Quality of care for in-hospital stroke: analysis of a statewide registry.

Background And Purpose: approximately 4% to 17% of all adult strokes have onset in the hospital. Previous research indicates significant in-hospital evaluation delays and lower adherence to some measures of quality care compared to out-of-hospital strokes.

Methods: quality of care for in-hospital ischemic strokes compared to stroke with out-of-hospital onset was examined using cohort analysis of a statewide stroke database maintained by the Colorado Stroke Alliance.

A strategy to advance the evidence base in palliative medicine: formation of a palliative care research cooperative group.

Background: Palliative medicine has made rapid progress in establishing its scientific and clinical legitimacy, yet the evidence base to support clinical practice remains deficient in both the quantity and quality of published studies. Historically, the conduct of research in palliative care populations has been impeded by multiple barriers including health care system fragmentation, small number and size of potential sites for recruitment, vulnerability of the population, perceptions of inappropriateness, ethical concerns, and gate-keeping.

Methods: A group of experienced investigators with backgrounds in palliative care research convened to consider developing a research cooperative group as a mechanism for generating high-quality evidence on prioritized, clinically relevant topics in palliative care.

Developing the evidence base for palliative care: formation of the Palliative Care Research Cooperative and its first trial.

The field of palliative care and hospice has gained accreditation, with a growing cadre of specialists being trained, but there is a dearth of robust research evidence to guide clinical practice. After 2 years of planning, a group of senior investigators convened in January 2010 to explore the possibility of forming a research cooperative group dedicated to advancing the evidence base in palliative care and hospice. The meeting launched the Palliative Care Research Cooperative (PCRC) with an initial national/international membership, and a plan for developing policies and procedures.

Methodological challenges in conducting a multi-site randomized clinical trial of massage therapy in hospice.

Researchers conducting multi-site studies of interventions for end-of-life symptom management face significant challenges with respect to obtaining an adequate sample and training and retaining on-site study teams. The purpose of this paper is to describe the strategies and responses to these challenges in a multi-site randomized clinical trial (RCT) of the efficacy of massage therapy for decreasing pain among patients with advanced cancer in palliative care/hospice settings. Over a period of 36 months, we enrolled 380 participants across 15 sites; 27% of whom withdrew prior to study completion (less than the anticipated 30% rate).

Variation in pain medication use in end-of-life care.

Background: Pain is a common and distressing symptom at the end of life that medications can help relieve. We sought to explore variation in approaches to pharmaceutical management of pain among hospice-eligible patients and to determine if variation was explained by patient or site of care characteristics. Variation in medication use may suggest areas for best practices or quality improvement in medication use in end-of-life care.

Brief communication: Management of implantable cardioverter-defibrillators in hospice: A nationwide survey.

Background: Communication about the deactivation of implantable cardioverter-defibrillators (ICDs) in patients near the end of life is rare.

Objective: To determine whether hospices are admitting patients with ICDs, whether such patients are receiving shocks, and how hospices manage ICDs.

Design: Cross-sectional survey.

Hospices' preparation and practices for quality measurement.

Context: Hospice and palliative care organizations need to measure and analyze quality of care, in response to national palliative care practice guidelines and new hospice regulatory requirements. Little is known about hospices' readiness to meet this new mandate.

Objectives: We analyzed data from a national survey of hospices to describe preparation and practices for quality measurement and research and to examine associated organizational characteristics.

Lack of patient knowledge regarding hospital medications.

Background: Patient involvement in preventing inpatient medication errors is predicated upon patient knowledge of their medications. However, there is little published on the accuracy of patient knowledge or understanding of their hospital medications.

Objective: To assess hospitalized patients' knowledge of their hospital medications and attitudes towards involvement in the medication safety process while hospitalized.

Bereavement: addressing challenges faced by advanced cancer patients, their caregivers, and their physicians.

Physicians who work with advanced cancer patients need to be aware of the process of grief and bereavement not only in terms of how it may impact the patient and family, but in how it can affect their own emotions and behavior. There are a number of simple things that physicians can do to normalize and promote adaptive grieving in advanced cancer patients and their families. Patients facing the end of life face enormous physical and existential challenges.

General internist communication about sexual function with cancer survivors.

Background: Sexual dysfunction is an important issue that affects many cancer survivors who are increasingly being cared for by internists.

Objective: To examine the attitudes and reported practices of internists regarding survivorship care as it pertains to sexual dysfunction.

Design: Surveys were sent to 406 physicians affiliated with the Department of Internal Medicine at the University of Colorado Denver School of Medicine.

Part-time careers in academic internal medicine: a report from the association of specialty professors part-time careers task force on behalf of the alliance for academic internal medicine.

To establish guidelines for more effectively incorporating part-time faculty into departments of internal medicine, a task force was convened in early 2007 by the Association of Specialty Professors. The task force used informal surveys, current literature, and consensus building among members of the Alliance for Academic Internal Medicine to produce a consensus statement and a series of recommendations. The task force agreed that part-time faculty could enrich a department of medicine, enhance workforce flexibility, and provide high-quality research, patient care, and education in a cost-effective manner.

Autoantibody formation after alloimmunization inducing bystander immune hemolysis.

The development of RBC autoantibodies resulting from or associated with allogeneic blood transfusions is not an easily determined complication of RBC transfusions. This report discusses one patient who developed RBC autoantibodies in association with an allogeneic blood transfusion and alloimmunization leading to a temporary bystander immune hemolysis. A 72-year-old woman was hospitalized as a result of severe anemia and received two units of ABO- and D-compatible RBCs.

A framework for assessing quality indicators for cancer care at the end of life.

Patients with advanced cancer often do not receive high-quality pain and symptom management or support with coordination of care, communication, and decision making. Implementing quality indicators that are reflective of the scope of care, feasible to implement, and supported by evidence might help to identify areas and settings most in need of improvement. However, recent reviews and policy initiatives identified only a few indicators that met these criteria.

Support needs of informal hospice caregivers: a qualitative study.

Background: Informal caregivers of hospice patients experience multiple stressors that can negatively impact physical, psychological, and emotional health. The goal of this qualitative study was to understand caregivers' needs to inform the feasibility, structure, and content of a telephone-based counseling intervention.

Methods: Focus groups and interviews with 36 former hospice caregivers and 11 hospice staff from 6 hospices were conducted.

Caring for cancer survivors: a survey of primary care physicians.

Background: The number of long-term US cancer survivors is expected to double by the year 2050. Although primary care physicians (PCPs) provide the majority of care for long-term cancer survivors, to the authors' knowledge, few data to date have detailed PCP practice patterns, attitudes, and challenges in caring for long-term cancer survivors.

Methods: Self-administered surveys were mailed to 406 community- and academic-based general internal medicine physicians in Denver, Colorado.

Brazilian experience with two conditioning regimens in patients with multiple sclerosis: BEAM/horse ATG and CY/rabbit ATG.

Studies have shown that autologous hematopoietic SCT (HSCT) can be used as an intensive immunosuppressive therapy to treat refractory patients and to prevent the progression of multiple sclerosis (MS). This is a prospective multicentric Brazilian MS trial comparing two conditioning regimens: BEAM/horse ATG and CY/rabbit ATG. Most (80.

Developing quality indicators for cancer end-of-life care: proceedings from a national symposium.

Quality indicators applicable to cancer end-of-life care exist, but have not been widely implemented. To advance this field, the authors worked with the Agency for Health Care Research and Quality and the National Cancer Institute to organize a national symposium to discuss key issues and future goals, based on a conceptual framework. Discussions focused on 8 key domains in end-of-life cancer care: pain; dyspnea; communication, care planning, and decision making; psychosocial care; communication about chemotherapy; depression; continuity, coordination, and care transitions; and spirituality and closure.

Providing massage therapy for people with advanced cancer: what to expect.

There is very little information in the literature to prepare massage therapists for what they might expect when they provide treatment to people with advanced cancer in hospice or palliative care. We report an analysis of a subset of data collected from a large multi-site clinical trial of the efficacy of massage therapy for people with advanced cancer. This is the first analysis of empirical data of patient presentation, massage treatment environment, and the characteristics of massage provided for this population.

Symptom burden, depression, and spiritual well-being: a comparison of heart failure and advanced cancer patients.

Background: A lower proportion of patients with chronic heart failure receive palliative care compared to patients with advanced cancer.

Objective: We examined the relative need for palliative care in the two conditions by comparing symptom burden, psychological well-being, and spiritual well-being in heart failure and cancer patients.

Design: This was a cross-sectional study.

[Termination of prokaryotic and eukaryotic translation].

In prokaryotic and eukaryotic organisms termination of translation differs in many aspects. In the first step of termination the release factors recognize stop codons in A site of the ribosome. These factors are responsible for hydrolysis of peptide-tRNA bond and release of newly synthesized peptide.