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Introduction Research in palliative care (PC) is often regarded as challenging due to the vulnerability of the population and other peculiarities. We aim to systematically identify barriers to research in PC in the literature. Methods The electronic databases CINAHL, MEDLINE were searched for papers published in the last 25 years. Citations and then abstracts were screened for inclusion. Original papers were included on first-level analysis. On a second level reviews, reports, and position papers were analyzed. Papers containing a direct patient report were specifically analyzed. Barriers were categorized (ethical considerations, financial and time expenses, study design and methodology, human resources and politics) and results quantified. Results Twenty-one original papers and 65 other papers were included. Five studies involved patients directly, five were systematic reviews, three were study experiences, and seven were surveys or workshop reports. Most papers originated from UK, USA, or Norwegian Universities. Ethics and methods were the most often mentioned categories on both levels. Accrual, attrition, and gatekeeping were frequently named barriers. Complex invasive studies or possible side effects hinder patients' participation, as patients are often willing to participate for altruistic motivations. Discussion Barriers to PC research are ethical concerns and methodological challenges. Possible strategies to overcome methodological barriers include international collaborative efforts to include more patients and improve study designs. Ethical barriers indicate the need for patient involvement in the research development process and tailoring research specifically to the PC population. [ABSTRACT FROM AUTHOR]

Aims and objectives This systematic review aims to synthesise the existing research on how patients participate in patient safety initiatives. Background Ambiguities remain about how patients participate in routine measures designed to promote patient safety. Design Systematic review using integrative methods. Methods Electronic databases were searched using keywords describing patient involvement, nursing input and patient safety initiatives to retrieve empirical research published between 2007 and 2013. Findings were synthesized using the theoretical domains of Vincent's framework for analysing risk and safety in clinical practice: 'patient', 'healthcare provider', 'task', 'work environment', 'organisation & management'. Results We identified 17 empirical research papers: four qualitative, one mixed-method and 12 quantitative designs. All 17 papers indicated that patients can participate in safety initiatives. Conclusions Improving patient participation in patient safety necessitates considering the patient as a person, the nurse as healthcare provider, the task of participation and the clinical environment. Patients' knowledge, health conditions, beliefs and experiences influence their decisions to engage in patient safety initiatives. An important component of the management of long-term conditions is to ensure that patients have sufficient knowledge to participate. Healthcare providers may need further professional development in patient education and patient care management to promote patient involvement in patient safety, and ensure that patients understand that they are 'allowed' to inform nurses of adverse events or errors. A healthcare system characterised by patient-centredness and mutual acknowledgement will support patient participation in safety practices. Further research is required to improve international knowledge of patient participation in patient safety in different disciplines, contexts and cultures. Relevance to clinical practice Patients have a significant role to play in enhancing their own safety while receiving hospital care. This review offers a framework for clinicians to develop comprehensive practical guidelines to support patient involvement in patient safety. [ABSTRACT FROM AUTHOR]

The article offers the information on the clinical pharmacology frameworks as a necessary strategy for improving the health care of patients. The article also mentions about the Clinical pharmacology (CP) as a multidisciplinary scientific field involving all aspects of the relationship between drugs and humans; Clinical pharmacologists in various phases of drug development in basic and clinical research, regulatory agencies.

Background and Purpose Patient participation is nowadays considered important for high quality patient care. Although the literature on health care professions provides some insights into this topic, specific aspects in the field of physiotherapy are less known. The objective of this review was to investigate how patients and physiotherapists perceive patient participation, especially in regards to what it means for them and the role patients play during physiotherapy treatment sessions. Methods We used a narrative synthesis of qualitative studies. We conducted a systematic search in six databases using a set of key words, extracted relevant data, performed quality assessment and synthesized findings from the selected studies. Results Out of 160 studies, 11 were retained. Two main themes emerged: the conceptualization of patient participation and the patients' role preferences. Patient participation included various activities including goal setting, information exchange, decision-making and exercise training and often influenced the power relation between patient and physiotherapist. Patients' willingness to participate varied, and they often did not play their desired role. Conclusions Patients and physiotherapists perceived participation to be valuable yet challenging. Problems of conceptualization, power inequalities, lack of health professionals' skills and lack of the right attitude to share power and responsibility from both sides were some of the barriers that impeded optimal participation. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Aims and objectives: To present an in-depth analysis of existing qualitative literature concerning experiences and needs of the relatives of patients with dementia in hospitals. Background: Relatives are an important resource for the care of patients with dementia in hospitals. They provide necessary information about the patient and can support the patient’s care. Simultaneously, they are themselves vulnerable, having specific needs and experiences. A number of studies have been conducted that focus on the perspectives of the relatives. The synthesis of qualitative studies contributes to a more comprehensive understanding of recent study findings. Design: A meta-ethnographic synthesis of qualitative research findings was used. Methods: The synthesis process followed six defined steps. We located relevant studies through searching the CINAHL, PubMed and PsycInfo databases and through searching journals and reference lists by hand. A list of metaphors was created and translated into one another. Identified metaphors were synthesised and interpreted as a new whole. Results: Relatives of patients with dementia frequently experience a negative cycle of specific worries, negative feelings and resulting roles and functions in hospital due to negative care experiences. Conclusions: Experiences of relatives are strongly influenced by the attitudes, expertise and communication that they receive from health professionals working in the hospital. The results clearly show how health professionals have the potential to break through the negative cycle and contribute to a more positive feeling about a patient’s hospital stay. Relevance to clinical practice: Structured and individually planned involvement of the relatives during the hospital care seems to be a key aspect for improving the experiences for the relatives and the patients with dementia. Collaboration with the relatives needs to be valued and supported by the organisation. Also a professional and defined frame for this area of responsibility needs to be provided. [ABSTRACT FROM AUTHOR]

Aims and objectives This study aimed at developing and implementing evidence-based patient and family education on oral anticoagulation therapy. Background The number of persons with chronic diseases who live at home is increasing. They have to manage multiple diseases and complex treatments. One such treatment is oral anticoagulation therapy, a high risk variable dose medication. Adherence to oral anticoagulation therapy is jeopardised by limited information about the medications, their risk and complications, the impact of individual daily routine and the limited inclusion of family members in education. Hence, improved and tailored education is essential for patients and families to manage oral anticoagulation therapy at home. Design and methods A community-based participatory research design combined with the Precede-Proceed model was used including a systematic literature review, posteducation analysis, an online nurse survey, a documentation analysis and patient/family interviews. The study was conducted between April 2010-December 2012 at a department of general internal medicine in a teaching hospital in Switzerland. Participants were the department's nursing and medical professionals including the patients and their families. Results The evidence-based patient and family education on oral anticoagulation therapy emerged comprising a learning assessment, teaching units, clarification of responsibilities of nurse professionals and documentation guidelines. Conclusion and clinical relevance The inclusion of the whole department has contributed to the development and implementation of this evidence-based patient family education on oral anticoagulation therapy, which encompasses local characteristics and patient preferences. This education is now being used throughout the department. [ABSTRACT FROM AUTHOR]

Aims and objectives The aim of this integrative literature review was twofold: (1) to investigate different collaborative programmes for older people with depression living at home with diverse access to care and (2) to describe conceptualisation of the nurses' role and interventions within these care models. Background One in four older people who visits a General Practitioner suffers from depression. Depression is a concern for 15% of all older home-care service clients. Detecting and managing depression in older people is highlighted as a key role of nurses. A literature review has been conducted to investigate collaborative models of care, aimed at ensuring low-threshold access to care and exploring the scope of nurse practice within these models. Methods Literature review comprising 14 studies and reviews. Results Three different collaborative care programmes ( Collaborative Care Model, Community Mental Health Team and Psychogeriatric Assessment and Treatment in City Housing programme) were identified. In all programmes, the essential aspects were complex and multifaceted interventions, provided by a variety of healthcare professionals, but the access to care differed. All studies described the role of nurses differently and with wide variations. Conclusions Despite a broad scope of practice, nurses play a pivotal role within the different models of care. Nurses have to have the educational background and expertise in mental health issues to recognise depression and eventually be able to provide more comprehensive interventions to alleviate depression in older people. Relevance to practice Collaboration is needed to meet the needs of older people with depression. New forms of work divisions are pivotal to achieve this objective. [ABSTRACT FROM AUTHOR]

Objectives: Two distinct types of specific respiratory muscle training (RMT), i.e. respiratory muscle strength (resistive/threshold) and endurance (hyperpnoea) training, have been established to improve the endurance performance of healthy individuals. We performed a systematic review and meta-analysis in order to determine the factors that affect the change in endurance performance after RMT in healthy subjects. Data sources: A computerized search was performed without language restriction in MEDLINE, EMBASE and CINAHL and references of original studies and reviews were searched for further relevant studies. Review methods: RMT studies with healthy individuals assessing changes in endurance exercise performance by maximal tests (constant load, time trial, intermittent incremental, conventional [non-intermittent] incremental) were screened and abstracted by two independent investigators. A multiple linear regression model was used to identify effects of subjects' fitness, type of RMT (inspiratory or combined inspiratory/expiratory muscle strength training, respiratory muscle endurance training), type of exercise test, test duration and type of sport (rowing, running, swimming, cycling) on changes in performance after RMT. In addition, a meta-analysis was performed to determine the effect of RMT on endurance performance in those studies providing the necessary data. Results: The multiple linear regression analysis including 46 original studies revealed that less fit subjects benefit more from RMT than highly trained athletes (6.0% per 10 mL • kg-1 • min-1 decrease in maximal oxygen uptake, 95% confidence interval [CI] 1.8, 10.2%; p=0.005) and that improvements do not differ significantly between inspiratory muscle strength and respiratory muscle endurance training (p=0.208), while combined inspiratory and expiratory muscle strength training seems to be superior in improving performance, although based on only 6 studies (+ 12.8% compared with inspiratory muscle strength training, 95% CI 3.6, 22.0%; p=0.006). Furthermore, constant load tests (+16%, 95% CI 10.2, 22.9%) and intermittent incremental tests (+18.5%, 95% CI 10.8, 26.3%) detect changes in endurance performance better than conventional incremental tests (both p<0.001) with no difference between time trials and conventional incremental tests (p=0.286). With increasing test duration, improvements in performance are greater (+0.4% per minute test duration, 95% CI 0.1, 0.6%; p=0.011) and the type of sport does not influence the magnitude of improvements (all p>0.05). The metaanalysis, performed on eight controlled trials revealed a significant improvement in performance after RMT, which was detected by constant load tests, time trials and intermittent incremental tests, but not by conventional incremental tests. Conclusion: RMT improves endurance exercise performance in healthy individuals with greater improvements in less fit individuals and in sports of longer durations. The two most common types of RMT (inspiratory muscle strength and respiratory muscle endurance training) do not differ significantly in their effect, while combined inspiratory/expiratory strength training might be superior. Improvements are similar between different types of sports. Changes in performance can be detected by constant load tests, time trials and intermittent incremental tests only. Thus, all types of RMT can be used to improve exercise performance in healthy subjects but care must be taken regarding the test used to investigate the improvements. [ABSTRACT FROM AUTHOR]