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


Performance of care for end-of-life cancer patients in Tuscany: The interplay between place of care, aggressive treatments, opioids, and place of death. A retrospective cohort study.

Int J Health Plann Manage 2019 Apr 17. Epub 2019 Apr 17.

Scuola Superiore Sant'Anna, Institute of Management and Department EMbeDS, Pisa, Italy.

Supportive and palliative care at the end of life (EOL) is a core component of health systems. Providing care at the EOL may require the interaction of several care providers working in different settings including nursing homes, home care, hospices, and hospitals. This work aims to (a) provide evidence on the performance of EOL care for cancer patients across healthcare organizations, with a focus on the place of care, aggressive treatments, opioids, and the place of death and (b) analyze factors associated with dying in hospital. Read More

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https://onlinelibrary.wiley.com/doi/abs/10.1002/hpm.2789
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http://dx.doi.org/10.1002/hpm.2789DOI Listing
April 2019
6 Reads

Novel Risk Factors for Posttraumatic Stress Disorder Symptoms in Family Members of Acute Respiratory Distress Syndrome Survivors.

Crit Care Med 2019 Apr 15. Epub 2019 Apr 15.

Division of Pulmonary, Critical Care, & Sleep Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, WA.

Objectives: Family members of ICU survivors report long-term psychologic symptoms of posttraumatic stress disorder. We describe patient- and family-member risk factors for posttraumatic stress disorder symptoms among family members of survivors of acute respiratory distress syndrome.

Design: Prospective cohort study of family members of acute respiratory distress syndrome survivors. Read More

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http://dx.doi.org/10.1097/CCM.0000000000003774DOI Listing
April 2019
1 Read

Association of Functional Impairment in Middle Age With Hospitalization, Nursing Home Admission, and Death.

JAMA Intern Med 2019 Apr 8. Epub 2019 Apr 8.

Division of Geriatrics, University of California, San Francisco.

Importance: Difficulty performing daily activities such as bathing and dressing ("functional impairment") affects nearly 15% of middle-aged adults. Older adults who develop such difficulties, often because of frailty and other age-related conditions, are at increased risk of acute care use, nursing home admission, and death. However, it is unknown if functional impairments that develop among middle-aged people, which may have different antecedents, have similar prognostic significance. Read More

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http://dx.doi.org/10.1001/jamainternmed.2019.0008DOI Listing

Effects of a Population Health Community-Based Palliative Care Program on Cost and Utilization.

J Palliat Med 2019 Apr 5. Epub 2019 Apr 5.

5 Santa Barbara Actuaries, Inc., Santa Barbara, California.

Background: New population health community-based models of palliative care can result in more compassionate, affordable, and sustainable high-quality care.

Objectives: We evaluated utilization and cost outcomes of a standardized, population health community-based palliative care program provided by nurses and social workers.

Design: We conducted a retrospective propensity-adjusted study to quantify cost savings and resource utilization associated with a community-based palliative care program. Read More

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https://www.liebertpub.com/doi/10.1089/jpm.2018.0489
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http://dx.doi.org/10.1089/jpm.2018.0489DOI Listing
April 2019
1 Read

Impact of comprehensive hospice palliative care on end-of-life care: a propensity-score-matched retrospective observational study.

CMAJ Open 2019 Apr-Jun;7(2):E197-E202. Epub 2019 Apr 4.

Epidemiology, Outcomes and Evaluation Research (Conlon, Caswell, Santi, Meigs), Health Sciences North Research Institute; ICES North Satellite Site (Conlon, Caswell), Health Sciences North Research Institute; Northeast Cancer Centre (Knight, Ballantyne, Hartman), Health Sciences North, Sudbury, Ont.; Cancer Care Ontario (Hartman); Ontario Palliative Care Network (Knight, Ballantyne); Canadian Partnership Against Cancer (Earle), Toronto, Ont.

Background: Access to hospice palliative care may improve quality of life, reduce the use of potentially aggressive end-of-life care and allow for death to occur outside of an acute care hospital. The aim of this study was to examine the impact of an ambulatory hospice palliative care program on end-of-life care compared to care received by a matched control group of deceased patients.

Methods: This retrospective study included patients who received hospice palliative care through the Symptom Management Program in Sudbury, Ontario, during 2012-2015. Read More

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http://dx.doi.org/10.9778/cmajo.20180148DOI Listing
April 2019
1 Read

Addressing Spiritual and Religious Influences in Care Delivery.

Prof Case Manag 2019 May/Jun;24(3):142-147

Jeannie LeDoux, RN, BSN, MBA, CCM, CPHQ, CTT+, is the 2018-2019 chair of the Commission for Case Manager Certification, the first and largest nationally accredited organization that certifies more than 45,000 professional case managers and over 2,600 disability management specialists. She is also a Senior Clinical Educator at MCG, part of Hearst Health. Her professional work includes work with diverse cultures and with special needs and complex medical issues. She also has extensive experience working with the military. Chikita Mann, MSN, RN, CCM, is a CCMC Commissioner and serves as 2018-2019 Secretary. She is also a disability RN case manager for GENEX Services Inc., for the State of Georgia, responsible for workers' compensation, short- and long-term disability, and legal nurse consulting. Her areas of expertise are cultural competency, worker compensation case management, medication reconciliation, and virtual case management. Michael Demoratz, PhD, LCSW, CCM, is a CCMC Commissioner. With more than 35 years of clinical experience as a social worker in end-of-life care, he currently works for the MemorialCare Hospice and Palliative Services in Orange County, California. Jared Young, PsyD, LCSW, CCM, CADC, is a CCMC Commissioner and serves as 2018-2019 Treasurer. A psychologist, Young has over 20 years of clinical experience in mental health and substance abuse treatment and behavioral health and physical health managed care, and works in Pennsylvania.

Purpose: The impact of spiritual and religious factors on health and care delivery has been identified in case management field research. The purpose of this article is to examine how case managers, taking a holistic, patient-centered approach, are required under professional and ethical standards to address the spiritual and religious influences that may impact the individual's health, care choices, and care delivery.

Primary Practice Settings: Case managers across health or human services must be able to identify and address the spiritual and/or religious factors that may influence a care plan and care delivery. Read More

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http://Insights.ovid.com/crossref?an=01269241-201905000-0000
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http://dx.doi.org/10.1097/NCM.0000000000000346DOI Listing
April 2019
3 Reads

Clinician-Family Communication About Patients' Values and Preferences in Intensive Care Units.

JAMA Intern Med 2019 Apr 1. Epub 2019 Apr 1.

Program on Ethics and Decision Making in Critical Illness, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

Importance: Little is known about whether clinicians and surrogate decision makers follow recommended strategies for shared decision making by incorporating intensive care unit (ICU) patients' values and preferences into treatment decisions.

Objectives: To determine how often clinicians and surrogates exchange information about patients' previously expressed values and preferences and deliberate and plan treatment based on these factors during conferences about prognosis and goals of care for incapacitated ICU patients.

Design, Setting, And Participants: A secondary analysis of a prospective, multicenter cohort study of audiorecorded clinician-family conferences between surrogates and clinicians of 249 incapacitated, critically ill adults was conducted. Read More

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http://dx.doi.org/10.1001/jamainternmed.2019.0027DOI Listing
April 2019
2 Reads

Advanced Heart Failure Treatment Modalities and Hospice Care: The Need for High Level Care Coordination.

Am J Hosp Palliat Care 2019 Mar 28:1049909119838250. Epub 2019 Mar 28.

3 Division of Cardiology, University of Washington School of Medicine, Seattle, WA, USA.

Advanced heart failure therapies such as ventricular assist devices and home inotrope use are becoming more common. Technology advances as well as increased indications for use of such therapies is leading to a higher percentage of patients with end-stage heart failure receiving these therapies at end of life. We present a case of a young man with dilated cardiomyopathy who undergoes advanced cardiac care in the setting of progressively declining cardiac function. Read More

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http://dx.doi.org/10.1177/1049909119838250DOI Listing
March 2019
1 Read

Review of Programs to Combat Elder Mistreatment: Focus on Hospitals and Level of Resources Needed.

J Am Geriatr Soc 2019 Mar 22. Epub 2019 Mar 22.

Division of Geriatrics and Palliative Care, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, New York.

Background: Elder mistreatment is common and has serious social and medical consequences for victims. Though programs to combat this mistreatment have been developed and implemented for more than three decades, previous systematic literature reviews have found few successful ones.

Objective: To conduct a more comprehensive examination of programs to improve elder mistreatment identification, intervention, or prevention, including those that had not undergone evaluation. Read More

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http://dx.doi.org/10.1111/jgs.15773DOI Listing
March 2019
3 Reads

Effect of Documenting Prognosis on the Information Provided to ICU Proxies: A Randomized Trial.

Crit Care Med 2019 Mar 15. Epub 2019 Mar 15.

Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD.

Objectives: The Critical Care Choosing Wisely Task Force recommends that intensivists offer patients at high risk for death or severe functional impairment the option of pursuing care focused on comfort. We tested the a priori hypothesis that intensivists who are prompted to document patient prognosis are more likely to disclose prognosis and offer comfort-focused care.

Design: Randomized controlled trial (clinicaltrials. Read More

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http://dx.doi.org/10.1097/CCM.0000000000003731DOI Listing
March 2019
1 Read

Implementing Advance Care Planning in Acute Hospitals: Leading the Transformation of Norms.

J Am Geriatr Soc 2019 Mar 10. Epub 2019 Mar 10.

Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.

Background: Despite being simply defined as a process to further one's understanding about future medical care, the process of implementing advance care planning (ACP) within acute hospital settings can be complex.

Aim: We describe different ACP service models adopted in Singapore, and the facilitators for, and barriers to, its effective implementation.

Design: Qualitative focus group study with thematic analysis. Read More

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http://dx.doi.org/10.1111/jgs.15857DOI Listing

Evaluation of dextromethorphan with select antidepressant therapy for the treatment of depression in the acute care psychiatric setting.

Ment Health Clin 2019 Mar 1;9(2):76-81. Epub 2019 Mar 1.

Research Coordinator, Cleveland Clinic Akron General, Akron, Ohio.

Introduction: Dextromethorphan (DXM), an -methyl-D-aspartate receptor antagonist, may have ketamine-like antidepressant effects. Dextromethorphan is extensively metabolized via cytochrome P450 (CYP) 2D6, and its half-life in extensive metabolizers is 2 to 4 hours. The purpose of this study was to evaluate the effects of DXM in combination with a moderate-to-strong CYP2D6 inhibitor antidepressant on depression in an acute care psychiatric setting. Read More

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http://dx.doi.org/10.9740/mhc.2019.03.076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6398352PMC

Patient experiences of nurse-facilitated advance care planning in a general practice setting: a qualitative study.

BMC Palliat Care 2019 Mar 6;18(1):25. Epub 2019 Mar 6.

School of Public Health and Community Medicine, University of New South Wales, Sydney, 2052, Australia.

Background: Advance care planning (ACP) can offer benefits to patients and their families, especially when delivered in outpatient settings, but uptake remains low. Common barriers for health professionals include a perceived lack of time and adequate training, experience, and confidence in conducting ACP. Patient-reported barriers include a lack of awareness of ACP or discomfort initiating or engaging in discussions about end-of-life. Read More

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http://dx.doi.org/10.1186/s12904-019-0411-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6404299PMC

Early integrated palliative care in chronic heart failure and chronic obstructive pulmonary disease: protocol of a feasibility before-after intervention study.

Pilot Feasibility Stud 2019 21;5:31. Epub 2019 Feb 21.

1Laboratory of Experimental Radiotherapy-Palliative Care, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.

Background: Patients with chronic heart failure (CHF) and patients with chronic obstructive pulmonary disease (COPD) are amenable to integrated palliative care (PC); however, despite the recommendation by various healthcare organizations, these patients have limited access to integrated PC services. In this study, we present the protocol of a feasibility prospective study that aims to explore if an "early integrated PC" intervention can be performed in an acute setting (cardiology and pulmonology wards) and whether it will have an effect on (i) the satisfaction of care and (ii) the quality of life and the level of symptom control of CHF/COPD patients and their informal caregivers.

Methods: A before-after intervention study with three phases, (i) baseline phase where the control group receives standard care, (ii) training phase where the personnel is trained on the application of the intervention, and (iii) intervention phase where the intervention is applied, will be carried out in cardiology and pulmonology wards in the University Hospital Leuven for patients with advanced CHF/COPD and their informal caregivers. Read More

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http://dx.doi.org/10.1186/s40814-019-0420-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6385452PMC
February 2019
8 Reads

Ethical and Clinical Considerations in Treating Infections at the End of Life.

J Hosp Palliat Nurs 2019 Apr;21(2):110-115

Leigh Vaughan, MD, FHM, FAAHPM, is assistant professor and fellowship director, Hospice and Palliative Medicine, Department on General Internal Medicine, Medical University of South Carolina, Charleston. Ashley A. Duckett, MD, FHM, is assistant professor and associate program director, Department of Internal Medicine, Medical University of South Carolina, Charleston. Mary Adler, ANP-C, ACHPN, is nurse practitioner, palliative care team, Medical University of South Carolina, Charleston. Joan Cain, FNP-BC, ACHPN, is nurse practitioner, palliative care team, Medical University of South Carolina, Charleston.

Patients often affirm the goal to pursue comfort at the end of life, although clinicians may struggle with how best to provide comfort and face the ethical dilemma of treating or allowing a suspected infection to unfold. Treating an infection at the end of life does not allow for uniform improvement in symptoms and more time with family and friends. Additionally, there is potential for burden to the patient or health care system and treatment may occur to the exclusion of other comfort measures. Read More

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http://dx.doi.org/10.1097/NJH.0000000000000541DOI Listing
April 2019
21 Reads

Improving Knowledge, Comfort, and Confidence of Nurses Providing End-of-Life Care in the Hospital Setting Through Use of the CARES Tools.

J Hosp Palliat Nurs 2019 Mar 2. Epub 2019 Mar 2.

Alison Stacy, DNP, RN, AGACNP-BC, nurse practitioner, Division of Pulmonary, Critical Care, and Sleep Medicine, Butler Memorial Hospital, Butler, Pennsylvania. Kathy Magdic, DNP, ACNP-BC, FAANP, assistant professor and coordinator, Adult-Gerontology Acute Care Nurse Practitioner Program, University of Pittsburgh, Pennsylvania. Margaret Rosenzweig, PhD, FNP-C, AOCNP, FAAN, professor, Vice Chair of Research, Acute & Tertiary Care Program, University of Pittsburgh, Pennsylvania. Bonnie Freeman, DNP, RN, ANP-BC, ACHPN, nurse practitioner, Department of Supportive Care Medicine, City of Hope National Medical Center, Duarte, California†. Denise Verosky, MSN, RN, CNS, director of Supportive and Palliative Care, University of Pittsburgh Medical Center (UPMC) Mercy, Pennsylvania.

Although most individuals prefer to die at home, approximately 60% of Americans die in the hospital setting. Nurses are inadequately prepared to provide end-of-life (EOL) care because of cure-focused education. Friends and family of dying patients report poor quality of death largely as a result of inadequate communication from health care professionals about the dying process. Read More

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http://dx.doi.org/10.1097/NJH.0000000000000510DOI Listing
March 2019
5 Reads

Delirium Monitoring: Yes or No? That Is The Question.

Am J Crit Care 2019 Mar;28(2):127-135

Annachiara Marra is an anesthesiologist, Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, and Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy. Katarzyna Kotfis is an assistant professor, Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland. Annmarie Hosie is a postdoctoral research fellow, IMPACCT-Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, Ultimo, Australia. Alasdair M. J. MacLullich is a professor, Edinburgh Delirium Research Group, Geriatric Medicine Unit, University of Edinburgh, Edinburgh, Scotland. Pratik P. Pandharipande is a professor, Division of Anesthesiology Critical Care Medicine, Department of Anesthesiology, and Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center. E. Wesley Ely is a professor, Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Center for Health Services Research, Department of Medicine, and Center for Quality Aging, Vanderbilt University Medical Center, and associate director for research, Geriatric Research, Education and Clinical Center (GRECC) Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee, and CIBS Center, Vanderbilt University Medical Center. Brenda T. Pun is an advanced practice nurse, CIBS Center, Vanderbilt University Medical Center.

Delirium, one of the most common manifestations of acute brain dysfunction, is a serious complication in patients receiving care throughout the hospital and a strong predictor of worse outcome. Although delirium monitoring is advocated in numerous evidence-based guidelines as part of routine clinical care, it is still not widely and consistently performed at the bedside in different patient care settings. In a debate on delirium monitoring in hospitalized patients at the 7th American Delirium Society meeting in Nashville, Tennessee, June 2017, areas related to the feasibility, acceptability, and effectiveness of routine delirium monitoring of hospitalized patients were identified, and arguments both for (pro) and against (con) the practice were presented. Read More

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http://dx.doi.org/10.4037/ajcc2019874DOI Listing
March 2019
3 Reads

Preparedness for caregiving: A phenomenological study of the experiences of rural Australian family palliative carers.

Health Soc Care Community 2019 Feb 27. Epub 2019 Feb 27.

La Trobe University, Wodonga, Vic, Australia.

The care of people with life-limiting illnesses is increasingly moving away from an acute setting into the community. Thus, the caregiver role is growing in significance and complexity. The importance of preparing and supporting family caregivers is well established; however, less is known about the impact of rurality on preparedness and how preparedness shapes the caregiving continuum including bereavement. Read More

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http://dx.doi.org/10.1111/hsc.12710DOI Listing
February 2019
4 Reads

The Impact of a Community-Based Serious Illness Care Program on Healthcare Utilization and Patient Care Experience.

J Am Geriatr Soc 2019 Apr 27;67(4):825-830. Epub 2019 Feb 27.

Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

Objective: Healthcare organizations are expanding community-based serious illness care programs to deliver care for homebound patients. Programs typically focus on home-based primary care or home-based palliative care, yet this population may require both services. We developed and evaluated a primary and palliative care program serving seriously ill older adults, called the Reaching Out to Enhance the Health of Adults in Their Communities and Homes (REACH) program. Read More

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http://dx.doi.org/10.1111/jgs.15814DOI Listing

Estimated Life-Time Savings in the Cost of Ongoing Care Following Specialist Rehabilitation for Severe Traumatic Brain Injury in the United Kingdom.

J Head Trauma Rehabil 2019 Feb 15. Epub 2019 Feb 15.

Department of Palliative Care, Policy and Rehabilitation, Faculty of Nursing, Midwifery and Palliative care, Cicely Saunders Institute, King's College London, London, UK (Drs Turner-Stokes and Dzingina); UK Rehabilitation Outcomes Collaborative, Regional/Hyper-acute Rehabilitation Unit, Northwick Park Hospital, Harrow, Middlesex, UK (Dr Turner-Stokes, Messrs Bill and Sephton, and Ms Williams); and Life Expectancy Project, San Francisco, California (Dr Shavelle). All UK authors are employed by the NHS and/or King's College London, which may cite this article as part of their research evaluation processes, including the UK Research Excellence Framework.

Objectives: To evaluate cost-efficiency of rehabilitation following severe traumatic brain injury (TBI) and estimate the life-time savings in costs of care.

Setting/participants: TBI patients (n = 3578/6043) admitted to all 75 specialist rehabilitation services in England 2010-2018.

Design: A multicenter cohort analysis of prospectively collated clinical data from the UK Rehabilitation Outcomes Collaborative national clinical database. Read More

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http://dx.doi.org/10.1097/HTR.0000000000000473DOI Listing
February 2019
1 Read

Access to Palliative Care for Cancer Patients Living in a Northern and Rural Environment in Ontario, Canada: The Effects of Geographic Region and Rurality on End-of-Life Care in a Population-Based Decedent Cancer Cohort.

Clin Med Insights Oncol 2019 14;13:1179554919829500. Epub 2019 Feb 14.

Northeast Cancer Centre, Health Sciences North Research Institute, Sudbury, ON, Canada.

Background: Access to palliative care has been associated with improving quality of life and reducing the use of potentially aggressive end-of-life care. However, many challenges and barriers exist in providing palliative care to residents in northern and rural settings in Ontario, Canada.

Aim: The purpose of this study was to examine access to palliative care and associations with the use of end-of-life care in a decedent cohort of northern and southern, rural and urban, residents. Read More

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http://dx.doi.org/10.1177/1179554919829500DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6378418PMC
February 2019
1 Read

Can mid-regional pro-adrenomedullin (MR-proADM) increase the prognostic accuracy of NEWS in predicting deterioration in patients admitted to hospital with mild to moderately severe illness? A prospective single-centre observational study.

BMJ Open 2019 Feb 22;8(11):e020337. Epub 2019 Feb 22.

NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK.

Objective: To assess the value added to the National Early Warning Score (NEWS) by mid-regional pro-adrenomedullin (MR-proADM) blood level in predicting deterioration in mild to moderately ill people.

Design: Prospective observational study.

Setting: The Medical Admissions Suite of the Royal Victoria Infirmary, Newcastle. Read More

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http://dx.doi.org/10.1136/bmjopen-2017-020337DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6278796PMC
February 2019
1 Read

Use of negative pressure wound therapy with instillation and a reticulated open cell foam dressing with through holes in the acute care setting.

Int Wound J 2019 Feb 19. Epub 2019 Feb 19.

Reading Hospital, Tower Health System, West Reading, Pennsylvania.

Negative pressure wound therapy with instillation and dwell time (NPWTi-d) is an automated system used to deliver, dwell, and remove topical solutions from the wound bed. Recently, a reticulated open cell foam dressing with through holes (ROCF-CC) was developed, which assists with wound cleansing by removing thick exudate and infectious materials. We present our experience using NPWTi-d with ROCF-CC on complex wounds when complete surgical debridement was inappropriate because of medical instability, recurrent non-viable tissue, or palliative treatment plan. Read More

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http://doi.wiley.com/10.1111/iwj.13097
Publisher Site
http://dx.doi.org/10.1111/iwj.13097DOI Listing
February 2019
17 Reads

Healthcare professionals' perceptions of learning communication in the healthcare workplace: an Australian interview study.

BMJ Open 2019 Feb 19;9(2):e025445. Epub 2019 Feb 19.

Monash Centre for Scholarship in Health Education (MCSHE), Monash University, Clayton, Victoria, Australia.

Objectives: The literature focuses on teaching communication skills in the 'classroom', with less focus on how such skills are informally learnt in the healthcare workplace. We grouped healthcare work based on the cure:care continuum to explore communication approaches based on work activities. This study asks: 1) How do healthcare professionals believe they learn communication in the workplace? 2) What are the differences (if any) across the 'type of work' as represented by the cure:care continuum?

Design: This qualitative study used semi-structured individual interviews. Read More

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http://dx.doi.org/10.1136/bmjopen-2018-025445DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6377557PMC
February 2019
5 Reads

The Cost-Effectiveness of Interventions to Increase Utilization of Prone Positioning for Severe Acute Respiratory Distress Syndrome.

Crit Care Med 2019 Mar;47(3):e198-e205

Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

Objectives: Despite strong evidence supporting proning in acute respiratory distress syndrome, few eligible patients receive it. This study determines the cost-effectiveness of interventions to increase utilization of proning for severe acute respiratory distress syndrome.

Design: We created decision trees to model severe acute respiratory distress syndrome from ICU admission through death (societal perspective) and hospital discharge (hospital perspective). Read More

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http://dx.doi.org/10.1097/CCM.0000000000003617DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6383780PMC
March 2019
1 Read

General practitioners and management of chronic noncancer pain: a cross-sectional survey of influences on opioid deprescribing.

J Pain Res 2019 22;12:467-475. Epub 2019 Jan 22.

School of Medicine and Public Health, University of Newcastle, NSW, Australia,

Background: General practitioners' (GPs) views about deprescribing prescription opioid analgesics (POAs) may influence the care provided for patients experiencing chronic noncancer pain (CNCP). There are limited data addressing GPs' beliefs about deprescribing, including their decisions to deprescribe different types of POAs.

Aim: To determine the proportion of GPs who hold attitudes congruent with local pain stewardship, describe their deprescribing decisions, and determine whether type of POA influences deprescribing. Read More

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http://dx.doi.org/10.2147/JPR.S168785DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6348964PMC
January 2019

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
3 Reads

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
1 Read

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 Mar 8;67(3):588-595. 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://doi.wiley.com/10.1111/jgs.15782
Publisher Site
http://dx.doi.org/10.1111/jgs.15782DOI Listing
March 2019
3 Reads

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
18 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 Mar 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
March 2019
2 Reads

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
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6410708PMC
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
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[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
24 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
10 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
4 Reads

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

Am J Clin Oncol 2019 Mar;42(3):265-269

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
March 2019
3 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
7 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 2019 Apr 14;22(4):393-399. 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
April 2019
1 Read

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 2019 Apr 7;20(4):426-431. Epub 2018 Dec 7.

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

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
6 Reads

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

J Am Geriatr Soc 2019 Mar 27;67(3):596-602. 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
Publisher Site
http://dx.doi.org/10.1111/jgs.15653DOI Listing
March 2019
10 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
6 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
3 Reads