American Journal of Hospice & Palliative Medicine最新文献_第5页

Prognostic Communication Between Parents and Clinicians in Pediatric Oncology: An Integrative Review. 儿科肿瘤学中家长与临床医生之间的预后沟通：综合综述。

IF 1.9 4区医学

American Journal of Hospice & Palliative Medicine Pub Date : 2024-05-01 Epub Date: 2023-06-13 DOI: 10.1177/10499091231183107

Na Ouyang, Shelli L Feder, Justin N Baker, M Tish Knobf

{"title":"Prognostic Communication Between Parents and Clinicians in Pediatric Oncology: An Integrative Review.","authors":"Na Ouyang, Shelli L Feder, Justin N Baker, M Tish Knobf","doi":"10.1177/10499091231183107","DOIUrl":"10.1177/10499091231183107","url":null,"abstract":"Background: Prognostic communication between clinicians and parents in pediatric oncology is complex. However, no review has exclusively examined research on prognostic communication in pediatric oncology. In this review, we synthesize the evidence on prognostic communication in pediatric oncology and provide recommendations for future research. Methods: We conducted an integrative review searching six databases for studies on prognostic communication in pediatric oncology as of August 2022. We applied descriptive and narrative approaches to data analysis. Results: Fourteen quantitative and five qualitative studies were included. All studies were conducted in Western developed countries. In total, 804 parents of 770 children with cancer were included. Across studies, parents were predominately female, Non-Hispanic White, and had high school or higher levels of education. Most parents reported that prognostic communication was initiated in the first year after their children's diagnosis. High-quality prognostic communication was positively associated with trust and hope and negatively associated with parental distress and decisional regret. In qualitative studies, parents suggested that prognostic communication should be open, ongoing, and delivered with sensitivity. Most studies were of moderate quality. The main gaps included inconsistent definitions of prognostic communication, and a lack of comprehensive and validated measurements, high-quality longitudinal studies, and diverse settings and participants. Conclusions: Clinicians should initiate high-quality prognostic communication early on in clinical practice. Future research should consider conducting high-quality longitudinal studies, developing prognostic communication definitions and measurements, and conducting studies across settings with diverse populations.","PeriodicalId":50810,"journal":{"name":"American Journal of Hospice & Palliative Medicine","volume":" ","pages":"545-557"},"PeriodicalIF":1.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9977431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Palliative Care Knowledge Following an Interdisciplinary Palliative Care Seminar. 跨学科姑息关怀研讨会后的姑息关怀知识。

IF 1.9 4区医学

American Journal of Hospice & Palliative Medicine Pub Date : 2024-05-01 Epub Date: 2023-06-15 DOI: 10.1177/10499091231184623

Sarah Mollman, Michelle Gierach, Amanda Sedlacek

{"title":"Palliative Care Knowledge Following an Interdisciplinary Palliative Care Seminar.","authors":"Sarah Mollman, Michelle Gierach, Amanda Sedlacek","doi":"10.1177/10499091231184623","DOIUrl":"10.1177/10499091231184623","url":null,"abstract":"Background: The COVID-19 pandemic created a unique opportunity to evolve an interdisciplinary palliative care seminar (IPC) into a virtual platform. This seminar provides foundational palliative and hospice concepts, introductions into palliative care disciplines, integration of teamwork, and incorporates interdisciplinary student led patient encounters. Traditionally, this experience had been in person, however during the COVID-19 pandemic, healthcare restrictions transitioned the educational delivery to a virtual platform.Methods: To assess the knowledge gained from this novel experience, the Palliative Care Knowledge Test (PCKT) was administered before and after the IPC Seminar. A 1-year follow up survey was also administered to evaluate how the IPC Seminar was applicable to the students' clinical experiences and practice.Results: The virtual didactics and virtual student led patient encounters significantly improved learners understanding of palliative and hospice care. This gain of knowledge was noted across undergraduate and graduate programs, which highlights the need for and benefit from foundational concepts. Furthermore, a 1-year follow up survey noted the IPC seminar was applicable to their practices and suggests that this experience will impact future patients.Discussion: Many of the students practice in rural areas where access to palliative care services is limited or non-existent. This experience exponentially impacts the growth of palliative and hospice care understanding and access to care across the region.Conclusion: Evolving our IPC Seminar has shown to significantly improve knowledge, foster collaboration of student led interdisciplinary teams, and increases capacity to meet the needs of more learners.","PeriodicalId":50810,"journal":{"name":"American Journal of Hospice & Palliative Medicine","volume":" ","pages":"501-507"},"PeriodicalIF":1.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9637119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The Association of Standardized Documentation of Serious Illness Conversations With Healthcare Utilization in Hospitalized Patients: A Propensity Score Matched Cohort Analysis. 住院病人重病对话的标准化记录与医疗服务利用率的关系：倾向得分匹配队列分析

IF 1.9 4区医学

American Journal of Hospice & Palliative Medicine Pub Date : 2024-05-01 Epub Date: 2023-06-29 DOI: 10.1177/10499091231186818

Myrna K Serna, Catherine Yoon, Julie Fiskio, Joshua R Lakin, Jeffrey L Schnipper, Anuj K Dalal

{"title":"The Association of Standardized Documentation of Serious Illness Conversations With Healthcare Utilization in Hospitalized Patients: A Propensity Score Matched Cohort Analysis.","authors":"Myrna K Serna, Catherine Yoon, Julie Fiskio, Joshua R Lakin, Jeffrey L Schnipper, Anuj K Dalal","doi":"10.1177/10499091231186818","DOIUrl":"10.1177/10499091231186818","url":null,"abstract":"Background: Serious Illness Conversations (SICs) conducted during hospitalization can lead to meaningful patient participation in the decision-making process affecting medical management. The aim of this study is to determine if standardized documentation of a SIC within an institutionally approved EHR module during hospitalization is associated with palliative care consultation, change in code status, hospice enrollment prior to discharge, and 90-day readmissions. Methods: We conducted retrospective analyses of hospital encounters of general medicine patients at a community teaching hospital affiliated with an academic medical center from October 2018 to August 2019. Encounters with standardized documentation of a SIC were identified and matched by propensity score to control encounters without a SIC in a ratio of 1:3. We used multivariable, paired logistic regression and Cox proportional-hazards modeling to assess key outcomes. Results: Of 6853 encounters (5143 patients), 59 (.86%) encounters (59 patients) had standardized documentation of a SIC, and 58 (.85%) were matched to 167 control encounters (167 patients). Encounters with standardized documentation of a SIC had greater odds of palliative care consultation (odds ratio [OR] 60.10, 95% confidence interval [CI] 12.45-290.08, P < .01), a documented code status change (OR 8.04, 95% CI 1.54-42.05, P = .01), and discharge with hospice services (OR 35.07, 95% CI 5.80-212.08, P < .01) compared to matched controls. There was no significant association with 90-day readmissions (adjusted hazard ratio [HR] .88, standard error [SE] .37, P = .73). Conclusions: Standardized documentation of a SIC during hospitalization is associated with palliative care consultation, change in code status, and hospice enrollment.","PeriodicalId":50810,"journal":{"name":"American Journal of Hospice & Palliative Medicine","volume":" ","pages":"479-485"},"PeriodicalIF":1.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10983774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9690158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Radiologically Inserted Gastrostomy Tube Placement Guided by the Assessment and Primary Palliative Care Provided by an Amyotrophic Lateral Sclerosis Multidisciplinary Clinic: A Single-Arm Retrospective Clinical Study. 肌萎缩侧索硬化症多学科诊所提供的评估和初级姑息治疗指导下的放射学插入胃管放置：单臂回顾性临床研究。

IF 1.9 4区医学

American Journal of Hospice & Palliative Medicine Pub Date : 2024-05-01 Epub Date: 2023-06-02 DOI: 10.1177/10499091231180553

Carolina Parra-Cantu, Jennifer M Martinez-Thompson, Forrest B Linch, Tasha L Welch, Claudia Z Chou, Adele K Pattinson, Nathan P Staff, Melissa Neisen

{"title":"Radiologically Inserted Gastrostomy Tube Placement Guided by the Assessment and Primary Palliative Care Provided by an Amyotrophic Lateral Sclerosis Multidisciplinary Clinic: A Single-Arm Retrospective Clinical Study.","authors":"Carolina Parra-Cantu, Jennifer M Martinez-Thompson, Forrest B Linch, Tasha L Welch, Claudia Z Chou, Adele K Pattinson, Nathan P Staff, Melissa Neisen","doi":"10.1177/10499091231180553","DOIUrl":"10.1177/10499091231180553","url":null,"abstract":"Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with a median survival of about 3 years. An ALS multidisciplinary team can provide primary palliative care and improve outcomes and quality of life for patients. Feeding tube insertion may be considered for patients with significant weight loss, or respiratory insufficiency. While radiologically inserted gastrostomy (RIG) tube placement may be an option, further studies are required to determine its best timing and appropriateness. This study's objectives were to evaluate the feasibility and outcomes of RIG tube placement in ALS patients over a 90-day follow-up period through the assessment and primary palliative care provided by the multidisciplinary team. This retrospective study reviewed the placement of 16 or 18 French RIG-tube without intubation or endoscopy for 36 ALS patients at a single center between April 2019 and December 2021. Measures included ALS Functional Rating Scale-Revised (ALSFRS-R) scores to determine the ALS stage. Demographic, clinical, procedural, and follow-up data were reviewed. Results showed that the RIG tube placement had a low rate of minor adverse events (11%) and no major procedure-related adverse events. The mean ALSFRS-R score at the time of procedure in subjects who died within 90 days was lower than of those alive beyond 90 days (P = .04). This study found that RIG-tube placement is a safe and effective way to manage dysphagia in ALS patients and highlights the importance of educating members of the multidisciplinary clinic in palliative care principles to determine the appropriateness of RIG tube placement.","PeriodicalId":50810,"journal":{"name":"American Journal of Hospice & Palliative Medicine","volume":" ","pages":"516-526"},"PeriodicalIF":1.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9933976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Healthcare Providers' Experiences of Caring for Patients With COVID-19 Requiring Extracorporeal Membrane Oxygenation Support. 医护人员护理需要体外膜氧合支持的 COVID-19 患者的经验。

IF 1.9 4区医学

American Journal of Hospice & Palliative Medicine Pub Date : 2024-05-01 Epub Date: 2023-05-22 DOI: 10.1177/10499091231178503

Lori Constantine, Danielle DeCicco, Roger D Carpenter, Stephanie Pockl, Katherine B Seachrist, R Osvaldo Navia

{"title":"Healthcare Providers' Experiences of Caring for Patients With COVID-19 Requiring Extracorporeal Membrane Oxygenation Support.","authors":"Lori Constantine, Danielle DeCicco, Roger D Carpenter, Stephanie Pockl, Katherine B Seachrist, R Osvaldo Navia","doi":"10.1177/10499091231178503","DOIUrl":"10.1177/10499091231178503","url":null,"abstract":"Background: Coronavirus 19 (COVID-19) affected healthcare workers (HCW) in ways more than increasing the volume of patients needing care. Increased numbers of patients at younger ages required support with extracorporeal membrane oxygenation (ECMO). Providing this care requires an interdisciplinary team.Aim: This study explored the experiences of HCW caring for patients with COVID-19 on ECMO.Methods: Face-to-face semi-structured interviews were conducted via videoconferencing, and transcript comparison was used for the analysis.Findings: Open coding of the data generated 7 categories including (1) fearing the unknown, (2) confronting challenges in patient and/or family interactions, (3) encountering barriers to providing care, (4) facing moral distress, (5) working through exhaustion, (6) persevering by strengthening teamwork, (7) and acknowledging frustration with non-believers.Discussion: HCW balanced pessimism and optimism while caring for patient with COVID-19 on ECMO. They used negative experiences caring for these patients to strength teamwork and bonding among peers.Conclusion: The practice implications for caring for patients with COVID-19 on ECMO include viligance by clinician and organization to protect the wellbeing of healthcare providers, particularly in ICU and ECMO units were moral distress and burnout can be high.","PeriodicalId":50810,"journal":{"name":"American Journal of Hospice & Palliative Medicine","volume":" ","pages":"568-573"},"PeriodicalIF":1.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10203850/pdf/10.1177_10499091231178503.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9574109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Exploring the Beliefs, Values, and Understanding of Quality End-of-Life Care in the Latino Community: A Spanish-Language Qualitative Study. 探索拉丁裔社区对优质临终关怀的信念、价值观和理解：西班牙语定性研究。

IF 1.9 4区医学

American Journal of Hospice & Palliative Medicine Pub Date : 2024-05-01 Epub Date: 2023-07-05 DOI: 10.1177/10499091231188693

Benjamin Gallo Marin, Rocío Oliva, Gowri Anandarajah

{"title":"Exploring the Beliefs, Values, and Understanding of Quality End-of-Life Care in the Latino Community: A Spanish-Language Qualitative Study.","authors":"Benjamin Gallo Marin, Rocío Oliva, Gowri Anandarajah","doi":"10.1177/10499091231188693","DOIUrl":"10.1177/10499091231188693","url":null,"abstract":"Context: Hospice services are underutilized by the Latino community in the United States. Previous research has identified that language is a key barrier contributing to disparities. However, very few studies have been conducted in Spanish to specifically explore other barriers to hospice enrollment or values related to end-of-life (EOL) care in this community. Here, we remove the language barrier in order to gain an in-depth understanding of what members of the diverse Latino community in one state in the USA considers high quality EOL and barriers to hospice. Methods: This exploratory semi-structured individual interview study of Latino community members was conducted in Spanish. Interviews were audio-recorded, transcribed verbatim and translated to English. Transcripts were analyzed by three researchers, using a grounded-theory approach to identify themes and sub-themes. Main Findings: Six major themes emerged: (1) concept of \"a good death\"-spiritual peace, family/community connection, no burdens left behind; (2) centrality of family; (3) lack of knowledge about hospice/palliative care; (4) Spanish language as critical; (5) communication style differences; and (6) necessity for cultural understanding. The central theme of \"a good death\" was closely linked to having the entire family physically and emotionally present. The four other themes represent interrelated, compounding barriers to achieving this \"good death.\" Principal Conclusions: Healthcare providers and the Latino community can work together to decrease hospice utilization disparities by: actively involving family at every step; addressing misconceptions regarding hospice; conducting important conversations in Spanish; and improving provider skills in culturally sensitive care, including communication style.","PeriodicalId":50810,"journal":{"name":"American Journal of Hospice & Palliative Medicine","volume":" ","pages":"508-515"},"PeriodicalIF":1.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10132848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

"It's a Heavy Thing to Carry:" Internal Medicine and Pediatric Resident Experiences Caring for Dying Patients. "背负沉重的负担："内科和儿科住院医师照顾垂死病人的经历。

IF 1.9 4区医学

American Journal of Hospice & Palliative Medicine Pub Date : 2024-05-01 Epub Date: 2023-06-08 DOI: 10.1177/10499091231181567

Lindsay M Gibbon, Laura Buck, Lauren Schmidt, Jori F Bogetz, Amy Trowbridge

{"title":"\"It's a Heavy Thing to Carry:\" Internal Medicine and Pediatric Resident Experiences Caring for Dying Patients.","authors":"Lindsay M Gibbon, Laura Buck, Lauren Schmidt, Jori F Bogetz, Amy Trowbridge","doi":"10.1177/10499091231181567","DOIUrl":"10.1177/10499091231181567","url":null,"abstract":"Background: Residents often feel unprepared to care for dying patients and may benefit from more training. Little is known about factors in the clinical setting that promote resident learning about end of life (EOL) care.Objectives: This qualitative study aimed to characterize the experiences of residents caring for dying patients and elucidate the impact of emotional, cultural, and logistical factors on learning.Methods: 6 US internal medicine and 8 pediatric residents who had cared for at least 1 dying patient completed a semi-structured one-on-one interview between 2019 and 2020. Residents described an experience caring for a dying patient including their confidence in clinical skills, emotional experience, role within the interdisciplinary team, and perspective on how to improve their education. Interviews were transcribed verbatim and investigators conducted content analysis to generate themes.Results: 3 themes (with subthemes) emerged: (1) experiencing strong emotion or tension (loss of patient personhood, emerging professional identity, emotional dissonance); (2) processing the experience (innate resilience, team support); and (3) recognition of a new perspective or skill (bearing witness, meaning making, recognizing biases, emotional work of doctoring).Conclusions: Our data suggests a model for the process by which residents learn affective skills critical to EOL care: residents (1) notice strong emotion, (2) reflect on the meaning of the emotion, and (3) crystallize this reflection into a new perspective or skill. Educators can use this model to develop educational methods that emphasize normalization of physician emotions and space for processing and professional identity formation.","PeriodicalId":50810,"journal":{"name":"American Journal of Hospice & Palliative Medicine","volume":" ","pages":"492-500"},"PeriodicalIF":1.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9646290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Are Safety-Net Primary Care Physicians Prepared to Engage in Serious Illness Conversations? 安全网初级保健医生是否做好了参与重病对话的准备？

IF 1.9 4区医学

American Journal of Hospice & Palliative Medicine Pub Date : 2024-05-01 Epub Date: 2023-08-03 DOI: 10.1177/10499091231190354

Deborah Swiderski, Rodrigo Ng Taniguchi, Elizabeth Chuang

{"title":"Are Safety-Net Primary Care Physicians Prepared to Engage in Serious Illness Conversations?","authors":"Deborah Swiderski, Rodrigo Ng Taniguchi, Elizabeth Chuang","doi":"10.1177/10499091231190354","DOIUrl":"10.1177/10499091231190354","url":null,"abstract":"Background: Advance Care Planning (ACP) has not reliably improved care for patients at end-of-life. Serious Illness Conversations when patients are in the late stages of chronic illness might be more effective to address patients' goals. The Serious Illness Conversation (SIC) Guide has been helpful but was not developed for use in safety-net settings serving racial and ethnic minority populations.Methods: Physicians were recruited to complete a needs assessment survey prior to training in the use of the SIC Guide.Results: Of the 44 physician participants, most were female (82%) and white, non-Hispanic (62%). Less than half of respondents rated themselves as skilled or very skilled in basic serious illness communication related tasks such as setting up goals of care discussions (44%), assessing informational preferences (42%), sharing prognosis (38%), exploring goals for future care (49%) and managing family dynamics (44%). Respondents reported lower skill levels in conducting goals of care conversations via telehealth and establishing trust in racially discordant provider/patient pairs.Conclusions: Most participants expressed the need for further training in critical end-of-life communications skills, including help with encounters with racial and/or language discordance. This may help to explain the failure of ACP discussions to reliably result in appropriate end-of-life care.","PeriodicalId":50810,"journal":{"name":"American Journal of Hospice & Palliative Medicine","volume":" ","pages":"486-491"},"PeriodicalIF":1.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9918167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Ketamine Use for Palliative Care in the Austere Environment: Is Ketamine the Path Forward for Palliative Care 在严酷环境中使用氯胺酮进行姑息治疗：氯胺酮是姑息治疗的必由之路吗？

IF 1.9 4区医学

American Journal of Hospice & Palliative Medicine Pub Date : 2024-04-17 DOI: 10.1177/10499091241246520

John R. Reed, Stephanie K. Parks, Antony Kaniaru, Justin Hefley, Young Yauger, Jeremy V. Edwards, Derrick C. Glymph

{"title":"Ketamine Use for Palliative Care in the Austere Environment: Is Ketamine the Path Forward for Palliative Care","authors":"John R. Reed, Stephanie K. Parks, Antony Kaniaru, Justin Hefley, Young Yauger, Jeremy V. Edwards, Derrick C. Glymph","doi":"10.1177/10499091241246520","DOIUrl":"https://doi.org/10.1177/10499091241246520","url":null,"abstract":"The goal of palliative care is to focus on the holistic needs of the patient and their family versus the pathology of the patient’s diagnosis to reduce the stress of illness. U.S. servicemembers deployed to austere environments worldwide have significantly less access to palliative care than in military treatment facilities in the U.S. Preparation for future conflicts introduces the concept of prolonged medical management for an environment where urgent casualty evacuation is impossible. Ketamine is currently widely used for analgesia and anesthesia in the care of military service members and its use has increased in combat zones of Iraq and Afghanistan due to the favorable preservation of respiratory function, minimal changes in hemodynamics, and lower pain scores compared to opioids. Ketamine acts as a non-competitive antagonist on N-methyl-D aspartate (NMDA) receptors. Its anesthesia and analgesic effects are complex and include both presynaptic and postsynaptic neurons in brain and spinal cord. The use of palliative care to minimize suffering should not be withheld due to the logistical boundaries of austere military environments or lack of guidelines for recommended use. The use of ketamine for palliative care is a new clinical management strategy to provide both sedation and pain management for an acute pain crisis or comfort measures for the terminally ill. This makes ketamine an attractive consideration for palliative care when managing critically wounded patients for an extended time.","PeriodicalId":50810,"journal":{"name":"American Journal of Hospice & Palliative Medicine","volume":"23 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140610687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Automated Electronic Health Record Score to Predict Mortality Risk at the US Department of Veterans Affairs 预测美国退伍军人事务部死亡率风险的电子健康记录自动评分系统

IF 1.9 4区医学

American Journal of Hospice & Palliative Medicine Pub Date : 2024-04-17 DOI: 10.1177/10499091241247841

Thomas F. Osborne, Zachary P. Veigulis, Anna Ware, David M. Arreola, Catherine Curtin, Marianne Yeung

{"title":"Automated Electronic Health Record Score to Predict Mortality Risk at the US Department of Veterans Affairs","authors":"Thomas F. Osborne, Zachary P. Veigulis, Anna Ware, David M. Arreola, Catherine Curtin, Marianne Yeung","doi":"10.1177/10499091241247841","DOIUrl":"https://doi.org/10.1177/10499091241247841","url":null,"abstract":"BackgroundTerminally ill patients benefit from earlier engagement in palliative care. However, this does not always occur. This project assessed if an already available risk score, the Care Assessment Needs (CAN) score, would be able to identify patients at greatest risk for mortality within 30 days of hospital admission within the Veterans Health Administration (VHA).MethodsThe cohort of this retrospective analysis included all VA acute are patients over 18 years of age with a recent CAN score. The CAN score is an automatically calculated VA risk score that was repurposed to determine if it could predict risk of mortality after acute care admission. Univariate logistic regression was performed to obtain the probability of mortality within 30 days of admission, based on their CAN score.Results298,467 patient records were assessed from January 1, 2019, to December 31, 2019. There was 6% mortality after 30 days of admissions, and 17% mortality within 1-year post-admission. Mean CAN score was 65 (SD: 29). On average, each incremental increase in the CAN score increased the probability of mortality by 7%. Patients with a CAN score of 90 had a 10% probability of 30-day post-admission mortality.ConclusionA readily available risk score, automatically calculated from EHR data, was able to identify patients at high risk for 30-day mortality in the acute care setting. Next steps will be to assess how the CAN score can be utilized to in improve end of life care for high-risk hospitalized Veterans.","PeriodicalId":50810,"journal":{"name":"American Journal of Hospice & Palliative Medicine","volume":"81 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140610686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0