Current Issue : April-June Volume : 2025 Issue Number : 2 Articles : 5 Articles
Introduction: Women with late-stage metastatic breast cancer are at an increased risk of pain and distress from symptoms and often struggle with associated emotional and financial burden of their disease. Palliative care is known to alleviate symptom burden in patients with end-stage, terminal diseases but is often underutilized in both inpatient and outpatient settings. The current study aims to investigate the prevalence of palliative care consultation on inpatients with metastatic breast cancer and examine the association between palliative care consultation and length of hospital stay and total hospital charges. Methods: Patients diagnosed with metastatic breast cancer between 1998–2017 were abstracted from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Database (NIS). The primary outcome was the presence of a palliative care consultation (PCC) during the inpatient stay. Secondary outcomes were hospital length of stay and total hospital charges. Multivariable logistic regression was used to examine factors associated with the presence of a PCC. The relationship between PCC and hospital length of stay and total hospital charges were investigated using linear regression. Results: 513,509 cases of metastatic breast cancer were identified, 5.7% had a documented in-hospital palliative care encounter. Of those who received PCC, total hospital charges were about USD 5452 less than those who did not receive consultation. Women who received PCC had higher odds of a longer hospital stay. Predictors of PCC were older age, non-White race, and residing in a lower-income ZIP code. Conclusions: Palliative care remains to be an underutilized resource among patients with end-stage metastatic breast cancer....
Background Intermediate care units (IMCUs) provide care for patients who need more intensive treatment than general wards but less than intensive care units (ICUs). Although the concept of an IMCU requires co-location with an ICU, some hospitals have IMCUs but no ICUs, which potentially worsens patient outcomes. This study aimed to examine the annual trends and care processes, and compare the outcomes of patients admitted to IMCUs in hospitals with and without ICUs using a nationwide inpatient database in Japan. Methods This retrospective cohort study was conducted from 2016 to 2022 using the Diagnosis Procedure Combination Database and Hospital Bed Function Reports in Japan. The main exposure was admission to the IMCU in hospitals with and without ICUs. The primary outcome was in-hospital mortality rate in hospitals with and without ICUs that were compared using multilevel logistic regression models adjusted for confounders. Results The number of IMCU beds in hospitals without ICUs increased by 59% from 3,388 in 2016 to 5,403 in 2022, and the IMCU beds in hospitals without ICUs represented 38% (n = 5,403/14,185) of all IMCU beds in Japan in 2022. Among the 3,061,960 eligible patients in the IMCUs, 2,296,939 (75%) and 765,021 (25%) were admitted to hospitals with and without ICUs, respectively. Transfer between IMCUs and ICUs occurred for 10.5% (n = 320,938/3,061,960) of patients, with a large variability between hospitals. After adjusting for potential confounders, patients admitted to IMCUs in hospitals without ICUs had significantly higher in-hospital mortality than those in hospitals with ICUs (adjusted odds ratio: 1.15; 95% confidence interval: 1.10–1.20; p < 0.001). Conclusions Admission in IMCUs in hospitals without ICUs increased, but was associated with higher in-hospital mortality. These findings suggest that IMCUs should be placed in hospitals with ICUs....
Purpose: This study aimed to identify the challenges and strategies of nurses in facilitating dialogue between patients with terminal cancer and their families in the post-COVID-19 phase. Methods: An online questionnaire was administered to 839 nurses with at least two years of clinical experience. The questionnaire included items on challenges and strategies in supporting dialogue between patients with terminal cancer and their families, as well as freeresponse statements. All responses were subjected to inductive qualitative analysis. Results: A total of 193 responses were received and analyzed. The difficulties faced by nurses in supporting dialogue were classified into six categories: “environmental restrictions on visits and dialogue due to infection control” on the organizational side, “inability to be fully involved in dialogue support due to COVID-19,” “influence of nurses’ values regarding death and family,” “insufficient skills of nurses in supporting dialogue,” “lack of cooperation within the team,” and “differences in how the patient and family perceive the disease, hindering dialogue” on the patient and family side. Conversely, five effective strategies for dialogue support were identified: “building trust by understanding the family daily,” “facilitating dialogue between the patient and family despite visitation restrictions,” “assessing the patient and family to guide dialogue,” “encouraging the patient and family to share their thoughts,” and “improving team quality in dialogue support.” Conclusion: The findings suggest that when facing difficulties in dialogue support, a system enabling nurses to reflect on and learn from their practice is needed....
Background Diarrhea-predominant irritable bowel syndrome (IBS-D) significantly impacts patients’ quality of life, with existing treatments offering limited relief. Self-administered acupressure presents a potential non-invasive, costeffective treatment option that could alleviate symptoms and enhance health outcomes in these patients. Aim This randomized controlled trial aimed to evaluate the effect of active acupressure compared to sham acupressure on primary and secondary outcomes among IBS-D patients. Method The study included 63 patients with IBS-D, recruited from Alexandria Main University Hospital, Egypt. Participants were randomized into either an active acupressure group or a sham acupressure group. Both groups underwent two days of training, followed by four weeks of intervention. The active group applied pressure to specific therapeutic acupoints, while the sham group used non-therapeutic points. Outcomes were assessed at baseline, week 2, and week 4. Results The active acupressure group showed a significant reduction in symptom severity, improved stool consistency, and frequency, and greater adequate symptom relief by week 4 compared to the sham group. Psychological outcomes, including anxiety and depression, also improved significantly in the active group. Additionally, the active group reported reduced use of rescue medications. Conclusion Active acupressure is an effective nursing intervention for alleviating symptoms of IBS-D, particularly when applied consistently over time. It improves both physical and psychological outcomes, offering a valuable nonpharmacological treatment option. Implications Nurses can integrate self-administered acupressure into IBS-D care plans, teaching patients this technique to manage symptoms independently, thus enhancing their quality of life (QOL) and reducing reliance on conventional medications. This intervention aligns with holistic nursing care and offers a cost-effective, patientfriendly solution for managing IBS-D....
Objectives: To establish the determinants of death in hospital for patients with moderate to severe traumatic brain injury (TBI) in Australia. Design, setting, participants: Retrospective analysis of Australia New Zealand Trauma Registry (ANZTR) data. Cases were included if they presented to a participating hospital between 1 July 2015 and 30 June 2020 and had an Abbreviated Injury Severity (AIS) score – head greater than 2. Main outcome measures: Death in hospital. Results: There were 16 350 patients. Their mean age was 51 years and 71% were male. After adjusting for measures of injury severity, there was an increased odds of in-hospital death for patients whose injury occurred outside daylight hours or first mode of transport was road ambulance, who were not transferred from another hospital, had an endotracheal tube placed prior to definitive hospital arrival or received...
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