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Lo Monaco M, Mallaci Bocchio R, Natoli G, Scibetta S, Bongiorno T, Argano C, Corrao S. Human relationships in patients' end-of-life: a qualitative study in a hospice ward. Intern Emerg Med 2020; 15:975-980. [PMID: 31848995 DOI: 10.1007/s11739-019-02254-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 12/04/2019] [Indexed: 10/25/2022]
Abstract
Living in a hospice department is an intense experience for patients, caregivers, and healthcare professionals. End-of-life care aims to conduct vulnerable dying patients towards a painless and peaceful death. The importance of a strong staff-patient relationship and the perspective of pain and suffering from patients has already been studied. This study aimed to explore patients' inner needs living in hospice through a qualitative research approach. A descriptive qualitative study was conducted in the hospice department at ARNAS Civico in Palermo, Italy. From a qualitative research point of view, a significant sample of ten dying patients was interviewed. Data were collected until saturation by in-depth interview using a semi-structured interview guide, and Colaizzi's method was used. Five themes emerged: experiencing hospice, hospice staff, family role, coping with the disease, and death. Human relationships seem to represent a fundamental key in patients' end-of-life, especially in their family fondness. Predictably, terminally ill patients seem to fear pain and incoming death. Even though patients had everything they needed in the hospice, their main thoughts were always focused on human relationships. End-of-life medicine should improve the quality of time that each patient could spend with significant others to improve end-of-life care.
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Affiliation(s)
- Marika Lo Monaco
- Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, 90127, Palermo, Italy
- I.E.ME.S.T., 90139, Palermo, Italy
- School of Biomedicine and Neuroscience BiND, University of Palermo, 90127, Palermo, Italy
| | - Raffaella Mallaci Bocchio
- Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, 90127, Palermo, Italy
- I.E.ME.S.T., 90139, Palermo, Italy
| | - Giuseppe Natoli
- Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, 90127, Palermo, Italy
- I.E.ME.S.T., 90139, Palermo, Italy
| | - Salvatore Scibetta
- Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, 90127, Palermo, Italy
| | - Teresa Bongiorno
- Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, 90127, Palermo, Italy
| | - Christiano Argano
- Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, 90127, Palermo, Italy
| | - Salvatore Corrao
- Materno Infantile, Medicina Interna E Specialistica Di Eccellenza "G. D'Alessandro", PROMISE, Dipartimento Di Promozione Della Salute, University of Palermo, 90133, Palermo, Italy.
- Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, 90127, Palermo, Italy.
- I.E.ME.S.T., 90139, Palermo, Italy.
- School of Biomedicine and Neuroscience BiND, University of Palermo, 90127, Palermo, Italy.
- Centre of Research for Effectiveness and Appropriateness in Medicine (CREAM), University of Palermo, Palermo, Italy.
- Biomedical Department of Internal Medicine and Subspecialities [DiBiMIS], University of Palermo, Palermo, Italy.
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Abstract
BACKGROUND A large number of the hospice patients have been reported to be with symptoms of pain. Thus, managing the patient's pain is one aspect of hospice care provision. The delivery of pain care services could be facilitated through effective communication. However, little has been done to explore the interactional details of the delivery of pain care services in palliative care. METHODS Conversation analysis is a useful method to explore the interactional details of interaction by hospice care providers and terminally ill patients. Using the method of Conversation Analysis (CA), this study aims to demonstrate how the hospice care provider employs different types of interactional practices to address the patient's pain concerns. The data showed in this study are collected from the Alexander St website http://ctiv.alexanderstreet.com , an educational resource presenting a large collection of psycho-therapeutic videos. RESULTS In this study, an illustrative analysis is demonstrated to show the potential of conversation analysis for research on pain talk in palliative care. It has been shown that conversation analysis could contribute to unfolding the interactional details regarding "pain talk" in hospice care settings. Specifically, conversation analysis could provide a detailed description and interpretation of the conversational practices, which are used to construct hospice care provider participation in delivering pain talk. In addition, conversation analysis could also demonstrate the interactional resources by which patients disclose their experiences of physical or spiritual pain to the hospice care provider and the way how the hospice care provider responds to the patient's troubles talk or feelings talk. CONCLUSIONS This study identifies five types of interactional resources which are used to deal with the patient's pain concerns in hospice care setting. A conversation analytical study of pain talk in hospice care could provide a turn-by-turn description of how the hospice care provider communicates with the terminally ill patient in terms of the patient's pain concerns. The findings in this study could inform how the hospice care provider initiates, delivers and develops a pain talk with the terminally ill patient effectively.
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Affiliation(s)
- Yijin Wu
- School of Translation Studies/Center for Medical Humanities in the Developing World, Qufu Normal University, No.5, Yantai Road, Donggang District, Rizhao, 250100, Shandong, China.
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Ćwirlej-Sozańska A, Wójcicka A, Kluska E, Stachoń A, Żmuda A. Assessment of the effects of a multi-component, individualized physiotherapy program in patients receiving hospice services in the home. BMC Palliat Care 2020; 19:101. [PMID: 32646517 PMCID: PMC7350635 DOI: 10.1186/s12904-020-00600-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 06/22/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The interest in physiotherapy programs for individuals in hospice is increasing. The aim of our study was to assess the impact of a multi-component, individualized physiotherapy program on the functional and emotional conditions and quality of life of patients receiving hospice services in the home. METHODS The study included 60 patients (mean 66.3 years) receiving hospice services in the home. A model of a physiotherapy program was designed, including breathing, strengthening, transfer, gait, balance, functional, and ergonomic exercises, as well as an adaptation of the patient's living environment to functional needs. The tests were performed before and after the intervention. The study used the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scales, the World Health Organization Quality of Life - Bref (WHOQOL-BREF), the Visual Analogue Scale (VAS) pain scale, the Tinetti POMA Scale, and the Geriatric Depression Scale (GDS). To enable comparison of our results worldwide, a set of International Classification of Functioning, Disability and Health (ICF) categories was used. RESULTS The average functional level of the ADL (mean 2.9) and the IADL (mean 11.9), as well as the WHOQOL-BREF (mean 46.4) of the patients before the intervention were low, whereas the intensity of pain (VAS mean 5.8), the risk of falling (Tinetti mean 8.2), and depression (GDS mean 16.7) were recorded as high. After the completion of the intervention program, a significant improvement was found in the ADL (mean 4.0), IADL (mean 13.9), WHOQOL-BREF (mean 52.6), VAS (mean 5.1), risk of falling (Tinetti mean 12.3), and GDS (mean 15.7) scores. CONCLUSIONS The physiotherapeutic intervention had a significant impact on improving the performance of ADL, as well as the emotional state and quality of life of patients receiving hospice services in the home. The results of our research provide evidence of the growing need for physiotherapy in individuals in hospice and for comprehensive assessment by means of ICF. Registered 02.12.2009 in the Research Registry ( https://www.researchregistry.com/why-register ) under the number research registry 5264.
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Affiliation(s)
| | - Agnieszka Wójcicka
- Institute of Health Sciences, Medical College of Rzeszow University, Rzeszow, Poland
| | - Edyta Kluska
- Institute of Health Sciences, Medical College of Rzeszow University, Rzeszow, Poland
| | - Anna Stachoń
- Institute of Health Sciences, Medical College of Rzeszow University, Rzeszow, Poland
| | - Anna Żmuda
- Institute of Health Sciences, Medical College of Rzeszow University, Rzeszow, Poland
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Ko E, Fuentes D, Singh-Carlson S, Nedjat-Haiem F. Challenges and facilitators of hospice decision-making: a retrospective review of family caregivers of home hospice patients in a rural US-Mexico border region-a qualitative study. BMJ Open 2020; 10:e035634. [PMID: 32611740 PMCID: PMC7332198 DOI: 10.1136/bmjopen-2019-035634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Hospice care (HC) is seen as a comprehensive approach, that enhances quality of end-of-life (EOL) care, for terminally ill patients. Despite its positive aspects, HC enrolment is disproportionate for rural patients, who are less likely to use HC in comparison to their urban counterparts. The purpose of this study was to explore decision-making experiences, related to utilisation of HC programmes from a retrospective perspective, with family caregivers (FCGs) in a rural US-Mexico border region. DESIGN This qualitative study was conducted from May 2017 to January 2018 using semistructured face to face interviews with FCGs. Data were analysed using thematic analysis. SETTING The HC programme was situated at a local home health agency, located in rural Southern California, USA. PARTICIPANTS Twenty-eight informal FCGs of patients who were actively enrolled in the HC programme agreed to participate in the study. RESULTS Conversation about HC as an option was initiated by home healthcare staff (39.3%), followed by physicians (32.1%). Emerging themes related to challenges in utilisation of HC and decision-making included: (1) communication barriers; (2) lack of knowledge/misperception about HC; (3) emotional difficulties, including fear of losing their patient, doubt and uncertainty about the decision, denial and (4) patients are not ready for HC. Facilitators included: (1) patient's known EOL wishes; (2) FCG-physician EOL communication; (3) the patient's deteriorating health and (4) home as the place for death. CONCLUSIONS HC patients' FCGs in this rural region reported a lack of knowledge or misunderstanding of HC. It is recommended that healthcare providers need to actively engage family members in patient's EOL care planning. Optimal transition to an HC programme can be facilitated when FCGs are informed and have a clear understanding about patients' medical status along with information about HC.
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Affiliation(s)
- Eunjeong Ko
- Social Work, San Diego State University, San Diego, California, USA
| | - Dahlia Fuentes
- Social Work, San Diego State University, San Diego, California, USA
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Abstract
Palliative medicine is specialized medical care for people with serious illness. Serious illness is one with high risk of mortality that negatively affects quality of life or function or is burdensome in symptoms, treatments, or caregiver stress. Palliative care improves symptom management and addresses the needs of patients and families, resulting in improved patient and caregiver quality of life and reduced symptom burden and health care utilization. Hospice is palliative care for patients with a prognosis of 6 months or less and is appropriate when goals are to avoid hospitalization and maximize time at home for patients who are dying.
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Affiliation(s)
- Paul E Tatum
- Dell Medical School, University of Texas in Austin, 1501 Red River Street, Austin, TX 78701, USA.
| | - Sarah S Mills
- Dell Medical School, University of Texas in Austin, 1501 Red River Street, Austin, TX 78701, USA
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Abstract
Within the hospice literature, spirituality and religion are usually defined in opposition to one another, with religion negatively associated with the external, authoritarian doctrines of Christianity and spirituality positively associated with the free search for truth, meaning, and authenticity. According to survey data, however, most Americans integrate spirituality and traditional religious commitments. The hospice literature is promoting spirituality to its own detriment by alienating potential patients and depriving religious patients of the resources that religious traditions and their affiliated religious communities have to offer.
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Affiliation(s)
- Kathleen Garces-Foley
- Department of Philosophy, Theology, and Religious Studies, Marymount University, 2807 N. Glebe Rd., Arlington, VA 22207-4299, USA
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Cozad MJ, Lindley LC, Mixer SJ. Staff Efficiency Trends Among Pediatric Hospices, 2002-2011. Nurs Econ 2016; 34:82-89. [PMID: 27265950 PMCID: PMC5045247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study provided the first examination of staff efficiency trends among pediatric hospices. Although pediatric staff efficiency demonstrated large variability from 2002 to 2011, the general trend in efficiency from 2003 to 2010. The decline in efficiency means, on average, pediatric hospices had higher operating expenses and used more capacity, but greater amounts of these greater outputs as measured by visits per patient. The study also highlights the crucial role pediatric hospice nurse managers play in developing effective workforce strategies that allow for responsive changes to workload fluctuations. Due to the associations between efficiency, regulation, and growth, nurse leaders' abilities to develop effective strategies are more imperative than ever to ensure quality end-of-life care for children and their families.
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Garner K. Hospice Medicare benefit increasingly popular. J Ark Med Soc 2015; 111:156-157. [PMID: 25665253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Staub A. [Germany's first pediatric hospice celebrates an anniversary]. Kinderkrankenschwester 2013; 32:433-435. [PMID: 24354089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Enguidanos S, Vesper E, Goldstein R. Ethnic differences in hospice enrollment following inpatient palliative care consultation. J Hosp Med 2013; 8:598-600. [PMID: 24022871 DOI: 10.1002/jhm.2078] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 07/08/2013] [Accepted: 07/09/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Susan Enguidanos
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California
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Harris P. Cross-cultural palliative care. Nurs Times 2013; 109:25. [PMID: 24313116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Forster TM, Martin MM, Postal SW. Hospice in the United states expands, evolves over 30 years--a data review. Caring 2013; 32:18-25. [PMID: 23862374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Gross N, Peek-Asa C, Nocera M, Casteel C. Workplace violence prevention policies in home health and hospice care agencies. Online J Issues Nurs 2013; 18:1. [PMID: 23452197] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Workplace violence in the home health industry is a growing concern, but little is known about the content of existing workplace violence prevention programs. The authors present the methods for this study that examined workplace violence prevention programs in a sample of 40 California home health and hospice agencies. Data was collected through surveys that were completed by the branch managers of participating facilities. Programs were scored in six different areas, including general workplace violence prevention components; management commitment and employee involvement; worksite analysis; hazard prevention and control; safety and health training; and recordkeeping and program evaluation. The results and discussion sections consider these six areas and the important gaps that were found in existing programs. For example, although most agencies offered workplace violence training, not every worker performing patient care was required to receive the training. Similarly, not all programs were written or reviewed and updated regularly. Few program differences were observed between agency characteristics, but nonetheless several striking gaps were found.
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Affiliation(s)
- Nathan Gross
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, IA, USA.
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Kucharska E. [Hospice--an institution of support to the patient]. Przegl Lek 2012; 69:212-216. [PMID: 23050420] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The paper summarises the past and the present of the palliative care. The author describes the developement in the field from the times of antiquity, through the deep Christian vocation of middle ages to alleviate pain and misery, the eigthteenth century's enlighted ideas until the relatively recent developement of the idea of hospice pioneered in 1967by dr Cicely Saunders in England, and in 1964 by Chrzanowska in Poland. The role of hospice and palliative care at large is summarised, with special focus on emotional, affirmative, instrumental and information-centered support. The paradox of hospice is discussed, which rests on caring for the incurable patient and helping them comfortably to pass the terminal stages of their disease and life, with dignity, without pain, depression, negligence and deprivation. The hospice movement, drawing form Christian tradition, affirms life while accepting the inevitability of death, opposes the idea of euthanasia, educates the society about the issues related to dying, rests on a set of autonomous units the organisation of which is adapted to local needs, and, finally, acts in concordance with other agendas of the healthcare system. The Polish system constituted by palliative care reach-out teams and palliative units and hospices should be strongly supported and adequately founded to supply best care available to the dying and distressed.
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Hegedus K. [Misbeliefs and reality--about hospice]. Lege Artis Med 2011; 21:744-748. [PMID: 22397135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Abstract
Authors describe the first steps of Palliative Care development in Georgia, including policy, educational issues, drug availability and services. It is underlined the importance and effectiveness of collaboration of Governmental institutions, NGOs and international organizations and experts to create the basis for Palliative care system in the Country. Georgian experience on revealing of problems of adequate pain control gained by survey with participation of advanced patients and their family members is also discussed. All current activities in the sphere of Palliative Care as well as the future models of Palliative Care provision in the capital and regions of Georgia is shown.
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Affiliation(s)
- Tamari Rukhadze
- Georgian National Association for Palliative Care, Iv. Javakhishvili Tbilisi State University, Tbilisi, Georgia.
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Fraser LK, Aldridge J, Manning S, O'Leary S, Miller M, McCulloch R, Childs AM. Hospice provision and usage amongst young people with neuromuscular disease in the United Kingdom. Eur J Paediatr Neurol 2011; 15:326-30. [PMID: 21371919 DOI: 10.1016/j.ejpn.2011.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 02/02/2011] [Indexed: 11/18/2022]
Abstract
AIM To identify the nature of services for children and young people with progressive neuromuscular disorders (NMD) provided by Children's Hospices in the UK. METHODS A questionnaire requesting aggregate data on the number of patients with a neuromuscular condition was sent to all children's hospices in the UK, in addition, specific data was collected on services for young people with DMD presenting to a single local hospice. RESULTS 87% of eligible hospices responded (27/31). 756 young people with an NM condition were being cared for by the hospices. These patients accounted for a mean of 17% of the total hospice population (range 5-35%). The age at which young people were required to leave the children's hospices varied from 18 up to 35 years. 73% of 'visits' were described as 'planned stays'. Although 'end of life care' is provided, few young people with NMD died in a hospice. CONCLUSIONS Children and young people with NMD form a large proportion of the Children's Hospice's caseload. Many valued services provided by children's hospices are not available through NHS funding. The lack of similar adult based services is a concern as increasing numbers of young people are surviving into adulthood.
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Affiliation(s)
- L K Fraser
- Paediatric Epidemiology Group, Centre for Epidemiology and Biostatistics, University Of Leeds, Level 8 Worsley Building, Room 8-49, Clarendon Way, Leeds LS2 9JT, UK.
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Hügler S. [Hospices - a place to die with dignity]. Dtsch Med Wochenschr 2011; 136:p12. [PMID: 21644256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Abstract
BACKGROUND It is unknown whether the rate of survival after in-hospital cardiopulmonary resuscitation (CPR) is improving and which characteristics of patients and hospitals predict survival. METHODS We examined fee-for-service Medicare data from 1992 through 2005 to identify beneficiaries 65 years of age or older who underwent CPR in U.S. hospitals. We examined temporal trends in the incidence of CPR and the rate of survival after CPR, as well as patient- and hospital-level predictors of survival to discharge. RESULTS We identified 433,985 patients who underwent in-hospital CPR; 18.3% of these patients (95% confidence interval [CI], 18.2 to 18.5) survived to discharge. The rate of survival did not change substantially during the period from 1992 through 2005. The overall incidence of CPR was 2.73 events per 1000 admissions; the incidence was higher among black and other nonwhite patients. The proportion of patients undergoing in-hospital CPR before death increased over time and was higher for nonwhite patients. The survival rate was lower among patients who were men, were older, had more coexisting illnesses, or were admitted from a skilled-nursing facility. The adjusted odds of survival for black patients were 23.6% lower than those for similar white patients (95% CI, 21.2 to 25.9). The association between race and survival was partially explained by hospital effects: black patients were more likely to undergo CPR in hospitals that have lower rates of post-CPR survival. Among patients surviving in-hospital CPR, the proportion of patients discharged home rather than to a health care facility decreased over time. CONCLUSIONS Survival after in-hospital CPR did not improve from 1992 through 2005. The proportion of in-hospital deaths preceded by CPR increased, whereas the proportion of survivors discharged home after undergoing CPR decreased. Black race was associated with higher rates of CPR but lower rates of survival after CPR.
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Affiliation(s)
- William J Ehlenbach
- Division of Pulmonary and Critical Care, Harborview Medical Center, University of Washington, Seattle 98104, USA.
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Kennedy J. The new hospice interpretive guidelines: are hospice providers compliant? Home Healthc Nurse 2009; 27:340-346. [PMID: 19509517 DOI: 10.1097/01.nhh.0000356823.40551.ce] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Brkljacić M, Mavrinac M, Sorta-Bilajac I, Bunjevac I, Cengić T, Golubović V, Sustić A. An increasing older population dictates the need to organise palliative care and estabilish hospices. Coll Antropol 2009; 33:473-480. [PMID: 19662766] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The aim of this study is to assess population needs for the organisation of palliative care and establishment of hospices. An opinion poll was created to investigate these needs. The research was carried out in 2007/2008 among 1564 citizens not working in health services, and 789 health service workers--a total of 2353 people questioned in 7 towns of the Republic of Croatia. The significant results obtained using adequate statistical methods confirm that 90.6% of all respondents favour the introduction of a palliative care system and 88% favour the establishment of hospices. This leads us to conclude that the need to establish a palliative care system and hospices has been recognised by citizens and health service workers, thus their implementation in the Republic of Croatia without further delay should be recommended.
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Affiliation(s)
- Morana Brkljacić
- Department of Social Sciences, School of Medicine, University of Rijeka, Rijeka, Croatia.
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Jones CA. A primer on hospice for the internist. Med Health R I 2008; 91:121-122. [PMID: 18595593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Halamandaris VJ. Political future of home care & hospice is bright. Caring 2008; 27:64. [PMID: 19397250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Io K, Ishibashi R, Katagiri J. [Present status of the specialized home medical care support clinic and its future perspectives]. Gan To Kagaku Ryoho 2007; 34 Suppl 2:207-208. [PMID: 20443263] [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: 05/29/2023]
Abstract
In the last 7 1/2 years, we nursed a total of 814 patients as a specialized home hospice care clinic. The number one hurdle of the specialized home medical care support clinic was to institute a system operated for 365 days a year and 24 hours a day. The system also required a number of doctors to be hired whenever a patient to be nursed. Recently, there have been many home medical care support clinics, in which one doctor will perform both outpatient and inpatient care. The system that supports such a medical clinic is necessary. It is ideal that if there is a home medical care support center in the region and provides a support for the medical clinic, give a home care education and the training and enlightenment activities to the citizen.
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Vejlgaard TB, Sjøgren P, Maagaard R. [Organisation and development of palliative care in Denmark]. Ugeskr Laeger 2007; 169:3737-3740. [PMID: 18028836] [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: 05/25/2023]
Abstract
The development of palliative care started in England where St. Christopher's Hospice opened in 1967. In 1990 palliative care was defined by WHO for the first time. In Denmark development has been retarded and palliative care has not been given high priority by the national health authorities. The first hospice in Denmark opened in 1992, and national guidelines were published in 1999. However, the intentions of the guidelines have not been followed systematically. This article describes the development in Denmark and outlines perspectives on possible future directions.
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Abstract
OBJECTIVE To evaluate the association of institutional residence and chronic disability with end-of-life Medicare utilization in 1989 and 1999. RESEARCH DESIGN Retrospective study of nationally representative survey data linked to Medicare claims. SUBJECTS Medicare beneficiaries who completed the National Long-Term Care Survey in 1989 or 1999 and died within 1 year. MEASURES Medicare utilization [hospital, hospice, and skilled nursing facility (SNF)] in the last year of life and at death among the nondisabled, chronically disabled, and institutionalized. RESULTS Medicare utilization over the last year of life was similar in 1989 and 1999 for the proportion hospitalized in all groups (eg, 76% vs. 73% among the nondisabled); there were significant increases in SNF use (eg, 9% vs. 20% among the nondisabled). Comparisons at the time of death were somewhat different, with significant increases in hospice use in all groups (eg, 4% vs. 22% in the nondisabled); there was a significant decrease in the proportion dying in the hospital only for the nondisabled group (53% vs. 40%). Utilization was similar for the nondisabled and chronically disabled, but was lower in the institutionalized (eg, proportion hospitalized in the last year of life was 51% in the institutionalized, 73% in the nondisabled, and 77% in the disabled group in 1999). CONCLUSIONS Despite dramatic growth in hospice use, hospital and SNF utilization generally did not decline. Institutional residence, which is not usually included in analyses of Medicare claims, was strongly associated with utilization. This may affect the usefulness of claims-based efficiency indicators.
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Affiliation(s)
- Sydney M Dy
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
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Abstract
The delivery of palliative care in Germany is still characterized by a wide-spread undersupply both for inpatients and outpatients. Nevertheless over the last 15 years progress has also been made in Germany, which is pleasing and which has directed professional and public attention increasingly to the situation of the incurably ill and dying. In the course of this development the first structures for specialized palliative care have been established. In particular the situation for inpatients in hospitals and hospices is pleasing, even if a satisfaction for total coverage is not yet reached. More seriously however is the demand for the outpatients. Financial means, which are steered so far only rudimentarily for palliative care, must be made sufficiently available, in order to be able to meet the demand with the help of appropriate structural offers. It is important to realize the needs of the incurably ill and dying and of their relatives and friends. Our society has to call attention to this subject and it should be placed on the healthpolitical agenda as a topic of the highest priority level. The current developments in the federation and in the federal states are encouraging and allowing hope that the delivery of palliative care for all who need it (and not only the ill) will improve further in the coming years.
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Affiliation(s)
- T Schindler
- Deutsche Gesellschaft für Palliativmedizin, Geldern, BRD.
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Koch U, Mehnert A. Palliative Versorgung in Deutschland. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2006; 49:1075-6. [PMID: 17103340 DOI: 10.1007/s00103-006-0096-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Rennie T. "Children's palliative care services are at the mercy of an insecure future". Nurs Times 2006; 102:12. [PMID: 17112147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Halmandaris VJ. Celebrating the past: claiming the future. Caring 2006; 25:52. [PMID: 17076136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Abstract
Palliative care is medical care focused on the relief of suffering and support for the best possible quality of life for patients facing serious, life-threatening illness and their families. It aims to identify and address the physical, psychological, and practical burdens of illness. Palliative care may be delivered simultaneously with all appropriate curative and life-prolonging interventions. In practice, palliative care practitioners provide assessment and treatment of pain and other symptom distress; employ communication skills with patients, families, and colleagues; support complex medical decision making and goal setting based on identifying and respecting patient wishes and goals; and promote medically informed care coordination, continuity, and practical support for patients, family caregivers, and professional colleagues across healthcare settings and through the trajectory of an illness. The field of hospital palliative care has grown rapidly in recent years in response to patient need and clinician interest in effective approaches to managing chronic life-threatening illness. The growth in the number and needs of seriously and chronically ill patients who are not clearly terminally ill has led to the development of palliative care services outside the hospice benefit provided by Medicare (and other insurers). This article reviews the clinical, educational, demographic, and financial imperatives driving this growth, describes the clinical components of palliative care and the range of service models available, defines the relation of hospital-based palliative care to hospice, summarizes the literature on palliative care outcomes, and presents practical resources for clinicians seeking knowledge and skills in the field.
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Affiliation(s)
- Diane E Meier
- Hertzberg Palliative Care Institute, Center to Advance Palliative Care, Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, New York 10029, USA.
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Affiliation(s)
- Christopher A Klinger
- Division of Access for End-of-Life Care, Research, & International Programs at the National Hospice and Palliative Care Organization, Alexandria, Virginia 22314, USA
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35
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Ferris M. Emerging trends in home care sales and marketing. Caring 2005; 24:54-5. [PMID: 15966160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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36
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Tomasović N. [Dubrovnik at the crossroads of the traditional hospital and the modern concept of hospice units]. Lijec Vjesn 2003; 125:339-43. [PMID: 15209032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
A short reminiscence of medical history in ancient Dubrovnik inspires for sustainable development of health care system and social care for the future. The main goal of the research is to confirm the necessity to establish hospice units in Dubrovnik, within an organized palliative care. Palliative care program offers preservation of the optimal quality of life for patients with advanced disease and very limited prognosis. Out of the total figure of the death-rate in the Dubrovnik area (1996-2001), singled-out were groups of special interest to the palliative care: oncologic patients and geriatric population. According to the results, only 14% of the death-rate in the Dubrovnik area were patients who did not belong to the mentioned groups. Patients who are in the terminal phase of their life and are not hospitalized have a greater need for an organized palliative care, due to the fact that permanent expert medical care is not always available to them. Significant percentage of geriatric population and oncologic patients dies out of Dubrovnik hospital.
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37
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Niessen S. [Hospice care in the USA]. Pflege Z 2003; 56:suppl 2-10. [PMID: 14679646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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Friedman MM. What's new in the 2003 Joint Commission? Home care and hospice standards: part 2. Home Healthc Nurse 2003; 21:152-5. [PMID: 12637818 DOI: 10.1097/00004045-200303000-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
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39
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[Modern hospice movement in Germany--III: From institutional resistance to acceptance]. Pflege Z 2001; 54:911-6. [PMID: 12630165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
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40
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Abstract
In April 1999 altogether 114 inpatient units providing palliative care (50 palliative care units, 64 inpatient-hospices) offered a total of 989 beds. Compared to 1993 this has been an increase of 256%, compared to 1997 of 60%. The number of available beds, compared to 1997, increased markedly (58%), with a availability of 12 beds per one million residents. However, there are still major deficits: the distribution of the units is very irregular and the number of available beds is still to low, compared to the estimated need of 50 inpatient beds per one million residents. The quality of palliative care shows significant deficits (e. g. the availability of nursing staff, cooperation with pain clinics, standardised documentation, education). Differences between palliative care wards and hospices were huge. According to the definition of the German Society for Palliative Care, a palliative care ward should provide a ratio of at least 1.4 nursing staff per bed, however, only 18% of the palliative care units fulfil this definition. Only few hospices and half of the palliative care units worked in close cooperation with pain clinics. Despite a significant increase in units and inpatient beds providing palliative care, there still is a major deficit in the overall number of beds and the quality of palliative care.
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Affiliation(s)
- R Sabatowski
- Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universität Köln.
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Steinhauser KE, Maddox GL, Person JL, Tulsky JA. The evolution of volunteerism and professional staff within hospice care in North Carolina. Hosp J 2001; 15:35-51. [PMID: 11033658 DOI: 10.1080/0742-969x.2000.11882946] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Although the pursuit of Medicare certification has been one of the most controversial events in hospice history no study has examined its impact using data from a defined population of hospices before, during, and after federal legislation was enacted. This paper revisits the debate over the changing role of volunteers using such a longitudinal data source. Over time, as the patient population grew, aggregate levels of volunteers and professional staff increased. However, the ratios of professional staff and volunteers to patients reveal that regardless of certification status, hospices retained more professional staff per patient and fewer volunteers per patient over time. These data suggest hospices, particularly certified organizations, have transitioned from voluntary organizations to professionally staffed organizations with a strong volunteer component. The most important issue for future research is whether the observed changes have affected the quality of hospice care.
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Affiliation(s)
- K E Steinhauser
- Services Research and Development, VA Medical Center, Durham, NC 27705, USA
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42
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Klaschik E. [Development and state of palliative treatment in Germany]. Z Arztl Fortbild Qualitatssich 2000; 94:538-40. [PMID: 11048337] [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] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Since the early nineties of the 20th century palliative medicine developed in a dynamic way. 65 palliative care units (p.c.u.), 81 hospices and some 600 outpatient services were in existence in spring 2000. Germany provides 7 beds in p.c.u. and 8 beds in hospices per 1 Mill. inhabitants. Stillitt is a long way to diminish the existing deficits in pain therapy, the control of other physical symptoms as well as the psychological, social and spiritual support.
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Affiliation(s)
- E Klaschik
- Universität Bonn, Zentrum für Palliativmedizin am Malteser Krankenhaus Bonn
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43
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Abstract
This article develops two previous research efforts. William J. Winston (1994, 1995) has proposed a set of strategies by which health care organizations can benefit from forging strategic alliances. Raadt and Self (1997) have proposed a classification model of alliances including horizontal, vertical, internal and osmotic. In the first of two articles, this paper presents a model of horizontal alliances. The subsets include transregional, service mergers, networks, venture capital investments, trade and professional organizations, and promotional alliances. Advantages and disadvantages of each are discussed.
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Affiliation(s)
- D R Self
- Auburn University, Montgomery, AL 36117, USA
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45
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Abstract
Cancer care extends from diagnosis through the late stages of advanced illness as patients confront dying and their families cope with caregiving and grief. Palliative care is a rapidly developing area of clinical focus that offers valuable services to patients in terms of symptom management and adjustment to illness, including issues of life completion and life closure. It is often appropriate to offer certain elements of palliative care early in the course of illness. As disease progresses, physical comfort and enhancing quality of life increasingly become primary goals of cancer care. Specialized palliative care programs, epitomized by hospice, are invaluable resources for patients with far-advanced illness and their families. Current regulations and prevailing payment structures limit access to and the scope of hospice services and highlight the need for innovative models of delivering and financing palliative care.
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Affiliation(s)
- I Byock
- Practical Ethics Center, University of Montana, Missoula, USA
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46
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Berke D. Demography is destiny: forecasting a bright future for home care and hospice. Caring 2000; 19:20-1. [PMID: 10847900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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47
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Abstract
This article reports preliminary findings from an ongoing study of occupational stress, coping, and change among employees at a hospice in New York state. The study sought to identify those aspects of hospice work that direct-service and middle-management staff considered unique and rewarding, and also to examine those conditions that created problematic levels of stress. A qualitative methodology was employed, based on heuristic principles of grounded theory and action research. Techniques included field observation and participation, 38 semi-structured interviews, and group discussion and review of data by research participants. The authors elaborate upon established models of occupational stress and coping, and identify hospice-specific stressors and resources for coping. The research highlights "support" as a critically important, multidimensional element for successful coping. A re-examination and reinterpretation of "coping" as it applies to stress in hospice work is suggested.
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Affiliation(s)
- M DiTullio
- Le Moyne College, Syracuse, New York, USA
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48
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49
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Davies RE. The growth of hospices in the UK. Paediatr Nurs 1998; 10:23-6. [PMID: 10095671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- R E Davies
- Ty Dewi Sant School of Nursing, University Hospital of Wales, College of Medicine, Cardiff
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50
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