1. Participants will be able to identify some of the reasons patients die prior to assessment by the consulted hospice team. Participants will be empowered to work with their corresponding ...institutions to implement changes to overcome these barriers such that patients and their families can benefit from services provided by hospice.
2. Participants will be able to appreciate the challenges faced by hospice teams to ensure that their services are used appropriately and on a timely basis for the benefit of the patient and their families.
One of the challenges that inpatient hospice services face is the fact that some of the hospitalized patients that receive a hospice consult do not survive before they are assessed by the hospice team. Investigating these barriers is important as hospice services provide a vast array of services and supports for patients and their families.
Overcoming the disparities that plague the use of hospice services, as well as predicting which patients are appropriate for these services, and thus would benefit from an inpatient hospice consult are just some of the challenges faced by this newer entity in medicine. Another hurdle in the system is the fact that some of the hospitalized patients that do receive a hospice consult do not survive to be assessed by the hospice team. Thus, the patient and their families do not benefit from the vast array of services and supports that can be provided to them by the hospice team.
To investigate the reasons that some patients who receive a hospice consult during their hospitalization do not survive prior to being assessed by the hospice team.
Collect data for patients’ sex, age, date of hospitalization, primary reason for diagnosis to hospital, primary reason for hospice consult, duration of hospitalization at time of hospice consult, day of hospitalization when palliative team assessed patient, time of death (if occurred inpatient), cause of death, previous contact with palliative care and/or hospice. Data will be obtained from the electronic health record and patients will be anonymized. Inclusion criteria: age >18, hospice was consulted on the patient. Exclusion criteria: age < 18. Automatic data collection will begin as soon as the project has IRB approval: aiming to begin data collection Oct 15th through Oct 31st. Data will be analyzed Nov-Dec 2023 with a final report for Jan-Feb 2024.
Data will be collected and analyzed to see if any consistent themes are revealed regarding reasons leading to patients dying before they are assessed by the hospice team.
Any emerging themes will be discussed regarding causes of patients dying before they are able to be assessed by the hospice team.
Patient Outcomes; Advocacy / Policy/ Regulations
Other than acute cerebrovascular accidents, multiple ring-enhancing lesions are among the most common lesions encountered in neuroimaging. We herein describe the case of a 63-year-old diabetic man ...presenting with altered mental status, hyperglycaemia and community-acquired pneumonia who was found to have two ring-enhancing lesions involving the left frontal lobe and left basal ganglia. The lesions were biopsied to reveal positive fungal cultures and toxoplasma cysts. RPR titres returned reactive for non-treponemal antibodies and a suppressed CD4 count was found without evidence of HIV infection.
An approach is discussed that will direct clinicians to decide whether to treat ring-enhancing brain lesions empirically or biopsy them first.
Cytomegalovirus (CMV) infection is a common cause of morbidity and mortality in immunocompromised hosts. Tissue-invasive CMV disease causing ulcerative skin disease or esophageal necrosis is rare. We ...herein describe two cases: a 47-year-old renal and pancreas transplant recipient who presented with skin ulcerations on his elbow and a 50-year-old renal transplant recipient who presented with acute esophageal necrosis. In both, tissue biopsy revealed CMV inclusion bodies by immunohistochemical staining of infected endothelial and mucosal cells. Ganciclovir was given to both cases and full remission occurred. Due to the varying presentations of acute CMV infection in immunosuppressed hosts, high suspicion and early tissue biopsy are vital for proper diagnosis and treatment when any suspicious cutaneous or mucosal manifestations are present.
•ACEi/ARB need not be discontinued in hospitalized COVID-19 patients•ACEi/ARB use need not be restricted due to COVID-19 pandemic•ACEi/ARB benefits for cardiovascular indications outweigh harm in ...COVID-19 patients.
Bacterial brain abscesses are typically spread through a haematogenous route. Open head wounds and neurosurgical interventions are uncommon aetiologies. Ectopic tissue found in the cerebral cortex is ...usually ascribed almost entirely from carcinomas. Here, we describe a 57-year-old gentleman who, 22 years after a fireworks related traumatic injury to the left orbit, presented with headaches and altered behaviour. Imaging revealed an abscess immediately superior to the orbit, whose bacterial aetiology was identified to be Pseudomonas aeruginosa, encapsulated by ciliated respiratory epithelium. This represents a case in which tissue was displaced during the initial trauma or craniofacial reconstructive surgery from the frontal sinus.
Therapeutic doses of anticoagulation have been administered to patients with coronavirus-19 disease (Covid-19) without thromboembolism, although there is a lack of robust evidence supporting this ...practice.
To compare outcomes between patients admitted to the hospital for Covid-19 who received full-dose anticoagulation purely for the indication of Covid-19 and patients who received prophylactic doses of anticoagulation.
This is a multicenter retrospective cohort study, including 7 community hospitals in Michigan. Patients were >18 years of age, confirmed positive for Covid-19 by polymerase chain reaction, and admitted to the hospital between March 10 and May 3, 2020. Exposed group: Patients receiving therapeutic dose anticoagulation for Covid-19 for any duration excluding clinically evident venous thromboembolism, atrial fibrillation, and myocardial infarction; control group: Patients receiving prophylactic anticoagulation. Propensity score matching was used to adjust for the nonrandomized nature of the study.
The primary endpoint: 30-day in-hospital mortality. Secondary endpoints: intubation, length of hospital stay, and readmissions in survivors.
A total of 115 exposed and 115 control patients were analyzed. Rates of 30-day in-hospital mortality were similar (exposed: 33.0% vs. control: 28.7%). Controlling for institution, there was no significant association between treatment and 30-day in-hospital mortality (hazard ratio: 0.63; 95% confidence interval: 0.37-1.06). Survivors had statistically similar length of hospital stay and readmission rates.
We found no difference in mortality in patients with Covid-19 without clinically evident venous thromboembolism, atrial fibrillation, and myocardial infarction who received therapeutic versus prophylactic doses of anticoagulation.
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