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American Journal of Hospice & Palliative Care

Talal Hilal
No abstract text is available yet for this article.
September 19, 2018: American Journal of Hospice & Palliative Care
Anne Williams, Leah Sera, Mary Lynn McPherson
BACKGROUND: End-of-life (EOL) patients with dementia have an increased risk for anticholinergic toxicities due to age-related pharmacokinetic and physiologic changes in conjunction with an increased susceptibility to drug-induced cognitive impairments. Despite this well-documented risk, the use of drugs with anticholinergic properties (DAPs) remains prevalent in EOL patients with dementia. OBJECTIVE: The aims of this study were to describe prescribing patterns and characterize anticholinergic burden among hospice patients with dementia, as measured by the Anticholinergic Cognitive Burden (ACB) scale...
September 13, 2018: American Journal of Hospice & Palliative Care
Christopher Lemon, Michael De Ridder, Mohamed Khadra
BACKGROUND: Documentation rates of advance directives (ADs) remain low. Using electronic medical records (EMRs) could help, but a synthesis of evidence is currently lacking. OBJECTIVES: To evaluate the evidence for using EMRs in documenting ADs and its implications for overcoming challenges associated with their use. DESIGN: Systematic review of articles in English, published from inception of databases to December 2017. DATA SOURCES: PubMed, PsycINFO, EMBASE, and CINAHL...
August 30, 2018: American Journal of Hospice & Palliative Care
Leanna R Jaward, Thomas A O'Neil, Adam Marks, Michael A Smith
BACKGROUND: Corticosteroids are frequently utilized in the palliative care setting to combat symptoms such as fatigue, dyspnea, pain, weakness, anorexia, cachexia, nausea, and vomiting. Often times, adverse effects arise with corticosteroid use, and it is unclear whether switching to another corticosteroid would reduce the risk of specific adverse effects or what measures can be taken to alleviate the adverse effects. OBJECTIVE: This article aims to review the differentiating pharmacokinetics, potency, and adverse effect profiles of corticosteroids and summarize their clinical applicability...
August 30, 2018: American Journal of Hospice & Palliative Care
Brijesh Patel, Paul Secheresiu, Mahek Shah, Lekha Racharla, Ahmad B Alsalem, Manyoo Agarwal, Byomesh Tripathi, Naveen Sablani, Lohit Garg, Shantanu Patil, Nauman Islam, Daniel Ray, Modele O Ogunniyi, Ron Freudenberger
OBJECTIVE: To determine the rate and predictors of palliative care referral (PCR) in hospitalized patients with acute heart failure (AHF). INTRODUCTION: The PCR is commonly utilized in terminal conditions such as metastatic cancers. There is no data on trends and predictors from large-scale registry of general population regarding PCR in patients with AHF. METHODS: For this retrospective study, data were obtained from National Inpatient Sample Database from 2010 to 2014...
August 29, 2018: American Journal of Hospice & Palliative Care
Nabeel Chauhan, Syed F Ali, Yousef Hannawi, Archana Hinduja
BACKGROUND: A significant percentage of terminally ill patients are discharged to hospice care following a devastating stroke. OBJECTIVE: We sought to determine the factors associated with hospital discharge to hospice care in a large cohort of patients with stroke. METHODS: Using the institutional Get With The Guidelines-Stroke database, all consecutive patients with acute ischemic stroke (AIS) who were alive at discharge, from January 2009 until July 2015, were analyzed...
August 28, 2018: American Journal of Hospice & Palliative Care
Michael W Rabow, Marilyn McGowan, Rebecca Small, Redwing Keyssar, Hope S Rugo
BACKGROUND: Engaging patients in advance care planning (ACP) is challenging but crucial to improving the quality of end-of-life care. Group visits and multiple patient-clinician interactions may promote advance directive (AD) completion. OBJECTIVE: Facilitate ACP discussions with patients and caregivers and the creation of notarized AD's at a comprehensive cancer center. DESIGN: Two-session, nurse-led ACP workshops for patients and their family caregivers...
August 28, 2018: American Journal of Hospice & Palliative Care
Alexia M Torke, Susan E Hickman, Bernard Hammes, Steven R Counsell, Lev Inger, James E Slaven, Dawn Butler
BACKGROUND: The Physician Orders for Life-Sustaining Treatment (POLST) form is an advance care planning tool designed for seriously ill patients. The discussions needed for high-quality POLST decision-making are time intensive and often do not occur in the outpatient setting. OBJECTIVE: We conducted a single-arm feasibility study of POLST facilitation by nonphysicians using Respecting Choices Last Steps, a standardized, structured approach to facilitation of POLST conversations...
August 28, 2018: American Journal of Hospice & Palliative Care
Elizabeth K Vig
CONTEXT: Patients in medical intensive care units (MICUs) are medically complex. This complexity can lead to uncertainty about patient goals and prognosis. Ethical dilemmas arise when there is uncertainty about the clinically and ethically appropriate actions for managing seriously ill patients. Ethics and palliative care involvement may promote improved quality of care and reduced staff moral distress. Project Description: In this clinical project, a physician with ethics, palliative care, and geriatrics expertise attended morning rounds with the MICU team weekly...
August 22, 2018: American Journal of Hospice & Palliative Care
Susan Carla Stone
Death by suicide has increased in the United States. Experts have identified risk factors that may identify those at risk. It is understood that depression is one of the major risk factor. The families and community are the secondary victims when a suicide attempt or completion is made, and they are at risk for complicated grief. Recently, our team was consulted for the case of a young woman with a catastrophic suicide attempt.
August 21, 2018: American Journal of Hospice & Palliative Care
Signe Peterson Flieger, Erica Spatz, Emily J Cherlin, Leslie A Curry
BACKGROUND: Despite substantial efforts to integrate palliative care and improve advance care planning, both are underutilized. Quality improvement initiatives focused on reducing mortality may offer an opportunity for facilitating engagement with palliative care and advance care planning. OBJECTIVE: In the context of an initiative to reduce acute myocardial infarction (AMI) mortality, we examined challenges and opportunities for engaging palliative care and improving advance care planning...
August 20, 2018: American Journal of Hospice & Palliative Care
Luca Pasina, Angela Recchia, Pasquale Agosti, Alessandro Nobili, Barbara Rizzi
BACKGROUND: The aim of pharmacotherapy in people at the end of life should be symptom control, more than prolonging life. Drugs for disease prevention should therefore be discouraged, but this is not the usual practice. The prevalence of unnecessary preventive drugs at the end of life is not well described, although some studies suggest it is common. METHODS: This retrospective longitudinal study describes the prevalence of patients receiving preventive and symptomatic drug treatments at admission (T1 ) and before death (T2 ) in an Italian hospice...
August 16, 2018: American Journal of Hospice & Palliative Care
Doralina L Anghelescu, Varayini Pankayatselvan, Rosa Nguyen, Deborah Ward, Jianrong Wu, Huiyun Wu, Denaya D Edwards, Wayne Furman
The use of bisphosphonates for pain control in children with cancer is not extensively studied. We retrospectively evaluated 35 children with cancer treated with intravenous bisphosphonates for pain management at a single institution from 1998 through 2015. We analyzed pain scores and opioid and adjuvant medication consumption before bisphosphonate administration, daily for 2 weeks, and at 3 and 4 weeks after administration. We also determined the time interval between diagnosis and first administration of bisphosphonates and duration of life after bisphosphonate administration...
August 16, 2018: American Journal of Hospice & Palliative Care
Meghan McDarby, Brian D Carpenter
OBJECTIVE: To identify factors that hinder or facilitate the palliative care consultation team's (PCCT) successful collaboration with other providers from the perspectives of both PCCT and nonpalliative specialists. METHODS: Qualitative study, including semistructured interviews with PCCT and nonpalliative care providers from various specialties at 4 Midwestern hospitals. Interviews were audio-recorded and transcribed into written text documents for thematic analysis...
August 14, 2018: American Journal of Hospice & Palliative Care
Polly Addison, Cathy Morley
BACKGROUND: Providing quality care to hospice and palliative care patients requires the ability to feel and demonstrate empathic behaviors. To acquire a heightened level of empathy, the learner needs to internalize a process of experiencing first-hand real-life symptom burdens common at end of life. Making this happen during new employee orientation is a challenge but with powerful outcomes. OBJECTIVE: To increase empathy levels in hospice and palliative care staff within the agency...
August 13, 2018: American Journal of Hospice & Palliative Care
Pamela Liao, Kathleen Rossini, Roberts Sauls
Lymphedema is a challenging condition that occurs as a complication to many life-limiting medical conditions. It has a number of associated symptoms including pain, functional impairments, and emotional distress. Majority of treatment interventions have been studied and applied outside of the palliative care context. Subcutaneous drainage is a technique that has been used in some case reports for the lower extremity and sacrum with good results. This report describes an adapted technique of subcutaneous drainage for treating upper extremity lymphedema in the palliative setting...
August 13, 2018: American Journal of Hospice & Palliative Care
Jason P Lambden, Peter Chamberlin, Elissa Kozlov, Lindsay Lief, David A Berlin, Latrice A Pelissier, Elina Yushuvayev, Cynthia X Pan, Holly G Prigerson
BACKGROUND: Futile or potentially inappropriate care (futile/PIC) has been suggested as a factor contributing to clinician well-being; however, little is known about this association. OBJECTIVE: To determine whether futile/PIC provision is associated with measures of clinician well-being. DESIGN: Cross-sectional, self-administered, online questionnaire. SETTING: Two New York City Hospitals. PARTICIPANTS: Attending physicians, residents, nurses, and physician assistants in the fields of internal medicine, surgery, neurology, or intensive care...
August 5, 2018: American Journal of Hospice & Palliative Care
Kathryn Thompson, Hyo Jung Tak, Magdy El-Din, Syed Madani, Simon G Brauer, John D Yoon
BACKGROUND: Physicians who are more religious or spiritual may report more positive perceptions regarding the link between religious beliefs/practices and patients' psychological well-being. METHODS: We conducted a secondary data analysis of a 2010 national survey of US physicians from various specialties (n = 1156). Respondents answered whether the following patient behaviors had a positive or negative effect on the psychological well-being of patients at the end of life: (1) praying frequently, (2) believing in divine judgment, and (3) expecting a miraculous healing...
August 5, 2018: American Journal of Hospice & Palliative Care
Ariana Barkley, Mike Liquori, Amy Cunningham, John Liantonio, Brooke Worster, Susan Parks
PURPOSE: Advance care planning (ACP) is theorized to benefit both the patient and their family when end of life is near as well as earlier in the course of serious illness. However, ACP remains underutilized, and little is known about the nature of ACP documentation in geriatrics practices. The study investigated the prevalence and nature of ACP documentation within a geriatric primary care clinic. METHODS: A retrospective chart review was conducted on a randomly selected sample of electronic medical record (EMR) charts...
August 2, 2018: American Journal of Hospice & Palliative Care
Orrin D Ware, John G Cagle
This prospective study investigates informal care networks and their impact on hospice outcomes. Primary caregivers (N = 47) were the main source of data from 2 time points: within a week of enrollment in hospice and bereavement. Data were also collected from 42 secondary caregivers. Intraclass correlation coefficients (ICCs) determined correspondence between primary and secondary caregivers regarding informal care network size. Correlations were used to test associations between variables. Nonparametric paired sample tests were used to analyze change in anger and guilt...
July 31, 2018: American Journal of Hospice & Palliative Care
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