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Palliative care emergency department

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https://www.readbyqxmd.com/read/29740693/associated-factors-and-costs-of-avoidable-visits-to-the-emergency-department-among-cancer-patients-1-year-experience-in-a-tertiary-care-hospital-in-south-korea
#1
Tak Kyu Oh, You Hwan Jo, Jae Wook Choi
PURPOSE: Patients receiving palliative care make avoidable emergency department visits (AvED), which may increase economic and social costs. However, the proportion of AvED among all patients, including cancer patients after curation, and the resulting costs are unknown in Asia. This study aimed to investigate the proportion, characteristics, and costs regarding factors associated with AvED among cancer patients. METHODS: This retrospective cohort study analyzed the medical records of patients who visited the emergency department (ED) at a tertiary care hospital in Korea in 2016...
May 8, 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/29739453/spontaneous-renal-hemorrhage-secondary-to-choriocarcinoma-in-a-man-with-congenital-hypospadias-and-cryptorchidism-a-case-report-and-literature-review
#2
Yi Li, Gang Chen, Han Chen, Shuang Wen, Chao-Yu Xiong, Zi-Yi Yang, Yun-Xiao Zhu, Nathan Jeffreys
BACKGROUND: Choriocarcinoma is a rare malignant germ-cell tumour, most commonly found in adult women. It infrequently presents as spontaneous renal haemorrhage (SRH). Genital malformation and SRH secondary to choriocarcinoma has previously been only reported in females. We present what we believe to be the first case of a male patient with genital malformation (hypospadias and cryptorchidism) and SRH at presentation of choriocarcinoma. CASE PRESENTATION: A 25-year-old man presented to the department with intense pain in the right flank region and lower back...
May 8, 2018: BMC Cancer
https://www.readbyqxmd.com/read/29737962/perceived-barriers-and-facilitators-to-goals-of-care-discussions-in-the-emergency-department-a-descriptive-analysis-of-the-views-of-emergency-medicine-physicians-and-residents
#3
Niran Argintaru, Kieran L Quinn, Lucas B Chartier, Jacques Lee, Paul Hannam, Erin O'Connor, Leah Steinberg, Howard Ovens, Melissa McGowan, Samuel Vaillancourt
CLINICIAN'S CAPSULE What is known about the topic? Goals of care discussions (GOC) are critical to reflecting patients' preferences in the provision of acute care, yet these discussions can be challenging to have in the emergency department (ED) setting. What did this study ask? What are emergency physicians' perspectives on barriers and facilitators to GOC discussions? What did this study find? In this survey of emergency medicine attending and resident physicians, the majority reported feeling comfortable and adequately trained to conduct GOC discussions...
May 8, 2018: CJEM
https://www.readbyqxmd.com/read/29732904/characterization-categorization-and-5-year-mortality-of-medicine-high-utilizer-inpatients
#4
Joyeeta G Dastidar, Min Jiang
BACKGROUND: Patients who are frequently admitted to Medicine inpatient services comprise a distinct subset of readmitted patients about whom not much is known. OBJECTIVE: We sought to characterize this group including mortality rates, with the goal of better understanding this population. DESIGN: Observational study of frequently hospitalized patients defined as 4 or more admissions over a 6-month period, with hospitalization defined as nonelective admission to the hospital...
January 1, 2018: Journal of Palliative Care
https://www.readbyqxmd.com/read/29707561/integrated-respiratory-and-palliative-care-may-improve-outcomes-in-advanced-lung-disease
#5
Natasha Smallwood, Michelle Thompson, Matthew Warrender-Sparkes, Peter Eastman, Brian Le, Louis Irving, Jennifer Philip
The unaddressed palliative care needs of patients with advanced, nonmalignant, lung disease highlight the urgent requirement for new models of care. This study describes a new integrated respiratory and palliative care service and examines outcomes from this service. The Advanced Lung Disease Service (ALDS) is a long-term, multidisciplinary, integrated service. In this single-group cohort study, demographic and prospective outcome data were collected over 4 years, with retrospective evaluation of unscheduled healthcare usage...
January 2018: ERJ Open Research
https://www.readbyqxmd.com/read/29698124/palliative-care-and-hospice-interventions-in-decompensated-cirrhosis-and-hepatocellular-carcinoma-a-rapid-review-of-literature
#6
Sandhya K Mudumbi, Claire E Bourgeois, Nicholas A Hoppman, Catherine H Smith, Manisha Verma, Marie A Bakitas, Cynthia J Brown, Alayne D Markland
BACKGROUND: Patients with decompensated cirrhosis (DC) and/or hepatocellular carcinoma (HCC) have a high symptom burden and mortality and may benefit from palliative care (PC) and hospice interventions. OBJECTIVE: Our aim was to search published literature to determine the impact of PC and hospice interventions for patients with DC/HCC. METHODS: We searched electronic databases for adults with DC/HCC who received PC, using a rapid review methodology...
April 26, 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29664697/best-practices-for-reducing-unplanned-acute-care-for-patients-with-cancer
#7
Nathan R Handley, Lynn M Schuchter, Justin E Bekelman
Variation and cost in oncology care represent a large and growing burden for the US health care system, and acute hospital care is one of the single largest drivers. Reduction of unplanned acute care is a major priority for clinical transformation in oncology; proposed changes to Medicare reimbursement for patients with cancer who suffer unplanned admissions while receiving chemotherapy heighten the need. We conducted a review of best practices to reduce unplanned acute care for patients with cancer. We searched PubMed for articles published between 2000 and 2017 and reviewed guidelines published by professional organizations...
May 2018: Journal of Oncology Practice
https://www.readbyqxmd.com/read/29663697/testing-a-new-form-to-document-goals-of-care-discussions-regarding-plans-for-end-of-life-care-for-patients-in-an-australian-emergency-department
#8
Amber C Mills, Michele Levinson, William A Dunlop, Edward Cheong, Timothy Cowan, Jennifer Hanning, Erin O'Callaghan, Katherine J Walker
OBJECTIVE: There is limited literature to inform the content and format of Goals-of-Care forms, for use by doctors when they are undertaking these important conversations. METHODS: This was a prospective, qualitative and quantitative study evaluating the utility of a new 'Goals-of-Care' form to doctors in a private, tertiary ED, used from December 2016 to February 2017 at Cabrini, Melbourne. A Goals-of-Care form was designed, incorporating medical aims of therapy and patient values and preferences...
April 16, 2018: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29649845/-early-palliative-care-in-emergency-medicine
#9
Maximilian Spickermann, Philipp Lenz
At the end of life patients with a life-limiting disease are often admitted to emergency departments (ED). Mostly, in the setting of an ED there may not be enough time to meet the needs for palliative care (PC) of these patients. Therefore, integration of PC into the ED offers a solution to improve their treatment. In the outpatient setting a cooperation between prehospital emergency services, the patient's general practitioner and specialized outpatient PC teams may allow the patient to die at home - this is what most patients prefer at the end of life...
April 2018: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/29649400/impact-of-inpatient-palliative-care-on-quality-of-end-of-life-care-and-downstream-acute-and-postacute-care-utilization
#10
Peter S Khang, Susan E Wang, In-Lu Amy Liu, Heather L Watson, Sandra Y Koyama, Dan N Huynh, Janet S Lee, Huong Q Nguyen
BACKGROUND: Additional evidence is needed regarding the impact of inpatient palliative care (IPC) on the quality of end-of-life care and downstream utilization. AIM: Examine the effects of IPC on quality of end-of-life care and acute and postacute care use in a large integrated system. DESIGN: Retrospective cohort design. SETTING/PARTICIPANTS: Adult decedents from January 1, 2012, to December 31, 2014, who had at least one hospitalization at 11 Kaiser Permanente Southern California medical centers in the 12 months before death and not hospitalized for a trauma-related condition or receiving home-based PC or hospice were included in the cohort...
March 13, 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29649399/a-rules-based-algorithm-to-prioritize-poor-prognosis-cancer-patients-in-need-of-advance-care-planning
#11
Christine M Bestvina, Kristen E Wroblewski, Bobby Daly, Brittany Beach, Selina Chow, Andrew Hantel, Monica Malec, Michael T Huber, Blase N Polite
BACKGROUND: Accurate understanding of the prognosis of an advanced cancer patient can lead to decreased aggressive care at the end of life and earlier hospice enrollment. OBJECTIVE: Our goal was to determine the association between high-risk clinical events identified by a simple, rules-based algorithm and decreased overall survival, to target poor prognosis cancer patients who would urgently benefit from advanced care planning. DESIGN: A retrospective analysis was performed on outpatient oncology patients with an index visit from April 1, 2015, through June 30, 2015...
March 13, 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29622389/dying-in-hospital-qualitative-study-among-caregivers-of-terminally-ill-patients-who-are-transferred-to-the-emergency-department
#12
Martin Pillet, Aline Chassagne, Régis Aubry
INTRODUCTION: Most people in France die in the hospital, even though a majority would like to die at home. These end-of-life hospital admissions sometimes occur in the emergency setting, in the hours preceding death. OBJECTIVE: To understand the motives that incite main natural caregivers to transfer terminally ill patients at the end of life to the emergency department. METHODS: A qualitative study was performed among caregivers of terminally ill patients receiving palliative care and living at home, and who died within 72hours of being admitted to the emergency department of the University Hospital of Besançon, France...
April 2, 2018: La Presse Médicale
https://www.readbyqxmd.com/read/29622009/health-service-utilisation-during-the-last-year-of-life-a-prospective-longitudinal-study-of-the-pathways-of-patients-with-chronic-kidney-disease-stages-3-5
#13
Shirley Chambers, Helen Healy, Wendy E Hoy, Adrian Kark, Sharad Ratanjee, Geoffrey Mitchell, Carol Douglas, Patsy Yates, Ann Bonner
BACKGROUND: Chronic kidney disease (CKD) is a growing global problem affecting around 10% of many countries' populations. Providing appropriate palliative care services (PCS) to those with advanced kidney disease is becoming paramount. Palliative/supportive care alongside usual CKD clinical treatment is gaining acceptance in nephrology services although the collaboration with and use of PCS is not consistent. METHODS: The goal of this study was to track and quantify the health service utilisation of people with CKD stages 3-5 over the last 12 months of life...
April 5, 2018: BMC Palliative Care
https://www.readbyqxmd.com/read/29608934/transition-points-for-the-routine-integration-of-palliative-care-in-patients-with-advanced-cancer
#14
Anna Collins, Vijaya Sundararajan, Jodie Burchell, Jeremy Millar, Sue-Anne McLachlan, Meinir Krishnasamy, Brian H Le, Linda Mileshkin, Peter Hudson, Jennifer Philip
CONTEXT: Increasing emphases are being placed upon early integration of palliative care for patients with advanced cancers, yet barriers to implementation in clinical practice remain. Criteria to standardise referral have been endorsed, but their application are yet to be tested at the population level. OBJECTIVES: This study sought to: 1) establish the need for standardised referral by examining current end of life care outcomes of decedents with cancer; and 2) define transition points within a cancer illness course which are associated with poor prognosis, whereby palliative care should be routinely introduced to augment clinician- based decision making...
March 30, 2018: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/29603317/innovative-discharge-process-for-families-with-pediatric-short-bowel-syndrome-a-prospective-nonrandomized-trial
#15
Bram P Raphael, Maria Jorina, Mary Gallotto, Glendalis Grullon, Meghan Dalton, Melissa Takvorian-Bené, Christina Tascione, Carolyn Rosa, Jennifer McClelland, Megan Gray, Alexis K Potemkin, Courtney Glavin, Kathleen M Gura, Margaret K Murphy, Kierrah Leger, Judith Mahoney, Jessica Kerr, Al Ozonoff, Christopher P Duggan
BACKGROUND: Home parenteral nutrition (HPN) is a life-sustaining therapy for short bowel syndrome (SBS) and other severe digestive diseases, but complications are common. We evaluated a predischarge HPN hands-on training course to reduce complications in children with SBS, including hospital readmissions. METHODS: We conducted a prospective, nonrandomized controlled research study between April 1, 2014, and April 30, 2017. Eligible participants were children aged <18 years old with SBS and anticipated HPN dependence duration ≥6 months...
March 30, 2018: JPEN. Journal of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/29589696/-palliative-care-pathways-of-older-patients
#16
Lourdes Zubieta, Réjean Hébert, Michel Raîche
INTRODUCTION: To determine the palliative care pathways of older patients in Sherbrooke, Qc by examining their transfers to other facilities. METHODS: This analysis was conducted by linking 3 databases: emergency department, hospitalizations and nursing homes. The study period ranged from January 2011 to December 2015. SPSS was used for statistical analysis. The study only included palliative care patients. RESULTS: 25% of patients waited less than 7 days for transfer, and 74% waited less than 3 weeks...
January 2018: Santé Publique: Revue Multidisciplinaire Pour la Recherche et L'action
https://www.readbyqxmd.com/read/29580074/early-palliative-care-for-patients-with-brain-metastases-decreases-inpatient-admissions-and-need-for-imaging-studies
#17
Akram Habibi, S Peter Wu, Daniel Gorovets, Alexandra Sansosti, Marc Kryger, Cameron Beaudreault, Wei-Yi Chung, Gary Shelton, Joshua Silverman, Joseph Lowy, Douglas Kondziolka
BACKGROUND: Early encounters with palliative care (PC) can influence health-care utilization, clinical outcome, and cost. AIM: To study the effect of timing of PC encounters on brain metastasis patients at an academic medical center. SETTING/PARTICIPANTS: All patients diagnosed with brain metastases from January 2013 to August 2015 at a single institution with inpatient and/or outpatient PC records available for review (N = 145). DESIGN: Early PC was defined as having a PC encounter within 8 weeks of diagnosis with brain metastases; late PC was defined as having PC after 8 weeks of diagnosis...
January 1, 2018: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/29575773/non-invasive-ventilation-practices-in-children-across-europe
#18
Juan Mayordomo-Colunga, Martí Pons-Òdena, Alberto Medina, Corsino Rey, Christophe Milesi, Merja Kallio, Andrea Wolfler, Mireia García-Cuscó, Demet Demirkol, Milagros García-López, Peter Rimensberger
OBJECTIVES: To describe the diversity in practice in non-invasive ventilation (NIV) in European pediatric intensive care units (PICUs). WORKING HYPOTHESIS: No information about the use of NIV in Pediatrics across Europe is currently available, and there might be a wide variability regarding the approach. STUDY DESIGN: Cross-sectional electronic survey. METHODOLOGY: The survey was distributed to the ESPNIC mailing list and to researchers in different European centers...
March 24, 2018: Pediatric Pulmonology
https://www.readbyqxmd.com/read/29569126/palliative-care-is-associated-with-reduced-aggressive-end-of-life-care-in-patients-with-gastrointestinal-cancer
#19
Shaila J Merchant, Susan B Brogly, Craig Goldie, Christopher M Booth, Sulaiman Nanji, Sunil V Patel, Katherine Lajkosz, Nancy N Baxter
BACKGROUND: We examined the delivery of physician palliative care (PC) services and its association with aggressive end-of-life care (EOLC) in patients with gastrointestinal (GI) cancer in Ontario, Canada. METHODS: All patients with primary cause of death from esophageal, gastric, colon, and anorectal cancer from January 2003 to December 2013 were identified. PC services within 2 years of death were classified: (1) any PC; (2) timing of first PC (≤ 7, 8-90, 91-180, and 181-730 days before death); and (3) intensity of PC measured by number of days used (1st-25th, 26th-50th, 51st-75th, and 76th-100th percentiles)...
June 2018: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/29559881/atypical-presentation-of-extramedullary-plasmacytoma
#20
Eric Wallace, Zachary Stewart, David Theriot, William Shaffer, Shane Guillory, Michael Hanemann, Raman Danrad, Bradley Spieler
Background: Plasmacytomas are monoclonal proliferations of plasma cells that typically affect the intramedullary axial skeleton. Imaging findings of an extramedullary plasmacytoma on radiograph and computed tomography can be nonspecific and can resemble other entities such as lymphoma, metastases, chondrosarcomas, or giant cell tumors. Case Report: A 60-year-old female with a medical history of partial complex seizures, hypertension, diabetes, glaucoma, and hyperlipidemia presented with complaints of superficial abdominal pain associated with erythema and swelling for 3 weeks...
2018: Ochsner Journal
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