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end of Life in emergency department

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https://www.readbyqxmd.com/read/29663697/testing-a-new-form-to-document-goals-of-care-discussions-regarding-plans-for-end-of-life-care-for-patients-in-an-australian-emergency-department
#1
Amber C Mills, Michele Levinson, William A Dunlop, Edward Cheong, Timothy Cowan, Jennifer Hanning, Erin O'Callaghan, Katherine J Walker
OBJECTIVE: There is limited literature to inform the content and format of Goals-of-Care forms, for use by doctors when they are undertaking these important conversations. METHODS: This was a prospective, qualitative and quantitative study evaluating the utility of a new 'Goals-of-Care' form to doctors in a private, tertiary ED, used from December 2016 to February 2017 at Cabrini, Melbourne. A Goals-of-Care form was designed, incorporating medical aims of therapy and patient values and preferences...
April 16, 2018: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29649845/-early-palliative-care-in-emergency-medicine
#2
Maximilian Spickermann, Philipp Lenz
At the end of life patients with a life-limiting disease are often admitted to emergency departments (ED). Mostly, in the setting of an ED there may not be enough time to meet the needs for palliative care (PC) of these patients. Therefore, integration of PC into the ED offers a solution to improve their treatment. In the outpatient setting a cooperation between prehospital emergency services, the patient's general practitioner and specialized outpatient PC teams may allow the patient to die at home - this is what most patients prefer at the end of life...
April 2018: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/29649400/impact-of-inpatient-palliative-care-on-quality-of-end-of-life-care-and-downstream-acute-and-postacute-care-utilization
#3
Peter S Khang, Susan E Wang, In-Lu Amy Liu, Heather L Watson, Sandra Y Koyama, Dan N Huynh, Janet S Lee, Huong Q Nguyen
BACKGROUND: Additional evidence is needed regarding the impact of inpatient palliative care (IPC) on the quality of end-of-life care and downstream utilization. AIM: Examine the effects of IPC on quality of end-of-life care and acute and postacute care use in a large integrated system. DESIGN: Retrospective cohort design. SETTING/PARTICIPANTS: Adult decedents from January 1, 2012, to December 31, 2014, who had at least one hospitalization at 11 Kaiser Permanente Southern California medical centers in the 12 months before death and not hospitalized for a trauma-related condition or receiving home-based PC or hospice were included in the cohort...
March 13, 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29649399/a-rules-based-algorithm-to-prioritize-poor-prognosis-cancer-patients-in-need-of-advance-care-planning
#4
Christine M Bestvina, Kristen E Wroblewski, Bobby Daly, Brittany Beach, Selina Chow, Andrew Hantel, Monica Malec, Michael T Huber, Blase N Polite
BACKGROUND: Accurate understanding of the prognosis of an advanced cancer patient can lead to decreased aggressive care at the end of life and earlier hospice enrollment. OBJECTIVE: Our goal was to determine the association between high-risk clinical events identified by a simple, rules-based algorithm and decreased overall survival, to target poor prognosis cancer patients who would urgently benefit from advanced care planning. DESIGN: A retrospective analysis was performed on outpatient oncology patients with an index visit from April 1, 2015, through June 30, 2015...
March 13, 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29622389/dying-in-hospital-qualitative-study-among-caregivers-of-terminally-ill-patients-who-are-transferred-to-the-emergency-department
#5
Martin Pillet, Aline Chassagne, Régis Aubry
INTRODUCTION: Most people in France die in the hospital, even though a majority would like to die at home. These end-of-life hospital admissions sometimes occur in the emergency setting, in the hours preceding death. OBJECTIVE: To understand the motives that incite main natural caregivers to transfer terminally ill patients at the end of life to the emergency department. METHODS: A qualitative study was performed among caregivers of terminally ill patients receiving palliative care and living at home, and who died within 72hours of being admitted to the emergency department of the University Hospital of Besançon, France...
April 2, 2018: La Presse Médicale
https://www.readbyqxmd.com/read/29622009/health-service-utilisation-during-the-last-year-of-life-a-prospective-longitudinal-study-of-the-pathways-of-patients-with-chronic-kidney-disease-stages-3-5
#6
Shirley Chambers, Helen Healy, Wendy E Hoy, Adrian Kark, Sharad Ratanjee, Geoffrey Mitchell, Carol Douglas, Patsy Yates, Ann Bonner
BACKGROUND: Chronic kidney disease (CKD) is a growing global problem affecting around 10% of many countries' populations. Providing appropriate palliative care services (PCS) to those with advanced kidney disease is becoming paramount. Palliative/supportive care alongside usual CKD clinical treatment is gaining acceptance in nephrology services although the collaboration with and use of PCS is not consistent. METHODS: The goal of this study was to track and quantify the health service utilisation of people with CKD stages 3-5 over the last 12 months of life...
April 5, 2018: BMC Palliative Care
https://www.readbyqxmd.com/read/29616592/attitudes-of-intensive-care-and-emergency-physicians-in-australia-with-regard-to-the-organ-donation-process-a-qualitative-analysis
#7
Emily Macvean, Eva Yn Yuen, Gregory Tooley, Heather M Gardiner, Tess Knight
Specialized hospital physicians have direct capacity to impact Australia's sub-optimal organ donation rates because of their responsibility to identify and facilitate donation opportunities. Australian physicians' attitudes toward this responsibility are examined. A total of 12 intensive care unit and three emergency department physicians were interviewed using a constructionist grounded theory and situational analysis approach. A major theme emerged, related to physicians' conflicts of interest in maintaining patients'/next-of-kin's best interests and a sense of duty-of-care in this context...
April 1, 2018: Journal of Health Psychology
https://www.readbyqxmd.com/read/29614131/association-between-quality-domains-and-health-care-spending-across-physician-networks
#8
Farah Rahman, Jun Guan, Richard H Glazier, Adalsteinn Brown, Arlene S Bierman, Ruth Croxford, Therese A Stukel
One of the more fundamental health policy questions is the relationship between health care quality and spending. A better understanding of these relationships is needed to inform health systems interventions aimed at increasing quality and efficiency of care. We measured 65 validated quality indicators (QI) across Ontario physician networks. QIs were aggregated into domains representing six dimensions of care: screening and prevention, evidence-based medications, hospital-community transitions (7-day post-discharge visit with a primary care physician; 30-day post-discharge visit with a primary care physician and specialist), potentially avoidable hospitalizations and emergency department (ED) visits, potentially avoidable readmissions and unplanned returns to the ED, and poor cancer end of life care...
2018: PloS One
https://www.readbyqxmd.com/read/29610509/ileocecal-anastomosis-type-significantly-influences-long-term-functional-status-quality-of-life-and-healthcare-utilization-in-postoperative-crohn-s-disease-patients-independent-of-inflammation-recurrence
#9
Mahesh Gajendran, Anthony J Bauer, Bettina M Buchholz, Andrew R Watson, Ioannis E Koutroubakis, Jana G Hashash, Claudia Ramos-Rivers, Nilesh Shah, Kenneth K Lee, Ruy J Cruz, Miguel Regueiro, Brian Zuckerbraun, Marc Schwartz, Jason Swoger, Arthur Barrie, Janet Harrison, Douglas J Hartman, Javier Salgado, William M Rivers, Benjamin Click, Alyce M Anderson, Chandraprakash Umapathy, Dmitriy Babichenko, Michael A Dunn, David G Binion
OBJECTIVES: Anastomotic reconstruction following intestinal resection in Crohn's disease (CD) may employ side-to-side anastomosis (STSA; anti-peristaltic orientation) or end-to-end anastomosis (ETEA). Our aim was to determine the impact of these two anastomotic techniques on long-term clinical status in postoperative CD patients. METHODS: We performed a comparative effectiveness study of prospectively collected observational data from consented CD patients undergoing their first or second ileocolonic bowel resection and re-anastomosis between 2008 and 2012, in order to assess the association between anastomosis type and 2-year postoperative quality of life (QoL), healthcare utilization, disease clinical or endoscopic recurrence, use of medications, and need for repeat resection...
April 2018: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/29608934/transition-points-for-the-routine-integration-of-palliative-care-in-patients-with-advanced-cancer
#10
Anna Collins, Vijaya Sundararajan, Jodie Burchell, Jeremy Millar, Sue-Anne McLachlan, Meinir Krishnasamy, Brian H Le, Linda Mileshkin, Peter Hudson, Jennifer Philip
CONTEXT: Increasing emphases are being placed upon early integration of palliative care for patients with advanced cancers, yet barriers to implementation in clinical practice remain. Criteria to standardise referral have been endorsed, but their application are yet to be tested at the population level. OBJECTIVES: This study sought to: 1) establish the need for standardised referral by examining current end of life care outcomes of decedents with cancer; and 2) define transition points within a cancer illness course which are associated with poor prognosis, whereby palliative care should be routinely introduced to augment clinician- based decision making...
March 30, 2018: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/29582040/insights-from-linking-routinely-collected-data-across-australian-health-jurisdictions-a-case-study-of-end-of-life-health-service-use
#11
Julia M Langton, David Goldsbury, Preeyaporn Srasuebkul, Jane M Ingham, Dianne L O'Connell, Sallie-Anne Pearson
OBJECTIVES: The jurisdictional nature of routinely collected health data in Australia has created challenges for linking data across state/territory and federal government boundaries. This has impeded understanding of the interplay between service use across hospital and community care. Our objective was to demonstrate the value-add of cross-jurisdictional data using a case study of health service use and the factors associated with healthcare use towards the end of life. STUDY TYPE: Retrospective cohort study using routinely collected health data...
March 15, 2018: Public Health Research & Practice
https://www.readbyqxmd.com/read/29579318/increased-resource-use-in-men-with-metastatic-prostate-cancer-does-not-result-in-improved-survival-or-quality-of-care-at-the-end-of-life
#12
Ron Golan, Adrien N Bernstein, Xiangmei Gu, Brian A Dinerman, Art Sedrakyan, Jim C Hu
BACKGROUND: Cancer care and end-of-life (EOL) care contribute substantially to health care expenditures. Outside of clinical trials, to our knowledge there exists no standardized protocol to monitor disease progression in men with metastatic prostate cancer (mPCa). The objective of the current study was to evaluate the factors and outcomes associated with increased imaging and serum prostate-specific antigen use in men with mPCa. METHODS: Using Surveillance, Epidemiology, and End Results-Medicare data from 2004 to 2012, the authors identified men diagnosed with mPCa with at least 6 months of follow-up...
March 26, 2018: Cancer
https://www.readbyqxmd.com/read/29569126/palliative-care-is-associated-with-reduced-aggressive-end-of-life-care-in-patients-with-gastrointestinal-cancer
#13
Shaila J Merchant, Susan B Brogly, Craig Goldie, Christopher M Booth, Sulaiman Nanji, Sunil V Patel, Katherine Lajkosz, Nancy N Baxter
BACKGROUND: We examined the delivery of physician palliative care (PC) services and its association with aggressive end-of-life care (EOLC) in patients with gastrointestinal (GI) cancer in Ontario, Canada. METHODS: All patients with primary cause of death from esophageal, gastric, colon, and anorectal cancer from January 2003 to December 2013 were identified. PC services within 2 years of death were classified: (1) any PC; (2) timing of first PC (≤ 7, 8-90, 91-180, and 181-730 days before death); and (3) intensity of PC measured by number of days used (1st-25th, 26th-50th, 51st-75th, and 76th-100th percentiles)...
March 22, 2018: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/29524917/efficacy-of-a-tool-to-predict-short-term-mortality-in-older-people-presenting-at-emergency-departments-protocol-for-a-multi-centre-cohort-study
#14
Magnolia Cardona, Ebony T Lewis, Robin M Turner, Hatem Alkhouri, Stephen Asha, John Mackenzie, Margaret Perkins, Sam Suri, Anna Holdgate, Luis Winoto, Chan-Wei Chang, Blanca Gallego-Luxan, Sally McCarthy, Mette R Kristensen, Michael O'Sullivan, Helene Skjøt-Arkil, Anette A Ekmann, Hanne H Nygaard, Jonas J Jensen, Rune O Jensen, Jonas L Pedersen, Dorothy Breen, John A Petersen, Birgitte N Jensen, Christian Backer Mogensen, Ken Hillman, Mikkel Brabrand
BACKGROUND: Prognostic uncertainty inhibits clinicians from initiating timely end-of-life discussions and advance care planning. This study evaluates the efficacy of the CriSTAL (Criteria for Screening and Triaging to Appropriate aLternative care) checklist in emergency departments. METHODS: Prospective cohort study of patients aged ≥65 years with any diagnosis admitted via emergency departments in ten hospitals in Australia, Denmark and Ireland. Electronic and paper clinical records will be used to extract risk factors such as nursing home residency, physiological deterioration warranting a rapid response call, personal history of active chronic disease, history of hospitalisations or intensive care unit admission in the past year, evidence of proteinuria or ECG abnormalities, and evidence of frailty to be concurrently measured with Fried Score and Clinical Frailty Scale...
March 6, 2018: Archives of Gerontology and Geriatrics
https://www.readbyqxmd.com/read/29524344/knights-without-armour
#15
Muhammad Irfan Farooque
Training in Emergency medicine for nearly 5 years, I thought the finish line was getting near and becoming a consultant was just down the corner. I was enjoying work, getting better every day and well appreciated by peers. But little did I know that life had other plans. I ended up in an emergency department presenting with status epilepticus preceded by vague ongoing symptoms lasting for 2 months. I was intubated and transferred to Intensive care and did not receive a formal diagnosis which still remains a mystery...
March 10, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29478966/use-of-health-services-in-the-last-year-of-life-and-cause-of-death-in-people-with-intellectual-disability-a-retrospective-matched-cohort-study
#16
Kate Brameld, Katrina Spilsbury, Lorna Rosenwax, Helen Leonard, James Semmens
OBJECTIVE: To describe the cause of death together with emergency department presentations and hospital admissions in the last year of life of people with intellectual disability. METHOD: A retrospective matched cohort study using de-identified linked data of people aged 20 years or over, with and without intellectual disability who died during 2009 to 2013 in Western Australia. Emergency department presentations and hospital admissions in the last year of life of people with intellectual disability are described along with cause of death...
February 25, 2018: BMJ Open
https://www.readbyqxmd.com/read/29477278/-initiation-of-first-dialysis-and-three-months-quality-of-life-of-patients-with-end-stage-renal-disease-in-the-french-territories-of-guadeloupe-and-guyane
#17
Jacqueline Deloumeaux, Gaël Samut, Devi Rochemont, Henri Merault, Roger Dufresne, Valérie Galantine, Yannick Tirolien, Catherine Léonardi, Antoine Adenis, Jessica Peruvien, Mathieu Nacher, Jean-Marc Gabriel
End stage renal disease is a major public health problem in the French Departments of Guadeloupe and Guiana because of the high prevalence of both type 2 diabetes and hypertension. We investigated factors associated with an emergency start of dialysis, 3 months' quality of life for patients starting a first replacement therapy in Guadeloupe and French Guiana using the data of the Réseau épidémiologie et information en néphrologie network, completed with data from the quality of life questionnaires SF-36 and KDQoL...
February 21, 2018: Néphrologie & Thérapeutique
https://www.readbyqxmd.com/read/29463092/super-utilization-of-health-care-resources-among-gynecologic-oncology-patients
#18
Casey M Hay, Joseph L Kelley, Robert P Edwards, Kathleen M Pombier, John T Comerci
Super-utilizers account for many emergency department visits (EDV) and hospitalizations. Among Medicare/Medicaid patients, 5% to 10% account for >50% of spending. Little is known about super-utilization in gynecologic oncology. Charts of 64 gynecologic oncology patients with ≥3 EDV and/or admissions over 12 months were reviewed retrospectively. Cancer type distribution was 47% ovarian, 23% cervical, 23% endometrial, and 6% vulvar. Treatment at index visit was 61% chemotherapy, 16% no treatment, 8% recent surgery, and 6% radiation...
February 1, 2018: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
https://www.readbyqxmd.com/read/29436003/is-hospitalisation-necessary-a-survey-of-frail-older-persons-with-cognitive-impairment-transferred-from-nursing-homes-to-the-emergency-department
#19
Maria Björck, Helle Wijk
BACKGROUND: Providing care for frail older persons is complex and demanding, and the transfer of older persons with cognitive impairment to the emergency department is associated with a high risk of them developing complications. AIM: To survey the most ill and frail older persons with cognitive impairment who were transferred from nursing homes to the emergency department, considering reasons for referral, symptoms and actions taken at the hospital. METHOD: A retrospective descriptive survey, conducting a review of 588 referral notes and medical records, analysed and presented with descriptive statistics and visualised with typical case narratives...
February 12, 2018: Scandinavian Journal of Caring Sciences
https://www.readbyqxmd.com/read/29421848/characterization-conservation-and-loss-of-dignity-at-the-end-of-life-in-the-emergency-department-a-qualitative-protocol
#20
Cayetano Fernández-Sola, José Granero-Molina, María Del Mar Díaz-Cortés, Francisca Rosa Jiménez-López, Pablo Roman-López, Encarnación Saez-Molina, Cayetano José Aranda-Torres, José María Muñoz-Terrón, María Paz García-Caro, José Manuel Hernández-Padilla
AIMS: To explore and understand the experiences of terminally ill patients and their relatives regarding dignity during end-of-life care in the emergency department. BACKGROUND: The respect given to the concept of dignity is significantly modifying the clinical relationship and the care framework involving the end-of-life patient in palliative care units, critical care units, hospices and their own homes. This situation is applicable to in-hospital emergency departments, where there is a lack of research which takes the experiences of end-of-life patients and their relatives into account...
February 8, 2018: Journal of Advanced Nursing
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