Preliminary Analysis of Worldwide Usage Patterns in a Mobile Palliative Care Reference App

14 Background: Opioid pharmacotherapy is used to manage moderate and severe pain in palliative care (PC). Pain affects 80% pancreatic cancer patients older than 65 years. We assessed the opioid utilization patterns in Medicare patients with pancreatic cancer whom did not use PC (NPC), used community-based PC (CBPC) or used hospital-based PC (HBPC). Methods: We assessed opioid use, types, dispensed days, opioid uptake rates, doses (measured by morphine equivalent doses (MEDs)), and related adverse events (AEs) after pancreatic cancer diagnosis in Medicare beneficiaries selected from the SEER-Medicare database between 2007 and 2013 using the log-binomial, generalized linear mixed, and Cox proportional hazards modeling. Results: 16,106 patients were identified (median age: 78 years; female: 55.2%), of whom 8.3% used CBPC and 19.6% used HBPC. PC users were more likely to use opioids (CBPC: 72.2% vs. HBPC: 63.4% vs. NPC: 56.3%, P<.001). The most commonly prescribed opioid type in NPC, HBPC and CBPC users was fentanyl (54.1%), hydromorphone (27.7%) and morphine (26.1%). Compared to other study patients, CBPC users had shorter median dispensed days per prescription (CBPC: 3 days vs. HBPC: 4 days vs. NPC: 4 days, P<.001) but higher median MEDs per prescription (CBPC: 25 mg vs. HBPC: 25 mg vs. NPC: 0.13 mg, P<.001). Adjusting for demographic and clinical factors, no significantly different uptake rates of opioids were determined in PC users compared to NPC users (CBPC: RR, 1.02, P=.057; HBPC: RR, 1.002, P=.783). HBPC users had higher adjusted daily MEDs than CBPC and NPC users 3 months after diagnosis (135.1 mg/d vs. 126.5 mg/d vs. 65.7 mg/d, P<.001). CBPC users had higher adjusted daily MEDs than HBPC and NPC users 3 months before death (164.3mg/d vs. 155.6 mg/d vs. 92.1 mg/d, P=.0002). CBPC users had lower but HBPC users had higher adjusted hazard ratios of delirium (CBPC: HR, 0.95, HBPC: HR, 1.26, P<.001) and drowsiness (CBPC: HR, 0.94, HBPC: HR, 1.53, P<.001) than NPC users. Conclusions: Older pancreatic cancer patients using PC tended to use opioids and consumed higher opioid doses. CBPC users had lower risks of opioid-related delirium and drowsiness. The factors of the opioid use variations need to be assessed.

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Early Canadiana on the World Wide Web: Preliminary Analysis of Usage Patterns and Usage Feedback

Proceedings of the Annual Conference of CAIS / Actes du congrès annuel de l'ACSI ◽

10.29173/cais447 ◽

2013 ◽

Author(s):

Joan M. Cherry ◽

Wendy M. Duff ◽

Gerry Oxford

Keyword(s):

World Wide Web ◽

Full Text ◽

Preliminary Analysis ◽

World Wide ◽

The Other ◽

User Survey ◽

Web Based ◽

The World ◽

Usage Patterns ◽

Software Monitoring

Early Canadiana Online (ECO) is a full-text, Web-based collection of pre-1900 documents which were published in Canada, or which were published in other countries but written by Canadians or about Canada. This paper reports preliminary findings from two studies of this collections- one involving software monitoring of usage of the collection; the other involving a Web-based user survey.

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Families’ priorities in life-limiting illness: improving quality with online empowerment

Archives of Disease in Childhood ◽

10.1136/archdischild-2015-308769 ◽

2015 ◽

Vol 101 (3) ◽

pp. 247-252 ◽

Cited By ~ 4

Author(s):

Nicola Harris ◽

Antonia Beringer ◽

Margaret Fletcher

Keyword(s):

Palliative Care ◽

Sleep Problems ◽

Patient Empowerment ◽

Qualitative Evaluation ◽

Ease Of Use ◽

Structured Interviews ◽

Social Interventions ◽

Usage Patterns ◽

Over Time

ObjectiveImproving quality of life (QOL) is the central focus of palliative care support for children with life-limiting illness (LLI), but achieving this can be challenging.InterventionMyQuality is an online tool that enables families to choose and monitor parameters they identify as having an impact on their QOL, which aims to improve patient–professional communications and also to enhance patient empowerment within healthcare dialogues.DesignA longitudinal, multisite mixed-method evaluation of MyQuality. Families were invited to use MyQuality and completed semi-structured interviews and a Family Empowerment Scale (FES) at T=0 and T+3 months.Patients and settingThirty-two families of children with LLIs, attending three children's hospices in one UK region.Outcome measuresWebsite access, usage patterns and parameter choice, FES scores and qualitative evaluation of interviews.Results23/32 families chose to use the website. Mean duration of use was 106 days (range 2–301), with families choosing two or three parameters (range 1–15), most commonly seizures (24/32), constipation (9/32), pain (6/32) and sleep problems (6/32). Mean FES scores increased over time (3.45–3.85). Interview feedback confirmed the acceptability and ease of use of the website, and the value of a graphic record of change over time to support ongoing management and collaborative review of medical, nursing or social interventions.ConclusionsThe identification and monitoring of patient-generated priorities via the MyQuality website empowers families and supports collaboration between parents and professionals to ensure that palliative care is truly patient and family centred.

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FeXIV Line Emission Polarization of the July 11, 1991 Solar Corona

International Astronomical Union Colloquium ◽

10.1017/s0252921100026002 ◽

1994 ◽

Vol 144 ◽

pp. 541-547

Author(s):

J. Sýkora ◽

J. Rybák ◽

P. Ambrož

Keyword(s):

High Resolution ◽

Solar Corona ◽

Emission Line ◽

Solar Eclipse ◽

White Light ◽

Preliminary Analysis ◽

Line Emission ◽

Total Solar Eclipse ◽

Degree Of Polarization ◽

High Resolution Images

AbstractHigh resolution images, obtained during July 11, 1991 total solar eclipse, allowed us to estimate the degree of solar corona polarization in the light of FeXIV 530.3 nm emission line and in the white light, as well. Very preliminary analysis reveals remarkable differences in the degree of polarization for both sets of data, particularly as for level of polarization and its distribution around the Sun’s limb.

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Vocal Communications of a Developmentally Delayed Child

Language Speech and Hearing Services in Schools ◽

10.1044/0161-1461.1802.112 ◽

1987 ◽

Vol 18 (2) ◽

pp. 112-130

Author(s):

Mary Ann Romski ◽

Sharon Ellis Joyner ◽

Rose A. Sevcik

Keyword(s):

Language Learning ◽

Developmental Delays ◽

Developmentally Delayed ◽

Language Impaired ◽

Diary Data ◽

Word Acquisition ◽

Diary Studies ◽

Usage Patterns ◽

Vocal Communications ◽

Impaired Children

Studies of first-word acquisition in typical language-learning children frequently take the form of diary studies. Comparable diary data from language-impaired children with developmental delays, however, are not currently available. This report describes the spontaneous vocalizations of a child with a developmental delay for 14 months, from the time he was age 6:5 to age 7:7. From a corpus of 285 utterances, 47 phonetic forms were identified and categorized. Analysis focused on semantic, communicative, and phonological usage patterns.

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Much Ado About Fried Chicken: Abetting Aspiration or Respecting Autonomy?

American Journal of Speech-Language Pathology ◽

10.1044/2019_ajslp-18-0207 ◽

2019 ◽

Vol 28 (3) ◽

pp. 1356-1362

Author(s):

Laurence Tan Lean Chin ◽

Yu Jun Lim ◽

Wan Ling Choo

Keyword(s):

Palliative Care ◽

End Of Life ◽

Multidisciplinary Team ◽

Biopsychosocial Model ◽

Family Members ◽

Clinical Decisions ◽

Goals Of Care ◽

Complex Needs ◽

Aspiration Risk ◽

Patient Centric

Purpose Palliative care is a philosophy of care that encompasses holistic, patient-centric care involving patients and their family members and loved ones. Palliative care patients often have complex needs. A common challenge in managing patients near their end of life is the complexity of navigating clinical decisions and finding achievable and realistic goals of care that are in line with the values and wishes of patients. This often results in differing opinions and conflicts within the multidisciplinary team. Conclusion This article describes a tool derived from the biopsychosocial model and the 4-quadrant ethical model. The authors describe the use of this tool in managing a patient who wishes to have fried chicken despite aspiration risk and how this tool was used to encourage discussions and reduce conflict and distress within the multidisciplinary team.

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AAC Supports for Individuals With Rett Syndrome Across the Lifespan

Perspectives on Augmentative and Alternative Communication ◽

10.1044/aac24.3.74 ◽

2015 ◽

Vol 24 (3) ◽

pp. 74-85

Author(s):

Sandra M. Grether

Keyword(s):

Rett Syndrome ◽

Communication Skills ◽

Preliminary Analysis ◽

Multidisciplinary Approach ◽

Motor Deficits ◽

Complex Profile ◽

Communication Behaviors ◽

The Individual

Individuals with Rett syndrome (RS) present with a complex profile. They benefit from a multidisciplinary approach for diagnosis, treatment, and follow-up. In our clinic, the Communication Matrix © (Rowland, 1990/1996/2004) is used to collect data about the communication skills and modalities used by those with RS across the lifespan. Preliminary analysis of this data supports the expected changes in communication behaviors as the individual with RS ages and motor deficits have a greater impact.

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Swallowing Management in Palliative Care

ASHA Leader ◽

10.1044/leader.ov.22092017.np ◽

2017 ◽

Vol 22 (9) ◽

Cited By ~ 1

Author(s):

Brenda Arend ◽

Kate Krival

Keyword(s):

Palliative Care

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