Journal of pain and symptom management
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J Pain Symptom Manage · Nov 2018
Do the Phenotypes of Symptom Fluctuation Differ Among Motor Subtypes in Patients With Delirium?
Fluctuation in symptoms is a core feature of delirium. However, it is not well known whether the fluctuating nature would differ or not among the delirium subtype groups. ⋯ The phenotypes of symptom fluctuation differed among the motor subtypes. These findings further support the rationale that fluctuations are a core feature of delirium and could differentiate delirium subtypes.
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J Pain Symptom Manage · Nov 2018
Using Routinely Collected Data to Ascertain Concordance With Advance Care Planning Preferences.
One of the key outcomes of advance care planning is whether patients had received care that was consistent with their expressed goals and preferences. ⋯ Administrative data offer a cost-efficient and powerful method for assessing outcomes for a large population-based national program. However, this approach is still at an early stage of development and needs to be further validated before it can be used at scale.
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J Pain Symptom Manage · Nov 2018
NephroTalk: Evaluation of a Palliative Care Communication Curriculum for Nephrology Fellows.
Nephrologists care for a medically complex population that faces difficult decisions around treatment options and end-of-life care. Yet communication training within nephrology fellowship is rare. Prior work suggests that communication training in nephrology can improve perceived preparedness to engage in difficult conversations; however, it is unclear if this training results in improved clinical skills. ⋯ Our findings support NephroTalk as an effective communication skills curriculum for nephrology trainees. Fellows increased their communication skills significantly in delivering bad news leading to more efficient encounters.
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J Pain Symptom Manage · Nov 2018
Hospice Underutilization in the U.S.: The Misalignment of Regulatory Policy and Clinical Reality.
After three and a half decades of experience with the Medicare hospice benefit in the U. S., despite excellent quality outcomes in symptom management, patient and family satisfaction, and reduction in health care costs, only 12%-15% of beneficiaries' days during the last year of life are spent being cared for within the highly cost-effective interdisciplinary coordinated advanced illness care model known as hospice. Although there are many reasons for this, including difficulties in acknowledging mortality among patients, their families, and physicians, a significant cause of low overall hospice utilization and intractably low median lengths of stay, reflective of late admissions, can be attributed to increasingly difficult and highly variable prognostic determinations for most of the leading causes of death among Medicare beneficiaries. ⋯ This clinical conundrum that limits access of seriously ill people to high-value quality care is of profound importance to the U. S. Medicare population and also one with potential relevance to all complex and regulated health systems and to other models of care whose eligibility criteria are based on prognostication.
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J Pain Symptom Manage · Nov 2018
Letter Case ReportsRectal Administration of Baclofen at the End of Life.