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https://www.readbyqxmd.com/read/28063865/evaluation-of-a-mastery-learning-intervention-on-hospitalists-code-status-discussion-skills
#1
Rashmi K Sharma, Eytan Szmuilowicz, Adeboye Ogunseitan, Sasha F Jones, Jessica A Montalvo, Kevin J O'Leary, Diane B Wayne
CONTEXT: Although code status discussions (CSD) occur frequently in the hospital setting, discussions often lack content necessary for informed decision making. Simulation-based mastery learning (SBML) has been used to improve clinical skills among resident physicians and may provide a novel way to improve hospitalists' CSD skills. OBJECTIVES: The objective of this pilot randomized controlled trial was to develop and evaluate a CSD SBML intervention for hospitalists...
January 4, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28062333/electronic-goals-of-care-alerts-an-innovative-strategy-to-promote-primary-palliative-care
#2
Erin M Haley, Deborah Meisel, Yevgeniy Gitelman, Laura Dingfield, David J Casarett, Nina R O'Connor
CONTEXT: Given the shortage of palliative care specialists, strategies are needed to promote primary palliative care by non-palliative care providers. Electronic reminders are frequently used in medicine to standardize practice, but their effectiveness in encouraging goals of care discussions is not well understood. OBJECTIVES: To determine whether brief education and electronic alerts increase the frequency of goals of care discussions. METHODS: All general medicine services at a large academic medical center were included...
January 3, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28028678/the-effect-of-advance-directive-completion-on-hospital-care-among-chronically-homeless-persons-a-prospective-cohort-study
#3
Alexander K Leung, Matthew J To, Linh Luong, Zahra Syavash Vahabi, Victor L Gonçalves, John Song, Stephen W Hwang
Advance care planning is relevant for homeless individuals because they experience high rates of morbidity and mortality. The impact of advance directive interventions on hospital care of homeless individuals has not been studied. The objective of this study was to determine if homeless individuals who complete an advance directive through a shelter-based intervention are more likely to have information from their advance directive documented and used during subsequent hospitalizations. The advance directive included preferences for life-sustaining treatments, resuscitation, and substitute decision maker(s)...
December 27, 2016: Journal of Urban Health: Bulletin of the New York Academy of Medicine
https://www.readbyqxmd.com/read/28001466/the-intensive-palliative-care-unit-changing-outcomes-for-hospitalized-cancer-patients-in-an-academic-medical-center
#4
Haipeng Zhang, Constance Barysauskas, Elizabeth Rickerson, Paul Catalano, Joseph Jacobson, Carol Dalby, Charlotta Lindvall, Kathy Selvaggi
BACKGROUND: Patients with advanced cancer often require complex symptom management. At Dana-Farber/Brigham and Women's Cancer Center, the intensive palliative care unit (IPCU) admits symptomatic oncology patients with uncontrolled symptoms throughout the trajectory of illness. Patients are uniquely managed by an interdisciplinary team of clinicians who focus on symptom management and advance care planning. OBJECTIVE: The purpose of our analysis was to investigate goals-of-care outcomes and healthcare utilization after admission to the IPCU...
December 21, 2016: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/27913246/measuring-content-overlap-during-handoff-communication-using-distributional-semantics-an-exploratory-study
#5
Joanna Abraham, Thomas Kannampallil, Vignesh Srinivasan, William Galanter, Gail Tagney, Trevor Cohen
OBJECTIVE: We develop and evaluate a methodological approach to measure the degree and nature of overlap in handoff communication content within and across clinical professions. This extensible, exploratory approach relies on combining techniques from conversational analysis and distributional semantics. MATERIALS AND METHODS: We audio-recorded handoff communication of residents and nurses on the General Medicine floor of a large academic hospital (n=120 resident and n=120 nurse handoffs)...
November 29, 2016: Journal of Biomedical Informatics
https://www.readbyqxmd.com/read/27908501/prospective-evaluation-of-surgical-palliative-care-immersion-training-for-general-surgery-residents
#6
Mustafa Raoof, Lisa O'Neill, Leigh Neumayer, Mindy Fain, Robert Krouse
BACKGROUND: Palliative care competencies in surgical training are recognized to improve the care of surgical patients with advanced or life-threatening illnesses. Formal programs to teach these competencies are lacking. The study aims to assess the feasibility and utility of a unique surgical palliative care immersion training program. STUDY DESIGN: A half-day Surgical Palliative Care Immersion Training (SPCIT) was developed using the American College of Surgeon's manual titled "Surgical Palliative Care: A Resident's Guide" as a framework...
November 27, 2016: American Journal of Surgery
https://www.readbyqxmd.com/read/27893952/acceptability-and-impact-of-a-required-palliative-care-rotation-with-prerotation-and-postrotation-observed-simulated-clinical-experience-during-internal-medicine-residency-training-on-primary-palliative-communication-skills
#7
Maxwell T Vergo, Sharona Sachs, Meredith A MacMartin, Kathryn B Kirkland, Amelia M Cullinan, Lisa A Stephens
BACKGROUND: Improving communication training for primary palliative care using a required palliative care rotation for internal medicine (IM) residents has not been assessed. OBJECTIVE: To assess skills acquisition and acceptability for IM residents not selecting an elective. DESIGN: A consecutive, single-arm cohort underwent preobjective structured clinical examination (OSCE) with learner-centric feedback, two weeks of clinical experience, and finally a post-OSCE to crystallize learner-centric take home points...
November 28, 2016: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/27850209/569-documentation-of-code-status-discussions-in-the-medical-intensive-care-unit
#8
Abigail Doyle, Elaine Chen
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27815753/pediatric-ethics-and-communication-excellence-peace-rounds-decreasing-moral-distress-and-patient-length-of-stay-in-the-picu
#9
Lucia Wocial, Veda Ackerman, Brian Leland, Brian Benneyworth, Vinit Patel, Yan Tong, Mara Nitu
This paper describes a practice innovation: the addition of formal weekly discussions of patients with prolonged PICU stay to reduce healthcare providers' moral distress and decrease length of stay for patients with life-threatening illnesses. We evaluated the innovation using a pre/post intervention design measuring provider moral distress and comparing patient outcomes using retrospective historical controls. Physicians and nurses on staff in our pediatric intensive care unit in a quaternary care children's hospital participated in the evaluation...
November 4, 2016: HEC Forum: An Interdisciplinary Journal on Hospitals' Ethical and Legal Issues
https://www.readbyqxmd.com/read/27720791/impact-of-palliative-care-screening-and-consultation-in-the-icu-a-multihospital-quality-improvement-project
#10
Robert J Zalenski, Spencer S Jones, Cheryl Courage, Denise R Waselewsky, Anna S Kostaroff, David Kaufman, Afzal Beemath, John Brofman, James W Castillo, Hicham Krayem, Anthony Marinelli, Bradley Milner, Maria Teresa Palleschi, Mona Tareen, Sheri Testani, Ayman Soubani, Julie Walch, Judy Wheeler, Sonali Wilborn, Hanna Granovsky, Robert D Welch
CONTEXT: There are few multicenter studies that examine the impact of systematic screening for palliative care and specialty consultation in the intensive care unit (ICU). OBJECTIVE: To determine the outcomes of receiving palliative care consultation (PCC) for patients who screened positive on palliative care referral criteria. METHODS: In a prospective quality assurance intervention with a retrospective analysis, the covariate balancing propensity score method was used to estimate the conditional probability of receiving a PCC and to balance important covariates...
January 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/27644048/trend-of-decreased-length-of-stay-in-the-intensive-care-unit-icu-and-in-the-hospital-with-palliative-care-integration-into-the-icu
#11
Eluned Mun, Clementina Ceria-Ulep, Lillian Umbarger, Craig Nakatsuka
CONTEXT: Is a decrease in length of stay (LOS) in the intensive care unit (ICU) and hospital possible with the implementation of a structured, palliative care, quality-improvement program in the ICU? OBJECTIVE: Incorporate palliative care into the routine ICU workflow to increase the numbers of palliative care consultations, improve end-of-life care in the ICU, and demonstrate an impact on ICU and/or hospital LOS. DESIGN: A program was developed that followed recommendations from the Center to Advance Palliative Care's Improving Palliative Care in the ICU project...
2016: Permanente Journal
https://www.readbyqxmd.com/read/27632677/a-comparison-of-usage-and-outcomes-between-nurse-practitioner-and-resident-staffed-medical-icus
#12
Rachel Scherzer, Marie P Dennis, Beth Ann Swan, Mani S Kavuru, David A Oxman
OBJECTIVE: To compare usage patterns and outcomes of a nurse practitioner-staffed medical ICU and a resident-staffed physician medical ICU. DESIGN: Retrospective chart review of 1,157 medical ICU admissions from March 2012 to February 2013. SETTING: Large urban academic university hospital. SUBJECTS: One thousand one hundred fifty-seven consecutive medical ICU admissions including 221 nurse practitioner-staffed medical ICU admissions (19...
September 14, 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27622294/availability-of-advance-care-planning-documentation-for-older-emergency-department-patients-a-cross-sectional-study
#13
Timothy F Platts-Mills, Natalie L Richmond, Eric M LeFebvre, Sowmya A Mangipudi, Allison G Hollowell, Debbie Travers, Kevin Biese, Laura C Hanson, Angelo E Volandes
INTRODUCTION: Increasing advance care planning (ACP) among older adults is a national priority. Documentation of ACP in the electronic health record (EHR) is particularly important during emergency care. OBJECTIVE: We sought to characterize completion and availability of ACP among a subset of older patients at an academic emergency department (ED) with an integrated EHR. METHODS: In this cross-sectional study, patients were eligible if aged ≥80 years or aged 65-79 with ≥1 indicator of high risk for short-term mortality...
January 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/27622148/criteria-for-level-1-and-level-2-trauma-codes-are-pelvic-ring-injuries-undertriaged
#14
Brittany E Haws, Scott Wuertzer, Laura Raffield, Leon Lenchik, Anna N Miller
AIM: To determine the association of unstable pelvic ring injuries with trauma code status. METHODS: A retrospective review of all pelvic ring injuries at a single academic center from July 2010 to June 2013 was performed. The trauma registry was used to identify level 1 and level 2 trauma codes for each injury. The computed tomography scans in all patients were classified as stable or unstable using the Abbreviated Injury Scale. Pelvic injury classifications in level 1 and level 2 groups were compared...
August 18, 2016: World Journal of Orthopedics
https://www.readbyqxmd.com/read/27500355/the-default-dilemma-code-status-regardless-of-medical-context
#15
Daniel G Kronenberg, Chelsea H Hagmann, Joseph D Ma, Carolyn Revta, Janet Armstrong, Eric J Roeland
No abstract text is available yet for this article.
August 8, 2016: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/27488959/when-terminal-illness-is-worse-than-death-a-multicenter-study-of-health-care-providers-resuscitation-desires
#16
Luis O Chavez, Sharon Einav, Joseph Varon
PURPOSE: To investigate how a terminal illness may affect the health-care providers' resuscitation preferences. METHODS: We conducted a cross-sectional survey in 9 health-care institutions located in 4 geographical regions in North and Central America, investigating attitudes toward end-of-life practices in health-care providers. Statistical analysis included descriptive statistics and χ(2) test for the presence of associations (P < 0.05 being significant) and Cramer V for the strength of the association...
August 3, 2016: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/27348842/commentary-clarifying-medical-decisionmaking-who-how-and-why
#17
Tyler S Gibb, Michael J Redinger
In its simplest interpretation, this is a case about goals of care and appropriate code status. At the outset, we must confess that we found this case to be extremely interesting-not for the novelty of the issues or its ethical complexity but because it is truly a case of the ordinary. Too often when teaching or discussing clinical ethics cases, we are distracted by the exotic and the unusual and ignore the mundane cases that every practicing clinical ethicist must be able to competently manage. 1,2,3.
July 2016: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
https://www.readbyqxmd.com/read/27301059/an-agenda-for-improving-perioperative-code-status-discussion
#18
Thomas R Hickey, Zara Cooper, Richard D Urman, David L Hepner, Angela M Bader
Code status discussions (CSDs) clarify patient preferences for cardiopulmonary resuscitation in the event of cardiac or respiratory arrest. CSDs are a key component of perioperative care, particularly at the end of life, and must be both patient-centered and shared. Physicians at all levels of training are insufficiently trained in and inappropriately perform CSD; this may be particularly true of perioperative physicians. In this article, we describe the difficulty of achieving a patient-centered, shared perioperative CSD in the case of a medical professional with a do-not-resuscitate order...
June 15, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27226151/barriers-and-perceptions-regarding-code-status-discussion-with-families-of-critically-ill-patients-in-a-tertiary-care-hospital-of-a-developing-country-a-cross-sectional-study
#19
Ahsan A Syed, Aysha Almas, Quratulain Naeem, Umer F Malik, Tariq Muhammad
BACKGROUND: In Asian societies including Pakistan, a complex background of illiteracy, different familial dynamics, lack of patient's autonomy, religious beliefs, and financial constraints give new dimensions to code status discussion. Barriers faced by physicians during code status discussion in these societies are largely unknown. AIM: To determine the barriers and perceptions in discussion of code status by physicians. DESIGN: Questionnaire-based cross-sectional study...
May 25, 2016: Palliative Medicine
https://www.readbyqxmd.com/read/27203483/emergency-physicians-experience-with-advance-care-planning-documentation-in-the-electronic-medical-record-useful-needed-and-elusive
#20
Joshua R Lakin, Eric Isaacs, Erin Sullivan, Heather A Harris, Ryan D McMahan, Rebecca L Sudore
OBJECTIVE: For patients' preferences to be honored, emergency department (ED) physicians must be able to find and use advance care planning (ACP) information in the electronic medical record (EMR). ED physicians' experiences with ACP EMR documentation and their documentation needs are unknown. METHODS: We surveyed 70 ED physicians (81% response rate) from a tertiary and county ED. Our primary outcome was confidence finding and using ACP EMR documentation (percentage reporting very/extremely on a five-point Likert scale)...
June 2016: Journal of Palliative Medicine
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