A Library of Instruments Endorsed by Published Systematic Reviews for Assessing Patients and Their Care Developed by the Palliative Care Research Cooperative

Dear Editor: Palliative care research encompasses a broad array of domains, care settings, and illnesses, and the instrument literature can be difficult and time consuming to navigate. The Palliative Care Research Cooperative (PCRC) has compiled a library of *150 instruments for assessing patients and their care in palliative and end-of-life care research. This library is a resource for investigators wanting to identify relevant and high-quality instruments

Study of Earthquake Recurrence Intervals on the Wasatch Fault, Utah: Little Cottonwood Canyon Site

Detailed geologic mapping, topographic profiling, and trenching are being conducted at selected sites along the Wasatch fault zone to measure the cumulative fault displacements in Quaternary strata of various ages and to obtain data regarding the amount of displacement per surface faulting event and the number and recurrence of faulting events that produced the cumulative displacement. These data are used to estimate the frequency of occurrence and magnitude of earthquakes associated with surface faulting along individual segments of the Wasatch fault zone. Investigations have been completed at three sites, the Kaysville, Hobble Creek, and Little Cottonwood Canyon sites. The results of the investigations at the Kaysville and Hobble Creek sites are discussion in our previous reports, which are listed in Appendix A. Detailed geologic investigations were conducted at the Little Cottonwood Canyon site during June, July, and October, 1979. This report presents our findings, interpretations, and preliminary conclusions based on our field investigations at the Little Cottonwood Canyon site

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. Measures included receipt of recommended elements of palliative care delivered by any clinician and specialty palliative care consult. We assessed associations between recommended elements of palliative care and in-hospital death and hospice referral using multivariable Poisson regression models. Results. Of 402 decedents, 67 (16.7%) died in hospital, and 168 (41.8%) had hospice referral. Among elements of palliative care, only goals-of-care discussion was associated with in-hospital death (incidence rate ratio [IRR] 1.37; 95% CI 1.01e1.84) and hospice referral (IRR 1.85; 95% CI 1.31e2.61). Specialty palliative care consult was associated with a lower likelihood of in-hospital death (IRR 0.57; 95% CI 0.44e0.73) and a higher likelihood of hospice referral (IRR 1.45; 95% CI 1.12e1.89) compared with no consult. Conclusion. Goals-of-care discussions by different types of clinicians commonly precede end-of-life care in hospital or hospice. However, engagement with specialty palliative care reduced in-hospital death and increased hospice referral. Understanding the causal pathways of goals-of-care discussions may help build primary palliative care interventions to support patients near the end of life

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. OBJECTIVE: To describe frequency, predictors, and timing of core elements of palliative care during the last 6 months of life. DESIGN: Retrospective chart review. SETTING: Inpatient academic medical center. PARTICIPANTS: Decedents with cancer, dementia, or chronic kidney disease (CKD) admitted during the 6 months preceding death. EXPOSURES: We identified receipt and timing of core elements of palliative care: pain and symptom management, goals of care, spiritual care; and specialty palliative care utilization; hospital encounters; demographics; and comorbid diagnoses.We ran Poisson regression models to assess whether diagnosis or hospital encounters were associated with core elements of palliative care. RESULTS: Among 402 decedents, themean (SD) number of appropriately screened and treated symptoms was 2.9 (1.7)/10. Among 76.1% with documented goals of care, 58.0% had a primary goal of comfort; 55.0% had documented spiritual care. In multivariable models, compared with decedents with cancer, those with dementia or CKD were less likely to have pain and symptom management (respectively, 31% (incidence rate ratio [IRR], 0.69; 95% CI, 0.56–0.85) and 17% (IRR, 0.83; CI, 0.71–0.97)). There was amedian of 3 days (IQR, 0–173) between transition to a goal of comfort and death, and amedian of 12 days (IQR, 5–47) between hospice referral and death. CONCLUSIONS AND RELEVANCE: Although a high proportion of patients received elements of palliative care, transitions to a goal of comfort or hospice happened very near death. Palliative care delivery can be improved by systematizing existing mechanisms, including prompts for earlier goals-of-care discussion, symptom screening, and spiritual care, and by building collaboration between primary and specialty palliative care services

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). DESIGN: We developed two EHR phenotypes. Each phenotype included International Classification of Diseases (ICD)-9 and ICD-10 codes. We used natural language processing (NLP) to further specify stage 4 cancer, and lab values for CKD. SUBJECTS: Decedents with cancer or CKD who had been admitted to an academic medical center in the last 6 months of life and died August 26, 2017–December 31, 2017. MAIN MEASURE: We calculated positive predictive values (PPV), false discovery rates (FDR), false negative rates (FNR), and sensitivity. Phenotypes were validated by a comparison with manual chart review. We also compared the EHR phenotype results to those admitted to the oncology and nephrology inpatient services. KEY RESULTS: The EHR phenotypes identified 271 decedents with cancer, of whom 186 had stage 4 disease; of 192 decedents with CKD, 89 had stage 4–5 disease. The EHR phenotype for stage 4 cancer had a PPV of 68.6%, FDR of 31.4%, FNR of 0.5%, and 99.5% sensitivity. The EHR phenotype for stage 4–5 CKD had a PPV of 46.4%, FDR of 53.7%, FNR of 0.0%, and 100% sensitivity. CONCLUSIONS: EHR phenotypes efficiently identified patients who died with late-stage cancer or CKD. Future EHR phenotypes can prioritize specificity over sensitivity, and incorporate stratification of high- and low-palliative care need. EHR phenotypes are a promising method for identifying patients for research and clinical purposes, including equitable distribution of specialty palliative care

Improving Decision-Making for Feeding Options in Advanced Dementia: A Randomized, Controlled Trial

Feeding problems are common in dementia, and decision-makers have limited understanding of treatment options

Resource Planning for Neglected Tropical Disease (NTD) Control Programs: Feasibility Study of the Tool for Integrated Planning and Costing (TIPAC).

<p>Resource Planning for Neglected Tropical Disease (NTD) Control Programs: Feasibility Study of the Tool for Integrated Planning and Costing (TIPAC)</p

Brain structural differences in children with fetal alcohol spectrum disorder and its subtypes

IntroductionThe teratogenic effects of prenatal alcohol exposure (PAE) have been examined in animal models and humans. The current study extends the prior literature by quantifying differences in brain structure for individuals with a fetal alcohol spectrum disorder (FASD) compared to typically developing controls, as well as examining FASD subtypes. We hypothesized the FASD group would reveal smaller brain volume, reduced cortical thickness, and reduced surface area compared to controls, with the partial fetal alcohol syndrome (pFAS)/fetal alcohol syndrome (FAS) subtypes showing the largest effects and the PAE/alcohol-related neurodevelopmental disorder (ARND) subtype revealing intermediate effects.MethodsThe sample consisted of 123 children and adolescents recruited from a single site including children with a diagnosis of FASD/PAE (26 males, 29 females) and controls (34 males, 34 females). Structural T1-weighted MRI scans were obtained on a 3T Trio TIM scanner and FreeSurfer v7.2 was used to quantify brain volume, cortical thickness, and surface area. Analyses examined effects by subgroup: pFAS/FAS (N = 32, Mage = 10.7 years, SEage = 0.79), PAE/ARND (N = 23, Mage = 10.8, SEage = 0.94), and controls (N = 68, Mage = 11.1, SEage = 0.54).ResultsTotal brain volume in children with an FASD was smaller relative to controls, but subtype analysis revealed only the pFAS/FAS group differed significantly from controls. Regional analyses similarly revealed reduced brain volume in frontal and temporal regions for children with pFAS/FAS, yet children diagnosed with PAE/ARND generally had similar volumes as controls. Notable differences to this pattern occurred in the cerebellum, caudate, and pallidum where children with pFAS/FAS and PAE/ARND revealed lower volume relative to controls. In the subset of participants who had neuropsychological testing, correlations between volume and IQ scores were observed. Goodness-of-Fit analysis by age revealed differences in developmental patterns (linear vs. quadratic) between groups in some cases.DiscussionThis study confirmed prior results indicating decreased brain volume in children with an FASD and extended the results by demonstrating differential effects by structure for FASD subtypes. It provides further evidence for a complex role of PAE in structural brain development that is likely related to the cognitive and behavioral effects experienced by children with an FASD

The Iowa Homemaker vol.21, no.3

Freshmen – Please Note, page 2 Hospital Research, Ann Koebel, page 3 Orchids to Pat, page 4 The Army Eats Well, Mary I. Barber, page 5 Making Things Grow, Betty Ann Iverson, page 6 Look Before You Snap, Kathryn Monson, page 7 Major Departments on Review, Elizabeth Murfield, page 8 Patriotic Sally, Patricia Hayes, page 10 What’s New in Home Economics, Dorothy Olson, page 12 Summer Job Holders Reap Experience, page 14 A List of Don’ts, Costume Design Class, page 15 We Salute Campus Leaders, Margaret Kirchner, page 16 Home Economics Looks to Future, M. L. Morton, page 17 Behind Bright Jackets, Julie Wendel, page 18 Alums in the News, Mary Elizabeth Sather, page 20 Nutrition for Defense, Dorothy Ann Roost, page 22 That Personal Touch, Margaret Ann Clarke, page 23 Journalistic Spindles, Elizabeth Hanson, page 2