Reversal of ‘the dying’ diagnosis

2021 ◽  
Vol 14 (6) ◽  
pp. e240133
Author(s):  
Maimoona Ali ◽  
Andrew Goddard ◽  
Eleanor Smith
Keyword(s):  
Palliative Care ◽  
Intensive Care ◽  
Supportive Care ◽  
End Of Life Care ◽  
Surgical Intervention ◽  
Best Supportive Care ◽  
Lower Limbs ◽  
Life Care ◽  
Incision And Drainage ◽  
History Of

A 75-year-old woman was admitted with sepsis and treated with broad-spectrum antibiotics until examination of her lower limbs noted necrotising wounds. Surgical intervention was advised by the plastic surgeons; however, she was deemed unsuitable for intensive care. She underwent incision and drainage of the necrotic area and biopsies were taken. She deteriorated clinically and the decision was made for best supportive care and was therefore transferred to the inpatient palliative care unit for end-of-life care. However, she stabilised, and based on culture sensitivities, antibiotics were restarted. It was also noted that the patient had a 3-month history of loose stools, which had not been addressed previously. The biopsies were suggestive of pyoderma gangrenosum, prompting a dermatology review, and prednisolone and doxycycline were started. The wounds and her loose stools improved, and with ongoing rehabilitation, she made a full recovery. Referral to gastroenterology was made.

scholarly journals 108 Palliative care for neonates: Retrospective mixed methods review of infant death in the Neonatal Intensive Care Unit

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e45-e45
Author(s):  
Marina Journault ◽  
Simone Stenekes ◽  
Robin McClure ◽  
Chelsea Ruth
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Infant Death ◽  
End Of Life Care ◽  
Neonatal Intensive Care ◽  
Life Care ◽  
Specialist Palliative Care ◽  
Age At Death

Abstract Background Neonatal palliative care is an under researched yet growing field in the provision of intensive care to neonates. There are currently no studies which explore infant death in the Neonatal Intensive Care Unit (NICU) itself where a shift from intensive to palliative care may occur. Objectives The purpose of this study was to explore the circumstances of infant death in the NICU and understand current utilization of specialist palliative care in this area. It aimed to characterize the infants’ clinical course and add unique understanding by analyzing documentation related to end of life care. Design/Methods A retrospective chart review of infants who died in a single centre NICU between January 2017 and March 2018 was undertaken. Infants of any gestational and post-natal age were included, excluding infants who died prior to arrival to the NICU or were discharged or transferred prior to death. Chart notes relating to prognosis, advanced care planning, and palliative interventions were sampled, coded, and collated for thematic analysis. Results Twenty-five infants met study criteria. Of these, 92% were preterm with more than half below 28 weeks gestation. Median age at death was 5.2 days (IQR 1, 26.2). All infants required ventilator support with planned withdrawal occurring in 60%. Specialist palliative care was involved in 28%; these infants tended to be older (mean age at death = 78 days). Most infants were labelled as “critical” 2-5 days prior to death. Seventy-six percent of infants were held on their last day of life with 72% of families having memory making documented as part of their care. Qualitative excerpts revealed themes of hope and acceptance, parental presence, and framed discussion. Within these emerged concepts of “parental agreement” and “palliative language/approach”. Conclusion There is a growing need for both primary and specialist palliative care in the NICU. This study highlights an under researched area and generates many more important questions. By exploring documented language, we aim to understand and improve the ability to frame the discussion while ensuring quality end of life care for dying infants and their families in the NICU.

Seventh-Day Adventists and Care for the Newborn

2019 ◽  
pp. 213-232
Author(s):  
Gerald R. Winslow
Keyword(s):  
Health Care ◽  
Intensive Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Neonatal Intensive Care ◽  
Family Members ◽  
Newborn Infants ◽  
Life Care ◽  
Freedom Of Conscience ◽  
History Of

As a practical expression of their faith, Seventh-day Adventists have established healthcare institutions, including facilities for the intensive care of newborn infants. This chapter provides a brief history of Adventist engagement in health care and seeks to explain how core Adventist convictions provide the motivation for providing such care and shape the way it is given. The chapter also describes how Adventist beliefs may affect the ways in which Adventists or their family members receive health care. This includes beliefs in divine creation, human wholeness, freedom of conscience, spiritual commitment to health, and worldwide mission. Adventists believe that, by the Creator’s design, each person is a spiritual and physical unity. Using the example of a specific case of neonatal intensive care, the chapter explores how Adventist convictions are likely to support and inform caregiving and care receiving. Also described are Adventist principles for end-of-life care.

Impact of mortality reviews on supportive care utilization, end-of-life care, and inpatient mortality.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 45-45
Author(s):  
Yasmin Karimi ◽  
Vasu Divi ◽  
Sandy Srinivas ◽  
Andrea Segura Smith ◽  
Jennifer Hansen ◽  
...  
Keyword(s):  
Palliative Care ◽  
Supportive Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Health Workers ◽  
Hospital Setting ◽  
Care Plan ◽  
Care Utilization ◽  
Life Care ◽  
Chi Square Analysis

45 Background: 22% of US patients with cancer die in a hospital setting. As part of an effort to reduce unexpected inpatient (inpt) mortality, we reviewed records of all inpt cancer deaths at Stanford Hospital and reported findings to the treatment teams. Methods: Deaths with a cancer related ICD 9/10 code between 5/2017 and 6/2019 were reviewed by a multidisciplinary team. Findings and potential opportunities for improvement were communicated to the pt’s primary outpt oncologist, inpt oncologists and other involved providers. Observed to expected (O:E) mortality for the year prior to the intervention (5/2016–4/2017), Year 1 (5/2017–4/2018) and Year 2 (5/2018–4/2019) of the intervention were compared with two sided t test, α=0.05 (Vizient Inc, Irving TX). Changes in supportive care utilization and end of life care between cases reviewed in Year 1 and Year 2 were compared with chi square analysis. Results: There were 236 inpatient deaths reviewed. The median age was 64 years; 76% had solid tumors; 68% had metastatic disease; 33% had a previous inpt admission; 34% received chemotherapy in the last 2 weeks of life. Median length of stay was 7 days and 37% were admitted to the intensive care unit (ICU). The O:E mortality ratio significantly decreased between the year prior to intervention and Year 2 (0.95 vs. 0.69; p = .019), and Years 1 and 2 (0.90 vs. 0.69; p = .003). There was no noted difference in number of palliative care consults or resuscitation status at the time of death between Years 1 and 2. There was an increased frequency of advance care plan documentation on admission in Year 2 (p = .007). Conclusions: Cancer pts who die in the hospital have high rates of recent hospitalizations, chemotherapy/radiation use in the last 2 weeks of life and ICU admissions. Decrease in O:E is likely multifactorial. Potential factors are improved documentation of comorbidities, increased access to palliative care services, and facilitation of hospice referrals which were partially driven by results of our reviews and resulting awareness around end of life care. Work is ongoing to standardize documentation of goals of care conversations in the electronic medical record and employ lay health workers for earlier end of life discussions.

Predictors of Specialized Pediatric Palliative Care Involvement and Impact on Patterns of End-of-Life Care in Children With Cancer

2018 ◽  
Vol 36 (8) ◽  
pp. 801-807 ◽  
Author(s):  
Kimberley Widger ◽  
Rinku Sutradhar ◽  
Adam Rapoport ◽  
Christina Vadeboncoeur ◽  
Shayna Zelcer ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
End Of Life ◽  
End Of Life Care ◽  
Pediatric Palliative Care ◽  
Life Care ◽  
Children With Cancer ◽  
The Impact

Purpose The impact of specialized pediatric palliative care (SPPC) teams on patterns of end-of-life care is unknown. We sought to determine (1) which children with cancer access SPPC and (2) the impact of accessing SPPC on the risk of experiencing high-intensity end-of-life care (intensive care unit admission, mechanical ventilation, or in-hospital death). Methods Using a provincial childhood cancer registry, we assembled a retrospective cohort of Ontario children with cancer who died between 2000 and 2012 and received care through pediatric institutions with an SPPC team. Patients were linked to population-based administrative data capturing inpatient, outpatient, and emergency visits. Children were classified as having SPPC, general palliative care, or no palliative care on the basis of SPPC clinical databases, physician billing codes, or inpatient diagnosis codes. Results Of the 572 children, 166 (29%) received care from an SPPC team for at least 30 days before death, and 100 (17.5%) received general palliative care. SPPC involvement was significantly less likely for children with hematologic cancers (OR, 0.3; 95% CI, 0.3 to 0.4), living in the lowest income areas (OR, 0.4; 95% CI, 0.2 to 0.8), and living further from the treatment center (OR, 0.5; 95% CI, 0.4 to 0.5). SPPC was associated with a five-fold decrease in odds of intensive care unit admission (OR, 0.2; 95% CI, 0.1 to 0.4), whereas general palliative care had no impact. Similar associations were seen with all secondary indicators. Conclusion When available, SPPC, but not general palliative care, is associated with lower intensity care at the end of life for children with cancer. However, access remains uneven. These results provide the strongest evidence to date supporting the creation of SPPC teams.

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