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Palliative care in stroke

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https://www.readbyqxmd.com/read/29156917/advance-care-planning-for-patients-with-advanced-neurology-diseases
#1
Ka-Chi Cheung, Vikki Wai-Kee Lau, Ka-Chun Un, Man-Sheung Wong, Kwok-Ying Chan
BACKGROUND: Advanced neurology diseases including motor neuron disease (MND) are usually progressive life-limiting illness and could be devastating for patients, families and caregivers. Although medical technologies, such as enteral feeding and non-invasive ventilation, may prolong life expectancy of the patients, their utilization prompts important ethical questions in regard to their quality of life (QoL). Little attention had been paid on how ACP practice would practically help with patients suffering from different neurology diseases...
October 13, 2017: Annals of Palliative Medicine
https://www.readbyqxmd.com/read/29156908/enhanced-psychosocial-support-as-important-component-of-neuro-palliative-service
#2
Kwok-Ying Chan, Man-Lui Chan
There are unmet palliative care (PC) needs for psychosocial and spiritual distress of neurology patients such as bad stroke as well as in chronic neurodegenerative diseases. As such, psychosocial support to both patients and their caregivers should be enhanced in order to provide comprehensive neuro-PC. The first step in developing this type of support/program was to recognize the main psychosocial care needs of the population. Once these were determined, a program was specifically devised to meet those needs as efficiently and effectively as possible...
September 7, 2017: Annals of Palliative Medicine
https://www.readbyqxmd.com/read/29040110/racial-differences-in-palliative-care-use-after-stroke-in-majority-white-minority-serving-and-racially-integrated-u-s-hospitals
#3
Roland Faigle, Wendy C Ziai, Victor C Urrutia, Lisa A Cooper, Rebecca F Gottesman
OBJECTIVES: Racial/ethnic differences in palliative care resource use after stroke have been recognized, but it is unclear whether patient or hospital characteristics drive this disparity. We sought to determine whether palliative care use after intracerebral hemorrhage and ischemic stroke differs between hospitals serving varying proportions of minority patients. DESIGN: Population-based cross-sectional study. SETTING: Inpatient hospital admissions from the Nationwide Inpatient Sample between 2007 and 2011...
December 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28982489/palliative-care-in-neurology
#4
REVIEW
Maisha T Robinson, Robert G Holloway
Palliative medicine is a specialty that focuses on improving the quality of life for patients with serious or advanced medical conditions, and it is appropriate at any stage of disease, including at the time of diagnosis. Neurologic conditions tend to have high symptom burdens, variable disease courses, and poor prognoses that affect not only patients but also their families and caregivers. Patients with a variety of neurologic conditions such as Parkinson disease, dementia, amyotrophic lateral sclerosis, brain tumors, stroke, and acute neurologic illnesses have substantial unmet needs that can be addressed through a combination of primary and specialty palliative care...
October 2017: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/28923988/contemporary-management-of-cardiogenic-shock-a-scientific-statement-from-the-american-heart-association
#5
REVIEW
Sean van Diepen, Jason N Katz, Nancy M Albert, Timothy D Henry, Alice K Jacobs, Navin K Kapur, Ahmet Kilic, Venu Menon, E Magnus Ohman, Nancy K Sweitzer, Holger Thiele, Jeffrey B Washam, Mauricio G Cohen
Cardiogenic shock is a high-acuity, potentially complex, and hemodynamically diverse state of end-organ hypoperfusion that is frequently associated with multisystem organ failure. Despite improving survival in recent years, patient morbidity and mortality remain high, and there are few evidence-based therapeutic interventions known to clearly improve patient outcomes. This scientific statement on cardiogenic shock summarizes the epidemiology, pathophysiology, causes, and outcomes of cardiogenic shock; reviews contemporary best medical, surgical, mechanical circulatory support, and palliative care practices; advocates for the development of regionalized systems of care; and outlines future research priorities...
October 17, 2017: Circulation
https://www.readbyqxmd.com/read/28892278/reflection-on-stroke-deaths-and-end-of-life-stroke-care
#6
Syed Zujajuddin Quadri, Thang Huynh, Cecilia Cappelen-Smith, Nirupama Wijesuriya, Abul Mamun, Roy Beran, Alan Mcdougall, Dennis Cordato
BACKGROUND: The benefit of palliative care referral for severe stroke patients on end-of-life care pathways (EOLCP) is increasingly recognised. Palliative care provides assistance with symptom management and transition to end-of-life care. Advance care planning (ACP) may help accommodate patient/family expectations and guide management. METHOD: Retrospective study of all stroke deaths (2014-2015) at Liverpool Hospital, Sydney, Australia. Data examined included age, co-morbidities, living arrangements, pre-existing ACP, palliative care referral rates and 'survival time'...
September 11, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28846483/palliative-care-needs-in-an-acute-internal-medicine-ward-in-mexico
#7
Tania Zertuche-Maldonado, Rodrigo Tellez-Villarreal, Antonio Pascual, Salvador B Valdovinos-Chavez, Abel Jesus Barragan-Berlanga, Maria Teresa Sanchez-Avila, Leonardo Bracho-Vela, Adria Tinoco-Aranda, Eduardo Bruera
BACKGROUND: Palliative care is an evolving but underdeveloped practice in Mexico. OBJECTIVE: The primary end point of this prospective observational study was to identify internal medicine inpatients fulfilling advanced criteria within a second-level hospital. Secondary end points were symptom burden, treatment, resource utilization, and one-year survival. DESIGN AND MEASUREMENTS: The 390-sample size calculation was based on previous studies where 15% of inpatients fulfilled palliative care needs...
August 28, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28818864/palliative-care-for-hospitalized-patients-with-stroke-results-from-the-2010-to-2012-national-inpatient-sample
#8
Tarvinder Singh, Steven R Peters, David L Tirschwell, Claire J Creutzfeldt
BACKGROUND AND PURPOSE: Substantial variability exists in the use of life-prolonging treatments for patients with stroke, especially near the end of life. This study explores patterns of palliative care utilization and death in hospitalized patients with stroke across the United States. METHODS: Using the 2010 to 2012 nationwide inpatient sample databases, we included all patients discharged with stroke identified by International Classification of Diseases-Ninth Revision codes...
September 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28768356/-singultus-diagnostic-workup-and-therapy
#9
Ohlrich Marcus, Georg Royl
A hiccup is a reflex movement with diffusely distributed afferents and efferents in the thorax; its functional relevance is controversial. In its physiological form, it is mostly a minor complaint that stops spontaneously and rarely leads to medical consultation. However, prolonged agonizing hiccups represent serious deterioration of quality of life. Chronic hiccups by definition last for more than 48 h, with gastroesophageal reflux being the frequent underlying disease. Various other causes affect multiple organ systems, some with serious underlying diseases...
July 2017: Laryngo- Rhino- Otologie
https://www.readbyqxmd.com/read/28711755/palliative-care-clinicians-caring-for-patients-before-and-after-continuous-flow-left-ventricular-assist-device
#10
Sara E Wordingham, Colleen K McIlvennan, Timothy J Fendler, Amy L Behnken, Shannon M Dunlay, James N Kirkpatrick, Keith M Swetz
Left ventricular assist devices (LVADs) are an available treatment option for carefully selected patients with advanced heart failure. Initially developed as a bridge to transplantation, LVADs are now also offered to patients ineligible for transplantation as destination therapy (DT). Individuals with a DT-LVAD will live the remainder of their lives with the device in place. Although survival and quality of life improve with LVADs compared with medical therapy, complications persist including bleeding, infection, and stroke...
July 13, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28699144/palliative-care-needs-assessment-in-the-neuro-icu-effect-on-family
#11
Claire J Creutzfeldt, Marina G Hanna, C Sherry Cheever, Abhijit V Lele, Charles Spiekerman, Ruth A Engelberg, J Randall Curtis
BACKGROUND: Examine the association of a daily palliative care needs checklist on outcomes for family members of patients discharged from the neurosciences intensive care unit (neuro-ICU). METHODS: We conducted a prospective, longitudinal cohort study in a single, thirty-bed neuro-ICU in a regional comprehensive stroke and level 1 trauma center. One of two neuro-ICU services that admit patients to the same ICU on alternating days used a palliative care needs checklist during morning work rounds...
October 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28674685/risk-factors-prophylaxis-and-treatment-of-venous-thromboembolism-in-congenital-heart-disease-patients
#12
REVIEW
Michael Silvey, Leonardo R Brandão
Congenital heart disease (CHD) is a common condition in the pediatric population, affecting up to 1% of all live births (i.e., around 40,000 newborns/year in the United States). Although CHD does have a wide range of severity, by the age of 5 years approximately 80% of patients will require at least one surgical intervention to achieve a complete/palliative cardiac repair. Today, in light of their much-improved surgical survival, the care of these patients focuses on morbidity prevention and/or treatment...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/28659419/aggressiveness-of-care-following-intracerebral-hemorrhage-in-women-and-men
#13
MULTICENTER STUDY
Rahul Guha, Amelia Boehme, Stacie L Demel, Janet J Li, Xuemei Cai, Michael L James, Sebastian Koch, Carl D Langefeld, Charles J Moomaw, Jennifer Osborne, Padmini Sekar, Kevin N Sheth, E Woodrich, Bradford B Worrall, Daniel Woo, Seemant Chaturvedi
OBJECTIVE: To compare comorbidities and use of surgery and palliative care between men and women with intracerebral hemorrhage (ICH). METHODS: The Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study is a prospective, multicenter, case-control study of ICH risk factors and outcomes. We compared comorbidities, treatments, and use of do-not-resuscitate (DNR) orders in men vs women. Multivariate analysis was used to assess the likelihood of ICH surgery and palliative care after adjustment for variables that were p < 0...
July 25, 2017: Neurology
https://www.readbyqxmd.com/read/28590159/which-patients-die-in-their-preferred-place-a-secondary-analysis-of-questionnaire-data-from-bereaved-relatives
#14
Natasja Jh Raijmakers, Anke Je de Veer, Rosanne Zwaan, Jolien M Hofstede, Anneke L Francke
BACKGROUND: Previous studies on factors influencing the place of death have focused on cancer patients dying at home. However, home is not always the preferred place. AIM: To provide insight into the extent to which patients with various diseases die in their preferred place and into factors associated with dying in the preferred place. DESIGN: A secondary analysis of the data set of the evaluation study of the National Quality Improvement Programme for Palliative Care was undertaken to explore factors related to 'dying in the preferred place'...
June 1, 2017: Palliative Medicine
https://www.readbyqxmd.com/read/28578306/multiple-recurrent-ischaemic-strokes-in-a-patient-with-cancer-is-there-a-role-for-the-initiation-of-anticoagulation-therapy-for-secondary-stroke-prevention
#15
Giselle Alexandra Suero-Abreu, Jia Zhen Cheng, Ryna Karina Then
A 52-year-old woman with a medical history of cervical and thyroid cancer, hypertension, dyslipidaemia, uncontrolled diabetes and heavy smoking was diagnosed with a new metastatic cholangiocarcinoma. While undergoing palliative chemotherapy, she developed dysarthria and left-sided weakness. Imaging studies showed multiple bilateral ischaemic strokes. On hospital days 2 and 5, she developed worsening neurological symptoms and imaging studies revealed new areas of ischaemia on respective days. Subsequent workup did not revealed a clear aetiology for the multiple ischaemic events and hypercoagulability studies were only significant for a mildly elevated serum D-dimer level...
June 3, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28514888/seeing-is-believing-healthcare-professionals-perceptions-of-a-complex-intervention-to-improve-care-towards-the-end-of-life-a-qualitative-interview-study
#16
Katherine Bristowe, Irene Carey, Adrian Hopper, Susanna Shouls, Wendy Prentice, Irene J Higginson, Jonathan Koffman
BACKGROUND: Methods to improve care, trust and communication are important in acute hospitals. Complex interventions aimed at improving care of patients approaching the end of life are increasingly common. While evaluating outcomes of complex interventions is essential, exploring healthcare professionals' perceptions is also required to understand how they are interpreted; this can inform training, education and implementation strategies to ensure fidelity and consistency in use. AIM: To explore healthcare professionals' perceptions of using a complex intervention (AMBER care bundle) to improve care for people approaching the end of life and their understandings of its purpose within clinical practice...
May 1, 2017: Palliative Medicine
https://www.readbyqxmd.com/read/28449220/survival-functional-status-and-eating-ability-after-percutaneous-endoscopic-gastrostomy-tube-placement-for-acute-stroke
#17
Karl Meisel, Robert M Arnold, Irena Stijacic Cenzer, John Boscardin, Alexander K Smith
OBJECTIVES: To determine the long-term survival and independence of individuals with stroke and percutaneous endoscopic gastrostomy (PEG) tube placement. DESIGN: Retrospective cohort study. SETTING: A longitudinal nationally representative community-based sample of older adults. PARTICIPANTS: Individuals with stroke who had a PEG tube placed (N = 174, mean age 79, 51% female, 29% African American). MEASUREMENTS: Functional status before incident stroke was determined based on data from the Health and Retirement Study (HRS), a national longitudinal survey of community-dwelling older adults, from 1993 to 2012...
August 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28169104/-benchmarking-in-patient-identification-an-opportunity-to-learn
#18
R M Salazar-de-la-Guerra, A Santotomás-Pajarrón, V González-Prieto, M D Menéndez-Fraga, C Rocha Hurtado
OBJECTIVE: To perform a benchmarking on the safe identification of hospital patients involved in "Club de las tres C" (Calidez, Calidad y Cuidados) in order to prepare a common procedure for this process. MATERIAL AND METHODS: A descriptive study was conducted on the patient identification process in palliative care and stroke units in 5medium-stay hospitals. The following steps were carried out: Data collection from each hospital; organisation and data analysis, and preparation of a common procedure for this process...
February 3, 2017: Revista de Calidad Asistencial: Organo de la Sociedad Española de Calidad Asistencial
https://www.readbyqxmd.com/read/28152436/an-individualized-coaching-program-for-patients-with-acute-ischemic-stroke-feasibility-study
#19
P Vanacker, D Standaert, N Libbrecht, I Vansteenkiste, D Bernard, L Yperzeele, G Vanhooren
OBJECTIVES: An individualized stroke care program was developed to match patients' education with their needs regarding stroke knowledge, secondary prevention and rehabilitation. Our purpose was to assess feasibility of in-hospital and post-discharge, personalized stroke coaching service. METHODS: Acute ischemic stroke patients enrolled in ASTRAL-B stroke registry (Sint-Lucashospital, Bruges Belgium) with: (a) hospitalization between 12/2014-12/2015, (b) hospital-to-home discharge, and (c) without cognitive decline, were selected...
March 2017: Clinical Neurology and Neurosurgery
https://www.readbyqxmd.com/read/28135810/post-acute-care-facility-as-a-discharge-destination-for-patients-in-need-of-palliative-care-in-brazil
#20
Luiz Guilherme L Soares, André M Japiassu, Lucia C Gomes, Rogéria Pereira
Patients with complex palliative care needs can experience delayed discharge, which causes an inappropriate occupancy of hospital beds. Post-acute care facilities (PACFs) have emerged as an alternative discharge destination for some of these patients. The aim of this study was to investigate the frequency of admissions and characteristics of palliative care patients discharged from hospitals to a PACF. We conducted a retrospective analysis of PACF admissions between 2014 and 2016 that were linked to hospital discharge reports and electronic health records, to gather information about hospital-to-PACF transitions...
January 1, 2017: American Journal of Hospice & Palliative Care
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