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Gabrielle B Rocque, J Nicholas Dionne-Odom, Chao-Hui Sylvia Huang, Soumya J Niranjan, Courtney P Williams, Bradford E Jackson, Karina I Halilova, Kelly M Kenzik, Kerri S Bevis, Audrey S Wallace, Nedra Lisovicz, Richard A Taylor, Maria Pisu, Edward E Partridge, Linda A Briggs, Elizabeth A Kvale
CONTEXT: Advance care planning (ACP) improves alignment between patient preferences for life-sustaining treatment and care received at end of life (EOL). OBJECTIVES: To evaluate implementation of lay navigator-led ACP. METHODS: A convergent, parallel mixed-methods design was employed to evaluate implementation of navigator-led ACP across 12 cancer centers. Data collection included: (1) electronic navigation records, (2) navigator surveys (n=45), (3) claims-based patient outcomes (n=820), and (4) semi-structured navigator interviews (n=26)...
January 3, 2017: Journal of Pain and Symptom Management
Rakhee Yash Pal, Win Sen Kuan, Yiwen Koh, Kuhan Venugopal, Irwani Ibrahim
INTRODUCTION: Elderly patients with serious chronic diseases often present to the emergency department (ED) in the last moments of their life, many with identifiable trajectories of dying: organ failure; advanced cancer; and chronic frailty. These patients and their families may benefit more from good end-of-life (EOL) care provision than the standard resuscitative approach. This study aimed to determine the incidence and nature of death among patients aged 65 years and above in an ED, and characterise their trajectories of dying...
December 5, 2016: Singapore Medical Journal
Krystal Song, Bhasker Amatya, Catherine Voutier, Fary Khan
Advance care planning (ACP) is a process of reflection and communication of a person's future health care preferences, and has been shown to improve end-of-life (EOL) care for patients. The aim of this systematic review is to present an evidence-based overview of ACP in patients with primary malignant brain tumors (pmBT). A comprehensive literature search was conducted using medical and health science electronic databases (PubMed, Cochrane, Embase, MEDLINE, ProQuest, Social Care Online, Scopus, and Web of Science) up to July 2016...
2016: Frontiers in Oncology
Jennifer Healy, Phylliss Chappell, Shuko Lee, Jeanette Ross, Sandra Sanchez-Reilly
CONTEXT: Dying is a natural process, yet physicians are often uncomfortable caring for dying patients. Learners have limited exposure to curriculum on caring for dying patients and often navigate these encounters without appropriate skills and confidence. We developed and implemented the Double Parallel Curriculum in Palliative Care (DP-PC): End-of-Life (EOL) module. The DP-PC focuses on teaching third-year medical students (MS3) to not only take care of patients in their last hours of life but give learners the confidence to teach patient's families what to expect as they hold vigil at their loved one's bedside...
November 7, 2016: American Journal of Hospice & Palliative Care
Artem Golev, Diego R Schmeda-Lopez, Simon K Smart, Glen D Corder, Eric W McFarland
For almost two decades waste electrical and electronic equipment, WEEE or e-waste, has been considered a growing problem that has global consequences. The value of recovered materials, primarily in precious and base metals, has prompted some parts of the world to informally and inappropriately process e-waste causing serious environmental and human health issues. Efforts in tackling this issue have been limited and in many ways unsuccessful. The global rates for formal e-waste treatment are estimated to be below the 20% mark, with the majority of end-of-life (EoL) electronic devices still ending up in the landfills or processed through rudimentary means...
December 2016: Waste Management
Kristy T Duggan, Sara Hildebrand Duffus, Ralph B D'Agostino, William J Petty, Nathan P Streer, Richard C Stephenson
INTRODUCTION: Prior research has shown that advanced stage nonsmall cell lung cancer (NSCLC) patients enrolled in hospice care receive less aggressive treatment at the end of life (EOL) without compromising survival. Our purpose was to profile the continuum of care of these patients, exploring the connection between hospice enrollment and quality indicators for excellence in EOL cancer care. METHODS: One hundred ninety-seven deceased stage IV NSCLC patients diagnosed between 2008 and 2010 at two separate tertiary care centers within the same county were identified...
January 2017: Journal of Palliative Medicine
Mei Lan Fang, Judith Sixsmith, Shane Sinclair, Glen Horst
BACKGROUND: Multiple factors influence the end-of-life (EoL) care and experience of poor quality services by culturally- and spiritually-diverse groups. Access to EoL services e.g. health and social supports at home or in hospices is difficult for ethnic minorities compared to white European groups. A tool is required to empower patients and families to access culturally-safe care. This review was undertaken by the Canadian Virtual Hospice as a foundation for this tool. METHODS: To explore attitudes, behaviours and patterns to utilization of EoL care by culturally and spiritually diverse groups and identify gaps in EoL care practice and delivery methods, a scoping review and thematic analysis of article content was conducted...
2016: BMC Geriatrics
Babur S Mirza, Darwin L Sorensen, R Ryan Dupont, Joan E McLean
Trichloroethene (TCE) in groundwater is a major health concern and biostimulation/bioaugmentation-based strategies have been evaluated to achieve complete reductive dechlorination with varying success. Different carbon sources were hypothesized to stimulate different extents of TCE reductive dechlorination. Ecological conditions that developed different dechlorination stages were investigated by quantitating Dehalococcoides 16S rRNA (Dhc) and reductive dehalogenase gene abundance, and by describing biogeochemical properties of laboratory columns in response to this biostimulation...
March 2016: Applied Microbiology and Biotechnology
Hengguang Wang, Yifan Gu, Yufeng Wu, Yi-Nan Zhang, Wei Wang
With the advances in electronics and information technology, China has gradually become the largest consumer of household appliances (HAs). Increasingly, end-of-life (EOL) HAs are generated in China. EOL recycling is a promising strategy to reduce dependence on virgin production, and indium is one of the recycled substances. The potential yield of indium recycling has not been systematically evaluated in China thus far. This paper estimates the potential yield of recycled indium from waste liquid crystal displays (LCDs) in China during the period from 2015 to 2030...
December 2015: Waste Management
Elizabeth Hahn, Catherine J Brady-Copertino, Barry R Meisenberg
BACKGROUND: There is increased interest among oncology and palliative professionals in providing appropriately timed hospice services for cancer patients. End of life (EoL) metrics have been included in oncology quality programs, but accurate EoL data and benchmarks are hard to obtain. OBJECTIVE: To improve EoL care by measuring patterns of care among recently deceased patients. METHODS: Care utilization among deceased patients was analyzed by using software integrated with patient electronic health records...
June 2015: Journal of Community and Supportive Oncology
Jennifer W Mack, Lie H Chen, Kimberley Cannavale, Olivia Sattayapiwat, Robert M Cooper, Chun R Chao
IMPORTANCE: Cancer is the leading disease-related cause of death among adolescents and young adults (AYAs), but little is known about the care that AYA patients with cancer receive at the end of life (EOL). OBJECTIVE: To evaluate the intensity of EOL care among AYA patients with cancer. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study of Kaiser Permanente Southern California (KSPC) cancer registry data and electronic health records for 663 AYA patients with either stage I to III cancer and evidence of cancer recurrence or stage IV cancer at diagnosis...
August 2015: JAMA Oncology
Ramona L Rhodes, Sabiha Kazi, Lei Xuan, Ruben Amarasingham, Ethan A Halm
BACKGROUND: Physicians often have difficulty with prognostication and identification of patients who are in need of counseling about options for care at the end of life. Consequently, the objective of this study was to describe the initial stages in development of a computerized algorithm that will identify breast and lung cancer patients most in need of counseling about care options, including advance care planning, palliative care, and hospice. METHODS: Clinical and non-clinical data were extracted from the electronic medical record of breast and lung cancer patients admitted to a large, urban hospital for the year 2010...
August 2016: American Journal of Hospice & Palliative Care
Katrina J Lin, Andrea Ching, Kyle P Edmonds, Eric J Roeland, Carolyn Revta, Joseph D Ma, Rabia S Atayee
BACKGROUND: Continuous morphine infusions (CMIs) treat pain and dyspnea at the end of life (EOL). CMIs may be initiated at an empiric rate and/or are rapidly escalated without proper titration. OBJECTIVE: The study objective was to evaluate CMI patterns at the EOL. METHODS: This single-center, retrospective chart review evaluated adult patients who died while receiving CMI at EOL. Patient demographics and opioid dosing information were extracted from an electronic medical record...
September 2015: Journal of Palliative Medicine
Francis Lau, Doris Barwich, Neil Hilliard, Colin Partridge, Bruce Hobson, Morgan Price, Douglas McGregor, Jesdeep Bassi, Dennis Lee, Julie Kim, Joanna Pyke, Gurprit Randhawa
This is a knowledge translation project to promote the uptake of best practices in end-of-life (EOL) care within the primary care setting in British Columbia (BC) through the use of tools embedded into electronic medical records (EMRs). The knowledge-to-action model is used to engage primary care providers in co-designing, adopting and evaluating the EOL care toolkit built for 3 EMRs. The toolkit has a set of EMR-specific data entry templates, query/report functions and access to additional downloadable resources...
2015: Studies in Health Technology and Informatics
Jeff Myers
PURPOSE OF REVIEW: This article provides an update on the recent research and evidence regarding quality in end-of-life (EOL) discussions with a focus on the care of a person with cancer. RECENT FINDINGS: Clinicians have the challenging task of customizing the information exchange that occurs during an EOL discussion. Patients identify important stipulations that accompany a desire for frank EOL discussions. These include timing of the discussion, ensuring evaluation of readiness to engage in the EOL discussion, and being invited to participate...
March 2015: Current Opinion in Supportive and Palliative Care
Melissa A LoPresti, Fritz Dement, Heather T Gold
BACKGROUND: Ethnic/racial minorities encounter disparities in healthcare, which may carry into end-of-life (EOL) care. Advanced cancer, highly prevalent and morbid, presents with worsening symptoms, heightening the need for supportive and EOL care. PURPOSE: To conduct a systematic review examining ethnic/racial disparities in EOL care for cancer patients. DESIGN: We searched four electronic databases for all original research examining EOL care use, preferences, and beliefs for cancer patients from ethnic/racial minority groups...
April 2016: American Journal of Hospice & Palliative Care
Kathryn Ingold, Fiona Hicks
A detailed health needs assessment (HNA) for end-of-life care (EoLC) services was led by public health in Leeds to inform a commissioning strategy. To answer the question: are we delivering the best possible EoLC services within the resources available? Mixed methods were used with three approaches: epidemiological, corporate and comparative. More people from deprived communities die in hospital. 18% of people who die each year are on a palliative care register, reflecting a lack of recognition and planning for EoLC given that 75% of people who die need EoLC...
June 2015: BMJ Supportive & Palliative Care
Ann Kutney-Lee, Caitlin W Brennan, Mark Meterko, Mary Ersek
CONTEXT: The Veterans Health Administration (VA) has improved the quality of end-of-life (EOL) care over the past several years. Several structural and process variables are associated with better outcomes. Little is known, however, about the relationship between the organization of nursing care and EOL outcomes. OBJECTIVES: To examine the association between the organization of nursing care, including the nurse work environment and nurse staffing levels, and quality of EOL care in VA acute care facilities...
March 2015: Journal of Pain and Symptom Management
Sudesh Yadav, Satyamanyu Yadav, Pawan Kumar
Environmentally safe disposal of end-of-life (EoL) or discarded mobile phone is a serious problem on account of their ever increasing number and toxic metals contents. In the present work, metal toxicity of mobile phone plastics, printed wire boards (PWBs) and batteries were assessed through dynamic batch leaching using Milli Q (MQ) water. Phone plastics failed Toxicity Characterization Leaching Procedure (TCLP) and Waste Extraction Test (WET) for Pb as the cumulative amount of Pb leached from plastics (5.33 mg/l) exceeded the regulatory limits (5...
July 2014: Waste Management
Hinrich P Hansen, Hanna-Mareike Engels, Maria Dams, Adriana F Paes Leme, Bianca Alves Pauletti, Vijaya Lakshmi Simhadri, Horst Dürkop, Katrin S Reiners, Sabine Barnert, Andreas Engert, Rolf Schubert, Fabio Quondamatteo, Michael Hallek, Elke Pogge von Strandmann
Classical Hodgkin's lymphoma (cHL)-affected lymphoid tissue contains only a few malignant Hodgkin and Reed-Sternberg (HRS) cells, which are disseminated within a massive infiltrate of reactive cells. In particular, the innate immune infiltrate is deemed to support tumour growth by direct cell-cell interaction. Since they are rarely found in close proximity to the malignant cells in situ, we investigated whether cHL-derived extracellular vesicles might substitute for a direct cell-cell contact. We studied the crosstalk of the transmembrane proteins CD30 and CD30 ligand (CD30L) because they are selectively expressed on HRS and innate immune cells, respectively...
March 2014: Journal of Pathology
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