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Palliative care in stroke

Rachael E C Schutz, Heather L Coats, Ruth A Engelberg, J Randall Curtis, Claire J Creutzfeldt
BACKGROUND: Patients with severe acute brain injury (SABI) raise important palliative care considerations associated with sudden devastating injury and uncertain prognosis. OBJECTIVE: The goal of this study was to explore how family members, nurses, and physicians experience the palliative and supportive care needs of patients with SABI receiving care in the neuroscience intensive care unit (neuro-ICU). DESIGN: Semistructured interviews were audiotaped, transcribed, and analyzed using thematic analysis...
October 20, 2016: Journal of Palliative Medicine
Shannon M Dunlay, Jacob J Strand, Sara E Wordingham, John M Stulak, Angela J Luckhardt, Keith M Swetz
BACKGROUND: Despite the ability of left ventricular assist device as destination therapy (DT-LVAD) to prolong survival for many patients with advanced heart failure, little is known about the eventual end-of-life care that patients with DT-LVAD receive. METHODS AND RESULTS: All patients undergoing DT-LVAD at the Mayo Clinic in Rochester, Minnesota, from January 1, 2007, to September 30, 2014, who subsequently died before July 1, 2015, were included. Information about end-of-life care was obtained from documentation in the electronic medical record...
October 2016: Circulation. Heart Failure
Aurélie Duruflé, Claire Le-Meur, Marie-Pierre Reillon, Claire Lozach, Benoit Nicolas
Many mobile teams were created over the past decade in various medical specialties including physical medicine and rehabilitation (MPR). The Pôle Saint-Helier has created a mobile team of rehabilitation-reintegration (EM2R) in December 2012 with support from the Regional Health Agency of Brittany. It operates on the health territory No. 5 of Brittany near people experiencing neurological disability. Its main mission is to implement the necessary devices to facilitate the home return of people hospitalized after a neurological event or maintaining to home people with neurological disorders...
September 2016: Annals of Physical and Rehabilitation Medicine
Lynne T Braun, Kathleen L Grady, Jean S Kutner, Eric Adler, Nancy Berlinger, Renee Boss, Javed Butler, Susan Enguidanos, Sarah Friebert, Timothy J Gardner, Phil Higgins, Robert Holloway, Madeleine Konig, Diane Meier, Mary Beth Morrissey, Tammie E Quest, Debra L Wiegand, Barbara Coombs-Lee, George Fitchett, Charu Gupta, William H Roach
The mission of the American Heart Association/American Stroke Association includes increasing access to high-quality, evidence-based care that improves patient outcomes such as health-related quality of life and is consistent with the patients' values, preferences, and goals. Awareness of and access to palliative care interventions align with the American Heart Association/American Stroke Association mission. The purposes of this policy statement are to provide background on the importance of palliative care as it pertains to patients with advanced cardiovascular disease and stroke and their families and to make recommendations for policy decisions...
September 13, 2016: Circulation
Nancy Luo, Joseph G Rogers, Gwen C Dodson, Chetan B Patel, Anthony N Galanos, Carmelo A Milano, Christopher M O'Connor, Robert J Mentz
Within the last decade, advancements in left ventricular assist device therapy have allowed patients with end-stage heart failure (HF) to live longer and with better quality of life. Like other life-saving interventions, however, there remains the risk of complications including infections, bleeding episodes, and stroke. The candidate for left ventricular assist device therapy faces complex challenges going forward, both physical and psychological, many of which may benefit from the application of palliative care principles by trained specialists...
September 1, 2016: American Journal of Cardiology
Ntsieni S Mashau, Vhonani O Netshandama, Makondelela J Mudau
BACKGROUND: The establishment of home-based care (HBC) programmes in developing countries has resulted in a shift of burden from hospitals to communities where palliative care is provided by voluntary home-based caregivers. AIM: The study investigated the impact of caregiving on voluntary home-based caregivers. SETTING: The study was conducted at HBC organisations located in Mutale Municipality of Limpopo Province, South Africa. METHODS: A quantitative cross-sectional descriptive survey design was applied to investigate the impact of caregiving on voluntary home-based caregivers...
2016: African Journal of Primary Health Care & Family Medicine
(no author information available yet)
Forty-two study days designed for nurses involved in the care of older people are being organised across Britain, entitled Nursing Older People: Best Practice Forum. The RCNaccredited full-day seminars include presentations from four eminent speakers on areas of current interest, including palliative care in the community, medicine administration issues, healthcare law and care following a stroke.
June 1, 2003: Nursing Older People
Aurora M Rojo-Sanchís, Manuel Vélez-Díaz-Pallarés, María Muñoz García, Eva Delgado Silveira, Teresa Bermejo Vicedo, Alfonso Cruz Jentoft
BACKGROUND: The use of anticholinergic drugs in the elderly has been associated to an increased frequency of delirium. There are different scales for estimating the anticholinergic burden, such as the Anticholinergic Drug Scale (ADS), Anticholinergic Risk Scale (ARS), and Anticholinergic Cognitive Burden (ACB). The aim of the study is to establish the relationship between anticholinergic burden measured by ADS, ARS, and ACB scales and incident or prevalent delirium. METHODS: An ambispective observational study was conducted for 76 days in the acute geriatric unit of a tertiary hospital...
July 2016: Revista Española de Geriatría y Gerontología
Daren K Heyland, Henry T Stelfox, Allan Garland, Deborah Cook, Peter Dodek, Jim Kutsogiannis, Xuran Jiang, Alexis F Turgeon, Andrew G Day
OBJECTIVE: We sought to develop and internally validate a clinical prediction model to estimate the outcome of very elderly patients 12 months after being admitted to the ICU. DESIGN: Prospective, longitudinal cohort study. SETTING: Twenty-two Canadian ICUs. PATIENTS: We recruited 527 patients 80 years or older who had a medical or urgent surgical diagnosis and were admitted to an ICU for at least 24 hours. MEASUREMENTS AND MAIN RESULTS: At baseline, we completed a comprehensive geriatric assessment of enrolled patients; survival and functional status was determined 12 months later...
September 2016: Critical Care Medicine
Raed A Joundi, Alejandro A Rabinstein, Davar Nikneshan, Jack V Tu, Jiming Fang, Robert Holloway, Gustavo Saposnik
BACKGROUND: Cardiac arrest is a devastating complication of acute ischemic stroke, but little is known about its incidence and characteristics. We studied a large ischemic stroke inpatient population and compared patients with and without cardiac arrest. METHODS: We studied consecutive patients from the Ontario Stroke Registry who had an ischemic stroke between July 2003 and June 2008 at 11 tertiary care stroke centers in Ontario. Multivariable analyses were used to determine independent predictors of cardiac arrest and associated outcomes...
July 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Angelika Alonso, Anne D Ebert, Dorothee Dörr, Dieter Buchheidt, Michael G Hennerici, Kristina Szabo
BACKGROUND: Crucial issues of modern stroke care include best practice end-of-life-decision (EOLD)-making procedures and the provision of high-quality palliative care for dying stroke patients. METHODS: We retrospectively analyzed records of those patients who died over a 4-year period (2011-2014) on our Stroke Unit concerning EOLD, focusing on the factors that most probably guided decisions to induce limitation of life-sustaining therapy and subsequently end-of-life-care procedures thereafter...
2016: BMC Palliative Care
Eileen Broomall, Mary E McBride, Barbara J Deal, Laurence Ducharme-Crevier, Alexandra Shaw, Mjaye Mazwi, Carl L Backer, Michael C Mongé, John Costello, Bradley S Marino, Andrew DeFreitas, Mark S Wainwright
BACKGROUND: Palliative procedures performed before the Fontan procedure may require ligation of the subclavian arteries, thereby affecting flow to the vertebral arteries. In adults with functionally univentricular heart disease, the implications of altered brainstem vascular anatomy for perioperative management of failing Fontan circulation are not known. METHODS: We identified abnormal posterior circulation anatomy in an adult patient with failing Fontan circulation who experienced a brainstem stroke after Fontan conversion...
June 2016: Annals of Thoracic Surgery
Pramod K Guru, Tarun D Singh, Swetha Pedavally, Alejandro A Rabinstein, Sara Hocker
OBJECTIVE: Posterior fossa stroke is unique in its presentation and outcomes, and mechanical ventilation is commonly used in the management of these patients. We aimed to identify predictors of extubation success in patients with posterior fossa stroke, who require mechanical ventilation. DESIGN: We included consecutive adult patients admitted to the neurosciences ICU from January 2003 to December 2012. Extubation failure was defined as re-intubation within 7 days of extubation...
August 2016: Neurocritical Care
Heather Black, Craig Waugh, Rosalia Munoz-Arroyo, Andrew Carnon, Ananda Allan, David Clark, Fiona Graham, Christopher Isles
BACKGROUND: Surveys suggest most people would prefer to die in their own home. AIM: To examine predictors of place of death over an 11-year period between 2000 and 2010 in Dumfries and Galloway, south west Scotland. DESIGN: Retrospective cohort study. SETTING/PARTICIPANTS: 19,697 Dumfries and Galloway residents who died in the region or elsewhere in Scotland. We explored the relation between age, gender, cause of death (cancer, respiratory, ischaemic heart disease, stroke and dementia) and place of death (acute hospital, cottage hospital, residential care and home) using regression models to show differences and trends...
September 2016: Palliative Medicine
Heléne Eriksson, Anna Milberg, Katarina Hjelm, Maria Friedrichsen
BACKGROUND: Although stroke is a significant public health challenge and the need for palliative care has been emphasized for these patients, there is limited data on end-of-life care for patients dying from stroke. OBJECTIVE: To study the end-of-life care during the last week of life for patients who had died of stroke in terms of registered symptom, symptom management, and communication, in comparison with patients who had died of cancer. DESIGN: This study is a retrospective, comparative registry study...
2016: PloS One
S S Kar, L Subitha, S Iswarya
Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through prevention and relief of suffering by means of early identification, assessment and treatment of pain, and other problems - physical, psychosocial, and spiritual. It is estimated that in India the total number of people who need palliative care is likely to be 5.4 million people a year. Though palliative care services have been in existence for many years, India ranks at the bottom of the Quality of Death index in overall score...
January 2015: Indian Journal of Cancer
Adrian R Parry-Jones, Lizz Paley, Benjamin D Bray, Alex M Hoffman, Martin James, Geoffrey C Cloud, Pippa J Tyrrell, Anthony G Rudd
BACKGROUND: Prognosis after intracerebral hemorrhage (ICH) is poor and care-limiting decisions may worsen outcomes. AIMS: To determine whether in current UK stroke practice, key acute care decisions are associated with stroke subtype (ICH/ischemic) and whether these decisions are independently associated with survival. METHODS: We extracted data describing all stroke patients included in a UK quality register between 1 April 2013 and 31 March 2014...
April 2016: International Journal of Stroke: Official Journal of the International Stroke Society
Iva Sorta-Bilajac Turina, Helena Glibotić Kresina, Svjetlana Gašparović Babić, Suzana Janković, Sandro Kresina, Morana Brkljačić
This paper analyses the current situation in the Croatian health-care system, with special emphasis on the (dis)organization of palliative care within the public health, more precisely gerontology context. Namely, population world-wide is getting older, that is both a statistical and an everyday-medical fact. Today we consider citizens after the age of 65 as the elderly, with a tendency to move the age-limit to 75 years. Croatia on the matter swiftly follows global trends, while literature points to the fact that an increase in the elderly population dictates the need for an organized system of palliative care and hospice building...
June 2015: Collegium Antropologicum
Adrian Parry-Jones
Prothrombin complex concentrate (PCC) reduces the risk of early haematoma expansion after intracerebral haemorrhage in patients taking vitamin K antagonists (VKA-ICH), so must be given without delay. We sought to identify and remove key barriers to rapid administration of PCC at our centre. We describe a single UK comprehensive stroke centre cohort study with mixed retrospective (1/1/2008 to 1/12/2010) and prospective (1/12/2010 to 31/7/2014) participant identification and a survey of UK stroke physicians. Seven hundred and thirteen ICH patients were admitted during the study period...
2015: BMJ Quality Improvement Reports
Susanne Lind, Jan Adolfsson, Bertil Axelsson, Carl Johan Fürst
BACKGROUND: All patients with palliative and end of life care needs should be guaranteed equal and safe treatment and care, regardless of their disease or site of care. The inclusion of quality indicators in national guidelines and other guiding documents supports quality assurance and improvement in provision of care. The aim of this paper was to review existing quality indicators in national Swedish policy documents relevant to palliative and end of life care. METHODS: We reviewed existing guidelines for diseases expected to require palliative care issued by the National Board of Health and Welfare, existing regional clinical practice guidelines and the annual report of the Swedish Register of Palliative Care (SRPC) up until 2010...
December 2015: BMJ Supportive & Palliative Care
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