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This chapter discusses the conclusions derived from the review presented in this book. It concludes that the findings of the review are positive. The review has introduced a new kind of care and has offered significant new knowledge and skills for the staff and care-givers in the palliative care network. It has also introduced a different type of palliative care innovation that uses voluntary rather than government funding. This new programme posed a great challenge to the traditional and conventional stereotypes of UK and US healthcare. In this chapter, the foreseeable changes in the field of palliative care are outlined. These are changes in the age target and age priority of palliative care, and in the boundaries between palliative care and care of long-term chronic illness, and an increase in the shift of care towards home and community and in the costs of palliative care. The chapter also provides suggestions for addressing the still-unexplored sectors of palliative care, such as the changing patient need, the new challenges in therapy, and the changing models of care.

This chapter develops an ideal palliative-care system by applying the key elements of Social Role Valorisation (SRV)-based systems to the palliative-care context. It argues that service systems can evolve beyond the institutional model to a dispersed services model. Beginning with a discussion of the evolution of systems beyond institutional models, the chapter then looks at how a dispersion of service provision allows institutions to be closed. After examining the feasibility and effectiveness of non-institutional models of care, the chapter describes the closure of a disability institution, a significant proportion of whose residents require palliative care. It concludes by outlining a reconfiguration of case management that can work towards a dispersion of service provision.

In the implementation of children’s rights standards into the practice of child-centred care in detention there were two key elements. First, the existing Children Detention Schools had to be merged to create a single, specialist service and second, a modern new facility, consistent with children’s rights, had to be designed and built to cater. The overarching objective was to develop a single, national facility providing child-centre care for all children on detention and remand orders in line with their rights to provision, protection, participation, preparation and partnership. A series of inter-connected measures were required to effect such change, including the completion of the new building in line with children’s rights standards; the creation of a new model of care for child detention (the ‘CEHOP’ model) and the development of a supportive environment for staff, through clarity of purpose and direction. This chapter documents the complex and significant process of change and development in creating a unified and specialist model of child detention, using the annual reports of the national inspection process to track the progress achieved. It seeks to reflect the scale and complexity of reforming child detention in line with children’s rights standards.

Since the 90s, long-term care policies have undergone significant transformations across many countries. In some instances, these changes have been the outcome of major explicit policy goals. In others, new systems have come about through the accumulation of incremental changes. As a result, LTC policy reforms in the last decades across OECD countries offer a rich body of experience that should inform the design of strategies for improving equity and efficiency in the LTC systems of the future. Therefore, the main purpose of this book is to analyse the range of solutions adopted internationally about how to organise, regulate and fund LTC services in the face of the growing needs of ageing societies. By adopting a public policy approach, this book examines the impact that the measures taken by the different public actors involved in the funding, regulation and commissioning of LTC have on dependent older people with different needs and their carers.

Patients in the intensive care unit (ICU) and their family members often have unmet palliative care needs, including informational needs, supportive needs, and uncontrolled symptoms such as pain, dyspnoea, agitation, and delirium. ICU providers can meet these needs by integrating a palliative approach to care using a consultative model, an integrative model, or a hybrid of the two. Assessing and addressing unmet palliative needs impact the lived experience of patients and their families, regardless of whether or not patients are expected to survive their admission. Skilled communication assists with patient-centred decision-making and aligning care with patient and family values. This chapter will explore opportunities to align the principles of palliative care and critical care.

This chapter describes Vermont’s hub-and-spoke system of care for treatment of opioid use disorders. The system not only addresses the clinical care needs of patients but also assists those in treatment in building the skills needed to address other aspects of well-being, such as self-care, parenting, and employment. The program is a collaborative effort of the state’s Medicaid program, the Department of Health, substance abuse treatment providers, and primary care practices. The goals of the system are to increase total access to care, decrease the risk of overdose and transmission of infectious disease, normalize care for substance use disorder, and link patients to other needed services. Both hubs and spokes use evidence-based medication-assisted treatment (MAT) to treat opioid use disorder. Individuals for whom MAT is not desired or indicated may receive non-MAT residential, intensive outpatient, or outpatient treatment, and a wide array of recovery support services.

Having examined the history of prematurity, Black women’s experiences of pregnancy, labor, and birthing, and their assessments of medical racism, this chapter gestures toward some approaches to address Black women’s high rates of prematurity. These approaches may also be applied to rates of infant and maternal mortality, as well as to addressing the adverse birth outcomes of other groups. Presently, much emphasis is placed on stereotyping the characteristics believed to cause prematurity. The general approach is to intervene in the problem. This chapter suggests that preventive approaches to birth outcomes must be deployed with the same commitment as is done with interventions. Transforming the model of care requires viewing pregnancy as an event, not a risk. And, unless risk is well established, pregnancy care need not be medicalized. In the event that medical interventions are necessary, a team-based model of care is preferable. Medical providers should be sharing the care with the family, a midwife, and a doula. Most important, medical professionals must acknowledge the ways that they uphold racism in their practice of medicine.

The author gratefully acknowledges Dr Debra Creedy who assisted Dr Dennis with the first version of this review in 2004. The author also wishes to thank: Julie Weston for her data extraction, independent evaluation of trial quality, contacting trial authors as necessary, and data entry; Danni Li for translating Sun 2004; Tang 2009; and Xu 2003. Edward Plaisance Jr for translating Ajh 2006. Alison Balmfirth, Laura Wills, Ed Doragh, and Nivene Raafat for translating Bittner 2009. Aoife Fogarty for translating Kleeb 2005. Francesca Gatenby, Nick Jones, and Juliet Sheath for translating Urech 2009; and the many study authors who were very helpful in responding to queries and providing additional data. Depression is a major cause of disability for all ages and both sexes worldwide. Postpartum depression is often defined as depression occurring within the first year following childbirth. In most studies this includes those women for whom the depression may be a continuation of that experienced during pregnancy, as well as those for whom it is a new onset. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) does not recognize postpartum depression as diagnostically distinct from depression at other times, although does allow for the addition of a ‘postpartum-onset specifier’ in women with an onset within 4 weeks of birth. A recent systematic review of postpartum depression found the period prevalence of all depression to be 19.2% in the first 12 weeks postnatally, with a period prevalence for major depression of 7.1% (Gaynes et al. 2005). This review also identified depression to be common during pregnancy with a period prevalence of 18.4% across the 9 months of pregnancy, with 12.7% having an episode of major depression during this time. Not surprisingly, antenatal depression is a strong risk factor of postpartum depression. The cause of postpartum depression suggests a multifactorial aetiology (Beck 2001; O’Hara and Swain 1996). Despite considerable research, no single causative factor has been isolated. However, meta-analytic findings consistently highlight the importance of psychosocial variables such as stressful life events, marital conflict, and the lack of social support.