Introduction: Identifying the complexity of palliative care needs is a key aspect of referral to specialized multidisciplinary early palliative care (EPC) teams. The PALCOM scale is an instrument consisting of five multidimensional assessment domains developed in 2018 and validated in 2023 to identify the level of complexity in patients with advanced cancer. (1) Objectives: The main objective of this study was to determine the degree of instability (likelihood of level change or death), health resource consumption and the survival of patients according to the level of palliative complexity assigned at the baseline visit during a 6-month follow-up. (2) Method: An observational, prospective, multicenter study was conducted using pooled data from the development and validation cohort of the PALCOM scale. The main outcome variables were as follows: (a) instability ratio (IR), defined as the probability of level change or death; (b) emergency department visits; (c) days of hospitalization; (d) hospital death; (e) survival. All the variables were analyzed monthly according to the level of complexity assigned at the baseline visit. (3) Results: A total of 607 patients with advanced cancer were enrolled. According to the PALCOM scale, 20% of patients were classified as low complexity, 50% as medium and 30% as high complexity. The overall IR was 45% in the low complexity group, 68% in the medium complexity group and 78% in the high complexity group ( < 0.001). No significant differences in mean monthly emergency department visits (0.2 visits/ patient/month) were observed between the different levels of complexity. The mean number of days spent in hospital per month was 1.5 in the low complexity group, 1.8 in the medium complexity group and 3.2 in the high complexity group ( < 0.001). The likelihood of in-hospital death was significantly higher in the high complexity group (29%) compared to the medium (16%) and low (8%) complexity groups ( < 0.001). Six-month survival was significantly lower in the high complexity group (24%) compared to the medium (37%) and low (57%) complexity groups ( < 0.001).
Conclusion: According to the PALCOM scale, more complex cases are associated with greater instability and use of hospital resources and lower survival. The data also confirm that the PALCOM scale is a consistent and useful tool for describing complexity profiles, targeting referrals to the EPC and managing the intensity of shared care.
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http://dx.doi.org/10.3390/cancers16091744 | DOI Listing |
Rehabil Nurs
December 2024
Center of Innovation for Complex Chronic Healthcare, Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, IL, USA.
Purpose: The study purpose was to develop and assess a simulation for registered nurses to apply knowledge, skills, and attitudes in conducting a focused assessment in the clinic setting to prevent community-acquired pressure injuries (CAPrIs) in individuals living with spinal cord injury (SCI).
Methods: Development, psychometric assessment, and pilot of a simulation for a nurse-patient clinic appointment to prevent CAPrIs at home. Evaluations were conducted via focus group.
Noise Health
January 2025
School of Public Health, Anhui University of Science and Technology, Huainan, Anhui, People's Republic of China.
Objectives: This study aims to investigate the relationship between noise kurtosis and cardiovascular disease (CVD) risk while exploring the potential of kurtosis assessment in evaluating CVD risk associated with complex noise exposure in coal mines.
Methods: This cross-sectional study started in April 2021 and ended in November 2022. It involved 705 coal miners selected from 1045 participants.
JCO Precis Oncol
January 2025
Sarcoma Translational Research Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain.
Purpose: Less than 5% of GI stromal tumors (GISTs) are driven by the loss of the succinate dehydrogenase (SDH) complex, resulting in a pervasive DNA hypermethylation pattern that leads to unique clinical features. Advanced SDH-deficient GISTs are usually treated with the same therapies targeting KIT and PDGFRA receptors as those used in metastatic GIST. However, these treatments display less activity in the absence of alternative therapeutic options.
View Article and Find Full Text PDFClin Orthop Relat Res
December 2024
Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, USA.
Background: Value-based care payment and delivery models such as the recently implemented Merit-based Incentive Payment System (MIPS) aim to both provide better care for patients and reduce costs of care. Gender disparities across orthopaedic surgery, encompassing reimbursement, industry payments, referrals, and patient perception, have been thoroughly studied over the years, with numerous disparities identified. However, differences in MIPS performance based on orthopaedic surgeon gender have not been comprehensively evaluated.
View Article and Find Full Text PDFMod Br Hist
January 2025
International Studies Group, University of the Free State, Bloemfontein, Free State, South Africa.
The histories of the global anti-apartheid struggle, and particularly the British Anti-Apartheid Movement (AAM), have predominantly been examined through a transnational and national prism, creating an inaccurate impression of a highly centralized and homogeneous movement. We argue, however, that refining the analysis to focus on the local setting reveals a more complex and diverse movement, which has not been fully captured in the existing scholarship. Using Dundee as a case study, this article charts the emergence, character, and evolution of anti-apartheid sentiment and activity in this small, peripheral industrial Scottish city.
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