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December 2019 List
Text
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December 2019 List
URL Address
<a href="http://doi.org/10.1097/01.ccm.0000551171.15113.a3" target="_blank" rel="noreferrer noopener">http://doi.org/10.1097/01.ccm.0000551171.15113.a3</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Palliative care allocation among critically ill children is highly variable in the United States
Publisher
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Critical Care Medicine
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Subject
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artificial ventilation; child; cohort analysis; conference abstract; controlled study; critically ill patient; female; hospitalization; household income; human; infant; insurance; length of stay; major clinical study; male; morbidity; mortality; multicenter study; neonatal intensive care unit; newborn; palliative therapy; race; resource allocation; retrospective study; suburban area; United States
Creator
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O'Keefe S; Maddux A; Bennett K; Youngwerth J; Czaja A
Description
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Learning Objectives: Palliative Care (PC) is a scarce resource. Little is known about its allocation among critically ill children. Previously proposed criteria may help identify children who may benefit from PC. Method(s): This is a retrospective cohort study of patients aged <40 years requiring ICU admission (excluding neonatal ICU) among 51 children's hospitals from 2010-2017. Hospitalizations were categorized into 3 mutually exclusive groups: 1. PICU based criteria adapted from previously published criteria (PC-ICU) 2. Additional Criteria (AC = chronic complex condition not in PCICU) 3. No Criteria (NC). Characteristics, outcomes and PC use (based on ICD administrative charges) were compared using chi2 or kruskal-wallis. We also explored PC patterns over time. Result(s): 93499 subjects with 114510 hospitalizations had >= 1 ICU admission. 15% subjects had >1 hospitalization. Median age at admission was 19 months (IQR 2-117). 56%, 39% and 5% of hospitalizations met PC-ICU, AC and NC criteria respectively. PC-ICU admissions had higher severity of illness, number of procedures, need for mechanical ventilation, CPR, mechanical ventilation days, length of stay, charges and mortality (p<=0.001). PC consult was present in 4.5% of hospitalizations, higher among PC-ICU than AC and NC groups (5.8%, 2.9% and 0.3% respectively, p<=0.001). Median age of children receiving PC was younger in PC-ICU (34 months v 52 and 59 months in AC and NC groups respectively). PC use was slightly higher among patients living in urban/suburban areas (4.5% v 4%, p<0.004), with governmentbased insurance (4.7% v 4%, p<=0.0001) and of non-white race (4.6% v 4.3%, p<0.04). Household income did not differ between PC and no-PC (p= 0.6). PC use increased steadily from 2010-2017 from 1% to 6.7%, with greatest change observed in PC-ICU group (1.4% to 9%), followed by the AC group (1% to 4.7%) and with little change in NC group (0 to 0.5%). PC use varied among institutions ranging from 0-44% in PC-ICU, 0-12% in AC and 0-2% in NC groups respectively. Conclusion(s): National PC use remain low but has increased over time, especially among those meeting PC-ICU criteria who are at high risk of morbidity and mortality. However, PC use varies substantially across ICUs and across certain demographic groups. Future research to understand the impact of PC for critically ill children could help optimize resource allocation.
Identifier
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<a href="http://doi.org/10.1097/01.ccm.0000551171.15113.a3" target="_blank" rel="noreferrer noopener">10.1097/01.ccm.0000551171.15113.a3</a>
Rights
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
2019
Artificial Ventilation
Bennett K
Child
Cohort Analysis
conference abstract
Controlled Study
Critical Care Medicine
Critically Ill Patient
Czaja A
December 2019 List
Female
Hospitalization
household income
Human
Infant
Insurance
Length Of Stay
Maddux A
Major Clinical Study
Male
Morbidity
Mortality
Multicenter Study
Neonatal Intensive Care Unit
Newborn
O'Keefe S
Palliative Therapy
race
Resource Allocation
Retrospective Study
suburban area
United States
Youngwerth J
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
November 2019 List
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
November 2019 List
URL Address
<a href="http://doi.org/10.1177/0269216319870647" target="_blank" rel="noreferrer noopener">http://doi.org/10.1177/0269216319870647</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Achieving beneficial outcomes for children with life-limiting and life-threatening conditions receiving palliative care and their families: A realist review
Publisher
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Palliative Medicine
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Subject
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child; healthcare facilities; manpower and services; palliative care; realist review; terminal care
Creator
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Mitchell S; Bennett K; Morris A; Slowther A; Coad J; Dale J
Description
An account of the resource
Background:Palliative care for children and young people is a growing global health concern with significant resource implications. Improved understanding of how palliative care provides benefits is necessary as the number of children with life-limiting and life-threatening conditions rises.Aim:The aim is to investigate beneficial outcomes in palliative care from the perspective of children and families and the contexts and hidden mechanisms through which these outcomes can be achieved.Design:This is a systematic realist review following the RAMESES standards. A protocol has been published in PROSPERO (registration no: CRD42018090646).Data sources:An iterative literature search was conducted over 2?years (2015?2017). Empirical research and systematic reviews about the experiences of children and families in relation to palliative care were included.Results:Sixty papers were included. Narrative synthesis and realist analysis led to the proposal of context?mechanism?outcome configurations in four conceptual areas: (1) family adaptation, (2) the child?s situation, (3) relationships with healthcare professionals and (4) access to palliative care services. The presence of two interdependent contexts, the ?expert? child and family and established relationships with healthcare professionals, triggers mechanisms, including advocacy and affirmation in decision-making, which lead to important outcomes including an ability to place the emphasis of care on lessening suffering. Important child and family outcomes underpin the delivery of palliative care.Conclusion:Palliative care is a complex, multifactorial intervention. This review provides in-depth understanding into important contexts in which child and family outcomes can be achieved so that they benefit from palliative care and should inform future service development and practice.
Identifier
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<a href="http://doi.org/10.1177/0269216319870647" target="_blank" rel="noreferrer noopener">10.1177/0269216319870647</a>
Rights
Information about rights held in and over the resource
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
2019
Bennett K
Child
Coad J
Dale J
healthcare facilities
manpower and services
Mitchell S
Morris A
November 2019 List
Palliative Care
Palliative Medicine
realist review
Slowther A
Terminal Care