Inpatient allergy delabeling of pediatric patients with low-risk penicillin allergy status through direct oral amoxicillin challenge.

Less than 5% of children who report penicillin allergy have clinically pertinent type 1 immunoglobulin E mediated hypersensitivity reaction by using direct oral amoxicillin challenge. Several pathways have been developed to delabel penicillin allergy by using direct oral amoxicillin challenge, mostly in the outpatient settings, but there is relative scarcity on published outcomes of these pathways, especially in the inpatient pediatric settings. This study aimed to evaluate the performance of an institutionally derived inpatient penicillin allergy screening tool.

Selecting outcomes for pragmatic clinical trials in dementia care: The IMPACT Collaboratory iLibrary.

Background: Many interventions improve care and outcomes for people with Alzheimer's Disease and related dementias (ADRD), yet are never disseminated. Pragmatic trials facilitate the adoption and dissemination of best practices, but gaps in pragmatic outcome measurement are a critical obstacle. Our objectives are (1) to describe the development and structure of the IMbedded Pragmatic ADRD Clinical Trials Collaboratory (IMPACT) iLibrary of potential outcome measures for ADRD pragmatic trials, and (2) to assess their pragmatic characteristics.

Palliative care for persons with late-stage Alzheimer's and related dementias and their caregivers: protocol for a randomized clinical trial.

Background: Limited access to specialized palliative care exposes persons with late-stage Alzheimer's disease and related dementias (ADRD) to burdensome treatment and unnecessary hospitalization and their caregivers to avoidable strain and financial burden. Addressing this unmet need, the purpose of this study was to conduct a randomized clinical trial (RCT) of the ADRD-Palliative Care (ADRD-PC) program.

Methods: The study will use a multisite, RCT design and will be set in five geographically diverse US hospitals.

N Addition Overwhelmed the Effects of P Addition on the Soil C, N, and P Cycling Genes in Alpine Meadow of the Qinghai-Tibetan Plateau.

Although human activities have greatly increased nitrogen (N) and phosphorus (P) inputs to the alpine grassland ecosystems, how soil microbial functional genes involved in nutrient cycling respond to N and P input remains unknown. Based on a fertilization experiment established in an alpine meadow of the Qinghai-Tibetan Plateau, we investigated the response of the abundance of soil carbon (C), N, and P cycling genes to N and P addition and evaluated soil and plant factors related to the observed effects. Our results indicated that the abundance of C, N, and P cycling genes were hardly affected by N addition, while P addition significantly increased most of them, suggesting that the availability of P plays a more important role for soil microorganisms than N in this alpine meadow ecosystem.

The Plant Interspecific Association in the Revegetated Alpine Grasslands Determines the Productivity Stability of Plant Community Across Restoration Time on Qinghai-Tibetan Plateau.

Grassland cultivation is the key measure for restoring "Black Beach," the extremely degraded alpine meadow in the Three River Headwater Area of the Qinghai-Tibetan Plateau. In this study, we examined the inter-specific relationship in the vegetation community of cultivated grasslands with different restoration times through the network analysis method. The results showed that with the extension of restoration time, the development of cultivated grassland would lead to increasing neutral interactions among the plant species.

Identification of Uncontrolled Symptoms in Cancer Patients Using Natural Language Processing.

Context: For patients with cancer, uncontrolled pain and other symptoms are the leading cause of unplanned hospitalizations. Early access to specialty palliative care (PC) is effective to reduce symptom burden, but more efficient approaches are needed for rapid identification and referral. Information on symptom burden largely exists in free-text notes, limiting its utility as a trigger for best practice alerts or automated referrals.

How well do documented goals-of-care discussions for patients with stage IV cancer reflect communication best practices?

Background: Written clinical communication regarding patients' disease understanding and values may facilitate goal-concordant care, yet little is known about the quality of electronic health record (EHR) documentation. We sought to (1) describe frequency of communication best practices in EHR-documented goals-of-care discussions, and (2) assess whether templated notes improve quality of documentation.

Methods: Researchers pulled text of EHR-documented goals-of-care discussions for hospitalized patients with Stage IV cancer from admission to 60-days follow-up.

Measuring Goal-Concordant Care in Palliative Care Research.

>Goal-concordant care is a priority outcome for palliative care research, yet the field lacks consensus on optimal methods for measurement. We sought to 1) categorize methods used to measure goal-concordant care, and 2) discuss strengths and limitations of each method using empirical examples from palliative care research. We categorized measurement methods for goal-concordant care.

Pre-Post Evaluation of Collaborative Oncology Palliative Care for Patients With Stage IV Cancer.

Context: The Collaborative Care Model improves care processes and outcomes but has never been tested for palliative care.

Objectives: To develop and evaluate a model of collaborative oncology palliative care for Stage IV cancer.

Methods: We conducted a pre-post evaluation of Collaborative Oncology Palliative Care (CO-Pal), enrolling patients with Stage IV lung, breast or genitourinary cancers and acute illness hospitalization.

Mortality Risk for Patients With Stage IV Cancer and Acute Illness Hospitalization.

Context: Cancer prognosis data often come from clinical trials which exclude patients with acute illness.

Objectives: For patients with Stage IV cancer and acute illness hospitalization to 1) describe predictors of 60-day mortality and 2) compare documented decision-making for survivors and decedents.

Methods: Investigators studied a consecutive prospective cohort of patients with Stage IV cancer and acute illness hospitalization.

Does Receipt of Recommended Elements of Palliative Care Precede In-Hospital Death or Hospice Referral?

Context: Palliative care aligns treatments with patients' values and improves quality of life, yet whether receipt of recommended elements of palliative care is associated with end-of-life outcomes is understudied.

Objectives: To assess whether recommended elements of palliative care (pain and symptom management, goals of care, and spiritual care) precede in-hospital death and hospice referral and whether delivery by specialty palliative care affects that relationship.

Methods: We conducted structured chart reviews for decedents with late-stage cancer, dementia, and chronic kidney disease with a hospital admission during the six months preceding death.

Elements of Palliative Care in the Last 6 Months of Life: Frequency, Predictors, and Timing.

Importance: Persons living with serious illness often need skilled symptom management, communication, and spiritual support. Palliative care addresses these needs and may be delivered by either specialists or clinicians trained in other fields. It is important to understand core elements of palliative care to best provide patient-centered care.

Electronic Health Record Phenotypes for Identifying Patients with Late-Stage Disease: a Method for Research and Clinical Application.

Background: Systematic identification of patients allows researchers and clinicians to test new models of care delivery. EHR phenotypes-structured algorithms based on clinical indicators from EHRs-can aid in such identification.

Objective: To develop EHR phenotypes to identify decedents with stage 4 solid-tumor cancer or stage 4-5 chronic kidney disease (CKD).

Quality of Life with Late-Stage Dementia: Exploring Opportunities to Intervene.

Background/objectives: In late-stage dementia, families often prioritize quality of life (QoL) and comfort, yet little research examines factors impacting QoL. We sought to (1) describe temporal trends in QoL in late-stage dementia, and (2) explore associations between patient characteristics, care interventions, and QoL.

Design: Secondary analysis of data from the Goals of Care clinical trial.

Concordance between Goals of Care and Treatment Decisions for Persons with Dementia.

Background: Nursing home (NH) residents with dementia experience high rates of intensive treatment near the end of life. Limited research examines whether treatment is concordant with goals of care (GOC).

Objectives: We analyzed data from the GOC trial to describe family decision makers' preferred GOC and perceptions of goal-concordant care for NH residents with late-stage dementia We compared subsequent treatment orders when families chose a primary goal of comfort versus other goals.

A Novel Screening Method to Identify Late-Stage Dementia Patients for Palliative Care Research and Practice.

Context: Investigators need novel methods for timely identification of patients with serious illness to test or implement new palliative care models.

Objectives: The study's aim was to develop an electronic health record (EHR) phenotype to identify patients with late-stage dementia for a clinical trial of palliative care consultation.

Methods: We developed a computerized method to identify patients with dementia on hospital admission.

Nationwide Quality of Hospice Care: Findings From the Centers for Medicare & Medicaid Services Hospice Quality Reporting Program.

Context: With increasing use of the Medicare hospice benefit, policymakers recognize the need for quality measurement to assure that terminally ill patients receive high-quality care and have the information they need when selecting a hospice. Toward these goals, Centers for Medicare & Medicaid Services has been collecting standardized patient-level quality data via the Hospice Item Set (HIS) since July 1, 2014.

Objective: This article presents a first look at the national hospice HIS quality data.

Nocardia Brain Abscess and CD4(+) Lymphocytopenia in a Previously Healthy Individual.

Nocardia brain abscesses are a known occurrence in patients with immunocompromised conditions. Nocardial infection is commonly an unfortunate sequela to other complications which these patients are being followed up and treated for. The incidence of nocardial brain abscess in an otherwise healthy patient is extremely rare.

Strategies to support recruitment of patients with life-limiting illness for research: the Palliative Care Research Cooperative Group.

Context: The Palliative Care Research Cooperative Group (PCRC) is the first clinical trials cooperative for palliative care in the U.S.

Objectives: To describe barriers and strategies for recruitment during the inaugural PCRC clinical trial.