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


Goals-of-Care Conversations for Older Adults With Serious Illness in the Emergency Department: Challenges and Opportunities.

Ann Emerg Med 2019 Feb 12. Epub 2019 Feb 12.

Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA; Department of Medicine, Division of Palliative Medicine, Brigham and Women's Hospital, Boston, MA.

During the last 6 months of life, 75% of older adults with preexisting serious illness, such as advanced heart failure, lung disease, and cancer, visit the emergency department (ED). ED visits often mark an inflection point in these patients' illness trajectories, signaling a more rapid rate of decline. Although most patients are there seeking care for acute issues, many of them have priorities other than to simply live as long as possible; yet without discussion of preferences for treatment, they are at risk of receiving care not aligned with their goals. Read More

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http://dx.doi.org/10.1016/j.annemergmed.2019.01.003DOI Listing
February 2019

Stereotactic Radiosurgery for Multiple Brain Metastases.

Curr Treat Options Neurol 2019 Feb 13;21(2). Epub 2019 Feb 13.

Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.

Purpose Of Review: To give an overview on the current evidence for stereotactic radiosurgery of brain metastases with a special focus on multiple brain metastases.

Recent Findings: While the use of stereotactic radiosurgery in patients with limited brain metastases has been clearly defined, its role in patients with multiple lesions (> 4) is still a matter of controversy. Whole-brain radiation therapy (WBRT) has been the standard treatment approach for patients with multiple brain lesions and is still the most commonly used treatment approach worldwide. Read More

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http://dx.doi.org/10.1007/s11940-019-0548-3DOI Listing
February 2019

Comfort care in trauma patients without severe head injury: In-hospital complications as a trigger for goals of care discussions.

Injury 2019 Jan 14. Epub 2019 Jan 14.

Perelman School of Medicine, University of Pennsylvania, Department of Surgery, Division of Trauma, Surgical Critical Care and Emergency Surgery, Philadelphia, PA, United States; Corporal Michael J. Crescenz VA Medical Center, Surgical Services, Section of Surgical Critical Care, Philadelphia, PA, United States. Electronic address:

Introduction: Many injured patients or their families make the difficult decision to withdraw life-sustaining therapies (WLST) following severe injury. While this population has been studied in the setting of severe traumatic brain injury (TBI), little is known about patients who undergo WLST without TBI. We sought to describe patients who may benefit from early involvement of end-of-life resources. Read More

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http://dx.doi.org/10.1016/j.injury.2019.01.024DOI Listing
January 2019

Starting Up a Hospital at Home Program: Facilitators and Barriers to Implementation.

J Am Geriatr Soc 2019 Feb 8. Epub 2019 Feb 8.

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

Background: Hospital at home (HaH) is a model of care that provides acute-level services in the home. HaH has been shown to improve quality and patient satisfaction, and reduce iatrogenesis and costs. Uptake of HaH in the United States has been limited, and little research exists on how to implement it successfully. Read More

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http://dx.doi.org/10.1111/jgs.15782DOI Listing
February 2019

Constant Observation Practices for Hospitalized Persons With Dementia: A Survey Study.

Am J Alzheimers Dis Other Demen 2019 Jan 31:1533317519826272. Epub 2019 Jan 31.

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

Despite substantial staffing and cost implications, the use of constant observation (CO) has been poorly described in the acute care setting. The purpose of this cross-sectional, multicenter, survey study was to assess hospital provider practices regarding the use of CO. Of the 543 surveys distributed, 231 were completed across 5 sites. Read More

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http://dx.doi.org/10.1177/1533317519826272DOI Listing
January 2019

Health Coaching for Patients With Type 2 Diabetes Mellitus to Decrease 30-Day Hospital Readmissions.

Prof Case Manag 2019 Mar/Apr;24(2):76-82

Veronica H. Sullivan, DNP, MSN, RN, is a clinical assistant professor at The University of Alabama in Huntsville. Dr. Sullivan is an instructor in the BSN program. She has 15 years' experience as a nurse. Her prior experience includes medical-surgical, community health, geriatric, and psychiatric-mental health nursing. Mary M. Hays, DSN, MSN, RN, is associate professor emeritus at The University of Alabama in Huntsville, where her 17-year career included teaching pathophysiology and nursing administration. Dr. Hays' clinical experiences for more than 30 years include intensive cardiac care and step-down units and long-term care as director of nursing and administrative consultant. Susan Alexander, DNP, ANP-BC, ADM-BC, is an associate professor at the University of Alabama in Huntsville, working with graduate students in doctoral and master's programs since 2009. Her clinical areas of interest includes older adults with chronic diseases, specifically diabetes. Her prior experiences include acute, home-based, hospice, and palliative care.

Purpose/objectives: The purpose of this program was to provide health coaching to patients with a primary or secondary diagnosis of Type 2 diabetes mellitus (T2DM) to increase self-management skills and reduce 30-day readmissions.

Primary Practice Setting: The setting was a 273-bed, acute care not-for-profit hospital in the southern region of the United States.

Findings/conclusions: Health coaching that emphasized self-management, empowered patients to set healthy goals, and provided support through weekly reminders to improve self-management for patients with T2DM in this pilot program. Read More

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http://dx.doi.org/10.1097/NCM.0000000000000304DOI Listing
January 2019
3 Reads

Recognising and managing dying patients in the acute hospital setting: can we do better?

Intern Med J 2019 Jan;49(1):119-122

Centre for Palliative Care, Victoria, Australia.

Healthcare professionals have limited formal end-of-life care training despite the large proportion of hospital deaths. A retrospective review of 201 acute hospital deaths revealed 166 (82.6%) had documentation to suggest the patient was dying but this was performed late with a median time between documentation and death of 0. Read More

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http://dx.doi.org/10.1111/imj.14177DOI Listing
January 2019
1 Read

Timing of emergency interhospital transfers from subacute to acute care and patient outcomes: A prospective cohort study.

Int J Nurs Stud 2019 Jan 2;91:77-85. Epub 2019 Jan 2.

Deakin University, Geelong, School of Nursing and Midwifery and Centre for Quality and Patient Safety Research - Epworth HealthCare Partnership, Australia.

Background: Australian and international data show that transfer from inpatient rehabilitation to acute care hospitals occurs in one in ten patients. Early unplanned transfers from subacute to acute care hospitals raises questions about the safety of patient transitions between health sectors.

Objectives: To explore the characteristics of early and late emergency interhospital transfers from subacute to acute care. Read More

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http://dx.doi.org/10.1016/j.ijnurstu.2018.12.008DOI Listing
January 2019
1 Read

Nurses' perspectives on the personal and professional impact of providing nurse-led primary palliative care in outpatient oncology settings.

Int J Palliat Nurs 2019 Jan;25(1):30-37

Associate Professor of Medicine, Director of Palliative Care Research, Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh.

Background:: Palliative care (PC) workforce shortages have led to a need for primary PC provided by non-specialists. The Care Management by Oncology Nurses (CONNECT) intervention provides infusion room oncology nurses with training and support to provide primary PC.

Aims:: To describe nurses' perspectives on the personal and professional impact of training and provision of primary PC as part of CONNECT. Read More

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http://dx.doi.org/10.12968/ijpn.2019.25.1.30DOI Listing
January 2019

Validation of a Short-Term, Objective, Prognostic Predictive Method for Terminal Cancer Patients in a Palliative Care Unit Using a Combination of Six Laboratory Test Items.

J Palliat Med 2019 Jan 14. Epub 2019 Jan 14.

1 Department of Clinical Pharmacy Research and Education, School of Pharmaceutical Sciences, Osaka University Graduate, Osaka, Japan.

Background: There is no established method to objectively predict short-term prognosis. Recently, we proposed objective, short-term, prognostic predictive methods that are combinations of laboratory test items: WPCBAL score, derived from six values (white blood cell, platelet, C-reactive protein, blood urea nitrogen, aspartate aminotransferase, and lactate dehydrogenase). However, that study was conducted in an acute-phase hospital to identify the test items useful for prognostic prediction; thus, whether WPCBAL score could be applied to terminal cancer patients in a palliative care unit was unverified. Read More

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http://dx.doi.org/10.1089/jpm.2018.0422DOI Listing
January 2019

[Palliative care in the cardiac setting: a consensus document of the Italian Society of Cardiology/Italian Society of Palliative Care (SIC/SICP)].

G Ital Cardiol (Rome) 2019 Jan;20(1):46-61

Presidente SIC, Struttura Cardiologica, Policlinico Universitario, Cagliari.

Palliative care is recognized as an approach that improves quality of life of patients and families facing life-threatening illnesses. This is achieved through prevention, early identification, assessment and treatment of symptoms and other psycho-social, spiritual and economic issues. Palliative care is not dependent on prognosis and can be delivered as "simultaneous care", together with disease-modifying treatments and adequate symptom relief. Read More

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http://www.giornaledicardiologia.it/articoli.php?archivio=ye
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http://dx.doi.org/10.1714/3079.30720DOI Listing
January 2019
12 Reads

Patients with End-Stage Renal Disease and Acute Surgical Abdomen: Opportunities for Palliative Care.

J Palliat Med 2019 Jan 10. Epub 2019 Jan 10.

Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.

Background: End-stage renal disease (ESRD) is a life-limiting condition that is often complicated by acute abdominal emergency. Palliative care (PC) has been shown to improve the quality of life in patients with serious illness and yet is underutilized. We hypothesize that ESRD patients with abdominal emergency have high unmet PC needs. Read More

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https://www.liebertpub.com/doi/10.1089/jpm.2018.0352
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http://dx.doi.org/10.1089/jpm.2018.0352DOI Listing
January 2019
6 Reads

What do geriatric patients experience during an episode of delirium in acute care hospitals? : A qualitative study.

Z Gerontol Geriatr 2019 Jan 8. Epub 2019 Jan 8.

Universitätsklinik für Geriatrie der PMU, Uniklinikum Salzburg Christian-Doppler-Klinik, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria.

Background: Predispositions and triggers for delirium, such as noxious agents are known and behavior can be monitored; however, there is little to no information available regarding the experience of patients during delirium episodes. Not much is known about a person's world of experiences, which therefore mostly remains as a sort of black box.

Objective: This study was motivated by the following question: "What do (Austrian) geriatric patients experience during an episode of delirium in an acute care hospital?" The main objective of this article is to present little snippets from the experiences and to allow geriatric patients to speak for themselves. Read More

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http://dx.doi.org/10.1007/s00391-018-01492-1DOI Listing
January 2019
3 Reads

Factors Influencing Clinical and Setting Pathways After Discharge From an Acute Palliative/Supportive Care Unit.

Am J Clin Oncol 2018 Dec 27. Epub 2018 Dec 27.

Department of Sciences for Health Promotion and Mother Child Care, University of Palermo, Palermo, Italy.

Aim: The aim of this study was to assess the factors which influence the care pathway after discharge from an acute palliative supportive care unit (APSCU).

Methods: Patients' demographics, indications for admission, kind of admission, the presence of a caregiver, awareness of prognosis, data on anticancer treatments in the last 30 days, ongoing treatment (on/off or uncertain), the previous care setting, analgesic consumption, and duration of admission were recorded. The Edmonton Symptom Assessment Scale (ESAS) at admission and at time of discharge (or the day before death), CAGE (cut down, annoy, guilt, eye-opener), and the Memorial Delirium Assessment Scale (MDAS), were used. Read More

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http://dx.doi.org/10.1097/COC.0000000000000510DOI Listing
December 2018
2 Reads

The Impact of Pediatric Palliative Care Involvement in the Care of Critically Ill Patients without Complex Chronic Conditions.

J Palliat Med 2018 Dec 27. Epub 2018 Dec 27.

1 Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital , Memphis, Tennessee.

Background: The impact of pediatric palliative care (PPC) is well established for children with chronic complex diseases. However, PPC likely also benefits previously healthy children with acute life-threatening conditions.

Objective: To determine the incidence and impact of PPC for previously healthy patients who died in a pediatric hospital. Read More

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http://dx.doi.org/10.1089/jpm.2018.0469DOI Listing
December 2018
3 Reads

Health-services utilisation amongst older persons during the last year of life: a population-based study.

BMC Geriatr 2018 Dec 20;18(1):317. Epub 2018 Dec 20.

Cancer Council NSW, Sydney, Australia.

Background: Accurate population-based data regarding hospital-based care utilisation by older persons during their last year of life are important in health services planning. We investigated patterns of acute hospital-based service use at the end of life, amongst older decedents in New South Wales (NSW), Australia.

Methods: Data from all persons aged ≥70 years who died in the state of NSW Australia in 2007 were included. Read More

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http://dx.doi.org/10.1186/s12877-018-1006-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6302397PMC
December 2018
1 Read

[Palliative sedation in the acute setting].

Ned Tijdschr Geneeskd 2018 Dec 17;163. Epub 2018 Dec 17.

Spaarne Gasthuis, afd. Interne Geneeskunde, Haarlem/Hoofddorp.

If a patient receiving palliative care suffers from an acute complication of an underlying disease and death is expected within minutes to hours, acute sedation may be necessary to alleviate intolerable refractory symptoms. Current guidelines do not provide sufficient information regarding the management of acute palliative sedation. Here, we describe the cases of three patients to stress the importance of anticipation for palliative sedation in the acute setting, a stepwise treatment approach and intensive counselling. Read More

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December 2018
3 Reads

Timing of Palliative Care Consultation and the Impact on Thirty-Day Readmissions and Inpatient Mortality.

J Palliat Med 2018 Dec 14. Epub 2018 Dec 14.

5 Jersey City, New Jersey.

Background: Inpatient palliative care consultation (PCC) may reduce 30-day readmissions and inpatient mortality among seriously ill patients.

Objective: To evaluate the impact of timing of PCC on 30-day readmissions and inpatient mortality.

Design: Retrospective, observational study comparing risk-adjusted, observed-to-expected (O/E) 30-day readmissions and inpatient mortality among patients receiving inpatient PCC to all other inpatients. Read More

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http://dx.doi.org/10.1089/jpm.2018.0399DOI Listing
December 2018

Use of “Months of the Year Backwards” (MOTYB) as a Screening Tool for Delirium in Palliative Care Patients in the Acute Hospital Setting

Ir Med J 2018 Sep 10;111(8):801. Epub 2018 Sep 10.

University Hospital Waterford

Introduction Delirium is common in palliative care. It effects up to 88% of patients with advanced cancer at end of life and has a point prevalence of 20% in the acute hospital setting across all diagnoses. It is under diagnosed and not optimally treated. Read More

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September 2018
1 Read

Comprehensive Tool to Assess Oral Feeding Support for Functional Recovery in Post-acute Rehabilitation.

J Am Med Dir Assoc 2018 Dec 6. Epub 2018 Dec 6.

Department of General Medicine and Diabetology, Kakamigahara Rehabilitation Hospital, Medical Corporation Seidoukai, Kakamigahara, Japan.

Objective: To determine the influence of the Kuchi-kara Taberu (KT) index on rehabilitation outcomes during hospitalized convalescent rehabilitation.

Design: A historical controlled study.

Setting And Participants: A rehabilitation hospital. Read More

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http://dx.doi.org/10.1016/j.jamda.2018.10.022DOI Listing
December 2018

How often are health care personnel hands colonized with multidrug- resistant organisms? A systematic review and meta-analysis.

Am J Infect Control 2018 Dec 5. Epub 2018 Dec 5.

Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI; Geriatrics Research Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI.

Background: Hands of health care personnel (HCP) can transmit multidrug-resistant organisms (MDROs), resulting in infections. Our aim was to determine MDRO prevalence on HCP hands in adult acute care and nursing facility settings.

Methods: A systematic search of PubMed/MEDLINE, Web of Science, CINAHL, Embase, and Cochrane CENTRAL was performed. Read More

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http://dx.doi.org/10.1016/j.ajic.2018.10.017DOI Listing
December 2018
4 Reads

Finding a 'new normal' following acute illness: A qualitative study of influences on frail older people's care preferences.

Palliat Med 2019 Mar 7;33(3):301-311. Epub 2018 Dec 7.

1 Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.

Background:: The frail older population is growing, and many frail older people have episodes of acute illness. Patient preferences are increasingly considered important in the delivery of person-centred care and may change following acute illness.

Aim:: To explore influences on the care preferences of frail older people with recent acute illness. Read More

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http://dx.doi.org/10.1177/0269216318817706DOI Listing
March 2019
10 Reads

Early initiation of palliative care is associated with reduced late-life acute-hospital use: A population-based retrospective cohort study.

Palliat Med 2018 Dec 3:269216318815794. Epub 2018 Dec 3.

3 Institute for Clinical Evaluative Sciences, McMaster University Medical Centre, Hamilton, ON, Canada.

Background:: Early palliative care can reduce end-of-life acute-care use, but findings are mainly limited to cancer populations receiving hospital interventions. Few studies describe how early versus late palliative care affects end-of-life service utilization.

Aim:: To investigate the association between early versus late palliative care (hospital/community-based) and acute-care use and other publicly funded services in the 2 weeks before death. Read More

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http://dx.doi.org/10.1177/0269216318815794DOI Listing
December 2018
2 Reads

Hospital at Home-Plus: A Platform of Facility-Based Care.

J Am Geriatr Soc 2018 Nov 27. Epub 2018 Nov 27.

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

Objectives: To describe the evolution of a hospital at home (HaH) program to a HaH with a 30-day posthospitalization transition period (HaH-Plus) and results of a retrospective review of cases.

Design: After launching HaH-Plus, we used the same interdisciplinary clinical team to provide acute home-based care for a broader range of home-based acute-level services than originally conceived in the Hospital at Home model. These included a palliative care unit at home (PCUaH), an observation unit at home (OUaH), a post-acute care rehabilitation at home (RaH), and a program for the hospital averse - those patients needing to be in the hospital but who refuse. Read More

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http://doi.wiley.com/10.1111/jgs.15653
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http://dx.doi.org/10.1111/jgs.15653DOI Listing
November 2018
7 Reads

Respiratory Failure, Noninvasive Ventilation, and Symptom Burden: An Observational Study.

J Pain Symptom Manage 2019 Feb 30;57(2):282-289.e1. Epub 2018 Oct 30.

Concord Hospital, Thoracic Medicine, Sydney, Australia; The George Institute, Sydney, Australia.

Background: Noninvasive ventilation (NIV) is commonly used to manage acute respiratory failure due to decompensated cardiorespiratory disease. We describe symptom burden in this population.

Measures: Fifty consecutive, consenting, English-speaking, cognitively intact patients, admitted to wards other than the intensive care unit in a tertiary teaching hospital and treated with NIV for hypercapnic respiratory failure, were recruited. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S08853924183105
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http://dx.doi.org/10.1016/j.jpainsymman.2018.10.505DOI Listing
February 2019
5 Reads

Pre-emptive prescription of medications for the management of potential, catastrophic events in patients with a terminal illness: A survey of palliative medicine doctors.

Palliat Med 2018 Oct 29:269216318809668. Epub 2018 Oct 29.

1 Victorian Paediatric Palliative Care Program, Royal Children's Hospital, Melbourne, VIC, Australia.

Background:: Distressing and potentially life-threatening events, such as significant external bleeding, may occur in patients with a known terminal condition. These events are often referred to as catastrophic or crisis events. Pharmacological management varies and there is little evidence to guide practice. Read More

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http://dx.doi.org/10.1177/0269216318809668DOI Listing
October 2018
4 Reads

Delirium and its consequences in the specialized palliative care unit: Validation of the Korean version of Memorial Delirium Assessment Scale.

Psychooncology 2019 Jan 8;28(1):160-166. Epub 2018 Nov 8.

Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea.

Objectives: Delirium is highly prevalent in patients with advanced cancer. This study aimed to investigate delirium rates and potential associated factors such as mortality in patients admitted to an acute palliative care unit (APCU). Our second aim was to validate the Korean version of the Memorial Delirium Assessment Scale (K-MDAS). Read More

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http://dx.doi.org/10.1002/pon.4926DOI Listing
January 2019
1 Read

Adaptation and Initial Validation of Minimum Data Set (MDS) Mortality Risk Index to MDS Version 3.0.

J Am Geriatr Soc 2018 Dec 18;66(12):2353-2359. Epub 2018 Oct 18.

Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.

Objectives: To evaluate the predictive validity of an adapted version of the Minimum Data Set (MDS) Mortality Risk Index-Revised (MMRI-R) based on MDS version 3.0 assessment items (MMRI-v3) and to compare the predictive validity of the MMRI-v3 with that of a single MDS item indicating limited life expectancy (LLE).

Design: Retrospective, cross-sectional study of MDS assessments. Read More

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http://doi.wiley.com/10.1111/jgs.15579
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http://dx.doi.org/10.1111/jgs.15579DOI Listing
December 2018
9 Reads

Interprofessional Intervention to Improve Geriatric Consultation Timing on an Acute Medical Service.

J Am Geriatr Soc 2018 Dec 9;66(12):2372-2376. Epub 2018 Oct 9.

Division of Geriatric and Palliative Medicine, Department of Internal Medicine lSchool of Medicine, University of Michigan, Ann Arbor, Michigan.

Objectives: To determine whether an interprofessional intervention would improve the use and timing of a geriatric consultation on a hospitalist service.

Design: Difference-in-differences (DID), which measures the difference in improvement over time between intervention and control team patients attributable to the intervention.

Setting: 1,000-bed U. Read More

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https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.15582
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http://dx.doi.org/10.1111/jgs.15582DOI Listing
December 2018
1 Read

Radiotherapy in palliation of thoracic tumors: a phase I-II study (SHARON project).

Clin Exp Metastasis 2018 Dec 8;35(8):739-746. Epub 2018 Oct 8.

Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital, via Giuseppe Massarenti 9, 40138, Bologna, Italy.

The main clinical goal for patients with advanced or metastatic thoracic cancer is palliation of tumor-related symptoms and improvement of quality of life. The aim of this phase I-II trial was to define the maximum tolerated dose (MTD) of a short-course of palliative radiotherapy (RT) and to evaluate its efficacy in terms of palliative response. A phase I trial was planned with escalating dose increments. Read More

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http://link.springer.com/10.1007/s10585-018-9942-6
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http://dx.doi.org/10.1007/s10585-018-9942-6DOI Listing
December 2018
2 Reads

Effectiveness of a Hospital-at-Home Integrated Care Program as Alternative Resource for Medical Crises Care in Older Adults With Complex Chronic Conditions.

J Am Med Dir Assoc 2018 Oct;19(10):860-863

Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia; Parc Sanitari Pere Virgili, Barcelona, Catalonia.

Objectives: To compare clinical outcomes in older patients with acute medical crises attended by a geriatrician-led home hospitalization unit (HHU) vs an inpatient intermediate-care geriatric unit (ICGU) in a post-acute care setting.

Design: Quasi-experimental longitudinal study, with 30-day follow-up.

Participants: Older patients with chronic conditions attended at the emergency department or day hospital for an acute medical crisis. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S15258610183033
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http://dx.doi.org/10.1016/j.jamda.2018.06.013DOI Listing
October 2018
10 Reads

Reflections on establishing a nurse practitioner role across acute hospital and home-based palliative care settings in Australia.

Int J Palliat Nurs 2018 Sep;24(9):436-442

Nurse Practitioner, Alfred Health, Melbourne, Australia.

Background:: Nurse practitioners have been well-established in many parts of the world and valued as a senior role in healthcare systems. This paper offers an appraisal of a palliative care nurse practitioner model of care project and augments an understanding of being a nurse practitioner (NP) in the Australian context.

Aims:: To enhance outcomes for people regardless of care setting; and to enhance professional relationships between hospital and community services. Read More

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http://www.magonlinelibrary.com/doi/10.12968/ijpn.2018.24.9.
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http://dx.doi.org/10.12968/ijpn.2018.24.9.436DOI Listing
September 2018
8 Reads

Outcomes of Older Hospitalized Patients Requiring Rapid Response Team Activation for Acute Deterioration.

Crit Care Med 2018 Dec;46(12):1953-1960

Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.

Objectives: Rapid response teams are groups of healthcare providers that have been implemented by many hospitals to respond to acutely deteriorating patients admitted to the hospital wards. Hospitalized older patients are at particular risk of deterioration. We sought to examine outcomes of older patients requiring rapid response team activation. Read More

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http://dx.doi.org/10.1097/CCM.0000000000003442DOI Listing
December 2018
4 Reads

Cognition and Incarceration: Cognitive Impairment and Its Associated Outcomes in Older Adults in Jail.

J Am Geriatr Soc 2018 Nov 19;66(11):2065-2071. Epub 2018 Sep 19.

Division of Geriatrics Department of Medicine, University of California, San Francisco, San Francisco, California.

Objectives: To determine prevalence of, and outcomes associated with, a positive screen for cognitive impairment in older adults in jail.

Design: Combined data from cross-sectional (n=185 participants) and longitudinal (n=125 participants) studies.

Setting: Urban county jail. Read More

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http://dx.doi.org/10.1111/jgs.15521DOI Listing
November 2018
3 Reads

A new approach to multi-professional end of life care training using a sequential simulation (SqS Simulation™) design: A mixed methods study.

Nurse Educ Today 2018 Dec 9;71:26-33. Epub 2018 Sep 9.

Chelsea and Westminster Hospital, Department of Palliative Care, London, UK.

Background: A need for improved education and training for hospital staff caring for patients in the last year of life was identified at an urban UK hospital. Sequential Simulation (SqS Simulation™) is a type of simulation that recreates a patient's journey, considering the longitudinal element of care and how this might impact on the patient's experiences, wishes and needs.

Objectives: The aim of this study was to investigate a new end of life care training intervention for multi-professional hospital staff, and its effect on their confidence in managing patients at the end of their life. Read More

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http://dx.doi.org/10.1016/j.nedt.2018.08.022DOI Listing
December 2018
1 Read

Management of radiation-induced nausea and vomiting with palonosetron in patients with pre-existing emesis: a pilot study.

Ann Palliat Med 2018 Oct 25;7(4):385-392. Epub 2018 Jun 25.

Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.

Background: Approved almost 15 years ago for use in the chemotherapy setting, palonosetron, a 2nd generation 5-hydroxtryptamine 3 receptor antagonist (5-HT3 RA), has demonstrated efficacy in preventing chemotherapy-induced nausea and vomiting. However, its utility in the prophylaxis and treatment of radiation-induced nausea and vomiting (RINV) has yet to be evaluated. In this pilot study, we investigated the rates of control in RINV in patients with pre-existing emesis. Read More

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http://dx.doi.org/10.21037/apm.2018.05.10DOI Listing
October 2018
1 Read

Family members´ experiences of the end-of-life care environments in acute care settings - a photo-elicitation study.

Int J Qual Stud Health Well-being 2018 Dec;13(1):1511767

c Division of Innovative Care Research, Department of Learning, Informatics, Management and Ethics , Karolinska Institutet , Stockholm , Sweden.

Purpose: This article explores experiences of the acute-care environment as a setting for end-of-life (EoL) care from the perspective of family members of a dying person.

Method: We used participant-produced photographs in conjunction with follow-up interviews with nine family members to persons at the EoL, cared for in two acute-care settings.

Results: The interpretive description analysis process resulted in three constructed themes-Aesthetic and un-aesthetic impressions, Space for privacy and social relationships, and Need for guidance in crucial times. Read More

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http://dx.doi.org/10.1080/17482631.2018.1511767DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6127834PMC
December 2018

Pain and delirium in people with dementia in the acute general hospital setting.

Age Ageing 2018 Nov;47(6):841-846

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

Background: Pain and delirium are common in people with dementia admitted to hospitals. These are often under-diagnosed and under-treated. Pain is implicated as a cause of delirium but this association has not been investigated in this setting. Read More

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http://dx.doi.org/10.1093/ageing/afy112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6201828PMC
November 2018
7 Reads

How can end of life care excellence be normalized in hospitals? Lessons from a qualitative framework study.

BMC Palliat Care 2018 Aug 8;17(1):100. Epub 2018 Aug 8.

Central and North West London NHS Foundation Trust, London, UK.

Background: There is a pressing need to improve end-of-life care in acute settings. This requires meeting the learning needs of all acute care healthcare professionals to develop broader clinical expertise and bring about positive change. The UK experience with the Liverpool Care of the Dying Pathway (LCP), also demonstrates a greater focus on implementation processes and daily working practices is necessary. Read More

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http://dx.doi.org/10.1186/s12904-018-0353-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6083610PMC
August 2018
4 Reads

Perceptions of hospitalized patients and their surrogate decision makers on dialysis initiation: a pilot study.

BMC Nephrol 2018 Aug 8;19(1):197. Epub 2018 Aug 8.

Department of Medicine at Duke University School of Medicine, Durham, NC, USA.

Background: Dialysis is often initiated in the hospital during episodes of acute kidney injury and critical illness. Little is known about how patients or their surrogate decision makers feel about dialysis initiation in the inpatient setting.

Methods: We conducted a prospective cohort study at a large academic center in the United States. Read More

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http://dx.doi.org/10.1186/s12882-018-0987-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6083629PMC
August 2018
16 Reads

Protocol and Fidelity Monitoring Plan for Four Supports. A Multicenter Trial of an Intervention to Support Surrogate Decision Makers in Intensive Care Units.

Ann Am Thorac Soc 2018 Sep;15(9):1083-1091

4 CRISMA Center, Department of Critical Care Medicine, School of Medicine.

Individuals acting as surrogate decision makers for critically ill patients frequently struggle in this role and experience high levels of long-term psychological distress. Prior interventions designed to improve the sharing of information by the clinical team with surrogate decision makers have demonstrated little effect on surrogates' outcomes or clinical decisions. In this report, we describe the study protocol and corresponding intervention fidelity monitoring plan for a multicenter randomized clinical trial testing the impact of a multifaceted surrogate support intervention (Four Supports) on surrogates' psychological distress, the quality of decisions about goals of care, and healthcare use. Read More

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http://dx.doi.org/10.1513/AnnalsATS.201803-157SDDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6322040PMC
September 2018
7 Reads

Effect of a spa bath on patient symptoms in an acute palliative care setting: A pilot study.

Complement Ther Clin Pract 2018 Aug 23;32:100-102. Epub 2018 May 23.

School of Psychology & Public Health, La Trobe University, Australia; Olivia Newton-John Cancer Wellness & Research Centre, Austin Health, Australia.

Background And Purpose: The purpose of this pilot study was to examine the potential for a spa bath intervention to reduce the perception of pain and anxiety, and to improve well-being, among palliative patients.

Materials And Methods: 52 palliative care patients rated their pain, anxiety and well-being before and after taking a bath in a purpose-built spa bath designed to accommodate frail and unwell patients.

Results: The intervention improved patients' self-reported pain (t(51) = -6. Read More

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http://dx.doi.org/10.1016/j.ctcp.2018.05.004DOI Listing

End of Life, Withdrawal, and Palliative Care Utilization among Patients Receiving Maintenance Hemodialysis Therapy.

Clin J Am Soc Nephrol 2018 Aug 19;13(8):1172-1179. Epub 2018 Jul 19.

Divisions of Nephrology and Hypertension, and

Background And Objectives: Withdrawal from maintenance hemodialysis before death has become more common because of high disease and treatment burden. The study objective was to identify patient factors and examine the terminal course associated with hemodialysis withdrawal, and assess patterns of palliative care involvement before death among patients on maintenance hemodialysis.

Design, Setting, Participants, & Measurements: We designed an observational cohort study of adult patients on incident hemodialysis in a midwestern United States tertiary center, from January 2001 to November 2013, with death events through to November 2015. Read More

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http://dx.doi.org/10.2215/CJN.00590118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6086702PMC
August 2018
10 Reads

Place of Care Trajectories in the Last Two Weeks of Life: A Population-Based Cohort Study of Ontario Decedents.

J Palliat Med 2018 Nov 16;21(11):1588-1595. Epub 2018 Jul 16.

4 Department of Oncology, McMaster University , Hamilton, Ontario, Canada .

Background/objectives: Place of death is a commonly reported indicator of palliative care quality, but does not provide details of service utilization near end of life. This study aims to explore place of care trajectories in the last two weeks of life in a general population and by disease cohorts.

Design/setting: A retrospective population-based cohort study using linked administrative-health data to examine Ontario decedents between April 1, 2010 and December 31, 2012. Read More

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http://dx.doi.org/10.1089/jpm.2018.0049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6211822PMC
November 2018

Frequency and Characteristics of Recommendations from Interdisciplinary Outpatient Cancer Rehabilitation Monthly Team Meetings.

PM R 2018 Jul 29. Epub 2018 Jul 29.

Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.

Background: Ambulatory cancer rehabilitation programs vary widely in the types of services offered, and there is a lack of consistency with respect to the coordination of rehabilitation with oncologic treatment plans. There are no guidelines for outpatient interdisciplinary rehabilitation team meetings, and the types and characteristics of recommendations that a physiatrist can provide during these meetings have not been reported.

Objective: To identify the frequency and characteristics of different types of recommendations that were derived through monthly interdisciplinary outpatient rehabilitation team meetings involving physiatrists, physical therapists, and occupational therapists. Read More

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http://dx.doi.org/10.1016/j.pmrj.2018.06.016DOI Listing
July 2018
25 Reads

Treatment decision making involving patients with dementia in acute care: A scoping review.

Patient Educ Couns 2018 11 28;101(11):1884-1891. Epub 2018 Jun 28.

William S. Middleton Memorial Veterans Hospital, Madison, USA; Department of Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, USA. Electronic address:

Objective: To summarize the evidence regarding the factors and processes of treatment decision making involving a person with dementia (PWD) in the acute care setting.

Methods: We conducted a scoping review, searching 4 databases (PubMed, CINAHL, Web of Science, & PsychINfo) for articles that contained primary data from a quantitative or qualitative study involving treatment decision making in the acute care setting for PWD and were published in English. We categorized the factors and processes of decision making identified in each article using inductive content analysis. Read More

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http://dx.doi.org/10.1016/j.pec.2018.06.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6179913PMC
November 2018
1 Read

The 'lived experience' of palliative care patients in one acute hospital setting - a qualitative study.

BMC Palliat Care 2018 Jul 6;17(1):91. Epub 2018 Jul 6.

Palliative Care Institute Liverpool, Cancer Research Centre, University of Liverpool, 200 London Road, Liverpool, L3 9TA, UK.

Background: There is limited understanding of the 'lived experience' of palliative care patient within the acute care setting. Failing to engage with and understand the views of patients and those close to them, has fundamental consequences for future health delivery. Understanding 'patient experience' can enable care providers to ensure services are responsive and adaptive to individual patient need. Read More

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http://dx.doi.org/10.1186/s12904-018-0345-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6034290PMC
July 2018
21 Reads

Association of a Bundled Hospital-at-Home and 30-Day Postacute Transitional Care Program With Clinical Outcomes and Patient Experiences.

JAMA Intern Med 2018 Aug;178(8):1033-1040

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

Importance: Hospital-at-home (HaH) care provides acute hospital-level care in a patient's home as a substitute for traditional inpatient care. In September 2017, the Physician-Focused Payment Model Technical Advisory Committee recommended implementation of an alternative payment model for a new model of HaH that bundles the acute episode with 30 days of postacute transitional care.

Objective: To report outcomes of this new payment model for HaH care. Read More

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http://dx.doi.org/10.1001/jamainternmed.2018.2562DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6143103PMC
August 2018
22 Reads

Pulmonary rehabilitation in patients with an acute exacerbation of chronic obstructive pulmonary disease.

J Thorac Dis 2018 May;10(Suppl 12):S1390-S1399

Harefield Pulmonary Rehabilitation and Muscle Research Laboratory, Royal Brompton and Harefield NHS Foundation Trust, UK.

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are one of the most common causes of emergency hospital admission and place great burden upon healthcare systems. Furthermore, AECOPD represent an important life event for patients, and are associated with significant reductions in physical activity, skeletal muscle function, exercise tolerance and health-related quality of life. Pulmonary rehabilitation, an intervention comprising supervised exercise-training and education, may counteract these negative consequences and target modifiable risk factors for hospital readmission. Read More

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http://dx.doi.org/10.21037/jtd.2018.03.18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5989101PMC
May 2018
4 Reads