Journal of palliative medicine
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To clarify the family-perceived necessity of improvement in death pronouncement and explore the potential association between behaviors of physicians and the family-perceived necessity of improvement. ⋯ Most of the family members who had experienced a patient's death at home were satisfied with the death pronouncement. Several factors were associated with family satisfaction, and further large studies are needed to confirm the results.
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As palliative care grows and evolves, robust programs to train and develop the next generation of leaders are needed. Continued integration of palliative care into the fabric of usual health care requires leaders who are prepared to develop novel programs, think creatively about integration into the current health care environment, and focus on sustainability of efforts. Such leadership development initiatives must prepare leaders in clinical, research, and education realms to ensure that palliative care matures and evolves in diverse ways. ⋯ The background, aims, and results to date of each of the projects from the scholars of the inaugural cohort are presented.
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For patients' preferences to be honored, emergency department (ED) physicians must be able to find and use advance care planning (ACP) information in the electronic medical record (EMR). ED physicians' experiences with ACP EMR documentation and their documentation needs are unknown. ⋯ EMR systems are not optimized to provide critical ACP information to ED physicians who lack confidence finding or using ACP EMR documentation to care for patients. Dedicated ACP information on the EMR home screen and tailored training may be needed to help ED providers find, use, and discuss ACP documentation to provide care aligned with patients' goals.
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Key to high-quality care of dying hospice patients at home is whether the hospice provides adequate training so the caregiver can safely care for the patient. ⋯ Sufficient preliminary reliability and validity warrants further testing of this composite to examine the adequacy of training provided to family members to care safely for the patient.
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For patients with traumatic paraplegia, the ability to push up is a prerequisite for basic movements, including the transfer from bed to wheelchair. However, this movement may be contraindicated in patients with advanced cancer with bone metastases because of the risk of pain and pathologic fractures and muscle weakness resulting from cancer cachexia and disuse syndrome. ⋯ Our findings suggest that the use of our newly devised system enables transfer from bed to wheelchair of even those patients with advanced cancer who cannot resume walking in the upright position because of paraplegia.