Abstract：
CONTEXT:Nursing home (NH) residents with advanced dementia are commonly suspected of having infections. Most episodes are treated with antimicrobials, although evidence supporting bacterial infections is often lacking. The extent to which other interventions are used in managing suspected infections is unknown. OBJECTIVES:To describe interventions used to manage suspected infections in advanced dementia and identify factors associated with greater intervention use. METHODS:Residents with advanced dementia who experienced suspected infections in 35 Boston NHs were followed for 12 months. Data describing interventions used in managing each episode were ascertained, including blood draws, chest radiographs, procurement of urine samples, and hospital transfers. Resident and episode characteristics associated with greater intervention use were identified using mixed model regression. RESULTS:A total of 240 residents experienced 496 suspected infections involving the following interventions: any, n = 360 (72.6%); hospital transfer, n = 51 (10.3%); blood draw, n = 215 (43.3%); chest radiograph, n = 120 (24.2%); and urine sample, n = 222 (44.8%). Factors associated with greater intervention use included black race (adjusted odds ratio [AOR] 3.19; 95% CI, 1.37-7.44); no do not hospitalize order (AOR, 1.83; 95% CI, 1.16-2.90); not on hospice (AOR, 5.41; 95% CI, 2.14-13.70); and suspected source being respiratory (AOR, 10.67; 95% CI, 4.99-22.80), urine (AOR, 15.79; 95% CI, 7.41-33.66) or fever of unknown source (AOR, 20.26; 95% CI, 8.42-48.73) vs. skin/soft tissue. CONCLUSION:NH residents with advanced dementia frequently experience potentially burdensome interventions when suspected of having an infection. Advance directives to limit such interventions may be appropriate for residents whose goal of care is comfort.
journal_name
J Pain Symptom Managejournal_title
Journal of pain and symptom managementauthors
Yates E,Mitchell SL,Habtemariam D,Dufour AB,Givens JLdoi
10.1016/j.jpainsymman.2015.06.011subject
Has Abstractpub_date
2015-12-01 00:00:00pages
806-13issue
6eissn
0885-3924issn
1873-6513pii
S0885-3924(15)00332-2journal_volume
50pub_type
杂志文章abstract：:Headache is a common and disabling aspect of pituitary disease. Chronic and episodic migraine are the most common clinical syndromes of headaches related to pituitary tumors, although other types of headache, such as trigeminal autonomic cephalalgias (TACs), can also be present. TACs include short-lasting, unilateral ...
journal_title：Journal of pain and symptom management
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journal_title：Journal of pain and symptom management
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journal_title：Journal of pain and symptom management
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abstract：:Assessing quality of care at the end of life involves measurements in several domains-use of evidence-based guidelines, patient and family satisfaction, quality of life, and incidence of adverse events, among others. There are several different data sources from which to calculate quality measures. Each data source ha...
journal_title：Journal of pain and symptom management
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journal_title：Journal of pain and symptom management
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journal_title：Journal of pain and symptom management
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journal_title：Journal of pain and symptom management
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abstract：CONTEXT:Palliative care for the older person is often limited, resulting in poor quality of dying. Pharmacological management can be one of the components to achieve better symptom control. OBJECTIVES:To describe the anticipatory prescription of medication for symptomatic treatment and the deprescription of potentiall...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章,多中心研究
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journal_title：Journal of pain and symptom management
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journal_title：Journal of pain and symptom management
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journal_title：Journal of pain and symptom management
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journal_title：Journal of pain and symptom management
pub_type： 杂志文章,多中心研究
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journal_title：Journal of pain and symptom management
pub_type： 杂志文章
doi：10.1016/j.jpainsymman.2007.01.016
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journal_title：Journal of pain and symptom management
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journal_title：Journal of pain and symptom management
pub_type： 杂志文章
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journal_title：Journal of pain and symptom management
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journal_title：Journal of pain and symptom management
pub_type： 杂志文章,多中心研究
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journal_title：Journal of pain and symptom management
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journal_title：Journal of pain and symptom management
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journal_title：Journal of pain and symptom management
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journal_title：Journal of pain and symptom management
pub_type： 杂志文章
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journal_title：Journal of pain and symptom management
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doi：10.1016/j.jpainsymman.2006.10.007
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journal_title：Journal of pain and symptom management
pub_type： 杂志文章
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journal_title：Journal of pain and symptom management
pub_type： 杂志文章
doi：10.1016/j.jpainsymman.2015.02.015
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abstract：:The Japanese Society of Palliative Medicine has developed a clinical guideline to minimize the large variation in clinical practice of artificial hydration therapy for terminally ill cancer patients. The primary aim of this preliminary study was to explore the effects of a five-hour interactive workshop based on the g...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章
doi：10.1016/j.jpainsymman.2008.10.007
更新日期：2009-09-01 00:00:00
abstract：:Symptom occurrence has been shown to predict treatment course and survival in cancer patients. The M. D. Anderson Symptom Inventory-Brain Tumor Module (MDASI-BT) was recently validated as a tool for primary brain tumor patient self-report of symptoms. This study evaluated the reliability and validity of the MDASI-BT i...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章
doi：10.1016/j.jpainsymman.2008.02.011
更新日期：2009-03-01 00:00:00
abstract：:To explore the factors that patients with malignant and nonmalignant pain consider when deciding whether to enroll in pain research studies, determine whether their views are different, and determine whether willingness to enroll in research is associated with pain severity, semi-structured interviews were conducted w...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章
doi：10.1016/s0885-3924(02)00527-4
更新日期：2002-11-01 00:00:00
abstract：CONTEXT:Sedation is administered to some palliative care patients at the end of their life. Nurses play an important role in this practice. OBJECTIVES:To systematically review the evidence on nurses' attitudes and practice of end-of-life sedation. METHODS:We searched eight electronic databases, four key palliative ca...
journal_title：Journal of pain and symptom management
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