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Palliative care emergency department

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https://www.readbyqxmd.com/read/29325441/five-year-experience-of-an-inpatient-palliative-care-unit-at-an-academic-referral-center
#1
Myrick C Shinall, Sara F Martin, Jill Nelson, Richard S Miller, Matthew W Semler, Eli E Zimmerman, Christy C Noblit, E Wesley Ely, Mohana Karlekar
BACKGROUND: Palliative care units (PCUs) staffed by specialty-trained physicians and nurses have been established in a number of medical centers. The purpose of this study is to review the 5-year experience of a PCU at a large, urban academic referral center. METHODS: We retrospectively reviewed a prospectively collected database of all admissions to the PCU at Vanderbilt University Medical Center in the first 5 years of its existence, from 2012 through 2017. RESULTS: Over these 5 years, there were 3321 admissions to the PCU...
January 1, 2018: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/29277163/criterion-validity-and-inter-rater-reliability-of-a-palliative-care-screening-tool-for-patients-admitted-to-an-emergency-department-intensive-care-unit
#2
Sabrina Corrêa da Costa Ribeiro, Ricardo Tavares de Carvalho, Juraci Aparecida Rocha, Roger Daglius Dias
OBJECTIVE: The use of palliative care (PC) screening criteria to trigger PC consultations may optimize the utilization of PC services, improve patient comfort, and reduce invasive and futile end-of-life care. The aim of the present study was to assess the criterion validity and inter-rater reliability of a PC screening tool for patients admitted to an emergency department intensive care unit (ED-ICU). METHOD: Observational retrospective study evaluating PC screening criteria based on the presence of advanced diagnosis and the use of two "surprise questions" (traditional and modified)...
December 26, 2017: Palliative & Supportive Care
https://www.readbyqxmd.com/read/29247265/end-of-life-care-pathway-of-head-and-neck-cancer-patients-single-institution-experience
#3
T Heinonen, V Loimu, K Saarilahti, T Saarto, A Mäkitie
BACKGROUND: Studies on palliative care of head and neck cancer (HNC) patients are scarce although the affected patient population is quite large. OBJECTIVE: To evaluate the role of a specialised palliative-care pathway of HNC patients. PATIENTS AND METHODS: Data on all HNC patients who were treated at the Helsinki University Hospital Palliative Care Center during 1 year were retrospectively reviewed. The analysis comprised 60 patients (49 males; mean age 67 years; range 28-88)...
December 15, 2017: European Archives of Oto-rhino-laryngology
https://www.readbyqxmd.com/read/29237654/investigating-the-effect-of-sociodemographic-factors-on-30-day-hospital-readmission-among-medical-patients-in-toronto-canada-a-prospective-cohort-study
#4
Robert W Smith, Kerry Kuluski, Andrew P Costa, Samir K Sinha, Richard H Glazier, Alan Forster, Lianne Jeffs
OBJECTIVE: To examine the influence of patient-level sociodemographic factors on the incidence of hospital readmission within 30 days among medical patients in a large Canadian metropolitan city. DESIGN: Prospective cohort study. SETTING AND PARTICIPANTS: Patients admitted to the General Internal Medicine service of an urban teaching hospital in Toronto, Canada participated in a survey of sociodemographic information. Patients were not surveyed if deemed medically unstable, receiving care in medical/surgical step-down beds or were isolated for infection control...
December 12, 2017: BMJ Open
https://www.readbyqxmd.com/read/29230475/improving-decisions-about-transport-to-the-emergency-department-for-assisted-living-residents-who-fall
#5
Jefferson G Williams, Michael W Bachman, Michael D Lyons, Benjamin B Currie, Lawrence H Brown, A Wooten Jones, Jose G Cabanas, Alan K Kronhaus, J Brent Myers
Background: Residents of assisted living facilities who fall may not be seriously ill or injured, but policies often require immediate transport to an emergency department regardless of the patient's condition. Objective: To determine whether unnecessary transport can be avoided. Design: Prospective cohort study. Setting: One large county with a single system of emergency medical services. Participants: Convenience sample of residents in 22 assisted living facilities served by 1 group of primary care physicians...
December 12, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/29229301/earlier-initiation-of-community-based-palliative-care-is-associated-with-fewer-unplanned-hospitalisations-and-emergency-department-presentations-in-the-final-months-of-life-a-population-based-study-amongst-cancer-decedents
#6
Cameron M Wright, David Youens, Rachael E Moorin
CONTEXT: While community-based palliative care (CPC) is associated with decreased acute care use in the lead up to death, it is unclear how the timing of CPC initiation affects this association. OBJECTIVES: We aimed to explore the association between timing of CPC initiation and hospital use, over the final 1, 3, 6 and 12 months of life. METHODS: We conducted a retrospective, population-based study in Perth, Western Australia. Linked administrative data including cancer registry, mortality, hospital admissions, emergency department (ED) and CPC records were obtained for cancer decedents from 1 January 2001 to 31 December 2011...
December 8, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/29206564/advance-care-planning-in-an-accountable-care-organization-is-associated-with-increased-advanced-directive-documentation-and-decreased-costs
#7
William F Bond, Minchul Kim, Chris M Franciskovich, Jason E Weinberg, Jessica D Svendsen, Linda S Fehr, Amy Funk, Robert Sawicki, Carl V Asche
BACKGROUND: Advance care planning (ACP) documents patient wishes and increases awareness of palliative care options. OBJECTIVE: To study the association of outpatient ACP with advanced directive documentation, utilization, and costs of care. DESIGN: This was a case-control study of cases with ACP who died matched 1:1 with controls. We used 12 months of data pre-ACP/prematch and predeath. We compared rates of documentation with logit model regression and conducted a difference-in-difference analysis using generalized linear models for utilization and costs...
December 5, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29205442/palliative-care-for-end-of-life-patients-in-a-basic-emergency-service
#8
REVIEW
Maria Eduarda Diniz Pereira, António Barbosa, Maria Dos Anjos Dixe
This research sought to describe the care provided by the nursing staff of the Western Department of the Basic Emergency Service for end-of-life patients. This was a retrospective, quantitative, exploratory and descriptive (level I) study, which sought to research the nursing records of 83 patients from admission to death. Patients who met the following inclusion criteria were considered eligible: adults; had an oncological or nononcological, advanced and irreversible chronic disease; and died in the Basic Emergency Service in the period from January 2011 to December 2012...
December 5, 2017: Scandinavian Journal of Caring Sciences
https://www.readbyqxmd.com/read/29199858/what-do-humanitarian-emergency-organizations-do-about-palliative-care-a-systematic-review
#9
Martin Schneider, Sophie Pautex, François Chappuis
BACKGROUND: Humanitarian emergency organizations have only recently integrated care for non-communicable diseases into their relief action. The needs for palliative care in emergencies are still largely unmet. OBJECTIVE: A systematic review of health programmes run by international humanitarian organizations that take palliative care and/or enhanced pain control into account. METHODS: Electronic databases were searched for publications of health programmes providing palliative care and/or enhanced pain control in emergency situations...
December 4, 2017: Medicine, Conflict, and Survival
https://www.readbyqxmd.com/read/29186782/forging-a-frailty-ready-healthcare-system-to-meet-population-ageing
#10
Wee Shiong Lim, Sweet Fun Wong, Ian Leong, Philip Choo, Weng Sun Pang
The beginning of the 21st century has seen health systems worldwide struggling to deliver quality healthcare amidst challenges posed by ageing populations. The increasing prevalence of frailty with older age and accompanying complexities in physical, cognitive, social and psychological dimensions renders the present modus operandi of fragmented, facility-centric, doctor-based, and illness-centered care delivery as clearly unsustainable. In line with the public health framework for action in the World Health Organization's World Health and Ageing Report, meeting these challenges will require a systemic reform of healthcare delivery that is integrated, patient-centric, team-based, and health-centered...
November 24, 2017: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/29170321/24%C3%A2-an-audit-into-the-number-of-patients-suffering-out-of-hospital-cardiac-arrest-that-are-resuscitated-despite-a-high-likelihood-of-futility
#11
Mia Cokljat, Gareth Clegg, Scott Clarke
BACKGROUND: For a significant number of patients suffering out-of-hospital cardiac arrest (OHCA) cardiopulmonary resuscitation (CPR) is likely to be futile and attempting it may be the wrong thing to do. Anticipatory care plans with do-not-attempt cardiopulmonary resuscitation (DNACPR) instructions exist to prevent this. Anecdotally we felt that many patients present to our Emergency Department (ED) with ongoing resuscitation which was not in their best interests. The aim of this study was to establish the proportion of patients arriving in our ED with ongoing CPR who had low, intermediate or high risk of futility...
December 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29162145/reducing-hospital-admissions-in-remote-australia-through-the-establishment-of-a-palliative-and-chronic-disease-respite-facility
#12
Timothy A Carey, Mick Arundell, Kellie Schouten, John S Humphreys, Fred Miegel, Simon Murphy, John Wakerman
BACKGROUND: There are limited respite services for palliative care patients and their families in the Northern Territory (NT). The high prevalence of complex chronic diseases, limited access to primary care services, and the poor living situations of many Aboriginal and Torres Strait Islander Australians result in high hospitalisation rates and pressure on tertiary health services. Palliative Care NT identified a need for a flexible, community based, culturally appropriate respite service in Alice Springs...
November 21, 2017: BMC Palliative Care
https://www.readbyqxmd.com/read/29153752/hospice-care-for-patients-with-dementia-in-the-united-states-a-longitudinal-cohort-study
#13
Aline De Vleminck, R Sean Morrison, Diane E Meier, Melissa D Aldridge
BACKGROUND: Patients with dementia form an increasing proportion of those entering hospice care. Little is known about the types of hospices serving patients with dementia and the patterns of hospice use, including timing of hospice disenrollment between patients with and without dementia. OBJECTIVES: To characterize the hospices that serve patients with dementia, to compare patterns of hospice disenrollment for patients with dementia and without dementia, and to evaluate patient-level and hospice-level characteristics associated with hospice disenrollment...
November 16, 2017: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/29130378/the-experiences-of-patients-with-advanced-cancer-and-caregivers-presenting-to-emergency-departments-a-qualitative-study
#14
Jennifer Philip, Cheryl Remedios, Sibilah Breen, Tracey Weiland, Lisa Willenberg, Mark Boughey, George Jelinek, Heather Lane, Claudia Marck, Jennifer Weil
BACKGROUND: Despite being a common event in the course of an advanced cancer illness, there is little understanding of patients' perceptions of hospital Emergency Department presentations. AIM: To explore the experiences and perceptions of Emergency Departments held by patients with advanced cancer and their informal caregivers. DESIGN: Cross-sectional study involving semi-structured interviews with advanced cancer patients and their informal caregivers...
October 1, 2017: Palliative Medicine
https://www.readbyqxmd.com/read/29123340/the-palliative-performance-scale-predicts-survival-among-emergency-department-patients-minia-egypt
#15
Amany Edward Seedhom, Nashwa Nabil Kamal
Background: Emergency department (ED) physicians provide care to patients with a wide range of prognoses, and must develop care plans that anticipate patient's survival. However, the tools available to guide care planning had limited data to support their use. There is a new concern to understand if palliative care (PC) should be offered in the ED and the Palliative Performance Scale (PPS), a screening tool used in other settings in PC, has been little used in the ED. Aim: The aim of this study is to assess the prognostic value of the PPS in predicting 1, 3 and 6 months survival in patients admitted through the ED...
October 2017: Indian Journal of Palliative Care
https://www.readbyqxmd.com/read/29105289/predictors-of-care-for-patients-with-cancer-of-unknown-primary-site-in-three-australian-hospitals
#16
Simon Y S Tan, Siobhan O'Neill, David Goldstein, Robyn L Ward, Benjamin Daniels, Claire M Vajdic
AIM: Cancer of unknown primary site (CUP) is a medically challenging malignancy with a poor prognosis. We describe an incident tertiary CUP patient cohort and identify factors predictive of specific types of health care. METHODS: We reviewed the medical records of 217 patients diagnosed with CUP (2006-2011) in three public hospitals in New South Wales, Australia. We systematically abstracted data and performed multivariable logistic regression to identify factors predictive of tumor biopsy, surgery, chemotherapy, radiotherapy and palliative care...
November 3, 2017: Asia-Pacific Journal of Clinical Oncology
https://www.readbyqxmd.com/read/29088916/managing-pain-in-patients-with-chronic-medical-illnesses-and-serious-mental-illnesses
#17
Sean O'Mahony, Steven Bines, James Gerhart, Erin Bagwell, McHugh Marlene, Ariel Card
OBJECTIVES: This study investigated the use of opioid treatment plans that included the implementation of opioid dependence risk with a validated screening tool and opioid dependence risk tool (UDT) in a noncancer palliative pain clinic. METHODS: We retrospectively reviewed the medical records for diagnostic information, information on analgesic medications, daily morphine equivalent dose, presence of pain management agreements and opioid dependence risk tools (ORT), and UDT...
January 1, 2017: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/29033602/early-in-hospital-clinical-deterioration-is-not-predicted-by-severity-of-illness-functional-status-or-comorbidity
#18
Janice Wang, Stella S Hahn, Myriam Kline, Rubin I Cohen
BACKGROUND: Prior studies concentrated on unplanned intensive care unit (ICU) transfer to gauge deterioration occurring shortly following hospital admission. However, examining only ICU transfers is not ideal since patients could stabilize with treatment, refuse ICU admission, or not require ICU evaluation. To further explore etiologies of early clinical deterioration, we used rapid response team (RRT) activation within 48 hours of admission as an index of early clinical worsening. METHODS: A retrospective analysis of prospectively gathered admissions from the emergency department in an academic medical center was done...
2017: International Journal of General Medicine
https://www.readbyqxmd.com/read/29019887/factors-predicting-a-home-death-among-home-palliative-care-recipients
#19
Ming-Chung Ko, Sheng-Jean Huang, Chu-Chieh Chen, Yu-Ping Chang, Hsin-Yi Lien, Jia-Yi Lin, Lin-Chung Woung, Shang-Yih Chan
Awareness of factors affecting the place of death could improve communication between healthcare providers and patients and their families regarding patient preferences and the feasibility of dying in the preferred place.This study aimed to evaluate factors predicting home death among home palliative care recipients.This is a population-based study using a national representative sample retrieved from the National Health Insurance Research Database. Subjects receiving home palliative care, from 2010 to 2012, were analyzed to evaluate the association between a home death and various characteristics related to illness, individual, and health care utilization...
October 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28987298/palliative-care-symptom-management-in-the-emergency-department-the-abc-s-of-symptom-management-for-the-emergency-physician
#20
Mari Siegel, Suzanne Bigelow
BACKGROUND: Palliative care is a rapidly evolving area of emergency medicine. With an estimated 5,000 to 10,000 baby boomers per day reaching retirement age, emergency departments (EDs) are treating more patients with chronic and serious disease. Palliative care offers comprehensive care for patients with advanced medical illness, aims to alleviate suffering and improve quality of life, and plays an important role in caring for these patients in the ED. OBJECTIVES: We sought to increase the emergency physician's knowledge of and comfort with symptom control in palliative and hospice patients...
October 5, 2017: Journal of Emergency Medicine
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