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]
Conclusion: Compared to international numbers, in Germany, proportion of CRC and DW reported by non-profit renal centers is in the lower range. Center practice of palliative care management varies and is driven by availability of local palliative care resources and presumably by attitudes of the renal teams. Quality of palliative care and the decision-making process need further evaluation.Kidney Blood Press Res
Abstract In this essay, we describe the evolution of attitudes toward dialysis discontinuation in historical context, beginning with the birth of outpatient dialysis in the 1960s and continuing through the present. From the start, attitudes toward dialysis discontinuation have reflected the clinical context in which dialysis is initiated. In the 1960s and 1970s, dialysis was only available to select patients and concerns about distributive justice weighed heavily. Because there was strong enthusiasm for new technology and dialysis was regarded as a precious resource not to be wasted, stopping treatment had negativ...
Conclusions: A practice change to ensure slow IV administration of furosemide eliminated permanent hearing loss. Centers caring for critically ill infants, particularly those with single-ventricle anatomy or hypoxia, should review their drug administration guidelines and adhere to best practice for administration of IV furosemide.
ConclusionsIn this systematic review, we synthesized the studies involving R/S assessment in dialysis patients and their benefit on QoL. R/S has a positive impact on most QoL parameters in 5D-CKD. We suggest that nephrology guidelines on palliative care and/or elderly should include specific recommendations on R/S support and opportunities for integrated specific therapies.
CONCLUSIONS:: Use of the POS-renal questionnaire identified a high symptom burden. The presence and severity of symptoms changed dramatically over a short follow-up period, highlighting the need for regular surveillance of symptoms in the dialysis population. Routine use of a symptom questionnaire in clinic may be useful for the identification and management of symptoms in dialysis patients. PMID: 30757953 [PubMed - as supplied by publisher]
CONCLUSION:: Our model could justify the creation of a novel palliative care introduction trigger, as patients with medium demand for care may benefit from additional palliative care evaluation. The trigger could facilitate the uniformization of conservative treatment preparations. It could prompt messages to a managing physician when a patient crosses the threshold between low and medium appointment utilization. It may also aid in system-level policy development. Furthermore, our results highlight the benefit of significant appointment utilization among high-risk patients. PMID: 30747040 [PubMed - as supplied by publisher]
At the End of Life: Agency, Role and Responsibilities of the Physician/Advanced Practitioner Registration is open for this national, two-day conference, Sept. 13-14, 2019, in Seattle. Physicians and advanced practitioners have the privilege and duty to care for patients at the end of life. Sometimes their actions factor into a patient’s death; such as discontinuing life support (including ventilators, cardiac d...
Conclusions: This study provides information of which factors are associated with self-effectiveness in surrogates of terminally ill renal patients so that strategies based on these considerations might be implemented in the future.
As multiple different studies and surveys continue to illustrate, palliative and hospice medicine has failed to have an appropriate impact on the quality of life for the end-stage renal disease (ESRD) population. People with Chronic Kidney Disease (CKD) remain less likely to die at home, spend more time in the hospital and at higher costs in the last 3 months of life. (Kerr M et al, NDT, 2016).
Patients with life-threatening illness face critical decisions regarding goals of care (GOC) and treatment preferences (TP). Palliative Care (PC) consultants play a pivotal role in clarifying and documenting patients ’ wishes to ensure they receive goals-aligned care. However, inconsistencies in documentation of GOC/TP in the electronic medical record (EMR) can result in patients receiving interventions incongruent with their preferences. Among a baseline sample of patients seen by the University of California San Francisco (UCSF) PC service for GOC discussions in April and May 2017, only 63.3% had any goals document...