, Fraser Health, 100 - 2296 McCallum Road, Abbotsford, BC V2S 3P4 Canada
| | - Sheryl Reimer-Kirkham
- 1School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC V2Y 1Y1 Canada.,7Faculty of Graduate Studies, University of Calgary, MacKimmie Tower, Room 213, 2500 University Drive NW, Calgary, AB T2N 1N4 Canada.,8Faculty of Graduate Studies, University of Victoria, PO Box 3025 STN CSC, Victoria, BC V8W 3P2 Canada
| | - Marian Krawczyk
- 1School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC V2Y 1Y1 Canada
| | - Joakim Öhlén
- 9Center for Person-Centered Care, Institute of Health and Care Sciences, Salgrenska Academy, University of Gothenburg, Box 457, 405 30 Göteborg, Sweden.,14Palliative Centre, Sahlgrenska University Hospital, Box 30110, 400 43 Göteborg, Sweden
| | - Barbara McLeod
- 6Palliative Care, Fraser Health, 100 - 2296 McCallum Road, Abbotsford, BC V2S 3P4 Canada
| | - Neil Hilliard
- 6Palliative Care, Fraser Health, 100 - 2296 McCallum Road, Abbotsford, BC V2S 3P4 Canada
| | - Carolyn Tayler
- 5School of Nursing and Institute on Aging & Lifelong Health, (IALH), University of Victoria, PO Box 1700, STN CSC, Victoria, BC V8W 2Y2 Canada.,BC Centre for Palliative Care, 300 - 601 Sixth St., New Westminster, BC V3L 3C1 Canada
| | - S Robin Cohen
- 11Departments of Oncology and Medicine, McGill University, Montreal, QC, Canada.,12Lady Davis Research Institute of the Jewish General Hospital, 3755 Côte Ste. Catherine Road, Montreal, QC H3T 1E2 Canada
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Hawkes RA, Patterson AJ, Priest AN, Harrison G, Hunter S, Pinney J, Set P, Hilliard N, Graves MJ, Smith GCS, Lomas DJ. Uterine artery pulsatility and resistivity indices in pregnancy: Comparison of MRI and Doppler US. Placenta 2016; 43:35-40. [PMID: 27324097 DOI: 10.1016/j.placenta.2016.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 03/20/2016] [Accepted: 04/04/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this work was to evaluate whether the uterine arteries (UtA) could be identified and their flow profiles measured during a fetal MRI examination. A comparison was performed against same day sonographic Doppler assessment. METHODS 35 normal, healthy, singleton pregnancies at 28-32 weeks gestation underwent routine Doppler examination, followed by MRI examination. The resistivity index (RI) and pulsatility index (PI) of the left and right UtA were measured using phase contrast MRI. Bland Altman statistics were used to compare MRI and ultrasound results. RESULTS Sixty-nine comparable vessels were analysed. Six vessels were excluded due to artefact or technical error. Bland-Altman analysis demonstrated the ultrasound indices were comparable, although systematically lower than the MRI indices; Right UtA RI bias -0.03 (95% limits of agreement (LOA) -0.27 to +0.20), and left UtA RI bias -0.06 (95% LOA -0.26 to +0.14); Right UtA PI bias -0.06 (95% LOA -0.50 to +0.38), Left UtA PI bias -0.11 (95% LOA -0.54 to +0.32). The inter-rater agreement for the MRI derived PI and RI analysis was good. CONCLUSION This study demonstrates that in the majority of early third trimester pregnancies, the uterine arteries can be identified, and their flow profiles measured using MRI, and that the derived PI and RI values are comparable with Doppler ultrasound values.
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Affiliation(s)
- R A Hawkes
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, United Kingdom.
| | - A J Patterson
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | - A N Priest
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | | | - S Hunter
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | - J Pinney
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | - P Set
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | - N Hilliard
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | - M J Graves
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | - G C S Smith
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge, United Kingdom
| | - D J Lomas
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, United Kingdom
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Abstract
BACKGROUND This case report describes an end-stage cancer patient with intractable neuropathic pain and delirium who was successfully managed during the last 3 weeks of her life with a continuous subcutaneous infusion of dexmedetomidine. CASE PRESENTATION A 55-year-old woman with locally advanced cervical cancer and uncontrolled pelvic pain was admitted to a tertiary palliative care unit for pain management. As her disease progressed, the patient's pelvic pain intensified despite treatment with methadone, gabapentin, ketamine, and hydromorphone administered by continuous subcutaneous infusion plus frequent breakthrough doses of hydromorphone and sufentanil. CASE MANAGEMENT A continuous subcutaneous infusion of dexmedetomidine was started and titrated to achieve pain relief. CASE OUTCOME The patient's pain and delirium cleared. The treatment was successful in fulfilling the patient's goal of care: not to be deeply and continuously sedated, but to be rousable and of clear mind while still having good pain control. CONCLUSION Dexmedetomidine is a potentially useful medication for the targeted treatment of intractable pain and delirium in the tertiary palliative care environment. Future research is required to compare dexmedetomidine infusion to standard treatment with midazolam infusion for treatment of intractable symptoms in the palliative care environment.
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Affiliation(s)
- Neil Hilliard
- End of Life Program, Fraser Health Authority, Abbotsford, BC, Canada
| | - Stuart Brown
- End of Life Program, Fraser Health Authority, Abbotsford, BC, Canada
| | - Steve Mitchinson
- End of Life Program, Fraser Health Authority, Abbotsford, BC, Canada
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Lau F, Barwich D, Hilliard N, Partridge C, Hobson B, Price M, McGregor D, Bassi J, Lee D, Kim J, Pyke J, Randhawa G. A Knowledge Translation Project on Best Practices in End-of-life Care. Stud Health Technol Inform 2015; 208:237-241. [PMID: 25676980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This is a knowledge translation project to promote the uptake of best practices in end-of-life (EOL) care within the primary care setting in British Columbia (BC) through the use of tools embedded into electronic medical records (EMRs). The knowledge-to-action model is used to engage primary care providers in co-designing, adopting and evaluating the EOL care toolkit built for 3 EMRs. The toolkit has a set of EMR-specific data entry templates, query/report functions and access to additional downloadable resources. It is based on the EOL learning module designed and offered by the BC General Practice Services Committee's Practice Support Program to improve EOL care by primary care providers in the province. Our web-based distribution method allows providers to download and install the toolkit then take part to evaluate its use and impact. Initial feedback from phases 1-3 (of 4) has been favorable and has led to iterative improvements.
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Hilliard N. Nuclear pharmacist training and certification. Int J Pharm Compd 1998; 2:427. [PMID: 23988316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- N Hilliard
- University of Arkansas College of Pharmacy, Little Rock, AR 72205
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Herity B, Hilliard N, Moriarty M, Fennelly J, Conroy R, Casey M. A study of the needs of cancer patients and their relatives. Ir J Med Sci 1987; 156:172-81. [PMID: 3623872 DOI: 10.1007/bf02955200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Graham IM, Hickey N, Daly L, Mulcahy R, Doyle Y, Conroy R, Mulcahy R, Donnelly MDI, Toner P, Nugent T, Anderson D, Chadwick E, Turkington E, Varma MPS, Graham I, Comerford D, Shelley E, Daly L, Gibney M, Hickey N, Kilcoyne D, O’Dwyer T, Radic A, Conroy R, Herity B, Fennelly J, Hilliard N, Moriarty M, Gavin AT, Telford AM, Lowry G, MacKenzie G, Bridges J, Nevin N, Blaney R, McDonnell M, Corridan JP, Doyle CT, Allwright S, Sadek F, Kirke PN, Molloy AM, Weir DG, Scott JM, Hillary I, Evans AE, Condren L, Sinclair H, Tohani VK, Dean G, Elian M. All-Ireland social medicine meeting. Ir J Med Sci 1987. [DOI: 10.1007/bf02954638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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