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Palliative care emergency department

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https://www.readbyqxmd.com/read/28813627/the-impact-on-resource-utilization-of-supportive-care-consults-on-patients-at-the-university-of-north-carolina-hospital-2010-2012
#1
Kristen Westfall, Dominic Moore, Matthew Meeneghan, Sandra Jarr, John Valgus, Stephen Bernard
BACKGROUND: Cancer patients have a high rate of emergency department (ED) visits and inpatient hospitalizations (IHs) that may be reduced by use of outpatient palliative care services. OBJECTIVE: To determine whether the outpatient adult palliative care service at the University of North Carolina (UNC) Hospital, begun in 2008, reduced the frequency of ED visits and IH during a two-year period. DESIGN: The charts of patients with lung cancer or head and neck cancer seen by the supportive care service from 2010 to 2011, and of a contemporaneous set of potential consults that were not seen, were retrospectively reviewed to determine the impact of this care delivery model...
August 16, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28796559/improvements-in-patient-and-health-system-outcomes-using-an-integrated-oncology-and-palliative-medicine-approach-on-a-solid-tumor-inpatient-service
#2
Richard F Riedel, Kim Slusser, Steve Power, Christopher A Jones, Thomas W LeBlanc, Arif H Kamal, Devi Desai, Deborah Allen, Yinxi Yu, Steven Wolf, Anthony N Galanos
PURPOSE: Early palliative care (PC) improves outcomes for outpatients with advanced cancer. Its effect on hospitalized patients with cancer is unknown. Herein, we report on the influence of a novel, fully integrated inpatient medical oncology and PC partnership at a tertiary medical center during its first year of implementation. METHODS: We conducted a retrospective, longitudinal, pre- and postintervention cohort study at Duke University Hospital. Pre- and postintervention cohorts were defined as all patients admitted to the solid tumor inpatient service from September 1, 2009, to June 30, 2010, and September 1, 2011 to June 30, 2012, respectively...
August 10, 2017: Journal of Oncology Practice
https://www.readbyqxmd.com/read/28754440/to-intubate-or-not-to-intubate-emergency-medicine-physicians-perspective-on-intubating-critically-ill-terminal-cancer-patients
#3
Kenneth Kim, Bharath Chakravarthy, Craig Anderson, Solomon Liao
CONTEXT: Emergency Physicians (EPs) often need to make a decision whether or not to intubate a terminal cancer patient. OBJECTIVE: To explore EPs' attitudes about intubating critically ill, terminal cancer patients. METHODS: Fifty EPs at three emergency departments (one university-based, one community, and one HMO) in Southern California participated in an anonymous survey that presented a hypothetical case of an end-stage lung cancer patient in pending respiratory failure...
July 25, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28721899/gaps-in-radiation-therapy-awareness-results-from-an-educational-multi-institutional-survey-of-us-internal-medicine-residents
#4
MULTICENTER STUDY
Narek Shaverdian, Sun Mi Yoo, Ryan Cook, Eric M Chang, Naomi Jiang, Ye Yuan, Kiri Sandler, Michael Steinberg, Percy Lee
PURPOSE: Internists and primary care providers play a growing role in cancer care. We therefore evaluated the awareness of radiation therapy in general and specifically the clinical utility of stereotactic body radiation therapy (SBRT) for early-stage non-small cell lung cancer (NSCLC) among current US internal medicine residents. METHODS AND MATERIALS: A web-based institutional review board-approved multi-institutional survey was distributed to US internal medicine residency programs...
August 1, 2017: International Journal of Radiation Oncology, Biology, Physics
https://www.readbyqxmd.com/read/28646590/randomized-controlled-double-blind-trial-comparing-haloperidol-combined-with-conventional-therapy-to-conventional-therapy-alone-in-patients-with-symptomatic-gastroparesis
#5
Carlos J Roldan, Kimberly A Chambers, Linda Paniagua, Sonali Patel, Marylou Cardenas-Turanzas, Yashwant Chathampally
OBJECTIVE: Gastroparesis is a debilitating condition that causes nausea, vomiting, and abdominal pain. Management includes analgesics and antiemetics, but symptoms are often refractory. Haloperidol has been utilized in the palliative care setting for similar symptoms. The study objective was to determine whether haloperidol as an adjunct to conventional therapy would improve symptoms in gastroparesis patients presenting to the emergency department. METHODS AND TRIAL DESIGN: This was a randomized, double-blind, placebo-controlled trial of adult emergency department patients with acute exacerbation of previously diagnosed gastroparesis...
June 24, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28547207/role-of-out-of-hours-primary-care-service-in-limiting-inappropriate-access-to-emergency-department
#6
Andrea Posocco, Maria Paola Scapinello, Irene De Ronch, Francesco Castrogiovanni, Gianluca Lollo, Guglielmo Sergi, Iginio Tomaselli, Loris Tonon, Marco Solmi, Daniele Pescador, Elena Battistuz, Stefano Traversa, Vincenzo Zambianco, Nicola Veronese
Out of hours (OOH) doctors can have an important gate-keeping role over the access to the emergency department (ED), but the outcome and the quality of their ED referrals have been poorly studied. We aimed to investigate the outcome of patients referred to ED from OOH service and the determinants of admission or short-stay dispositions. We collected retrospectively data about referrals to ED from a local OOH service in the north-east of Italy using the OOH paper register and the ED electronic database, over the period of 01/10/2012 to 31/03/2013...
May 25, 2017: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/28489813/implementing-a-novel-model-for-hospice-and-palliative-care-in-the-emergency-department-an-experience-from-a-tertiary-medical-center-in-taiwan
#7
Tzu-Chieh Weng, Ya-Chun Yang, Ping-Jen Chen, Wen-Fu Kuo, Wei-Lin Wang, Ya-Ting Ke, Chien-Chin Hsu, Kao-Chang Lin, Chien-Cheng Huang, Hung-Jung Lin
Hospice and palliative care has been recognized as an essential part of emergency medicine; however, there is no consensus on the optimal model for the delivery of hospice and palliative care in the emergency department (ED). Therefore, we conducted a novel implementation in a tertiary medical center in Taiwan. In the preintervention period, we recruited a specialist for hospice and palliative medicine in the ED to lead our intervention. In the early stage of the intervention, starting on July 1, 2014, we encouraged and funded ED physicians and nurses to receive training for hospice and palliative medicine and residents of emergency medicine to rotate to the hospice ward...
May 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28472598/supportive-cardiology-moving-palliative-care-upstream-for-patients-living-with-advanced-heart-failure
#8
Warren Harris Lewin, Wendy Cheung, A Nina Horvath, Shana Haberman, Archna Patel, Dorothy Sullivan
Heart failure (HF) affects ∼600,000 Canadians and is a chronic, life-limiting illness marked by exacerbations of distressing symptoms requiring acute medical management, typically sought in Canada's emergency departments. HF often has an unpredictable illness trajectory and is a chronic terminal illness with a poor prognosis. Patients living with advanced HF have difficulty in accessing palliative care (PC) supports, which can result in unnecessary suffering as their HF progresses and they near end of life (EOL)...
May 4, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28453361/trends-in-hospital-utilization-and-costs-among-pediatric-palliative-care-recipients
#9
Prasanna Ananth, Patrice Melvin, Jay G Berry, Joanne Wolfe
OBJECTIVE AND BACKGROUND: Few previous studies have explored how pediatric palliative care (PPC) influences hospital utilization. We evaluated this among PPC recipients in a single center. METHODS: This is a retrospective cohort study of 109 patients ≥2 years of age who received PPC consultation at a large quaternary children's hospital from April 2009 to September 2010. We assessed frequencies of hospital admissions and emergency department (ED) visits, use of intensive interventions, and hospital costs...
April 28, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28437201/the-impact-of-community-based-palliative-care-on-utilization-and-cost-of-acute-care-hospital-services-in-the-last-year-of-life
#10
David Youens, Rachael Moorin
BACKGROUND: Community-based palliative care may potentially benefit patients by offering their preferred care at the end of life and benefit systems by reducing hospital use. OBJECTIVE: To compare place of death and acute care hospital use in the last year of life between cancer decedents who did and did not access a community-based palliative care service (PCS). DESIGN: Retrospective observational cohort study using linked individual administrative records from cancer registry, hospital, emergency department (ED), mortality, and PCS databases...
July 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28434771/pharmacological-management-of-cerebral-venous-sinus-thrombosis-with-full-dose-iv-heparin-infusion-and-its-clinical-outcomes
#11
Andrea Fernandez, Vidya Nair, Anna Mckeone, Joseph Ho
OBJECTIVE: To report a case of successful use of unfractionated heparin (UFH) infusion to treat cerebral venous sinus thrombosis (CVST). CASE SUMMARY: A 54-year-old female with a history of ovarian cancer addressed through palliative care, presents to the Emergency Department complaining of nausea, vomiting and headache for the last 72h. The patient was on a home regimen of enoxaparin 1.5mg/kg subcutaneously daily for recent pulmonary embolism and deep vein thrombosis that developed while on warfarin therapy previously...
August 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28429643/emergency-department-staff-priorities-for-improving-palliative-care-provision-for-older-people-a-qualitative-study
#12
Rebecca J Wright, Karen Lowton, Glenn Robert, Corita R Grudzen, Patricia Grocott
BACKGROUND: Emergency department-based palliative care services are increasing, but research to develop these services rarely includes input from emergency clinicians, jeopardizing the effectiveness of subsequent palliative care interventions. AIM: To collaboratively identify with emergency clinicians' improvement priorities for emergency department-based palliative care for older people. DESIGN: This was one component of an experience-based co-design project, conducted using semi-structured interviews and feedback sessions...
April 1, 2017: Palliative Medicine
https://www.readbyqxmd.com/read/28401622/predicting-mortality-in-the-emergency-department-external-validation-and-derivation-of-a-clinical-prediction-tool
#13
Rajat N Moman, Caitlin E Loprinzi Brauer, Katherine M Kelsey, Rachel D Havyer, Christine M Lohse, M Fernanda Bellolio
BACKGROUND: The Choosing Wisely campaign has called for better engagement of palliative and hospice care services for patients in the emergency department (ED). PREDICT is a clinical prediction tool that was derived in an Australian ED cohort. It assesses a patient's risk of mortality at 1 year to select those who would benefit from advanced care planning. Such goals-of-care discussion can improve patients' ability to communicate what they want out of their healthcare and, in cases of end of life, potentially reduce the number of futile interventions...
July 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28353509/innovative-urgent-care-for-the-palliative-patient-at-home
#14
Carmel L Montgomery, Charlotte Pooler, Julia E Arsenault, Colleen Berean, Robert Sharman, Cheryl L Cameron, Ingrid de Kock
Palliative and end-of-life patients in their homes are at risk of developing symptom crises requiring urgent care. The usual care for these patients involves transport to an Emergency Department (ED) despite the preference of most palliative patients to stay home. The objective of this initiative was to develop an innovative strategy to provide collaborative care in the home to alleviate symptoms and avoid transport. A partnership was created among Emergency Medical Services and Community Care staff, physicians, and leaders to enable patients to stay at home with existing resources during symptom crisis...
April 2017: Home Healthcare Now
https://www.readbyqxmd.com/read/28325586/-prognostic-indices-for-older-adults-during-the-year-following-hospitalization-in-an-acute-medical-ward-an-update
#15
REVIEW
Josephine Thomazeau, Samantha Huo Yung Kai, Yves Rolland, Sandrine Sourdet, Nicolas Saffon, Fati Nourhashemi
CONTEXT: As population grow older, chronic diseases are more prevalent. It leads to an increase of hospitalization for acute decompensation, sometimes iterative. Management of these patients is not always clear, and care provided is not always proportional to life expectancy. Making decisions in acute situations is not easy. OBJECTIVE: This review aims to list and describe mortality scores within a year following hospitalization of patients of 65 years or older...
April 2017: La Presse Médicale
https://www.readbyqxmd.com/read/28289851/withdrawal-of-artificial-nutrition-and-hydration-in-neonatal-intensive-care-parents-and-healthcare-practitioners-views
#16
Véronique Fournier, Elisabeth Belghiti, Laurence Brunet, Marta Spranzi
Withdrawing Artificial Nutrition and Hydration (WANH) in the neonatal intensive care units (NICUs) has long been controversial. In France, the practice has become a legal option since 2005. But even though, the question remains as to what the stakeholders' experience is, and whether they consider it ethically appropriate. In order to contribute to the debate, we initiated a study in 2009 to evaluate parental and health care professionals (HCP) perspectives, after they experienced WAHN for a newborn. The study included 25 cases from 5 different clinical neonatology departments...
March 13, 2017: Medicine, Health Care, and Philosophy
https://www.readbyqxmd.com/read/28264944/innovative-oncology-care-models-improve-end-of-life-quality-reduce-utilization-and-spending
#17
Erin Murphy Colligan, Erin Ewald, Sarah Ruiz, Michelle Spafford, Caitlin Cross-Barnet, Shriram Parashuram
Three models that received Health Care Innovation Awards from the Centers for Medicare and Medicaid Services (CMS) aimed to reduce the cost and use of health care services and improve the quality of care for Medicare beneficiaries with cancer. Each emphasized a different principle: the oncology medical home, patient navigation, or palliative care. Comparing participants in each model who died during the study period to matched comparators, we found that the oncology medical home and patient navigation models were associated with decreased costs in the last ninety days of life ($3,346 and $5,824 per person, respectively) and fewer hospitalizations in the last thirty days of life (fifty-seven and forty per 1,000 people, respectively)...
March 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28261765/complicated-colorectal-cancer-in-nonagenarian-patients-is-it-better-not-to-perform-anastomosis-in-emergency
#18
Belinda De Simone, Federico Coccolini, Luca Ansaloni, Antonio Tarasconi, Gianluca Baiocchi, Nereo Vettoretto, Peggy Joly, Marianne Ferron, Alessandro Pozzo, Lionel Charre, Salomone Di Saverio, Josephine Andrea Napoli, Ferdinando Agresta, Massimo Sartelli, Fausto Catena
BACKGROUND: Colorectal cancer (CRC) is predominantly a disease of elderly people. Cancer in nonagenarian patients presents an ethical dilemma for surgeons and oncologists, and management of this group of patients in emergency for complicated CRC is debated. Presently described is retrospective study reporting experience of 6 departments of emergency surgery with management of nonagenarian patients sent to emergency surgery for CRC complications. METHODS: Data concerning patients aged over 90 years hospitalized from January 2011 to June 2015 in 6 departments of emergency surgery for complicated CRC were retrospectively analyzed...
January 2017: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
https://www.readbyqxmd.com/read/28209392/transfer-of-do-not-resuscitate-orders-to-the-emergency-department-from-extended-care-facilities
#19
Colleen M McQuown, Jennifer A Frey, Ahmad Amireh, Ali Chaudhary
PURPOSE/OBJECTIVE: With an elderly and chronically ill patient population visiting the emergency department, it is important to know patients' wishes regarding care preferences and advanced directives. Ohio law states DNR orders must be transported with the patient when they leave an extended care facility (ECF). We reviewed the charts of ECF patients to evaluate which patients presenting to the ED had their DNR status recognized by the physician and DNR orders that were made during their hospital stay...
February 4, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28169049/the-association-of-community-based-palliative-care-with-reduced-emergency-department-visits-in-the-last-year-of-life-varies-by-patient-factors
#20
Katrina Spilsbury, Lorna Rosenwax, Glenn Arendts, James B Semmens
STUDY OBJECTIVE: Palliative care has been shown to reduce end-of-life emergency department (ED) use. Our objective was to determine how the association of community-based palliative care with reduced ED visits in the last year of life varied by patient factors. METHODS: This was a retrospective cohort study of 11,875 decedents who died with neoplasms, heart failure, renal failure, chronic obstructive pulmonary disease, or liver failure in Western Australia in 2009 to 2010...
April 2017: Annals of Emergency Medicine
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