Prediction of pediatric death in the year after hospitalization: a population-level retrospective cohort study
Child; Female; Humans; infant; Male; Young Adult; Cohort Studies; Patient Discharge; Pediatrics; Hospital Mortality; Logistic Models; Prognosis; adolescent; Preschool; infant; Models; Newborn; retrospective studies; Theoretical; mortality; Pennsylvania/epidemiology
BACKGROUND: The study of how the quality of pediatric end-of-life care varies across systems of health care delivery and financing is hampered by lack of methods to adjust for the probability of death in populations of ill children. OBJECTIVE: To develop a prognostication models using administratively available data to predict the probability of in-hospital and 1-year postdischarge death. METHODS: Retrospective cohort study of 0-21 year old patients admitted to Pennsylvania hospitals from 1994-2001 and followed for 1-year postdischarge mortality, assessing logistic regression models ability to predict in-hospital and 1-year postdischarge deaths. RESULTS: Among 678,365 subjects there were 2,202 deaths that occurred during the hospitalization (0.32% of cohort) and 860 deaths that occurred 365 days or less after hospital discharge (0.13% of cohort). The model predicting hospitalization deaths exhibited a C statistic of 0.91, with sensitivity of 65.9% and specificity of 92.9% at the 99th percentile cutpoint; while the model predicting 1-year postdischarge deaths exhibited a C statistic of 0.92, with sensitivity of 56.1% and specificity of 98.4% at the 99th percentile cutpoint. CONCLUSIONS: Population-level mortality prognostication of hospitalized children using administratively available data is feasible, assisting the comparison of health care services delivered to children with the highest probability of dying during and after a hospital admission.
2009
Feudtner C; Hexem KR; Shabbout M; Feinstein JA; Sochalski J; Silber JH
Journal Of Palliative Medicine
2009
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1089/jpm.2008.0206" target="_blank" rel="noreferrer">10.1089/jpm.2008.0206</a>
Advanced illness index: Predictive modeling to stratify elders using self-report data
Female; Humans; Male; Terminally Ill; Aged; Severity of Illness Index; Risk Assessment; Self Disclosure; Forecasting; 80 and over; Models; retrospective studies; Health Surveys; Theoretical
OBJECTIVES: Develop a prediction model to identify persons who have an increased risk of dying within the next 36 months, in order to focus additional resources and assessment in areas related to advanced care planning. DESIGN: Retrospective study with a 3-year observation period. SETTING: Integrated, not-for-profit managed care organization. Participants: Beneficiaries aged 65-105 responding to an annual survey (n = 4888). MEASUREMENTS: Survey instrument includes physical function, geriatric syndromes, health care utilization, special equipment use, self-care deficits, caregiving responsibilities, and general health problems. RESULTS: An 11-variable model changed the baseline chi2 from 315.71 (df = 1) to 742.511 (df = 11). The percent of subjects correctly classified was 74.3% and the negative predictive value was 92.2%. CONCLUSION: Advanced Illness Index (AII) model is stable. Characteristic variables used are not easily reversed: the 1997 cohort classified as at-risk consistently remained at risk or died in the subsequent years (1998, 92%; and 1999, 96%) and 92% of those not at-risk survived the next 36 months. Persons at high risk should at a minimum be made aware of the types of integrated home and community-based services available to them should it be needed. They also should be targeted for elicitation of treatment preferences, values, designation of health care proxy, planning, and advanced care directives.
2006
Brody KK; Perrin NA; Dellapenna R
Journal Of Palliative Medicine
2006
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1089/jpm.2006.9.1310" target="_blank" rel="noreferrer">10.1089/jpm.2006.9.1310</a>
Social network analysis as an analytic tool for interaction patterns in primary care practices
Interprofessional Relations; Medical; decision making; Models; Family Practice/organization & administration; Primary Health Care/organization & administration; Theoretical; Process Mapping; Practice Management
PURPOSE: Social network analysis (SNA) provides a way of quantitatively analyzing relationships among people or other information-processing agents. Using 2 practices as illustrations, we describe how SNA can be used to characterize and compare communication patterns in primary care practices. METHODS: Based on data from ethnographic field notes, we constructed matrices identifying how practice members interact when practice-level decisions are made. SNA software (UCINet and KrackPlot) calculates quantitative measures of network structure including density, centralization, hierarchy and clustering coefficient. The software also generates a visual representation of networks through network diagrams. RESULTS: The 2 examples show clear distinctions between practices for all the SNA measures. Potential uses of these measures for analysis of primary care practices are described. CONCLUSIONS: SNA can be useful for quantitative analysis of interaction patterns that can distinguish differences among primary care practices.
2005
Scott J; Tallia A; Crosson JC; Orzano AJ; Stroebel C; DiCicco-Bloom B; O'Malley D; Shaw E; Crabtree B
Annals Of Family Medicine
2005
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Journal Article
<a href="http://doi.org/10.1370/afm.344" target="_blank" rel="noreferrer">10.1370/afm.344</a>
The health and well-being of caregivers of children with cerebral palsy.
Child; Female; Humans; Male; Cohort Studies; Adult; Parent-Child Relations; Parents; Questionnaires; Middle Aged; Self Concept; Ontario; Severity of Illness Index; Longitudinal Studies; Professional-Patient Relations; Family Health; Stress; Adaptation; Psychological; Caregivers/psychology; Models; social support; Theoretical; disabled children; Caregivers/psychology; Cerebral Palsy/psychology; Cerebral Palsy/psychology; Child Behavior Disorders/etiology; Foster Home Care; Psychological/epidemiology/etiology; Psychological/epidemiology/etiology
OBJECTIVE: Most children enjoy healthy childhoods with little need for specialized health care services. However, some children experience difficulties in early childhood and require access to and utilization of considerable health care resources over time. Although impaired motor function is the hallmark of the cerebral palsy (CP) syndromes, many children with this development disorder also experience sensory, communicative, and intellectual impairments and may have complex limitations in self-care functions. Although caregiving is a normal part of being the parent of a young child, this role takes on an entirely different significance when a child experiences functional limitations and possible long-term dependence. One of the main challenges for parents is to manage their child's chronic health problems effectively and juggle this role with the requirements of everyday living. Consequently, the task of caring for a child with complex disabilities at home might be somewhat daunting for caregivers. The provision of such care may prove detrimental to both the physical health and the psychological well-being of parents of children with chronic disabilities. It is not fully understood why some caregivers cope well and others do not. The approach of estimating the "independent" or "direct" effects of the care recipient's disability on the caregiver's health is of limited value because (1) single-factor changes are rare outside the context of constrained experimental situations; (2) assumptions of additive relationships and perfect measurements rarely hold; and (3) such approaches do not provide a complete perspective, because they fail to examine indirect pathways that occur between predictor variables and health outcomes. A more detailed analytical approach is needed to understand both direct and indirect effects simultaneously. The primary objective of the current study was to examine, within a single theory-based multidimensional model, the determinants of physical and psychological health of adult caregivers of children with CP. METHODS: We developed a stress process model and applied structural equation modeling with data from a large cohort of caregivers of children with CP. This design allowed the examination of the direct and indirect relationships between a child's health, behavior and functional status, caregiver characteristics, social supports, and family functioning and the outcomes of caregivers' physical and psychological health. Families (n = 468) of children with CP were recruited from 19 regional children's rehabilitation centers that provide outpatient disability management and supports in Ontario, Canada. The current study drew on a population available to the investigators from a previous study, the Ontario Motor Growth study, which explored patterns of gross motor development in children with CP. Data on demographic variables and caregivers' physical and psychological health were assessed using standardized, self-completed parent questionnaires as well as a face-to-face home interview. Structural equation modeling was used to test specific hypotheses outlined in our conceptual model. This analytic approach involved a 2-step process. In the first step, observed variables that were hypothesized to measure the underlying constructs were tested using confirmatory factor analysis; this step led to the so-called measurement model. The second step tested hypotheses about relationships among the variables in the structural model. All of the hypothesized paths in the conceptual model were tested and included in the structural model. However, only paths that were significant were shown in the final results. The direct, indirect, and total effects of theoretical constructs on physical and psychological health were calculated using the structural model. RESULTS: The most important predictors of caregivers' well-being were child behavior, caregiving demands, and family function. A higher level of behavior problems was associated with lower levels of both psychological (beta = -.22) and physical health (beta = -.18) of the caregivers, whereas fewer child behavior problems were associated with higher self-perception (beta = -.37) and a greater ability to manage stress (beta = -.18). Less caregiving demands were associated with better physical (beta = .23) and psychological (beta = .12) well-being of caregivers, respectively. Similarly, higher reported family functioning was associated with better psychological health (beta = .33) and physical health (beta = .33). Self-perception and stress management were significant direct predictors of caregivers' psychological health but did not directly influence their physical well-being. Caregivers' higher self-esteem and sense of mastery over the caregiving situation predicted better psychological health (beta = .23). The use of more stress management strategies was also associated with better psychological health of caregivers (beta = .11). Gross income (beta = .08) and social support (beta = .06) had indirect overall effects only on psychological health outcome, whereas self-perception (beta = .22), stress management (beta = .09), gross income (beta = .07), and social support (beta = .06) had indirect total effects only on physical health outcomes. CONCLUSIONS: The psychological and physical health of caregivers, who in this study were primarily mothers, was strongly influenced by child behavior and caregiving demands. Child behavior problems were an important predictor of caregiver psychological well-being, both directly and indirectly, through their effect on self-perception and family function. Caregiving demands contributed directly to both the psychological and the physical health of the caregivers. The practical day-to-day needs of the child created challenges for parents. The influence of social support provided by extended family, friends, and neighbors on health outcomes was secondary to that of the immediate family working closely together. Family function affected health directly and also mediated the effects of self-perception, social support, and stress management. In families of children with CP, strategies for optimizing caregiver physical and psychological health include supports for behavioral management and daily functional activities as well as stress management and self-efficacy techniques. These data support clinical pathways that require biopsychosocial frameworks that are family centered, not simply technical and short-term rehabilitation interventions that are focused primarily on the child. In terms of prevention, providing parents with cognitive and behavioral strategies to manage their child's behaviors may have the potential to change caregiver health outcomes. This model also needs to be examined with caregivers of children with other disabilities.
2005-06
Raina P; O'Donnell M; Rosenbaum P; Brehaut J; Walter SD; Russell D; Swinton M; Zhu Bin; Wood E
Pediatrics
2005
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Journal Article
<a href="http://doi.org/10.1542/peds.2004-1689" target="_blank" rel="noreferrer">10.1542/peds.2004-1689</a>
Testing the grief to personal growth model using structural equation modeling.
Humans; Adult; Models; social support; Grief; Parents/psychology; Personality Development; Theoretical
The belief that loss can result in growth has been hypothesized for centuries.Yet, traditional grief theories have viewed grief work as a process of resolving grief and returning to normal. Formal conceptualizations of grief to growth models have been recently delineated by several grief theorists.The Grief to Personal Growth model represents one emergent perspective of the qualitative changes resulting from the loss of a loved one.The model delineates a pathway through grief that indicates the bereft experience despair and detachment followed by intrusive thoughts and later avoidance of intense preoccupation with grief. Social support is shown to facilitate the bereft as they reconstruct their lives and find new meaning in life. A second path indicates that some bereaved individuals become mired in grief and need help to proceed toward personal growth.The model was tested in a sample of bereaved parents using structural equation modeling as a method of theory testing.The results of testing this model are presented within a framework of theory testing as a mechanism to bridge the gaps between theory, practice, and research. Implications for practice are considered.
2002
Hogan NS; Schmidt LA
Death Studies
2002
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Journal Article
<a href="http://doi.org/10.1080/07481180290088338" target="_blank" rel="noreferrer">10.1080/07481180290088338</a>
Sense of coherence: a relevant resource in the coping process of mothers of deaf and hard-of-hearing children?
Female; Humans; Questionnaires; Analysis of Variance; Stress; Adaptation; Psychological; Models; Mothers/psychology; Psychological/psychology; Theoretical; Deafness/psychology
This study examined the importance of reported sense of coherence (Antonovsky, 1987) in mothers of children with hearing impairment. Sense of coherence was explored as a factor in relation to the experience of stress and subjective life satisfaction and in the context of other relevant variables in coping (e.g., social support, additional handicaps of the child, child's hearing status, means of communication). Two hundred thirty-five mothers completed a questionnaire, and path analysis corroborated a theoretical model in which sense of coherence was delineated as a factor contributing directly to stress perception. Both sense of coherence and the experience of social support were identified as resources that reduced reported stress and improved quality of life, with sense of coherence especially important in reducing stress. Child variables, including additional handicaps and extent of hearing impairment, intensified reported stress for the mothers, but mode of communication with the deaf child did not affect stress experience. The findings are discussed within the context of socialization theory. Recommendations for further research (e.g., longitudinal data, control designs, socio-economic status, applicability to fathers) are made.
2004
Hintermair M
Journal Of Deaf Studies And Deaf Education
2004
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Journal Article
<a href="http://doi.org/10.1093/deafed/enh005" target="_blank" rel="noreferrer">10.1093/deafed/enh005</a>
Coordinating the norms and values of medical research, medical practice and patient worlds-the ethics of evidence based medicine in orphaned fields of medicine
Delivery of Health Care; Humans; Personal Autonomy; Attitude to Health; Clinical Competence; Ethics; Medical; Analytical Approach; Models; Theoretical; Health Care and Public Health; Social Responsibility; Allied Health Occupations/ethics; Cognitive Therapy/ethics; Evidence-Based Medicine/ethics; Integrated/ethics; Interprofessional Relations/ethics; Logic; Patient Care Team/ethics; Physical Therapy Modalities/ethics; Social Justice/ethics
Evidence based medicine is rightly at the core of current medicine. If patients and society put trust in medical professional competency, and on the basis of that competency delegate all kinds of responsibilities to the medical profession, medical professionals had better make sure their competency is state of the art medical science. What goes for the ethics of clinical trials goes for the ethics of medicine as a whole: anything that is scientifically doubtful is, other things being equal, ethically unacceptable. This particularly applies to so called orphaned fields of medicine, those areas where medical research is weak and diverse, where financial incentives are lacking, and where the evidence regarding the aetiology and treatment of disease is much less clear than in laboratory and hospital based medicine. Examples of such orphaned fields are physiotherapy, psychotherapy, medical psychology, and occupational health, which investigate complex syndromes such as RSI, whiplash, chronic low back pain, and chronic fatigue syndrome. It appears that the primary ethical problem in this context is the lack of attention to the orphaned fields. Although we agree that this issue deserves more attention as a matter of potential injustice, we want to argue that, in order to do justice to the interplay of heterogeneous factors that is so typical of the orphaned fields, other ethical models than justice are required. We propose the coordination model as a window through which to view the important ethical issues which relate to the communication and interaction of scientists, health care workers, and patients.
2004
Vos R; Willems D; Houtepen R
Journal Of Medical Ethics
2004
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Journal Article
<a href="http://doi.org/10.1136/jme.2003.007153" target="_blank" rel="noreferrer">10.1136/jme.2003.007153</a>
Designing a mixed methods study in primary care
Humans; Qualitative Research; Research Design; Primary Health Care; Models; Multi-site Ethics; Theoretical; Health Services Research/methods
BACKGROUND: Mixed methods or multimethod research holds potential for rigorous, methodologically sound investigations in primary care. The objective of this study was to use criteria from the literature to evaluate 5 mixed methods studies in primary care and to advance 3 models useful for designing such investigations. METHODS: We first identified criteria from the social and behavioral sciences to analyze mixed methods studies in primary care research. We then used the criteria to evaluate 5 mixed methods investigations published in primary care research journals. RESULTS: Of the 5 studies analyzed, 3 included a rationale for mixing based on the need to develop a quantitative instrument from qualitative data or to converge information to best understand the research topic. Quantitative data collection involved structured interviews, observational checklists, and chart audits that were analyzed using descriptive and inferential statistical procedures. Qualitative data consisted of semistructured interviews and field observations that were analyzed using coding to develop themes and categories. The studies showed diverse forms of priority: equal priority, qualitative priority, and quantitative priority. Data collection involved quantitative and qualitative data gathered both concurrently and sequentially. The integration of the quantitative and qualitative data in these studies occurred between data analysis from one phase and data collection from a subsequent phase, while analyzing the data, and when reporting the results. DISCUSSION: We recommend instrument-building, triangulation, and data transformation models for mixed methods designs as useful frameworks to add rigor to investigations in primary care. We also discuss the limitations of our study and the need for future research.
2004
Creswell JW; Fetters MD; Ivankova NV
Annals Of Family Medicine
2004
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Journal Article
<a href="http://doi.org/10.1370/afm.104" target="_blank" rel="noreferrer">10.1370/afm.104</a>
Continuity of care: an approach to measurement
Hospitalization; Humans; Questionnaires; Follow-Up Studies; Prospective Studies; Communication; Psychotherapy; Comprehensive Health Care; Medical Records; Ambulatory Care; Models; referral and consultation; Theoretical; Community Mental Health Services; Evaluation Studies as Topic; Community Psychiatry; Day Care; Mental Disorders/therapy; Transfer Agreement
1972
Bass RD; Windle C
The American Journal Of Psychiatry
1972
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Journal Article
<a href="http://doi.org/10.1176/ajp.129.2.196" target="_blank" rel="noreferrer">10.1176/ajp.129.2.196</a>
An alternative in terminal care: results of the National Hospice Study
Female; Hospitalization; Male; United States; Adult; Aged; Health Services Research; Cancer Care Facilities; Outcome and Process Assessment (Health Care); quality of life; Non-U.S. Gov't; U.S. Gov't; Comparative Study; Models; Costs and Cost Analysis; Health; Insurance; Medicare/economics; Human; Theoretical; Support; Middle Age; home care services; Non-P.H.S.; Neoplasms/physiopathology/psychology/therapy; Hospices/classification/economics/organization & administration; Terminal Care/economics/organization & administration; Pain/epidemiology; Reimbursement/economics
Hospice is a program of supportive services for terminally ill patients and their families, provided either at home or in designated inpatient settings, which is purported to improve patient and family quality of life at lower cost than conventional terminal care. The National Hospice Study was a multi-site, quasi-experimental study to compare the experiences of terminal cancer patients and their families in hospices with those of similar patients and families receiving conventional terminal care. The results indicate that, although care is different in hospices, e.g. lesser utilization of aggressive interventional therapy and diagnostic testing, patients' quality of life is similar in the hospice and conventional care systems with the exception of pain and symptom control, which may be better in the inpatient hospice setting. Hospice patients are more likely to die at home and their families are satisfied with that outcome. Otherwise, no consistent superiority of family outcome was associated with the hospice approach. The cost of hospice care is less than that of conventional terminal care for patients in hospices without inpatient facilities, but the cost of hospice appears to be equivalent to conventional care for patients in hospices having beds.
1986
Greer DS; Mor V; Morris JN; Sherwood S; Kidder D; Birnbaum H
Journal Of Chronic Diseases
1986
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Journal Article
National hospice study analysis plan
United States; Family; Research Design; Non-U.S. Gov't; P.H.S.; U.S. Gov't; Models; Costs and Cost Analysis; Human; Theoretical; Support; Hospices/economics; Evaluation Studies/methods; Health Services Research/methods
Since the founding of the first hospice in the United States in 1974, the number of health care organizations providing hospice services has grown rapidly. In 1978, the U.S. General Accounting Office identified 59 operational hospices [1]. A survey undertaken by the National Hospice Organization (NHO) in 1980 found 235 operational programs and many more actively planning to deliver services. By the summer of 1981, the Joint Commission on the Accreditation of Hospitals (JCAH), in studying the feasibility of a voluntary hospice accreditation program, had 650 responses to a national survey [2]. Finally, the 1981 NHO directory identifies 464 operational "provider programs" as well as 33 functioning state-level hospice organizations with an additional 353 programs in various stages of establishing hospice programs of care [3]. The growth of the movement and the public recognition it has received have catalyzed advocacy of Federal support for hospice services. In 1979, the Congress responded by mandating a study to delineate the implications of inclusion of hospice services in the Medicare program. The Health Care Financing Administration (HCFA) then selected 26 hospices (from an applicant pool of 233) to participate in a two-year experimental program. These demonstration sites receive reimbursement for services provided Medicare beneficiaries not otherwise available under current regulations. The special reimbursement provisions went into effect on October 1, 1980. (See Appendix A: Description of the Hospice Reimbursement Program.) In the spring of 1980, the Robert Wood Johnson Foundation and the John A. Hartford Foundation joined with the Health Care Financing Administration (HCFA) to solicit proposals for a national evaluation of hospice care as a basis for future Federal fiscal policy and legislation. Brown University was selected as the evaluation center by competitive process and the grant was awarded on September 30, 1980. The evaluation employs a quasi-experimental design in which the impact of hospice care (with and without reimbursement) on quality of life and costs are compared to non-hospice (conventional) terminal care. Eight hundred patients and families in 24 comparison sites located in three regional areas (Southern New England, Northern Midwest and Southern California) are expected to participate. Primary data collection began on August 1, 1981. Analyses of differential outcome are performed using standard linear multiple regression and logistic multiple regression with separate models for each comparison group. Effects are tested by separately estimating the specific response variable for the prototype (average) hospice patient for each model.
1983
Greer DS; Mor V; Sherwood S; Morris JN; Birnbaum H
Journal Of Chronic Diseases
1983
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Journal Article
On the mathematical modelling of pain
Humans; Analgesia; Reproducibility of Results; Animals; Models; Pain/physiopathology; Axons/physiology; Nerve Net/physiology; Neurological; Neuronal Plasticity; Neurons/physiology; Theoretical
In this review a case is presented for the use of mathematical modelling in the study of pain. The philosophy of mathematical modelling is outlined and a recommendation is made for the use of modern nonlinear techniques and computational neuroscience in the modelling of pain. Classic and more recent examples of modelling in neurobiology in general and pain in particular, at three different levels-molecular, cellular and neural networks-are described and evaluated. Directions for further progress are indicated, particularly in plasticity and in modelling brain mechanisms. Major advantages of mathematical modelling are that it can handle extremely complex theories and it is non-invasive, and so is particularly valuable in the investigation of chronic pain.
1996
Britton NF; Skevington SM
Neurochemical Research
1996
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Journal Article
<a href="http://doi.org/10.1007/bf02532424" target="_blank" rel="noreferrer">10.1007/bf02532424</a>
Re-examining perceived ease of use and usefulness: a confirmatory factor analysis
Evaluation Studies; Models; Statistics; Theoretical
Adams et al. (1992) presented the results of 2 studies designed to replicate previous work by Davis (1989) regarding perceived usefulness, ease of use, and their influence on the usage of information technology. To measure the influence of usefulness and ease of use on reported levels of usage, Adams et al. employed structural equation modeling. This technique allows the researchers to analyze a set of latent constructs much like independent and dependent variables in regression analysis. Unfortunately, in this part of the analysis, less-than-satisfactory model fit was observed. Further, inconsistencies within and across the 2 studies regarding the strength of causal influence of Davis' constructs on usage seem to suggest that these relationships may be more complex than previously thought. It as suggested that further analysis of these scales be undertaken to better establish their measurement properties, underlying structure, and stability over various technologies. Such an analysis is presented to provide important information to researchers seeking to statistically test relationships among these variables through structural equation modeling.
1993
Segars A; Grover V
Management Information Systems Quarterly
1993
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Journal Article
<a href="http://doi.org/10.2307/249590" target="_blank" rel="noreferrer">10.2307/249590</a>
Palliative care: an international view
Terminal Care; Age Factors; Research; Models; Human; hospice care; Theoretical; Palliative Care/methods/standards
This review article addresses first the different palliative care models currently in use. Studies addressing the effectiveness of the models used are briefly summarized. Special attention is further given to models developed and tested in palliative care in children. Finally, the problems and pitfalls encountered in evaluating palliative care services are highlighted and recommendations are made where further research is still warranted.
2000
Abu-Saad HH
Patient Education And Counseling
2000
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Journal Article
AIDS palliative care demands a new model
Models; Human; Theoretical; Palliative Care; Terminal Care; Acquired Immunodeficiency Syndrome/therapy
1992
Malcolm JA; Sutherland DC
Medical Journal Of Australia
1992
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Journal Article