Self-Management for Persistent Subacromial Pain
Condition: Shoulder Pain Chronic Intervention: Behavioral: Self-Managed Exercise Strategy Sponsors: Oslo and Akershus University College of Applied Sciences; Oslo University Hospital; Keele University; National Institute of Occupational Health; Diakonhjemmet Hospital Completed
Among seriously ill patients, those with advanced chronic kidney disease (CKD) and end-stage kidney disease (ESKD) arguably receive among the worst end-of-life care. These patients frequently die in the hospital, often after an intensive procedure like cardiopulmonary resuscitation, and with a low referral rate to hospice. There is now a concerted effort in the nephrology and palliative care communities to integrate palliative care into the treatment of these seriously ill patients. The Pathways Project is a national demonstration, funded by the Gordon and Betty Moore Foundation, to develop scalable innovations in kidney supportive care.
Increasing numbers of patients living with serious illness are requesting access to medical cannabis as well as guidance about its use for pain and symptom management, as a disease-modifying drug for cancer and other diseases, and as a strategy to avoid chronic opioid and benzodiazepine use. Select palliative care clinics have incorporated cannabis into their therapeutic toolkit, and “cannabis consultations” have become an entry point for accessing palliative care for some patients. In many states, physicians and advance practice providers are responsible for counseling and registering patients for medical cann...
Palliative care practitioners are increasingly treating patients with comorbid opioid use disorder (OUD), yet guidance is lacking for managing pain in this population. Historically, palliative care clinicians have liberally prescribed opioids to patients with limited prognosis. As medicine has evolved, patients with chronic illnesses, even metastatic cancer, are living longer thanks to immunotherapies and other novel treatments. Thus, palliative care patients are at greater risk of both developing OUD and/or chemical coping while receiving intensive treatments.
Bilateral renal agenesis has historically been described as “incompatible with life” as chronic anhydramnios results in pulmonary hypoplasia, leading to respiratory failure at birth. Recent reports have detailed the survival of infants with renal disease and severe oligo-/anhydramnios following prenatal serial amnioinfusions as a bridge to neonatal dialy sis with the goal of pediatric kidney transplant. Subsequently, clinical trials have proposed treating fetuses with bilateral renal agenesis with serial prenatal amnioinfusions to allow for pulmonary maturation and the potential for long-term survival.
Chronic lung disease is the fourth leading cause of death in the United States and third leading cause of death worldwide. Patients often live for years with reduced quality of life and significant distress related to symptoms, stigma, reduced functional capabilities, social isolation, and complicated self-management protocols. Evaluating the potential benefits of advanced life support and bronchoscopic or surgical interventions can be daunting, even for actively involved patients. The World Health Organization's GOLD Guidelines recommend pulmonary rehabilitation (PR), a 6- to 8-week course of exercise training, education,...
Guidelines recommend advance care planning (ACP) as essential to quality chronic kidney disease (CKD) management, but the nephrology community has yet to incorporate ACP upstream of the dialysis decision. Others have attempted to improve ACP for dialysis patients, but many patients report wishing they had been engaged in ACP earlier. This project tested integration of ACP coaching in the upstream setting of nephrology offices.
Advance care planning (ACP) is the process of understanding and sharing personal values and goals to ensure people with serious illnesses receive medical care that is consistent with their preferences. With the increasing complexity of medical options available to patients, ACP is regarded as a means of preserving individual autonomy. Despite significant public awareness and interventions developed to increase ACP participation, this practice remains under-utilized by those with chronic illnesses.
Patients suffering from incurable and debilitating conditions are in crucial need of interprofessional palliative care services. Palliative care teams monitor, manage, and maintain such patients' performance status while improving symptoms and facilitating goals-of-care discussions. A growing workforce shortage in palliative care professionals as well as access issues in remote areas are significant barriers to patient-centered, serious illness care. Efforts to bring palliative care interprofessional expertise to patients in the community have proven successful in increasing early goals-of-care discussions, improving compl...
Children with complex chronic conditions (CCC) are assisted with technology and receive intensive medical care throughout their lives, resulting in unique end-of-life (EOL) needs. Parent perspectives are necessary to improving care, yet little is known about the lived experience of parents of children with CCC.
End-stage chronic obstructive disease (COPD) has a high level of symptom burden, requirement for long-term oxygen therapy and frequent exacerbations that require hospitalization. Research to date is limited regarding the delivery and impact of palliative care services in patients with end-stage COPD.