832 results match your criteria Palliative Care in the Acute Care Setting


Challenges in the management of older patients with acute coronary syndromes in the COVID-19 pandemic.

Heart 2020 May 22. Epub 2020 May 22.

Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK

Ischaemic heart disease (IHD), in particular acute coronary syndrome (ACS), comprising ST-elevation myocardial infarction, non-ST-elevation myocardial infarction and unstable angina, is the leading cause of death worldwide. Age is a major predictor of adverse outcome following ACS. COVID-19 infection seems to escalate the risk in older patients with heart disease. Read More

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http://dx.doi.org/10.1136/heartjnl-2020-317011DOI Listing

Characteristics and Outcomes of Dementia Patients Who Receive Inpatient Palliative Care Consultation.

J Am Geriatr Soc 2020 May 16. Epub 2020 May 16.

Division of Geriatrics, Department of Internal Medicine, Duke School of Medicine, Durham, North Carolina, USA.

Background/objectives: Acute hospitalization may be an ideal opportunity to introduce palliative care to dementia patients, who may benefit from symptom management and goals of care discussions. We know little about patients who receive inpatient palliative care consultations (IPCCs).

Design: Retrospective analysis using electronic medical record. Read More

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http://dx.doi.org/10.1111/jgs.16521DOI Listing

Proposed Workflow for Rehabilitation in a Field Hospital Setting During the COVID-19 Pandemic.

PM R 2020 May 15. Epub 2020 May 15.

Department of Physical Medicine and Rehabilitation, 325 E Eisenhower Pkwy, Ste 100, University of Michigan, Ann Arbor, MI, 48108.

The novel Coronavirus Disease 2019 (COVID-19) pandemic has challenged healthcare facilities throughout the world. In many regions, the need for acute inpatient healthcare services has exceeded the capacity of hospital systems, and field hospitals are being utilized as one part of the response strategy. Given the urgency and novelty of this pandemic, healthcare systems are attempting to rapidly execute plans for field hospitals, and rehabilitative care in this environment merits particular consideration given the potential impacts of mobilization and rehabilitative therapies on morbidity, mortality, duration of ventilation, and lengths of ICU/hospital stay. Read More

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http://dx.doi.org/10.1002/pmrj.12405DOI Listing

Implementation of Hip Fracture Co-Management Program (AGS CoCare: Ortho®) in a Large Health System.

J Am Geriatr Soc 2020 May 11. Epub 2020 May 11.

Division of Geriatrics and Palliative Medicine, Department of Medicine, Northwell Health, Manhasset, New York, USA.

Objectives: Acute hip fracture is common and leads to significant morbidity and mortality. Co-management programs, such as American Geriatric Society (AGS) CoCare: Ortho®, that optimize perioperative care of older adults, have demonstrated improved outcomes. Yet there is substantial variation in hip fracture care nationally. Read More

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http://dx.doi.org/10.1111/jgs.16483DOI Listing

Choosing Inpatient vs Home Treatment: Why Patients Accept or Decline Hospital at Home.

J Am Geriatr Soc 2020 May 6. Epub 2020 May 6.

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

Background/objectives: Hospital at home (HaH) provides interdisciplinary acute care in the home as a substitute for inpatient hospitalization. Studies have demonstrated that HaH care is associated with better quality care, fewer complications, and better patient and caregiver experience. Still, some patients decline HaH. Read More

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http://dx.doi.org/10.1111/jgs.16486DOI Listing

Withholding or withdrawing life support in long-term neurointensive care patients: a single-centre, prospective, observational pilot study.

J Med Ethics 2020 May 5. Epub 2020 May 5.

Department of Neurology and Stroke and Hertie Institute of Clinical Brain Reseach, University Hospital Tübingen, Tübingen, Germany

Purpose: Scarce evidence exists regarding end-of-life decision (EOLD) in neurocritically ill patients. We investigated the factors associated with EOLD making, including the group and individual characteristics of involved healthcare professionals, in a multiprofessional neurointensive care unit (NICU) setting.

Materials And Methods: A prospective, observational pilot study was conducted between 2013 and 2014 in a 10-bed NICU. Read More

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http://dx.doi.org/10.1136/medethics-2019-106027DOI Listing

Estimating cost implications of potentially avoidable hospitalizations among Oncology Care Model patients with prostate cancer.

J Cancer Policy 2020 Mar 14;23. Epub 2020 Jan 14.

Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Purpose/objectives: We sought to estimate the expected cost savings generated if a set of potentially avoidable hospitalizations (PAHs) among oncology care model (OCM) patients with prostate cancer were shifted to an acute care model in the outpatient setting.

Methods: We previously identified a set of 28 PAHs among OCM prostate cancer patients. Outpatient management costs for a characteristically similar cohort of cancer patients were obtained from our institution's ambulatory acute-care Oncology Care Unit (OCU). Read More

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http://dx.doi.org/10.1016/j.jcpo.2020.100218DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7189771PMC

Response and role of palliative care during the COVID-19 pandemic: A national telephone survey of hospices in Italy.

Palliat Med 2020 Apr 29:269216320920780. Epub 2020 Apr 29.

Cicely Saunders Institute, King's College London, London, UK.

Background: Palliative care is an important component of health care in pandemics, contributing to symptom control, psychological support, and supporting triage and complex decision making.

Aim: To examine preparedness for, and impact of, the COVID-19 pandemic on hospices in Italy to inform the response in other countries.

Design: Cross-sectional telephone survey, in March 2020. Read More

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http://dx.doi.org/10.1177/0269216320920780DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7218350PMC

Goals-of-Care Consultations Are Associated with Lower Costs and Less Acute Care Use among Propensity-Matched Cohorts of African Americans and Whites with Serious Illness.

J Palliat Med 2020 Apr 27. Epub 2020 Apr 27.

Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA.

African Americans receive more aggressive end-of-life care than Whites. Little is known about how palliative care consultation to discuss goals-of-care ("PCC") is associated with acute care utilization and costs by race. To compare future acute care costs and utilization between propensity-matched cohorts of African Americans with and without PCC, and Whites with and without PCC. Read More

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http://dx.doi.org/10.1089/jpm.2019.0522DOI Listing

Implementation of Post-Acute Rehabilitation at Home: A Skilled Nursing Facility-Substitutive Model.

J Am Geriatr Soc 2020 Apr 28. Epub 2020 Apr 28.

Geriatric Research Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA.

Objectives: For patients who require frequent and intensive therapy services after hospitalization, rehabilitation is predominantly provided in skilled nursing facilities (SNFs). Delivering post-acute rehabilitation in patients' homes offers a potential alternative. Our aim was to describe and evaluate services and functional outcomes and then identify factors associated with the provision of a 30-day post-acute care (PAC) bundle of rehabilitation, medical, and social services provided via the Rehabilitation at Home (RaH) program. Read More

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http://dx.doi.org/10.1111/jgs.16474DOI Listing

Social regulation activities in end-of-life: a qualitative study on completion of advance directives in Swiss nursing homes.

BMC Palliat Care 2020 Apr 23;19(1):57. Epub 2020 Apr 23.

Institut et Haute Ecole de la Santé La Source, Avenue Vinet 30, CH - 1004, Lausanne, Switzerland.

Background: In Switzerland as in many countries, steady trend is observed in nursing homes to promote writing of advanced directives (ADs). Implementation of ADs reflects the rise in public concern for the persons' right to self-determination and informed decision. The issue of end-of-life conditions is particularly acute in situations with dementia. Read More

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http://dx.doi.org/10.1186/s12904-020-00562-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7181527PMC

Sociodemographic and clinical factors for non-hospital deaths among cancer patients: A nationwide population-based cohort study.

PLoS One 2020 23;15(4):e0232219. Epub 2020 Apr 23.

Singapore General Hospital, Singapore, Singapore.

Background: Factors associated with place of death inform policies with respect to allocating end-of-life care resources and tailoring supportive measures.

Objective: To determine factors associated with non-hospital deaths among cancer patients.

Design: Retrospective cohort study of cancer decedents, examining factors associated with non-hospital deaths using multinomial logistic regression with hospital deaths as the reference category. Read More

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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232219PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7179880PMC

Partnering with Palliative Care: A Case Report of Severe Pain in Critical Limb Ischemia Treated Successfully with a Continuous Popliteal Nerve Catheter.

Case Rep Anesthesiol 2020 6;2020:1054521. Epub 2020 Apr 6.

Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 1 St SW, Rochester, MN 55904, USA.

Background: Critical limb ischemia (CLI) is limb pain occurring at rest or impending limb loss as a result of lack of blood flow to the affected extremity. CLI pain is challenging to control despite multimodal pharmacologic analgesia and surgical intervention. We described the successful use of a continuous local anesthetic infusion via a popliteal nerve catheter to control severe refractory ischemic lower limb pain in a patient who failed surgical intervention and performed a brief narrative literature review on regional anesthesia for ischemic pain. Read More

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http://dx.doi.org/10.1155/2020/1054521DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7166256PMC

Real-world evidence of NEPA, netupitant-palonosetron, in chemotherapy-induced nausea and vomiting prevention: effects on quality of life.

Future Oncol 2020 May 16;16(14):939-953. Epub 2020 Apr 16.

Gynecological Oncology Practice, Berlin, Germany.

To determine quality of life, effectiveness and safety of oral netupitant-palonosetron (NEPA)-based antiemetic prophylaxis in the real-world setting. Prospective, noninterventional study in adults receiving highly or moderately emetogenic chemotherapy and NEPA for three cycles. NEPA was administered per summary of product characteristics. Read More

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http://dx.doi.org/10.2217/fon-2020-0187DOI Listing

[Palliation in patients with severe COVID-19].

Lakartidningen 2020 04 3;117. Epub 2020 Apr 3.

överläkare, Capio ASiH/SPSV Nacka.

Coronavirus Disease 2019 (COVID-19) can cause severe respiratory failure and distressing symptoms including fever, cough, breathlessness and anxiety. Symptomatic (palliative) treatment is of fundamental importance both in conjuncture with life-sustaining interventions and in end of life care. Based on the evidence to date, there are several treatment options to consider for the relief of fever (acetaminophen, NSAID, oral glucocorticoids), cough (morphine), breathlessness (morphine, oxygen, fan), anxiety (benzodiazepines) and pain (NSAID, morphine). Read More

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Predicting Mortality in Children With Pediatric Acute Respiratory Distress Syndrome: A Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Study.

Crit Care Med 2020 06;48(6):e514-e522

Department of Pediatrics and Public Health Science, Division of Pediatric Critical Care Medicine, Penn State Hershey Children's Hospital, Hershey, PA.

Objectives: Pediatric acute respiratory distress syndrome is heterogeneous, with a paucity of risk stratification tools to assist with trial design. We aimed to develop and validate mortality prediction models for patients with pediatric acute respiratory distress syndrome.

Design: Leveraging additional data collection from a preplanned ancillary study (Version 1) of the multinational Pediatric Acute Respiratory Distress syndrome Incidence and Epidemiology study, we identified predictors of mortality. Read More

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http://dx.doi.org/10.1097/CCM.0000000000004345DOI Listing

Creating a Palliative Care Inpatient Response Plan for COVID-19-The UW Medicine Experience.

J Pain Symptom Manage 2020 Mar 31. Epub 2020 Mar 31.

Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA. Electronic address:

Context: The coronavirus disease 2019 (COVID-19) pandemic is stressing health care systems throughout the world. Significant numbers of patients are being admitted to the hospital with severe illness, often in the setting of advanced age and underlying comorbidities. Therefore, palliative care is an important part of the response to this pandemic. Read More

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http://dx.doi.org/10.1016/j.jpainsymman.2020.03.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7171263PMC

Creating and Implementing a Resident Emotional Wellness Initiative in an Acute Care Setting: The Role of the Palliative Care Social Worker.

Authors:
Sheila B Weiner

J Soc Work End Life Palliat Care 2020 Apr 2:1-10. Epub 2020 Apr 2.

Department of Palliative Medicine, Crozer-Chester Medical Center, Upland, PA, USA.

Caring for dying patients is often a new experience for ICU residents. End-of-life and palliative training in medical schools is lacking. Many residents experience troublesome emotions during residency. Read More

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http://dx.doi.org/10.1080/15524256.2020.1745730DOI Listing

Effect of Default Options in Advance Directives on Hospital-Free Days and Care Choices Among Seriously Ill Patients: A Randomized Clinical Trial.

JAMA Netw Open 2020 Mar 2;3(3):e201742. Epub 2020 Mar 2.

Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.

Importance: There is limited evidence regarding how patients make choices in advance directives (ADs) or whether these choices influence subsequent care.

Objective: To examine whether default options in ADs influence care choices and clinical outcomes.

Design, Setting, And Participants: This randomized clinical trial included 515 patients who met criteria for having serious illness and agreed to participate. Read More

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http://dx.doi.org/10.1001/jamanetworkopen.2020.1742DOI Listing

Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology.

Eur J Prev Cardiol 2020 Mar 30:2047487320913379. Epub 2020 Mar 30.

REHPA-Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark, Odense University Hospital, Denmark.

Secondary prevention through comprehensive cardiac rehabilitation has been recognized as the most cost-effective intervention to ensure favourable outcomes across a wide spectrum of cardiovascular disease, reducing cardiovascular mortality, morbidity and disability, and to increase quality of life. The delivery of a comprehensive and 'modern' cardiac rehabilitation programme is mandatory both in the residential and the out-patient setting to ensure expected outcomes. The present position paper aims to update the practical recommendations on the core components and goals of cardiac rehabilitation intervention in different cardiovascular conditions, in order to assist the whole cardiac rehabilitation staff in the design and development of the programmes, and to support healthcare providers, insurers, policy makers and patients in the recognition of the positive nature of cardiac rehabilitation. Read More

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http://dx.doi.org/10.1177/2047487320913379DOI Listing

Supported self-management as a model for end-of-life care in the setting of malignant bowel obstruction: A qualitative study.

Gynecol Oncol 2020 Mar 23. Epub 2020 Mar 23.

Department of Obstetrics & Gynecology, University of Toronto, Toronto, ON, Canada; Division of Gynecologic Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada. Electronic address:

Objective: Women with advanced gynecologic cancer and malignant bowel obstruction (MBO) undergo repeated hospitalizations, experience feelings of isolation and abandonment, and often die in acute settings. Innovative outpatient models of care are needed to address the unmet needs of this population at the end-of-life. We implemented a novel supported self-management (SMS) program focused on increasing patients' skill and confidence in managing MBO proactively in the ambulatory setting. Read More

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http://dx.doi.org/10.1016/j.ygyno.2020.03.009DOI Listing

ISCCM Guidelines for the Use of Non-invasive Ventilation in Acute Respiratory Failure in Adult ICUs.

Indian J Crit Care Med 2020 Jan;24(Suppl 1):S61-S81

Department of Division of Critical Care Medicine, Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India, , e-mail:

A. ACUTE HYPERCAPNIC RESPIRATORY FAILURE A1. Acute Exacerbation of COPD: Recommendations: NIV should be used in management of acute exacerbation of COPD in patients with acute or acute-on-chronic respiratory acidosis (pH = 7. Read More

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http://dx.doi.org/10.5005/jp-journals-10071-G23186DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7085817PMC
January 2020

How to care for the brought in dead and their relatives. A qualitative study protocol based on interpretive description.

J Adv Nurs 2020 Mar 17. Epub 2020 Mar 17.

The Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.

Aim: This project has two aims: (a) What do relatives to brought in dead (BID) describe as helpful and supportive care when they arrive at the emergency department to see and say goodbye to a deceased? (b) What do nurses describe as good nursing practice for BID persons and their relatives and what may hinder or facilitate this practice in an emergency setting?

Design: A qualitative study in the methodology interpretive description.

Methods: Data will be collected through three data sources: Individual interviews with relatives to BID persons, participant observations of relatives to BID persons during their presence in the emergency department and focus group interviews with emergency nurses.

Discussion: Brought in dead persons and their relatives are received and cared for in emergency departments by emergency nurses. Read More

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http://dx.doi.org/10.1111/jan.14353DOI Listing

Using Safety-II and resilient healthcare principles to learn from Never Events.

Int J Qual Health Care 2020 May;32(3):196-203

Human Factors and Complex Systems, Loughborough Design School, Loughborough University, Leicestershire LE11 3TU, UK.

Objectives: Conduct a secondary analysis of root cause analysis (RCA) reports of Never Events to determine whether and how Safety-II/resilient healthcare principles could contribute to improving the quality of investigation reports and therefore preventing future Never Events.

Design: Qualitative and quantitative retrospective analysis of RCA reports.

Setting: A large acute healthcare Trust in London. Read More

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http://dx.doi.org/10.1093/intqhc/mzaa009DOI Listing

Frailty assessment and risk prediction by GRACE score in older patients with acute myocardial infarction.

BMC Geriatr 2020 Mar 13;20(1):102. Epub 2020 Mar 13.

BHF Centre for Cardiovascular Science, University of Edinburgh, Room SU.305 Chancellor's Building, Edinburgh, EH16 4SB, UK.

Background: Risk prediction after myocardial infarction is often complex in older patients. The Global Registry of Acute Coronary Events (GRACE) model includes clinical parameters and age, but not frailty. We hypothesised that frailty would enhance the prognostic properties of GRACE. Read More

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http://dx.doi.org/10.1186/s12877-020-1500-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7069195PMC

Incorporating integrative medicine and patient preferences into a pilot interdisciplinary sickle cell wellness clinic.

Complement Ther Med 2020 Mar 30;49:102333. Epub 2020 Jan 30.

Department of Pain, Palliative Care, and Integrative Medicine, Children's Hospitals and Clinics of Minnesota, 2525 Chicago Avenue South, Suite 32-T5, Minneapolis, MN 55304, USA; Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, Minneapolis, MN 55454, USA. Electronic address:

Objective: Sickle Cell Disease (SCD) is an inherited blood disorder that includes acute pain episodes and chronic pain that can dramatically impact quality of life and goal-achievement. Our staff had limited success in connecting families with the Pain, Palliative Care and Integrative Medicine Clinic (PPCIM) to receive specialized skills for pain management. We created a partnership between Hematology and PPCIM to provide SCD patients/families with needed resources. Read More

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http://dx.doi.org/10.1016/j.ctim.2020.102333DOI Listing

Opioid Prescription Filling Trends Among Children with Sickle Cell Disease After the Release of State-Issued Guidelines on Pain Management.

Pain Med 2020 Mar 6. Epub 2020 Mar 6.

Center for Surgical Outcomes Research and Center for Innovation in Pediatric Practice, Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA.

Objective: To assess the impact of Ohio's 2012, 2013, and 2016 opioid prescribing guidelines on opioid and nonsteroidal anti-inflammatory drug (NSAID) prescription filling and health care utilization for pain among children with sickle cell disease (SCD).

Design: Quasi-experimental retrospective cohort study.

Setting: Ohio Medicaid claims data from August 2011 to August 2016. Read More

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http://dx.doi.org/10.1093/pm/pnaa002DOI Listing

Rapid cognitive decline in a patient with chronic lymphocytic leukaemia: a case report.

J Med Case Rep 2020 Mar 3;14(1):39. Epub 2020 Mar 3.

The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.

Background: The use of monoclonal antibodies in various settings has been linked to the development of progressive multifocal leukoencephalopathy (PML). Whilst this association is well-described with agents such as rituximab and natalizumab, the literature describing the occurrence of PML with ofatumumab therapy (especially in a haematology setting) is sparse. This case aims to draw attention to the above association with a particular focus on the mechanisms by which B-cell-depleting therapy can precipitate PML during the treatment of haematological malignancy. Read More

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http://dx.doi.org/10.1186/s13256-020-2360-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7055117PMC

Benzodiazepines for treatment of patients with delirium excluding those who are cared for in an intensive care unit.

Cochrane Database Syst Rev 2020 02 28;2:CD012670. Epub 2020 Feb 28.

Dongzhimen Hospital, Beijing University of Chinese Medicine, Key Laboratory of Chinese Internal Medicine of Ministry of Education, Haiyuncang Lane, Dongcheng District, Beijing, China, 100700.

Background: Delirium is a very common condition associated with significant morbidity, mortality, and costs. Current critical care guidelines recommend first and foremost the use of nonpharmacological strategies in both the prevention and treatment of delirium. Pharmacological interventions may augment these approaches and they are currently used widely in clinical practice to manage the symptoms of delirium. Read More

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http://dx.doi.org/10.1002/14651858.CD012670.pub2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7047222PMC
February 2020

Risk Factors for Long-term Mortality and Patterns of End-of-Life Care Among Medicare Sepsis Survivors Discharged to Home Health Care.

JAMA Netw Open 2020 Feb 5;3(2):e200038. Epub 2020 Feb 5.

Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia.

Importance: Despite a growing recognition of the increased mortality risk among sepsis survivors, little is known about the patterns of end-of-life care among this population.

Objective: To describe patterns of end-of-life care among a national sample of sepsis survivors and identify factors associated with long-term mortality risk and hospice use.

Design, Setting, And Participants: This cohort study assessed sepsis survivors who were Medicare fee-for-service beneficiaries discharged to home health care using national Medicare administrative, claims, and home health assessment data from 2013 to 2014. Read More

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http://dx.doi.org/10.1001/jamanetworkopen.2020.0038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7137683PMC
February 2020

Association of Low Baseline Diaphragm Muscle Mass With Prolonged Mechanical Ventilation and Mortality Among Critically Ill Adults.

JAMA Netw Open 2020 Feb 5;3(2):e1921520. Epub 2020 Feb 5.

Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.

Importance: Low diaphragm muscle mass at the outset of mechanical ventilation may predispose critically ill patients to poor clinical outcomes.

Objective: To determine whether lower baseline diaphragm thickness (Tdi) is associated with delayed liberation from mechanical ventilation and complications of acute respiratory failure (reintubation, tracheostomy, prolonged ventilation >14 days, or death in the hospital).

Design, Setting, And Participants: Secondary analysis (July 2018 to June 2019) of a prospective cohort study (data collected May 2013 to January 2016). Read More

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http://dx.doi.org/10.1001/jamanetworkopen.2019.21520DOI Listing
February 2020

Evaluating Patients' Perception of the Risk of Acute Care Visits During Systemic Therapy for Cancer.

JCO Oncol Pract 2020 Feb 19:JOP1900551. Epub 2020 Feb 19.

University of Toronto, Toronto, Ontario, Canada.

Purpose: Unplanned emergency department (ED) visits and hospitalizations are common during systemic cancer therapy. To determine how patients with cancer trade off treatment benefit with risk of experiencing an ED visit or hospitalization when deciding about systemic therapy, we undertook a discrete choice experiment.

Materials And Methods: Patients with breast, colorectal, or head and neck cancer contemplating, receiving, or having previously received systemic therapy were presented with 10 choice tasks (5 in the curative and 5 in the palliative setting) that varied on 3 attributes: benefit, risk of ED visit, and risk of hospitalization. Read More

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http://dx.doi.org/10.1200/JOP.19.00551DOI Listing
February 2020

Key constituents for integration of care for children assisted with long-term home ventilation: a European study.

BMC Pediatr 2020 Feb 15;20(1):71. Epub 2020 Feb 15.

Department of Medicine and Division of General Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, USA.

Background: The number of children requiring long-term home ventilation has consistently increased over the last 25 years. Given the growing population of children with complex care needs (CCNs), this was an important area of focus within the Models of Child Health Appraised (MOCHA) project, funded by the European Union (EU) under the Horizon 2020 programme. We examined the structures and processes of care in place for children with CCNs and identified key constituents for effective integration of care for these children at the community and acute care interface across 30 EU/ European Economic Area (EEA) countries. Read More

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http://dx.doi.org/10.1186/s12887-020-1979-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7023713PMC
February 2020

The Impact of Frailty on Long-Term Patient-Oriented Outcomes after Emergency General Surgery: A Retrospective Cohort Study.

J Am Geriatr Soc 2020 May 11;68(5):1037-1043. Epub 2020 Feb 11.

The Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.

Objectives: Few studies examine the impact of frailty on long-term patient-oriented outcomes after emergency general surgery (EGS). We measured the prevalence of frailty among older EGS patients and examined the impact of frailty on 1-year outcomes.

Design: Retrospective cohort study using 2008 to 2014 Medicare claims. Read More

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http://dx.doi.org/10.1111/jgs.16334DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7234900PMC

Models of Palliative Care Delivery for Patients With Cancer.

J Clin Oncol 2020 Mar 5;38(9):852-865. Epub 2020 Feb 5.

University of Texas MD Anderson Cancer Center, Houston, TX.

Palliative care has evolved over the past five decades as an interprofessional specialty to improve quality of life and quality of care for patients with cancer and their families. Existing evidence supports that timely involvement of specialist palliative care teams can enhance the care delivered by oncology teams. This review provides a state-of-the-science synopsis of the literature that supports each of the five clinical models of specialist palliative care delivery, including outpatient clinics, inpatient consultation teams, acute palliative care units, community-based palliative care, and hospice care. Read More

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http://dx.doi.org/10.1200/JCO.18.02123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7082156PMC

Critical Care Nephrology: Core Curriculum 2020.

Am J Kidney Dis 2020 03 22;75(3):435-452. Epub 2020 Jan 22.

Division of Nephrology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM.

The intensive care unit (ICU) is a common source of high-acuity nephrology consultations. Although advanced chronic kidney disease is associated with increased ICU mortality, the prognosis of acute kidney injury (AKI) requiring renal replacement therapy is far worse, with short-term mortality rates that often exceed 50%. As such, it is essential that practicing nephrologists be comfortable caring for critically ill patients. Read More

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http://dx.doi.org/10.1053/j.ajkd.2019.10.010DOI Listing

Acute Care Nurses' Experiences of Basic Palliative Care.

Authors:
Tammy Neiman

J Hosp Palliat Nurs 2020 Apr;22(2):101-107

Tammy Neiman, PhD, RN, is assistant professor, School of Nursing, Minnesota State University, Mankato.

As the population of chronically ill, older adults increases, there is a growing need for palliative care. The Institute of Medicine recommends that health care providers have a basic competency in palliative care. However, the definition of basic palliative care in practice and providers' understanding of basic palliative care lack clarity. Read More

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http://dx.doi.org/10.1097/NJH.0000000000000622DOI Listing

How best to palliate and treat emergency conditions in geriatric patients with colorectal cancer.

Eur J Surg Oncol 2020 Mar 2;46(3):369-378. Epub 2020 Jan 2.

Department of General Surgery, Ospedale Civico di Lugano, Via Tesserete 46, 6900, Lugano, Switzerland; Department of Visceral Surgery, Lausanne University Hospital and Lausanne University, Rue du Bugnon 21, 1011, Lausanne, Switzerland. Electronic address:

Almost one third of colorectal cancer (CRC) cases are diagnosed in an emergency setting, mostly among geriatric patients. Clinical scenarios are often complex and decision making delicate. Besides the obvious need to consider the patient's and/or family and care givers' desires, the surgeon should be able to make the best educated guess on future outcomes in three areas: oncological prognosis, morbidity and mortality risk, and long-term functional loss. Read More

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http://dx.doi.org/10.1016/j.ejso.2019.12.020DOI Listing

Recurrent major depressive disorder's impact on end-of-life care of cancer: A nationwide study.

J Affect Disord 2020 Feb 5;263:326-335. Epub 2019 Dec 5.

Aix-Marseille Univ., CEReSS - Health Service Research and Quality of Life Center, Marseille, France; Department of Medical Information, APHM, Marseille, France; Department of Epidemiology and Health Economics, APHM, Marseille, France.

Objective: We still don't know if recurrent major depressive disorder (RMDD) may impact the quality of the end-of-life (EOL) cancer care in France. To tackle this knowledge gap, we explored EOL care in RMDD subjects who died from cancer compared to subjects without psychiatric disorder in a 4-year nationwide cohort study.

Design: Nationwide cohort study. Read More

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http://dx.doi.org/10.1016/j.jad.2019.12.003DOI Listing
February 2020

Dementia palliative care in the acute psychiatric hospital: A feasibility study.

Perspect Psychiatr Care 2020 Jan 14. Epub 2020 Jan 14.

Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota.

Purpose: We explored the feasibility of a clinical pathway to identify hospitalized patients with dementia who would benefit from a palliative intervention.

Design And Methods: Consecutive geropsychiatric admissions were screened for terminal dementia to be randomized to a palliative consultation vs usual care.

Findings: A total of 43 of the 188 patients (23%) had dementia; however, dementia stages were severe but not terminal. Read More

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http://dx.doi.org/10.1111/ppc.12473DOI Listing
January 2020

Older Adults Hospitalized for Pneumonia in the United States: Incidence, Epidemiology, and Outcomes.

J Am Geriatr Soc 2020 May 9;68(5):1007-1014. Epub 2020 Jan 9.

Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Louisville, Kentucky.

Objectives: To define the current incidence, epidemiology, and mortality of older adult patients hospitalized with community-acquired pneumonia (CAP) in Louisville, KY and thus estimate the burden of CAP in the older adult population of the United States. To define risk factors associated with early and late outcomes.

Design: This was a secondary analysis of older adults (aged ≥65 years) from the University of Louisville Pneumonia Study, a prospective population-based cohort study of all hospitalized adults with CAP between June 1, 2014, and May 31, 2016. Read More

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http://dx.doi.org/10.1111/jgs.16327DOI Listing

Clinical trial participation and aggressive care at the end of life in patients with ovarian cancer.

Int J Gynecol Cancer 2020 02 6;30(2):201-206. Epub 2020 Jan 6.

Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA.

Objectives: In non-gynecologic cancers, clinical trial participation has been associated with aggressive care at the end of life. The objective of this investigation was to examine how trial participation affects end of life outcomes in patients with ovarian cancer.

Methods: In a retrospective review of women diagnosed with ovarian cancer at our institution between January 2010 and December 2015, we collected variables identified by the National Quality Forum as measures of aggressive end of life care including chemotherapy in the last 14 days of life, intensive care unit (ICU) admission in the last 30 days of life, or death in the acute care setting. Read More

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http://dx.doi.org/10.1136/ijgc-2019-000851DOI Listing
February 2020

Management of bleeding in palliative care patients in the general internal medicine ward: a systematic review.

Ann Med Surg (Lond) 2020 Feb 18;50:14-23. Epub 2019 Dec 18.

Internal Medicine Department, Fribourg Hospital, Chemin des Pensionnats 2-6, 1752, Villars-sur-Glâne, Switzerland.

Background: Palliative care patients, those suffering from at least one chronic lifelong medical condition and hospice care patients, those with a life expectancy less than 6 months, are regularly hospitalised in general internal medicine wards. By means of a clinical case, this review aims to equip the internist with an approach to bleeding in this population. Firstly, practical advice on platelet transfusions will be provided. Read More

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http://dx.doi.org/10.1016/j.amsu.2019.12.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6940657PMC
February 2020

Virtual Reality Use for Symptom Management in Palliative Care: A Pilot Study to Assess User Perceptions.

J Palliat Med 2020 Jan 2. Epub 2020 Jan 2.

Western Michigan University Homer Stryker, M.D. School of Medicine, Kalamazoo, Michigan.

In the past two decades, virtual reality (VR) technology has found use in a variety of clinical settings including pain management, physical medicine and rehabilitation, psychiatry, and neurology. However, little is known about the utility of VR in the palliative care setting. Moreover, previous investigations have not explored user perceptions of the VR experience in this population. Read More

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http://dx.doi.org/10.1089/jpm.2019.0411DOI Listing
January 2020

Reducing time in acute hospitals: A stepped-wedge randomised control trial of a specialist palliative care intervention in residential care homes.

Palliat Med 2020 May 2;34(5):571-579. Epub 2020 Jan 2.

Calvary Health Care, Canberra, ACT, Australia.

Background: Care home residents are frequently transferred to hospital, rather than provided with appropriate and timely specialist care in the care home.

Aim: To determine whether a model of care providing specialist palliative care in care homes, called Specialist Palliative Care Needs Rounds, could reduce length of stay in hospital.

Design: Stepped-wedge randomised control trial. Read More

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http://dx.doi.org/10.1177/0269216319891077DOI Listing

A National Study of End-of-Life Care among Older Veterans with Hearing and Vision Loss.

J Am Geriatr Soc 2020 Apr 30;68(4):817-825. Epub 2019 Dec 30.

Veterans Affairs Boston Healthcare System, Boston, Massachusetts.

Objectives: Hearing and visual sensory loss is prevalent among older adults and may impact the quality of healthcare they receive. Few studies have examined sensory loss and end-of-life (EOL) care quality. Our aim was to describe hearing and vision loss and their associations with the quality of EOL care and family perception of care in the last 30 days of life among a national sample of veteran decedents. Read More

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http://dx.doi.org/10.1111/jgs.16298DOI Listing

Heterogeneity of Cause, Care, and Prognosis in Severe Acute Kidney Injury in Hospitalized Patients: A Prospective Observational Study.

Can J Kidney Health Dis 2019 4;6:2054358119892174. Epub 2019 Dec 4.

Service Nephrologie-Dialyse-Aphérèse, CHU Carémeau, Université de Montpellier-Nîmes, France.

Background: KDIGO (Kidney Disease: Improving Global Outcomes) defines acute kidney injury (AKI) solely by serum creatinine (SCr) and urine output variation. Severe AKI is a syndrome covering various clinical situations.

Objective: To describe severe AKI heterogeneity by department of hospitalization. Read More

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http://dx.doi.org/10.1177/2054358119892174DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6896136PMC
December 2019

The Leg Activity measure, a new measure of passive and active function and impact on quality of life; informing goal setting and outcome evaluation in leg spasticity.

Disabil Rehabil 2019 Dec 4:1-9. Epub 2019 Dec 4.

Regional Hyper-acute Rehabilitation Unit, Northwick Park Hospital, London North West Healthcare NHS Trust, London, UK.

Application of the Leg Activity measure in acquired brain injury spasticity intervention to identify areas for goal setting prior to treatment, document the treatments applied and evaluate outcome. A prospective cohort from three specialist spasticity management centres was used. Primary outcome measures were, Leg Activity Measure, Modified Ashworth Scale and Goal Attainment Scaling - light. Read More

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http://dx.doi.org/10.1080/09638288.2019.1697765DOI Listing
December 2019

Predictors of Rehospitalization in Post-Acute Rehabilitation among Different Ethnic Groups.

J Am Med Dir Assoc 2020 Apr 20;21(4):513-518. Epub 2019 Nov 20.

School of Professional Studies, Columbia University, New York, NY.

Objectives: Previous research has shown that ethnicity may play a role in increased risk for hospital readmission during a post-acute rehabilitation care (PARC) stay. However, little is known about risk factors influencing discharge status from PARC settings among different ethnic groups. Hence, the aim of our study was to investigate the relationship of individual characteristics (eg, sex, neighborhood quality) and health behavior (use of rehabilitation services) with rehospitalization across ethnic groups of older adult patients who received post-acute rehabilitation for a cardiovascular disease at a skilled nursing facility (SNF). Read More

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http://dx.doi.org/10.1016/j.jamda.2019.10.008DOI Listing

Prevalence of Hospital-Associated Disability in Older Adults: A Meta-analysis.

J Am Med Dir Assoc 2020 Apr 14;21(4):455-461.e5. Epub 2019 Nov 14.

Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, UAB School of Medicine, University of Alabama at Birmingham, Birmingham, AL; Birmingham/Atlanta Veterans Affairs Geriatric Research, Education, and Clinical Center, Birmingham Veterans Affairs Medical Center, Birmingham, AL.

Objectives: Hospital-associated disability (HAD), defined as loss of independence in activities of daily living (ADL) following acute hospitalization, is observed among older adults. The study objective is to determine overall prevalence of HAD among older adults hospitalized in acute care, and to assess the impact of study initiation year in moderation of prevalence.

Design: Meta-analysis of data collected from randomized trials, quasi-experimental, and prospective cohort studies. Read More

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http://dx.doi.org/10.1016/j.jamda.2019.09.015DOI Listing