Palliative Care and Hospice: Opportunities to Improve Care for the Sickest Patients

The article discusses how palliative care and hospice services address the quality and cost concerns in the U.S. health care system. By focusing on symptom management, coordination among providers, and improved transitions of care, the services meet the needs of the sickest persons at lower costs. The author suggests putting in place the right leadership and resources and strengthening the workforce to successfully expand the programs

Palliative Care and the Health Care Crisis in the United States: A Candid Conversation With Dr. Diane Meier

This paper is a synthesis of the 2012 Lourie Lecture, framed as a series of questions and responses, and supported by images used in the lecture. I’m going to focus on the growth of this new field called palliative care and will make the connection that the crisis afflicting healthcare in the United States cannot be addressed without widespread scaling and implementation of palliative care across the system. My subject is not end-of-life care, but rather care during serious illness. A serious illness is something a person can live with for many years, such as emphysema, or end-stage renal disease on dialysis, or dementia. Of course, serious illnesses are also progressive and eventually lead to end-of-life, but I want to address care for a much broader patient population, not those who are clearly dying and who will qualify for hospice services

Enhancing legacy in palliative care: study protocol for a randomized controlled trial of Dignity Therapy focused on positive outcomes.

BackgroundDignity Therapy is a brief psychotherapy that can enhance a sense of legacy while addressing the emotional and existential needs of patients receiving hospice or palliative care. In Dignity Therapy, patients create a formalized "legacy" document that records their most cherished memories, their lessons learned in life, as well as their hopes and dreams for loved ones in the future. To date, this treatment has been studied for its impact on mitigating distress within hospice and palliative care populations and has provided mixed results. This study will instead focus on whether Dignity Therapy enhances positive outcomes in this population.Methods/designIn this study, 90 patients with cancer receiving hospice or palliative care will complete a mixed-methods randomized controlled trial of Dignity Therapy (n = 45) versus Supportive Attention (n = 45). The patients will be enrolled in the study for 3 weeks, receiving a total of six study visits. The primary outcomes examine whether the treatment will quantitatively increase levels of positive affect and a sense of life closure. Secondary outcomes focus on gratitude, hope, life satisfaction, meaning in life, resilience, and self-efficacy. Using a fixed, embedded dataset design, this study will additionally use qualitative interviews to explore patients' perceptions regarding the use of positive outcome measures and whether these outcomes are appropriately matched to their experiences in therapy.DiscussionDignity Therapy has shown mixed results when evaluating its impact on distress, although no other study to date has solely focused on the potential positive aspects of this treatment. This study is novel in its use of mixed methods assessments to focus on positive outcomes, and will provide valuable information about patients' direct experiences in this area.Trial registrationISRCTN91389194

Renal Allograft Survival in Transplant Recipients with Focal Segmental Glomerulosclerosis

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73852/1/j.1600-6143.2003.30111.x.pd

Fixed- or Controlled-Dose Mycophenolate Mofetil with Standard- or Reduced-Dose Calcineurin Inhibitors: The Opticept Trial

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74911/1/j.1600-6143.2009.02668.x.pd

Defining Advance Care Planning for Adults: A Consensus Definition From a Multidisciplinary Delphi Panel

Despite increasing interest in advance care planning (ACP) and prior ACP descriptions, a consensus definition does not yet exist to guide clinical, research, and policy initiatives

Dense Gas, Dynamical Equilibrium Pressure, and Star Formation in Nearby Star-Forming Galaxies

We use new ALMA observations to investigate the connection between dense gas fraction, star formation rate, and local environment across the inner region of four local galaxies showing a wide range of molecular gas depletion times. We map HCN (1-0), HCO$^+$ (1-0), CS (2-1), $^{13}$CO (1-0), and C$^{18}$O (1-0) across the inner few kpc of each target. We combine these data with short spacing information from the IRAM large program EMPIRE, archival CO maps, tracers of stellar structure and recent star formation, and recent HCN surveys by Bigiel et al. and Usero et al. We test the degree to which changes in the dense gas fraction drive changes in the SFR. $I_{HCN}/I_{CO}$ (tracing the dense gas fraction) correlates strongly with $I_{CO}$ (tracing molecular gas surface density), stellar surface density, and dynamical equilibrium pressure, $P_{DE}$. Therefore, $I_{HCN}/I_{CO}$ becomes very low and HCN becomes very faint at large galactocentric radii, where ratios as low as $I_{HCN}/I_{CO} \sim 0.01$ become common. The apparent ability of dense gas to form stars, $\Sigma_{SFR}/\Sigma_{dense}$ (where $\Sigma_{dense}$ is traced by the HCN intensity and the star formation rate is traced by a combination of H$\alpha$ and 24$\mu$m emission), also depends on environment. $\Sigma_{SFR}/\Sigma_{dense}$ decreases in regions of high gas surface density, high stellar surface density, and high $P_{DE}$. Statistically, these correlations between environment and both $\Sigma_{SFR}/\Sigma_{dense}$ and $I_{HCN}/I_{CO}$ are stronger than that between apparent dense gas fraction ($I_{HCN}/I_{CO}$) and the apparent molecular gas star formation efficiency $\Sigma_{SFR}/\Sigma_{mol}$. We show that these results are not specific to HCN.Comment: 31 pages, 13 figures, accepted for publication in The Astrophysical Journal, email for access to data table before publicatio