The Impact of Palliative Care Consultation in the ICU on Length of Stay

2016 ◽  
Vol 33 (6) ◽  
pp. 346-353 ◽  
Author(s):  
Kwadwo Kyeremanteng ◽  
Louis-Philippe Gagnon ◽  
Kednapa Thavorn ◽  
Daren Heyland ◽  
Gianni D’Egidio
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
Small Sample ◽  
Cochrane Library ◽  
Palliative Care Consultation ◽  
Multicenter Rct ◽  
Retrospective Cohort Studies ◽  
Small Sample Sizes ◽  
The Cochrane Library ◽  
The Impact

Introduction: The intensive care unit (ICU) consumes 20% of hospital expenditures and 1% of gross domestic product. Many strategies have been attempted to reduce ICU costs. A systematic review was conducted to evaluate the effect of palliative care (PC) consultations in the ICU on length of stay (LOS) and costs. Methods: A literature search was performed using PubMed, MEDLINE, EMBASE, and the Cochrane Library. Randomized controlled trials (RCTs), prospective, and retrospective cohort studies looking at PC consultations in adult ICUs published between January 2000 and February 2016 were selected. Independent reviewers assessed the eligibility of studies, extracted data on ICU, hospital LOS, and mortality, and rated each study’s quality. The cost was derived from an existing model in the literature; the primary outcome was ICU LOS and the secondary outcomes were direct variable costs, mortality, and hospital LOS. Results: We reviewed 814 abstracts, but only 8 studies met inclusion criteria and were included. The patients with a PC consultation in the ICU, when compared to those who did not, showed a trend toward reduced LOS. This reduction was statistically significant in the higher quality studies. Mortality was similar in both groups. Palliative care consultations also lead to a reduction in costs in 5 of the 8 eligible trials. On average, ICU costs were USD7533 and USD6406 (control vs PC, P < .05) and hospital direct variable costs were USD9518 and USD8971 ( P < .05) per admission. Due to interstudy heterogeneity, all outcomes were described narratively. Conclusion: This review demonstrates a trend that PC consultations reduce LOS and costs without impacting mortality. However, due to the small sample sizes and varying degrees of quality of evidence, many questions remain. A large multicenter RCT and formal economic evaluation would be needed for more definitive results.

Early Palliative Care Consultation in the Burn Unit: A Quality Improvement Initiative to Increase Utilization

2021 ◽  
Author(s):  
Heather Carmichael ◽  
Hareklia Brackett ◽  
Maurice C Scott ◽  
Margaret M Dines ◽  
Sarah E Mather ◽  
...  
Keyword(s):  
Palliative Care ◽  
Small Sample ◽  
Quality Improvement Initiative ◽  
Comfort Care ◽  
Early Palliative Care ◽  
Palliative Care Consultation ◽  
Before And After ◽  
Care Consultation ◽  
Patient Values ◽  
The Impact

Abstract Despite significant morbidity and mortality for major burns, palliative care consultation (PCC) is underutilized in this population. The purpose of this study is to examine the impact of a protocol using recommended “triggers” for PCC at a single academic burn center. This is a retrospective review of patient deaths over a four-year period. Use of life-sustaining treatments, comfort care (de-escalation of one or more life-sustaining treatments) and do not attempt resuscitation (DNAR) orders were determined. Use of PCC was compared during periods before and after a protocol establishing recommended triggers for early (&lt;72 hrs of admission) PCC was instituted in 2019. A total of 33 patient deaths were reviewed. Most patients were male (n=28, 85%) and median age was 62 years [IQR 42-72]. Median revised Baux score was 112 [IQR 81-133]. Many patients had life-sustaining interventions such as intubation, dialysis, or cardiopulmonary resuscitation, often prior to admission. Amongst patients who survived &gt;24 hrs, 67% (n=14/21) had PCC. Frequency of PCC increased after protocol development, with 100% vs. 36% of these patients having PCC before death (p=0.004). However, even during the later period, less than half of patients had early PCC despite meeting criteria at admission. In conclusion, initiation of life-sustaining measures in severely injured burn patients occurs prior to or early during hospitalization. Thus, value-based early goals of care discussions are valuable to prevent interventions that do not align with patient values and assist with de-escalation of life-sustaining treatment. In this small sample, we found that while there was increasing use of PCC overall after developing a protocol of recommended triggers for consultation, many patients who met criteria at admission did not receive early PCC. Further research is needed to elucidate reasons why providers may be resistant to PCC.

scholarly journals Beyond forest plots: clinical gestalt and its influence on COPD telemonitoring studies and outcomes review

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e030779 ◽  
Author(s):  
Sheree M Smith ◽  
Anne E Holland ◽  
Christine F McDonald
Keyword(s):  
Decision Making ◽  
Length Of Stay ◽  
Systematic Reviews ◽  
Verbal Communication ◽  
Small Sample ◽  
Acute Hospital ◽  
Cochrane Library ◽  
Sample Sizes ◽  
Health Services Needs ◽  
The Impact

BackgroundChronic obstructive pulmonary disease (COPD) is a progressive chronic condition. Improvements in therapies have resulted in better patient outcomes. The use of technology such as telemonitoring as an additional intervention is aimed at enhancing care and reducing unnecessary acute hospital service use. The influence of verbal communication between health staff and patients to inform decision making regarding use of acute hospital services within telemonitoring studies has not been assessed.MethodA systematic overview of published systematic reviews of COPD and telemonitoring was conducted using ana prioriprotocol to ascertain the impact of verbal communication in telemonitoring studies on health service outcomes such as emergency department attendances, hospitalisation and hospital length of stay. The search of the following electronic databases: Cochrane Library, Medline, Pubmed, CINAHL, Embase, TROVE, Australian Digital Thesis and Proquest International Dissertations and Theses was conducted in 2017 and updated in September 2019.ResultsSix systematic reviews were identified. All reviews involved home monitoring of COPD symptoms and biometric data. Included reviews reported 5–28 studies with sample sizes ranging from 310 to 2891 participants. Many studies reported in the systematic reviews were excluded as they were telephone support, cost effectiveness studies, and/or did not report the outcomes of interest for this overview. Irrespective of group assignment, verbal communication with the health or research team did not alter the emergency attendance or hospitalisation outcome. The length of stay was longer for those who were assigned home telemonitoring in the majority of studies.ConclusionThis overview of telemonitoring for COPD had small sample sizes and a wide variety of included studies. Communication was not consistent in all included studies. Understanding the context of communication with study participants and the decision-making process for referring patients to various health services needs to be reported in future studies of telemonitoring and COPD.

scholarly journals Breastfeeding in Cystic Fibrosis: A Systematic Review on Prevalence and Potential Benefits

Nutrients ◽  
2021 ◽  
Vol 13 (9) ◽  
pp. 3263
Author(s):  
Carla Colombo ◽  
Gianfranco Alicandro ◽  
Valeria Daccò ◽  
Alessandra Consales ◽  
Fabio Mosca ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cystic Fibrosis ◽  
Retrospective Cohort ◽  
Cochrane Library ◽  
Healthy Population ◽  
Retrospective Cohort Studies ◽  
Normative Standard ◽  
Measure Of Association ◽  
The Cochrane Library ◽  
The Impact

Breastfeeding (BF) is considered the normative standard of feeding for all infants. However, the impact of BF in patients with cystic fibrosis (CF) is not completely defined. Therefore, we conducted a systematic review to evaluate BF prevalence in the CF population and its impact on anthropometric and pulmonary outcomes. We searched MEDLINE, Embase and the Cochrane Library for original articles published in English up to 4 December 2020 that report the prevalence of BF and/or any measure of association between BF and anthropometric or pulmonary outcomes. Nine observational studies were identified (six retrospective cohort studies, one prospective cohort study, one survey and one case–control study within a retrospective cohort). The BF rate in CF patients is lower than that of the healthy population (approximately 50–60% of infants were breastfed at any time). The benefits in anthropometric outcomes of BF for >2 months in this at-risk population are unclear. A few relatively small studies suggest a potential benefit of BF in reducing lung infections, although data are inconsistent. The currently available data are insufficient to draw definite conclusions on the benefits of exclusive BF in anthropometric and pulmonary outcomes in CF. Clinical trials evaluating well-defined BF promotion interventions are needed.

102 Early Palliative Care Consultation in the Burn Unit: Increasing Utilization and Areas for Improvement

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S69-S70
Author(s):  
Heather Carmichael ◽  
Sarah E Mather ◽  
Tyler M Smith ◽  
Patrick S Duffy ◽  
Arek J Wiktor ◽  
...  
Keyword(s):  
Palliative Care ◽  
Small Sample ◽  
Do Not Resuscitate ◽  
Comfort Care ◽  
Early Palliative Care ◽  
Palliative Care Consultation ◽  
Before And After ◽  
Care Consultation ◽  
Patient Values ◽  
The Impact

Abstract Introduction Despite significant morbidity and mortality for major burns, palliative care consultation (PCC) is underutilized in this population. While use of PCC is increasing, a prior study showed that less than 2% of patients with major burns had PCC during admission. The purpose of this study is to examine the impact of a protocol using recommended “triggers” for PCC at a single academic burn center. Methods This is a retrospective review of patient deaths over a four-year period (9/2016–8/2020). Use of life-sustaining treatments, comfort care (de-escalation of one or more life-sustaining treatments) and do not resuscitate (DNR) orders were determined. Use of PCC was compared during periods before and after a protocol establishing recommended “triggers” for early (&lt; 48 hrs of admission) PCC was instituted in 2019. Triggers included Baux score &gt; 100 and/or complex decisions about treatment including need for cardiopulmonary resuscitation (CPR)/renal replacement therapy (RRT)/vasopressors, or at least two of the following: age &gt; 70, major comorbidities, disagreement amongst family/patient/providers about best course of treatment, or no longer meeting expected milestones. Results A total of 33 patient deaths were reviewed. Most patients were male (n=28, 85%) and median age was 62 years [IQR 42–72]. Median Baux score was 112 [IQR 81–133]. Eleven patients (33%) had major comorbidities. Many patients had life-sustaining interventions such as intubation, RRT, or CPR, often prior to admission. Amongst patients who survived &gt;24 hrs, 67% (n=14/21) had PCC. Frequency of PCC increased after protocol development, with 100% vs. 36% of patients having PCC before death (p=0.004). However, even during the later period, only half of patients had early PCC despite meeting criteria at admission. Conclusions Frequently, initiation of life-sustaining measures in severely injured burn patients occurs prior to or early during hospitalization. Thus, early goals of care discussions are valuable to prevent interventions that do not align with patient values and assist with de-escalation of life-sustaining treatment. In this small sample, we found that while there was increasing use of PCC overall after developing a protocol of recommended “triggers” for consultation, many patients who met criteria at admission did not receive early PCC.

Appendectomy Does Not Increase the Risk of Future Emergence of Parkinson’s Disease: A Meta-analysis

2021 ◽  
pp. 000313482198903
Author(s):  
Mitsuru Ishizuka ◽  
Norisuke Shibuya ◽  
Kazutoshi Takagi ◽  
Hiroyuki Hachiya ◽  
Kazuma Tago ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Random Effects Models ◽  
Significant Difference ◽  
The Cochrane Library ◽  
The Impact ◽  
The Relationship ◽  
Observation Period

Objective To explore the impact of appendectomy history on emergence of Parkinson’s disease (PD). Background Although there are several studies to investigate the relationship between appendectomy history and emergence of PD, the results are still controversial. Methods We performed a comprehensive electronic search of the literature (the Cochrane Library, PubMed, and the Web of Science) up to April 2020 to identify studies that had employed databases allowing comparison of emergence of PD between patients with and those without appendectomy history. To integrate the impact of appendectomy history on emergence of PD, a meta-analysis was performed using random-effects models to calculate the risk ratio (RR) and 95% confidence interval (CI) for the selected studies, and heterogeneity was analyzed using I2 statistics. Results Four studies involving a total of 6 080 710 patients were included in this meta-analysis. Among 1 470 613 patients with appendectomy history, 1845 (.13%) had emergences of PD during the observation period, whereas among 4 610 097 patients without appendectomy history, 6743 (.15%) had emergences of PD during the observation period. These results revealed that patients with appendectomy history and without appendectomy had almost the same emergence of PD (RR, 1.02; 95% CI, .87-1.20; P = .83; I2 = 87%). Conclusion This meta-analysis has demonstrated that there was no significant difference in emergence of PD between patients with and those without appendectomy history.

scholarly journals Viscoelastometric Testing to Assess Hemostasis of COVID-19: A Systematic Review

2021 ◽  
Vol 10 (8) ◽  
pp. 1740
Author(s):  
Marion Bareille ◽  
Michaël Hardy ◽  
Jonathan Douxfils ◽  
Stéphanie Roullet ◽  
Dominique Lasne ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mechanical Strength ◽  
Small Sample ◽  
The Common ◽  
Small Sample Sizes ◽  
Definition Of ◽  
Reported Data ◽  
Prophylactic Anticoagulation ◽  
The Impact ◽  
Heparin Neutralization

Infection by SARS-CoV-2 is associated with a high risk of thrombosis. The laboratory documentation of hypercoagulability and impaired fibrinolysis remains a challenge. Our aim was to assess the potential usefulness of viscoelastometric testing (VET) to predict thrombotic events in COVID-19 patients according to the literature. We also (i) analyzed the impact of anticoagulation and the methods used to neutralize heparin, (ii) analyzed whether maximal clot mechanical strength brings more information than Clauss fibrinogen, and (iii) critically scrutinized the diagnosis of hypofibrinolysis. We performed a systematic search in PubMed and Scopus databases until December 31st, 2020. VET methods and parameters, and patients’ features and outcomes were extracted. VET was performed for 1063 patients (893 intensive care unit (ICU) and 170 non-ICU, 44 studies). There was extensive heterogeneity concerning study design, VET device used (ROTEM, TEG, Quantra and ClotPro) and reagents (with non-systematic use of heparin neutralization), timing of assay, and definition of hypercoagulable state. Notably, only 4 out of 25 studies using ROTEM reported data with heparinase (HEPTEM). The common findings were increased clot mechanical strength mainly due to excessive fibrinogen component and impaired to absent fibrinolysis, more conspicuous in the presence of an added plasminogen activator. Only 4 studies out of the 16 that addressed the point found an association of VETs with thrombotic events. So-called functional fibrinogen assessed by VETs showed a variable correlation with Clauss fibrinogen. Abnormal VET pattern, often evidenced despite standard prophylactic anticoagulation, tended to normalize after increased dosing. VET studies reported heterogeneity, and small sample sizes do not support an association between the poorly defined prothrombotic phenotype of COVID-19 and thrombotic events.

scholarly journals Excess weight and dyslipidemia and their complications during pregnancy: a systematic review

2016 ◽  
Vol 16 (2) ◽  
pp. 93-101 ◽  
Author(s):  
Iramar Baptistella do Nascimento ◽  
Willian Barbosa Sales ◽  
Raquel Fleig ◽  
Grazielle Dutra da Silva ◽  
Jean Carl Silva
Keyword(s):  
Systematic Review ◽  
Key Words ◽  
Excess Weight ◽  
Cochrane Library ◽  
Obstetric Outcomes ◽  
Lipid Disorders ◽  
Key Words Lipids ◽  
The Cochrane Library ◽  
The Impact ◽  
In Pregnancy

Abstract Objectives: to identify bibliographically disorders related to excess weight, dyslipidemia and their complication during pregnancy and in the fetus and newborn. Methods: a systematic review including observational and interventional studies and reviews, based on MEDLINE, LILACS, Embase and the Cochrane Library between 2000 and 2015. The key-words "lipids, pregnancy, obesity and newborn" were used to establish a selective stage for inclusion/exclusion of titles, repeated studies, key-words, abstracts, methodological incompatibility and correlation with objectives. Results: 58 studies were selected, of which 36 (62%) addressed prevention and the risk in pregnancy of excess weight and lipid disorders and 19 (32.7%) suggestions and/or consequences for the fetus and newborn. Conclusions: excess weight and lipidemic disorders in pregnancy are causes for concern in scientific studies, posing risks both for the mother and the newborn. Higher prevalence of caesarian and pre-eclampsia were the two most noteworthy complications for gestational outcomes. In short, the impact on care of maternal habits and excess weight during pregnancy is highly significant, owing to the different degrees of complication in obstetric outcomes and their influence on the clinical characteristics of the newborn.

scholarly journals Cannabis and breastfeeding

2020 ◽  
Vol 25 (Supplement_1) ◽  
pp. S26-S28 ◽  
Author(s):  
Lisa Graves
Keyword(s):  
Health Care Providers ◽  
Small Sample ◽  
Adverse Outcomes ◽  
Care Providers ◽  
High Quality ◽  
High Quality Evidence ◽  
Small Sample Sizes ◽  
The Impact ◽  
Quality Evidence

Abstract Cannabis is one of the most commonly used substances in Canada with 15% of Canadians reporting use in 2019. There is emerging evidence that cannabis is linked to an impact on the developing brain in utero and adverse outcomes in infants, children, and adolescents. The impact of cannabis during breastfeeding has been limited by studies with small sample sizes, follow-up limited to 1 year and the challenge of separating prenatal exposure from that during breastfeeding. In the absence of high-quality evidence, health care providers need to continue to engage women in conversation about the potential concerns related to breastfeeding and cannabis use.

scholarly journals Hygienic assessment of the impact of 5G/IMT-2020 communication networks on public health (literature review)

2021 ◽  
Vol 100 (9) ◽  
pp. 929-932
Author(s):  
Anna M. Egorova ◽  
Lydiya A. Lutsenko ◽  
Anna V. Sukhova ◽  
Vyacheslav V. Kolyuka ◽  
Rustam V. Turdyev
Keyword(s):  
Public Health ◽  
Radio Frequency ◽  
Electromagnetic Radiation ◽  
Communication Networks ◽  
Biological Effects ◽  
Three Dimensional ◽  
Cochrane Library ◽  
Pubmed Search ◽  
The Cochrane Library ◽  
The Impact

The program “Digital Economy of the Russian Federation” approved the Concept for the creation and development of 5G / IMT-2020 networks. The development of 5G communications will significantly impact the implementation of many innovative projects and initiatives: the Smart City project, Unmanned Transport, etc. Along with significant technical advantages compared to previous generations of communication (2G, 3G, 4G), 5G technology has completely different emitting characteristics: more emitting elements, signal modulation, three-dimensional beam, the ability to control the beam, SHF (ultra-high) and EHF (extremely high) radio frequency ranges and centimetre and millimetre wavelengths of electromagnetic radiation. Therefore, it is becoming an especially urgent problem to ensure exposure to the human body of non-ionizing electromagnetic fields of the radio frequency range (30 kHz-300 GHz). The authors searched the literature on the biological effects of 5G cellular communications and electromagnetic radiation in the centimetre and millimetre ranges using the appropriate keywords in PubMed search engines, Scopus, Web of Science, Medline, The Cochrane Library, EMBASE, Global Health, CyberLeninka, RSCI and others. There is currently tentative and conflicting evidence on the impact of 5G. The rapidly growing density of wireless devices and antennas (considering future 5G networks) increases the public health risk from exposure to RF EMFs as the penetration depth for 5G EHF radiation is only a few millimetres. At these wavelengths, resonance phenomena are possible at the cellular and molecular levels, particularly concerning stimulating SHF and EHF oxidative processes and damaging DNA. The influence of the millimetre range of RF-EMF is poorly understood; oncological and non-oncological (impact on the reproductive, immune systems, etc.) effects are possible. Using numerical simulation methods of EMF radiation resonances on insects, Thielens A et al., 2018, found a significant overall increase in the absorbed RF power at a frequency of 6 GHz and higher than a frequency below 6 GHz.

Sign in / Sign up

Export Citation Format

Share Document