Palliative medicine and hospital readmissions in end-stage liver disease

2019 ◽  
pp. bmjspcare-2018-001635 ◽  
Author(s):  
Barret Rush ◽  
Clark Fruhstofer ◽  
Keith R Walley ◽  
Leo Anthony Celi ◽  
Mayur Brahmania
Keyword(s):  
Liver Disease ◽  
Hospital Readmission ◽  
Hospital Admissions ◽  
Hospital Readmissions ◽  
Symptom Burden ◽  
Nursing Facilities ◽  
Index Hospitalisation ◽  
Beneficial Effects ◽  
End Stage Liver Disease ◽  
End Stage

BackgroundPatients with end-stage liver disease (ESLD) have a reduced life expectancy and a significant symptom burden. Our aim is to determine if inpatient palliative care (PC) referral for patients with ESLD is associated with decreased hospital readmission rates.MethodsThe 2013 US Nationwide Readmission Database (NRD) was used for the current analysis. The NRD allows for longitudinal analysis of all patient hospital admissions across 22 states. Patients ≥18 years of age with a diagnosis of ESLD with at least two decompensating events were included in the analysis. PC referral at the index hospitalisation divided the cohort into two groups, which were tracked for 9 months.ResultsA total of 14 325 172 hospital admissions from the 2013 NRD were examined. In the first 3 months of 2013, a total of 3647 patients with ESLD were admitted with 206 (5.6%) receiving PC referral during the index admission. After the index hospitalisation, patients referred to PC were more likely to be discharged to skilled nursing facilities (45.5% vs 14.7%; p<0.01) or hospice/home care (32.9% vs 15.3%; p<0.01). After propensity score matching, those patients referred to PC demonstrated a significantly lower rate of 1-year hospital readmission (11.0% vs 32.1%; p<0.01).ConclusionInpatient PC referral for patients with ESLD was associated with lower rates of hospital readmission. Early concurrent PC referral likely has added beneficial effects beyond quality of life issues and symptom management.

scholarly journals Background and design of the symptom burden in end-stage liver disease patient-caregiver dyad study

2017 ◽  
Vol 40 (5) ◽  
pp. 398-413 ◽  
Author(s):  
Lissi Hansen ◽  
Karen S. Lyons ◽  
Nathan F. Dieckmann ◽  
Michael F. Chang ◽  
Shirin Hiatt ◽  
...  
Keyword(s):  
Liver Disease ◽  
Disease Patient ◽  
Symptom Burden ◽  
End Stage Liver Disease ◽  
End Stage

446 Beneficial effects of topical testosterone replacement in patients with end stage liver disease

Hepatology ◽  
2003 ◽  
Vol 38 ◽  
pp. 376-376
Author(s):  
G NEFF ◽  
K SAFDAR ◽  
M KARL ◽  
C OBRIEN ◽  
A DEMANNO ◽  
...  
Keyword(s):  
Liver Disease ◽  
Testosterone Replacement ◽  
Beneficial Effects ◽  
End Stage Liver Disease ◽  
End Stage

scholarly journals Palliative Care in End-Stage Liver Disease Patients Awaiting Liver Transplantation: Review

2020 ◽  
Vol 27 (6) ◽  
pp. 417-428
Author(s):  
Sara Vieira Silva ◽  
Elga Freire ◽  
Helena Pessegueiro Miranda
Keyword(s):  
Palliative Care ◽  
Liver Transplantation ◽  
Liver Disease ◽  
Symptom Burden ◽  
Future Research ◽  
Family Needs ◽  
End Stage Liver Disease ◽  
Advanced Phase ◽  
Insufficient Response ◽  
End Stage

<b><i>Introduction:</i></b> End-stage liver disease (ESLD) is the advanced phase of most liver diseases. The cure is liver transplantation (LT), only available for a minority of patients. This review summarizes the evidence regarding palliative care (PC) in ESLD patients awaiting LT. <b><i>Methods:</i></b> Review of the literature available in Medline, Scopus and Web of Knowledge, with keywords ESLD and PC. <b><i>Results:</i></b> Fifteen of the 230 articles reviewed met the inclusion criteria. Ten main themes were addressed: symptom burden; perspectives of life-sustaining treatment and comfort for patients, families and health professionals; goals of care discussions; patient and family needs; quality of life; PC and survival; referral to PC, barriers and opportunities; integration of PC; outpatient care and cost-effectiveness analysis. The referral of patients to PC was only evaluated in a few studies, all of which reported low referral rates. Better knowledge of how PC professionals can support other professionals was considered important, and also better ways to integrate PC were considered essential. <b><i>Conclusion:</i></b> ESLD patients awaiting LT have a significant need for PC and, despite the insufficient response, were reported to benefit from this type of care. Future research is essential to determine the means to overcome barriers and better integrate PC for ESLD patients awaiting LT.

PWE-119 Complex symptom burden and unmet need in end-stage liver disease

Gut ◽  
2015 ◽  
Vol 64 (Suppl 1) ◽  
pp. A264.2-A265
Author(s):  
S Kriese ◽  
K Bristowe ◽  
WM Prentice ◽  
MA Heneghan ◽  
IJ Higginson ◽  
...  
Keyword(s):  
Liver Disease ◽  
Unmet Need ◽  
Symptom Burden ◽  
End Stage Liver Disease ◽  
End Stage

scholarly journals S1141 Telemedicine Reduces Cirrhosis-Related Hospital Readmissions in Patients With End Stage Liver Disease

2020 ◽  
Vol 115 (1) ◽  
pp. S572-S572
Author(s):  
Inki Hong ◽  
Richard Kalman ◽  
Victor J. Navarro ◽  
Simona Rossi ◽  
Manisha Verma ◽  
...  
Keyword(s):  
Liver Disease ◽  
Hospital Readmissions ◽  
End Stage Liver Disease ◽  
End Stage

CASE REPORT: Beneficial Effects of Topical Testosterone Replacement in Patients with End-Stage Liver Disease

2004 ◽  
Vol 49 (7/8) ◽  
pp. 1186-1189 ◽  
Author(s):  
Guy W. Neff ◽  
Christopher B. O'brien ◽  
Marzia Montalbano ◽  
Douglas Meyer ◽  
Antoinette De Dmanno ◽  
...  
Keyword(s):  
Case Report ◽  
Liver Disease ◽  
Testosterone Replacement ◽  
Beneficial Effects ◽  
End Stage Liver Disease ◽  
End Stage

Using Quality Improvement Methods to Understand Incidence, Timing, and Factors Associated With Unplanned Intensive Care Unit Transfers of Patients With End-Stage Liver Disease

2019 ◽  
Vol 29 (4) ◽  
pp. 361-363
Author(s):  
Kelly S. Grimshaw ◽  
Kitty Fan ◽  
Alyssa Mullins ◽  
Janet Parkosewich
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
Liver Disease ◽  
Hospital Admissions ◽  
Chi Square ◽  
Improvement Project ◽  
Factors Associated ◽  
End Stage Liver Disease ◽  
End Stage

Introduction: Patients with end-stage liver disease are at risk for clinical deterioration, often requiring hospital admissions while awaiting transplantation. Nurses observed that many patients were or became unstable soon after arrival, requiring transfers to the medical intensive care unit. Objective: To explore the incidence, timing, and factors associated with unplanned intensive care transfers. Design: We conducted a quality improvement project using plan-do-study-act methods to explore administrative data from adult patients admitted to the hepatology service’s medical–surgical unit. Chi-square and t-tests were used to examine associations between demographic, clinical, and temporal factors and unplanned transfers. Data were analyzed at the hospital encounter level. Results: Unplanned transfers occurred in 8.6% of 1418 encounters. The number of transfers during these encounters ranged from 1 to 6. Most unplanned transfers (65.9%) occurred during the evening shift. On average, there was a 4.2-hour delay to the transfer. Fifty-one percent of these encounters required support from clinicians outside the unit while waiting for a bed. Factors associated with unplanned intensive care unit transfer were male sex ( P = .02), self-referral to the emergency department ( P < .001), and lower initial mean Rothman Index ( P < .001). Discussion: Results validated nurses’ concerns about the patients’ severity of illnesses at the time of admission and frequent need for transfer to intensive care soon after admission. We now have actionable data that are being used by leaders to assess unit admission criteria and develop operating budgets for human and material resources needed to care for this challenging population.

Position Paper on Treatment of Hepatitis C in Romania, 2017. Part One

2017 ◽  
Vol 26 (2) ◽  
pp. 171-181 ◽  
Author(s):  
Liana Gheorghe ◽  
Ioan Sporea ◽  
Speranţa Iacob ◽  
Roxana Şirli ◽  
Anca Trifan ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Liver Disease ◽  
Hepatitis C ◽  
Limit Of Detection ◽  
Position Paper ◽  
Hcv Infection ◽  
Fixed Dose ◽  
Diagnostic Tools ◽  
End Stage Liver Disease ◽  
End Stage

Background & Aims: Hepatitis C Virus (HCV) infection is a common condition with endemic prevalence in some areas of the world. In Romania, the mean prevalence is about 3%. New treatments became available on the market in recent years and new drugs are in the pipeline. A re-evaluation of HCV therapy was considered mandatory. The Romanian Society of Gastroenterology and Hepatology undertook this task for the practitioners of this country.Methodology: A group of recognized experts was created who screened the available literature and the major available guidelines. A list of items requiring attention has been created. These items were discussed and rated. Decisions were taken by consensus.Recommendations: We present here the first of the two parts of our Society’s recommendations for chronic HCV infection treatment. An agreement was reached regarding the diagnostic tools, the assessment of severity and the up-dated therapy schedules.Conclusions: This Position Paper represents a guide for the assessment and the therapy of HCV infection. The recommendations are in concordance with other guidelines but are applied to the real-life conditions in this country.Abbreviations: DAAs: Direct-acting antivirals; DDIs: Drug-drug interactions; ESLD: End-stage liver disease; ESRD: End-stage renal disease; eGFR: Estimated glomerular filtration rate; EASL: European Association for the Study of the Liver; EMA: European Medicines Agency; FDA: US Food and Drug Administration; FDC: Fixed-dose combination; GT: Genotype; GRADE: Grading of Recommendations Assessment, Development and Evaluation; HCV: Hepatitis C virus; HCC: Hepatocellular carcinoma; LT: Liver transplantation; LLD: Lower limit of detection; MELD score: Mayo-Clinic End-Stage Liver Disease score; ANMDM: National Agency of Medicines and Medical Devices; PPIs: Proton pump inhibitors; PWID: People who inject drugs; RCT: Randomized controlled trial; RDT: Rapid diagnostic test; RAS: Resistance-associated substitution; SRGH: Romanian Society of Gastroenterology and Hepatology; SAE: serious adverse events; SPC: Summary of Product Characteristics; SVR: Sustained virologic response.

Sign in / Sign up

Export Citation Format

Share Document