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End-of-life care in emergency department

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https://www.readbyqxmd.com/read/29157510/euthanasia-requests-in-a-canadian-psychiatric-emergency-room-a-case-series-part-1-of-the-mcgill-university-euthanasia-in-psychiatry-case-series
#1
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
https://www.readbyqxmd.com/read/29153752/hospice-care-for-patients-with-dementia-in-the-united-states-a-longitudinal-cohort-study
#2
Aline De Vleminck, R Sean Morrison, Diane E Meier, Melissa D Aldridge
BACKGROUND: Patients with dementia form an increasing proportion of those entering hospice care. Little is known about the types of hospices serving patients with dementia and the patterns of hospice use, including timing of hospice disenrollment between patients with and without dementia. OBJECTIVES: To characterize the hospices that serve patients with dementia, to compare patterns of hospice disenrollment for patients with dementia and without dementia, and to evaluate patient-level and hospice-level characteristics associated with hospice disenrollment...
November 16, 2017: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/29113549/the-final-30-days-of-life-a-study-of-patients-with-gastrointestinal-cancer-in-ontario-canada
#3
Shaila J Merchant, Katherine Lajkosz, Susan B Brogly, Christopher M Booth, Sulaiman Nanji, Sunil V Patel, Nancy N Baxter
BACKGROUND: Studies have reported overly aggressive end-of-life care (EOLC) in many cancers. We investigate trends in, and factors associated with, aggressive EOLC among patients who died of gastrointestinal (GI) cancers 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 through the Ontario Cancer Registry, and information was collected from linked databases...
January 1, 2017: Journal of Palliative Care
https://www.readbyqxmd.com/read/29100653/understanding-the-struggles-to-be-a-medical-provider-view-through-medical-student-essays
#4
William J Peterson, Joseph B House, Cemal B Sozener, Sally A Santen
BACKGROUND: The clinical learning environment helps to shape the professional identity of medical students. This process begins from existing personal identity and is influenced by various factors, including clinical experiences and clinical learning environment. OBJECTIVE: The purpose of this study was to examine medical students' reflections as a way to identify and better characterize the modern struggles that medical students face, in order to inform the development of professional identity...
October 31, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28987963/improving-cancer-patient-emergency-room-utilization-a-new-jersey-state-assessment
#5
Anthony J Scholer, Omar M Mahmoud, Debopyria Ghosh, Jacob Schwartzman, Mohammed Farooq, Javier Cabrera, Robert Wieder, Nabil R Adam, Ravi J Chokshi
INTRODUCTION: Due to its increasing incidence and its major contribution to healthcare costs, cancer is a major public health problem in the United States. The impact across different services is not well documented and utilization of emergency departments (ED) by cancer patients is not well characterized. The aim of our study was to identify factors that can be addressed to improve the appropriate delivery of quality cancer care thereby reducing ED utilization, decreasing hospitalizations and reducing the related healthcare costs...
October 4, 2017: Cancer Epidemiology
https://www.readbyqxmd.com/read/28954604/untapped-potential-in-australian-hospitals-for-organ-donation-after-circulatory-death
#6
Sandeep S Rakhra, Helen I Opdam, Laura Gladkis, Byron Arcia, Michael A Fink, John Kanellis, Peter S Macdonald, Gregory I Snell, David V Pilcher
OBJECTIVE: To determine the potential for organ donation after circulatory death (DCD) in Australia by applying ideal and expanded organ suitability criteria, and to compare this potential with actual DCD rates. DESIGN: Retrospective cohort study. Setting, methods: We analysed DonateLife audit data for patients aged 28 days to 80 years who died between July 2012 and December 2014 in an intensive care unit or emergency department, or who died within 24 hours of discharge from either, in the 75 Australian hospitals contributing data to DonateLife...
September 2, 2017: Medical Journal of Australia
https://www.readbyqxmd.com/read/28918550/advance-care-planning-challenges-at-the-emergency-department-of-a-cancer-care-center
#7
Maria T Cruz-Carreras, Patrick Chaftari, Jayne Viets-Upchurch
INTRODUCTION: Code status discussions form an important part of advance care planning (ACP) as it enables physicians to respect the patient's wishes for end-of-life care. However, in some cases, code status discussions can be challenging causing the physician to go against the patient's wishes and the code of medical ethics. This is especially true in an emergency setting. In this paper, we will discuss three cases of advanced cancer patients, where code status discussions posed challenges to healthcare providers...
September 16, 2017: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/28838779/predictors-of-emergency-department-attendance-by-people-with-dementia-in-their-last-year-of-life-retrospective-cohort-study-using-linked-clinical-and-administrative-data
#8
Katherine E Sleeman, Gayan Perera, Robert Stewart, Irene J Higginson
INTRODUCTION: A fall in hospital deaths in dementia has been interpreted as indicating an improvement in end-of-life care. Whether other indicators of quality of end-of-life care, such as emergency department (ED) attendance, show a similar trend is unclear. METHODS: Retrospective cohort study using electronic medical records from a large mental health care provider, linked to national mortality and hospital use data (2008-2013). RESULTS: Of 4867 patients, 78...
August 8, 2017: Alzheimer's & Dementia: the Journal of the Alzheimer's Association
https://www.readbyqxmd.com/read/28832240/-was-it-worth-it-intrathecal-analgesia-for-cancer-pain-a-qualitative-study-exploring-the-views-of-family-carers
#9
Nishi Patel, Melanie Huddart, Helen Makins, Theresa Mitchell, Jane L Gibbins, Juan Graterol, Deborah Stevens, Paul Perkins
BACKGROUND: Intrathecal drug delivery is known to reduce pain in patients where conventional systemic analgesia has been ineffective or intolerable. However, there is little information regarding the effects of intrathecal drug delivery on quality of life and function in those with advanced, incurable cancer. AIM: Retrospective exploration of the views of bereaved carers regarding the physical and psychosocial effects of external tunnelled intrathecal drug delivery in patients with advanced incurable cancer...
August 1, 2017: Palliative Medicine
https://www.readbyqxmd.com/read/28817376/association-between-hospice-spending-on-patient-care-and-rates-of-hospitalization-and-medicare-expenditures-of-hospice-enrollees
#10
Melissa D Aldridge, Andrew J Epstein, Abraham A Brody, Eric J Lee, R Sean Morrison, Elizabeth H Bradley
BACKGROUND: Care at the end of life is increasingly fragmented and is characterized by multiple hospitalizations, even among patients enrolled with hospice. OBJECTIVE: To determine whether hospice spending on direct patient care (including the cost of home visits, drugs, equipment, and counseling) is associated with hospital utilization and Medicare expenditures of hospice enrollees. DESIGN: Longitudinal, observational cohort study (2008-2010)...
August 17, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28802638/spiritual-perspectives-of-emergency-medicine-doctors-and-nurses-in-caring-for-end-of-life-patients-a-mixed-method-study
#11
Yingting Zhang, Rakhee Yash Pal, Wai San Wilson Tam, Alice Lee, Mabel Ong, Lay Hwa Tiew
BACKGROUND: End-of-life care is becoming more prevalent in the Emergency Department. Quality end-of-life care includes spiritual support. As spirituality is a relatively vague concept, understanding healthcare professionals' spiritual perspectives is important. AIMS: To explore the perspectives of Emergency Department doctors and nurses in (i) spirituality, (ii) spiritual care domain in end-of-life care and (iii) factors influencing spiritual care provision in the Emergency Department...
August 9, 2017: International Emergency Nursing
https://www.readbyqxmd.com/read/28760210/a-randomized-trial-of-a-1-hour-troponin-t-protocol-in-suspected-acute-coronary-syndromes-design-of-the-rapid-assessment-of-possible-acs-in-the-emergency-department-with-high-sensitivity-troponin-t-rapid-tnt-study
#12
RANDOMIZED CONTROLLED TRIAL
Cynthia Papendick, Andrew Blyth, Anil Seshadri, Michael J R Edmonds, Tom Briffa, Louise Cullen, Stephen Quinn, Jon Karnon, Anthony Chuang, Adam J Nelson, Matthew Horsfall, Erin Morton, Derek P Chew
BACKGROUND: Protocols incorporating high-sensitivity troponin to guide decision making in the disposition of patients with suspected acute coronary syndromes (ACS) in the emergency department have received a lot of attention. Traditionally, patients with chest pain have required long periods of observation in emergency department before being deemed safe for discharge. In an era of limited health service resources, a protocol that could discharge patients safely within an hour of presentation is extremely attractive...
August 2017: American Heart Journal
https://www.readbyqxmd.com/read/28709581/trends-in-end-of-life-care-and-health-care-spending-in-women-with-uterine%C3%A2-cancer
#13
Benjamin Margolis, Ling Chen, Melissa K Accordino, Grace Clarke Hillyer, June Y Hou, Ana I Tergas, William M Burke, Alfred I Neugut, Cande V Ananth, Dawn L Hershman, Jason D Wright
BACKGROUND: High-intensity care including hospitalizations, chemotherapy, and other interventions at the end of life is costly and often of little value for cancer patients. Little is known about patterns of end-of-life care and resource utilization for women with uterine cancer. OBJECTIVE: We examined the costs and predictors of aggressive end-of-life care for women with uterine cancer. STUDY DESIGN: In this observational cohort study the Surveillance, Epidemiology, and End Results-Medicare linked database was used to identify women age ≥65 years who died from uterine cancer from 2000 through 2011...
October 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28659072/improving-interdepartmental-communication-following-a-patient-death
#14
Nina Whittle
When patients die in emergency departments (EDs), it is important to record information that can be shared with staff in other departments, such as the mortuary and bereavement office. This can be a time-consuming exercise but, if information is omitted, it can increase families' distress by delaying documents such as death certificates. This article describes how a new, tick-box-style death-in-department checklist was introduced in a London hospital adult ED to increase and improve communication and information sharing between the ED, the mortuary and the bereavement office...
June 29, 2017: Nursing Management (Harrow)
https://www.readbyqxmd.com/read/28655591/promoting-dignified-end-of-life-care-in-the-emergency-department-a-qualitative-study
#15
María Del Mar Díaz-Cortés, José Granero-Molina, José Manuel Hernández-Padilla, Rocío Pérez Rodríguez, Matías Correa Casado, Cayetano Fernández-Sola
BACKGROUND: Preservation of a dying person's dignity in the emergency department (ED) is fundamental for the patient, his/her relatives and healthcare professionals. The aim of this study was to explore and interpret physicians' and nurses' experiences regarding conservation of dignity in end-of-life care in dying patients in the ED. METHODS: A qualitative study based on the hermeneutic phenomenological approach, was carried out in the emergency department of two general hospitals...
June 24, 2017: International Emergency Nursing
https://www.readbyqxmd.com/read/28637450/health-care-use-and-costs-at-the-end-of-life-a-comparison-of-elderly-australian-decedents-with-and-without-a-cancer-history
#16
Rebecca Reeve, Preeyaporn Srasuebkul, Julia M Langton, Marion Haas, Rosalie Viney, Sallie-Anne Pearson
BACKGROUND: There is limited population-level research on end-of-life care in Australia that considers health care use and costs across hospital and community sectors. The aim of this study was to quantify health care use and costs in the last 6 months of life in a cohort of elderly Australian decedents and to examine the factors associated with end-of-life resource use and costs. METHODS: A retrospective cohort study using routinely collected health data from Australian Government Department of Veterans' Affairs clients...
June 21, 2017: BMC Palliative Care
https://www.readbyqxmd.com/read/28631517/what-factors-influence-emergency-department-visits-by-patients-with-cancer-at-the-end-of-life-analysis-of-a-124-030-patient-cohort
#17
Lesley A Henson, Irene J Higginson, Wei Gao
BACKGROUND: Emergency department visits towards the end of life by patients with cancer are increasing over time. This is despite evidence of an association with poor patient and caregiver outcomes and most patients preferring home-based care. AIM: To identify socio-demographic and clinical factors associated with end-of-life emergency department visits and determine the relationship between patients' prior emergency department use and risk of multiple (⩾2) visits in the last month of life...
June 1, 2017: Palliative Medicine
https://www.readbyqxmd.com/read/28620978/comparison-of-healthcare-utilization-and-life-sustaining-interventions-between-elderly-patients-with-dementia-and-those-with-cancer-near-the-end-of-life-a-nationwide-population-based-study-in-taiwan
#18
Yu-Han Chen, Chung-Han Ho, Chien-Cheng Huang, Ya-Wen Hsu, Yueh-Chun Chen, Ping-Jen Chen, Guan-Ting Chen, Jhi-Joung Wang
AIM: Little is known about the pattern of healthcare services for end-of-life patients with dementia (PwD) in East Asia. We compared this pattern between PwD and cancer patients in their last year of life in Taiwan. METHODS: Taiwan's National Health Insurance Research Database was applied for this case-control analysis. The records of patients who had dementia and died between 2002 and 2011 were reviewed. The control group was decedents with cancer. The utilization of hospitalization, emergency department visits and life-sustaining interventions during the last year of life between the two groups were compared...
June 16, 2017: Geriatrics & Gerontology International
https://www.readbyqxmd.com/read/28589462/discharge-or-admit-emergency-department-management-of-incidental-pulmonary-embolism-in-patients-with-cancer-a-retrospective-study
#19
Srinivas R Banala, Sai-Ching Jim Yeung, Terry W Rice, Cielito C Reyes-Gibby, Carol C Wu, Knox H Todd, W Frank Peacock, Kumar Alagappan
BACKGROUND: Hospitalization and early anticoagulation therapy remain standard care for patients who present to the emergency department (ED) with pulmonary embolism (PE). For PEs discovered incidentally, however, optimal therapeutic strategies are less clear-and all the more so when the patient has cancer, which is associated with a hypercoagulable state that exacerbates the threat of PE. METHODS: We conducted a retrospective review of a historical cohort of patients with cancer and incidental PE who were referred for assessment to the ED in an institution whose standard of care is outpatient treatment of selected patients and use of low-molecular-weight heparin for anticoagulation...
December 2017: International Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28495487/effect-of-psychiatric-illness-on-acute-care-utilization-at-end-of-life-from-serious-medical-illness
#20
Kyle Lavin, Dimitry S Davydow, Lois Downey, Ruth A Engelberg, Ben Dunlap, James Sibley, William B Lober, Kelson Okimoto, Nita Khandelwal, Elizabeth T Loggers, Joan M Teno, J Randall Curtis
CONTEXT: Little is known about psychiatric illness and utilization of end-of-life care. OBJECTIVES: We hypothesized that preexisting psychiatric illness would increase hospital utilization at end of life among patients with chronic medical illness due to increased severity of illness and care fragmentation. METHODS: We reviewed electronic health records to identify decedents with one or more of eight chronic medical conditions based on International Classification of Diseases-9 codes...
May 9, 2017: Journal of Pain and Symptom Management
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