A5057760480- Palliative Care and End-of-Life Issues
- Dialysis and Renal Disease Management
- Patient Dignity and Privacy
- Patient-Provider Communication in Healthcare
- Organ Donation and Transplantation
- Ethics in medical practice
- Family and Patient Care in Intensive Care Units
- Healthcare cost, quality, practices
- Healthcare Policy and Management
- Childhood Cancer Survivors' Quality of Life
- Geriatric Care and Nursing Homes
- Chronic Kidney Disease and Diabetes
- Opioid Use Disorder Treatment
- Chronic Disease Management Strategies
- Interprofessional Education and Collaboration
- Health Systems, Economic Evaluations, Quality of Life
- Patient Satisfaction in Healthcare
- Innovations in Medical Education
- Primary Care and Health Outcomes
- Central Venous Catheters and Hemodialysis
- Frailty in Older Adults
- Pharmacological Effects and Toxicity Studies
- Acute Kidney Injury Research
- Pain Management and Opioid Use
- Health Literacy and Information Accessibility
University of Pittsburgh
2016-2025
UPMC Health System
2018-2024
Stanford University
2024
Harman (United States)
2024
Children's Hospital of Pittsburgh
2024
Ethics and Public Policy Center
2024
University of Pittsburgh Medical Center
2013-2023
Johns Hopkins University
2008-2022
Nephrology Center of Maryland
2022
Welch Foundation
2022
Nephrology fellows often face difficult conversations about dialysis initiation or withdrawal but are frequently unprepared for these discussions. Despite evidence that communication skills teachable, few fellowship programs include such training. A workshop nephrology (NephroTalk) focused on delivering bad news and helping patients define care goals, including end-of-life preferences. This 4-hour workshop, held in October November 2011, included didactics practice sessions with standardized...
Despite growing evidence on benefits of increased physical activity in hemodialysis (HD) patients and safety intra-dialytic exercise, it is not part standard clinical care, resulting a missed opportunity to improve outcomes these patients. To develop successful exercise program for HD patients, critical understand patients', staff nephrologists' knowledge, barriers, motivators preferences patient exercise. In-depth interviews were conducted with purposive sample nephrologists from 4 dialysis...
Historic migration and the ever–increasing current into Western countries have greatly changed ethnic cultural patterns of patient populations. Because health care beliefs minority groups may follow their religion country origin, inevitable conflict can arise with decision making at end life. The principles truth telling autonomy are embedded in framework Anglo–American medical ethics. In contrast, many parts world, norm is protection from truth, by family, a tradition familial piety, where...
Background Given the high prevalence of chronic kidney disease (CKD), primary care physicians (PCPs) frequently manage early stage CKD. Nonetheless, there are challenges in providing optimal CKD setting. This study sought to understand PCPs' perceptions barriers and facilitators management Study design Mixed methods Settings participants Community-based PCPs four US cities: Baltimore, MD; St. Louis, MO; Raleigh, NC San Francisco, CA. Methodology We used a self-administered questionnaire...
Kidney palliative care is a growing discipline within nephrology. specifically addresses the stress and burden of advanced kidney disease through provision expert symptom management, caregiver support, advance planning with goal optimizing quality life for patients families. The integration principles necessary to address multidimensional impact on patients. In particular, have high experience greater intensity at end compared other chronic serious illnesses. Currently, access lacking,...
Older adults with advanced chronic kidney disease ( CKD ) experience functional impairment that can complicate management. Failure to recognize may put these individuals at risk of further decline, nursing home placement, and missed opportunities for timely goals‐of‐care conversations. Routine geriatric assessment could be a useful tool identifying older who are decline provide contextual information guide clinical decision‐making. Two innovative programs were implemented in the Veterans...
Older kidney transplant recipients are susceptible to cognitive impairment, frailty, comorbidities, immunosuppression-related complications, and chronic graft failure, however, there has been limited focus on their concerns expectations related transplantation. This study aims describe the perspectives of older about experience transplantation, self-management, treatment goals inform strategies interventions that address specific needs.Face-to-face semistructured interviews were conducted...
Abstract Nephrologists frequently must discuss serious news with patients, especially those advanced comorbidities. These discussions include giving bad news, addressing prognosis, and assisting treatment decision making. Few data exist about how nephrologists approach these difficult conversations. This article presents a framework for engaging in using case example, provides tools making initiating or forgoing dialysis. Communication skills presented Ask‐Tell‐Ask discussing the N‐U‐R‐S‐E...
Frail elderly patients with advanced kidney disease experience many of the burdens associated dialysis. Although these constitute fastest-growing population starting dialysis, they often suffer loss functional status, impaired quality life, and increased mortality after dialysis initiation. Nephrology clinicians face challenges helping decide if potential benefits outweigh risks preparing such for future setbacks. A communication framework decision-making that aligns treatment choices...
Purpose Shared decision making (SDM) is a core competency in health policy and guidelines. Most U.S. internal medicine residencies lack an SDM education curriculum. A standardized patient (SP)-based curriculum teaching key concepts skills of was developed. Method This consisted innovative seven-step model skills-focused SP case, integrated into the ambulatory rotation for senior residents at University Pittsburgh Medical Center 2015. Evaluation pre/postcurriculum surveys assessing residents’...
Burnout decreases job satisfaction and leads to poor patient outcomes but remains underinvestigated in nephrology. We explored the prevalence determinants of burnout among a sample nephrologists.Cross-sectional.The nephrologists were approached via American Medical Association Physicians Masterfile, National Kidney Foundation listserv, email, social media between April August 2019. The predictors demographics practice characteristics. outcome was burnout, defined as responding "once week" or...
Quoting patients in electronic medical record (EMR) notes is controversial. Quotations may be used to promote accuracy documentation. However they also cast skepticism on patient speech. Little known about how quotations are EMR documenting goal of care (GOC) conversations. 1) How often GOC notes; 2) what content do clinicians quote; and 3) does quotation use vary by clinician specialty sociodemographic characteristics? This multihospital, cross-sectional study assessed for seriously ill...
1Division of Vascular Surgery, University Washington, Seattle, WA, USA 2Division Pittsburgh Medical Center, Pittsburgh, PA, USA. 3Department School Medicine, 4Section Palliative Care and Ethics, 5Division Renal Electrolyte, aCorresponding author address for reprints: Amit Pujari, MD, Email: [email protected] This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, reproduction in any medium, provided...