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January 4, 2013 by howtonestforless 175 Comments Make sure you follow me on Instagram and Pinterest for a sneak peek into my recent projects! To begin you will need some type of graphic computer software such as Photoshop or Photoshop Elements. And just type away right on top of the chalk board background in Photoshop with your new fonts! Hi, I downloaded the chalkboard background and a font, but how do I type on the background since it saves it like a picture?
I am having trouble knowing how to change the graphic image from Black to white in Photoshop elements. This free paddle fan program printable, exclusive to Sweet Violet Bride, is blooming at the seams. With the non-blade point of an X-acto knife and a ruler, score the program down the center fold.
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In this report clinicians at nine hospitals describe how they and their colleagues established formal programs of palliative care.
The report is one result of an ongoing collaboration between two foundations that have similar missions and complementary operating styles. The Robert Wood Johnson Foundation (RWJF) has as its mission improving the health and health care of all Americans through funding for demonstration projects, training, educational and communications activities, policy analysis, and research. These case studies are stories written by leaders, clinicians who became innovators when they saw the need for palliative care at their hospitals and devoted themselves to creating programs to meet that need.
Whether they were senior or junior faculty members, all the leaders overcame significant barriers to the development of palliative care within their hospitals. The narratives exemplify the current debate that exists about the definition of "palliative care." Is it end-of-life care? The authors' programs serve different groups of people and employ diverse clinical models appropriate for particular patient populations. As the charts of financial information show, there is considerable variation in the financing of hospital-based palliative care programs and in institutions' methods of collecting and reporting data.
Palliative care programs should be constructed around an interdisciplinary team, including at least a doctor, nurse, social worker, pharmacist, and chaplain. Patients, families, and physicians should discuss goals and preferences and should plan the care together.
Palliative care should reach patients throughout the hospital, should encourage collaboration across clinical and administrative boundaries, and should foster respect for patients' and families' wishes. Palliative care programs should provide bereavement services for families and staff members. The impetus for commissioning these case studies was the growing national concern about care at the end of life. Through study or advocacy, a number of projects are now seeking to make end-of-life care more widely available. These pioneers have developed creative ways to surmount obstacles and effect change, and they provide practical advice for other practitioners.
The Balm of Gilead is a comprehensive program for end-of-life care supported in large part through funding from the Initiative for Excellence in End-of-Life Care of the Robert Wood Johnson Foundation. To relieve the suffering of terminally ill patients and their families, the Balm of Gilead Center has created a team of staff, family members, and community volunteers dedicated to providing high quality end-of-life care.
The Balm of Gilead Center provides inpatient palliative care for medically underserved people with terminal illnesses who do not have a place to live or do not have support services at home. For those who need home hospice care, the Balm of Gilead Center provides teams of physicians, nurses, clergy, and volunteers who are dedicated to helping families care for their loved ones at the end of life.
My desire to develop palliative care services within the public health system is rooted in my desire for overall high-quality care for the medically underserved. In 1994, I was recruited from my private practice for underserved persons in the mountains to a public-health practice for underserved persons in urban Birmingham with the Jefferson Health System and Cooper Green Hospital. I developed and administered a three-month survey of inpatients at Cooper Green Hospital, identifying 18 terminally ill medical-surgical patients who needed palliative care. The county's home hospice program had eliminated the financial barrier to palliative care by offering its services regardless of insurance status or ability to pay.
The institutions sealed their collaboration by sending a joint team to the Institute for Healthcare Improvement (IHI) series on palliative and end-of-life care to begin building a team and a cohesive program. Patients admitted to the Palliative Care Unit receive a comprehensive evaluation of their needs by the Center's palliative care specialist and by its medical director.
The medical director provides clinical leadership through daily rounds, 24-hour consultation, and interdisciplinary meetings for review and planning. To meet social, emotional, and spiritual needs, a multidisciplinary team of physicians, nurses, patient care technicians, clergy, social workers, and volunteers coordinates comfort care. The entire interdisciplinary team coordinates holistic comfort care, addressing the four major areas of suffering associated with the end of life in biweekly meetings where the team reviews the physical, social, emotional, and spiritual needs of each patient and family. The Balm of Gilead Center also reaches out and educates medical providers, patients, students, and the general public. The Balm of Gilead Center has provided information to other institutions interested in establishing their own palliative care programs.
For those who have adequate family support and choose to die at home, the Balm of Gilead Center provides physicians, nurses, clergy, and volunteer care teams who are dedicated to helping families care for loved ones at the end of life. During the coordination of home care and care on the inpatient unit, the family or other caregivers receive training in hospice care, end-of-life issues, and bereavement.
From 1998 to 1999, the average daily census of patients in home-based hospice has increased from 22 to 28 patients (a 27 percent increase). Engaging the wider community is central to Gilead's mission to encourage high quality end-of-life care far beyond its own patients and their families. Volunteer care teams of six to ten persons offer practical, emotional, and spiritual support to patients and families in both the hospital and the hospice. Community Care Teams developed by church, civic, and neighborhood groups form Circles of Care to serve those in the hospice, as well as those who are pre-hospice, during terminal illness and bereavement. Volunteer professional partners offer specialized skills to patients and families, train clinical staff, and provide valuable aid to the Center's administrative staff. Undergraduate and graduate students serve and learn at the Balm of Gilead, offering support for patients and families and for Gilead administrative and research projects while simultaneously meeting their own academic and career-preparation goals. This mission to engage the community is guided by Gilead's coordinator of Community Education and CareSharing, who has more than 25 years' experience in clinical psychology as a therapist specializing in the needs of professional and personal caregivers and five years' experience as lay chaplain in the collaborative health ministry of two congregations whose members were primarily elderly. Eight community-based volunteer teams totaling 68 members contributed 835 hours to Gilead patients and families.
Five church teams from four denominations contributed 373 hours to four families served by the Gilead home-hospice program and to each successive family occupying a church-sponsored room on the Gilead Palliative Care Unit.
One neighborhood organization team contributed 289 hours to two pre-hospice families and to one hospice family. Two teams of first- and second-year medical students contributed 173 hours to patients and families served by the Gilead Palliative Care Unit. From November 1998 through September 1999, 20 professionals from fields such as mental health, academic research, pastoral care, music, photography, computer consultation, data management, massage therapy, cosmetology, and barbering volunteered a total of 559 hours during Gilead's first year—286 in direct patient service and 273 in staff consultation and program assistance. From November 1998 through September 1999, 18 undergraduates, who were preparing for careers in various pre-health disciplines at local colleges and universities, contributed 458 hours visiting Balm of Gilead patients and assisting with Gilead research projects and public presentations. From November 1998 through September 1999, two hospital volunteers choosing service on the Balm of Gilead Palliative Care Unit contributed 10 additional hours of visiting and sitting with patients.
The integration of palliative care into the larger health care system is transformting palliative care in medical settings through consultation, education, and advocacy. Throughout Cooper Green Hospital, the Balm of Gilead Center provided the leadership and expertise to institute a routine procedure for addressing pain as a fifth vital sign (along with blood pressure, respiration, temperature, and heart rate). Referrals to the consult service provided by Gilead's medical director and its palliative care specialist have increased the frequency of the dissemination of palliative processes throughout Cooper Green. Initial steps have been taken to introduce advance directives for health care (ADHC) into the hospital and its clinics. Effective practices in bereavement care flow from the Gilead Center into the surrounding community in several ways. For this program, Cooper Green's Human Resources Department provided Gilead with the names of employees who had recently experienced the death of a family member.


The Balm of Gilead is now developing a county-wide bereavement program for families served by the entire network of safety-net institutions and clinics. The Balm of Gilead staff participates in the palliative care training of medical students and physicians at the University of Alabama at Birmingham. Gilead also disseminates the best practices of end-of-life care to the broader health-care delivery network. The Balm of Gilead program responded to these reservations with friendly persistence, establishing mutually beneficial collaboration as much as possible, regardless of contractual arrangements.
In response to other emerging, unanticipated realities, Gilead's Palliative Care Unit is trying to supplement its palliative care beds with hospice beds. The Balm of Gilead Center has assumed a statewide leadership role in end-of-life issues by participating in the creation of Alabamians for Better Care at Life's End (ABCLE).
The palliative care specialist, project administrator, and community care sharing coordinator are funded through grants.
The project administrator's position is funded through a grant from the Robert Wood Johnson Foundation. Beth Israel Hospital and Deaconess Hospital, which merged in October 1996 to form Beth Israel Deaconess Medical Center (BIDMC), had each been strongly committed to improving the care of patients near the end of life. At the time of the merger, many pieces of a comprehensive palliative care program already existed, including a 15-bed inpatient hospice unit established at Deaconess Hospital in early 1996, an affiliated outpatient hospice system, and the region's largest pain center.
With crucial and timely support through the Faculty Scholars Program of the Project on Death in America, BIDMC and CareGroup leaders made a renewed two-year commitment in 1999 to support the development of a comprehensive palliative care program.
The Boston Jewish community founded Beth Israel Hospital in 1916 to meet the needs of a growing immigrant population. At the same time that Beth Israel and Deaconess merged to form Beth Israel Deaconess Medical Center, BIDMC joined with Mount Auburn Hospital, New England Baptist Hospital, and several suburban Boston hospitals to form CareGroup. The three years following the BIDMC merger and the simultaneous formation of CareGroup brought enormous organizational change, even turmoil. CareGroup has experienced analogous changes during the second and third years of its existence. Amid these organizational upheavals, it was difficult to develop any new clinical initiatives, like an enhanced palliative care program, that required the consistent support of leaders or the allocation of new financial resources.
Both Beth Israel Hospital and Deaconess Hospital had been pioneers in palliative care before their 1996 merger.
Beth Israel Hospital (BIH) brought its own record of leadership to the merger as creator in 1972 of the first patient's bill of rights, as a pioneer in DNR policies and procedures during the mid-1970s (Rabkin et al., 1976), as the location for Frederick Wiseman's widely acclaimed six-hour 1990 documentary "Near Death," and as one of five national sites for the landmark SUPPORT study. While Beth Israel's staff accepted the overall validity of the SUPPORT study, they did not believe that the failure of the intervention phase meant that hospital-based efforts to improve end-of-life care were doomed.
In addition, the aggregate, institution-wide nature of the SUPPORT study's results did not indicate that specific individuals, clinical departments, or service units had particular responsibilities or opportunities for improving care.
Nonetheless, in the wake of the SUPPORT study, I had encouraging initial discussions with BIH leaders about developing and implementing an institution-wide effort to improve end-of-life care in late 1995 and early 1996. Building from focus groups of patients that identified core "dimensions" of "patient-centered care," Picker developed a standardized method for surveying patients after their discharge from U.S. Although Beth Israel had begun using early Picker instruments to assess quality of hospital care by 1989, organization-wide attention to Picker "scores" was heightened dramatically in 1997.
The BIDMC–Picker results in early 1997 attracted immediate and intense attention throughout the organization.
Perhaps more important, the Picker results seemed to have clear and direct implications for quality improvement activities, in striking contrast to the uncertain implications of the SUPPORT results. While Beth Israel Hospital was grappling with the implications of the SUPPORT study in late 1995, nearby Deaconess Hospital was planning for improved end-of-life care of its own. The average number of deaths per year at Deaconess Hospital at this time was approximately 350.
Given the discrepancy between the January and February 1995 inpatient surveys, the Deaconess Hospital financial staff needed to anticipate the consequences of changing the care of current inpatients. In April 1996 Deaconess Hospital and HealthCare Dimensions signed a contract establishing a 15-bed inpatient hospice in the hospital's Palmer Building.
As a result of this contract, Deaconess Hospital now had an on-site hospice unit to which acute care inpatients who were too ill to go home could easily be transferred.
Since 1996, more than 1,000 patients have received care on the unit, with a mean length of stay of just over 20 days but a median stay of only nine days. A relatively consistent average daily census of greater than nine patients (recently 11.5 patients) has resulted in an operating surplus for the unit. One primary financial benefit of the PCC that BIDMC hoped for was the reduction in acute care inpatient stays, beyond DRG reimbursement, for terminally ill patients.
To provide prompt, interdisciplinary, and comprehensive palliative care consultation services that meet the needs of BIDMC patients and families who confront life-threatening or life-limiting illness, and that enhance the clinical excellence of physicians, nurses, and others who are responsible for their care. To provide educational programs that create and sustain palliative care knowledge and skills of the highest order throughout the BIDMC and CareGroup communities.
To create systematic programs throughout CareGroup that will transform the quality of care that patients and families receive near the end of life, sharing ideas and achievements with the communities we serve and with others working in this field, locally, nationally, and internationally. To conduct research that strengthens and expands the knowledge needed to improve palliative care.
Tangible results from BIDMC's involvement in the 1997-98 IHI Breakthrough Series Collaborative were disappointing.
Initial steps to encourage nursing staff on one of the general medical units, with nearly 100 deaths annually, to record pain as a fifth vital sign by documenting the frequency of pain levels greater than five on a 10-point scale found fewer than 5 percent of patients with levels that high, a percentage so low that the staff did not consider a major unit-wide change in pain assessment to be worthwhile. Post-merger difficulties in integrating Beth Israel and Deaconess administrative and clinical activities continued to consume much of the time and energy of Palliative Care Working Group members who might otherwise have been available for additional program development. Shortly after the FY1999 budget lines were approved in principle, BIDMC's overall financial projections for the fiscal year were revised significantly.
During the mid-1999 development of the FY2000 BIDMC budget, the challenge of reducing an anticipated FY1999 operating deficit by nearly $40 million led to the first layoffs that Beth Israel personnel had experienced in decades, including the reduction of Social Work Department staff on inpatient services by nearly 50 percent. 100% Drug Free Recovery Badge - 12 Step Program Slogans and Sayings - Pin Back Badges, Buttons, Key Chains, and Tags! The use of word clouds in the classroom is a powerful way to really get through to visual learners. Several features that do not figure in Wordle are incorporated in Tagul.For example, you have the option of choosing personalized shapes and multiple fonts to be used in your cloud. This one is from Image Chef and is one of the best creative tools you can find for your classroom.
Wordsift is presented by Stanford University and allows you to do anything with or to a word.
This great tool shows you the fun way to match words as well as how to upload a picture to share with friends on social networking sites or through email.
Kate Smitty is an education blogger who loves to share easy study methods and teaching solutions. Since I only provide online lessons, it’s vital for me to have fresh and innovative ways to produce productive lesson plans. I think you saved the best until last… Although I subscribed to visualthesaurus many months ago, it has not been until today that I have finally found a way to integrate vocabulary in a visually appealing and productive manner, for both my online video library and lesson plans for live online classes.
Se state cercando un convertitore video gratuito, potente, versatile e semplicissimo da usare allora Free Make Video Converter e il programma che fa per voi. Incredibile programma completamente gratuito per la gestione completa di una o piu aziende. I made this map for Epic World – Cinematic Landscapes, a sampling album by composer Eduardo Tarilonte. The Midway Inn, as made evident by it’s name, lies at the midpoint between two towns.
Campaign Cartographer 3 (CC3) is a fantasy mapping software by ProFantasy, and it is the software used to create most of the maps on this website.
This map was made using CC3‘s Fantasy Worlds style, which is based on the artwork of Swedish cartographer Par Lindstrom. This map was made using Campaign Cartographer 3 and the January 2011 Overland Perspective Annual.
I made this isometric dungeon map using Campaign Cartographer and the Annual 2012 June edition.
I love these…I made one for my daughter to give to her teacher for Christmas and she loved it!
A paddle fan is a fun way to incorporate your ceremony details while serving double duty as it can keep your guests cool during a warm garden ceremony!


Recruit friends and family to help with the project, and have one person score and fold, another trim, and another tape and press. My suggestion if you want to make the fan larger is to insert a bigger rectangle between the two sheets when gluing it all together (maybe so that it extends by an inch around all sides). Clinicians and managers at each of these institutions negotiated innovative clinical and institutional arrangements and made effective use of the reimbursement policies of public and private payers.
Through the hospice program of Jefferson County's Department of Health, home-based services are extended to all people regardless of their ability to pay.
In addition, I found that on any given day from four to seven patients who had been hospitalized for more than seven days could have been discharged if they had had palliative care.
Thus the county public health system had provided an end-of-life "safety net" for uninsured people whose ages disqualified them from the government insurance reserved for the very young and the very old through Medicaid and Medicare. Carole Samuelson, the health officer of the Jefferson County Department of Health, which sponsors the public home-hospice program, was equally receptive. Generous awards from national and local foundations provided vital financial backing and credibility within the institutions and the community. Representatives from a number of hospitals in Alabama as well as from Wishard Health Services of Indianapolis have visited the unit.
Through the hospice program of the Jefferson County Department of Health, we extend home-based services to all people regardless of their ability to pay. Congregational care teams participating in the palliative unit's Adopt-A-Room Program add to the comfort of patients and families. Consultations focusing on alternatives to current and future treatment also provide a natural forum in which to educate medical and nursing colleagues about palliative care methods and about decision making concerning ethical issues. Thomas Delbanco, chief of BIH's Division of General Medicine and Primary Care, founded the Picker Institute in 1987. But the fact that the unit remains the only inpatient facility of its kind in Massachusetts has caused an unexpected, sometimes problematic, pattern of referrals. Joanne Lynn's presentation at medical grand rounds in January 1997, as part of the BIDMC-JAMA "Clinical Crossroads" series, helped spark renewed efforts to address the inadequate care that had been documented by the SUPPORT study. David Eisenberg, which had documented in two recent studies that approximately 70 percent of BIDMC oncology patients and approximately the same number of HIV patients use alternative therapies for symptomatic or curative goals. The details about the following nine word cloud generators will give you a fair idea how, as an educator, you can get the best out of them. Once it is ready with the results, you can make changes to the font or color and pick any layout at random. Unlike Wordle, there is no provision for choosing color, layout variations or even creating a unique style. Though it does not have the features Wordle has, it is a versatile app that lets you study a word cloud. It has more than enough features that can be used to create lessons to understand what you’re reading a bit better. I run an online business that provides online English classes to Turkish speakers and I’m really pleased that I read your article thoroughly.
I have spent four hours today going slowly through each of the applications you mention in your article and am now finally, at 9pm, putting together a new lesson plan template the incorporates a few of them. The Town of Gragmoor Quarry and the Monastery of Lacador Many years ago, a monastery to the goddess Lacodor was established alongside the wide river of Gragmoor, in an isolated part of an ancient kingdom. After endless miles of trudging and sloshing, even the heartiest of travelers needs a break.
This style works well for large-scale maps covering entire continents and worlds, focusing more on political boundaries and large bodies of water rather than the minutiae of specific regions, cities, waterways and smaller natural features.
Anna of Download & Print designed this pretty and romantic fan with flowers in reds and pinks. Each of these programs of palliative care is a product of the organizational culture of the institution in which it operates.
However, there were few palliative care services in Jefferson County for people with no home or family or for people whose families were too old, too ill, or too drained by life's other demands to provide consistent care. He was highly receptive to my proposal of an inpatient palliative care unit and of hospital-wide adoption of pain assessment and control measures. Under my leadership as its medical director, the county hospice had not only seen its daily census increase dramatically but also had become licensed and accredited.
Samuelson saw that if the hospital and the health department collaborated on their clinical and administrative leadership and shared a medical director, their institutions would provide complementary care for the terminally ill. Each room is furnished and decorated in home-like fashion by a local church or community group.
Home health aides help with activities of daily living, such as bathing, eating, or changing linen. However, it does not enable the same function on word frequency, which is a drawback for seasoned users.
The application enables the word cloud to be personalized as per requirement and lets you choose the font, color theme, and the size as well. You can experiment with different colors, fonts and shapes, and is an easy to use word cloud. The words may be listed by their commonality and rarity, and allows them to be listed in order, alphabetically.
VocabGrabber, as the name suggests, picks the most useful words in the text and tells you how these words have been used according to the context. CC3 makes it easy to take all the map elements and combine them together to make a dungeon any way you see fit. At the end when you admire your handiwork you’ll be rewarded and satisfied at having tackled a DIY project. Schwartz Department of Geriatrics and Adult Development at Mount Sinai School of Medicine, who helped to initiate and lead the process that produced this report, describes lessons from the short history of these programs in her introduction. They could envisage a comprehensive program for suffering people within the public health system, a program that would provide compassionate and continuous care through all phases and all treatment settings.
Save options have been provided in the traditional jpeg format with options to get print-outs. If you do not want to use certain words, would like to exclude them, and lets you ignore them and keep them out. By merely clicking on a word, Wordsift lets you view the meaning in an online dictionary; helps view the images through Google, and understand the word sentence placement as well. All you need to do is cut, copy, and paste text from any document and hit Grab Vocabulary and watch the magic unfold. I find 67lb paper works best as most home printers can handle the weight just fine, and it is heavy enough to give a professional feel to your DIY project.
The indispensable contribution of a nurse practitioner to the daily functioning of a palliative care unit had been confirmed for the medical director during his observations as a visiting scholar at Northwestern University. Dissemination throughout the hospital has begun with the development of a hospital-wide employee bereavement program. The initial displacement of numerous senior administrative and clinical leaders, when many positions were consolidated, was followed by a second period of major leadership turnover. In addition, this one does not need email or login and the free usage is to promote the nonprofit concept. This application does not need a log in, however to use the saving options, email is required. This one too does not require email or login, though it would make sense to go through the terms and conditions before setting off. Forse and a hospice nurse, surveyed 263 patients, identified 19 of them as being appropriate for admission to a palliative care unit, identified another 60 as patients who would benefit from a palliative care consultation, and identified nine more as needing palliative care at home. Rabkin, CEO of CareGroup, pledged $225,000 in new institutional funds to supplement the requested $450,000 in RWJ support. Mitchell Rabkin as CEO of CareGroup, and many other senior leadership changes in both BIDMC and CareGroup followed.



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