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Wang S, Wang L, Wang Y, Zong S, Fan H, Jiang Y, Li X. Association between frailty index based on laboratory tests and all-cause mortality in critically ill patients with heart failure. ESC Heart Fail 2024. [PMID: 38979803 DOI: 10.1002/ehf2.14948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 06/05/2024] [Accepted: 06/21/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND The frailty index based on laboratory tests (FI-lab) can identify individuals at increased risk for adverse health outcomes. The association between the FI-lab and all-cause mortality in patients with heart failure (HF) in the intensive care unit (ICU) remains unknown. This study aimed to determine the correlation between FI-lab and all-cause mortality to evaluate the impact of FI-lab on the prognosis of critically ill patients with HF. METHODS This retrospective observational study utilized data extracted from the Medical Information Mart for Intensive Care IV database. The FI-lab, which consists of 33 laboratory tests, was constructed. Patients were then grouped into quartiles (Q1-Q4) based on their FI-lab scores. Kaplan-Meier analysis was used to compare all-cause mortality among the four groups. A Cox proportional hazard analysis was conducted to examine the association between the FI-lab score and all-cause mortality. The incremental predictive value of adding FI-lab to classical disease severity scores was assessed using Harrell's C statistic, integrated discrimination improvement (IDI) and net reclassification improvement (NRI). RESULTS Among 3021 patients, 838 (27.74%) died within 28 days, and 1400 (46.34%) died within a 360 day follow-up period. Kaplan-Meier analysis indicated that patients with higher FI-lab scores had significantly higher risks of all-cause mortality (log-rank P < 0.001). Multivariable Cox regression suggested that FI-lab, evaluated as a continuous variable (for each 0.01 increase), was associated with increased 28 day mortality [hazard ratio (HR) 1.02, 95% confidence interval (CI) (1.01-1.03), P < 0.001] and 360 day mortality [HR 1.02, 95% CI (1.01-1.02), P < 0.001]. When assessed in quartiles, the 28 day mortality risk [HR 1.66, 95% CI (1.28-2.15), P < 0.001] and 360 day mortality risk [HR 1.48, 95% CI (1.23-1.8), P < 0.001] were significantly higher for FI-lab Q4 compared with FI-lab Q1. FI-lab significantly improved the predictive capability of classical disease severity scores for 28 and 360 day mortality. CONCLUSIONS In ICU patients diagnosed with HF, the FI-lab is a potent predictor of short-term and long-term mortality in critically ill patients with HF. The active use of FI-lab to identify high-risk groups among critically ill HF patients and initiate timely interventions may have significant value in improving the prognosis of critically ill patients with HF.
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Affiliation(s)
- Sutong Wang
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Lin Wang
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yongcheng Wang
- Department of Cardiovascular Diseases, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China
| | - Shuli Zong
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Hesong Fan
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yuehua Jiang
- Central Laboratory, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China
| | - Xiao Li
- Department of Cardiovascular Diseases, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China
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Almobarak F. A content analysis of YouTube videos on palliative care: understanding the quality and availability of online resources. Palliat Care Soc Pract 2024; 18:26323524241231819. [PMID: 38390558 PMCID: PMC10883131 DOI: 10.1177/26323524241231819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/25/2024] [Indexed: 02/24/2024] Open
Abstract
Background Improvement in quality care is an important aspect of palliative care for individuals with serious illnesses. Palliative care is a multidisciplinary strategy that addresses the physical, emotional, social, and spiritual needs of patients and their families. As technology advances, digital media - especially YouTube - has come to serve as a virtual educational platform, offering resources for health-related information, including information about palliative care. Objectives In this research, the main goal was to evaluate the quality and availability of online resources related to palliative care. Design Two theoretical frameworks were used: the Health Communication Model and the Information Quality Framework. These frameworks offer a way to understand how YouTube videos contribute to palliative care information and assess the quality of that information. Methods This study utilizes a quantitative analysis approach to assess the quality and accessibility of YouTube videos on palliative care. Specifically, a random sample of 300 YouTube videos addressing palliative care was examined. Descriptive statistics were used to analyze the data, including the frequency and distribution of the different types of content, sources, and quality indicators. Chi-square tests were done to compare the quality of information provided by different sources and types of content. Results The results showed a variety of video types, with educational videos being the most common (40%), followed by personal stories (26.7%) and promotional videos (16.7%). We found that healthcare organizations (30%) and individual content creators (46.7%) were the sources for these videos. Conclusion There were varying scores in terms of accuracy, completeness, and relevance when it came to quality assessment. While many videos received excellent ratings, some received poor ratings. Additionally, this analysis revealed that the majority of these videos were in English (83.3%), which poses a limitation for non-English speakers who may have difficulty understanding them.
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Affiliation(s)
- Fhaied Almobarak
- Fundamentals of Nursing Department, College of Nursing, Imam Abdulrahman Bin Faisal University, Dammam 34221, Saudi Arabia
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3
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Sciacchitano S, Carola V, Nicolais G, Sciacchitano S, Napoli C, Mancini R, Rocco M, Coluzzi F. To Be Frail or Not to Be Frail: This Is the Question-A Critical Narrative Review of Frailty. J Clin Med 2024; 13:721. [PMID: 38337415 PMCID: PMC10856357 DOI: 10.3390/jcm13030721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/07/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
Many factors have contributed to rendering frailty an emerging, relevant, and very popular concept. First, many pandemics that have affected humanity in history, including COVID-19, most recently, have had more severe effects on frail people compared to non-frail ones. Second, the increase in human life expectancy observed in many developed countries, including Italy has led to a rise in the percentage of the older population that is more likely to be frail, which is why frailty is much a more common concern among geriatricians compared to other the various health-care professionals. Third, the stratification of people according to the occurrence and the degree of frailty allows healthcare decision makers to adequately plan for the allocation of available human professional and economic resources. Since frailty is considered to be fully preventable, there are relevant consequences in terms of potential benefits both in terms of the clinical outcome and healthcare costs. Frailty is becoming a popular, pervasive, and almost omnipresent concept in many different contexts, including clinical medicine, physical health, lifestyle behavior, mental health, health policy, and socio-economic planning sciences. The emergence of the new "science of frailty" has been recently acknowledged. However, there is still debate on the exact definition of frailty, the pathogenic mechanisms involved, the most appropriate method to assess frailty, and consequently, who should be considered frail. This narrative review aims to analyze frailty from many different aspects and points of view, with a special focus on the proposed pathogenic mechanisms, the various factors that have been considered in the assessment of frailty, and the emerging role of biomarkers in the early recognition of frailty, particularly on the role of mitochondria. According to the extensive literature on this topic, it is clear that frailty is a very complex syndrome, involving many different domains and affecting multiple physiological systems. Therefore, its management should be directed towards a comprehensive and multifaceted holistic approach and a personalized intervention strategy to slow down its progression or even to completely reverse the course of this condition.
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Affiliation(s)
- Salvatore Sciacchitano
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy;
- Unit of Anaesthesia, Intensive Care and Pain Medicine, Sant’Andrea University Hospital, 00189 Rome, Italy; (M.R.); (F.C.)
- Department of Life Sciences, Health and Health Professions, Link Campus University, 00165 Rome, Italy
| | - Valeria Carola
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, 00189 Rome, Italy; (V.C.); (G.N.)
| | - Giampaolo Nicolais
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, 00189 Rome, Italy; (V.C.); (G.N.)
| | - Simona Sciacchitano
- Department of Psychiatry, La Princesa University Hospital, 28006 Madrid, Spain;
| | - Christian Napoli
- Department of Surgical and Medical Science and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy;
| | - Rita Mancini
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy;
| | - Monica Rocco
- Unit of Anaesthesia, Intensive Care and Pain Medicine, Sant’Andrea University Hospital, 00189 Rome, Italy; (M.R.); (F.C.)
- Department of Surgical and Medical Science and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy;
| | - Flaminia Coluzzi
- Unit of Anaesthesia, Intensive Care and Pain Medicine, Sant’Andrea University Hospital, 00189 Rome, Italy; (M.R.); (F.C.)
- Department Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, 04100 Latina, Italy
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Craig S, Cao Y, McMahon J, Anderson T, Stark P, Brown Wilson C, Creighton L, Gonella S, Bavelaar L, Vlčková K, Mitchell G. Exploring the Holistic Needs of People Living with Cancer in Care Homes: An Integrative Review. Healthcare (Basel) 2023; 11:3166. [PMID: 38132056 PMCID: PMC10743280 DOI: 10.3390/healthcare11243166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
Up to 26% of individuals residing in care homes are impacted by cancer. This underscores the importance of understanding the holistic needs of care home residents living with cancer to enhance the quality of their care. The primary objective of this integrative literature review was to consolidate the available evidence concerning the comprehensive needs of people living with cancer in care home settings, providing valuable insights into addressing their diverse needs. An integrative literature review was conducted using a systematic approach. Extensive searches were conducted in three databases, complemented by a thorough examination of grey literature and reference lists of relevant papers. The review focused on literature published between 2012 and 2022. The screening process involved two independent reviewers, with a third reviewer resolving any discrepancies. The review identified twenty research papers that met the eligibility criteria. These papers shed light on three primary themes related to the holistic needs of care home residents with cancer: physical, psychological, and end-of-life needs. Physical needs encompassed pain management, symptom control, and nutrition, while psychological needs involved social support, emotional well-being, and mental health care. End-of-life needs addressed end-of-life care and advance care planning. These themes highlight the multifaceted nature of cancer care in care homes and underscore the importance of addressing residents' holistic needs in a comprehensive and integrated manner. Improving care home education about cancer and integrating palliative and hospice services within this setting are vital for addressing the diverse needs of residents with cancer.
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Affiliation(s)
- Stephanie Craig
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (S.C.); (J.M.); (T.A.); (P.S.); (C.B.W.); (L.C.)
| | - Yanting Cao
- The Shanghai Medical College, Fudan University, Shanghai 200437, China;
- Stellar Care NW Ltd., Ellesmere Port CH65 1A, UK
| | - James McMahon
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (S.C.); (J.M.); (T.A.); (P.S.); (C.B.W.); (L.C.)
| | - Tara Anderson
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (S.C.); (J.M.); (T.A.); (P.S.); (C.B.W.); (L.C.)
| | - Patrick Stark
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (S.C.); (J.M.); (T.A.); (P.S.); (C.B.W.); (L.C.)
| | - Christine Brown Wilson
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (S.C.); (J.M.); (T.A.); (P.S.); (C.B.W.); (L.C.)
| | - Laura Creighton
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (S.C.); (J.M.); (T.A.); (P.S.); (C.B.W.); (L.C.)
| | - Silvia Gonella
- Direction of Health Professions, City of Health and Science University Hospital of Torino, Corso Bramante 88-90, 10126 Turin, Italy;
- Department of Public Health and Pediatrics, University of Torino, Via Santena 5 bis, 10126 Turin, Italy
| | - Laura Bavelaar
- Department of Public Health and Primary Care, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | | | - Gary Mitchell
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (S.C.); (J.M.); (T.A.); (P.S.); (C.B.W.); (L.C.)
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Mazzu MA, Campbell ML, Schwartzstein RM, White DB, Mitchell SL, Fehnel CR. Evidence Guiding Withdrawal of Mechanical Ventilation at the End of Life: A Review. J Pain Symptom Manage 2023; 66:e399-e426. [PMID: 37244527 PMCID: PMC10527530 DOI: 10.1016/j.jpainsymman.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/10/2023] [Accepted: 05/19/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Distress at the end of life in the intensive care unit (ICU) is common. We reviewed the evidence guiding symptom assessment, withdrawal of mechanical ventilation (WMV) process, support for the ICU team, and symptom management among adults, and specifically older adults, at end of life in the ICU. SETTING AND DESIGN Systematic search of published literature (January 1990-December 2021) pertaining to WMV at end of life among adults in the ICU setting using PubMed, Embase, and Web of Science. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. PARTICIPANTS Adults (age 18 and over) undergoing WMV in the ICU. MEASUREMENTS Study quality was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. RESULTS Out of 574 articles screened, 130 underwent full text review, and 74 were reviewed and assessed for quality. The highest quality studies pertained to use of validated symptom scales during WMV. Studies of the WMV process itself were generally lower quality. Support for the ICU team best occurs via structured communication and social supports. Dyspnea is the most distressing symptom, and while high quality evidence supports the use of opiates, there is limited evidence to guide implementation of their use for specific patients. CONCLUSION High quality studies support some practices in palliative WMV, while gaps in evidence remain for the WMV process, supporting the ICU team, and medical management of distress. Future studies should rigorously compare WMV processes and symptom management to reduce distress at end of life.
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Affiliation(s)
- Maria A Mazzu
- University of New England College of Osteopathic Medicine (M.A.M.), Biddeford, Maine, USA
| | | | - Richard M Schwartzstein
- Beth Israel Deaconess Medical Center (R.M.S., S.L.M., C.R.F.), Boston, Massachusetts, USA; Harvard Medical School (R.M.S., S.L.M., C.R.F.), Boston, Massachusetts, USA
| | - Douglas B White
- University of Pittsburgh School of Medicine (D.B.W.), Pittsburgh, Pennsylvania, USA
| | - Susan L Mitchell
- Beth Israel Deaconess Medical Center (R.M.S., S.L.M., C.R.F.), Boston, Massachusetts, USA; Harvard Medical School (R.M.S., S.L.M., C.R.F.), Boston, Massachusetts, USA; Hebrew SeniorLife, Marcus Institute for Aging Research (S.L.M., C.R.F.), Boston, Massachusetts, USA
| | - Corey R Fehnel
- Beth Israel Deaconess Medical Center (R.M.S., S.L.M., C.R.F.), Boston, Massachusetts, USA; Harvard Medical School (R.M.S., S.L.M., C.R.F.), Boston, Massachusetts, USA; Hebrew SeniorLife, Marcus Institute for Aging Research (S.L.M., C.R.F.), Boston, Massachusetts, USA.
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6
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Conroy A, Zhang V, Kaito M, Ramamoorthy V, Roy M, Ahmed MA, Zhang Z, McGranaghan P, Appunni S, Saxena A, Rubens M, Cristian A. Effect of Frailty on Hospital Outcomes Among Pediatric Cancer Patients in the United States: Results From the National Inpatient Sample. Am J Clin Oncol 2023; 46:381-386. [PMID: 37259194 DOI: 10.1097/coc.0000000000001017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Studies on frailty among pediatric patients with cancer are scarce. In this study, we sought to understand the effects of frailty on hospital outcomes in pediatric patients with cancer. METHODS This retrospective study used data collected and stored in the Nationwide Inpatient Sample (NIS) between 2005 and 2014. These were hospitalized patients and hence represented the sickest group of patients. Frailty was measured using the frailty definition diagnostic indicator by Johns Hopkins Adjusted Clinical Groups. RESULTS Of 187,835 pediatric cancer hospitalizations included in this analysis, 11,497 (6.1%) were frail. The average hospitalization costs were $86,910 among frail and $40,358 for nonfrail patients. In propensity score matching analysis, the odds of in-hospital mortality (odds ratio, 2.08; 95% CI, 1.71-2.52) and length of stay (odds ratio, 3.76; 95% CI, 3.46-4.09) were significantly greater for frail patients. The findings of our study suggest that frailty is a crucial clinical factor to be considered when treating pediatric cancer patients in a hospital setting. CONCLUSIONS These findings highlight the need for further research on frailty-based risk stratification and individualized interventions that could improve outcomes in frail pediatric cancer patients. The adaptation and validation of a frailty-defining diagnostic tool in the pediatric population is a high priority in the field.
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Affiliation(s)
- Abigail Conroy
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale
| | - Vicky Zhang
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale
| | - Max Kaito
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale
| | | | - Mukesh Roy
- Miami Cancer Institute, Baptist Health South Florida
| | | | | | - Peter McGranaghan
- Miami Cancer Institute, Baptist Health South Florida
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, Berlin, Germany
| | | | - Anshul Saxena
- Center for Advanced Analytics
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | - Muni Rubens
- Miami Cancer Institute, Baptist Health South Florida
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL
- Universidad Espíritu Santo, Guayaquil, Ecuador
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Sacco A, Tavecchia G, Ditali V, Garatti L, Villanova L, Colombo C, Viola G, Scavelli F, Varrenti M, Milani M, Morici N, Tavazzi G, Lissoni B, Forni L, Gorni G, Saporetti G, Oliva F. Effect of a quality-improvement intervention on end-of-life care in cardiac intensive care unit. Eur J Clin Invest 2023:e13982. [PMID: 36912206 DOI: 10.1111/eci.13982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/17/2023] [Accepted: 02/27/2023] [Indexed: 03/14/2023]
Affiliation(s)
- Alice Sacco
- "De Gasperis" Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giovanni Tavecchia
- "De Gasperis" Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Laura Garatti
- "De Gasperis" Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Luca Villanova
- "De Gasperis" Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Claudia Colombo
- "De Gasperis" Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giovanna Viola
- "De Gasperis" Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Francesca Scavelli
- "De Gasperis" Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marisa Varrenti
- "De Gasperis" Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Martina Milani
- "De Gasperis" Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Nuccia Morici
- S. Maria Nascente-Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Guido Tavazzi
- Unit of Anaesthesia and Intensive Care, Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, University of Pavia Italy.,Department of Anaesthesia, Intensive Care and Pain Therapy, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Barbara Lissoni
- Clinical Psicology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Lorena Forni
- Comitato per l'Etica di Fine Vita, Milan, Italy.,School of Law, Università Milano-Bicocca, Milan, Italy
| | - Giovanna Gorni
- Palliative Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giorgia Saporetti
- Quality and Risk Management, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Fabrizio Oliva
- "De Gasperis" Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Chelazzi C, Villa G, Lanini I, Romagnoli S, Latronico N. The adult and pediatric palliative care: differences and shared issues. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE (ONLINE) 2023; 3:1. [PMID: 37386675 DOI: 10.1186/s44158-023-00085-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/05/2023] [Indexed: 07/01/2023]
Abstract
Adult and pediatric palliative care (PC) share common aims and ethical principles but differ in many organizational and practical aspects. The aim of this narrative review is to analyze these differences and focus on which key aspects of pediatric palliative care could integrate adult services for a better care of suffering patients.Interventions which are peculiar of pediatric PC respect to adult PC include: an earlier referral to the PC service to identify the needs and plan the interventions at an earlier stage of the disease; consequently, a more systematic cooperation with the disease-specific physicians to reduce the burden of treatments; a better integration with the community and the social surroundings of the patients, to prevent social isolation and preserve their social role; a more dynamic organization of the PC services, to give patients the chance of being stabilized at in-hospital or residential settings and subsequently discharged and cared at home whenever possible and desired; the implementation of respite care for adults, to help the families coping with the burden of the disease of their beloved and promote the home-based PC.This review underlines the relevance of some key-aspects of pediatric PC that can be beneficial also within PC of adults. Its findings give the chance for a more dynamic and modern organization of adult PC services and may serve as a basis of future research for new interventions.
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Affiliation(s)
- Cosimo Chelazzi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
- Unit of Palliative Care and Integrated Home Service, Spedali Civili University Hospital, Brescia, Italy.
| | - Gianluca Villa
- Department of Health Sciences, Section of Anesthesia, Intensive Care and Pain Medicine, University of Florence, Florence, Italy
- Department of Anesthesia and Intensive Care, Section of Oncological Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | | | - Stefano Romagnoli
- Department of Health Sciences, Section of Anesthesia, Intensive Care and Pain Medicine, University of Florence, Florence, Italy
- Department of Anesthesia and Intensive Care, Section of Oncological Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Nicola Latronico
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy
- "Alessandra BONO" University Research Center On LOng Term Outcome (LOTO) in Survivors of Critical Illness, University of Brescia, Brescia, Italy
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Jones S, Mulaikal TA. End of Life: What Is the Anesthesiologist's Role? Adv Anesth 2022; 40:1-14. [PMID: 36333041 DOI: 10.1016/j.aan.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Anesthesiologists receive extensive training in the area of perioperative care and the specialized skills required to maintain life during surgery and complex procedures. Integrated into almost every facet of contemporary medicine, they interact with patients at multiple stages of their health care journeys. While traditionally thought of as the doctors best equipped to save lives, they may also be some of the best doctors to help navigate the chapters at the end of life. Successfully navigating end-of-life care, particularly in the COVID-19 era, is a complicated task. Competing ethical principles of autonomy and nonmaleficence may often be encountered as sophisticated medical technologies offer the promise of extending life longer than ever before seen. From encouraging patients to actively engage in advance care planning, normalizing the conversations around the end of life, employing our skills to relieve pain and suffering associated with dying, and using our empathy and communication skills to also care for the families of dying patients, there are many ways for the anesthesiologist to elevate the care provided at the end of life. The aim of this article is to review the existing literature on the role of the anesthesiologist in end-of-life care, as well as to encourage future development of our specialty in this area.
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Affiliation(s)
- Stephanie Jones
- Columbia University Irving Medical Center, Division of Critical Care Medicine, 622 W. 168th St, New York, NY 10032, USA
| | - Teresa A Mulaikal
- Division of Cardiothoracic and Critical Care, Columbia University Medical Center, 622 W. 168th St., PH 5 Stem 133, New York, NY 10032, USA.
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10
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León-Ramón S, Navarro-Flores E, Losa-Iglesias ME, Becerro-de-Bengoa-Vallejo R, Jiménez-Cebrián AM, Romero-Morales C, Palomo-López P, López-López D. Reliability of Frail and Barthel Tests for Detecting Frailty in Palliative Oncological Patients in a Home Hospitalization Unit: A Comparative Study. Life (Basel) 2022; 12:286. [PMID: 35207573 PMCID: PMC8878425 DOI: 10.3390/life12020286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 11/16/2022] Open
Abstract
Cancer is a condition that can increase the risk of frailty. In addition, palliative oncological patients in home hospitalization can find their activities of daily living affected. The main objective was to measure the degree of frailty in the oncological population in home hospitalization comparing Barthel and Frail-VIG Indexes. This is a descriptive cross-sectional study. A sample of oncological patients in home hospitalization (n = 50) that included 27 men and 23 women were recruited, and disability due to frailty was measured using the VIG frailty index and the Barthel scale for Activities of Daily Living (ADLs). Spearman's correlation coefficients were categorized as weak (rs ≤ 0.40), moderate (0.41 ≤ rs ≥ 0.69) or robust (0.70 ≤ rs ≥ 1.00), with a strong indirect correlation between the domains using the toilet, transferring and wandering on the Frail-VIG scale with an r (s) value -0.810 (p < 0.001), -0.831 (p < 0.001) and -0.805 (p < 0.001), respectively, and a moderate indirect correlation for the domains of eating -0.718 (p < 0.001), dressing -0.770 (p < 0.001) and urination -0.704 (<0.001). The Frail-VIG index above 0.35 points, that is, from moderate to severe, does not affect ADLs except in the nutritional dimension in a palliative oncological population in home hospitalization. The preliminary outcomes obtained should be considered to determine the impact of nutritional status with regard to ADLs in palliative oncological patients in a home hospitalization unit.
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Affiliation(s)
- Susana León-Ramón
- Home Hospitalization Unit, General University Hospital of Valencia, Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, 46001 Valencia, Spain;
| | - Emmanuel Navarro-Flores
- Frailty Research Organized Group, Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, 46001 Valencia, Spain
| | | | | | - Ana María Jiménez-Cebrián
- Department Nursing and Podiatry, Faculty of Health Sciences, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Malaga, 29010 Malaga, Spain;
| | - Carlos Romero-Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28001 Madrid, Spain;
| | | | - Daniel López-López
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, 15403 Ferrol, Spain;
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11
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Yen YF, Hu HY, Chou YC, Chen CC, Ho CY. Utilization of Palliative Care Screening Tool to Early Identify Patients with COVID-19 Needing Palliative Care: A Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031054. [PMID: 35162078 PMCID: PMC8834527 DOI: 10.3390/ijerph19031054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/01/2022] [Accepted: 01/17/2022] [Indexed: 02/04/2023]
Abstract
There are very few programs that identify patients with coronavirus disease 2019 (COVID-19) who need palliative care. This cohort study presents a model to use a validated palliative care screening tool (PCST) to systematically identify hospitalized patients with COVID-19 in need of palliative care. In this prospective study, we consecutively recruited patients with COVID-19 admitted to Taipei City Hospital between 1 January and 30 July 2021. Patients’ palliative care needs were determined by using the PCST. Advance care planning (ACP) and advance directives (AD) were systemically provided for all patients with a PCST score ≥ 4. Of 897 patients, 6.1% had a PCST score ≥ 4. During the follow-up period, 106 patients died: 75 (8.9%) with a PCST score < 4 and 31 (56.4%) with a PCST score ≥ 4. The incidence of mortality was 2.08 and 0.58/100 person-days in patients with PCST scores ≥ 4 and <4, respectively. After controlling for other covariates, a PCST score ≥ 4 was associated with a higher risk of mortality in patients with COVID-19 (adjusted HR = 2.08; 95% CI: 1.22–3.54; p < 0.001). During hospitalization, 55 patients completed an ACP discussion with their physicians, which led to 15 of them completing the AD. Since hospitalized patients with COVID-19 had a high mortality rate, it is imperative to implement a comprehensive palliative care program to early identify patients needing palliative care and promotion of AD and ACP.
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Affiliation(s)
- Yung-Feng Yen
- Section of Infectious Diseases, Taipei City Hospital, Yangming Branch, Taipei 112, Taiwan
- Institute of Public Health, National Yang-Ming Chiao Tung University, Taipei 112, Taiwan;
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan;
- Department of Education and Research, Taipei City Hospital, Taipei 106, Taiwan;
- Department of Psychology and Counseling, University of Taipei, Taipei 100, Taiwan
- Correspondence: (Y.-F.Y.); (C.-Y.H.)
| | - Hsiao-Yun Hu
- Institute of Public Health, National Yang-Ming Chiao Tung University, Taipei 112, Taiwan;
- Department of Education and Research, Taipei City Hospital, Taipei 106, Taiwan;
- Department of Psychology and Counseling, University of Taipei, Taipei 100, Taiwan
| | - Yi-Chang Chou
- Department of Education and Research, Taipei City Hospital, Taipei 106, Taiwan;
| | - Chu-Chieh Chen
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan;
| | - Chin-Yu Ho
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Department of Family Medicine, Taipei City Hospital, Yangming Branch, Taipei 112, Taiwan
- Department of Psychology, Soochow University, Taipei 100, Taiwan
- General Education Center, University of Taipei, Taipei 100, Taiwan
- Correspondence: (Y.-F.Y.); (C.-Y.H.)
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12
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Barbiellini Amidei C, Macciò S, Cantarutti A, Gessoni F, Bardin A, Zanier L, Canova C, Simonato L. Hospitalizations and emergency department visits trends among elderly individuals in proximity to death: a retrospective population-based study. Sci Rep 2021; 11:21472. [PMID: 34728661 PMCID: PMC8563963 DOI: 10.1038/s41598-021-00648-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 10/11/2021] [Indexed: 11/25/2022] Open
Abstract
Acute healthcare services are extremely important, particularly during the COVID-19 pandemic, as healthcare demand has rapidly intensified, and resources have become insufficient. Studies on specific prepandemic hospitalization and emergency department visit (EDV) trends in proximity to death are limited. We examined time-trend specificities based on sex, age, and cause of death in the last 2 years of life. Datasets containing all hospitalizations and EDVs of elderly residents in Friuli-Venezia Giulia, Italy (N = 411,812), who died between 2002 and 2014 at ≥ 65 years, have been collected. We performed subgroup change-point analysis of monthly trends in the 2 years preceding death according to sex, age at death (65-74, 75-84, 85-94, and ≥ 95 years), and main cause of death (cancer, cardiovascular, or respiratory disease). The proportion of decedents (N = 142,834) accessing acute healthcare services increased exponentially in proximity to death (hospitalizations = 4.7, EDVs = 3.9 months before death). This was inversely related to age, with changes among the youngest and eldest decedents at 6.6 and 3.5 months for hospitalizations and at 4.6 and 3.3 months for EDVs, respectively. Healthcare use among cancer patients intensified earlier in life (hospitalizations = 6.8, EDVs = 5.8 months before death). Decedents from respiratory diseases were most likely to access hospital-based services during the last month of life. No sex-based differences were found. The greater use of acute healthcare services among younger decedents and cancer patients suggests that policies potentiating primary care support targeting these at-risk groups may reduce pressure on hospital-based services.
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Affiliation(s)
- Claudio Barbiellini Amidei
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, 35131, Padua, Italy.
| | - Silvia Macciò
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, 35131, Padua, Italy
| | - Anna Cantarutti
- Division of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
| | - Francesca Gessoni
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, 35131, Padua, Italy
| | - Andrea Bardin
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, 35131, Padua, Italy
| | - Loris Zanier
- Epidemiological Service, Health Directorate, Friuli-Venezia Giulia Region, Udine, Italy
| | - Cristina Canova
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, 35131, Padua, Italy.
| | - Lorenzo Simonato
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, 35131, Padua, Italy
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13
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Evolving Therapeutic Approaches for Older Patients with Acute Myeloid Leukemia in 2021. Cancers (Basel) 2021; 13:cancers13205075. [PMID: 34680226 PMCID: PMC8534216 DOI: 10.3390/cancers13205075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 09/29/2021] [Accepted: 10/04/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary The better understanding of disease biology, the availability of new effective drugs and the increased awareness of patients’ heterogeneity in terms of fitness and personal expectations has made the current treatment paradigm of AML in the elderly very challenging. Here, we discuss the evolving criteria used to define eligibility for induction chemotherapy and transplantation, the introduction of new agents in the treatment of patients with very different clinical conditions, the implications of precision medicine and the importance of quality of life and supportive care, proposing a simplified algorithm that we follow in 2021. Abstract Acute myeloid leukemia (AML) in older patients is characterized by unfavorable prognosis due to adverse disease features and a high rate of treatment-related complications. Classical therapeutic options range from intensive chemotherapy in fit patients, potentially followed by allogeneic hematopoietic cell transplantation (allo-HCT), to hypomethylating agents or palliative care alone for unfit/frail ones. In the era of precision medicine, the treatment paradigm of AML is rapidly changing. On the one hand, a plethora of new targeted drugs with good tolerability profiles are becoming available, offering the possibility to achieve a prolonged remission to many patients not otherwise eligible for more intensive therapies. On the other hand, better tools to assess patients’ fitness and improvements in the selection and management of those undergoing allo-HCT will hopefully reduce treatment-related mortality and complications. Importantly, a detailed genetic characterization of AML has become of paramount importance to choose the best therapeutic option in both intensively treated and unfit patients. Finally, improving supportive care and quality of life is of major importance in this age group, especially for the minority of patients that are still candidates for palliative care because of very poor clinical conditions or unwillingness to receive active treatments. In the present review, we discuss the evolving approaches in the treatment of older AML patients, which is becoming increasingly challenging following the advent of new effective drugs for a very heterogeneous and complex population.
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14
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Catalisano G, Ippolito M, Marino C, Giarratano A, Cortegiani A. Palliative Care Principles and Anesthesiology Clinical Practice: Current Perspectives. J Multidiscip Healthc 2021; 14:2719-2730. [PMID: 34611408 PMCID: PMC8486274 DOI: 10.2147/jmdh.s240563] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 09/14/2021] [Indexed: 11/24/2022] Open
Abstract
Background Palliative care is a person-centered approach aiming to relieve patient’s health-related suffering and it is often needed when caring for critically ill patients to manage symptoms and identify goals of care. Aim To describe the integration of palliative care principles in anesthesiology clinical practice, within and outside the ICU and to analyze the additional challenges that COVID-19 pandemic is posing in this context. Methods For the purpose of this review, PubMed database was searched for studies concerning palliative care and end of life care, in contexts involving anesthesiologists and intensivists, published in the last 5 years. Results Anesthesiologists and intensivists integrate palliative care within their daily practice providing symptoms management as well as family counseling. High-quality communicational skills are fundamental for anesthesiologists and intensivists especially when interfacing with surrogate decision makers in the ICU or with patients in the preoperative setting while discussing goals of care. Coronavirus disease 2019 (COVID-19) pandemic has challenged many aspects of palliative care delivery: reduced family presence within the ICU, communication with families through phone calls or video calls, patient–physician relationship mediated by bulky personal protective equipment and healthcare workers physical and psychological distress due to the increased workload and limitations in resources are some of the most evident. Conclusion Anesthesiologists and intensivists are increasingly facing challenging clinical situations where principles and practice of palliative care have to be applied. In this sense, increasing knowledge on palliative care and providing specific training would allow to deliver high-quality symptom management, family counseling and end of life guidance in critical care settings. COVID-19 pandemic sets additional difficulties to palliative care delivery.
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Affiliation(s)
- Giulia Catalisano
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
| | - Mariachiara Ippolito
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
| | - Claudia Marino
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
| | - Antonino Giarratano
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy.,Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy.,Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
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15
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Allen LL, Uphold CR, Koniaris-Rambaud C, House K, Gray F, Fitzgerald L, Vaughan C, Johnson TM. Palliative care aspects of wound healing in complex patients: a case report. J Wound Care 2021; 30:845-852. [PMID: 34644138 DOI: 10.12968/jowc.2021.30.10.845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
DECLARATION OF INTEREST The authors have no conflicts of interest to declare.
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Affiliation(s)
- Latricia L Allen
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Decatur, GA, US.,Atlanta Department of Veterans Affairs Medical Center, Decatur, GA, US.,Department of Medicine, Emory University, Atlanta, GA, US
| | - Constance R Uphold
- VA Geriatric Research Education and Clinical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL, US
| | - Christine Koniaris-Rambaud
- Department of Medicine, Emory University, Atlanta, GA, US.,Department of Family and Preventive Medicine, Emory University, Atlanta, GA, US
| | - Kim House
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Decatur, GA, US.,Atlanta Department of Veterans Affairs Medical Center, Decatur, GA, US.,Department of Medicine, Emory University, Atlanta, GA, US
| | - Frances Gray
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Decatur, GA, US.,Atlanta Department of Veterans Affairs Medical Center, Decatur, GA, US
| | - Linda Fitzgerald
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Decatur, GA, US.,Atlanta Department of Veterans Affairs Medical Center, Decatur, GA, US
| | - Camille Vaughan
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Decatur, GA, US.,Atlanta Department of Veterans Affairs Medical Center, Decatur, GA, US.,Department of Medicine, Emory University, Atlanta, GA, US
| | - Theodore M Johnson
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Decatur, GA, US.,Atlanta Department of Veterans Affairs Medical Center, Decatur, GA, US.,Department of Medicine, Emory University, Atlanta, GA, US.,Department of Family and Preventive Medicine, Emory University, Atlanta, GA, US
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16
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Spiritual care needs and their associated influencing factors among elderly patients with moderate-to-severe chronic heart failure in China: A cross-sectional study. Palliat Support Care 2021; 20:264-274. [DOI: 10.1017/s1478951521001279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackgroundThe significance of spiritual care needs among chronic diseases patients has been emphasized across countries and cultures in many studies. However, there were few studies on spiritual care needs among elderly patients with moderate-to-severe chronic heart failure (CHF) in China.ObjectiveTo investigate spiritual care needs and associated influencing factors among elderly patients with moderate-to-severe CHF, and to examine the relationships among spiritual care needs, self-perceived burden, symptom management self-efficacy, and perceived social support.MethodsA cross-sectional design was implemented, and the STROBE Checklist was used to report the study. A convenience sample of 474 elderly patients with moderate-to-severe CHF were selected from seven hospitals in Tianjin, China. The sociodemographic characteristics questionnaire, the Spiritual Needs Questionnaire Scale, the Self-Perceived Burden Scale, the Self-efficacy for Symptom Management Scale, and the Perceived Social Support Scale were used. Descriptive statistics, univariate, multiple linear regression, and Pearson's correlation analysis were used to analyze data.ResultsThe total score of spiritual care needs among 474 elderly patients with moderate-to-severe CHF was 37.95 ± 14.71, which was moderate. Religious belief, educational background, self-perceived burden, symptom management self-efficacy, and perceived social support were the main factors affecting spiritual care needs, and spiritual care needs were negatively correlated with self-perceived burden (r = −0.637, p < 0.01) and positively correlated with symptom management self-efficacy (r = 0.802, p < 0.01) and social support (r = 0.717, p < 0.01).Significance of resultsThe spiritual care needs of elderly patients with moderate-to-severe CHF were moderate, which were influenced by five factors. It is suggested that clinical nurses, families, and society should take targeted spiritual care measures to improve patients’ symptom management self-efficacy and perceived social support from many aspects, and reduce self-perceived burden to meet their spiritual care needs and improve the quality and satisfaction of spiritual care in nursing practice.
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17
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Sigler LE, Reitschuler-Cross E, Arnold RM, Hall DE. Preoperative Frailty Assessment #407. J Palliat Med 2021; 24:285-286. [PMID: 33522858 DOI: 10.1089/jpm.2020.0629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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18
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Correia I, Simas Â, Chaves S, Paixão AI, Catarino A, Gonçalves-Pereira J. The PALliative MUlticenter Study in Intensive Care (PalMuSIC). Results From a Multicenter Study Addressing Frailty and Palliative Care Interventions in Intensive Care Units in Portugal. J Palliat Care 2021; 37:552-561. [PMID: 34128431 DOI: 10.1177/08258597211020964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Frailty is a clinically recognizable state of increased vulnerability common in critical medicine. When underrecognized, it may lead to invasive treatments that do not serve the patients' best interest. Our aim was to evaluate the use of both palliative care consultation and invasive interventions in frail patients admitted to Intensive Care Units in Portugal. METHODS This was a prospective, observational study. All consecutive adult patients admitted for more than 24 h, over a 15-day period were enrolled. Twenty-three Portuguese Intensive Care Units were included. Informed consent was obtained from all patients or their surrogate. The doctor and nurse in charge calculated the Clinical Frailty Score as well as the reference family member. RESULTS A total of 335 patients were included in the study (66% male). Mean age was 63.2 ± 16.8 and SAPS II score was 41.8 ± 17.4. Mean Clinical Frailty Score value was 3.5 ± 1.7. Frailty prevalence (mean score ≥ 5) was 20.9%. Frail patients were offered organ support therapy (64,3% invasive mechanical ventilation; 24,3% renal replacement therapy; 67,1% vasopressors) more often than non-frail patients. Nevertheless, limitation of therapeutic effort or a do not resuscitate order (p < 0.001) were more common in frail patients. Mortality rate by 6 months was higher among frail patients (50% vs. 32.3%, p < 0.001). Palliative Care was offered to only 15% of frail patients (3.9% overall). CONCLUSIONS The authors suggest that palliative care should be universally consulted once frailty is identified in critical patients.
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Affiliation(s)
- Iuri Correia
- Intra-hospital Palliative Care Support Team of Hospital, Prof. Fernando Fonseca, Amadora, NOVA Medical School, Lisbon, Portugal
| | - Ângela Simas
- Intensive Care Unite, Hospital Vila Franca de Xira, Portugal
| | - Susana Chaves
- Intensive Care Unite, Hospital Nélio Mendonça, Funchal, Portugal
| | | | - Ana Catarino
- Intensive Care Unit, Hospital Universitário de Coimbra, Centro Hospitalar Universitário de Coimbra, Portugal
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Nurses' Role in Providing Comprehensive Communication, Prognostication, and Palliative Care During the COVID-19 Pandemic. J Hosp Palliat Nurs 2020; 22:442-446. [PMID: 32947392 DOI: 10.1097/njh.0000000000000703] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This article presents the case of a mother of young children who has terminal stage IV cancer with whom providers had not discussed goals of care and prognostication. Communications about prognostication and goals of care are commonly initiated by physicians. Adolescents and young and middle-age adults with complex chronic or terminal illness often are not provided with timely, clear, complete information or palliative care support. Early palliative care for chronically ill patients facilitates discussions of prognostication and goals of care, in addition to providing symptom management. Such discussions do not diminish hope but rather allow patients to adjust hope to attain an optimal quality of life. Nurses can become active, confident advocates for patients with terminal illness of any age, and they are well positioned to assess patients and engage in goals of care and end-of-life conversations. It is especially important that palliative care nurses promote and maintain these early and comprehensive discussions during the COVID-19 pandemic because this population is at a high risk of complications from the coronavirus.
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Whitlock EL, Whittington RA. The Frailty Syndrome: Anesthesiologists Must Understand More and Fear Less. Anesth Analg 2020; 130:1445-1448. [PMID: 32384332 PMCID: PMC7678012 DOI: 10.1213/ane.0000000000004789] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Elizabeth L. Whitlock
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA
| | - Robert A. Whittington
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY, USA
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