Browsing by Subject "Palliative Care"
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Item Back to basics: lessons from housecalls that may help to save American medicine(2012-03-30) Shah, AmitItem Donald W. Seldin, M.D., Research Symposium finalist presentations(2020-05-29) Adomako, Emmanuel; Hinkamp, Colin; Liu, Po-Hong (Stuart); McAdams, Meredith; Omar, Wally; Segar, MatthewThis edition of the UT Southwestern Internal Medicine Grand Rounds features presentations by the six Foster Fellows selected as finalists from the Fifth Annual Donald W. Seldin, M.D. Research Symposium, which was held on May 21, 2020. These Foster Fellows presented work that spanned the breadth and depth of scholarly activity across the department, and at the close of Grand Rounds, one will be selected as the 2020 Seldin Scholar, in honor of Dr. Donald W. Seldin. The Grand Rounds presentation also includes additional awards honoring Clinical Vignettes and an award for work in Quality and Education at Parkland Hospital.Item End of life care in the ICU(2016-05-13) Finklea, David JrItem High value health care: the role of palliative care(2021-01-22) Kutner, JeanItem Improving the life of the dying patient: the role of the physician(2001-07-12) Paulk, Mary ElizabethItem Palliative Care for Refugees and Asylees: A Systematic Review and Single-Institution Analysis of Healthcare Utilization(2021-05-01T05:00:00.000Z) Tao, Zoe Renee; Gimpel, Nora; McGregor, Tamara; Dussel, Veronica; Wang, WinnieBACKGROUND: Palliative care addresses physical, psychosocial, and spiritual dimensions of suffering. Palliative care may have significant impact for populations such as refugees and asylees, who flee conflict and persecution and may have a high burden of chronic and life-limiting illness. OBJECTIVES: The goal of this systematic review was to synthesize existing observational studies on palliative care for refugees and asylees. Additionally, the goal of the accompanying single-institution review was to analyze healthcare access and utilization in a safety net refugee outreach clinic. METHODS: A systematic review was undertaken using PRISMA guidelines. Six full-length articles were selected for review. National Consensus Project palliative care domains were utilized for thematic analysis. A retrospective chart review was undertaken for refugee patients establishing care between 2014-2016. Data was extracted on demographics, insurance status, and outpatient clinic and emergency department (ED) visits. RESULTS: Articles selected for systematic review covered heterogeneous research methodology and refugee populations, with all investigators originating from high-income nations. Identified Challenges and Practices to palliative care encompassed all NCP domains, and Recommendations for palliative care for refugees and asylees encompassed all but the Ethical and Legal aspects of care. In our single-institution review, we found that most refugee patients were able to maintain healthcare insurance and attended follow-up primary care visits, with few relying on the ED for primary care. CONCLUSIONS: Greater attention and funding should be allocated to lower-income nations for addressing refugee palliative care needs. Increased focus should be given to studying ethical, legal, and systemic barriers to care. Outpatient care in safety net hospitals may be an important means of addressing refugee and asylee palliative care in well-resourced settings.Item Smooth transitions: facilitating appropriate, timely hospice referrals in advanced diseases(2023-10-06) Newcomer, KelleyItem Transitions of care in cystic fibrosis(2021-06-11) Cohen, LeahItem Underutilization of Palliative Care in Metastatic Foregut Cancer Patients Is Associated with Socioeconomic Disparities(2020-05-01T05:00:00.000Z) Paul, Subhadeep; Porembka, Matthew R.; Wang, Sam; Yopp, AdamBACKGROUND: Metastatic foregut cancers are frequently associated with debilitating symptoms that significantly impact patient's quality of life. Palliative care aims to mitigate disease-, psychosocial- and treatment-related effects. Despite numerous reported benefits and current guidelines and recommendations, palliative care remains heavily underutilized in patients with metastatic cancers. OBJECTIVE: Our aim was to determine the rate of palliative care utilization among patients with metastatic foregut neoplasms and determine the socioeconomic factors associated with receipt of palliative care. METHODS: A retrospective review of the National Cancer Database (NCDB) was conducted to identify patients diagnosed with metastatic foregut cancers between 2004-2013. The NCDB captures over 70% of all incident cancer cases in the United States. We identified patients with stage IV gastric, pancreatic, biliary, gallbladder and esophageal adenocarcinoma. Receipt of PC as defined by the NCDB participant use file was correlated to demographic and clinicopathologic factors. PC treatment included surgery, radiation, systemic therapy, and pain management to alleviate symptoms. Logistic regression was performed to assess the impact of factors on the likelihood of receiving PC. Overall survival was estimated using the Kaplan-Meier method and compared using log-rank tests. RESULTS: Palliative care utilization rates increased among all groups over time (12.3% 2004-2006 vs. 14.7% 2007-2010 vs. 16.4% 2011-2013 for all cancers). Female sex, Medicaid, median income < USD 46,000/year, higher education level, higher Charlson/Deyo Score, and pancreatic or biliary cancers were associated with increased likelihood of palliative care interventions. Additionally, patients treated at an academic center or integrated network cancer program were more likely to receive palliative care than patients treated in the community setting. When receipt of palliative care was stratified by race, Hispanics were significantly less likely to have undergone palliative interventions compared to non-Hispanic Whites (OR 0.70, 95% CI 0.66-0.73). Patients with Medicare or private insurance were less likely to receive palliative care than uninsured patients (OR 0.92, 95% CI 0.87-0.97 and 0.81, 95% CI 0.77-0.89, respectively) CONCLUSION: Although PC use has increased over time, it remains significantly underutilized in MFC. Disparities exist in receipt of PC with regards to demographic and socioeconomic factors such as age, race, gender, insurance status, education, comorbidities and year of diagnosis. These identified factors can serve as targeted interventions aimed at increasing palliative care utilization. Additional research is necessary to better optimize PC use in metastatic cancers of the foregut and mitigate potential disparities.