Journal of palliative medicine
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For patients with traumatic paraplegia, the ability to push up is a prerequisite for basic movements, including the transfer from bed to wheelchair. However, this movement may be contraindicated in patients with advanced cancer with bone metastases because of the risk of pain and pathologic fractures and muscle weakness resulting from cancer cachexia and disuse syndrome. ⋯ Our findings suggest that the use of our newly devised system enables transfer from bed to wheelchair of even those patients with advanced cancer who cannot resume walking in the upright position because of paraplegia.
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In the United States the quality and cost associated with medical treatment for individuals experiencing an advanced illness is highly variable and is often misaligned with the patient's and family's quality of life values and priorities. Many of the obstacles that stand in the way of aligning the care that an individual receives with their priorities are well understood in the context of behavioral science. Through employing behavioral based approaches to improve the quality of communication and shared decision making processes among patients, providers and families it is possible to enhance the efficiency of delivering care which is also more highly aligned with the individual's preferences. ⋯ Members with advanced illness who participated in LWCP had significantly lower end-of-life (EOL) spending compared to matched members who did not participate in the program.
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Emergency departments (EDs) are seeing more patients with palliative care (PC) needs, but evidence on best practice is scarce. ⋯ There is yet no evidence that ED-based PC affects patient outcomes except for indication from one study of no association with 90-day hospital readmission but a possible reduction in LOS if integrated PC is introduced early at ED rather than after hospital admission. There is an urgent need for trials to confirm these findings alongside other potential benefits and survival effects.