scholarly journals The Palliative Performance Scale predicts mortality in hospitalized patients with COVID-19

2020 ◽  
Vol 34 (9) ◽  
pp. 1228-1234 ◽  
Author(s):  
Michele Fiorentino ◽  
Sri Ram Pentakota ◽  
Anne C Mosenthal ◽  
Nina E Glass
Keyword(s):  
Palliative Care ◽  
Scale Score ◽  
Public Hospital ◽  
The Elderly ◽  
Hospitalized Patients ◽  
Risk Patients ◽  
Observational Cohort ◽  
Retrospective Observational Cohort Study ◽  
Performance Scale ◽  
Overall Mortality

Background: Coronavirus disease 2019 (COVID-19) has a substantial mortality risk with increased rates in the elderly. We hypothesized that age is not sufficient, and that frailty measured by preadmission Palliative Performance Scale would be a predictor of outcomes. Improved ability to identify high-risk patients will improve clinicians’ ability to provide appropriate palliative care, including engaging in shared decision-making about life-sustaining therapies. Aim: To evaluate whether preadmission Palliative Performance Scale predicts mortality in hospitalized patients with COVID-19. Design: Retrospective observational cohort study of patients admitted with COVID-19. Palliative Performance Scale was calculated from the chart. Using logistic regression, Palliative Performance Scale was assessed as a predictor of mortality controlling for demographics, comorbidities, palliative care measures and socioeconomic status. Setting/participants: Patients older than 18 years of age admitted with COVID-19 to a single urban public hospital in New Jersey, USA. Results: Of 443 admitted patients, we determined the Palliative Performance Scale score for 374. Overall mortality was 31% and 81% in intubated patients. In all, 36% (134) of patients had a low Palliative Performance Scale score. Compared with patients with a high score, patients with a low score were more likely to die, have do not intubate orders and be discharged to a facility. Palliative Performance Scale independently predicts mortality (odds ratio 2.89; 95% confidence interval 1.42–5.85). Conclusions: Preadmission Palliative Performance Scale independently predicts mortality in patients hospitalized with COVID-19. Improved predictors of mortality can help clinicians caring for patients with COVID-19 to discuss prognosis and provide appropriate palliative care including decisions about life-sustaining therapy.

scholarly journals Benzodiazepine Use and Morbidity-Mortality Outcomes in a Geriatric Palliative Care Unit: A Retrospective Review

2021 ◽  
pp. 1-9
Author(s):  
Helen Senderovich ◽  
Sandra Gardner ◽  
Anna Berall ◽  
Michael Ganion ◽  
Dennis Zhang ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Scale Score ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Increased Risk ◽  
Benzodiazepine Use ◽  
Hospice And Palliative Care ◽  
Performance Scale ◽  
Overall Mortality

<b><i>Introduction:</i></b> Patients often experience delirium at the end of life. Benzodiazepine use may be associated with an increased risk of developing delirium. Alternate medications used in conjunction with benzodiazepines may serve as an independent precipitant of delirium. The aim is to understand the role of benzodiazepines in precipitating delirium and advanced mortality in palliative care population at the end of life. <b><i>Methods:</i></b> A retrospective medical chart review was conducted at a hospice and palliative care inpatient unit between the periods of June 2017–December 2017 and October 2017–November 2018. It included patients in hospice and palliative care inpatient units who received a benzodiazepine and those who did not. Patient characteristics, as well as Palliative Performance Scale score, diagnosis, and occurrence of admission, terminal, and/or recurrent delirium, were collected and analyzed. <b><i>Results:</i></b> Use of a benzodiazepine was not significantly associated with overall mortality nor cause-specific death without terminal delirium rate. However, it was significantly associated with higher cause-specific death with terminal delirium rate and a higher recurrent delirium rate. <b><i>Discussion:</i></b> This retrospective chart review suggests an association between benzodiazepine use and specific states of delirium and cause-specific death. However, it does not provide strong evidence on the use of this drug, especially at the end of life, as it pertains to the overall mortality rate. Suggested is a contextual approach to the use of benzodiazepines and the need to consider Palliative Performance Scale score and goals of care in the administration of this drug at varying periods during patient length of stay.

scholarly journals Serum potassium disorders predict subsequent kidney injury: a retrospective observational cohort study of hospitalized patients

2022 ◽  
Author(s):  
Gianmarco Lombardi ◽  
Giovanni Gambaro ◽  
Pietro Manuel Ferraro
Keyword(s):  
Cohort Study ◽  
Serum Potassium ◽  
Hospital Admissions ◽  
Kidney Injury ◽  
Observational Cohort Study ◽  
Hospitalized Patients ◽  
P Value ◽  
Significant Difference ◽  
Observational Cohort ◽  
Retrospective Observational Cohort Study

Introduction Electrolytes disorders are common findings in kidney diseases and might represent a useful biomarker preceding kidney injury. Serum potassium [K+] imbalance is still poorly investigated for association with acute kidney injury (AKI) and most evidence come from intensive care units (ICU). The aim of our study was to comprehensively investigate this association in a large, unselected cohort of hospitalized patients. Methods: We performed a retrospective observational cohort study on the inpatient population admitted to Fondazione Policlinico Universitario A. Gemelli IRCCS between January 1, 2010 and December 31, 2014 with inclusion of adult patients with at least 2 [K+] and 3 serum creatinine (sCr) measurements who did not develop AKI during an initial 10-day window. The outcome of interest was in-hospital AKI. The exposures of interest were [K+] fluctuations and hypo (HoK) and hyperkalemia (HerK). [K+] variability was evaluated using the coefficient of variation (CV). Cox proportional hazards regression models were used to obtain hazard ratios (HRs) and 95% confidence intervals (CIs) of the association between the exposures of interest and development of AKI. Results: 21,830 hospital admissions from 18,836 patients were included in our study. During a median follow-up of 5 (interquartile range [IQR] 7) days, AKI was observed in 555 hospital admissions (2.9%); median time for AKI development was 5 (IQR 7) days. Higher [K+] variability was independently associated with increased risk of AKI with a statistically significant linear trend across groups (p-value = 0.012). A significantly higher incidence of AKI was documented in patients with HerK compared with normokalemia. No statistically significant difference was observed between HoK and HerK (p-value = 0.92). Conclusion: [K+] abnormalities including fluctuations even within the normal range are associated with development of AKI.

scholarly journals Perspectivas para os cuidados paliativos na atenção primária à saúde: estudo descritivo

2016 ◽  
Vol 15 (4) ◽  
pp. 683
Author(s):  
Cissa Azevedo ◽  
Camila Maria Pereira Rates ◽  
Juliana Dias Reis Pessalacia ◽  
Luciana Regina Ferreira Da Mata
Keyword(s):  
Palliative Care ◽  
Cardiovascular Diseases ◽  
Primary Healthcare ◽  
Medical Records ◽  
Professional Training ◽  
Health Sector ◽  
The Elderly ◽  
Karnofsky Performance Scale ◽  
Early Care ◽  
Performance Scale

Aim: To identify eligible patients for palliative care and characterize the  services  involved  in  primary  healthcare.  Method:  This  was  a  descriptive  and documental  study  conducted  in  19  health  units  in  a  municipality  in  the  countryside  of Minas  Gerais  in  Brazil.  The  Karnofsky  performance  scale  was  applied  to  the  medical records  of  patients  in  the  health  sector  with  the  largest  number  of  eligible  individuals. Results:  We  identified  2,715  eligible  individuals,  representing 3.59%  of  the  registered population  and  25.3%  of  patients  in  sector  seven,  which  had the  highest  number  of eligible  individuals.  Diabetes  was the most common  pathology,  followed  by  cancer  and cardiovascular   diseases.   Furthermore,   17.2%   of   these   individuals   have   required palliative  care  precociously;  9.7%,  required  exclusive  care,  and  the  elderly  above  60 years  constituted  the  highest  number  among  those  eligible.  Discussion:  The  data confirmed  the  need  for  structuring  the  primary  healthcare  for  early  care in  palliative care,  especially  for  the  elderly.  Conclusion:  It is  necessary to  structure  a  care  network that is integrated and ordained by PHC and professional training.

The Development of Statistical Models for Predicting Surgical Site Infections in Japan: Toward a Statistical Model–Based Standardized Infection Ratio

2015 ◽  
Vol 37 (3) ◽  
pp. 260-271 ◽  
Author(s):  
Haruhisa Fukuda ◽  
Manabu Kuroki
Keyword(s):  
Prediction Model ◽  
Statistical Models ◽  
Prediction Models ◽  
Risk Index ◽  
Surgical Site Infections ◽  
Hospital Performance ◽  
Surveillance Data ◽  
Risk Patients ◽  
Observational Cohort ◽  
Retrospective Observational Cohort Study

OBJECTIVETo develop and internally validate a surgical site infection (SSI) prediction model for Japan.DESIGNRetrospective observational cohort study.METHODSWe analyzed surveillance data submitted to the Japan Nosocomial Infections Surveillance system for patients who had undergone target surgical procedures from January 1, 2010, through December 31, 2012. Logistic regression analyses were used to develop statistical models for predicting SSIs. An SSI prediction model was constructed for each of the procedure categories by statistically selecting the appropriate risk factors from among the collected surveillance data and determining their optimal categorization. Standard bootstrapping techniques were applied to assess potential overfitting. The C-index was used to compare the predictive performances of the new statistical models with those of models based on conventional risk index variables.RESULTSThe study sample comprised 349,987 cases from 428 participant hospitals throughout Japan, and the overall SSI incidence was 7.0%. The C-indices of the new statistical models were significantly higher than those of the conventional risk index models in 21 (67.7%) of the 31 procedure categories (P<.05). No significant overfitting was detected.CONCLUSIONSJapan-specific SSI prediction models were shown to generally have higher accuracy than conventional risk index models. These new models may have applications in assessing hospital performance and identifying high-risk patients in specific procedure categories.Infect. Control Hosp. Epidemiol. 2016;37(3):260–271

Severe hemodialysis access-induced distal ischemia may be associated with poor survival

2020 ◽  
pp. 112972982093345 ◽  
Author(s):  
Michael WM Gerrickens ◽  
Reshabh Yadav ◽  
Rosanne Wouda ◽  
Charles H Beerenhout ◽  
Marc RM Scheltinga
Keyword(s):  
Signs And Symptoms ◽  
Hemodialysis Patients ◽  
Control Group ◽  
Hemodialysis Access ◽  
Poor Survival ◽  
Digital Pressure ◽  
Observational Cohort ◽  
Retrospective Observational Cohort Study ◽  
Overall Mortality

Background: Some hemodialysis patients develop hemodialysis access-induced distal ischemia due to insufficient loco-regional perfusion pressure and consequent poor arterial flow. We hypothesized that patients with severe hemodialysis access-induced distal ischemia had worse survival compared with patients with mild or no hemodialysis access-induced distal ischemia. Methods: This single-center retrospective observational cohort study included three groups of prevalent hemodialysis patients with an upper extremity vascular access between 2006 and 2018. Symptomatic patients had signs and symptoms of hemodialysis access-induced distal ischemia and low digital brachial indices (<60%) and were divided into a mild (Grade I–IIa) and a severe hemodialysis access-induced distal ischemia (IIb–IV) group. The control group consisted of hemodialysis patients without signs of hemodialysis access-induced distal ischemia with digital brachial indices ≥60%. Factors potentially related to 4-year survival were analyzed. Results: Mild hemodialysis access-induced distal ischemia-patients displayed higher digital brachial indices ( n = 23, 41%, ±3) compared with severe hemodialysis access-induced distal ischemia-patients ( n = 28, 24%, ±4), whereas controls had the highest values ( n = 48, 80%, ±2; p < .001). A total of 44 patients (44%) died during follow-up. Digital brachial index (hazards ratio 0.989 [0.979–1.000] p = .046) was related to overall mortality following correction for presence of arterial occlusive disease (hazards ratio 2.28 [1.22–4.29], diabetes (hazards ratio 2.00 [1.07–3.72], and increasing age (hazards ratio 1.03 [1.01–1.06] as was digital pressure (hazards ratio 0.990 [0.983–0.998], p = .011). Overall survival was similar in mild hemodialysis access-induced distal ischemia and controls (2-year, 79% ±5; 4-year, 57% ±6, p = .818). In contrast, 4-year survival was >20% lower in patients with severe hemodialysis access-induced distal ischemia (2-year 62%± 10; 4-year 34% ± 10; p = .026). Conclusion: Presence of severe hemodialysis access-induced distal ischemia may be associated with poorer survival in hemodialysis patients. Lower digital brachial index values are associated with higher overall mortality, even following correction for other known risk factors.

Preventing Readmissions Through Effective Partnerships—Communication and Palliative Care (PREP-CPC): A Multisite Intervention for Encouraging Goals of Care Conversations for Hospitalized Patients Facing Serious Illness

2019 ◽  
Vol 37 (8) ◽  
pp. 582-588
Author(s):  
Kelsey Gradwohl ◽  
Gordon J. Wood ◽  
Rebecca K. Clepp ◽  
Liza Rivnay ◽  
Eytan Szmuilowicz
Keyword(s):  
Palliative Care ◽  
Quality Improvement ◽  
Health Care Professionals ◽  
Essential Elements ◽  
Hospitalized Patients ◽  
Goals Of Care ◽  
Serious Illness ◽  
Risk Patients ◽  
Life Sustaining Treatment ◽  
Hospital Teams

Background: Despite evidence showing that goals of care (GOC) conversations increase the likelihood that patients facing a serious illness receive care that is concordant with their wishes, only a minority of at-risk patients receive the opportunity to engage in such conversations. Objective: The Preventing Readmissions through Effective Partnerships—Communication and Palliative Care (PREP-CPC) intervention was designed to increase the frequency of GOC conversations for hospitalized patients facing serious illness. Methods: The PREP-CPC employed a sequential, multicohort design using a yearlong mentored implementation approach to support nonpalliative care health-care professionals at participating hospitals to implement quality improvement projects focused on GOC conversations. Results: Over the 3-year study period, 134 clinicians from 29 hospital teams were trained to facilitate GOC conversations. After the kickoff conference, participants reported improvements in their confidence in facilitating GOC conversations. The hospital teams then instituted site-specific pilot interventions to promote GOC conversations, identifying essential elements required for ongoing improvement. Since projects varied by hospital, results did as well, but reported positive outcomes included increased GOC conversations, increased Practitioner Orders for Life-Sustaining Treatment form completion rates, new screening and documentation methods, and increased support from leadership. Conclusions: The PREP-CPC pilot successfully engaged a diverse set of hospitals to participate in quality improvement collaborative promoting primary palliative care and more frequent GOC conversations. This initiative revealed several lessons that should guide future interventions.

scholarly journals Hydroxychloroquine and Tocilizumab Therapy in COVID-19 Patients – An Observational Study

2020 ◽  
Author(s):  
Andrew Ip ◽  
Donald A. Berry ◽  
Eric Hansen ◽  
Andre H. Goy ◽  
Andrew L Pecora ◽  
...  
Keyword(s):  
Cohort Study ◽  
Primary Outcome ◽  
Observational Cohort Study ◽  
Hospitalized Patients ◽  
Icu Patients ◽  
Positive Polymerase Chain Reaction ◽  
Observational Cohort ◽  
Polymerase Chain ◽  
Retrospective Observational Cohort Study

AbstractBackgroundHydroxychloroquine has been touted as a COVID-19 treatment. Tocilizumab, an inhibitor of IL-6, has been proposed as a treatment of critically ill patients.ObjectiveTo describe the association between mortality and hydroxychloroquine or tocilizumab therapy among hospitalized COVID-19 patients.DesignRetrospective observational cohort study of electronic health records Setting: 13-hospital network spanning the state of New Jersey.ParticipantsPatients hospitalized between March 1, 2020 and April 22, 2020 with positive polymerase chain reaction results for SARS-CoV-2. Follow up was through May 5, 2020.Main OutcomesThe primary outcome was death.ResultsAmong 2512 hospitalized patients with COVID-19 there have been 547 deaths (22%), 1539 (61%) discharges and 426 (17%) remain hospitalized. 1914 (76%) received at least one dose of hydroxychloroquine and 1473 (59%) received hydroxychloroquine with azithromycin. After adjusting for imbalances via propensity modeling, compared to receiving neither drug, there were no significant differences in associated mortality for patients receiving any hydroxychloroquine during the hospitalization (HR, 0.99 [95% CI, 0.80-1.22]), hydroxychloroquine alone (HR, 1.02 [95% CI, 0.83-1.27]), or hydroxychloroquine with azithromycin (HR, 0.98 [95% CI, 0.75-1.28]). The 30-day unadjusted mortality for patients receiving hydroxychloroquine alone, azithromycin alone, the combination or neither drug was 25%, 20%, 18%, and 20%, respectively. Among 547 evaluable ICU patients, including 134 receiving tocilizumab in the ICU, an exploratory analysis found a trend towards an improved survival association with tocilizumab treatment (adjusted HR, 0.76 [95% CI, 0.57-1.00]), with 30 day unadjusted mortality with and without tocilizumab of 46% versus 56%.ConclusionsThis observational cohort study suggests hydroxychloroquine, either alone or in combination with azithromycin, was not associated with a survival benefit among hospitalized COVID-19 patients. Tocilizumab demonstrated a trend association towards reduced mortality among ICU patients. Our findings are limited to hospitalized patients and must be interpreted with caution while awaiting results of randomized trials.Trial RegistrationClinicaltrials.gov Identifier: NCT04347993

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