Impact of a palliative care initiative on end-of-life care in the general wards: A before-and-after study._
Female; Humans; Male; retrospective studies; Palliative Care; Logistic Models; Aged; Comorbidity; cardiopulmonary resuscitation; Program Evaluation; Social Class; retrospective studies; DNAR; cardiopulmonary resuscitation; Resuscitation Orders; Chronic Disease/therapy; Palliative Care; DNAR Outcomes; Life Support Care/statistics & numerical data; Withholding Treatment/statistics & numerical data; Chronic Disease/epidemiology; Patient Admission/statistics & numerical data; Palliative Care; Hospital Mortality/trends; Advance Care Planning/st [Standards]; Forms and Records Control; Life Support Care/mt [Methods]; Advance Care Planning/standards; Asian; Chronic Disease/ep [Epidemiology]; Chronic Disease/th [Therapy]; Clinical Audit; Do-not-resuscitate orders; Forms and Records Control; general wards; Hospital Mortality/td [Trends]; Life Support Care/methods; Life Support Care/sn [Statistics & Numerical Data]; Patient Admission/statistics & numerical data; Patient Admission/td [Trends]; Patient Admission/trends; Resuscitation Orders; Singapore/ep [Epidemiology]; Singapore/epidemiology; Withholding Treatment/sn [Statistics & Numerical Data]
BACKGROUND: Data on deaths in the general wards of our hospital in 2007 revealed infrequent discussions on end-of-life care and excessive burdensome interventions., AIM: A physician order form to withhold inappropriate life-sustaining interventions was initiated in 2009. The use of the form was facilitated by staff educational sessions and a palliative care consult service. This study aims to evaluate the impact of these interventions in 2010., DESIGN: Retrospective medical chart review with comparisons was made for the following: baseline patient characteristics, orders concerning life-sustaining therapies, treatment provided in last 24 h of life, and discussion of specific life-sustaining therapies with patients and families., SETTINGS/PARTICIPANTS: This study included all adult patients who died in our hospital's general wards in 2007 (N = 683) versus 2010 (N = 714)., RESULTS: There was an increase in orders to withhold life-sustaining therapies, such as cardiopulmonary resuscitation (66.2%-80.0%). There was a decrease in burdensome interventions such as antibiotics (44.9%-24.9%) and a small increase in palliative treatments such as analgesia (29.1%-36.7%). There were more discussions on the role of cardiopulmonary resuscitation with conversant patients (4.6%-10.2%) and families (56.5%-79.8%) (p-value all < 0.05). On multivariate analysis, the physician order form independently predicted orders to withhold cardiopulmonary resuscitation., CONCLUSIONS: A multifaceted intervention of a physician order form, educational sessions, and palliative care consult service led to an improvement in documentation of end-of-life discussions and was associated with an increase in such discussions and less burdensome treatments. There were small improvements in the proportion of palliative treatments administered.
2014
Tan A; Seah A; Chua G; Lim Tow K; Phua J
Palliative Medicine
2014
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).
Journal Article
<a href="http://doi.org/10.1177/0269216313484379" target="_blank" rel="noreferrer">10.1177/0269216313484379</a>
Stress, social rank and leukocyte telomere length
Humans; Social Class; Stress; Social; Telemeres; Telomere/genetics; Polymorphism; Aging/genetics; Cell Aging/genetics; Cell Cycle/genetics; Cell Death/genetics; Genetic/genetics; Hierarchy; Psychological/genetics; Stem Cells/cytology/physiology
Blood leukocytes are a heterogeneous mixture of cell types whose telomere lengths differ greatly, reflecting variation in stem cell turnover and recruitment, expansion and replacement of more mature cell types as well as variable telomere loss and telomere repair. These differences in cell and telomere length dynamics, together with the evidence that telomere length is influenced strongly by genetic polymorphisms, greatly complicate the interpretation of claims that socio-economic status modulates the rate of telomere attrition.
2006
Lansdorp PM
Aging Cell
2006
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).
Journal Article
<a href="http://doi.org/10.1111/j.1474-9726.2006.00247.x" target="_blank" rel="noreferrer">10.1111/j.1474-9726.2006.00247.x</a>
Socioeconomic differences in childhood hospital inpatient service utilisation and costs: prospective cohort study
Child; Female; Humans; infant; Male; England; Prospective Studies; Socioeconomic Factors; Health Services Research; Social Class; Preschool; Non-U.S. Gov't; Research Support; infant; Newborn; Epidemiologic Methods; Length of Stay/statistics & numerical data; Hospital Costs/statistics & numerical data; Hospitalized/classification/statistics & numerical data; Hospitals/utilization
STUDY OBJECTIVE: To examine the association between socioeconomic position at the time of birth and the use and cost of hospital inpatient services during the first 10 years of life. DESIGN: Analysis of a database of linked birth registrations, hospital records, and death certificates. Associations between the social class of the head of household and hospital inpatient service utilisation and costs during the first 10 years of life were analysed using multilevel multiple regression modelling. PARTICIPANTS AND SETTING: All 117 212 children born to women who both lived and delivered in hospital in Oxfordshire or West Berkshire, southern England, during the period 1 January 1979 to 31 December 1988. MAIN RESULTS: The study showed that children born into social classes II, III-NM, III-M, IV, and V were more likely to be admitted to hospital, spend longer in hospital overall, and generate greater hospital costs than children born into social class I. The adjusted effect regarding hospital inpatient admissions, days, and costs was 1.27 (95% CI: 1.26, 1.27), 1.20 (1.19, 1.21), and 1.50 (1.49, 1.53), respectively, for children born into social class V when compared with children born into social class I. The impact of social class on hospital inpatient admissions, days, and costs was most acutely felt during years 3-10 of life as compared with the first two years of life. CONCLUSIONS: Health service decision makers need to be alert to the adverse sequelae that might result from socioeconomic disadvantage when planning health services for children. Particular attention should be paid to targeting deprived populations with prevention interventions that are known to be effective.
2005
Petrou S; Kupek E
Journal Of Epidemiology And Community Health
2005
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).
Journal Article
<a href="http://doi.org/10.1136/jech.2004.025395" target="_blank" rel="noreferrer">10.1136/jech.2004.025395</a>
Mothers' perceptions of benefit following pediatric stem cell transplantation: a longitudinal investigation of the roles of optimism, medical risk, and sociodemographic resources
Child; Female; Hospitalization; Humans; Male; Adult; Mother-Child Relations; Attitude; Longitudinal Studies; Risk Factors; Social Class; Regression Analysis; Perception; adolescent; Preschool; P.H.S.; Research Support; U.S. Gov't; Adaptation; Psychological; infant; Psychological; Stress; social support; Hematopoietic stem cell transplantation
BACKGROUND: This longitudinal study investigated the course and predictors of benefit finding among 144 mothers of children undergoing hematopoietic stem cell transplantation (HSCT), a severely stressful and life-threatening medical procedure. PURPOSE: Children's medical risk and mothers' dispositional optimism and sociodemographic resources were examined as predictors of benefit finding. The association between benefit finding and mothers' psychosocial adaptation was also investigated. METHODS: Assessments occurred during hospitalization for HSCT (Time 1 [T1]) and 6 months later (Time 2 [T2]). RESULTS: Hierarchial multiple regression analyses revealed that predictors of benefit finding differed systematically across assessments, with optimism and medical risk predicting benefit finding at both time points but sociodemographic resources predicting only T2 benefit findings. Benefit finding did not predict psychosocial adaptation until optimism was considered as a moderator of their relation: T1 benefit finding was positively associated with T2 adaptation only for mothers high in optimism. CONCLUSION: The need for longitudinal research on posttrauma adaptation and the utility of considering the natural history of the trauma are discussed.
Rini C; Manne S; DuHamel KN; Austin J; Ostroff J; Boulad F; Parsons SK; Martini R; Williams SE; Mee L; Sexson S; Redd WH
Annals Of Behavioral Medicine: A Publication Of The Society Of Behavioral Medicine
2004
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).
Journal Article
<a href="http://doi.org/10.1207/s15324796abm2802_9" target="_blank" rel="noreferrer">10.1207/s15324796abm2802_9</a>