Grief Training in Palliative Care Fellowships.

Introduction: No prior study has assessed grief and bereavement curriculum in Hospice and Palliative Medicine (HPM) fellowship programs in the United States.

Methods: A 14-item survey was created and distributed to Accreditation Council for Graduate Medical Education (ACGME)-accredited HPM fellowship Program Directors to assess program demographics, curriculum emphasis, grief and bereavement programming, and attitudes toward grief and bereavement training for HPM fellows.

Results: The overall survey response rate was 63%.

Caring for Each Other: A Resident-Led Peer Debriefing Skills Workshop.

Background: Inadequate time and space to process critical incidents contribute to burnout. Residents do not regularly participate in emotional debriefs. An institutional needs assessment revealed only 11% of surveyed pediatrics and combined medicine-pediatrics residents had participated in a debrief.

Palliative Care Consultations in Patients with Severe Traumatic Brain Injury: Who Receives Palliative Care Consultations and What Does that Mean for Utilization?

Background: Palliative care has the potential to improve goal-concordant care in severe traumatic brain injury (sTBI). Our primary objective was to illuminate the demographic profiles of patients with sTBI who receive palliative care encounters (PCEs), with an emphasis on the role of race. Secondary objectives were to analyze PCE usage over time and compare health care resource utilization between patients with or without PCEs.

Age, knowledge, preferences, and risk tolerance for invasive cardiac care.

Background/objectives: The extent to which individual knowledge, preferences, and priorities explain lower use of invasive cardiac care among older vs. younger adults presenting with acute coronary syndrome (ACS) is unknown. We directly surveyed a group of patients to ascertain their preferences and priorities for invasive cardiovascular care.

Palliative Care Consultation Is Underutilized in Critically Ill General Surgery Patients.

Background: American College of Surgeons recommends palliative care and surgeons collaborate on the care of patients with poor prognoses. These collaborations are done to discuss symptom management and goals of care. However, contemporary practice patterns of palliative care consultation for surgical patients are poorly defined.

Assessing the Impact of a Novel Integrated Palliative Care and Medical Oncology Inpatient Service on Health Care Utilization before Hospice Enrollment.

Background: Evidence increasingly supports the integration of specialist palliative care (PC) into routine cancer care. A novel, fully integrated PC and medical oncology inpatient service was developed at Duke University Hospital in 2011.

Objective: To assess the impact of PC integration on health care utilization among hospitalized cancer patients before hospice enrollment.

Hip Fracture in the Elderly Patients: A Sentinel Event.

Importance: Hip fracture in the elderly patients is associated with increased morbidity and mortality. There is great need for advance care planning should a patient fail to rehabilitate or experience an adverse event during or after recovery. This study was performed to evaluate for palliative care consultation and changes in code status and/or advance directives in elderly patients with hip fracture.

Improvements in Patient and Health System Outcomes Using an Integrated Oncology and Palliative Medicine Approach on a Solid Tumor Inpatient Service.

Purpose: Early palliative care (PC) improves outcomes for outpatients with advanced cancer. Its effect on hospitalized patients with cancer is unknown. Herein, we report on the influence of a novel, fully integrated inpatient medical oncology and PC partnership at a tertiary medical center during its first year of implementation.

Usefulness of Palliative Care to Complement the Management of Patients on Left Ventricular Assist Devices.

Within the last decade, advancements in left ventricular assist device therapy have allowed patients with end-stage heart failure (HF) to live longer and with better quality of life. Like other life-saving interventions, however, there remains the risk of complications including infections, bleeding episodes, and stroke. The candidate for left ventricular assist device therapy faces complex challenges going forward, both physical and psychological, many of which may benefit from the application of palliative care principles by trained specialists.

Expectations and outcomes in geriatric patients with do-not-resuscitate orders undergoing emergency surgical management of bowel obstruction.

Objective: To describe the outcomes and the expected postoperative course for patients with do-not-resuscitate (DNR) orders (DNR patients) who undergo emergency surgical management of bowel obstruction.

Design: We retrospectively identified all patients who underwent emergency surgical management of intestinal obstruction and who were classified previously as DNR using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Participant Use Data File for 2005 through 2009. We constructed a forward stepwise multivariate logistic regression model to determine predictors of postoperative mortality.

Adaptive leadership: a novel approach for family decision making.

Family members of intensive care unit (ICU) patients want to be involved in decision making, but they may not be best served by being placed in the position of having to solve problems for which they lack knowledge and skills. This case report presents an exemplar family meeting in the ICU led by a palliative care specialist, with discussion about the strategies used to improve the capacity of the family to make a decision consistent with the patient's goals. These strategies are presented through the lens of Adaptive Leadership.

End-of-life care at an academic medical center: are attending physicians, house staff, nurses, and bereaved family members equally satisfied? Implications for palliative care.

Background: End-of-life care is deemed to be poor in the United States - particularly in large teaching hospitals. Via a brief survey, we examined satisfaction with end-of-life care for those patients who died in our academic medical center from provider and family perspectives.

Methods: To assess the correlation between overall satisfaction between providers (attending, housestaff, and nurses) as well as family members for decedents who died in our hospital, we conducted a satisfaction survey regarding care in the last three days of life.

Home automated external defibrillators in a geriatric population: a brief discussion of the evidence.

The literature has identified significant successes in cardiac resuscitation with the use of automated external defibrillators (AEDs) in public areas. As of September 2004, the Food and Drug Administration has authorized the purchase of these devices by the general public without a prescription. For the practicing geriatrician attempting to understand the utility of these devices in a geriatric population, this article reviews the relevant literature of cardiac resuscitation and AEDs, with special attention to large public access trials.

Ethnic differences in the place of death of elderly hospice enrollees.

Elderly minorities are more likely to die in inpatient settings than their Caucasian counterparts. It is not known whether this difference is due to cultural preferences for place of death or decreased access to hospice. This analysis examines ethnic differences in the place of death of elderly hospice patients.