Palliative medicine
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Paramedics may be involved in the care of patients experiencing a health crisis associated with palliative care. However, little is known about the paramedic's role in the care of these patients. ⋯ Paramedics have a significant role in caring for patients receiving palliative care. These results should inform the design of integrated systems of care that involve ambulance services in the planning and delivery of community-based palliative care.
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Palliative medicine · Apr 2019
Predicting outcomes following holistic breathlessness services: A pooled analysis of individual patient data.
Holistic breathlessness services have been developed for people with advanced disease and chronic breathlessness, leading to improved psychological aspects of breathlessness and health. The extent to which patient characteristics influence outcomes is unclear. ⋯ Outcomes of mastery and distress following holistic breathlessness services are influenced by baseline scores for these variables, and not by diagnosis, lung function or health status. Stratifying patients by levels of mastery and/or distress due to breathlessness appears appropriate for clinical trials and services.
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Palliative medicine · Apr 2019
A systematic review and critical appraisal of quality indicators to assess optimal palliative care for older people with dementia.
A challenge for commissioners and providers of end-of-life care in dementia is to translate recommendations for good or effective care into quality indicators that inform service development and evaluation. ⋯ We systematically derived and assessed a set of quality indicators using a robust framework that provides clear definitions of aspects of palliative care, which are dementia specific, and strengthens the theoretical underpinning of new complex interventions in end-of-life care in dementia.
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Palliative medicine · Apr 2019
What is the evidence that people with frailty have needs for palliative care at the end of life? A systematic review and narrative synthesis.
The number of older people living and dying with frailty is rising, but our understanding of their end-of-life care needs is limited. ⋯ People with frailty have varied physical and psychosocial needs at the end of life that may benefit from palliative care. Frailty services should be tailored to patient and family needs and preferences at the end of life.
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Palliative medicine · Apr 2019
Appointment utilization as a trigger for palliative care introduction: A retrospective cohort study.
Chronic kidney disease palliative care guidelines would benefit from more diverse and objectively defined health status measures. ⋯ Our model could justify the creation of a novel palliative care introduction trigger, as patients with medium demand for care may benefit from additional palliative care evaluation. The trigger could facilitate the uniformization of conservative treatment preparations. It could prompt messages to a managing physician when a patient crosses the threshold between low and medium appointment utilization. It may also aid in system-level policy development. Furthermore, our results highlight the benefit of significant appointment utilization among high-risk patients.