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End-of-life care in emergency department

Magnolia Cardona, Ebony T Lewis, Robin M Turner, Hatem Alkhouri, Stephen Asha, John Mackenzie, Margaret Perkins, Sam Suri, Anna Holdgate, Luis Winoto, Chan-Wei Chang, Blanca Gallego-Luxan, Sally McCarthy, Mette R Kristensen, Michael O'Sullivan, Helene Skjøt-Arkil, Anette A Ekmann, Hanne H Nygaard, Jonas J Jensen, Rune O Jensen, Jonas L Pedersen, Dorothy Breen, John A Petersen, Birgitte N Jensen, Christian Backer Mogensen, Ken Hillman, Mikkel Brabrand
BACKGROUND: Prognostic uncertainty inhibits clinicians from initiating timely end-of-life discussions and advance care planning. This study evaluates the efficacy of the CriSTAL (Criteria for Screening and Triaging to Appropriate aLternative care) checklist in emergency departments. METHODS: Prospective cohort study of patients aged ≥65 years with any diagnosis admitted via emergency departments in ten hospitals in Australia, Denmark and Ireland. Electronic and paper clinical records will be used to extract risk factors such as nursing home residency, physiological deterioration warranting a rapid response call, personal history of active chronic disease, history of hospitalisations or intensive care unit admission in the past year, evidence of proteinuria or ECG abnormalities, and evidence of frailty to be concurrently measured with Fried Score and Clinical Frailty Scale...
March 6, 2018: Archives of Gerontology and Geriatrics
Muhammad Irfan Farooque
Training in Emergency medicine for nearly 5 years, I thought the finish line was getting near and becoming a consultant was just down the corner. I was enjoying work, getting better every day and well appreciated by peers. But little did I know that life had other plans. I ended up in an emergency department presenting with status epilepticus preceded by vague ongoing symptoms lasting for 2 months. I was intubated and transferred to Intensive care and did not receive a formal diagnosis which still remains a mystery...
March 10, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Kate Brameld, Katrina Spilsbury, Lorna Rosenwax, Helen Leonard, James Semmens
OBJECTIVE: To describe the cause of death together with emergency department presentations and hospital admissions in the last year of life of people with intellectual disability. METHOD: A retrospective matched cohort study using de-identified linked data of people aged 20 years or over, with and without intellectual disability who died during 2009 to 2013 in Western Australia. Emergency department presentations and hospital admissions in the last year of life of people with intellectual disability are described along with cause of death...
February 25, 2018: BMJ Open
Jacqueline Deloumeaux, Gaël Samut, Devi Rochemont, Henri Merault, Roger Dufresne, Valérie Galantine, Yannick Tirolien, Catherine Léonardi, Antoine Adenis, Jessica Peruvien, Mathieu Nacher, Jean-Marc Gabriel
End stage renal disease is a major public health problem in the French Departments of Guadeloupe and Guiana because of the high prevalence of both type 2 diabetes and hypertension. We investigated factors associated with an emergency start of dialysis, 3 months' quality of life for patients starting a first replacement therapy in Guadeloupe and French Guiana using the data of the Réseau épidémiologie et information en néphrologie network, completed with data from the quality of life questionnaires SF-36 and KDQoL...
February 21, 2018: Néphrologie & Thérapeutique
Casey M Hay, Joseph L Kelley, Robert P Edwards, Kathleen M Pombier, John T Comerci
Super-utilizers account for many emergency department visits (EDV) and hospitalizations. Among Medicare/Medicaid patients, 5% to 10% account for >50% of spending. Little is known about super-utilization in gynecologic oncology. Charts of 64 gynecologic oncology patients with ≥3 EDV and/or admissions over 12 months were reviewed retrospectively. Cancer type distribution was 47% ovarian, 23% cervical, 23% endometrial, and 6% vulvar. Treatment at index visit was 61% chemotherapy, 16% no treatment, 8% recent surgery, and 6% radiation...
February 1, 2018: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
Maria Björck, Helle Wijk
BACKGROUND: Providing care for frail older persons is complex and demanding, and the transfer of older persons with cognitive impairment to the emergency department is associated with a high risk of them developing complications. AIM: To survey the most ill and frail older persons with cognitive impairment who were transferred from nursing homes to the emergency department, considering reasons for referral, symptoms and actions taken at the hospital. METHOD: A retrospective descriptive survey, conducting a review of 588 referral notes and medical records, analysed and presented with descriptive statistics and visualised with typical case narratives...
February 12, 2018: Scandinavian Journal of Caring Sciences
Cayetano Fernández-Sola, José Granero-Molina, María Del Mar Díaz-Cortés, Francisca Rosa Jiménez-López, Pablo Roman-López, Encarnación Saez-Molina, Cayetano José Aranda-Torres, José María Muñoz-Terrón, María Paz García-Caro, José Manuel Hernández-Padilla
AIMS: to explore and understand the experiences of terminally-ill patients and their relatives regarding dignity during end-of-life care in the emergency department. BACKGROUND: the respect given to the concept of dignity is significantly modifying the clinical relationship and the care framework involving the end-of-life patient in palliative care units, critical care units, hospices and their own homes. This situation is applicable to in-hospital emergency departments, where there is a lack of research which takes the experiences of end-of-life patients and their relatives into account...
February 8, 2018: Journal of Advanced Nursing
Paolo Cotogni, Andrea Saini, Anna De Luca
Traditionally, palliative care (PC) systems focused on the needs of advanced cancer patients, but most patients needing PC have end-stage organ diseases. Similarly, PC models focus on the needs of patients in hospices or at home; however, in most cases PC is provided in acute hospitals. Indeed, the symptom burden that these patients experience in the last year of life frequently forces them to seek care in emergency departments. The majority of them are admitted to the hospital and many die. This issue poses important concerns...
January 30, 2018: Journal of Clinical Medicine
Luciana Martins Rozman, Alessandro Gonçalves Campolina, Rossana Verónica Mendonça López, Silvia Takanohashi Kobayashi, Toshio Chiba, Patrícia Coelho de Soárez
BACKGROUND: Integrating palliative care into standard oncology care has been recommended for cancer patients. Early palliative care is associated with less aggressive treatment at the end of life. OBJECTIVE: To describe cancer patients receiving palliative care in Brazil, determining the time from entry into palliative care to death, and investigating whether late referral to palliative care is associated with aggressive end-of-life treatment. DESIGN: This was a cross-sectional study of cancer patients receiving palliative care in Brazil...
January 25, 2018: Journal of Palliative Medicine
Chi-Wei Lee, Yu-Ying Chao, Jentaie Shiea, Jheng-Heng Shen, Hei-Hwa Lee, Bai-Hsiun Chen
A 25-year-old man suffered from consciousness change was sent to our emergency department by friends who reported that they were not sure what had happened to him. Physical examination revealed bilateral pupils dilatation, lethargy, slurred speech, and ataxia. Computer-aided tomographic scan of the brain revealed no definite evidence of intracranial lesions. Routine laboratory tests revealed total physiological turmoil. Despite immediate commencement of aggressive treatment, the patient's condition deteriorated long before the traditional drug screen provided an answer for the identities of the multiple drugs overdose...
December 20, 2017: American Journal of Emergency Medicine
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
Jessica Rizzuto, Melissa D Aldridge
OBJECTIVES: To determine whether there is racial variation in hospice enrollees in rates of hospitalization and hospice disenrollment and, if so, whether systematic differences in hospice provider patterns explain the variation. DESIGN: Longitudinal cohort study. SETTING: Hospice. PARTICIPANTS: Medicare beneficiaries (N = 145,038) enrolled in a national random sample of hospices (N = 577) from the National Hospice Survey and followed until death (2009-10)...
December 18, 2017: Journal of the American Geriatrics Society
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
Yuhua Bao, Renee C Maciejewski, Melissa M Garrido, Manish A Shah, Paul K Maciejewski, Holly G Prigerson
CONTEXT: For patients with metastatic cancer and limited life expectancy, potential benefits of chemotherapy must be balanced against harms to quality of life near death and increased out-of-pocket costs of care. OBJECTIVES: To evaluate the association between chemotherapy use by patients with Stage IV pancreatic cancer and health care use and Medicare and out-of-pocket costs in the last 30 days of life. METHODS: We conducted a retrospective cohort study of 3825 patients aged 66 years or older when diagnosed with Stage IV pancreatic cancer in 2006-2011, using the linked Surveillance, Epidemiology, and End Results-Medicare data...
April 2018: Journal of Pain and Symptom Management
Alberto Alvarez-Perea, Luciana Kase Tanno, María L Baeza
Anaphylaxis is defined as a severe life-threatening generalized or systemic hypersensitivity reaction characterized by rapidly developing airway and/or circulation problems. It presents with very different combinations of symptoms and apparently mild signs and can progress to fatal anaphylactic shock unpredictably. The difficulty in recognizing anaphylaxis is due, in part, to the variability of diagnostic criteria, which in turn leads to a delay in administration of appropriate treatment, thus increasing the risk of death...
2017: Clinical and Translational Allergy
Joyce L Merrigan
Miscarriage is the unwanted ending of a pregnancy before 20 weeks gestation. Women experiencing miscarriage require specialized care from nurses and other healthcare professionals. Many women are dissatisfied with emergency care related to miscarriage and desire honest communication, validation of urgency, and more robust information at discharge. Perinatal bereavement education offers an opportunity for emergency department nurses to acquire specific knowledge and communication skills that assist with understanding the individualized experience of early pregnancy loss...
January 2018: MCN. the American Journal of Maternal Child Nursing
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
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
Katja Empson, Sarah Beale, Jacques Kerr, Dale Gardiner
INTRODUCTION: The 2015 RCEM End of Life Care best practice guideline highlighted the need for organ and tissue donation to be a usual part of end of life care in the Emergency Department (ED). NICE guideline states that all deaths meeting defined clinical triggers in the ED (in practice - mechanical ventilation, plan to withdraw life sustaining treatment, death expected) should prompt timely referral to organ donation services. Any family discussion in the ED regarding organ donation should be held collaboratively with a specialist nurse for organ donation (SNOD)...
December 2017: Emergency Medicine Journal: EMJ
David Benrimoh, Antoine Perreault, Frederique Van Den Eynde
Euthanasia was decriminalized in Quebec in December 2015, and Canada-wide in June 2016. Both the Provincial and Federal legislation have limited the right to medical assistance in dying (MAID) to end-of-life cases; which makes MAID inaccessible to most patients solely suffering from psychiatric illness. While some end-stage anorexia nervosa or elderly patients may meet the end-of-life criterion because of their medical comorbidities or their age (Kelly et al., 2003), repeated suicide attempts or psychotic disorganization would not qualify since they would not be seen as elements of an illness leading to a foreseeable "natural death" (Canada, 2016)...
November 2017: International Journal of Law and Psychiatry
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