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Identification and documentation of persons being in palliative phase regardless of age, diagnosis and places of care, and their use of a sitting service at the end of life.

https://arctichealth.org/en/permalink/ahliterature127631
Source
Scand J Caring Sci. 2012 Sep;26(3):561-8
Publication Type
Article
Date
Sep-2012
Author
Birgitta Wallerstedt
Eva Sahlberg-Blom
Eva Benzein
Birgitta Andershed
Author Affiliation
School of Health and Medical Sciences, Örebro University, Örebro, Norway. b.wallerstedt@telia.com
Source
Scand J Caring Sci. 2012 Sep;26(3):561-8
Date
Sep-2012
Language
English
Publication Type
Article
Keywords
Aged
Female
Health Services Accessibility
Humans
Male
Palliative Care
Retrospective Studies
Sweden
Abstract
Older persons and persons with diseases other than cancer are often discriminated against when applying for palliative care despite growing numbers of both older persons and individuals with chronic diseases. An intention for palliative care in Sweden is that all persons in the final stage of life, irrespective of age, domicile, diagnosis, and care place shall have access to palliative care on equal terms. One way to support these persons in final stage of life and their relatives is to offer sitting service.
To describe individuals who were identified and documented as being in a palliative phase in a Swedish municipality, with respect to demographics, use of a sitting service, continuity of care in the last month of life and the place of death. A second aim was to describe and compare the groups who received/did not receive sitting services related to the aforementioned variables.
Retrospective data from nursing records and palliative care identification forms were analyzed with descriptive and analytic statistical methods.
Among individuals deceased during 2007, 51% were identified and documented as being in palliative phase. The majority was older people (mean 83 years) with a noncancer diagnosis (58%). Twenty-eight individuals (16%) had received a sitting service between 8 and 249 hours (one extreme value = 2211). It is indicated that sitting service significantly increased the possibility of dying at home (p = 0.00004), but did not affect how often the place of care changed during the last month of life.
A small sample from a Swedish context must be considered.
These results can be related to an awareness in the municipality that led to adopting the concept of palliative care as not only for those with a cancer diagnosis.
PubMed ID
22276925 View in PubMed
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[The so-called inoperable rectal carcinoma. Simultaneously, a contribution to the prognosis of rectal carcinoma]

https://arctichealth.org/en/permalink/ahliterature27976
Source
Med Klin. 1975 May 30;70(22):977-80
Publication Type
Article
Date
May-30-1975
Author
R. Winkler
Source
Med Klin. 1975 May 30;70(22):977-80
Date
May-30-1975
Language
German
Publication Type
Article
Keywords
English Abstract
Germany, West
Humans
Methods
Palliative Care
Prognosis
Rectal Neoplasms - diagnosis - mortality - surgery
Retrospective Studies
Sweden
Abstract
Rectal cancer is quite easy to identify. Simple methods of investigations and early symptoms should allow a good prognosis. This is patholphysiologically supported by slow increasement and relatively late filialisation along long metastatic roads. Therefore it is to be regretted, that of 632 patients, suffering from rectal cancer in the years 1955-1970, 179 (28,3%) could not be treated on cure. Even palliative procedures had a postoperative mortality of 24,6%. This delay in early diagnose reduced the time of survival from 72% 2-jears-survival, when operated on cure (see article) to 59,1% (see article), respectively from 52,1% 5-years-survival (see article) to 38,5% (see article). These results can be only improved by regular prophylactic examinations.
PubMed ID
50554 View in PubMed
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Survival after operations for colorectal cancer in patients aged 75 years or over.

https://arctichealth.org/en/permalink/ahliterature20355
Source
Eur J Surg. 2000 Jun;166(6):473-9
Publication Type
Article
Date
Jun-2000
Author
J T Mäkelä
H. Kiviniemi
S. Laitinen
Author Affiliation
Department of Surgery, Oulu University Hospital, Finland.
Source
Eur J Surg. 2000 Jun;166(6):473-9
Date
Jun-2000
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Colorectal Neoplasms - mortality - surgery
Humans
Multivariate Analysis
Palliative Care
Recurrence
Retrospective Studies
Risk factors
Survival Analysis
Abstract
OBJECTIVE: To define factors that predict mortality and survival in patients with colorectal cancer who are aged 75 or over. DESIGN: Retrospective study. SETTING: University hospital, Finland. SUBJECTS: 231 patients aged 75 or over who were admitted to hospital with colorectal cancer during the 14-year period 1980-93. MAIN OUTCOME MEASURES: Morbidity, mortality, recurrence, and survival. RESULTS: In-hospital mortality after any kind of operation was 8/211 (4%), and 8/175 (5%) of those who had their tumours resected. Morbidity was 35/175 (20%). Factors associated with mortality were weight loss, Dukes'stage, extent of resection, and type of operation. Overall 5-year survival was 28%, overall 10-year survival was 4%, and median survival was 33 months (range 0-150). Survival was most closely related to Duke's stage, extent of resection, and recurrent disease on univariate analysis, but multivariate analysis identified only mode of recurrence (p
PubMed ID
10890544 View in PubMed
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The influence of training level and surgical experience on survival in colorectal cancer.

https://arctichealth.org/en/permalink/ahliterature177381
Source
Langenbecks Arch Surg. 2004 Nov;389(6):524-31
Publication Type
Article
Date
Nov-2004
Author
Marja Hilska
Peter J Roberts
Jyrki Kössi
Hannu Paajanen
Yrjö Collan
Matti Laato
Author Affiliation
Department of Surgery, Turku University Central Hospital, 20520 Turku, Finland. marja.hilska@pp.inet.fi
Source
Langenbecks Arch Surg. 2004 Nov;389(6):524-31
Date
Nov-2004
Language
English
Publication Type
Article
Keywords
Aged
Clinical Competence
Colorectal Neoplasms - mortality - pathology - surgery
Female
Finland
Gastroenterology
Hospitals, Teaching
Humans
Male
Neoplasm Staging
Palliative Care
Prognosis
Retrospective Studies
Abstract
The effect of surgical training level, experience, and operation volume on complications and survival in colorectal cancer during a 10-year period in a medium-volume university hospital was retrospectively studied.
Four hundred and fifty-six patients were resected for primary colorectal adenocarcinoma during the 10-year period of 1981-1990, and of these, 387 patients underwent resection with curative intent. The surgeons were divided into three groups according to training level and volume: group 1, surgeons in training and other surgeons operating annually on only 1-4 patients; group 2, surgeons specializing in gastrointestinal surgery (average annual volume 4-13 operations); group 3, specialists in gastrointestinal surgery (average annual volume 3-8 operations). Postoperative morbidity and mortality rates, as well as long-term survival rates, were analysed, and comparisons were made between the patients in the three groups.
There were no statistically significant differences between the three groups in postoperative morbidity or mortality. Cancer-specific 5-year survival rate of all patients was 57%, and that of those resected in the aforementioned three groups was 51%, 63%, and 55%, respectively, P=0.087. The 5-year survival rates for colon cancer were 59% (total), 52%, 69%, and 58%, respectively, P=0.067, and for rectal cancer were 51% (total), 42%, 53%, and 52%, respectively, P=0.585.
There were no significant differences in the rates of postoperative mortality, morbidity, and long-term overall survival between the volume groups. However, in patients with colon cancer, there was a trend for better survival for those operated on by the surgeons specializing in gastrointestinal surgery, and in rectal cancer patients, a tendency of fewer local recurrences in those operated on by the specialist surgeons.
PubMed ID
15549371 View in PubMed
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Pediatric patients receiving palliative care in Canada: results of a multicenter review.

https://arctichealth.org/en/permalink/ahliterature163184
Source
Arch Pediatr Adolesc Med. 2007 Jun;161(6):597-602
Publication Type
Article
Date
Jun-2007
Author
Kimberley Widger
Dawn Davies
Danielle J Drouin
Laura Beaune
Lysanne Daoust
R Peter Farran
Nago Humbert
Filomena Nalewajek
Marion Rattray
Maria Rugg
Michelle Bishop
Author Affiliation
Pediatric Palliative Care, IWK Health Centre, Halifax, Nova Scotia. kim.widger@utoronto.ca
Source
Arch Pediatr Adolesc Med. 2007 Jun;161(6):597-602
Date
Jun-2007
Language
English
Publication Type
Article
Keywords
Canada
Child
Child, Preschool
Congenital Abnormalities - mortality
Cross-Sectional Studies
Humans
Infant
Neoplasms - mortality
Nervous System Diseases - mortality
Palliative Care - utilization
Retrospective Studies
Abstract
To describe the patients who received care from the 8 dedicated pediatric palliative care programs in Canada in 2002 and to estimate the number of children who may have benefited but did not receive services from these programs.
Retrospective review of medical records combined with a survey of each program.
Seven pediatric palliative care programs based in tertiary care settings and 1 freestanding children's hospice.
The programs cared for 317 children during 2002, of whom 123 died during that year. An additional 32 children died by the end of 2003.
Pediatric palliative care program.
Nearly half (48.6%) of the patients were younger than 5 years, and almost half of these were younger than 1 year. Primary diagnoses were disorders of the nervous system (39.1%), malignancies (22.1%), and conditions arising in the perinatal period or congenital anomalies (22.1%). Most of the children (43.9%) died at home, with those centers reporting more comprehensive home care services having the highest percentage of home deaths. From a national perspective, between 5% and 12% of the children who could benefit from palliative care received services from 1 of these programs.
Pediatric palliative care programs in Canada care for a diverse population of patients with a wide range of age and disease conditions. Only a small percentage of children who die, however, receive services from these dedicated programs.
PubMed ID
17548766 View in PubMed
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Factors associated with length of survival among 1081 terminally ill cancer patients.

https://arctichealth.org/en/permalink/ahliterature216668
Source
J Palliat Care. 1995;11(3):20-4
Publication Type
Article
Date
1995
Author
P. Allard
A. Dionne
D. Potvin
Author Affiliation
Groupe de Recherche en Epidémiologie, Université Laval.
Source
J Palliat Care. 1995;11(3):20-4
Date
1995
Language
English
Publication Type
Article
Keywords
Aged
Female
Humans
Logistic Models
Male
Middle Aged
Neoplasms - mortality
Palliative Care
Prognosis
Proportional Hazards Models
Quebec - epidemiology
Retrospective Studies
Risk factors
Survival Analysis
Abstract
To improve their ability to estimate the survival of terminally ill cancer patients, palliative care physicians require accurate information on prognostic factors. The objective of this study was to assess the extent to which variables such as patient characteristics and primary tumor site affect the length of survival of terminally ill cancer patients. The study population consisted of 1081 cancer patients admitted for terminal care to a 15-bed palliative care unit from 1985 to 1991. Univariate Kaplan-Meier survival analysis and multivariate Cox regression analyses were used to examine the relationship between patient characteristics at admission and survival time. The factor most strongly associated with shorter survival was poor performance status; this strong relationship was not altered by taking into account sex and primary cancer site in the multivariate analysis. For patients who were bedridden at admission, the death rate was 5.5 times higher (95% confidence interval (Cl) 3.4-9.0) than that for ambulatory patients during the first four days of stay, and it was 2.8 times higher (95% Cl 2.0-3.9) subsequently (up to 19 days). The other prognostic factors significantly but slightly associated with poorer survival in the univariate analysis were primary lung cancer, male sex, and living with a spouse. These findings indicate that performance status is the main prognostic factor for accurately estimating the survival time of terminally ill cancer patients.
PubMed ID
7472787 View in PubMed
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Data collection as the first step in program development: the experience of a chronic care palliative unit.

https://arctichealth.org/en/permalink/ahliterature208068
Source
J Palliat Care. 1997;13(2):39-42
Publication Type
Article
Date
1997
Author
B. Munn
F. Worobec
Author Affiliation
St. Peter's Hospital, Hamilton, Ontario, Canada.
Source
J Palliat Care. 1997;13(2):39-42
Date
1997
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Female
Health Services Research
Hospitals, Public
Humans
Male
Medical Audit
Ontario
Palliative Care - organization & administration
Program Development
Retrospective Studies
Abstract
This retrospective descriptive study of 73 patients who died in St. Peter's Hospital examines and contrasts the patients profile and referral sources of a palliative care unit in a chronic care hospital over two six-month periods during 1994 and 1995. Shortened length of stay (83.8 and 43.2 days respectively), documentation issues, CPR practices (CPR was desired by seven patients up to the time of death), and lack of referrals from long-term care facilities have led St. Peter's Hospital to ask further questions of its palliative care program, e.g. given the lack of referrals from long-term care facilities, how is palliative care being managed in this sector? In Ontario, palliative care has been placed under the domain of chronic care and program development depends in part on the knowledge of the population it serves. This study is a first step.
PubMed ID
9231586 View in PubMed
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Correlates of health status for family caregivers in bereavement.

https://arctichealth.org/en/permalink/ahliterature185942
Source
J Palliat Med. 2002 Dec;5(6):849-55
Publication Type
Article
Date
Dec-2002
Author
Kevin Brazil
Michel Bédard
Kathleen Willison
Author Affiliation
Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada. brazilk@mcmaster.ca
Source
J Palliat Med. 2002 Dec;5(6):849-55
Date
Dec-2002
Language
English
Publication Type
Article
Keywords
Aged
Bereavement
Caregivers - psychology
Female
Health status
Home Nursing
Humans
Linear Models
Male
Middle Aged
Multivariate Analysis
Ontario
Palliative Care
Retrospective Studies
Terminal Care - methods
Abstract
The purpose of this retrospective cohort study was to identify aspects of caregiving associated with health status among family caregivers in bereavement. Study participants included 151 family caregivers of terminally ill patients who had died, on average, 294 days prior to the study telephone interview. The interview covered two main areas: patient characteristics and caregiver characteristics. Multivariate linear regressions revealed that as the age of the care recipient (regression coefficient [b] = -0.32; 95% confidence interval [CI] -0.48,-0.15) and caregiver (b = -0.14; 95% CI = -0.25, -0.02) increased, caregivers experienced a decline in their physical health during bereavement. Furthermore, caregivers who reported that caregiving interrupted their usual activities (b = -5.97; 95% CI = -9.79, -2.15) had a decline in physical health during bereavement. A poorer mental health status during bereavement was seen in caregivers who reported poor physical health during caregiving (b = -4.31; 95% CI = -8.17, -0.45); and that they received insufficient family support in caregiving (b = -6.01; 95% CI = -9.75, -2.27). It was also revealed that a home death was associated with higher mental health of the caregiver (b = 3.55; 95% CI = 0.26, 6.84). The practice implications of these findings are discussed in this paper.
PubMed ID
12685531 View in PubMed
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Rapid response teams, do not resuscitate orders, and potential opportunities to improve end-of-life care: a multicentre retrospective study.

https://arctichealth.org/en/permalink/ahliterature117062
Source
J Crit Care. 2013 Aug;28(4):498-503
Publication Type
Article
Date
Aug-2013
Author
James Downar
Danielle Rodin
Reeta Barua
Brandon Lejnieks
Rakesh Gudimella
Victoria McCredie
Chris Hayes
Andrew Steel
Author Affiliation
Critical Care and Palliative Care, University Health Network, 9N-926, Toronto, Canada, M5G 2C4. james.downar@utoronto.ca
Source
J Crit Care. 2013 Aug;28(4):498-503
Date
Aug-2013
Language
English
Publication Type
Article
Keywords
Aged
Comorbidity
Decision Making
Female
Hospital Mortality
Hospital Rapid Response Team
Humans
Male
Ontario
Palliative Care
Quality Improvement
Resuscitation Orders
Retrospective Studies
Terminal Care - organization & administration
Abstract
Rapid response teams (RRTs) were created to stabilize acutely ill patients on the ward, but recent studies suggest that RRTs may improve end-of-life care (EOLC). To learn more about the role of the RRT in EOLC at our institutions, we conducted a retrospective review.
Retrospective review of 300 RRT consultations at 3 academic hospitals in Toronto, Canada.
The typical consultation was for an elderly patient with chronic illness. More than 90% had a "full resuscitation" order at the time of consultation. One third were admitted to the intensive care unit within 48 hours of the RRT consultation, and 24.7% ultimately died. Twenty-seven (9.3%) had a patient/family conference on the ward within 48h of the RRT consultation, 24 (8.3%) of whom changed their resuscitation order as a result. Among those who changed their resuscitation order, fewer than 20% were referred to the palliative care or spiritual care service, or prescribed comfort medications as needed (pro re nata), within 48 h of the RRT consultation; 2 patients died without receiving any common EOLC orders, and 15 (63%) died before discharge.
RRT consultation is an important milestone for many patients approaching EOL. RRTs frequently participate in EOL discussions and decision-making, but they may miss opportunities to facilitate EOLC.
PubMed ID
23337483 View in PubMed
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144 records – page 1 of 15.