Prognoses Associated With Palliative Performance Scale Scores in Modern Palliative Care Practice.

Importance: The Palliative Performance Scale (PPS) is one of the most widely used prognostic tools for patients with serious illness. However, current prognostic estimates associated with PPS scores are based on data that are over a decade old.

Objective: To generate updated prognostic estimates by PPS score, care setting, and illness category, and examine how well PPS predicts short- and longer-term survival.

Geriatric conditions and healthcare utilization among older adults living in subsidized housing.

Background: Nearly 2.9 million older Americans with lower incomes live in subsidized housing. While regional and single-site studies show that this group has higher rates of healthcare utilization compared to older adults in the general community, little is known about healthcare utilization nationally nor associated risk factors.

High Chlorine Concentrations in an Unconventional Oil and Gas Development Region and Impacts on Atmospheric Chemistry.

Growth in unconventional oil and gas development (UOGD) in the United States has increased airborne emissions, raising environmental and human health concerns. To assess the potential impacts on air quality, we deployed instrumentation in Karnes City, Texas, a rural area in the middle of the Eagle Ford Shale. We measured several episodes of elevated Cl levels, reaching maximum hourly averages of 800 ppt, the highest inland Cl concentration reported to date.

Telephone Outreach Enhances Recruitment of Underrepresented Seriously Ill Patients for an Advance Care Planning Pragmatic Trial.

Background: Patients experiencing systemic patterns of disadvantage, such as racial/ethnic minorities and those with limited English proficiency, are underrepresented in research. This is particularly true for large pragmatic trials of potentially sensitive research topics, such as advance care planning (ACP). It is unclear how phone outreach may affect research participation by underrepresented individuals.

Potential for remote vital sign monitoring to improve hospital patient sleep: A feasibility study.

Background: Even low-acuity patients suffer from disrupted sleep in the hospital in part due to routine overnight vital sign (VS) checks. When invasive monitoring is not needed, vital sign monitoring devices (VSMDs) similar to consumer-grade health monitors may play a role in promoting sleep, which can aid healing and recovery.

Methods: We provided one VSMD to neuroscience ward patients during their hospital stays and used surveys to assess patient and nurse attitudes toward the device and the impact of the device on patient comfort.

Impact of persistent pain on function, cognition, and well-being of older adults.

Background: We sought to determine the population-level associations between persistent pain and subsequent changes in physical function, cognitive function, and well-being, outcomes important to older adults.

Methods: We used data from National Health Aging Trends Study (NHATS) of community-dwelling Medicare beneficiaries age 65+ from 2011 to 2019. We defined "persistent pain" as being bothered by pain in the last month in both the 2011and 2012 interviews and "intermittent" pain including those reporting bothersome pain in one interview only.

Life expectancy for community-dwelling persons with dementia and severe disability.

Background: Understanding life expectancy can help persons with dementia, their care partners, and policymakers plan for what lies ahead. We sought to determine life expectancy and predictors of mortality for community-dwelling persons with dementia and severe disability.

Methods: Using the National Health and Aging Trends Study (NHATS) linked to Medicare claims, we identified community-dwelling respondents age 65+ who entered NHATS in 2011 with dementia and severe disability (defined as three impairments in activities of daily living), or who subsequently met criteria for dementia and then severe disability.

COVID-19 severity and age increase the odds of delirium in hospitalized adults with confirmed SARS-CoV-2 infection: a cohort study.

Background: Despite recognition of the neurologic and psychiatric complications associated with SARS-CoV-2 infection, the relationship between coronavirus disease 19 (COVID-19) severity on hospital admission and delirium in hospitalized patients is poorly understood. This study sought to measure the association between COVID-19 severity and presence of delirium in both intensive care unit (ICU) and acute care patients by leveraging an existing hospital-wide systematic delirium screening protocol. The secondary analyses included measuring the association between age and presence of delirium, as well as the association between delirium and safety attendant use, restraint use, discharge home, and length of stay.

Validation of automated fluorescent-based technology for measuring total nucleated cell viability of hematopoietic progenitor cell products.

Background: A reliable rapid method for measuring total nucleated cell (TNC) viability is essential for cell-based products manufacturing. The trypan blue (TB) exclusion method, commonly used to measure TNC viability of hematopoietic progenitor cell (HPC) products, is a subjective assay, typically uses a microscope, and includes a limited number of cells. The NucleoCounter NC-200 is an automated fluorescent-based cell counter that uses pre-calibrated cartridges with acridine orange and DAPI dyes to measure cell count and viability.

Evaluation of Neighborhood Socioeconomic Characteristics and Advance Care Planning Among Older Adults.

Importance: Advance care planning (ACP) is low among older adults with socioeconomic disadvantage. There is a need for tailored community-based approaches to increase ACP, but community patterns of ACP are poorly understood.

Objective: To examine the association between neighborhood socioeconomic status (nSES) and ACP and to identify communities with both low nSES and low rates of ACP.

Post-transcriptional air pollution oxidation to the cholesterol biosynthesis pathway promotes pulmonary stress phenotypes.

The impact of environmentally-induced chemical changes in RNA has been fairly unexplored. Air pollution induces oxidative modifications such as 8-oxo-7,8-dihydroguanine (8-oxoG) in RNAs of lung cells, which could be associated with premature lung dysfunction. We develop a method for 8-oxoG profiling using immunocapturing and RNA sequencing.

The Association Between Patient-reported Clinical Factors and 30-day Acute Care Utilization in Chronic Heart Failure.

Background: Heart failure patients have high rates of repeat acute care use. Current efforts for risk prediction often ignore postdischarge data.

Objective: To identify postdischarge patient-reported clinical factors associated with repeat acute care use.

Multimorbidity and Opioid Prescribing in Hospitalized Older Adults.

Multimorbidity and pain are both common among older adults, yet pain treatment strategies for older patients with multimorbidity have not been well characterized. To assess the prevalence and relationship between multimorbidity and opioid prescribing in hospitalized older medical patients with pain. We collected demographic, morbidity, pain, and analgesic treatment data through structured review of the electronic medical records of a consecutive sample of 238 medical patients, aged ≥65 years admitted between November 2014 and May 2015 with moderate-to-severe pain by numerical pain rating scale (range 4-10).

Social Support and Patterns of Institutionalization Among Older Adults: A Longitudinal Study.

Objectives: To identify participants living at home and to estimate the risk of their transition into an institutional setting.

Design: Prospective cohort study from the National Health and Aging Trends Study (NHATS), a nationally representative survey of US adults aged 65 and older.

Setting: US national sample.

Care Settings and Clinical Characteristics of Older Adults with Moderately Severe Dementia.

Objectives: Little population-level evidence exists to guide the development of interventions for people with dementia in non-nursing home settings. We hypothesized people living at home with moderately severe dementia would differ in social, functional, and medical characteristics from those in either residential care or nursing home settings.

Design: Retrospective cohort study using pooled data from the National Health and Aging Trends Study, an annual survey of a nationally representative sample of Medicare beneficiaries.

Interdisciplinary Teams and Home-Based Medical Care: Secondary Analysis of a National Survey.

Objectives: The objective of this study was to describe the use of interdisciplinary teams (IDTs) in home-based medical care practices.

Design: We performed a secondary data analysis using results from the 2013 National Home-Based Primary Care and Palliative Care Network survey of home-based medical care (HBMC) practices.

Setting And Participants: Two hundred forty-six unique HBMC practices were included in this study.

Managing Chronic Pain in Cancer Survivors Prescribed Long-Term Opioid Therapy: A National Survey of Ambulatory Palliative Care Providers.

Context: Chronic pain, or pain lasting more than three months, is common among cancer survivors, who are often prescribed long-term opioid therapy (LTOT).

Objective: Our objective was to explore palliative care providers' experiences with managing chronic pain in cancer survivors prescribed LTOT, specifically in ambulatory palliative care settings, and their strategies for overcoming challenges.

Methods: We recruited providers through leading national palliative care organizations who manage chronic pain in cancer survivors.

Pain and Emergency Department Use in the Last Month of Life Among Older Adults With Dementia.

Context: Pain may be a potentially modifiable risk factor for expensive and burdensome emergency department (ED) visits near the end of life for older adults with dementia.

Objectives: The objective of this study was to assess the effect of pain and unmet need for pain management on ED visits in the last month of life in older adults with dementia.

Methods: This is a mortality follow-back study of older adults with dementia in the National Health and Aging Trends Study who died between 2012 and 2014, linked to Medicare claims.

Prevalence and Characteristics of Moderate to Severe Pain among Hospitalized Older Adults.

Objectives: To investigate the prevalence, characteristics, and management of pain in older hospitalized medical patients.

Design: Medical record aggregate review.

Setting: Tertiary care hospital.

Medication burden attributable to chronic co-morbid conditions in the very old and vulnerable.

Objective: Polypharmacy is common in older patients but relationships between polypharmacy and common co-morbid conditions have not been elucidated. Our goal was to determine relationships between daily oral medication use and common co-morbid disease dyads and triads using comprehensive medication and diagnostic data from a national sample of nursing homes (NH).

Design: Retrospective, cross-sectional study.

Similar clinical benefits from below-target and target dose enalapril in patients with heart failure in the SOLVD Treatment trial.

Aims: To examine associations of below-target and target dose of enalapril, an angiotensin-converting enzyme (ACE) inhibitor, with outcomes in patients with heart failure and reduced ejection fraction (HFrEF) in the Studies of Left Ventricular Dysfunction (SOLVD) Treatment trial.

Methods And Results: Two thousand five hundred and sixty-nine patients with HFrEF (ejection fraction ≤35%) were randomized to below-target (5-10 mg/day) dose placebo (n = 1284) or enalapril (n = 1285). One month post-randomization, blind up-titration to target (20 mg/day) dose was attempted for both study drugs in 2458 patients.

Characteristics of Older Adults in Primary Care Who May Benefit From Primary Palliative Care in the U.S.

Context: Older adults with advanced illness and associated symptoms may benefit from primary palliative care, but limited data exist to identify older adults in U.S. primary care to benefit from this care.

Association between patients' perception of the comorbidity burden and symptoms in outpatients with common solid tumors.

Background: Cancer patients' symptom burden is commonly attributed to their cancer and treatment. Increasingly, cancer patients have many other chronic comorbid conditions. However, the degree to which these comorbid conditions may contribute to the patient-reported symptom burden is unclear.

"She Would Be Flailing Around Distressed": The Critical Role of Home-Based Palliative Care for Patients with Advanced Cancer.

Background: Patients with advanced cancer experience significant symptoms, ineffective treatments, and hospice underutilization. Home-based palliative care (HBPC) may fill a service gap for patients who require intensive home management, but are not enrolled in hospice. Even as data emerge on the utilization impacts of HBPC, other impacts are not as well known.

Life-Space Assessment Predicts Hospital Readmission in Home-Limited Adults.

Objectives: To describe the association between restricted life-space and characteristics of community-dwelling adults hospitalized for congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD), to estimate the effect of hospitalization on postdischarge mobility, and to determine whether baseline restricted life-space predicts hospital readmission.

Design: Observational.

Setting: Urban academic hospital that serves as a safety net for urban and rural populations with low resources and serves central and northern Alabama.