Dialysis in the Elderly and Impact of Institutionalization in the United States Renal Data System.
CONCLUSION: There was increased mortality in institutionalized elderly patients as compared to noninstutionalized elderly patients in the same age group. In accordance with the increased frailty and decreased benefits of therapies in the very elderly, especially in those with additional co-morbidities besides age, palliative and end-of-life care should be considered. PMID: 28704826 [PubMed - as supplied by publisher]
Join me in Seattle for "At the End of Life: The Physician's Role, Responsibility, and Agency." This national two-day conference is Sept. 13 and 14, 2019, at the University of Washington in Seattle. We will explore the complex issues—professional, moral, and legal—facing physicians caring for dying patients. Physicians have the privilege and duty to care for patients at the end of life. Sometimes a physician’s actions factor into a patient’s death; such as discontinuing life-support (including ventilators, cardiac devices, and dialysis), clinically supporting patients who volunta...
Background:Patients with acute myeloid leukemia (AML) admitted to the ICU have high in-hospital mortality, ranging from 40-70% (Halpern A, JAMA Oncology, 2017, 3; 374 and Thakkar SG, Cancer, 2008, 112; 2233). A model that considers AML-specific as well as ICU-specific variables could be of great value to identify critically ill patients likely to survive beyond hospital discharge and would help providers frame goals of care discussions. The AML Composite Model (AML-CM) was recently developed to predict early as well as late mortality after diagnosis of AML (Sorror ML, JAMA Oncology, 2017, 3:1675). The AML-CM incorporates A...
Conclusions:Health care utilization following post-HCT relapse is associated with receipt of disease-directed therapy, but remains high across all groups despite known poor prognosis. Interventions are needed to minimize non-beneficial treatments and promote goal-concordant EOL care in this seriously ill patient population.DisclosuresMuffly: Adaptive Biotechnologies: Research Funding; Shire Pharmaceuticals: Research Funding.
Introduction: Children with newly diagnosed acute lymphoblastic leukemia (ALL) are at risk for developing tumor lysis syndrome (TLS), an oncologic emergency with potentially severe consequences. Effective TLS management centers on prevention, achieved in large part through control of hyperuricemia with allopurinol or rasburicase. Though rasburicase is known to be very effective for children at high TLS risk, there are limited evidence-based data to guide its usage. Currently available guidelines rely on expert opinion and provide conflicting recommendations, especially for patients at intermediate TLS risk. To address this...
Conclusions: Symptom-based clusters identify patients with different health needs and might help to tailor palliative care.
Condition: End Stage Renal Disease Intervention: Other: Palliative care consultation Sponsors: University of Vermont; Icahn School of Medicine at Mount Sinai Recruiting
ConclusionOur patient population had good short ‐term survival outcomes despite most receiving palliative treatment. Cancer patients can achieve positive outcomes after ICU admission and appropriate selection of patients is crucial.This article is protected by copyright. All rights reserved.
CONCLUSIONS: Penile calciphylaxis is a rare, life-threatening disease that portends a poor prognosis. Conservative principles for management include normalization of calcium phosphate levels and local wound care. Penectomy may not impact survival. Ultimately, each case is individualized, and we encourage establishing goals of care in collaborative discussion with an interdisciplinary care team, patient, and family.