Abstract:
CONTEXT:Recent analyses of Medicare data show decreases over time in intensity of end-of-life care. Few studies exist regarding trends in intensity of end-of-life care for those under 65 years of age. OBJECTIVES:To examine recent temporal trends in place of death, and both hospital and intensive care unit (ICU) utilization, for age-stratified decedents with chronic, life-limiting diagnoses (<65 vs. ≥65 years) who received care in a large healthcare system. METHODS:Retrospective cohort using death certificates and electronic health records for 22,068 patients with chronic illnesses who died between 2010 and 2015. We examined utilization overall and stratified by age using multiple regression. RESULTS:The proportion of deaths at home did not change, but hospital admissions in the last 30 days of life decreased significantly from 2010 to 2015 (hospital b = -0.026; CI = -0.041, -0.012). ICU admissions in the last 30 days also declined over time for the full sample and for patients aged 65 years or older (overall b = -0.023; CI = -0.039, -0.007), but was not significant for younger decedents. Length of stay (LOS) did not decrease for those using the hospital or ICU. CONCLUSION:From 2010 to 2015, we observed a decrease in hospital admissions for all age groups and in ICU admissions for those over 65 years. As there were no changes in the proportion of patients with chronic illness who died at home nor in hospital or ICU LOS in the last 30 days, hospital and ICU admissions in the last 30 days may be a more responsive quality metric than site of death or LOS for palliative care interventions.
journal_name
J Pain Symptom Managejournal_title
Journal of pain and symptom managementauthors
Sathitratanacheewin S,Engelberg RA,Downey L,Lee RY,Fausto JA,Starks H,Dunlap B,Sibley J,Lober W,Loggers ET,Khandelwal N,Curtis JRdoi
10.1016/j.jpainsymman.2017.08.032subject
Has Abstractpub_date
2018-01-01 00:00:00pages
75-81issue
1eissn
0885-3924issn
1873-6513pii
S0885-3924(17)30438-4journal_volume
55pub_type
杂志文章abstract:CONTEXT:Rheumatoid arthritis (RA) is a chronic disease that often impacts patient's quality of life. For young people with RA, there is a need for rehabilitative approaches that have been shown to be safe and to lead to improved functioning. OBJECTIVES:This pilot study investigated the feasibility of a single-arm, gro...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2009.09.018
更新日期:2010-05-01 00:00:00
abstract:CONTEXT:Oncology patients with persistent pain treated in outpatient settings and their family caregivers have significant responsibility for managing pain medications. However, little is known about their practical day-to-day experiences with pain medication management. OBJECTIVES:The aim was to describe day-to-day p...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jpainsymman.2013.12.242
更新日期:2014-11-01 00:00:00
abstract::The hospice model of care of the dying patient is regarded as a model of excellence; however, outcomes of this care have been poorly demonstrated. Integrated Care Pathways (ICPs) provide a method of recording and measuring outcomes of care. The ICP document replaces all previous documentation and is a multiprofessiona...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/s0885-3924(00)00240-2
更新日期:2001-01-01 00:00:00
abstract::The microcirculation appears to be impaired in cold chronic complex regional pain syndrome (CRPS). This double-blind, placebo-controlled, randomized trial investigated the effect of the nitric oxide (NO) donor isosorbide dinitrate (ISDN) on the peripheral blood flow in patients with chronic CRPS. Twenty-four patients ...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jpainsymman.2008.10.006
更新日期:2009-09-01 00:00:00
abstract:CONTEXT:Spirituality is a distinctive subject within palliative care practice and literature, but research to date is relatively undeveloped in this field and studies often throw more light on conceptual and methodological issues than producing reliable data for clinical practice. OBJECTIVES:To determine what is known...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章,评审
doi:10.1016/j.jpainsymman.2011.06.017
更新日期:2012-06-01 00:00:00
abstract:CONTEXT:Although many family members who make surrogate decisions report problems with communication, there is no validated instrument to accurately measure surrogate/clinician communication for older adults in the acute hospital setting. OBJECTIVES:The objective of this study was to validate a survey of surrogate-rat...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2016.08.010
更新日期:2017-01-01 00:00:00
abstract::Visual analogue scales (VAS) and verbal rating scales (VRS) are widely used to assess pain. This paper presents a secondary analysis of a subsection of data collected as part of an evaluation of an intervention to improve nighttime pain. The aims were to describe the relationship between the VAS and VRS; to compare ch...
journal_title:Journal of pain and symptom management
pub_type: 临床试验,杂志文章
doi:10.1016/s0885-3924(99)00092-5
更新日期:1999-12-01 00:00:00
abstract:CONTEXT:Palliative sedation is used to relieve end-of-life refractory symptoms. OBJECTIVE:The objective of this study was to describe the use of palliative sedation in patients who die in internal medicine departments. METHODS:An observational, cross-sectional, retrospective, and multicenter clinical audit study was ...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2019.10.013
更新日期:2020-02-01 00:00:00
abstract:CONTEXT:There are no previously published studies examining opioid doses administered to opioid-tolerant cancer patients during emergency department (ED) encounters. OBJECTIVES:To determine if opioid-tolerant cancer patients presenting with acute pain exacerbations receive adequate initial doses of as needed (PRN) opi...
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:10.1016/0885-3924(89)90007-9
更新日期:1989-09-01 00:00:00
abstract::The purpose of this randomized, controlled, home care intervention was to test the effectiveness of two nurse-targeted, e-mail-based interventions to increase home care nurses' adherence to pain assessment and management guidelines, and to improve patient outcomes. Nurses from a large urban non-profit home care organi...
journal_title:Journal of pain and symptom management
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/j.jpainsymman.2004.08.018
更新日期:2005-05-01 00:00:00
abstract::The aim of this study was to evaluate the prevalence, severity, and management of pain in Korean patients with advanced cancer, and to identify the predictors of inadequate management of cancer pain in Korea. From 8 university hospitals, 655 patients with advanced cancer were surveyed. Information concerning analgesic...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章,多中心研究
doi:10.1016/s0885-3924(03)00103-9
更新日期:2003-05-01 00:00:00
abstract:CONTEXT:Autonomic nervous system dysfunction (AD) is a common syndrome in patients with advanced cancer. It is associated with decreased survival in several patient populations, including diabetes mellitus, heart failure, and neurological diseases. Based on this evidence, we hypothesized that autonomic dysfunction is a...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2009.06.014
更新日期:2010-02-01 00:00:00
abstract:CONTEXT:Limited studies have identified symptom clusters (SCs) and their risk factors and the relationships with inflammatory biomarkers in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). OBJECTIVES:In this study, we aimed to investigate SCs in patients with AECOPD and explore their...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2020.03.037
更新日期:2020-09-01 00:00:00
abstract::Activity in primary afferent fibers that usually mediate fine touch can evoke sensations of pain in conditions in which there is sensitization of central neurons. Input from these large diameter Abeta afferents may also sustain and exacerbate these central mechanisms. The role of these fibers in clinical pain syndrome...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/s0885-3924(02)00541-9
更新日期:2003-01-01 00:00:00
abstract::Patient-controlled analgesia (PCA) has been incorporated into the management of chronic pain in cancer patients despite limited evidence of safety and efficacy. Potential benefits of PCA include decreased delay in the administration of opioids from the time requested, rapidity and ease of dose titration, and adaptabil...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2010.11.020
更新日期:2011-08-01 00:00:00
abstract::Several aspects of venipuncture technique were evaluated to assess their relationship to reported pain. Subjects were 514 children aged 5-17 who had venipuncture performed by a technician in a hospital outpatient laboratory. A research assistant timed the duration of venipuncture and then obtained visual analogue pain...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/0885-3924(92)90087-x
更新日期:1992-08-01 00:00:00
abstract:CONTEXT:Fatigue and depression are two prominent concerns in patients on in-hospital hemodialysis (IHHD) that have recently been identified as research priorities in the nephrology community. Although they are often reported to co-exist, no synthesis of the literature examining their relationship is available. OBJECTI...
journal_title:Journal of pain and symptom management
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更新日期:2017-04-01 00:00:00
abstract::To identify aspects of end-of-life care in the U.S. Department of Veterans Affairs (VA) health care system that are not assessed by existing survey instruments and to identify issues that may be unique to veterans, telephone interviews using open-ended questions were conducted with family members of veterans who had r...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
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abstract:CONTEXT:Being diagnosed with incurable cancer can be a life-changing experience, evoking different spiritual questions and needs. Confronting a serious life-threatening event occurs not only often unexpected but also can disrupt a person's self-image and ideals of their personhood. This confrontation makes it difficult...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2017.11.007
更新日期:2018-03-01 00:00:00
abstract::A cross-sectional study was conducted among 249 Chinese cancer patients with multiple diagnoses to validate a Chinese version of the Brief Fatigue Inventory (BFI-C). Cronbach's coefficient alpha was 0.92 for fatigue severity items and 0.90 for fatigue interference items. Construct validity was explored by principal fa...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2003.09.008
更新日期:2004-04-01 00:00:00
abstract::To improve assessment and management of pain in nonverbal older adults with dementia, an effective means of recognizing and evaluating pain in this vulnerable population is needed. The purpose of this review is to critically evaluate the existing tools used for pain assessment in this population to provide recommendat...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章,评审
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更新日期:2006-02-01 00:00:00
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journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2013.08.007
更新日期:2014-06-01 00:00:00
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journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2014.09.004
更新日期:2015-10-01 00:00:00
abstract:CONTEXT:Sleep is a significant problem in breast cancer survivors (BCS) and measured frequently using the Pittsburgh Sleep Quality Index (PSQI). Thus, it is important to evaluate its factor structure. The two-process model of sleep regulation was the theoretical framework for this study. OBJECTIVES:To perform a confir...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2012.03.008
更新日期:2013-03-01 00:00:00
abstract::The safety and efficacy of intraspinal opioids as therapy for selected patients with cancer pain are well-established. The choice of the appropriate drug is influenced by many variables that are to date incompletely elucidated. The cost of therapy is an increasingly important component of decision-making. This report ...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/s0885-3924(96)00266-7
更新日期:1997-02-01 00:00:00
abstract::To validate the Greek version of the Brief Fatigue Inventory (BFI-Gr) in a sample of cancer patients, the scale was translated with the "forward-backward" procedure to Greek. It was administered twice, at a three-day interval, to 102 eligible patients with cancer. Together with the BFI-Gr scale, the patients also comp...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2007.10.021
更新日期:2008-10-01 00:00:00
abstract::The aims of this study were (a) to estimate the prevalence of pain and eight other common symptoms in a large population of patients with advanced cancer from different palliative care centers, and (b) to assess the differences in prevalence of the symptoms by primary site. In 1990-1991, the prevalence of eight major ...
journal_title:Journal of pain and symptom management
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1016/0885-3924(96)00042-5
更新日期:1996-07-01 00:00:00
abstract:CONTEXT:Undertreatment of cancer pain among outpatient cancer patients needs to be addressed to enhance care and improve patients' quality of life (QoL). OBJECTIVES:This prospective, cross-sectional, patient-focused study aimed to explore the prevalence of pain and undertreatment of cancer pain in outpatients in Taiwa...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jpainsymman.2017.02.018
更新日期:2017-07-01 00:00:00
abstract::Cancer patients suffer multiple symptoms and require numerous drug therapies. Parenteral administration of multiple medications from a single container can simplify drug regimens for patient self-administration. This simplification reduces drug preparation costs and risk of infection. Therapeutic options are limited b...
journal_title:Journal of pain and symptom management
pub_type: 临床试验,杂志文章
doi:10.1016/0885-3924(96)00127-3
更新日期:1996-09-01 00:00:00