Journal of palliative medicine
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Comparative Study
The economic and clinical impact of an inpatient palliative care consultation service: a multifaceted approach.
While there has been a rapid increase of inpatient palliative care (PC) programs, the financial and clinical benefits have not been well established. ⋯ The large reduction in mean daily costs and LOS resulted in an estimated annual savings of $2.2 million in the study hospital. Our results extend the evidence base of financial and clinical benefits associated with inpatient PC programs. We recommend additional study of best practices for identifying patients and providing consultation services, in addition to progressive management support and reimbursement policy.
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Grouping patients' rating of pain intensity from 0 to 10 into categories of mild, moderate, and severe pain is useful for informing treatment decisions, interpreting study outcomes, as well as aiding policy or clinical practice guidelines development. In 1995, Serlin and colleagues developed a technique to establish the cut points for mild, moderate, and severe pain by grading pain intensity with functional interference. Since then, a number of studies attempted to confirm these findings in similar or different populations but had different results. Such inconsistencies in the literature prompt for more research to establish the definition of mild, moderate and severe pain. Thus, the purpose of the current study was to identify optimal cut points (CP) of the three pain severity categories for worst, average, and current pain. ⋯ These findings are pivotal in further understanding the meaning of pain intensity levels and the assessment of pain in patients with metastatic cancer. However, further research in alternative methods of defining the optimal CP and clinically important change should be considered.
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There is an acknowledged difficulty in distinguishing between some morally and legally accepted acts that hasten dying, such as refusing life-sustaining treatment, and other acts that also hasten dying that are labeled as acts of "suicide." Recent empirical findings suggest that most terminally ill and suffering patients who voluntarily chose to stop eating and drinking as a means to hasten their dying generally experienced a "good" death. This paper explores the moral and legal status of a decision to stop eating and drinking as a means to hasten dying that is voluntarily chosen by a competent, terminally ill and suffering patient. The option of voluntarily forgoing food and fluid will be compared to other end-of-life clinical practices known to hasten dying, with emphasis on the issue of whether such practices can or should be distinguished from suicide.
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Numbers of patients with stage 5 chronic kidney disease (CKD) managed conservatively (without dialysis) are increasing steadily but prevalence and severity of symptoms in this population are not yet known. ⋯ This study demonstrates that patients with stage 5 CKD have considerable symptom control needs, similar to advanced cancer populations, but with different patterns of individual symptoms and severity, particularly pain. Implications for palliative care, hospice, and nephrology services in planning and providing care are discussed.
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To quantify the association between individual physicians and decisions to limit use of life supporting therapies for critically ill patients. ⋯ We have, for the first time, quantified the association between individual physicians and decisions made to limit life support for critically ill patients. More research is needed to understand the nature and implications of this association.