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palliative care - Top 30 Publications

Survival, Functional Status, and Eating Ability After Percutaneous Endoscopic Gastrostomy Tube Placement for Acute Stroke.

To determine the long-term survival and independence of individuals with stroke and percutaneous endoscopic gastrostomy (PEG) tube placement.

The frequency of QTc prolongation among pediatric and young adult patients receiving methadone for cancer pain.

A prolonged corrected QT (QTc) interval in pediatric patients is defined as ≥470 msec. Methadone can cause a prolonged QTc interval that can lead to ventricular arrhythmias. The risk of methadone-induced prolongation of the QTc interval in children and young adults is unknown. The purpose of the study was to determine the frequency of QTc prolongation among pediatric and young adult patients with cancer pain on methadone treatment.

Validation of the Behavioural Observation Scale 3 for the evaluation of pain in adults.

Many behavioural scales are available to assess pain but none are suitable for a quick evaluation of non-sedated and non-geriatric adults. The Behavioural Observation Scale 3 (BOS-3) is short, composed of five items. This study examined its feasibility and diagnostic performances.

Effect of Neoadjuvant Chemotherapy Followed by Surgical Resection on Survival in Patients With Limited Metastatic Gastric or Gastroesophageal Junction Cancer: The AIO-FLOT3 Trial.

Surgical resection has a potential benefit for patients with metastatic adenocarcinoma of the stomach and gastroesophageal junction.

Hospice or community network? Choices in end-of-life care in Jamaica.

National and international healthcare agencies and organizations typically attribute slow or haphazard growth in hospice and palliative care in developing countries to various resource constraints. This study provides evidence of the substantial and widening gap between policy advocacy and individual decision-making concerning end-of-life care. It does so by establishing the incentives and risks that underlie choices of patients and providers against the relative scarcity of hospices in these countries.

Development of a French Version of the Edmonton Symptom Assessment System-Revised: A Pilot Study of Palliative Care Patients' Perspectives.

The Edmonton Symptom Assessment System-revised (ESAS-r) is a nine-item self-report symptom intensity tool developed for palliative care patients, with the option of adding a 10th patient-specific symptom. Due to growing international uptake, the ESAS-r has been translated into different languages. There has not been agreement, however, regarding a standard process for translation into multiple languages, which also includes patients' perspectives.

Better Together: The Making and Maturation of the Palliative Care Research Cooperative Group.

To describe the growth and outcomes of the Palliative Care Research Cooperative Group (PCRC).

Role of anesthesiology in pain medicine and palliative care treatment in German hospitals : Survey of department heads of anesthesiology on treatment structures.

The aim of this analysis was to describe the role of anesthesiology departments in pain medicine and palliative care services in German hospitals.

Establishment of Specialized Pediatric Palliative Home Care in the Medical Valley of the European Metropolitan Area Nuremberg.

Background As part of the 2007 health reform in Germany the structure of outpatient palliative care for children and adolescents was adopted for the first time and then implemented in Erlangen-Nuremberg in 2009. Methods The introduction of Pediatric Palliative Home Care (PPHC) at the Hospital for Children and Adolescents at the University of Erlangen-Nuremberg was retrospectively analyzed between the years 2009 to 2014. Referring medical records (paper-based and electronic) were evaluated systematically. Results Considering 69 patients within this study, 44 (63.8%) died during the investigated period and 61% of these Patients deceased at home. 60 patients (87%) had a written emergency plan, which was jointly developed with patients and particularly their parents and relatives in cooperation with the PPHC team. Over the years and with increasing experience, the number and duration of emergency hospitalization decreased. Even complex therapies, such as patient-controlled analgesia with PCA pump could be implemented on an outpatient basis. Conclusion The descriptive cohort study demonstrates that palliative care for children, despite the medical and structural complexity is possible in an ambulatory setting. It allows a similar, if not better care, compared to inpatient palliative care for children and adolescents, not only for the affected patients, but also for their families.

The Provision of Spiritual Care in Hospices: A Study in Four Hospices in North Rhine-Westphalia.

This article considers the role and the practices of spiritual care in hospices. While spiritual care was firmly established as one of the four pillars of practical hospice care alongside medical, psychological and social care by Cicely Saunders, the importance and functions of spiritual care in daily practice remain arguable. When speaking about spirituality, what are we actually speaking about? What form do the spiritual relations take between full-time staff and volunteers on the one hand, and the patients and their family members on the other? These were central questions of a qualitative study that we carried out in four hospices in North Rhine-Westphalia, Germany, to explore how spiritual care is provided in hospices and what significance spirituality has in hospices. The study shows that the advantages of a broader definition of spirituality lie in "spiritual care" no longer being bound to one single profession, namely that of the chaplain. It also opens the way for nurses and volunteers-irrespective of their own religious beliefs-to provide spiritual end-of-life care to patients in hospices. If the hospice nurses and volunteers were able to mitigate the patients' fear not only by using medications but also in a psychosocial or spiritual respect, then they saw this as a successful psychological and spiritual guidance. The spiritual guidance is to some degree independent of religious belief because it refers to a "spirit" or "inner core" of human beings. But this guidance needs assistance from professional knowledge considering religious rituals if the patients are deeply rooted in a (non-Christian) religion. Here, the lack of knowledge could be eliminated by further education as an essential but not sufficient condition.

Application of palliative ventilation: potential and clinical evidence in palliative care.

See the person behind the patient.

During my first clinical placement on a surgical ward, I helped care for a female patient with peritoneal cancer. The patient, who I will call Jane, was about 60 years old and was receiving palliative care.

Neuroscience Intermediate-Level Care Units Staffed by Intensivists: Clinical Outcomes and Cost Analysis.

With an aging population and increasing numbers of intensive care unit admissions, novel ways of providing quality care at reduced cost are required. Closed neurointensive care units improve outcomes for patients with critical neurological conditions, including decreased mortality and length of stay (LOS). Small studies have demonstrated the safety of intermediate-level units for selected patient populations. However, few studies analyze both cost and safety outcomes of these units. This retrospective study assessed clinical and cost-related outcomes in an intermediate-level neurosciences acute care unit (NACU) before and after the addition of an intensivist to the unit's care team.

The Addiction Recovery Clinic: A Novel, Primary-Care-Based Approach to Teaching Addiction Medicine.

Substance use is highly prevalent in the United States, but little time in the curriculum is devoted to training internal medicine residents in addiction medicine.

Gateways to the Laboratory: How an MD-PhD Program Increased the Number of Minority Physician-Scientists.

Traditional underrepresented minority (URM) groups (African Americans, Hispanic Americans, Native Americans) remain underrepresented among physician-scientists. To address the dearth of URM physician-scientists, in 1993 the Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD Program developed a pipeline program, Gateways to the Laboratory (Gateways), which focuses on increasing the breadth and depth of the URM physician-scientist pipeline by offering an all-encompassing summer research training program which mirrors the life of a physician-scientist. This includes hypothesis-driven research and clinical shadowing opportunities, coupled with weekly career development workshops and extensive multitiered mentoring. Among the 245 alumni who had "graduated" from Gateways as of 2013, 88% have pursued or completed advanced degrees. Among these, 74% completed or are pursuing MD, PhD, or MD-PhD degrees; and 17% completed or are pursuing combined MD-PhD degrees, over one-third of whom are enrolled in the Tri-Institutional MD-PhD Program. Gateways outcomes are compared to other programs with similar missions, which shows that Gateways has been successful at preparing URMs for MD-PhD Programs. The program serves as a model for how to increase the national pool of competitive URM MD-PhD applicants.

Still Searching: A Meta-Synthesis of a Good Death from the Bereaved Family Member Perspective.

The concept of a good death continues to receive attention in end-of-life (EOL) scholarship. We sought to continue this line of inquiry related to a good death by conducting a meta-synthesis of published qualitative research studies that examined a good death from the bereaved family member's perspective. Results of the meta-synthesis included 14 articles with 368 participants. Based on analysis, we present a conceptual model called The Opportunity Model for Presence during the EOL Process. The model is framed in socio-cultural factors, and major themes include EOL process engagement with categories of healthcare participants, communication and practical issues. The second theme, (dis)continuity of care, includes categories of place of care, knowledge of family member dying and moment of death. Both of these themes lead to perceptions of either a good or bad death, which influences the bereavement process. We argue the main contribution of the model is the ability to identify moments throughout the interaction where family members can be present to the EOL process. Recommendations for healthcare participants, including patients, family members and clinical care providers are offered to improve the quality of experience throughout the EOL process and limitations of the study are discussed.

Continued Care in Palliative Bowel Surgery: An Invited Brief Commentary on "Long-Term Functional Outcome After Internal Delorme's Procedure for Obstructed Defecation Syndrome and the Role of Post-Operative Rehabilitation".

Agency and communion in people with Alzheimer's disease, as described by themselves and their spousal carers.

Agency (individuality) and communion (togetherness) are vital to a positive sense of self. People with Alzheimer's disease are at risk of experiencing diminished agency and decreased communion. Their family members', especially their partner's, view on their agency and communion is also likely to influence their sense of agency, communion, and self. In the present study, individual interviews with 10 people with Alzheimer's disease and their spousal carers were qualitatively analysed to describe how in each couple the two spouses viewed the agency and communion of the person with Alzheimer's disease from an individual perspective. The findings show that the carers generally described the agency of the person with Alzheimer's disease as slightly weaker compared with the persons with Alzheimer's disease themselves. The carers also appeared to have poor knowledge of what supported and threatened the sense of communion of the person with Alzheimer's disease.

Palliative care education for medical students: Differences in course evolution, organisation, evaluation and funding: A survey of all UK medical schools.

A proportion of newly qualified doctors report feeling unprepared to manage patients with palliative care and end-of-life needs. This may be related to barriers within their institution during undergraduate training. Information is limited regarding the current organisation of palliative care teaching across UK medical schools.

Perspectives on advance care planning among patients recently requiring non-invasive ventilation for acute respiratory failure: A qualitative study using thematic analysis.

Patients requiring non-invasive ventilation for acute-on-chronic respiratory failure due to chronic obstructive pulmonary disease or heart failure exacerbations may have a poor prognosis underscoring the importance of advance care planning.

Delivering care to those in need: Improving palliative care using linked data.

Barriers to information provision regarding breast cancer and its treatment.

Women with breast cancer require information about their cancer and its treatment during the process of treatment decision-making, yet it is unclear if there are barriers to information support. This study explores the experience of making treatment decisions in breast cancer, paying particular attention to the barriers experienced to the provision of information.

Association of endotracheal tube repositioning and acute laryngeal lesions during mechanical ventilation in children.

The objective of this study is to determine the incidence of post-extubation acute laryngeal lesions in a pediatric intensive care unit (PICU) and potential risk factors. Children, aged 28 days to 5 years, admitted to the PICU who required endotracheal intubation for at least 24 h were enrolled. Exclusion criteria were a previous intubation, history of laryngeal disease, current or past tracheostomy, the presence of craniofacial malformations and patients considered on palliative care. All patients underwent flexible fiber-optic laryngoscopy (FFL) not later than 8 h after extubation. A blinded researcher identified and classified laryngeal lesions based on recorded media. 231 children were enrolled between November 2005 and December 2015. At FFL examination, 102 children (44.15%) presented moderate to severe laryngeal lesions. On a multivariable analysis, we found that for each additional day with repositioning of the endotracheal tube, there was an increase of 7.3% (RR 95% CI 1.012-1.137; P = 0.018) on the baseline risk of developing moderate to severe acute laryngeal lesions. Furthermore, for each additional dose of sedation per day of intubation, there was also an increase of 3.5% on the same baseline risk (RR 95% CI 1.001-1.070; P = 0.041). The amount of tube repositioning episodes and the need for extra doses of sedation (as a proxy for possible agitation) were found to be associated with acute laryngeal lesions. Adequate sedation and minimized tube repositioning should be pursued to possibly prevent the development of post-extubation airway compromise.

Lenalidomide, adriamycin, dexamethasone (RAD) for induction followed by stem-cell transplant in newly diagnosed myeloma.

Leukemia accepted article preview online, 25 April 2017. doi:10.1038/leu.2017.124.

Palliative care clinicians' knowledge of the law regarding the use of the Deprivation of Liberty Safeguards (DoLS).

To examine palliative care clinicians' level of knowledge of the law regarding the use of the Deprivation of Liberty Safeguards (DoLS).

Specialty Palliative Care Consultations for Nursing Home Residents with Dementia.

U.S. nursing home (NH) residents with dementia have limited access to specialty palliative care beyond Medicare hospice.

Intranasal Vinegar as an Effective Treatment for Persistent Hiccups in a Patient with Advanced Cancer Undergoing Palliative Care.

Strategies for enhancing family participation in research in the ICU: Findings from a qualitative study.

Family members of critically ill patients who participate in research focused on palliative care issues have been found to be systematically different from those who do not. These differences threaten the validity of research and raise ethical questions about worsening disparities in care by failing to represent diverse perspectives.

The Paradigm Shift.

Using internal and external reviewers can help to optimise neonatal mortality and morbidity conferences.

This study determined if there was a difference in the conclusions reached by paediatricians in morbidity and mortality conferences based on their level of involvement in a case.