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American Journal of Hospice & Palliative Care

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https://www.readbyqxmd.com/read/29343085/a-lack-of-systemic-absorption-following-the-repeated-application-of-topical-quetiapine-in-healthy-adults
#1
Bryce Kayhart, Maria I Lapid, Sarah Nelson, Julie L Cunningham, Virginia H Thompson, Jonathan G Leung
In the absence of suitable oral or intravenous access for medication administration and when the intramuscular medications are undesirable, alternative routes for drug delivery may be considered. Antipsychotics administered via an inhaled, intranasal, rectal, or topical route have been described in the literature. Topically administered antipsychotics have been previously reported to produce negligible systemic absorption despite being used in clinical practice for nausea and behavioral symptoms associated with dementia...
January 1, 2018: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/29334753/physicians-perceptions-of-hope-and-how-hope-informs-interactions-with-patients-a-qualitative-exploratory-study
#2
Airin Wolf, Catherine F Garlid, Kristiina Hyrkas
OBJECTIVES: Today some studies of physicians' perceptions of hope are available, but not studies of how hope informs patient care. The objectives of this qualitative study were to describe the ways physicians conceptualize hope and how these may inform interactions with their patients. METHODS: Ten physicians working in a large tertiary care teaching hospital were interviewed. They represented palliative care, oncology, and 7 other specialties. Minimal amount of background information was collected...
January 1, 2018: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/29325441/five-year-experience-of-an-inpatient-palliative-care-unit-at-an-academic-referral-center
#3
Myrick C Shinall, Sara F Martin, Jill Nelson, Richard S Miller, Matthew W Semler, Eli E Zimmerman, Christy C Noblit, E Wesley Ely, Mohana Karlekar
BACKGROUND: Palliative care units (PCUs) staffed by specialty-trained physicians and nurses have been established in a number of medical centers. The purpose of this study is to review the 5-year experience of a PCU at a large, urban academic referral center. METHODS: We retrospectively reviewed a prospectively collected database of all admissions to the PCU at Vanderbilt University Medical Center in the first 5 years of its existence, from 2012 through 2017. RESULTS: Over these 5 years, there were 3321 admissions to the PCU...
January 1, 2018: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/29325440/case-mix-adjustment-of-the-bereaved-family-survey
#4
Ann Kutney-Lee, Joan Carpenter, Dawn Smith, Joshua Thorpe, Alina Tudose, Mary Ersek
Surveys of bereaved family members are increasingly being used to evaluate end-of-life (EOL) care and to measure organizational performance in EOL care quality. The Bereaved Family Survey (BFS) is used to monitor EOL care quality and benchmark performance in the Veterans Affairs (VA) health-care system. The objective of this study was to develop a case-mix adjustment model for the BFS and to examine changes in facility-level scores following adjustment, in order to provide fair comparisons across facilities...
January 1, 2018: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/29316802/it-s-all-about-communication-a-mixed-methods-approach-to-collaboration-between-volunteers-and-staff-in-pediatric-palliative-care
#5
Dorothee Meyer, Pia Schmidt, Boris Zernikow, Julia Wager
BACKGROUND: Multidisciplinary teamwork is considered central to pediatric palliative care. Although different studies state that volunteers play an essential role in palliative care, little is known about the collaboration between volunteers and staff. AIM: This study aims to explore and compare the perspectives of volunteers and staff regarding collaboration in a pediatric palliative care unit. DESIGN: A mixed-methods approach was chosen to appropriately reflect the complex aspects of collaboration...
January 1, 2018: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/29298494/development-of-a-community-based-palliative-care-screening-tool-for-underserved-older-adults-with-chronic-illnesses
#6
Angela Ghesquiere, Daniel S Gardner, Caitlin McAfee, Cara Kenien, Elizabeth Capezuti, Elissa Kozlov, Jo Anne Sirey, M Carrington Reid
Although they experience high rates of chronic illness, low-income minority communities have traditionally underutilized palliative care services compared to whites and those with higher incomes. One reason for this trend is lack of screening by community providers. We utilized a community-based participatory research approach to develop and implement an innovative multidomain palliative care screening tool in aging service agencies. Participants were aging service providers and clients in the East and Central Harlem neighborhoods of New York City, which are characterized by high poverty, largely African American and Latino populations, disproportionally high rates of chronic conditions, and limited health-care access...
January 1, 2018: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/29320874/german-version-of-the-inventory-of-motivations-for-hospice-palliative-care-volunteerism-are-there-gender-differences
#7
Eva-Maria Stelzer, Frieder R Lang, Melanie Hörl, Stefan T Kamin, Stephen Claxton-Oldfield
The present study examined gender differences in motivations for volunteering for hospice using a German version of the Inventory of Motivations for Hospice Palliative Care Volunteerism (IMHPCV). The IMHPCV was translated into German and back-translated into English following the World Health Organization's guidelines for the translation and adaptation of instruments. In an online survey, 599 female and 127 male hospice volunteers from hospice organizations throughout Germany completed the translated version of the IMHPCV, the Scales of the Attitude Structure of Volunteers as well as questions pertaining to their volunteer experience...
February 2018: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/28196448/provider-perspectives-on-advance-care-planning-documentation-in-the-electronic-health-record-the-experience-of-primary-care-providers-and-specialists-using-advance-health-care-directives-and-physician-orders-for-life-sustaining-treatment
#8
Ellis Dillon, Judith Chuang, Atul Gupta, Sharon Tapper, Steve Lai, Peter Yu, Christine Ritchie, Ming Tai-Seale
CONTEXT: Advance care planning (ACP) is valued by patients and clinicians, yet documenting ACP in an accessible manner is problematic. OBJECTIVES: In order to understand how providers incorporate electronic health record (EHR) ACP documentation into clinical practice, we interviewed providers in primary care and specialty departments about ACP practices (n = 13) and analyzed EHR data on 358 primary care providers (PCPs) and 79 specialists at a large multispecialty group practice...
December 2017: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/28193106/improving-end-of-life-care-knowledge-among-senior-baccalaureate-nursing-students
#9
Toni L Glover, Cynthia Garvan, Rose M Nealis, Sandra W Citty, David J Derrico
OBJECTIVE: It is imperative that nurses are proficient and comfortable providing care to patients at the end of life. Recent studies show that nurses' knowledge of end-of-life care is less than optimal. Effective, evidence-based methods to infuse palliative and end-of-life care education into the undergraduate nursing curriculum are needed. METHODS: A descriptive pre- and postassessment evaluating senior nursing students' acquisition of knowledge on end-of-life care after attending the End-of-Life Nursing Education Consortium (ELNEC) core course was conducted...
December 2017: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/28193105/a-qualitative-analysis-of-information-sharing-in-hospice-interdisciplinary-group-meetings
#10
Karla T Washington, George Demiris, Debra Parker Oliver, Jeffrey A Swarz, Alexandria M Lewis, Uba Backonja
BACKGROUND: In the United States, hospice agencies are required to convene interdisciplinary group (IDG) meetings no less frequently than every 15 days to review patients' care plans. Challenges associated with information sharing during these meetings can impede efficiency and frustrate attendees. OBJECTIVES: We sought to examine information sharing in the context of hospice IDG meetings as a first step toward developing an informatics tool to support interdisciplinary collaboration in this setting...
December 2017: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/27903774/-they-shouldn-t-be-coming-to-the-ed-should-they-a-descriptive-service-evaluation-of-why-patients-with-palliative-care-needs-present-to-the-emergency-department
#11
Emilie Green, Sarah Ward, Will Brierley, Ben Riley, Henna Sattar, Tim Harris
BACKGROUND: Patients with palliative care needs frequently attend the emergency department (ED). There is no international agreement on which patients are best cared for in the ED, compared to the primary care setting or direct admission to the hospital. This article presents the quantitative phase of a mixed-methods service evaluation, exploring the reasons why patients with palliative care needs present to the ED. METHODS: This is a single-center, observational study including all patients under the care of a specialist palliative care team who presented to the ED over a 10-week period...
December 2017: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/27729481/end-of-life-care-patterns-at-a-community-hospital-the-rest-of-the-story
#12
Kip Waite, Jane Rhule, David Bush, Barry Meisenberg
We undertook a retrospective review of a subset of expired patients at our community hospital to evaluate end-of-life care patterns and the use of advanced care planning tools among patients who died in the hospital. These 162 expired patients fell into 1 of the 3 diagnosis-related groups of cardiac, respiratory, or infectious disease. Seventy-nine percent of patients arrived to the hospital with no requested limitations in the extent of resuscitative efforts, even though 98% of all patients had major or extreme severity of illness and risk of mortality scores...
December 2017: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/27729480/baby-o-and-the-withdrawal-of-life-sustaining-medical-treatment-in-the-devastated-neonate-a-review-of-clinical-ethical-and-legal-issues
#13
Joseph Sacco, Rebecca Virata
The discontinuation of life sustaining medical treatment (LSMT) in severely and permanently impaired neonates, especially artificial nutrition and hydration (ANH) is subject to uncertainty and controversy. Definitive clinical guidelines are lacking, clinical research is limited, ethical disagreement is commonplace, and while case and statutory law provide legal underpinning for the practice in defined circumstances, uncertainty in this realm likely influences clinical practice. We use the case of a neurologically devastated neonate to highlight and review these arenas, and show how, using available legal, ethical, and clinical standards and practice, the case of Baby O was resolved, and to underline the need for further research in neonatal palliative care...
December 2017: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/27650219/tough-conversations-development-of-a-curriculum-for-medical-students-to-lead-family-meetings
#14
Yuya Hagiwara, Jeanette Ross, Shuko Lee, Sandra Sanchez-Reilly
BACKGROUND: Few educational interventions have been developed to teach Family Meeting (FM) communication skills at the undergraduate level. We developed an innovative curriculum to address this gap. METHODS: Fourth year medical students during 2011-2013 (n = 674) completed training for conducting a FM. To assess the effectiveness of this training, students completed a FM Objective Structured Clinical Exam (OSCE) that included 15 domains rated on a 1-5 point Likert scale...
December 2017: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/27625354/safe-use-of-subcutaneous-diphenhydramine-in-the-inpatient-hospice-unit
#15
Aileen Chen, Erwin J Loquias, Ramesh Roshan, Richard Levene, Raymond Zelhof, Terry Hickey, Gail Austin Cooney, Faustino Gonzalez
BACKGROUND: Diphenhydramine (DPH) is most commonly used via oral, topical, intramuscular (IM) and intravenous (IV) routes for the palliation of pruritus, treatment of extrapyramidal symptoms, management of parkinsonism and for allergic reactions. However, many hospice patients are unable to take oral medications and/or do not have IV access. Moreover, topical administration has a relatively slow rate of absorption. For this reason, in the hospice setting it is not uncommon for diphenhydramine to be administered via the subcutaneous (SC) route secondary to its ease of access, low infection rates and its low levels of discomfort...
December 2017: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/27599724/advance-care-planning-understanding-clinical-routines-and-experiences-of-interprofessional-team-members-in-diverse-health-care-settings
#16
Kelly Arnett, Rebecca L Sudore, David Nowels, Cindy X Feng, Cari R Levy, Hillary D Lum
BACKGROUND: Interprofessional health care team members consider advance care planning (ACP) to be important, yet gaps remain in systematic clinical routines to support ACP. A clearer understanding of the interprofessional team members' perspectives on ACP clinical routines in diverse settings is needed. METHODS: One hundred eighteen health care team members from community-based clinics, long-term care facilities, academic clinics, federally qualified health centers, and hospitals participated in a 35-question, cross-sectional online survey to assess clinical routines, workflow processes, and policies relating to ACP...
December 2017: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/27577723/trust-building-recruitment-strategies-for-researchers-conducting-studies-in-african-american-aa-churches-lessons-learned
#17
Gloria Bonner, Sharon Williams, Diana Wilkie, Alysha Hart, Glenda Burnett, Geraldine Peacock
BACKGROUND: An initial and vital important step in recruiting participants for church-based hospice and palliative care research is the establishment of trust and credibility within the church community. Mistrust of medical research is an extremely important barrier hindering recruitment in African American (AA) communities. A church-based EOL dementia education project is currently being conducted at four large urban AA churches. Church leaders voiced mistrust concerns of previous researchers who conducted investigations in their faith-based institutions...
December 2017: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/27496829/-pain-is-what-the-patient-says-it-is-nurse-patient-communication-information-seeking-and-pain-management
#18
Laura E Miller, Scott A Eldredge, Elizabeth D Dalton
Nurse-patient conversations about pain management are complex. Given recent increases in prescription pain pill abuse, such interactions merit scholarly attention. In-depth interviews with 21 nurses were conducted to explicitly explore nurses' information seeking about pain. The participants in this study gathered pain information from patients through a variety of means and reported facing challenges and dilemmas when communicating with patients about pain management and medicinal preferences. These results have important implications for nurses, patient outcomes, and the broader health-care system and imply that continued educational and intervention efforts are essential in this complicated communicative context...
December 2017: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/27465404/physician-burnout-and-the-calling-to-care-for-the-dying-a-national-survey
#19
John D Yoon, Natalie B Hunt, Krishna C Ravella, Christine S Jun, Farr A Curlin
BACKGROUND: Physician burnout raises concerns over what sustains physicians' career motivations. We assess whether physicians in end-of-life specialties had higher rates of burnout and/or calling to care for the dying. We also examined whether the patient centeredness of the clinical environment was associated with burnout. METHODS: In 2010 to 2011, we conducted a national survey of US physicians from multiple specialties. Primary outcomes were a validated single-item measure of burnout or sense of calling to end-of-life care...
December 2017: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/27465403/hospice-family-caregiver-involvement-in-care-plan-meetings-a-mixed-methods-randomized-controlled-trial
#20
Debra Parker Oliver, George Demiris, Karla Washington, Robin L Kruse, Greg Petroski
BACKGROUND AND OBJECTIVE: Untrained family caregivers struggle with complicated medical management regimens for hospice patients. An intervention was tested to improve caregiver's perception of pain management and patient's pain. DESIGN, SETTING, AND PARTICIPANTS: The intervention was tested with a 2-group (usual care vs intervention) randomized controlled trial using parallel mixed-methods analysis of 446 caregivers in 3 Midwestern hospice programs representing rural and urban settings...
November 2017: American Journal of Hospice & Palliative Care
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