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https://www.readbyqxmd.com/read/28922625/living-and-dying-with-advanced-dementia-a-prospective-cohort-study-of-symptoms-service-use-and-care-at-the-end-of-life
#1
Elizabeth L Sampson, Bridget Candy, Sarah Davis, Anna Buylova Gola, Jane Harrington, Michael King, Nuriye Kupeli, Gerry Leavey, Kirsten Moore, Irwin Nazareth, Rumana Z Omar, Victoria Vickerstaff, Louise Jones
BACKGROUND: Increasing number of people are dying with advanced dementia. Comfort and quality of life are key goals of care. AIMS: To describe (1) physical and psychological symptoms, (2) health and social care service utilisation and (3) care at end of life in people with advanced dementia. DESIGN: 9-month prospective cohort study. SETTING AND PARTICIPANTS: Greater London, England, people with advanced dementia (Functional Assessment Staging Scale 6e and above) from 14 nursing homes or their own homes...
August 1, 2017: Palliative Medicine
https://www.readbyqxmd.com/read/28922291/population-based-models-of-planning-for-palliative-care-in-older-people
#2
David C Currow, Jane Phillips, Meera Agar
PURPOSE OF REVIEW: Health service planning requires demographic, clinical, and health systems data and is unique to each health system. Planning for palliative care in older people must include patients and their carers. This review explores literature from the last 24 months. RECENT FINDINGS: The proportion of people living in skilled nursing facilities is increasing and many residents require quality palliative care. Simultaneously, the complexity of care for older people is also increasing...
September 16, 2017: Current Opinion in Supportive and Palliative Care
https://www.readbyqxmd.com/read/28919394/concomitant-chemotherapy-and-radiotherapy-with-sbrt-boost-for-unresectable-stage-iii-non-small-cell-lung-cancer-a-phase-i-study
#3
Kristin A Higgins, Rathi N Pillai, Zhengjia Chen, Sibo Tian, Chao Zhang, Pretesh Patel, Suchita Pakkala, Jay Shelton, Seth D Force, Felix G Fernandez, Conor E Steuer, Taofeek K Owonikoko, Suresh S Ramalingam, Jeffrey D Bradley, Walter J Curran
PURPOSE: Stereotactic Body Radiation Therapy (SBRT) is now the standard of care in medically inoperable stage I non-small cell lung cancer, yielding high rates of local control. It is unknown if SBRT can be safely utilized in the locally advanced NSCLC setting. This multi-institution phase I study evaluated the safety of 44 Gy conventionally fractionated thoracic radiation with concurrent chemotherapy plus a dose escalated SBRT boost to both the primary tumor and involved mediastinal lymph nodes...
September 12, 2017: Journal of Thoracic Oncology
https://www.readbyqxmd.com/read/28918906/radiotherapy-and-the-tumor-microenvironment-the-macro-picture
#4
EDITORIAL
Emma Louise Walton
In this issue of the Biomedical Journal, we explore the inner workings of tumor-associated macrophages and seek to understand how these cells can boost or limit the efficacy of radiotherapy, depending on the context. We also highlight a study revealing that staffing patterns in the intensive care unit may affect the outcome of patients with severe sepsis. Finally, we learn how an advanced imaging technique can improve endodontic treatment planning.
August 2017: Biomedical Journal
https://www.readbyqxmd.com/read/28918550/advance-care-planning-challenges-at-the-emergency-department-of-a-cancer-care-center
#5
Maria T Cruz-Carreras, Patrick Chaftari, Jayne Viets-Upchurch
INTRODUCTION: Code status discussions form an important part of advance care planning (ACP) as it enables physicians to respect the patient's wishes for end-of-life care. However, in some cases, code status discussions can be challenging causing the physician to go against the patient's wishes and the code of medical ethics. This is especially true in an emergency setting. In this paper, we will discuss three cases of advanced cancer patients, where code status discussions posed challenges to healthcare providers...
September 16, 2017: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/28918387/prospective-comparative-effectiveness-cohort-study-comparing-two-models-of-advance-care-planning-provision-for-australian-community-aged-care-clients
#6
Karen Margaret Detering, Rachel Zoe Carter, Marcus William Sellars, Virginia Lewis, Elizabeth Anne Sutton
OBJECTIVES: Conduct a prospective comparative effectiveness cohort study comparing two models of advance care planning (ACP) provision in community aged care: ACP conducted by the client's case manager (CM) ('Facilitator') and ACP conducted by an external ACP service ('Referral') over a 6-month period. METHODS: This Australian study involved CMs and their clients. Eligible CM were English speaking, ≥18 years, had expected availability for the trial and worked ≥3 days per week...
September 16, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28917611/end-of-life-practice-patterns-at-u-s-adult-cystic-fibrosis-care-centers-a-national-retrospective-chart-review
#7
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/28913697/developing-a-post-treatment-survivorship-care-plan-to-help-breast-cancer-survivors-understand-their-fertility
#8
Jessica R Gorman, Anne K Julian, Samantha A Roberts, Sally A D Romero, Jennifer L Ehren, Michael L Krychman, Sarah G Boles, Jun Mao, H Irene Su
PURPOSE: Reproductive-aged breast cancer survivors (BCS) who have completed initial cancer treatment frequently want to know about their future fertility potential. The purpose of this qualitative study was to assess if the fertility-related content presented in the survivorship care plan prototype met the informational needs of post-treatment BCS and to provide an opportunity for the target audience to review and react to the proposed content and design. METHODS: We conducted and analyzed transcripts from seven focus groups with BCS to evaluate their reactions to the survivorship care plan prototype...
September 14, 2017: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/28901973/identifying-palliative-care-needs-in-people-with-dementia
#9
Mari Lloyd-Williams, Caroline Mogan, Karen Harrison Dening
PURPOSE OF REVIEW: Dementia is now recognized as a progressive life-limiting illness where many patients can benefit from access to palliative care. RECENT FINDINGS: The present review has focused on three areas namely, advanced care planning in supporting palliative care for dementia, hospice provision for people with dementia and provision of care within family home. In advanced care planning, there is little research on systematically developed and implemented advance care planning interventions or whether they achieve desired outcomes for end-of-life care...
September 8, 2017: Current Opinion in Supportive and Palliative Care
https://www.readbyqxmd.com/read/28898796/transjugular-biopsy-case-report-of-inferior-vena-cava-hepatocellular-carcinoma-with-intracardiac-extension
#10
Laurence Weinberg, Diana Abu-Ssaydeh, Chris Macgregor, Jason Wang, Clarence Wong, Manfred Spanger, Vijayragavan Muralidharan
BACKGROUND: Diagnosis of hepatocellular carcinoma (HCC) can be established with near certainty by correlating radiological imaging with clinical presentation. However, in the absence of diagnostic certainty, biopsy of liver tissue is mandatory for optimal management. We present our management of a patient with advanced liver disease who presented with an IVC mass extending into the right atrium, with co-existing liver lesions not meeting criteria for an imaging diagnosis of HCC. CASE PRESENTATION: A 62-year-old male with Child-Pugh C liver cirrhosis presented with decompensated liver failure...
September 5, 2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/28898605/the-team-approach-to-improving-oncology-outcomes-by-incorporating-palliative-care-in-practice
#11
Marie A Bakitas, Areej El-Jawahri, Morag Farquhar, Betty Ferrell, Corita Grudzen, Irene Higginson, Jennifer S Temel, Camilla Zimmermann, Thomas J Smith
Palliative care (PC) concurrent with usual oncology care is now the standard of care that is recommended for any patient with advanced cancer to begin within 8 weeks of diagnosis on the basis of evidence-driven national clinical practice guidelines; however, there are not enough interdisciplinary palliative care teams to provide such care. How and what can an oncology office incorporate into usual care, borrowing the tools used in PC randomized clinical trials (RCTs), to improve care for patients and their caregivers? We reviewed the multiple RCTs for common practical elements and identified methods and techniques that oncologists can use to deliver some parts of concurrent interdisciplinary PC...
September 2017: Journal of Oncology Practice
https://www.readbyqxmd.com/read/28892602/locating-advance-care-planning-facilitators-in-general-practice-increases-consumer-participation
#12
Jill Mann, Stephen D Gill, Lisa Mitchell, Margaret J Rogers, Peter Martin, Frances Quirk, Charlie Corke
BACKGROUND: Advance care planning (ACP) can positively affect end-of-life care experiences. However, uptake of ACP completion is low. The aim of this study was to investigate whether co-locating ACP facilitators in general practice increased participation METHODS: Barwon Health commenced promoting its ACP program in 2008. Trained ACP facilitators assisted consumers, which usually occurred in the program's community-based consulting rooms. From 2012 onwards, ACP facilitators were co-located with 18 general practices, where they assisted consumers at the point of care...
September 2017: Australian Family Physician
https://www.readbyqxmd.com/read/28892278/reflection-on-stroke-deaths-and-end-of-life-stroke-care
#13
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/28891406/clinical-practice-guideline-evaluation-of-the-neck-mass-in-adults
#14
Melissa A Pynnonen, M Boyd Gillespie, Benjamin Roman, Richard M Rosenfeld, David E Tunkel, Laura Bontempo, Itzhak Brook, Davoren Ann Chick, Maria Colandrea, Sandra A Finestone, Jason C Fowler, Christopher C Griffith, Zeb Henson, Corinna Levine, Vikas Mehta, Andrew Salama, Joseph Scharpf, Deborah R Shatzkes, Wendy B Stern, Jay S Youngerman, Maureen D Corrigan
Objective Neck masses are common in adults, but often the underlying etiology is not easily identifiable. While infections cause most of the neck masses in children, most persistent neck masses in adults are neoplasms. Malignant neoplasms far exceed any other etiology of adult neck mass. Importantly, an asymptomatic neck mass may be the initial or only clinically apparent manifestation of head and neck cancer, such as squamous cell carcinoma (HNSCC), lymphoma, thyroid, or salivary gland cancer. Evidence suggests that a neck mass in the adult patient should be considered malignant until proven otherwise...
September 2017: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/28887268/association-of-advance-directives-completion-with-the-utilization-of-life-sustaining-treatments-during-the-end-of-life-care-in-older-patients
#15
Yung-Feng Yen, Li-Ying Huang, Hsiao-Yun Hu, Wen-Jung Sun, Ming-Chung Ko, Ya-Ling Lee, Sheng-Jean Huang, Dachen Chu
CONTEXT: Evidence is mixed regarding the impact of advance directives (AD) on the utilisation of end-of-life treatments. OBJECTIVES: This study evaluated the effect of AD on the utilization of end-of-life treatments during the last month of life in older patients. METHODS: Taipei City Hospital initiated an advance care planning (ACP) program to promote AD for admitted patients in 2015. This prospective study recruited deceased older patients who completed ACP communication between 2015 and 2016...
September 5, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28885989/the-role-of-health-information-technology-in-advancing-care-management-and-coordination-in-accountable-care-organizations
#16
Frances M Wu, Stephen M Shortell, Thomas G Rundall, Joan R Bloom
BACKGROUND: To be successful, accountable care organizations (ACOs) must effectively manage patient care. Health information technology (HIT) can support care delivery by providing various degrees of coordination. Few studies have examined the role of HIT functionalities or the role of different levels of coordination enabled by HIT on care management processes. PURPOSES: We examine HIT functionalities in ACOs, categorized by the level of coordination they enable in terms of information and work flow, to determine which specific HIT functionalities and levels of coordination are most strongly associated with care management processes...
October 2017: Health Care Management Review
https://www.readbyqxmd.com/read/28884703/definition-and-recommendations-for-advance-care-planning-an-international-consensus-supported-by-the-european-association-for-palliative-care
#17
REVIEW
Judith A C Rietjens, Rebecca L Sudore, Michael Connolly, Johannes J van Delden, Margaret A Drickamer, Mirjam Droger, Agnes van der Heide, Daren K Heyland, Dirk Houttekier, Daisy J A Janssen, Luciano Orsi, Sheila Payne, Jane Seymour, Ralf J Jox, Ida J Korfage
Advance care planning (ACP) is increasingly implemented in oncology and beyond, but a definition of ACP and recommendations concerning its use are lacking. We used a formal Delphi consensus process to help develop a definition of ACP and provide recommendations for its application. Of the 109 experts (82 from Europe, 16 from North America, and 11 from Australia) who rated the ACP definitions and its 41 recommendations, agreement for each definition or recommendation was between 68-100%. ACP was defined as the ability to enable individuals to define goals and preferences for future medical treatment and care, to discuss these goals and preferences with family and health-care providers, and to record and review these preferences if appropriate...
September 2017: Lancet Oncology
https://www.readbyqxmd.com/read/28882812/health-information-technology-hit-adaptation-refocusing-on-the-journey-to-successful-hit-implementation
#18
Po-Yin Yen, Ann Scheck McAlearney, Cynthia J Sieck, Jennifer L Hefner, Timothy R Huerta
In past years, policies and regulations required hospitals to implement advanced capabilities of certified electronic health records (EHRs) in order to receive financial incentives. This has led to accelerated implementation of health information technologies (HIT) in health care settings. However, measures commonly used to evaluate the success of HIT implementation, such as HIT adoption, technology acceptance, and clinical quality, fail to account for complex sociotechnical variability across contexts and the different trajectories within organizations because of different implementation plans and timelines...
September 7, 2017: JMIR Medical Informatics
https://www.readbyqxmd.com/read/28881249/cost-effectiveness-analysis-of-pet-ct-guided-management-for-locally-advanced-head-and-neck-cancer
#19
A F Smith, P S Hall, C T Hulme, J A Dunn, C C McConkey, J K Rahman, C McCabe, H Mehanna
BACKGROUND: A recent large United Kingdom (UK) clinical trial demonstrated that positron-emission tomography-computed tomography (PET-CT)-guided administration of neck dissection (ND) in patients with advanced head and neck cancer after primary chemo-radiotherapy treatment produces similar survival outcomes to planned ND (standard care) and is cost-effective over a short-term horizon. Further assessment of long-term outcomes is required to inform a robust adoption decision. Here we present results of a lifetime cost-effectiveness analysis of PET-CT-guided management from a UK secondary care perspective...
September 4, 2017: European Journal of Cancer
https://www.readbyqxmd.com/read/28880145/-dementia-care-in-germany
#20
M H van der Vaart
In Germany there are approximately 1.6 million people with dementia. A quarter of them live in a care home, often alongside residents who have a physical condition. The quality of nursing for physical conditions is good; although specialised dementia care is less developed, this lag is slowly being addressed. Medical care in German care homes is delivered by GPs. Preservation of life is the norm. Due to the lack of both advance care planning and a non-resuscitation policy, many care home residents with dementia undergo life-extending measures...
2017: Nederlands Tijdschrift Voor Geneeskunde
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