Validity, Reliability, and Diagnostic Accuracy of the Respiratory Distress Observation Scale for Assessment of Dyspnea in Adult Palliative Care Patients

Gastrointestinal duplication cysts are actually rare congenital anomalies that can accompany various anomalies and are most frequently seen in the small intestine. Gastrointestinal duplication may accompany anomalies such as vertebral anomalies, spinal cord malformations. Depending on the location, symptoms such as chest pain, shortness of breath, cough, asthma-like symptoms, hemoptysis, cyanosis, vomiting, difficulty swallowing, weight loss, hematemesis and melena can be observed. To our knowledge, we report a rare case that has not been reported in pediatric palliative care. We present a case operated for diaphragmatic hernia in the neonatal period. A 3-month-old patient with respiratory distress who was followed up in pediatric palliative care was reoperated and pathologically diagnosed as gastrointestinal duplication cyst. Thoracic cysts can have a wide variety of etiology. The correct diagnosis can be made by performing further examinations and appropriate surgery.

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Diagnostic accuracy of Yale observational scale in bacteremia in infants and children.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.07.3412 ◽

2020 ◽

Vol 27 (07) ◽

pp. 1346-1352

Author(s):

Motia Javed ◽

Mehboob Alam Siddiqui ◽

Zahid Mahmood Anjum ◽

Fazal Elahi Bajwa ◽

Hina Ayesha

Keyword(s):

Blood Culture ◽

Diagnostic Accuracy ◽

Rural Areas ◽

Viral Infections ◽

Signs And Symptoms ◽

Early Screening ◽

Cross Sectional ◽

Observation Scale ◽

Viable Bacteria ◽

Yale Observation Scale

Bacteremia is the presence of viable bacteria in the circulating blood. Bacteremia is diagnosed by blood culture. Yale Observation Scale (YOS) is a scale consisting of six observational items originally and is validated in young febrile children to detect serious illness. If YOS found to be highly accurate, it will help us to design a protocol for early screening and diagnosis of bacteremia in infants so that patient’s morbidity and mortality can be minimized by early treatment. Objectives: To determine the diagnostic accuracy of Yale Observation Scale (YOS) for diagnosing bacteremia, taking blood culture as gold standard. Study Design: Cross-Sectional Validation study. Setting: Department of Pediatrics, D.H.Q Hospital, Faisalabad. Period: 26th May, 2016 to 25th November, 2016. Material & Methods: One hundred and five patients suffering from fever>38 0C, having age from 3-36 months were included in the study. Patients already taking antibiotics, immune compromised, patients with signs and symptoms of malaria or viral infections were excluded. YOS was calculated and blood culture was performed in all patients to diagnose bacteremia. Results: Out of 105 patients, mean age was 12.9±8.24 months. There were 55(52.4%) male and 50(47.6%) female patients. Sensitivity of YOS in diagnosing bacteremia was 90.63%, specificity 79.45%, PPV 65.91%, NPV 95.08% and diagnostic accuracy was 82.86%. Conclusion: YOS can be used as a key diagnostic tool in detecting bacteremia. So, by using this tool many cases in the rural areas can be diagnosed and managed early.

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Validation of a palliative care outcome measurement tool supplemented by neurological symptoms (HOPE+): Identification of palliative concerns of neurological patients

Palliative Medicine ◽

10.1177/0269216319861927 ◽

2019 ◽

Vol 33 (9) ◽

pp. 1221-1231

Author(s):

Kim Dillen ◽

Markus Ebke ◽

Andreas Koch ◽

Ingrid Becker ◽

Christoph Ostgathe ◽

...

Keyword(s):

Palliative Care ◽

Diagnostic Accuracy ◽

Discriminant Validity ◽

Assessment Tool ◽

Outcome Measurement ◽

Performance Status ◽

Eastern Cooperative Oncology Group ◽

Measurement Tool ◽

Operating Characteristics ◽

Neurological Patients

Background: There is growing interest to integrate palliative care and its structures into the care of neurological patients. However, in Germany there is no comprehensive assessment tool capturing the symptoms of patients with advanced neurological diseases. Aim: To validate a newly developed palliative care measurement tool based on an extension of the validated core documentation system Hospice and Palliative Care Evaluation considering additional neurological issues (HOPE+). Design: Prospective, observational study using HOPE+ and as external criteria, the Eastern Cooperative Oncology Group (ECOG) performance status and the 12 months “surprise” question (12-SQ) in a neurological population, and assessment for its construct validity and diagnostic accuracy. Setting/participants: All newly admitted patients to the Department of Neurorehabilitation, Dr. Becker Rhein-Sieg-Clinic aged 18–100 years (#DRKS00010947). Results: Data from 263 patients (63 ± 14 years of age) were analyzed. HOPE+ revealed a moderately correlated six-factor structure ( r = –0.543–0.525). Correlation analysis to evaluate discriminant validity using ECOG as external criterion was high ( rs(261) = 0.724, p < 0.001) and confirmed for severely affected patients by adding the 12-SQ (“No”-group: 48.00 ± 14.92 vs “Yes”-group: 18.67 ± 7.57, p < 0.009). Operating characteristics show satisfactory diagnostic accuracy (area under the curve: 0.746 ± 0.049, 95% confidence interval = 0.650–0.842). Conclusion: HOPE+ demonstrates promising psychometric properties. It helps to assess palliative care issues of patients in neurological settings and, in combination with the 12-SQ, conceivably conditions when to initiate the palliative care approach in a population underrepresented in palliative care structures so far.

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Outcome of cancer patients admitted through the emergency department (ED) of a comprehensive cancer center: A call for ED-based palliative care.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.31_suppl.194 ◽

2014 ◽

Vol 32 (31_suppl) ◽

pp. 194-194

Author(s):

Ahmed F. Elsayem ◽

Julio Silvestre ◽

Kelly W. Merriman ◽

Patrick S. Chaftari ◽

Carmen E. Gonzalez ◽

...

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Palliative Care ◽

Hospital Mortality ◽

Respiratory Distress ◽

Cancer Patients ◽

Altered Mental Status ◽

Cancer Center ◽

Hospital Death ◽

Icu Admission

194 Background: The National Cancer Policy Forum advocated for improving quality of end life care, and reducing cost for cancer patients. Identifying those at high risk for Intensive Care Unit (ICU) admission, and hospital death may allow earlier palliative care and avoid futile interventions. The purpose of this study is to examine risk factors for ICU admission, and hospital death among cancer patients admitted through the emergency department (ED). Methods: We queried MD Anderson Cancer Center databases for all patients who visited our ED in 2010. ICU admission and hospital deaths of these patients were reviewed, and individual patients’ data were analyzed. Results: In 2010, 16,038 ED visits were made by 9,246 unique cancer patients. Of these patients, 5,362 (58%) were admitted to the hospital at least once (range 1-13 admits). Of all patients admitted through the ED, 697 (13%) were admitted at least once to ICU. Of all patients admitted, 11% died during hospitalization; of those, 29% died in ICU. Among patients who died in ICU, 73/233 (31.3%) had hematologic malignancies and 96/354 (27.1%) had solid tumors (P<0.001). Patients admitted to ICU had median lengths of hospital stay (MLOS) of 13 days for hematologic and 8 days for solid tumors (P<0.001; using means); patients without ICU admission had MLOS of 6 and 5 days, respectively (P<0.001). In a multivariate logistic regression model for predicting in-hospital mortality, we found that ED presenting symptoms of respiratory distress or altered mental status; primary tumor of lung cancer, leukemia, unknown primary, or lymphoma; and nonwhite ethnicities were independent predictors of death. Insignificant factors included age, gender, residence, fever and pain. Conclusions: Cancer patients admitted through the ED experience high ICU admission rate, and hospital mortality. Lung and certain other cancers; race; and symptoms of respiratory distress and altered mental status were associated with increased risk of in-hospital death. Patients with these risk factors may benefit from efforts to improve palliative care and prevent futile interventions.

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