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Poor end-of-life care

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https://www.readbyqxmd.com/read/29156054/hospice-care-cancer-directed-therapy-and-medicare-expenditures-among-older-patients-dying-with-malignant-brain-tumors
#1
Laura L Dover, Caleb R Dulaney, Courtney P Williams, John B Fiveash, Bradford E Jackson, Paula P Warren, Elizabeth A Kvale, D Hunter Boggs, Gabrielle B Rocque
Background: End-of-life care for older adults with malignant brain tumors is poorly understood. The purpose of this study is to quantify end-of-life utilization of hospice care, cancer-directed therapy, and associated Medicare expenditures among older adults with malignant brain tumors. Methods: This retrospective cohort study included deceased Medicare beneficiaries age ≥65 with primary (PMBT) or secondary (SMBT) malignant brain tumor receiving care within a Southeastern cancer community network including academic and community hospitals from 2012-2015...
November 15, 2017: Neuro-oncology
https://www.readbyqxmd.com/read/29143390/chemotherapy-and-healthcare-utilisation-near-the-end-of-life-in-patients-with-cancer
#2
K J G Schulkes, I C van Walree, L J R van Elden, F van den Bos, L van Huis-Tanja, J-W J Lammers, D Ten Bokkel Huinink, M E Hamaker
The quality of medical care delivered to patients with cancer near the end of life is a significant issue. Previous studies have defined several areas suggestive of aggressive cancer treatment as potentially representing poor quality care. The primary objective of current analysis was to examine chemotherapy and healthcare utilisation in the last 3 months of life among patients with cancer that received palliative chemotherapy. Patients were selected from the hospital administration database of the Diakonessenhuis Utrecht, the Netherlands...
November 16, 2017: European Journal of Cancer Care
https://www.readbyqxmd.com/read/29130405/what-is-the-role-of-community-at-the-end-of-life-for-people-dying-in-advanced-age-a-qualitative-study-with-bereaved-family-carers
#3
Merryn Gott, Janine Wiles, Tess Moeke-Maxwell, Stella Black, Lisa Williams, Ngaire Kerse, Gabriella Trussardi
BACKGROUND: New public health approaches to palliative care prioritise the role of community at end of life. However, little is known about community support for the increasing numbers of people dying in advanced age. AIM: To explore the role of community at end of life for people dying in advanced age from the perspective of their bereaved family caregivers. DESIGN: A constructionist framework underpinned a qualitative research design. Data were analysed using critical thematic analysis...
October 1, 2017: Palliative Medicine
https://www.readbyqxmd.com/read/29121886/the-strange-case-of-mr-h-starting-dialysis-at-90%C3%A2-years-of-age-clinical-choices-impact-on-ethical-decisions
#4
Giorgina Barbara Piccoli, Andreea Corina Sofronie, Jean-Philippe Coindre
BACKGROUND: Starting dialysis at an advanced age is a clinical challenge and an ethical dilemma. The advantages of starting dialysis at "extreme" ages are questionable as high dialysis-related morbidity induces a reflection on the cost- benefit ratio of this demanding and expensive treatment in a person that has a short life expectancy. Where clinical advantages are doubtful, ethical analysis can help us reach decisions and find adapted solutions. CASE PRESENTATION: Mr...
November 9, 2017: BMC Medical Ethics
https://www.readbyqxmd.com/read/29112876/factors-influencing-attitudes-toward-advance-directives-in-korean-older-adults
#5
Ji Eun Lee, Dong Wook Shin, Ki Young Son, Hyun Jung Park, Jae-Young Lim, Mi Soon Song, Yeon-Hwan Park, BeLong Cho
AIM: We aimed to determine the factors influencing attitudes toward advance directives in Korean older adults with consideration of an Asian cultural background. METHODS: We recruited community-dwelling older adults aged 60 years or older at a regional senior welfare center in Korea. Demographic factors and mental and physical health status were examined using questionnaires and a physical examination. The questionnaire also assessed perceived necessity of advance directives and related experiences...
October 31, 2017: Archives of Gerontology and Geriatrics
https://www.readbyqxmd.com/read/29110922/cost-effectiveness-of-trifluridine-tipiracil-for-previously-treated-metastatic-colorectal-cancer-in-england-and-wales
#6
Ash Bullement, Stuart Underhill, Ronan Fougeray, Anthony James Hatswell
BACKGROUND: Treatment options at third-line and beyond for patients with late-line metastatic colorectal cancer (mCRC) are limited, and outcomes are poor with best supportive care (BSC). This study investigated the cost-effectiveness of trifluridine/tipiracil and regorafenib relative to BSC alone in patients with mCRC who have been previously treated with, or are not considered candidates for, standard chemotherapies. MATERIALS AND METHODS: A partitioned survival model was constructed to assess the lifetime costs and benefits accrued by patients...
September 28, 2017: Clinical Colorectal Cancer
https://www.readbyqxmd.com/read/29110738/what-can-we-learn-from-simulation-based-training-to-improve-skills-for-end-of-life-care-insights-from-a-national-project-in-israel
#7
Mayer Brezis, Yael Lahat, Meir Frankel, Alan Rubinov, Davina Bohm, Matan J Cohen, Meni Koslowsky, Orit Shalomson, Charles L Sprung, Henia Perry-Mezare, Rina Yahalom, Amitai Ziv
BACKGROUND: Simulation-based training improves residents' skills for end-of-life (EOL) care. In the field, staff providers play a significant role in handling those situations and in shaping practice by role modeling. We initiated an educational intervention to train healthcare providers for improved communication skills at EOL using simulation of sensitive encounters with patients and families. METHODS: Hospital physicians and nurses (n = 1324) attended simulation-based workshops (n = 100) in a national project to improve EOL care...
November 6, 2017: Israel Journal of Health Policy Research
https://www.readbyqxmd.com/read/29095938/challenges-to-code-status-discussions-for-pediatric-patients
#8
Katherine E Kruse, Jason Batten, Melissa L Constantine, Saraswati Kache, David Magnus
OBJECTIVES: In the context of serious or life-limiting illness, pediatric patients and their families are faced with difficult decisions surrounding appropriate resuscitation efforts in the event of a cardiopulmonary arrest. Code status orders are one way to inform end-of-life medical decision making. The objectives of this study are to evaluate the extent to which pediatric providers have knowledge of code status options and explore the association of provider role with (1) knowledge of code status options, (2) perception of timing of code status discussions, (3) perception of family receptivity to code status discussions, and (4) comfort carrying out code status discussions...
2017: PloS One
https://www.readbyqxmd.com/read/29061185/the-community-navigator-study-a-feasibility-randomised-controlled-trial-of-an-intervention-to-increase-community-connections-and-reduce-loneliness-for-people-with-complex-anxiety-or-depression
#9
Brynmor Lloyd-Evans, Jessica K Bone, Vanessa Pinfold, Glyn Lewis, Jo Billings, Johanna Frerichs, Kate Fullarton, Rebecca Jones, Sonia Johnson
BACKGROUND: Loneliness is associated with poor health outcomes at all ages, including shorter life expectancy and greater risk of developing depression. People with mental health problems are particularly vulnerable to loneliness and, for those with anxiety or depression, loneliness is associated with poorer outcomes. Interventions which support people to utilise existing networks and access new social contact are advocated in policy but there is little evidence regarding their effectiveness...
October 23, 2017: Trials
https://www.readbyqxmd.com/read/29057245/a-case-report-of-congenital-glycogen-storage-liver-cirrhosis-treated-with-bone-marrow-derived-stem-cells
#10
Terek W Wehbe, Nassim H Abi Chahine, Abdul-Rahman A Annous, Mohammad A Ferri, Robert C Boulous, Majid F El-Mestrah
Liver cirrhosis represents a state of end-stage failure that is usually fatal. The condition results in liver dysfunction, recurrent ascites, encephalopathy, renal failure, splenomegaly, bleeding, and a poor quality of life in general. With the current severe shortage of donated organs, the only available treatment in the developing countries remains palliative care. We report a case of congenital metabolic liver cirrhosis due to glycogen storage disease diagnosed at age eight. The patient, a male, received bone marrow derived mononuclear cells (BMMC) at age 16 and again at age 17 with significant improvement of his biochemical liver function tests, ascites build-up, asthenia, splenomegaly and quality of life...
2017: Stem Cell Investigation
https://www.readbyqxmd.com/read/29049396/improved-data-validity-in-the-swedish-register-of-palliative-care
#11
Lisa Martinsson, Per-Anders Heedman, Staffan Lundström, Bertil Axelsson
INTRODUCTION: The Swedish Register of Palliative Care (SRPC) is a national quality register that collects data about end-of-life care from healthcare providers that care for dying patients. Data are used for quality control and research. Data are mainly collected with an end-of-life questionnaire (ELQ), which is completed by healthcare staff after the death of a patient. A previous validity assessment of the ELQ showed insufficient validity in some items including symptom relief. The aim of this study was to examine the validity of the revised ELQ...
2017: PloS One
https://www.readbyqxmd.com/read/29034687/predictors-of-placement-of-inpatient-palliative-care-consult-orders-among-patients-with-breast-lung-and-colon-cancer-in-a-safety-net-hospital-system
#12
Lauren N Smith, Ramona L Rhodes, Lei Xuan, Ethan A Halm
BACKGROUND: The provision of palliative and end-of-life care to patients who are underrepresented and underserved provides unique challenges and opportunities. OBJECTIVES: To examine predictors of placement of inpatient palliative care consult orders among patients with breast, lung, and colorectal cancer hospitalized in a safety net hospital in 2010. METHODS: Simple and multivariable logistic regression of data on selected patients with cancer was performed to identify predictors of placement of inpatient palliative care consult orders...
January 1, 2017: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/29033560/proactive-palliative-care-for-patients-with-copd-prolong-a-pragmatic-cluster-controlled-trial
#13
R G Duenk, C Verhagen, E M Bronkhorst, Pjwb van Mierlo, Meac Broeders, S M Collard, Pnr Dekhuijzen, Kcp Vissers, Y Heijdra, Y Engels
BACKGROUND AND AIM: Patients with advanced chronic obstructive pulmonary disease (COPD) have poor quality of life. The aim of this study was to assess the effects of proactive palliative care on the well-being of these patients. TRIAL REGISTRATION: This trial is registered with the Netherlands Trial Register, NTR4037. PATIENTS AND METHODS: A pragmatic cluster controlled trial (quasi-experimental design) was performed with hospitals as cluster (three intervention and three control) and a pretrial assessment was performed...
2017: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/29029757/palliative-care-and-end-of-life-care-for-polypathological-patients
#14
E Martinez-Litago, M C Martínez-Velasco, M P Muniesa-Zaragozano
Patients with advanced chronic diseases receive fragmented care, which entails high resource consumption and a poor quality of life. Uncertainty in the prognosis and scarce investigation into the importance of symptomatic control in this patient group hinders a proper therapeutic approach. Palliative care teams optimise the use of resources through comprehensive patient care, the optimization of the patient's environment, communication, the preparation of early care plans and the creation of coordinated healthcare circuits, which improve the quality of the patient's care in advanced stages of the disease...
October 10, 2017: Revista Clínica Española
https://www.readbyqxmd.com/read/28987265/performance-and-sleepiness-in-nurses-working-12-h-day-shifts-or-night-shifts-in-a-community-hospital
#15
Marian Wilson, Regan Permito, Ashley English, Sandra Albritton, Carlana Coogle, Hans P A Van Dongen
Hospitals are around-the-clock operations and nurses are required to care for patients night and day. The nursing shortage and desire for a more balanced work-to-home life has popularized 12-h shifts for nurses. The present study investigated sleep/wake cycles and fatigue levels in 22 nurses working 12-h shifts, comparing day versus night shifts. Nurses (11day shift and 11 night shift) were recruited from a suburban acute-care medical center. Participants wore a wrist activity monitor and kept a diary to track their sleep/wake cycles for 2 weeks...
October 5, 2017: Accident; Analysis and Prevention
https://www.readbyqxmd.com/read/28979519/classic-cases-revisited-oscar-the-cat-and-predicting-death
#16
Piotr Szawarski
Uncertainty, although inherent in medicine, is rarely discussed in spite of being ubiquitous. Communication of uncertainty is poor due to anxiety associated with it, yet one could argue that lack of such disclosure could undermine trust, lead to perception of deceit, alter decision making and in some cases could invalidate the consent process. Predictions concerning end of life are particularly difficult and may lead to excessive or insufficient medical interventions. Acknowledging uncertainty when prognosticating outcomes, and in particular death, may help in facilitating patient-centred care in context of a critical illness...
November 2016: J Intensive Care Soc
https://www.readbyqxmd.com/read/28975244/end-of-life-care-in-older-patients-after-serious-or-severe-traumatic-brain-injury-in-low-mortality-hospitals-compared-with-all-other-hospitals
#17
Elizabeth J Lilley, John W Scott, Joel S Weissman, Anna Krasnova, Ali Salim, Adil H Haider, Zara Cooper
Importance: More than 80% of older patients die or are seriously impaired within 1 year after severe traumatic brain injury (TBI). Given their poor survival, information about end-of-life care is a relevant marker of high-value trauma care for these patients. In-hospital mortality is commonly used to measure quality of trauma care; however, it is not known what type of end-of-life care hospitals with the best survival outcomes provide to those who die. Objective: To determine whether end-of-life care for older patients with TBI is correlated with in-hospital mortality...
September 20, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28968346/adjunctive-hyperbaric-oxygen-therapy-for-healing-of-chronic-diabetic-foot-ulcers-a-randomized-controlled-trial
#18
Chen-Yu Chen, Re-Wen Wu, Mei-Chi Hsu, Ching-Jung Hsieh, Man-Chun Chou
PURPOSE: The purpose of this study was to compare the effect of standard wound care with adjunctive hyperbaric oxygen therapy (HBOT) to standard wound care alone on wound healing, markers of inflammation, glycemic control, amputation rate, survival rate of tissue, and health-related quality of life in patients with diabetic foot ulcers (DFUs). DESIGN: Prospective, randomized, open-label, controlled study. SUBJECTS AND SETTING: The sample comprised 38 patients with nonhealing DFUs who were deemed poor candidates for vascular surgery...
November 2017: Journal of Wound, Ostomy, and Continence Nursing
https://www.readbyqxmd.com/read/28967376/a-very-early-rehabilitation-trial-after-stroke-avert-a-phase-iii-multicentre-randomised-controlled-trial
#19
Peter Langhorne, Olivia Wu, Helen Rodgers, Ann Ashburn, Julie Bernhardt
BACKGROUND: Mobilising patients early after stroke [early mobilisation (EM)] is thought to contribute to the beneficial effects of stroke unit care but it is poorly defined and lacks direct evidence of benefit. OBJECTIVES: We assessed the effectiveness of frequent higher dose very early mobilisation (VEM) after stroke. DESIGN: We conducted a parallel-group, single-blind, prospective randomised controlled trial with blinded end-point assessment using a web-based computer-generated stratified randomisation...
September 2017: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/28949788/care-at-end-of-life-influences-grief-a-nationwide-long-term-follow-up-among-young-adults-who-lost-a-brother-or-sister-to-childhood-cancer
#20
Malin Lövgren, Josefin Sveen, Tommy Nyberg, Alexandra Eilegård Wallin, Holly G Prigerson, Gunnar Steineck, Ulrika Kreicbergs
BACKGROUND: A majority of cancer-bereaved siblings report long-term unresolved grief, thus it is important to identify factors that may contribute to resolving their grief. OBJECTIVE: To identify modifiable or avoidable family and care-related factors associated with unresolved grief among siblings two to nine years post loss. DESIGN: This is a nationwide Swedish postal survey. MEASUREMENTS: Study-specific questions and the standardized instrument Hospital Anxiety and Depression Scale...
September 26, 2017: Journal of Palliative Medicine
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