scholarly journals Clinical presentation, complications, and outcomes of hospitalized COVID ‐19 patients in an academic center with a centralized palliative care consult service

2021 ◽  
Vol 4 (4) ◽  
Author(s):  
Sarah M. Baker ◽  
Doug J. Leedy ◽  
Jesse Abbott Klafter ◽  
Yilin Zhang ◽  
Kayla M. Secrest ◽  
...  
Keyword(s):  
Palliative Care ◽  
Clinical Presentation ◽  
Consult Service ◽  
Academic Center

scholarly journals The Impact of a Palliative Care Consult Service on the Functions of a Medical Ethics Committee (701)

2010 ◽  
Vol 39 (2) ◽  
pp. 421-422
Author(s):  
Teresa Albanese ◽  
Jessica Moeller ◽  
Steven Radwany ◽  
Summa Health SystemAkron ◽  
Jill Bradshaw ◽  
...  
Keyword(s):  
Palliative Care ◽  
Medical Ethics ◽  
Ethics Committee ◽  
Consult Service ◽  
The Impact

scholarly journals Comparison of Patients with Malignant - Versus Non-malignant Disease Referred to an Inpatient Palliative Care Consult Service in Ontario, Canada

2018 ◽  
Vol 56 (6) ◽  
pp. e110
Author(s):  
Amy Nolen ◽  
Kirsten Wentlandt ◽  
Christopher Meany ◽  
Ebru Kaya ◽  
Camilla Zimmermann
Keyword(s):  
Palliative Care ◽  
Malignant Disease ◽  
Consult Service

scholarly journals Building a Palliative Care Consult Service in Long-Term Care Facilities: Strategy, Business Model, And Outcomes (S704)

2013 ◽  
Vol 45 (2) ◽  
pp. 418 ◽  
Author(s):  
Teresa Albanese ◽  
Steven Radwany ◽  
Erica Hoiles ◽  
Christine Hudak ◽  
Kelly McGranahan
Keyword(s):  
Palliative Care ◽  
Business Model ◽  
Long Term Care ◽  
Consult Service ◽  
Term Care ◽  
Care Facilities

scholarly journals Changes in Clinical Presentation and Perioperative Management of Pheochromocytomas and Paragangliomas: A Four-Decade Experience in a Academic Center

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A78-A79
Author(s):  
Thomas Uslar ◽  
Ignacio San Francisco ◽  
Roberto Ignacio Olmos ◽  
Stefano Pietro Macchiavello ◽  
Alvaro Zuñiga ◽  
...  
Keyword(s):  
Genetic Testing ◽  
Latin American ◽  
Clinical Presentation ◽  
Length Of Hospital Stay ◽  
Female Gender ◽  
Perioperative Outcomes ◽  
Multidisciplinary Program ◽  
Academic Center ◽  
Frequent Mutations ◽  
Biochemical Genetic

Abstract Objective: Latin American reports on pheochromocytomas and paragangliomas (PPGL) are scarce. Recent studies have shown changes in both clinical presentation and management of these patients. We aimed to assess the main characteristics of PPGL patients in a single academic center over the last four decades. Experimental design: Cohort study. Patients and methods: Demographic, clinical, biochemical, genetic and perioperative data from 105 PPGL patients were retrospectively and prospectively collected over the 1980–2019 period. Patients were categorized into four groups (14 patients in the 1st, 25 patients in the 2nd, 27 patients in the 3th and 39 patients in the 4th decade) according to the date of diagnosis. Results: The mean age at diagnosis was 46±19 years, and the tumor size was 5.3±2.2 cm, female gender was 63%, bilateral tumor of 15%, paragangliomas 9% and metastatic disease in 15%. The aforementioned parameters remained stable across the four decades. During the study period we observed significant increases in doxazosin dosing (2.7±2.6 mg vs. 8.0±4.5 p<0.003) and laparoscopic procedures (28% vs. 84% p<0.001) along with a decrease in the length of hospital stay (10.0±8.9 vs. 3.8±1.7 days p=0.007). Among the 24 genetic tests performed, we identified 59% germline mutations. The most frequent mutations were RET (18%) and SDHX (18%), followed by VHL (14%), MAX (5%) and NF1 (4%). Notably, in the last decade we observed a dramatic increase in the proportion of incidental PPGL diagnosis (0% vs. 53% p<0.001) and genetic testing analyses (0 vs. 19 p<0.001). When comparing incidental diagnosis (n=25) versus clinically suspicious cases(n=50), incidentalomas had fewer adrenergic symptoms (38 vs. 62%; p<0.001), and lower rates of hypertension (64 vs. 80%; p=0.01), hypertension crises (28 vs. 44%; p=0.02), functionality (79 vs. 100%; p=0.01) and total catecholamines and/or metanephrine levels (8.4 vs. 12.5 fold above the upper normal limit; p=0.04). Conclusions: The implementation of a multidisciplinary program increased diagnosis and genetic testing and also optimized anesthesia and surgical procedure, translating into a notorious improvement in perioperative outcomes. In addition, we observed a change in the clinical presentation of PPGL in recent decades with a marked increase in incidental cases, which highlights the importance of early diagnosis and treatment.

Experience and Views of Oncology and Palliative Care Professionals on a Corounding Model of Care for Inpatients With Advanced Cancer

2018 ◽  
Vol 35 (11) ◽  
pp. 1433-1438
Author(s):  
Grace Meijuan Yang ◽  
Sungwon Yoon ◽  
Yung Ying Tan ◽  
Karen Liaw
Keyword(s):  
Palliative Care ◽  
Patient Care ◽  
Advanced Cancer ◽  
Health Care Professionals ◽  
Care Delivery ◽  
Hospital Setting ◽  
Model Of Care ◽  
Consult Service ◽  
Quality Of Patient Care

Background: Palliative care is associated with better outcomes in advanced cancer, but there is limited research comparing different models of palliative care delivery alongside oncology care. For inpatients with cancer, palliative care is mostly delivered through a consult service, primarily relying on oncologist-initiated referrals to a separate specialist palliative care team. In our hospital setting, we piloted a palliative care and oncology corounding model of care. Aim: To explore the views and experience of oncology and palliative care professionals on the corounding model compared to an inpatient consult service. Design: A qualitative study nested within a pre–post study of the corounding model of care, with semistructured interviews using thematic analysis. Setting/Participants: Eleven doctors and nurses involved in the pilot corounding model were interviewed. Results: Two main themes emerged: (1) the efficiency of care delivery and (2) quality of patient care. The theme on the efficiency of care delivery was related to access to palliative care input, team communications, and parallel workflow. The quality of patient care was described in terms of holistic approach to cancer care and rapport building with patients and their families. Most participants acknowledged positive aspects of the corounding model, yet some minor concerns were reported, such as disagreements between oncology and palliative care professionals. Conclusions: This study provides insights into the benefits and drawbacks of a corounding model of care for inpatients. The views of health-care professionals can be incorporated into the development of integrated oncology and palliative care models to improve care for patients with advanced cancer.

The management of bleeding in palliative care

2015 ◽  
Author(s):  
Jose Pereira ◽  
Jennifer Brodeur
Keyword(s):  
Palliative Care ◽  
Care Setting ◽  
Clinical Presentation ◽  
Advanced Disease ◽  
Case Reports ◽  
Treatment Modalities ◽  
Low Grade ◽  
Palliative Care Setting ◽  
Life Threatening ◽  
Number Of Treatment

Bleeding is one of the more distressing symptoms experienced by patients with advanced life-threatening illnesses. The prevalence and incidence of bleeding in these patients vary depending on the disease and the illness trajectory. The causes of bleeding in patients with advanced disease are varied and sometimes several aetiologies or aggravating factors occur simultaneously in any given patient. The clinical presentation may be visible, as in haemoptysis or hematemesis, or invisible, as in cerebral haemorrhaging, and volumes may vary, from low-grade oozing to massive and catastrophic haemorrhaging. Catastrophic, terminal haemorrhaging warrants special attention because of its dramatic clinical presentation and the profound distress it causes to patients, families, and caregivers. A number of treatment modalities are available and these can be divided into (a) general measures, (b) local measures, and (c) systemic measures. Unfortunately studies in the palliative care setting comparing various modalities and approaches are generally lacking and guidelines are largely based on case reports and expert opinion.

scholarly journals Care Integration Decreases Hospitalization Costs: Retrospective Cohort Study of Palliative Care Consult Service for Hospital Patients With Metastatic Cancer

2020 ◽  
Author(s):  
Antal Tamás Zemplenyi ◽  
Ágnes Csikós ◽  
Petra Fadgyas-Freyler ◽  
Marcell Csanádi ◽  
Zoltán Kaló ◽  
...  
Keyword(s):  
Palliative Care ◽  
Hospice Care ◽  
Hospital Admissions ◽  
Metastatic Cancer ◽  
Cost Of Care ◽  
Index Number ◽  
Consult Service ◽  
Complex Needs ◽  
Hospitalization Costs ◽  
The Impact

Abstract Background: Palliative Care Consult Service (PCCS) programme was established in Hungary to provide palliative care to hospitalized patients with complex needs and to manage the patients’ pathway when discharged from the hospital. The aim of this study was to measure the impact of PCCS on healthcare costs from the perspective of the payer.Methods: Study population consisted of patients with metastatic cancer (identified by TNM status or ICD-10 code), who were admitted to the Clinical Center of the University of Pécs between 1 January 2014 and 31 December 2016. Patients who did not die within 180-days from enrolment were excluded. Patients receiving services from PCCS team (intervention patients) were compared to patients receiving usual care (controls). The two populations were matched using propensity scores based on age, gender, number of tumor affected organs, Charlson comorbidity index, number of hospital admissions in the year prior to enrollment, outpatient visits in 90 days prior to hospitalization, and number of days to death. Data was obtained from electronic health records linked to claims data. Results: 197 matched pairs were identified with comparable characteristics. Mean number of hospital admissions was 2.1 and 2.5 (p =0.020); ratio of hospital deaths was 75% and 86% (p = 0.003); cost of inpatient care was 1,053 EUR and 1,300 EUR (p = 0.013); cost of home hospice care was 58 EUR and 21 EUR (p = 0.003); and total cost of care was 1,719 EUR and 1,982 EUR (p = 0.099) in the intervention and control groups, respectively. Conclusion: This study demonstrated that palliative care consult service for end-stage cancer patients with a very limited prognosis can add value to healthcare by reducing costs associated with hospital stays and unnecessary examinations and treatments. The data suggest that early initiation of palliative care could have even greater implications.

Impact of a Palliative Care Consult Service

2013 ◽  
Vol 31 (2) ◽  
pp. 175-182 ◽  
Author(s):  
Kevin Whitford ◽  
Nilay D. Shah ◽  
James Moriarty ◽  
Megan Branda ◽  
Bjoerg Thorsteinsdottir
Keyword(s):  
Palliative Care ◽  
Consult Service
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