1
40
8
-
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September 2021 List
Text
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September 2021 List
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<a href="http://doi.org/10.1097/PEC.0000000000001620" target="_blank" rel="noreferrer noopener">http://doi.org/10.1097/PEC.0000000000001620</a>
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What Do We Know about Pediatric Palliative Care Patients Consulting to the Pediatric Emergency Department?
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Pediatric Emergency Care
Date
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2021
Subject
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child; emergency health service; hospitalization; palliative care; referral and consultation; retrospective studies
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Gaucher N; Humbert N; Gauvin F
Description
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Objectives The objective of this study was to describe the characteristics of pediatric palliative care (PPC) patients presenting to a pediatric emergency department (ED) and these patients' ED visits. Methods This retrospective chart review was conducted from April 1, 2007, to March 31, 2012, in a tertiary care pediatric university-affiliated hospital. Eligible patients had initial PPC consultations during the study period; all ED visits by these patients were included. Data were drawn from the ED's electronic data system and patient's medical chart. Results A total of 290 new patients were followed by the PPC team, and 94 (32.4%) consulted the ED. Pediatric palliative care patients who consulted the ED had a median age of 7 years and baseline diagnoses of cancer (39.4%) or encephalopathy (27.7%). No patients died in the ED, but 36 (38.3%) died in hospital after an ED visit and 18 (19.1%) within 72 hours of admission. Pediatric palliative care patients consulted 219 times, with a median number of visits per patient of 2 (range, 1-8). They presented acutely ill as per triage scales. Reasons for consultation included respiratory distress/dyspnea (30.6%), pain (12.8%), seizure (11.4%), and fever (9.1%). Patients were often admitted to wards (61.2%) and the pediatric intensive care unit (7.3%). Two thirds (65.7%) of patients had signed an advanced care directive at the time of their visit. Discussions about goals of care occurred in 37.4% of visits. Conclusions Pediatric palliative care patients present to the ED acutely ill, often at their end of life, and goals of care are not always discussed. This is a first step toward understanding how to improve PPC patients' ED care. Copyright © Wolters Kluwer Health, Inc. All rights reserved.
Identifier
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<a href="http://doi.org/10.1097/PEC.0000000000001620" target="_blank" rel="noreferrer noopener">10.1097/PEC.0000000000001620</a>
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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).
2021
Child
Emergency Health Service
Gaucher N
Gauvin F
Hospitalization
Humbert N
Palliative Care
Pediatric Emergency Care
Referral And Consultation
Retrospective Studies
September 2021 List
-
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Title
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May 2018 List
Text
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May 2018 List
URL Address
<a href="http://doi.org/10.1016/j.jpedsurg.2018.02.038" target="_blank" rel="noreferrer noopener">http://doi.org/10.1016/j.jpedsurg.2018.02.038</a>
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Interventions in the operating room for children near end of life: A multidisciplinary approach
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Journal of Pediatric Surgery.
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2018
Subject
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article
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Goudreault M; Humbert N; Gauvin F; Marzouki M; Beaumier CK; St-Vil D; Piche N
Description
An account of the resource
Introduction: Pediatric surgeons are often involved in the management of severely or terminally ill patients. However, articles addressing their specific roles in the context of palliative care are almost inexistent. We sought to characterize the involvement of pediatric surgeons caring for children near end of life. Methods: Chart review of children who had a procedure under general anesthesia within 6. months of their death over a five-year period at a tertiary children's hospital (excluding traumas and neonatology cases). In addition to demographic and clinical data, we recorded the aim of the procedures performed, the involvement of the palliative care service, and presence of DNAR orders. Results: The analysis included 83 patients (mean age: 8. years). Forty-four children had more than one procedure (range 2-10). Pediatric palliative care service was involved in 66 cases (80%). A majority of patients had cancer (50%), and the most frequent cause of death was oncologic progression (46%). Ten patients died of a complication following their intervention. The aim of the procedure was palliative in 48 cases (29 for symptoms control and 19 to facilitate care), diagnostic in 16, and curative in 19. Forty-five procedures were performed urgently and 14 despite DNAR orders. Conclusion: Surgeon involvement with children near end of life is not infrequent. The procedures performed are varied and can be categorized according to their aim. Lack of formal palliative care training by surgeons highlights the need for increased collaboration with palliative care services to provide children optimal care when they need it most. Level of Evidence: IV.
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).
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<a href="http://doi.org/10.1016/j.jpedsurg.2018.02.038" target="_blank" rel="noreferrer noopener">10.1016/j.jpedsurg.2018.02.038</a>
2018
Article
Beaumier CK
Gauvin F
Goudreault M
Humbert N
Journal of Pediatric Surgery.
Marzouki M
May 2018 List
Piche N
St-Vil D
-
Dublin Core
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PedPalASCNet Member Publications
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A collection of relevant articles published by one or more of PedPalASCNet's members
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Backlog
URL Address
<a href="http://doi.org/10.1001/archpedi.161.6.597" target="_blank" rel="noreferrer">http://doi.org/10.1001/archpedi.161.6.597</a>
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Title
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Pediatric patients receiving palliative care in Canada: results of a multicenter review
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Archives Of Pediatrics & Adolescent Medicine
Date
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2007
Subject
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Child; Cross-Sectional Studies; Humans; Canada; Preschool; infant; Congenital Abnormalities/mortality; Neoplasms/mortality; Nervous System Diseases/mortality; Palliative Care/utilization; retrospective studies
Creator
An entity primarily responsible for making the resource
Widger K; Davies D; Drouin DJ; Beaune L; Daoust L; Farran RP; Humbert N; Nalewajek F; Rattray M; Rugg M; Bishop M
Description
An account of the resource
OBJECTIVES: To describe the patients who received care from the 8 dedicated pediatric palliative care programs in Canada in 2002 and to estimate the number of children who may have benefited but did not receive services from these programs. DESIGN: Retrospective review of medical records combined with a survey of each program. SETTING: Seven pediatric palliative care programs based in tertiary care settings and 1 freestanding children's hospice. PARTICIPANTS: The programs cared for 317 children during 2002, of whom 123 died during that year. An additional 32 children died by the end of 2003. MAIN EXPOSURE: Pediatric palliative care program. RESULTS: Nearly half (48.6%) of the patients were younger than 5 years, and almost half of these were younger than 1 year. Primary diagnoses were disorders of the nervous system (39.1%), malignancies (22.1%), and conditions arising in the perinatal period or congenital anomalies (22.1%). Most of the children (43.9%) died at home, with those centers reporting more comprehensive home care services having the highest percentage of home deaths. From a national perspective, between 5% and 12% of the children who could benefit from palliative care received services from 1 of these programs. CONCLUSIONS: Pediatric palliative care programs in Canada care for a diverse population of patients with a wide range of age and disease conditions. Only a small percentage of children who die, however, receive services from these dedicated programs.
2007
Identifier
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<a href="http://doi.org/10.1001/archpedi.161.6.597" target="_blank" rel="noreferrer">10.1001/archpedi.161.6.597</a>
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Type
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Journal Article
2007
Archives Of Pediatrics & Adolescent Medicine
Backlog
Beaune L
Bishop M
Canada
Child
Congenital Abnormalities/mortality
Cross-sectional Studies
Daoust L
Davies D
Drouin DJ
Farran RP
Humans
Humbert N
Infant
Journal Article
Nalewajek F
Neoplasms/mortality
Nervous System Diseases/mortality
Palliative Care/utilization
Preschool
Rattray M
Retrospective Studies
Rugg M
Widger K
-
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PedPalASCNet Member Publications
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A collection of relevant articles published by one or more of PedPalASCNet's members
Text
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Citation List Month
June 2017 List
URL Address
<a href="https://doi.org/10.1177/1049732315622189" target="_blank" rel="noreferrer">http://journals.sagepub.com/doi/abs/10.1177/1049732315622189?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed</a>
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Title
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Understanding How Bereaved Parents Cope With Their Grief To Inform The Services Provided To Them
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Qualitative Health Research
Date
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2017
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Stevenson M; Achille M; Liben S; Proulx MC; Humbert N; Petti A; Macdonald ME; Cohen SR
Description
An account of the resource
Our objective was to develop a rich description of how parents experience their grief in the first year after the death of their child, and how various bereavement follow-up and support services helped them during this time, with the aim of informing follow-up and support services offered to bereaved parents. Our findings situated parents’ individual experiences of coping within the social and institutional contexts in which they grieved. In the first year after the death of their child, parents regulated their intense feelings of grief through loss-oriented, restoration-oriented, and/or meaning reconstruction strategies. Often, parents’ relationships with others and many of the bereavement follow-up and support services helped them in this regard. This article also explores how the results may aid service providers in accompanying parents in a way that optimizes outcomes for these parents.
Identifier
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<a href="https://doi.org/10.1177/1049732315622189" target="_blank" rel="noreferrer">10.1177/1049732315622189</a>
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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).
Subject
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America, North; adolescents/ youth; bereavement/grief; cancer, coping, psychology/psychosocial issues; children; end-of-life issues; families, caregiving; infants; interpretive description; interviews, semistructured; knowledge transfer; palliative care; program evaluation; psychosocial issues; relationships, parent–child; research, clinical; research, qualitative
2017
Achille M
Cohen SR
Humbert N
June 2017 List
Liben S
Macdonald ME
Petti A
Proulx MC
Qualitative Health Research
Stevenson M
-
Text
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Citation List Month
October 2017 List
Notes
<p>1651-2227<br />Archambault-Grenier, Marie-Anne<br />Roy-Gagnon, Marie-Helene<br />Gauvin, France<br />Doucet, Hubert<br />Humbert, Nago<br />Stojanovic, Sanja<br />Payot, Antoine<br />Fortin, Sylvie<br />Janvier, Annie<br />Duval, Michel<br />Journal Article<br />Norway<br />Acta Paediatr. 2017 Aug 9. doi: 10.1111/apa.14013.</p>
URL Address
<a href="https://doi.org/10.1111/apa.14013" target="_blank" rel="noreferrer">https://doi.org/10.1111/apa.14013</a>
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Survey Highlights The Need For Specific Interventions To Reduce Frequent Conflicts Between Healthcare Professionals Providing Paediatric End-of-life Care
Publisher
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Acta Paediatrica
Date
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2017
Subject
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Children; Conflict; End-of-life Care; Healthcare Professionals; Survey
Creator
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Archambault-Grenier MA; Roy-Gagnon MH; Gauvin F; Doucet H; Humbert N; Stojanovic S; Payot A; Fortin S; Janvier A; Duval M
Description
An account of the resource
AIMS: This study explored how paediatric healthcare professionals experienced and coped with end-of-life conflicts and identified how to improve coping strategies. METHODS: A questionnaire was distributed to all 2,300 professionals at a paediatric university hospital, covering the frequency of end-of-life conflicts, participants, contributing factors, resolution strategies, outcomes and the usefulness of specific institutional coping strategies. RESULTS: Of the 946 professionals (41%) who responded, 466 had witnessed or participated in paediatric end-of-life discussions: 73% said these had led to conflict, more frequently between professionals (58%) than between professionals and parents (33%). Frequent factors included professionals' rotations, unprepared parents, emotional load, unrealistic parental expectations, differences in values and beliefs, parents' fear of hastening death, precipitated situations and uncertain prognosis. Discussions with patients and parents and between professionals were the most frequently used coping strategies. Conflicts were frequently resolved by the time of death. Professionals mainly supported designating one principal physician and nurse for each patient, two-step interdisciplinary meetings - between professionals then with parents - post-death ethics meetings, bereavement follow-up protocols and early consultations with paediatric palliative care and clinical ethics services. CONCLUSION: End-of-life conflicts were frequent and predominantly occurred between healthcare professionals. Specific interventions could target most of the contributing factors. This article is protected by copyright. All rights reserved.
Identifier
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<a href="https://doi.org/10.1111/apa.14013" target="_blank" rel="noreferrer">10.1111/apa.14013</a>
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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).
2017
Acta Paediatrica
Archambault-Grenier MA
Children
Conflict
Doucet H
Duval M
End-of-life Care
Fortin S
Gauvin F
Healthcare Professionals
Humbert N
Janvier A
October 2017 List
Payot A
Roy-Gagnon MH
Stojanovic S
Survey
-
Text
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Citation List Month
February 2017 List
Dublin Core
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Title
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Tensions At The End Of Life In Pediatrics: Actors, Causes, Coping Strategies And Remedies
Publisher
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Journal Of Pain And Symptom Management
Date
A point or period of time associated with an event in the lifecycle of the resource
2016
Creator
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Payot A; Archambault-Grenier MA; Roy-Gagnon MH; Humbert N; Stojanovic S; Janvier A; Duval M
Description
An account of the resource
Background: The majority of children die in pediatric hospitals after a decision to withhold or withdraw life sustaining interventions. Tensions and conflicts at the end of life (EOL) are not rare in pediatric hospitals. Objective: To investigate how frequent these conflicts are and how health-care professionals (HCPs) experience, cope and suggest improvements regarding endof- life communications in pediatrics. Design/Methods: Questionnaire sent to all 2300 HCPs who care for patients in a large mother-child university hospital. Results: 946 HCPs answered the questionnaire (nurses, physicians and other disciplines). A majority (70%, 663) had witnessed or cared for at least one dying child over the preceding five years. Of those, 73% experienced at least a conflict at the end of life. Conflict occurred more frequently among HCPs (58%) than between HCPs and parents (33%), p LT 0.05. More than 40% reported the following factors as being frequently associated with end-of-life conflicts: * HCP Related: lack of continuity (physicians and/ or nurses), differences in values and beliefs between HCP. * Patient-Disease Related: precipitated or critical situations, uncertain prognosis. * Parent Related: unprepared parents, emotional load, unrealistic parental expectations, differences in values and beliefs, parents' fear of hastening death. * Institution Related: lack of practical guidelines to deal with difficult end-of-life cases. HCP report using these strategies to solve confrontations: negotiating with parents and patients, educating parents and discussing with peers. Nurses and physicians reported significantly different types of coping strategies. For 66% of respondents, conflicts were resolved by the time of the child's death. Only 25% felt they received adequate training to cope with EOL conflicts. Suggestions for improvement: primary health-care providers or case-managers, interdisciplinary meetings involving the parents, post-death ethics meetings, bereavement follow-up protocols andearlier consultation in pediatric palliative care and/or clinical ethics service. Conclusions: End-of-life conflicts are frequent in pediatrics. The main source of tension is between providers who may have different views and values. Coping mechanisms may be different from one provider to another, but many identify useful strategies to solve conflicts. Future research should investigate whether these perspectives parallel those of parents and patients.
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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).
2016
Archambault-Grenier MA
Duval M
February 2017 List
Humbert N
Janvier A
Journal of Pain and Symptom Management
Payot A
Roy-Gagnon MH
Stojanovic S
-
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
March 2016 List
Dublin Core
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Title
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An Order Protocol For Respiratory Distress/acute Pain Crisis In Pediatric Palliative Care Patients: Medical And Nursing Staff Perceptions
Publisher
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Journal Of Palliative Medicine
Date
A point or period of time associated with an event in the lifecycle of the resource
2016
Subject
The topic of the resource
Acute Pain/therapy; Adolescent; Adult; Advance Directives; Aged; Attitude Of Health Personnel; Canada; Child; Child Preschool; Female; Humans; Infant; Infant Newborn; Male; Medical Staff Hospital/psychology; Middle Aged; Nursing Staff Hospital/psychology; Palliative Care/standards; Pediatric Nursing/standards; Practice Guidelines As Topic; Respiratory Distress Syndrome Adult/therapy; Surveys And Questionnaires; Young Adult
Creator
An entity primarily responsible for making the resource
Bidet G; Daoust L; Duval M; Ducruet T; Toledano B; Humbert N
Description
An account of the resource
BACKGROUND:
An order protocol for distress (OPD), including respiratory distress and acute pain crisis, has been established for pediatric palliative care patients at Sainte-Justine Hospital (SJH). After discussion with the patient/his or her family, the OPD is prescribed by the attending physician whenever judged appropriate. The OPD can then be initiated by the bedside nurse when necessary; the physician is notified after the first dose is administered.
OBJECTIVES:
The study objectives were to evaluate the perceptions and experience of the medical/nursing staff towards the use of the OPD.
METHODS:
A survey was distributed to all physicians/nurses working on wards with pediatric palliative care patients. Answers to the survey were anonymous, done on a voluntary basis, and after consent of the participant.
RESULTS:
Surveys (258/548) were answered corresponding to a response rate of 47%. According to the respondents, the most important motivations in using the OPD were the desire to relieve patient's distress and the speed of relief of distress by the OPD; the most important obstacles were going against the patient's/his or her family's wishes and fear of hastening death. The respondents reported that the OPD was frequently (56%) or always (36%) effective in relieving the patient's distress. The respondents felt sometimes (16%), frequently (34%), or always (41%) comfortable in giving the OPD. They thought the OPD could never (12%), rarely (32%), sometimes (46%), frequently (8%), or always (1%) hasten death. Physicians were less favorable than nurses with the autonomy of bedside nurses to initiate the OPD before notifying the physician (p = 0.04). Overall, 95% of respondents considered that they would use the OPD in the future.
CONCLUSIONS:
Data from this survey shows that respondents are in favor of using the OPD at SJH and find it effective. Further training as well as support for health care professionals are mandatory in such palliative care settings.
Identifier
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DOI: 10.1089/jpm.2015.0100
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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).
2016
Acute Pain/therapy
Adolescent
Adult
Advance Directives
Aged
Attitude Of Health Personnel
Bidet G
Canada
Child
Child Preschool
Daoust L
Ducruet T
Duval M
Female
Humans
Humbert N
Infant
Infant Newborn
Journal of Palliative Medicine
Male
March 2016 List
Medical Staff Hospital/psychology
Middle Aged
Nursing Staff Hospital/psychology
Palliative Care/standards
Pediatric Nursing/standards
Practice Guidelines As Topic
Respiratory Distress Syndrome Adult/therapy
Surveys And Questionnaires
Toledano B
Young Adult
-
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
December 2016 List
Dublin Core
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Title
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What Do We Know About Pediatric Palliative Care Patients Who Consult The Emergency Department?
Publisher
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Canadian Journal Of Emergency Medicine
Date
A point or period of time associated with an event in the lifecycle of the resource
2016
Subject
The topic of the resource
Palliative Care; Pediatrics; Ethics
Creator
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Gaucher N; Humbert N; Gauvin F
Description
An account of the resource
Introduction: There is very little data about pediatric palliative care (PPC) patients’ visits to the emergency department (ED). This study’s goal was to determine the characteristics of PPC patients who consult the ED. Methods: A five-year retrospective chart review, conducted at a tertiary care pediatric university-affiliated hospital. Eligible patients initially consulted with the PPC team between April 1st 2007 and March 31st 2012. For each eligible patient, ED visits between these dates were included, using the ED’s electronic data system. Data about each visit was drawn from the electronic data system and the patient’s medical chart. This study was IRB approved. Results: During the study period, 290 new patients were followed by the PPC team; of these, 94 (32.4%) consulted the ED at least once (total of 219 visits). The median number of visits per patient was 2 (range: 1-8). Patient median age was 7 years 5 months (range: 1 month-22 years) and most common baseline diagnoses were: oncological diagnosis (39.4%), encephalopathy (27.7%) or genetic/chromosomal anomaly (13.8%). No patients died in the ED, but 36 (38.3%) died during the episode of care following one of their ED visits and 18 (19.1%) of them died within 72h of admission. PPC patients presented to the ED 219 times acutely ill: 11.4% of visits were triaged CTAS (Canadian Triage and Acuity Scale) level 1, 39.3% CTAS 2, 39.3% CTAS 3 and 10% CTAS 4 or 5. Many patients (37.9%) arrived by ambulance, 24.2% were admitted to the resuscitation room. Most patients consulted during day (45.2%) or evening (41.1%) shifts. Median length of stay was 3h50min (range: 13min - 15h10min). Reasons for consultation were respiratory distress/dyspnea (30.6%), pain (12.8%), seizure (11.4%), fever (9.1%), gastrointestinal symptoms (8.2%), fatigue (7.3%) and technical issues with catheters (5.9%). Most (79%) patients had investigations in the ED; 61.2% were admitted to wards, 7.3% to the PICU, and 20.5% were discharged. Two-thirds of patients (65.7%) had previously signed an advanced care directive at the time of their ED visit; discussions about goals of care were present in 37.4% of medical charts. Conclusion: Most PPC patients presented to the ED acutely ill, requiring work-up and admission. One-third presented in their end of life. Understanding the characteristics of PPC patients who consult the ED is the first step in offering better care for these complex patients.
Identifier
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DOI: https://doi.org/10.1017/cem.2016.221
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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).
2016
Canadian Journal of Emergency Medicine
December 2016 List
Ethics
Gaucher N
Gauvin F
Humbert N
Palliative Care
Pediatrics