Aggressiveness of care in a prospective cohort of patients with advanced NSCLC.

Background: Optimal end of life care of patients with terminal cancer is poorly understood. In this study, the aggressiveness of care is described in a cohort of patients with newly diagnosed advanced nonsmall-cell lung cancer (NSCLC).

Methods: Patients within 8 weeks of diagnosis of stage IIIb (with effusions) or IV NSCLC were enrolled in a study to examine the feasibility of involving palliative care services early in the provision of cancer care.

Patient experience of neurologic rehabilitation: a qualitative investigation.

Objective: To understand the experiences of patients who had undergone neurologic rehabilitation.

Design: An interpretative phenomenological analysis of semistructured interviews.

Setting: Neurologic rehabilitation unit.

Symptom distress and quality of life in patients with advanced congestive heart failure.

Little is known about the burden of illness associated with advanced congestive heart failure (CHF). Understanding the needs of this population requires further information about symptoms and other factors related to quality of life. We studied a convenience sample of 103 community-dwelling patients with New York Heart Association Class III/IV CHF.

Some reflections on a few of the pitfalls in the world of foundation grant making.

This paper offers some reflections on the grant-making process from a former foundation executive. Some of the opportunities, challenges, and pitfalls inherent in the foundation world are described, and one approach to grant making, the "call for proposals," is examined as an example of the need for greater attention to and investment in the science of grant making itself, to maximize the potential return from philanthropy.

Improving the management of care for high-cost Medicaid patients.

Increased policy attention is being focused on the management of high-cost cases in Medicaid. In this paper we present an algorithm that identifies patients at high risk of future hospitalizations and offer a business-case analysis with a range of assumptions about the rate of reduction in future hospitalization and the cost of the intervention. The characteristics of the patients identified by the algorithm are described, and the implications of these findings for policymakers, payers, and providers interested in responding more effectively to the needs of these patients are discussed, including the challenges likely to be encountered in implementing an intervention initiative.

Notes from the field: jumpstarting the IRB approval process in multicenter studies.

Objective: To identify strategies that facilitate readiness for local Institutional Review Board (IRB) review, in multicenter studies.

Study Setting: Eleven acute care hospitals, as they applied to participate in a foundation-sponsored quality improvement collaborative.

Study Design: Case series.

Phase II study: integrated palliative care in newly diagnosed advanced non-small-cell lung cancer patients.

Purpose: To assess the feasibility of early palliative care in the ambulatory setting in patients with newly diagnosed advanced non-small-cell lung cancer (NSCLC).

Patients And Methods: Patients were eligible if they had a performance status of 0 to 1 and were within 8 weeks of diagnosis of advanced NSCLC. Participants received integrated care from oncology and palliative care throughout the course of their disease.

Organizational Systems Questionnaire (OSQ) Validity Study.

Marriage and family therapists (MFTs), who are trained in systems theory and consult with complex and difficult systems (e.g., couples and families), are uniquely suited to both assess and intervene in broader organizational systems.

High prevalence of proximal and distal gastroesophageal reflux disease in advanced COPD.

Background: Gastroesophageal reflux disease (GERD) is common in a variety of chronic respiratory diseases, but little is known about GERD in the setting of COPD. The aims of this study were to determine the prevalence, presentation, and predictors of GERD based on proximal and distal esophageal pH monitoring in patients with severe COPD.

Methods: Forty-one COPD patients with a mean FEV1 of 24% of predicted underwent dual-probe 24-h esophageal pH monitoring, and 1 patient underwent esophagogastroduodenoscopy.

Spirituality training for palliative care fellows.

Introduction: Spirituality is a major domain of palliative medicine training. No data exist on how it is taught, nor is there a consensus about the content or methods of such education. We surveyed palliative medicine fellowship directors in the United States to learn how they teach spirituality, who does the teaching, and what they teach.

Lung function and ischemic stroke incidence: the Atherosclerosis Risk in Communities study.

Background: Few studies have examined the relation between lung function and ischemic stroke incidence; none have studied African Americans.

Methods: We followed 13,842 middle-aged adults initially free of stroke and coronary heart disease and observed 472 incident ischemic strokes over 13 years. Quartiles of FEV(1) as a percentage of predicted value (FEV(1)PP) and FVC as a percentage of a predicted value (FVCPP) were used as the indicators of lung function.

Proposed quality measures for palliative care in the critically ill: a consensus from the Robert Wood Johnson Foundation Critical Care Workgroup.

For critically ill patients and their loved ones, high-quality health care includes the provision of excellent palliative care. To achieve this goal, the healthcare system needs to identify, measure, and report specific targets for quality palliative care for critically ill or injured patients. Our objective was to use a consensus process to develop a preliminary set of quality measures to assess palliative care in the critically ill.

Merging cultures: palliative care specialists in the medical intensive care unit.

We summarize the key interventions and general findings from a 3-yr project titled, "Merging Palliative and Critical Care Cultures in the Medical Intensive Care Unit." This multifaceted demonstration project was designed so palliative care and intensive care clinicians would share their expertise and develop projects that promote end-of-life care in a medical intensive care unit (ICU) setting. A variety of interventions are described, including collaborating with ICU leaders, training nurses as "palliative care champions," opening visiting hours, educating house officers and other staff about relevant palliative practices, establishing the presence of a palliative care specialist during work rounds, teaching about and promoting family meetings, introducing a "Get to Know Me" poster, staff support efforts, and modeling of interdisciplinary teamwork.

Creating enduring change: demonstrating the long-term impact of a faculty development program in palliative care.

Background: Improved educational and evaluation methods are needed in continuing professional development programs.

Objective: To evaluate the long-term impact of a faculty development program in palliative care education and practice.

Design: Longitudinal self-report surveys administered from April 2000 to April 2005.

Case finding for patients at risk of readmission to hospital: development of algorithm to identify high risk patients.

Objective: To develop a method of identifying patients at high risk of readmission to hospital in the next 12 months for practical use by primary care trusts and general practices in the NHS in England.

Data Sources: Data from hospital episode statistics showing all admissions in NHS trusts in England over five years, 1999-2000 to 2003-4; data from the 2001 census for England. Population All residents in England admitted to hospital in the previous four years with a subset of "reference" conditions for which improved management may help to prevent future admissions.

The role of faith-based institutions in addressing health disparities: a case study of an initiative in the southwest Bronx.

Although many public health initiatives have been implemented through collaborations with faith-based institutions, little is known about best practices for developing such programs. Using a community-based participatory approach, this case study examines the implementation of an initiative in the Bronx, New York, that is designed to educate community members about health promotion and disease management and to mobilize church members to seek equal access to health care services. The study used qualitative methods, including the collaborative development of a logic model for the initiative, focus groups, interviews, analysis of program reports, and participant observation.

Fostering organizational change through a community-based initiative.

Program funders and managers are increasingly interested in fostering changes in the policies, practices, and procedures of organizations participating in community-based initiatives. But little is known about what factors contribute to the institutionalization of change. In this study, the authors assess whether the organizational members of the Bronx Health REACH Coalition have begun to change their functioning and role with regard to their clients and their staff and in the broader community, apart from their implementation of the funded programs for which they are responsible.

Racial and ethnic disparities in health: a view from the South Bronx.

This study seeks to understand the perspective of Black and Hispanic/Latino residents of the South Bronx, New York, on the causes of persistent racial and ethnic disparities in health outcomes. In particular, it focuses on how people who live in this community perceive and interact with the health care system. Findings from 9 focus groups with 110 participants revealed a deep and pervasive distrust of the health care system and a sense of being disrespected, exacerbated by difficulties that patients experience in communicating with their providers.