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Palliative care in the ICU

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https://www.readbyqxmd.com/read/28917611/end-of-life-practice-patterns-at-u-s-adult-cystic-fibrosis-care-centers-a-national-retrospective-chart-review
#1
Elaine Chen, Karen Homa, Jessica Goggin, Kathryn A Sabadosa, Sarah Hempstead, Bruce C Marshall, Albert Faro, Elisabeth P Dellon
BACKGROUND: There are many challenges to providing end-of-life care (EOLC) to people with cystic fibrosis (CF). METHODS: Chart abstraction was used to examine EOLC in adults with CF who died between 2011 and 2013. RESULTS: We reviewed 248 deaths from 71 CF care centers. Median age at death was 29years (range 18-73). While median FEV1 was in the severe lung disease category (FEV1<40%), 38% had mild or moderate lung disease in the year preceding death...
September 13, 2017: Journal of Cystic Fibrosis: Official Journal of the European Cystic Fibrosis Society
https://www.readbyqxmd.com/read/28887270/temporal-trends-between-2010-and-2015-in-intensity-of-care-at-end-of-life-for-patients-with-chronic-illness-influence-of-age-under-versus-over-65-years
#2
Seelwan Sathitratanacheewin, Ruth A Engelberg, Lois Downey, Robert Y Lee, James A Fausto, Helene Starks, Ben Dunlap, James Sibley, William Lober, Elizabeth T Loggers, Nita Khandelwal, J Randall Curtis
CONTEXT: Recent analyses of Medicare data show decreases over time in intensity of end-of-life care. Few studies exist regarding trends in intensity of end-of-life care for those under 65. OBJECTIVES: To examine recent temporal trends in place of death, and both hospital and ICU utilization, for age-stratified decedents with chronic, life-limiting diagnoses (<65 versus ≥65 years) who received care in a large healthcare system. METHODS: Retrospective cohort using death certificates and electronic health records for 22,068 patients with chronic illnesses who died between 2010 and 2015...
September 5, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28864431/palliative-care-professional-development-for-critical-care-nurses-a-multicenter-program
#3
Wendy G Anderson, Kathleen Puntillo, Jenica Cimino, Janice Noort, Diana Pearson, Deborah Boyle, Michelle Grywalski, Jeannette Meyer, Edith O'Neil-Page, Julia Cain, Heather Herman, Susan Barbour, Kathleen Turner, Eric Moore, Solomon Liao, Bruce Ferrell, William Mitchell, Kyle Edmonds, Nathan Fairman, Denah Joseph, John MacMillan, Michelle M Milic, Monica Miller, Laura Nakagawa, David L O'Riordan, Christopher Pietras, Kathryn Thornberry, Steven Z Pantilat
BACKGROUND: Integrating palliative care into intensive care units (ICUs) requires involvement of bedside nurses, who report inadequate education in palliative care. OBJECTIVE: To implement and evaluate a palliative care professional development program for ICU bedside nurses. METHODS: From May 2013 to January 2015, palliative care advanced practice nurses and nurse educators in 5 academic medical centers completed a 3-day train-the-trainer program followed by 2 years of mentoring to implement the initiative...
September 2017: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
https://www.readbyqxmd.com/read/28859648/engaging-patients-and-families-to-create-a-feasible-clinical-trial-integrating-palliative-and-heart-failure-care-results-of-the-enable-chf-pc-pilot-clinical-trial
#4
Marie Bakitas, J Nicholas Dionne-Odom, Salpy V Pamboukian, Jose Tallaj, Elizabeth Kvale, Keith M Swetz, Jennifer Frost, Rachel Wells, Andres Azuero, Konda Keebler, Imatullah Akyar, Deborah Ejem, Karen Steinhauser, Tasha Smith, Raegan Durant, Alan T Kono
BACKGROUND: Early palliative care (EPC) is recommended but rarely integrated with advanced heart failure (HF) care. We engaged patients and family caregivers to study the feasibility and site differences in a two-site EPC trial, ENABLE CHF-PC (Educate, Nurture, Advise, Before Life Ends Comprehensive Heartcare for Patients and Caregivers). METHODS: We conducted an EPC feasibility study (4/1/14-8/31/15) for patients with NYHA Class III/IV HF and their caregivers in academic medical centers in the northeast and southeast U...
August 31, 2017: BMC Palliative Care
https://www.readbyqxmd.com/read/28806221/admission-to-intensive-care-for-palliative-care-or-potential-organ-donation-demographics-circumstances-outcomes-and-resource-use
#5
Andrew Melville, Gali Kolt, David Anderson, Joanna Mitropoulos, David Pilcher
OBJECTIVES: To describe the characteristics, circumstances, change over time, resource use, and outcomes of patients admitted to ICUs in Australia and New Zealand for the purposes of "palliative care of a dying patient" or "potential organ donation," and compare with actively managed ICU patients. DESIGN: A retrospective study of data from the Australian and New Zealand Intensive Care Society Adult Patient Database and a nested cohort analysis of a single center...
October 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28804862/oncological-patients-in-the-intensive-care-unit-prognosis-decision-making-therapies-and-end-of-life-care
#6
Ewelina Biskup, Fengfeng Cai, Marcus Vetter, Stephan Marsch
The effectiveness of intensive care unit (ICU) care for cancer patients remains controversial. Advances in antitumour and supportive care led to major improvements in outcomes of oncological patients in the ICU. Improved cancer therapies and supportive management of organ dysfunctions have contributed to improved survival rates. As a consequence, the number of cancer patients requiring ICU admission is rising. Frequently, cancer patients have a poor performance status and are vulnerable. It is a heterogeneous population, where the nature and curability of the neoplasm and the severity of critical illness cause a plethora of issues about ICU admissions...
August 14, 2017: Swiss Medical Weekly
https://www.readbyqxmd.com/read/28776144/-validation-of-medical-ethical-decisions-at-the-bedside-by-the-autopsy-experience-of-the-ethics-committee-at-the-stuttgart-clinic
#7
REVIEW
A Bosse, C Schupp
BACKGROUND: Ethics consultations in a clinical setting can be challenging, specifically with respect to limiting therapeutic interventions in terminally ill patients. Some decisions will even be controversial. OBJECTIVE: Can a clinical autopsy be used to confirm the recommendations given by the ethics committee, i. e. limitation of therapy to palliative care? MATERIAL AND METHODS: We report an exemplary case of a patient with endocarditis and subsequent septic cerebral infarction...
August 3, 2017: Der Pathologe
https://www.readbyqxmd.com/read/28711371/extubation-to-high-flow-nasal-cannula-in-critically-ill-surgical-patients
#8
Navpreet K Dhillon, Eric J T Smith, Ara Ko, Megan Y Harada, Danielle Polevoi, Richard Liang, Galinos Barmparas, Eric J Ley
BACKGROUND: High-flow nasal cannula (HFNC) is increasingly used to reduce reintubations in patients with respiratory failure. Benefits include providing positive end expiratory pressure, reducing anatomical dead space, and decreasing work of breathing. We sought to compare outcomes of critically ill surgical patients extubated to HFNC versus conventional therapy. METHODS: A retrospective review was conducted in the surgical intensive care unit of an academic center during August 2015 to February 2016...
July 12, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28707460/the-effect-of-hospice-consultation-on-aggressive-treatment-of-lung-cancer
#9
Shin Hye Yoo, Bhumsuk Keam, Miso Kim, Tae Min Kim, Dong-Wan Kim, Dae Seog Heo
Purpose: The aims of this study were to investigate trends of aggressive treatment of non-small cell lung cancer (NSCLC) patients at the end-of-life (EOL) during the recent five years and examine the relationship between hospice consultation (HC) and aggressive care. Materials and Methods: The medical records of 789 patients with stage IIIB-IV NSCLC at SNUH who received palliative chemotherapy and died from 2010 to 2014 were retrospectively reviewed. Indicators of aggressive treatment were evaluated, and the association of HC with these indicators was analyzed...
July 14, 2017: Cancer Research and Treatment: Official Journal of Korean Cancer Association
https://www.readbyqxmd.com/read/28701842/quality-of-dying-in-the-medical-intensive-care-unit-comparison-between-thai-buddhists-and-thai-muslims
#10
Veerapong Vattanavanit, Supattra Uppanisakorn, Rungsun Bhurayanontachai, Bodin Khwannimit
BACKGROUND AND AIMS: Religious belief is an important aspect that influences the life of a patient, especially in Asia. We aim to compare the quality of death in an Intensive Care Unit (ICU) between Buddhists and Muslims from the perspectives of the relatives of the patients and the nurses and physicians. SUBJECTS AND METHODS: This was a cohort study of critically ill patients who died after admission to a medical ICU in Songklanagarind Hospital in Thailand between 2015 and 2016...
June 2017: Indian Journal of Critical Care Medicine
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...
July 11, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28689992/characteristics-of-palliative-care-consultation-at-an-academic-level-one-trauma-center
#12
Emily B Rivet, Paula Ferrada, Tara Albrecht, J Brian Cassel, Beth Broering, Danielle Noreika, Egidio Del Fabbro
BACKGROUND: The current status of palliative care consultation for trauma patients has not been well characterized. We hypothesized that palliative care consultation currently is requested for patients too late to have any clinical significance. METHODS: A retrospective chart review was performed for traumatically injured patients' ≥18 years of age who received palliative care consultation at an academic medical center during a one-year period. RESULTS: The palliative care team evaluated 82 patients with a median age of 60 years...
June 28, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28658501/palliative-and-end-of-life-care-education-needs-of-nurses-across-inpatient-care-settings
#13
Deborah M Price, Linda Strodtman, Marcos Montagnini, Heather M Smith, Jillian Miller, Jennifer Zybert, Justin Oldfield, Tyler Policht, Bidisha Ghosh
BACKGROUND: Educating nurses about palliative and end-of-life (EOL) care is a high priority in health care settings. The purpose of this study was to assess nurses' perceived competency regarding the provision of palliative and EOL care to hospitalized patients. METHOD: This study surveyed nurses from 25 pediatric and adult acute and intensive care units (ICU; N = 583) Quantitative data analysis was descriptive and correlational. Qualitative data analysis identified themes of participant concerns...
July 1, 2017: Journal of Continuing Education in Nursing
https://www.readbyqxmd.com/read/28601143/psychiatric-and-palliative-care-in-the-intensive-care-unit
#14
REVIEW
Stephanie M Harman
Palliative care is specialized medical care focused on patients with serious illness and their families. In the intensive care unit (ICU), palliative care encompasses core skills to support patients and their families throughout their ICU course and post-ICU stays. Psychiatric symptoms are common among patients approaching the end of life and require particular attention in the setting of sedating medications, typically used when patients require ventilators and other life-sustaining treatments. For patients with preexisting severe mental illness who have a concurrent serious medical illness, a palliative psychiatric approach can address complex symptom management and support ethical and value-based shared decision making...
July 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28598196/derivation-and-validation-of-a-prognostic-model-to-predict-six-month-mortality-in-an-intensive-care-unit-population
#15
Sarah Hadique, Stacey Culp, Rahul G Sangani, Kyle D Chapman, Saad Khan, John E Parker, Alvin H Moss
RATIONALE: Identification of terminally ill patients in the intensive care unit (ICU) would facilitate decision making and timely palliative care. OBJECTIVE: To develop and validate a patient-specific integrated prognostic model to predict six-month mortality in medical ICU patients. METHODS: A longitudinal prospective cohort study of temporally split samples of 1049 consecutive Medical ICU patients in a tertiary care hospital was performed...
June 9, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28595447/therapeutic-suggestions-with-critically-ill-in-palliative-care
#16
Adrienn K Szilágyi, Zoltán Kekecs, Katalin Varga
Suggestions can be used without formal hypnosis, especially with critically ill patients, due to their spontaneous trance state. In this paper we outline data on the effectiveness of therapeutic suggestions. We interpret the possible mechanism of therapeutic suggestions in the context of stress cognition. Basic principles of formulating suggestions are discussed and some recommended versions of non-pharmacological pain control are provided. Case vignettes are given of how suggestions are used with critically ill ICU patients...
May 28, 2017: Annals of Palliative Medicine
https://www.readbyqxmd.com/read/28590164/care-of-the-critically-ill-burn-patient-an-overview-from-the-perspective-of-optimizing-palliative-care
#17
Daniel E Ray, Mohana B Karlekar, Donnelle L Crouse, Margaret Campbell, J Randall Curtis, Jeffrey Edwards, Dana R Lustbader, Anne C Mosenthal, Colleen Mulkerin, Kathleen A Puntillo, David E Weissman, Renee D Boss, Karen J Brasel, Judith E Nelson
Burn specialists have long recognized the need for and have role modeled a comprehensive approach incorporating relief of distress as part of care during critical illness. More recently, palliative care specialists have become part of the healthcare team in many U.S. hospitals, especially larger academic institutions that are more likely to have designated burn centers. No current literature describes the intersection of palliative care and burn care or integration of primary and specialist palliative care in this unique context...
July 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28589374/-integration-of-palliative-care-into-intensive-care-systematic-review
#18
K Adler, D Schlieper, D Kindgen-Milles, S Meier, J Schwartz, P van Caster, M S Schaefer, M Neukirchen
BACKGROUND: One of the prime aims of intensive care is to cure patients or at least to extend life duration, sometimes to the extent of losing quality of life. Palliative care aims to improve the quality of life of patients with life-limiting conditions; however, some patients need both intensive and palliative care. About 5-10% of all deaths in Germany and 20% of all deaths in the USA occur in an intensive care unit (ICU) and many of those as well as other patients may benefit from palliative care consultation...
June 6, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28509949/palliative-care-in-the-icu-of-2050-past-is-prologue
#19
Kusum S Mathews, Judith E Nelson
No abstract text is available yet for this article.
May 16, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28438584/strategies-for-enhancing-family-participation-in-research-in-the-icu-findings-from-a-qualitative-study
#20
Danae Dotolo, Elizabeth L Nielsen, J Randall Curtis, Ruth A Engelberg
CONTEXT: Family members of critically ill patients who participate in research focused on palliative care issues have been found to be systematically different from those who do not. These differences threaten the validity of research and raise ethical questions about worsening disparities in care by failing to represent diverse perspectives. OBJECTIVES: This study's aims were to explore: 1) barriers and facilitators influencing family members' decisions to participate in palliative care research; and 2) potential methods to enhance research participation...
August 2017: Journal of Pain and Symptom Management
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