Journal of pain and symptom management
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J Pain Symptom Manage · Feb 2018
Determining Palliative Care Penetration Rates in the Acute Care Setting.
Intermountain Healthcare, in collaboration with Cerner Corporation, developed a hospital-based electronic palliative care algorithm. ⋯ This study successfully optimized an electronic palliative care identification algorithm with a PPV of 80.1% and indicates appropriate palliative care penetration rates may be as high as 26.4% of the total inpatient population.
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J Pain Symptom Manage · Feb 2018
Cranial Electrotherapy Stimulation for the Management of Depression, Anxiety, Sleep Disturbance, and Pain in Patients with Advanced Cancer: A preliminary study.
Cranial electrotherapy stimulation (CES) is a safe modulation of brain activity for treating depression, anxiety, insomnia, and pain. However, there are no published studies in patients with advanced cancer (ACPs). ⋯ In this preliminary study, we found that the use of CES was safe and feasible in ACP. The use of CES was associated with significant improvement of depression, anxiety, pain, and sleep scores. These findings support further studies of CES in ACP for symptom control.
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J Pain Symptom Manage · Feb 2018
Acute Leukemia Patients' Needs: Qualitative Findings and Opportunities for Early Palliative Care.
Patients with acute leukemias likely have needs that palliative care can respond to, yet little is known about specific challenges they face, particularly during active treatment. We examined acute myeloid leukemia (AML) patients' expressed challenges and supports after intensive induction chemotherapy. ⋯ AML patients face substantial challenges regarding physical symptoms, psychological distress, and uncertainty regarding prognosis. These challenges signal needs for which palliative care in high-risk AML patients may help. Our findings highlight opportunities to develop targeted palliative care interventions addressing unmet needs in AML patients.
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J Pain Symptom Manage · Feb 2018
Beyond Idiopathic Pulmonary Fibrosis diagnosis: Multidisciplinary care with an early integrated palliative approach is associated with a decrease in acute care utilization and hospital deaths.
Idiopathic pulmonary fibrosis (IPF) is a progressive, incurable interstitial lung disease with heavy symptom burden and poor quality of life. The last year of life is characterized by increased acute care utilization and hospital deaths. Clinical guidelines recommend early integration of palliative care but are rarely implemented. In 2012, we reorganized our clinic into a multidisciplinary team comprising two pulmonologists (expertise in interstitial lung disease and palliative respiratory care, respectively), nurse, respiratory therapist, physiotherapist, and a dietitian. We adopted an early integrated palliative approach with a focus on early symptom management and advance care planning starting at the first clinic visit. We designed a Multidisciplinary collaborative (MDC) care model with emphasis on community-based care to manage patients in their homes and support caregivers. ⋯ MDC care model for IPF was associated with reduced health care use in the last year of life and more home deaths.
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J Pain Symptom Manage · Feb 2018
Development and Field-Test of an Audit Tool and Tracer Methodology for Clinician Assessment of Quality in End-of-Life Care.
Quality improvement in end-of-life care generally acquires data from charts or caregivers. "Tracer" methodology, which assesses real-time information from multiple sources, may provide complementary information. ⋯ The Tracer EoLC v1 can be used with tracer methodology to guide the assessment and rate the quality of end-of-life care.