1,099 results match your criteria Palliative Care in the Acute Care Setting


Conceptualising paediatric advance care planning: a qualitative phenomenological study of paediatricians caring for children with life-limiting conditions in Australia.

BMJ Open 2022 May 16;12(5):e060077. Epub 2022 May 16.

Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.

Objectives: Advance care planning (ACP) helps families and paediatricians prepare and plan for end-of-life decision-making. However, there remains inconsistency in its practice with the limited literature describing what this preparation involves, and whether paediatricians recognise a difference between the process of ACP and its outcomes, such as resuscitation plans. This study aims to understand how paediatricians conceptualise ACP when caring for children with life-limiting conditions (LLC) who are unable to participate in decision-making for his/herself. Read More

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The electronic prescribing of subcutaneous infusions: A before-and-after study assessing the impact upon patient safety and service efficiency.

Int J Med Inform 2022 Jul 23;163:104777. Epub 2022 Apr 23.

School of Pharmacy & Pharmaceutical Sciences, University of Sunderland, Sunderland SR1 3SD, United Kingdom.

Objectives: To assess the impact of electronically prescribed mixed-drug infusions on the prevalence and types of prescription errors and staff time.

Design, Setting And Participants: Before-and-after study on acute medical wards of a large UK teaching hospital, utilising patient and staff data from the assessed wards.

Intervention: Electronically-generated mixed-drug infusions. Read More

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Defining Physiological Decompensation: An Expert Consensus and Retrospective Outcome Validation.

Crit Care Explor 2022 Apr 1;4(4):e0677. Epub 2022 Apr 1.

Center for Resuscitation Science, University of Pennsylvania, Philadelphia, PA.

Objectives: Physiological decompensation of hospitalized patients is common and is associated with substantial morbidity and mortality. Research surrounding patient decompensation has been hampered by the absence of a robust definition of decompensation and lack of standardized clinical criteria with which to identify patients who have decompensated. We aimed to: 1) develop a consensus definition of physiological decompensation and 2) to develop clinical criteria to identify patients who have decompensated. Read More

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Multidisciplinary Care of Patients with Inherited Metabolic Diseases and Epilepsy: Current Perspectives.

J Multidiscip Healthc 2022 25;15:553-566. Epub 2022 Mar 25.

Department of Inborn Errors of Metabolism and Paediatrics, the Institute of Mother and Child, Warsaw, Poland.

More than 650 inherited metabolic diseases may present with epilepsy or seizures. These diseases are often multisystem, life-long and induce complex needs of patients and families. Multidisciplinary care involves all stages of disease management: diagnostics, specific or symptomatic, acute and chronic treatments, and integrated care that takes into account not only medical, but also manifold psychosocial, educational, vocational and other needs of patients and their caregivers. Read More

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Prognostic decision-making about imminent death within multidisciplinary teams: a scoping review.

BMJ Open 2022 Apr 5;12(4):e057194. Epub 2022 Apr 5.

Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK.

Objective: To summarise evidence on how multidisciplinary team (MDTs) make decisions about identification of imminently dying patients.

Design: Scoping review.

Setting: Any clinical setting providing care for imminently dying patients, excluding studies conducted solely in acute care settings. Read More

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"Holding back my own emotions": Evaluation of an online education module in pediatric end-of-life care.

J Child Health Care 2022 Apr 5:13674935221076214. Epub 2022 Apr 5.

Palliative and Supportive Services, 1065Flinders University, Bedford Park, SA, Australia.

Providing quality end-of-life care to a child who is dying in hospital can be stressful and challenging, and health professionals often feel ill-prepared and require additional support. End-of-Life Essentials offers online education modules for health professionals working in acute hospitals, including one on end-of-life care in pediatric settings. This study aimed to evaluate this module and explore learners' views on challenges faced when caring for a dying child and their family in a hospital setting. Read More

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A systematic review and recommendations for prom instruments for older people with frailty in emergency care.

J Patient Rep Outcomes 2022 Apr 1;6(1):30. Epub 2022 Apr 1.

MRC Unit for Lifelong Health and Ageing, University College London, London, UK.

Introduction: The current service metrics used to evaluate quality in emergency care do not account for specific healthcare outcome goals for older people living with frailty. These have previously been classified under themes of 'Autonomy' and 'Functioning'. There is no person-reported outcome measure (PROM) for older people with frailty and emergency care needs. Read More

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Ethnic differences in success at application for consultant posts among United Kingdom physicians from 2011 to 2019: a retrospective cross-sectional observational study.

J R Soc Med 2022 Mar 31:1410768221085691. Epub 2022 Mar 31.

Medical Workforce Unit, Royal College of Physicians, London, NW1 4LE,UK.

Objectives: To identify associations between success following application for consultant physician posts and demographic factors.

Design: Logistic regression analysis of nationwide survey data.

Setting: United Kingdom (UK) physicians with a recent certificate of completion of training (CCT). Read More

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Potential determinants of unfavourable healthcare utilisation trajectories during the last year of life of people with incident Alzheimer Disease or Related Syndromes: a nationwide cohort study using administrative data.

Age Ageing 2022 03;51(3)

CERPOP, UMR1295, Unité Mixte INSERM - Université Toulouse III Paul Sabatier, Axe Maintain, Aging Research Team, University Toulouse III Paul Sabatier, 37 Allées Jules Guesde, 31000 Toulouse, France.

Background: people approaching the end-of-life frequently face inappropriate care. With Alzheimer Disease or Related Syndromes (ADRS), end-of-life is characterised by progressive decline, but this period remains difficult to identify. This leads to a lack of anticipation and sometimes with unfavourable healthcare utilisation trajectories (HUTs). Read More

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Evaluation of diagnostic and treatment approaches to acute dyspnea in a palliative care setting among medical doctors with different educational levels.

Support Care Cancer 2022 Mar 25. Epub 2022 Mar 25.

Karl Landsteiner University of Health Sciences, Krems, Austria.

Background: Dyspnea is common in patients with advanced cancer. Diagnostic procedures in patients with dyspnea are mandatory but often time-consuming and hamper rapid treatment of the underlying refractory symptoms. Opioids are the first-line drugs for the treatment of refractory dyspnea in palliative care patients with advanced lung cancer. Read More

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Post-Acute Care Outcomes and Functional Status Changes of Adults with New Cancer Discharged to Skilled Nursing Facilities.

J Am Med Dir Assoc 2022 Mar 23. Epub 2022 Mar 23.

Division of General Internal Medicine, University of Colorado Denver, Aurora, CO, USA.

Objective: Older hospitalized adults with an existing diagnosis of cancer rarely receive cancer treatment after discharge to a skilled nursing facility (SNF). It is unclear to what degree these outcomes may be driven by cumulative effects of previous cancer treatment and their complications vs an absolute functional threshold from which it is not possible to return. We sought to understand post-acute care outcomes of adults newly diagnosed with cancer and explore functional improvement during their SNF stay. Read More

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Vulnerability of Inexperience: A Qualitative Exploration of Physician Grief and Coping after Impactful Pediatric Patient Deaths.

J Palliat Med 2022 Mar 25. Epub 2022 Mar 25.

Graduate School of Education and Human Development, The George Washington University, Washington, DC, USA.

Caring for dying patients can result in burnout, stress, and emotional trauma for some physicians, particularly among trainees. Research is lacking that focuses on the emotional impact and coping techniques utilized by novice and experienced pediatricians after impactful pediatric patient deaths. To define the salient features of an impactful pediatric patient death and physicians' grief and coping responses. Read More

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Patient suitability for free water protocols in acute stroke and general medicine: a qualitative study of clinician perceptions.

Int J Lang Commun Disord 2022 May 23;57(3):630-644. Epub 2022 Mar 23.

Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.

Background: The free water protocol (FWP) is an alternate management strategy for patients with dysphagia, who would otherwise be nil by mouth or prescribed thickened fluids, allowing them to drink and potentially aspirate water under strict guidelines to minimize the risk of adverse consequences. The FWP is not widely implemented in acute settings, and it is unclear whether this is due to the complexity of patient presentations, clinician decision-making or barriers related to the setting.

Aims: To explore the perceptions and decision-making process of clinicians about using FWPs to manage dysphagia for patients admitted to acute stroke and general medicine. Read More

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Exploring Experiences of Bereaved Caregivers of Older Adult Patients With Acute Myeloid Leukemia.

Clin J Oncol Nurs 2022 04;26(2):135-139

University of North Carolina at Chapel Hill.

Caregivers of older adults with acute myeloid leukemia (AML) are requiring more support now that novel, nonintensive therapies, such as hypomethylating agents and venetoclax, are shifting the burden of care to the outpatient setting. Early findings from a larger study describe supportive care needs from the perspective of bereaved caregivers that align with existing research, informing the development of best practices for oncology nurses who support caregivers of older adults with AML. Read More

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Characteristics of Post-ICU and Post-COVID Recovery Clinics in 29 U.S. Health Systems.

Crit Care Explor 2022 Mar 9;4(3):e0658. Epub 2022 Mar 9.

Department of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky, Lexington, KY.

The multifaceted long-term impairments resulting from critical illness and COVID-19 require interdisciplinary management approaches in the recovery phase of illness. Operational insights into the structure and process of recovery clinics (RCs) from heterogeneous health systems are needed. This study describes the structure and process characteristics of existing and newly implemented ICU-RCs and COVID-RCs in a subset of large health systems in the United States. Read More

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Long-term Outcomes Among Patients With Advanced Kidney Disease Who Forgo Maintenance Dialysis: A Systematic Review.

JAMA Netw Open 2022 03 1;5(3):e222255. Epub 2022 Mar 1.

Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle.

Importance: An understanding of the long-term outcomes of patients with advanced chronic kidney disease not treated with maintenance dialysis is needed to improve shared decision-making and care practices for this population.

Objective: To evaluate survival, use of health care resources, changes in quality of life, and end-of-life care of patients with advanced kidney disease who forgo dialysis.

Evidence Review: MEDLINE, Embase (Excerpta Medica Database), and CINAHL (Cumulative Index of Nursing and Allied Health Literature) were searched from inception through December 3, 2021, for all English language longitudinal studies of adults in whom there was an explicit decision not to pursue maintenance dialysis. Read More

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Traumatic Brain Injury in Older Adults: Characteristics, Outcomes, and Considerations. Results From the American Association for the Surgery of Trauma Geriatric Traumatic Brain Injury (GERI-TBI) Multicenter Trial.

J Am Med Dir Assoc 2022 Apr 10;23(4):568-575.e1. Epub 2022 Mar 10.

Division of Trauma, Critical Care and Acute Care Surgery, R Adams Cowley Shock Trauma Center, The University of Maryland Medical Center, Baltimore, MD, USA.

Objectives: Describe the epidemiology of a large cohort of older adults with isolated traumatic brain injury (TBI) and identify predictors of mortality, palliative interventions, and discharge to preinjury residence in those presenting with moderate/severe TBI.

Design: Prospective observational study of geriatric patients with TBI enrolled across 45 trauma centers.

Setting And Participants: Inclusion criteria were age ≥40 years, and computed tomography (CT)-verified TBI. Read More

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Development of a Decision-Aid Form (DAF) for the stratification of care in a French comprehensive cancer center, a tool to support identification of care goals.

Ann Palliat Med 2022 Feb 28. Epub 2022 Feb 28.

Intensive Care Unit, Gustave Roussy, Paris-Saclay University, Villejuif, France.

Background: For cancer patients, life-threatening complications may be difficult to anticipate, which can lead to complex medical decision-making processes. Since 2015, the Gustave Roussy Cancer Center has used a Decision-Aid Form (DAF), which contains an estimated gradation of care in cases where patients' conditions worsen. In this study, we assessed the acceptability of the DAF and the predictive value of the proposed stratification of care with regard to care delivered and patient's outcomes. Read More

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February 2022

Caring in the silences: why physicians and surgeons do not discuss emergency care and treatment planning with their patients - an analysis of hospital-based ethnographic case studies in England.

BMJ Open 2022 03 7;12(3):e046189. Epub 2022 Mar 7.

Warwick Medical School, University of Warwick, Coventry, UK

Background: Despite increasing emphasis on integrating emergency care and treatment planning (ECTP) into routine medical practice, clinicians continue to delay or avoid ECTP conversations with patients. However, little is known about the clinical logics underlying barriers to ECTP conversations.

Objective: This study aims to develop an ethnographic account of how and why clinicians defer and avoid ECTP conversations, and how they rationalise these decisions as they happen. Read More

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Impact of ambulatory palliative care on symptoms and service outcomes in cancer patients: a retrospective cohort study.

BMC Palliat Care 2022 Mar 4;21(1):28. Epub 2022 Mar 4.

Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, 154 Wattletree Road, Malvern, VIC, 3144, Australia.

Background: The integration of palliative care into routine cancer care has allowed for improved symptom control, relationship building and goal setting for patients and families. This study aimed to assess the efficacy of an ambulatory palliative care clinic on improving symptom burden and service outcomes for patients with cancer.

Methods: A retrospective review of data of cancer patients who attended an ambulatory care clinic and completed the Symptom Assessment Scale between January 2015 and December 2019. Read More

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Characteristics Associated With Disparities Among Older Adults in Coronavirus Disease 2019 Outcomes in an Academic Health Care System.

Med Care 2022 May;60(5):332-341

Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York.

Background: An improved understanding of the coronavirus disease 2019 (COVID-19) pandemic is needed to identify predictors of outcomes among older adults with COVID-19.

Objective: The objective of this study was to examine patient and health system factors predictive of in-hospital mortality, intensive care unit (ICU) admission, and readmission among patients with COVID-19.

Design, Setting, And Participants: A cohort study of patients aged 18 years and older with COVID-19 discharged from 5 New York hospitals within the Mount Sinai Health System (March 1, 2020-June 30, 2020). Read More

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Utilization of Palliative Care for Patients with COVID-19 and Acute Kidney Injury during a COVID-19 Surge.

Clin J Am Soc Nephrol 2022 03 24;17(3):342-349. Epub 2022 Feb 24.

Division of Nephrology, Department of Internal Medicine, New York University Grossman School of Medicine, New York, New York.

Background And Objectives: AKI is a common complication of coronavirus disease 2019 (COVID-19) and is associated with high mortality. Palliative care, a specialty that supports patients with serious illness, is valuable for these patients but is historically underutilized in AKI. The objectives of this paper are to describe the use of palliative care in patients with AKI and COVID-19 and their subsequent health care utilization. Read More

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Association of primary and community care services with emergency visits and hospital admissions at the end of life in people with cancer: a retrospective cohort study.

BMJ Open 2022 Feb 23;12(2):e054281. Epub 2022 Feb 23.

Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.

Objective: To examine the association between primary and community care use and measures of acute hospital use in people with cancer at the end of life.

Design: Retrospective cohort study.

Setting: We used Discover, a linked administrative and clinical data set from general practices, community and hospital records in North West London (UK). Read More

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February 2022

Acute and Posttraumatic Stress in Family Members of Children With a Prolonged Stay in a PICU: Secondary Analysis of a Randomized Trial.

Pediatr Crit Care Med 2022 04 22;23(4):306-314. Epub 2022 Feb 22.

Department of Behavioral Nursing Science, University of Illinois, Chicago, IL.

Objectives: To identify the prevalence of screening criteria for acute and posttraumatic stress disorders (PTSDs) and stress symptoms among family members of children in the PICU for more than 8 days and examine risk factors for stress symptoms.

Design: Secondary analysis of data from a randomized trial of a palliative care intervention conducted between 2010 and 2014.

Setting: An urban pediatric hospital in Seattle, WA. Read More

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Implementation of an acute palliative care unit for COVID-19 patients in a tertiary hospital: Qualitative data on clinician perspectives.

Palliat Med 2022 02 17;36(2):332-341. Epub 2022 Feb 17.

Department of Palliative Medicine, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.

Background: During the COVID-19 pandemic, it has become apparent that palliative care has dynamically adapted to the care of dying patients with and without COVID-19 and has developed new forms of collaboration. Evaluation is needed to assess which innovations should be integrated into future pandemic management.

Aim: To explore the experiences of stakeholders and staff in implementing and operating an ad hoc unit delivering acute palliative care. Read More

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February 2022

A Case Study of Pain Management at End-of-Life for a Patient on High-Dose Buprenorphine.

J Patient Exp 2022 11;9:23743735221079141. Epub 2022 Feb 11.

Alfred Health Palliative Care Service, Alfred Health, Prahran, VIC, Australia.

In Australia, high-dose sublingual buprenorphine and long-acting injectable buprenorphine are available. High-dose buprenorphine is used predominantly in the setting of opioid use disorder and has a role in chronic pain. Palliative care specialists are increasingly involved in pain management and end-of-life care for patients on these medications, yet there is a lack of education and training about high-dose buprenorphine for palliative care specialists. Read More

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February 2022

Discharge Destinations of Delirious Patients: Findings From a Prospective Cohort Study of 27,026 Patients From a Large Health Care System.

J Am Med Dir Assoc 2022 Feb 13. Epub 2022 Feb 13.

Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland.

Objectives: Delirium is known to contribute to increased rates of institutionalization and mortality. The full extent of adverse outcomes, however, remains understudied. We aimed to systematically assess the discharge destinations and mortality risk in delirious patients in a large sample across all hospital services. Read More

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February 2022

Complexity of the Diagnosis of COVID-19 in the Context of Pandemicity: Need for Excellence in Diagnostic Acumen.

Korean J Fam Med 2022 Jan 20;43(1):16-26. Epub 2022 Jan 20.

Department of Medicine, Muribushi Okinawa Center for Teaching Hospitals, Urasoe, Japan.

Coronavirus disease 2019 (COVID-19) is a highly infectious disease that has caused a pandemic devastating many countries worldwide. It is a complex and multifaceted disease with a unique coronavirus etiology, pathogenesis, zoonotic, and human-to-human transmission, causing acute respiratory distress syndrome with high mortality. Accurate and timely diagnosis is of utmost importance. Read More

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January 2022

Proliferative glomerulonephritis with monoclonal immunoglobulin deposits triggered by COVID-19: a case report.

CEN Case Rep 2022 Feb 4. Epub 2022 Feb 4.

Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA.

Acute kidney injury (AKI) frequently complicates corona virus disease 2019 (COVID-19) and is associated with significant mortality. Kidney disease in COVID-19 is usually due to acute tubular injury, but a variety of glomerular processes, especially collapsing glomerulopathy, have been increasingly described. Until recently, proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID) had not been reported in the setting of COVID-19. Read More

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February 2022

[Clinical profile and care pathways of nursing home residents having the intervention of hospital at home and comparison according to the referrers].

Geriatr Psychol Neuropsychiatr Vieil 2022 Feb 1. Epub 2022 Feb 1.

14 rue Vésale, Paris, France.

Background : Nursing homes' (NH) residents present a mix of medical, psychological and social needs associated with a high risk of hospitalization. The intervention of the hospitalization at home (HAH) in NH has been implemented in France to better fit the residents' needs and decrease the risk of hospitalization. No study has described the population of residents receiving this intervention. Read More

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February 2022