Browsing by Subject "Patient Care"

Now showing 1 - 20 of 25

Building trust in a time of turmoil
(2023-02-03) Lee, Thomas H.
Developing and Evaluating the Efficacy and Feasibility of Delivering a Psychoeducational Individual Intervention to Women with Advanced Stage Ovarian Cancer: A Two Phase Study
(2007-08-08) Doyle, Kimberly Cecile; Gershenfeld, Howard
PURPOSE: The purpose of this study was to assess the psychosocial needs of women with ovarian cancer treated at Baylor University Medical Center Sammons Cancer Center, and to design and evaluate the feasibility and efficacy of an individual psychoeducational intervention on reported symptoms of depression, anxiety, and psychosocial adjustment to illness. Secondary aims included identifying the barriers to accessing group support services as well as identifying a mechanism to address those barriers. METHOD: This study was conducted in two phases. Phase I consisted of a psychosocial needs assessment (n = 15) to determine the appropriate elements necessary for inclusion in an individual intervention. Perceived barriers to participation in psychosocial services, including group support, were also assessed. The outcome of the needs assessment combined with an extensive literature review was used to develop the Phase II intervention. In Phase II, participants (n = 30) were recruited from the gynecologic oncology practice at Baylor Sammons Cancer Center. Participants were randomized to intervention (n = 15) vs. control (n=15) groups. Intervention sessions lasted 60 minutes and were conducted weekly over a period of 8 weeks. Sessions consisted of a combination of education and psychosocial support. Growth modeling was used to evaluate variation in within-individual rate of change in outcome measures during the treatment (weeks 1-8) and followup (weeks 16-48) periods of the study. Repeated measures ANOVA was used to evaluate average group differences in outcome measures during the treatment and follow-up periods of the study. RESULTS: No main effects of time, group, age, or education were observed with regard to rate of change of psychosocial adjustment to illness during the treatment period of the study using growth modeling. However, during the follow-up period of the study, time and group were significant predictors of within-individual variation in rate of change in psychosocial adjustment to illness. Similarly, repeated measures ANOVA yielded no main effects of time or group in psychosocial adjustment to illness during the treatment period of the study; however, a main effect of group (p<.05) and an interaction between group and time (p<.05) were noted during the follow-up period of the study with the most significant differences in group means occurring at week 48 (effect size = .70). Although not stable across all models created, time was the only significant predictor of within-individual variation in rate of change in depression symptoms during the treatment and follow-up periods. A main effect of time without consideration of group (p<.01) and an interaction between group and time (p<.01) with regard to depression symptoms was noted in the treatment phase of the study, most significantly at week 8. A main effect of group (p<.05), most significantly at week 48, was observed during the follow-up phase (effect size = .69). Similar to depression scores, withinindividual variation in anxiety symptom scores was significantly predicted by time during the treatment period of the study. Although no main effects of predictors were observed with regard to anxiety symptoms during the follow-up period of the study, the model with the greatest goodness of fit included the predictors education, group, and time. Repeated measures ANOVA suggest a main effect of time (p<.05) with regard to anxiety symptoms during the treatment period of the study but no main effect of group. However, during the follow-up period of the study, a main effect of time (p<.05) and group (p<.05) were noted with regard to differences in the average state anxiety symptom score between groups, with the most significant difference occurring at week 48 (effect size = .43). Cost analyses suggest minimal differences in the number of medical office visits and phone calls between groups and a moderate difference in usage of psychiatric and pain medication between groups. Treatment satisfaction was high across all intervention topics, with participants rating sessions 1 and 8 the most helpful. RESEARCH AND CLINICAL IMPLICATIONS: Concordant with the literature, the results of this study suggest that individual interventions with women with advanced stage ovarian cancer may help improve neurocognitive-related mood symptoms and anxiety during the initial phase of treatment and diagnosis. Decline in depression symptoms in intervention participants was primarily related to decline in neurocognitive complaints. A reduction in neurocognitive mood symptoms and anxiety likely contributed to the improvement in psychosocial adjustment to illness noted in the treatment group during the follow-up period of the study. The impact of psychosocial sequelae on cognitive functioning warrants attention by clinicians. ACKNOWLEDGEMENT OF FUNDING: Baylor University Medical Center Research Foundation
Efficacy of an Early Biopsychosocial Intervention for Patients with Acute Temporomandibular Disorder-Related Pain: a Six- to Ten-Year Follow Up Study
(2011-12-09) Fraley, Sarah Elizabeth; Gatchel, Robert J.; Stowell, Anna W.; Chiu, Chung-Yi
A long-term follow up study was conducted to further evaluate the efficacy of an early biopsychosocial intervention for patients with acute high risk (HR) temporomandibular disorder (TMD). Subjects from Gatchel and colleagues’ one-year outcome study (Gatchel, Stowell, Wildenstein, Riggs, & Ellis, 2006), and two- to six-year follow up study (Gatchel, Potter, Hinds, & Ingram, 2011) were contacted to assess pain and psychosocial measures six to ten years post intake. An early intervention (EI) group had received cognitive behavioral skills training and biofeedback, while a nonintervention (NI) group had received no intervention. EI group subjects demonstrated significant improvement as well as maintenance of gains in several psychosocial domains, including coping skills and reduction in depression scores relative to NI group subjects. EI group subjects also showed a decreasing trend in jaw pain-related healthcare visits relative to NI group subjects, providing further evidence for reduced costs associated with early interventions. The present study supports the findings of the earlier one-year outcome study and two- to six-year follow up study, indicating that an early biopsychosocial intervention is beneficial for patients with acute TMD. In utilizing this approach to treat patients in the acute stage of TMD, these patients are less likely to develop chronic TMD, and to be impacted long-term by the physical, emotional, and financial aspects of TMD.
Ethics large and small: moral considerations in response to childhood obesity
(2022-03-08) Hester, D. Micah
Obesity in the U.S. has been described as an epidemic, and in response to such rhetoric, individuals, healthcare providers, public health officials, even state legislatures, and courts have proposed initiatives or enacted consequences either to encourage better eating habits, discourage poor eating habits, or even punish poor nutritional practices. All these actions raise ethical concerns for public health and individual patient care. This talk will explore a number of these issues and will suggest that certain state-based responses do not merit ethical scrutiny, but individual provider directiveness in regards to nutritional counseling, especially with parents of overweight children, is warranted.
Ethics of patient care: can we protect patients from ourselves?
(2013-10-25) Yarbrough, William, Jr.
In "the room where it happens"
(2022-12-16) Freeland, Deborah G.
Medical ethics in the carceral setting
(2024-01-09) Kendig, Newton E.
In this Ethics Grand Rounds, we will discuss ethical concerns that commonly arise when caring for patients in the carceral setting. Topics include respecting patient autonomy within a public safety setting, obtaining informed consent from patients in an inherently coercive environment, determining medical necessity of correctional health services, and navigating ethical concerns for specific patient populations such as those with behavioral health conditions, hepatitis C, reproductive and gender-related health care needs, the aging, and those living with life-limiting conditions. We will explore the interface of public policy, legal mandates, evidence-based clinical guidance, and ethical decision-making.
Research activities at the University of Texas Southwestern Medical School
(1963-05-21) Gill, Atticus J.
[Southwestern News]
(1992-08-14) Doremus, David
[Southwestern News]
(2002-04-25) Echeverria, Ione
[Southwestern News]
(2002-05-08) Shields, Amy
[TEST] Synopsis in the Electronic Medical Record: Recapturing the Apheresis Patient Story
(2017-05) Armendariz, Tomas; Chernesky, Shelli; Lin, Christina; De Simone, Nicole; Sarode, Ravi
This is a test sample.
[TEST] Synopsis in the Electronic Medical Record: Recapturing the Apheresis Patient Story
(2017-05) Armendariz, Tomas; Chernesky, Shelli; Lin, Christina; De Simone, Nicole; Sarode, Ravi
[ This is a test sample.] PURPOSE: To report the implementation of a concise and easily accessible “apheresis synopsis” report to improve team communication, overall efficiency, patient safety and comfort. With the birth of electronic medical records (EMR), the patient story has been lost. In the past, physicians would review nursing apheresis procedure flowsheets in the paper charts. However, in the EMR used at our institution (EPIC®), physicians did not have access to apheresis display screens due to differing configurations based on provider type. An employed solution was for nurses to write a procedure summary note including final machine data. This documentation was not standardized and did not provide sequential data from previous procedures to make patient specific treatment decisions. Historical and current data drives these decisions. Historical data, such as inlet flow rates, use of calcium to treat citrate reactions, or use of tissue plasminogen activator, drives future treatment. Current data, such as most recent hematocrit or vital signs, are used to adjust procedure run parameters. Further inefficiencies occurred due to having to toggle between tabs in the EMR, such as between prior procedure notes, labs and recent vital signs, to determine parameters for that day’s procedure. METHODS: Physicians, advanced practice providers, nurses and technologists collaborated on identifying data points needed to assess patients for their apheresis procedures. Nursing worked with the EMR team to develop a well-organized, comprehensive and easily accessible report. All this was developed into the “apheresis synopsis” display screen within the EMR. This ensures that all relevant parameters are automatically displayed at the end of a procedure for ease of viewing. It also allows physicians to view sequential apheresis procedure data to observe for any trends, allowing appropriate adjustments in the apheresis plan. RESULTS: We now use the synopsis screen to help coordinate and improve patient care in our clinic. The synopsis is a summarized report displayed as a running timeline of procedures, containing information regarding dates, types of apheresis procedures, information of pre- and post-procedure machine parameters, vital signs, types of access, and adverse reactions. If more detailed information is needed, clicking the hyperlinked date opens expanded documentation for that procedure (Image). Providers can now review multiple parameters from multiple procedures without having to open various EMR tabs or encounters, thus making for more efficient and individualized treatment decisions by trending data. CONCLUSION: The patient story has been recaptured by maximizing the potential of the EMR through use of a synopsis. Communication between nurses and physicians has improved with standardized information available about each procedure leading to less frustration and ultimately, safer care.
The University of Texas Southwestern Medical Center at Dallas: Six-Year Plan 2004-2010
(2003-12) University of Texas Southwestern Medical Center, 2004-2010 Six-Year Plan Steering Committee; University of Texas Southwestern Medical Center
UT Southwestern’s Six-Year Plan is a rolling strategic plan updated every two years by committees appointed by the President. The committees, comprised mostly of faculty, help the institution prioritize its needs and suggest where to use resources.
The University of Texas Southwestern Medical Center at Dallas: Six-Year Plan 2006-2012
(2005-12) University of Texas Southwestern Medical Center, 2006-2012 Six-Year Plan Steering Committee; University of Texas Southwestern Medical Center
UT Southwestern’s Six-Year Plan is a rolling strategic plan updated every two years by committees appointed by the President. The committees, comprised mostly of faculty, help the institution prioritize its needs and suggest where to use resources.
The University of Texas Southwestern Medical Center at Dallas: Six-Year Plan 2008-2014
(2007-12) University of Texas Southwestern Medical Center, 2008-2014 Six-Year Plan Steering Committee; University of Texas Southwestern Medical Center
UT Southwestern’s Six-Year Plan is a rolling strategic plan updated every two years by committees appointed by the President. The committees, comprised mostly of faculty, help the institution prioritize its needs and suggest where to use resources.
The University of Texas Southwestern Medical Center at Dallas: Six-Year Plan 2010-2016
(2009-12) University of Texas Southwestern Medical Center, 2010-2016 Six-Year Plan Steering Committee; University of Texas Southwestern Medical Center
UT Southwestern’s Six-Year Plan is a rolling strategic plan updated every two years by committees appointed by the President. The committees, comprised mostly of faculty, help the institution prioritize its needs and suggest where to use resources.
The University of Texas Southwestern Medical Center at Dallas: Six-Year Plan 2012-2018
(2012-05) University of Texas Southwestern Medical Center, 2012-2018 Six-Year Plan Steering Committee; University of Texas Southwestern Medical Center
UT Southwestern’s Six-Year Plan is a rolling strategic plan updated every two years by committees appointed by the President. The committees, comprised mostly of faculty, help the institution prioritize its needs and suggest where to use resources.
[UT Southwestern Medical Center News]
(2011-09-30) Ladson, LaKisha
[UT Southwestern Medical Center News]
(2011-01-13) Rian, Russell